Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Feb 2014
ReviewFirst-line beta-blockers versus other antihypertensive medications for chronic type B aortic dissection.
Thoracic aortic dissection (TAD) is a severe and often lethal complication in people with hypertension. Current practice in the treatment of chronic type B aortic dissections is the use of beta-blockers as first-line therapy to decrease aortic wall stress. Other antihypertensive medications, such as calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), have been suggested for the medical therapy of type B TAD. ⋯ We did not find any RCTs that compared first-line beta-blockers with other first-line antihypertensive medications for the treatment of chronic type B TAD. Therefore, there is no RCT evidence to support the current guidelines recommending the use of beta-blockers. RCTs are required to assess the benefits and harms of beta-blockers and other antihypertensive medications as first-line treatment of chronic type B TAD.
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Cochrane Db Syst Rev · Feb 2014
Review Meta AnalysisHeparin-bonded catheters for prolonging the patency of central venous catheters in children.
Central venous catheters (CVCs) are a mainstay in the management of critically ill children. However, these catheters are associated with mechanical and infectious complications which reduce their life span. Heparin bonding of catheters has shown promise in animal studies and in adults. This is the first update of a review published in 2007. ⋯ Two eligible studies on the use of heparin-bonded catheters versus placebo in children were identified. Meta-analysis of the two studies revealed no reduction in catheter-related thrombosis with heparin-bonded catheters. One study reported a reduction in catheter-related blood stream infection and colonization following the use of heparin-bonded catheters. The strength of evidence is low and further well-designed multicenter randomized controlled trials are warranted.
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Cochrane Db Syst Rev · Feb 2014
ReviewInterventions for preventing the spread of infestation in close contacts of people with scabies.
Scabies, caused by Sarcoptes scabiei variety hominis or the human itch mite, is a common parasitic infection. While anyone can become infected, it causes significant morbidity in immunocompromised hosts and it spreads easily between human hosts where there is overcrowding or poor sanitation. The most common symptom reported is itch which is worse at night. As the symptoms are attributed to an allergic reaction to the mite, symptoms usually develop between four to six weeks after primary infection. Therefore, people may be infected for some time prior to developing symptoms. During this time, while asymptomatic, they may spread infection to others they are in close contact with. Consequently, it is usually recommended that when an index case is being treated, others who have been in close contact with the index case should also be provided with treatment. ⋯ The effects of providing prophylactic treatments for contacts of people with scabies to prevent infestation are unknown. We need well-designed RCTs of the use of prophylactic measures to prevent the transmission of scabies conducted with people who had the opportunity for prolonged skin contact with an index case, such as family members, healthcare workers or residential care personnel, within the previous six weeks.
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Cochrane Db Syst Rev · Feb 2014
Review Meta AnalysisVoriconazole versus amphotericin B or fluconazole in cancer patients with neutropenia.
Opportunistic fungal infections are a major cause of morbidity and mortality in neutropenic cancer patients and antifungal therapy is used both empirically and therapeutically in these patients. ⋯ Liposomal amphotericin B is significantly more effective than voriconazole for empirical therapy of fungal infections in neutropenic cancer patients and should be preferred. For treatment of aspergillosis, there are no trials that have compared voriconazole with amphotericin B given under optimal conditions. For prophylactic fungal treatment in patients receiving allogeneic stem cell transplantation, there was no difference between voriconazole and fluconazole regarding fungal free survival or invasive fungal infections.
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Cochrane Db Syst Rev · Feb 2014
ReviewVision screening of older drivers for preventing road traffic injuries and fatalities.
Demographic data in North America, Europe, Asia, Australia and New Zealand suggest a rapid growth in the number of persons over the age of 65 years as the baby boomer generation passes retirement age. As older adults make up an increasing proportion of the population, they are an important consideration when designing future evidence-based traffic safety policies, particularly those that lead to restrictions or cessation of driving. Research has shown that cessation of driving among older drivers can lead to negative emotional consequences such as depression and loss of independence. Older adults who continue to drive tend to do so less frequently than other demographic groups and are more likely to be involved in a road traffic crash, possibly due to what is termed the "low mileage bias". Available research suggests that older driver crash risk estimates based on traditional exposure measures are prone to bias. When annual driving distances are taken in to consideration, older drivers with low driving distances have an increased crash risk, while those with average or high driving distances tend to be safer drivers when compared to other age groups. In addition, older drivers with lower distance driving tend to drive in urban areas which, due to more complex and demanding traffic patterns, tend to be more accident-prone. Failure to control for actual annual driving distances and driving locations among older drivers is referred to as "low mileage bias" in older driver mobility research. It is also important to note that older drivers are more vulnerable to serious injury and death in the event of a traffic crash due to changes in physiology associated with normal ageing. Vision, cognition, and motor functions or skills (e.g., strength, co-ordination, and flexibility) are three key domains required for safe driving. To drive safely, an individual needs to be able to see road signs, road side objects, traffic lights, roadway markings, other vulnerable road users, and other vehicles on the road, among many other cues-all while moving, and under varying light and weather conditions. It is equally important that drivers must have appropriate peripheral vision to monitor objects and movement to identify possible threats in the driving environment. It is, therefore, not surprising that there is agreement among researchers that vision plays a significant role in driving performance. Several age-related processes/conditions impair vision, thus it follows that vision testing of older drivers is an important road safety issue. The components of visual function essential for driving are acuity, static acuity, dynamic acuity, visual fields, visual attention, depth perception, and contrast sensitivity. These indices are typically not fully assessed by licensing agencies. Also, current vision screening regulations and cut-off values required to pass a licensing test vary from country to country. Although there is a clear need to develop evidence-based and validated tools for vision screening for driving, the effectiveness of existing vision screening tools remains unclear. This represents an important and highly warranted initiative to increase road safety worldwide. ⋯ Most countries require a vision screening test for the renewal of an individual's driver's licence. There is, however, lack of methodologically sound studies to assess the effects of vision screening tests on subsequent motor vehicle crash reduction. There is a need to develop valid and reliable tools of vision screening that can predict driving performance.