Cochrane Db Syst Rev
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Invasive pneumococcal disease is associated with significant mortality and many countries have introduced routine pneumococcal vaccination into their childhood immunisation programmes. Whilst pneumococcal disease in cystic fibrosis is uncommon, pneumococcal immunisation may offer some protection against pulmonary exacerbations caused by this pathogen. In the USA and UK pneumococcal vaccination is currently recommended for all children and adults with cystic fibrosis. ⋯ As no trials were identified we cannot draw conclusions on the efficacy of routine pneumococcal immunisation in people with cystic fibrosis in reducing their morbidity or mortality. As many countries now include pneumococcal immunisation in their routine childhood vaccination schedule it is unlikely that future randomised controlled trials will be initiated. Rigorously conducted epidemiological studies may offer the opportunity to evaluate the efficacy of pneumococcal vaccination in reducing morbidity and mortality in people with cystic fibrosis.
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Cochrane Db Syst Rev · Sep 2012
Review Meta AnalysisInterposition vein cuff for infragenicular prosthetic bypass graft.
The use of prosthetic grafts such as polytetrafluorethylene (PTFE) or Dacron to bypass occluded arteries in the lower leg is an accepted practice in the absence of suitable autologous vein. The aim is limb salvage or functional improvement in critical limb ischaemia, but patency rates for below knee prosthetic bypasses are low. Creating a vein cuff at the distal anastomosis is thought to improve outcomes. Other techniques including the use of pre-cuffed synthetic grafts, spliced segments of vein and the creation of an arterio-venous fistula (AVF) are also used to improve patency. ⋯ There is evidence that a vein cuff at the distal anastomosis site improves primary graft patency rates for below knee PTFE graft, but this does not reduce the risk of limb loss. Pre-cuffed PTFE grafts have comparable patency and limb salvage rates to vein cuff PTFE grafts. The use of spliced veins improved secondary patency but this did not translate into improved limb salvage. The use of an AVF alone showed no added benefits. Evidence for a beneficial effect of vein cuffed PTFE grafts is weak and based on underpowered trials. A large study with a specific focus on below knee vein cuff prosthetic grafts, including PTFE, is required.
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Cochrane Db Syst Rev · Sep 2012
Review Meta AnalysisInterventions for preventing falls in older people living in the community.
Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009. ⋯ Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.
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Cochrane Db Syst Rev · Sep 2012
Review Meta AnalysisHome safety education and provision of safety equipment for injury prevention.
In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. ⋯ Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Viral warts are a common skin condition, which can range in severity from a minor nuisance that resolve spontaneously to a troublesome, chronic condition. Many different topical treatments are available. ⋯ Data from two new trials comparing SA and cryotherapy have allowed a better appraisal of their effectiveness. The evidence remains more consistent for SA, but only shows a modest therapeutic effect. Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with SA. Only one trial showed cryotherapy to be better than both SA and placebo, and this was only for hand warts. Adverse effects, such as pain, blistering, and scarring, were not consistently reported but are probably more common with cryotherapy.None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy. Two trials of clear duct tape demonstrated no advantage over placebo. Dinitrochlorobenzene (and possibly other similar contact sensitisers) may be useful for the treatment of refractory warts.