RESUMEN
Abdominal aortic aneurysm (AAA) is present in 5-10% of men aged 65-79 years and is often asymptomatic. The major complication is rupture, which requires emergency surgery. The mortality rate after rupture is high: about 80% of those who reach the hospital and 50% of those undergoing emergency surgery will die. Elective surgical repair of AAA aims to prevent death from rupture; the 30-day surgical mortality rate for open surgery is approximately 5%. Currently elective surgical repair is recommended for aneurysms larger than 5-5 cm to prevent rupture. There is interest in population screening to detect, monitor and repair AAA before rupture. A Cochrane systematic review of 4 randomised studies involving 127,891 men and 9,342 women revealed a significant reduction in mortality from AAA in men aged 65-79 years who underwent ultrasonographic screening (odds ratio (OR): 0.60; 95% CI: 0.47-0.78). There was insufficient evidence to demonstrate a benefit in women. Men who had been screened underwent more surgery for AAA (OR: 2.03; 95% CI: 1.59-2.59). These findings should be considered carefully when determining whether a coordinated population-based screening programme should be introduced. A gap in the current research is the balance of benefits and risks in women. Furthermore, detailed studies are needed on how to best provide information on the potential benefits and risks to individuals who are offered screening, and on the psychological effects of screening on patients and their partners.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Tamizaje Masivo/métodos , Anciano , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/mortalidad , Rotura de la Aorta/prevención & control , Humanos , Masculino , Prevalencia , Factores de Riesgo , UltrasonografíaRESUMEN
Acute bacterial conjunctivitis is one of the most frequently encountered ocular disorders in primary care. It is frequently self-limiting, and the widespread use of broad-spectrum antibiotics has led to concerns regarding antibiotic resistance. Therefore, a Cochrane systematic review of 5 randomised clinical trials that compared antibiotic treatment with placebo in patients with acute bacterial conjunctivitis was recently updated. The chances of clinical and microbiological benefits of topical antibiotics were small but statistically significantly higher compared with placebo in the early stage (2 to 5 days after the first day of the intervention) and late stage (6 to 10 days after the first day of the intervention). The risk of adverse events in patients treated with placebo appeared to be low. Future trials should assess the cost-effectiveness of antibiotic treatment for acute bacterial conjunctivitis.
Asunto(s)
Antibacterianos/uso terapéutico , Conjuntivitis Bacteriana/tratamiento farmacológico , Enfermedad Aguda , Análisis Costo-Beneficio , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
Approximately 30% of people over 65 years of age and living in the community fall each year; the percentage is higher in institutions. A fifth of the incidents require medical attention. A Cochrane systematic review of 62 studies, encompassing 21,668 elderly people, showed that several interventions are effective in preventing falls, especially in people who have already fallen once, including multidisciplinary interventions targeting multiple risk factors, individually prescribed muscle strengthening combined with balance training at home, cardiac pacing for hypersensitivity of the sinus node, and withdrawal of psychotropic medication. Individually tailored interventions delivered by a health professional were more effective than standard or group-delivered programmes. Some potential interventions were of unknown effectiveness or unlikely to be beneficial. Examples of these are physical exercises, the use of dietary supplements and the correction of impaired vision.
Asunto(s)
Accidentes por Caídas/prevención & control , Ejercicio Físico/fisiología , Accidentes Domésticos/prevención & control , Anciano , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Planificación Ambiental , Femenino , Humanos , Masculino , Educación del Paciente como Asunto , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/prevención & controlRESUMEN
A Cochrane systematic review of 5 randomised clinical trials compared the safety and efficacy of expectant management versus curettage for early foetal loss. The expectant-care group was more likely to have an incomplete miscarriage, a need of unplanned curettage, and bleeding. In contrast, curettage was associated with a significantly higher risk ofinfection. Given the lack of clear superiority of either approach, the woman's preference should play a dominant role in reaching a decision.
Asunto(s)
Aborto Espontáneo/terapia , Legrado/métodos , Infecciones/epidemiología , Legrado/efectos adversos , Femenino , Humanos , Infecciones/etiología , Embarazo , Seguridad , Resultado del TratamientoRESUMEN
Removing dental plaque plays a key role in maintaining oral health and reducing gingivitis and parodontitis. A systematic Cochrane review ofrandomised controlled trials encompassing participants from the general public with uncompromised manual dexterity showed that when compared to the use of manual toothbrushes, the use of powered toothbrushes with a rotating oscillation action for a period of three months reduced gingivitis and (although not statistically significantly) plaque. The long-term clinical relevance of the differences is unclear. Electric toothbrushes that did not have an oscillating rotating movement were not consistently better than manual toothbrushes.