[From the Cochrane Library: ultrasonographic screening for abdominal aortic aneurysm in men aged 65 years and older: low risk of fatal aneurysm rupture]. / Uit de Cochrane Library: echografische screening van aorta abdominalis bij mannen van 65 jaar en ouder: kleiner risico op dodelijke aneurysmaruptuur.

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.

[From the Cochrane Library: Marginally higher chance of cure by antibiotic treatment in acute bacterial conjunctivitis]. / Uit de Cochrane Library: Marginaal grotere genezingskans door antibioticabehandeling bij acute bacteriële conjunctivitis.

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.

[From the Cochrane Library: effective measures are available to prevent falls in the elderly]. / Uit de Cochrane Library: effectieve maatregelen beschikbaar voor valpreventie bij ouderen.

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.

[From the Cochrane Library: both expectant management and curettage are suitable options in case of miscarriage]. / Uit de Cochrane Library: afwachtend beleid en curettage bij miskraam beide geschikte opties.

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.