Cochrane Db Syst Rev
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Congenital cataracts are opacities of the lens in one or both eyes of children that cause a reduction in vision severe enough to require surgery. Cataract is the largest treatable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration. ⋯ Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.
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Cochrane Db Syst Rev · Jul 2006
ReviewSetting and organization of care for persons living with HIV/AIDS.
Treating the world's 40.3 million persons currently infected with HIV/AIDS is an international responsibility that involves unprecedented organizational challenges. Key issues include whether care should be concentrated or decentralized, what type and mix of health workers are needed, and which interventions and mix of programs are best. High volume centres, case management and multi-disciplinary care have been shown to be effective for some chronic illnesses. Application of these findings to HIV/AIDS is less well understood. ⋯ Certain settings of care (i.e. high volume of HIV positive patients) and models of care (i.e. case management) may improve patient mortality and other outcomes. More detailed descriptions of care models, consistent definition of terms, and studies on innovative models suitable for developing countries are needed. There is not yet enough evidence to guide policy and clinical care in this area.
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Cochrane Db Syst Rev · Jul 2006
ReviewIn vitro fertilisation versus tubal reanastomosis (sterilisation reversal) for subfertility after tubal sterilisation.
Tubal sterilisation is the most popular contraceptive method in the world. Approximately 138 million women of reproductive age have had tubal sterilisation and there is evidence that increasingly younger women are being sterilized. With such large numbers of women choosing this option of birth control, it is clear that even if a small percentage of women later regret the decision, large numbers of women will seek counselling regarding reversal from their physicians. ⋯ There is a need for well-designed controlled clinical trials to compare the efficacy and safety of surgical reversal of tubal sterilisation and IVF in restoring fertility in women seeking pregnancy following tubal sterilisation.
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Cochrane Db Syst Rev · Jul 2006
ReviewOrientation and mobility training for adults with low vision.
Orientation and mobility (O&M) training is provided to people who are visually impaired to help them maintain travel independence. It teaches them new orientation and mobility skills to compensate for reduced visual information. ⋯ The review found two small trials with similar methods, comparing (O&M) training to physical exercise, which were unable to demonstrate a difference. Therefore, there is little evidence on which type of orientation and mobility training is better for people with low vision who have specific characteristics and needs. Orientation and mobility instructors and scientists should plan randomised controlled studies to compare the effectiveness of different types of (O&M) training. A consensus is needed on the adoption of standard measurement instruments of mobility performance which are proved to be reliable and sensitive to the diverse mobility needs of people with low vision. For this purpose, questionnaires and performance-based tests may represent different tools that explore people with low vision's subjective experience or their objective functioning, respectively.
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Cochrane Db Syst Rev · Jul 2006
ReviewContainment strategies for people with serious mental illness.
The management of acutely disturbed people during periods of psychiatric crisis poses a particular challenge for mental health professionals. The challenge is to maintain safety while providing a safe and therapeutic environment. Non-pharmaceutical methods currently used to accomplish this include special observations, de-escalation, behavioural contracts and locking doors. ⋯ Current non-pharmacological approaches to containment of disturbed or violent behaviour are not supported by evidence from controlled studies. Clinical practice is based on evidence that is not derived from trials and continued practice entirely outside of well designed, conducted and reported randomised studies is difficult to justify.