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Antimicrobial‐impregnated central venous catheters to prevent bloodstream infection in newborn infants

Background: Infection in the bloodstream is a frequent and harmful complication for newborn infants who have a central venous catheter (a cannula that extends several centimetres into the infant's blood vessel). While the catheter may provide a secure route for delivering drugs and nutrition, it may also be a locus for infecting organisms to grow and cause long‐term or more severe infection. One potential method of reducing this serious complication is to use central venous catheters that contain antiseptics or antibiotics to stop organisms from sticking to or growing on the catheter.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Central action beta‐blockers versus placebo for neuroleptic‐induced acute akathisia

Akathisia is recognised as one of the most common and distressing of the early‐onset adverse effects of neuroleptic drugs. This movement disorder is characterised by a subjective report of inner restlessness, mental unease or dysphoria, which can be intense.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Central venous access sites to prevent venous blood clots, blood vessel narrowing, and infection

Central venous access (CVA) involves a large bore catheter inserted in a vein in the neck, upper chest or groin (femoral) area to give drugs that cannot be given by mouth or via a conventional needle (cannula or tube in the arm). CVA is widely used. However, its thrombotic (causing a blood clot) and infectious complications can be life‐threatening and involve high‐cost therapy. Research has revealed that the risk of catheter‐related complications varies according to the sites of central venous catheter (CVC) insertion. It would be helpful to find the preferred site of insertion to minimize the risk of catheter‐related complications. This review examined whether there was any evidence to show that CVA through any one site (neck, upper chest, or femoral area) is better than the other. Four studies were identified comparing data from 1513 participants. For the purpose of this review, three comparisons were evaluated: 1) internal jugular versus subclavian CVA routes; 2) femoral versus subclavian CVA routes; and 3) femoral versus internal jugular CVA routes. We compared short‐term and long‐term catheter insertion. We defined long‐term as for more than one month and short‐term as for less than one month, according to the Food and Drug Administration (FDA). No randomized controlled trial was found comparing all three CVA routes and reporting the complications of venous stenosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Steroids inserted into the eye versus observation for macular edema secondary to central retinal vein occlusion

We aimed to examine the benefits and harms of inserting steroids into the eye for treating macular edema secondary to central retinal vein occlusion (CRVO‐ME).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings [Internet]

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

NICE Clinical Guidelines - Centre for Clinical Practice at NICE (UK).

Version: November 2013
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Adult Central Nervous System Tumors Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of adult central nervous system tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 27, 2016

Suspected Cancer: Recognition and Referral

Cancer is an important condition, both in terms of the number of people affected and the impacts on those people and the people close to them. Around one third of a million new cancers are diagnosed annually in the UK, across over 200 different cancer types. Each of these cancer types has different presenting features, though there may be overlap. More than one third of the population will develop a cancer in their lifetime. Although there have been large advances in treatment and survival, with a half of cancer sufferers now living at least ten years after diagnosis, it remains the case that more than a quarter of all people alive now will die of cancer.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: June 2015
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Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation

Study finds that educational interventions for preventing vascular catheter bloodstream infections in critical care may be cost-effective or cost-saving if implemented in the NHS.

Health Technology Assessment - NIHR Journals Library.

Version: February 2014
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Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

Study finds evidence that expedited partner therapy is clinically more effective in reducing reinfection of index patients who have had chlamydia, gonorrhoea or trichomonas when compared with simple patient referral but not when compared with simple patient referral but not when compared with enhanced methods of patient referral. It is possible that partner notification for the current or most recent sexual partner has the greatest impact on reducing chlamydia transmission in heterosexual young adults.

Health Technology Assessment - NIHR Journals Library.

Version: January 2014
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Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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Cysteine, cystine or N‐acetylcysteine supplementation in parenterally fed neonates

Sick or preterm newborn infants may require intravenous nutrition, including intravenous administration of solutions containing amino acids. Newborn infants need cysteine (an amino acid) for growth under certain conditions. Cysteine may decrease the chance of liver disease and brittle bones. This systemic review was done to analyze whether adding cysteine (or related compounds) to intravenous nutrition affects growth and other outcomes in newborn infants. Five trials studied the effects of adding cysteine to intravenous nutrition that did not contain cysteine. Addition of cysteine significantly improved the babies' ability to build body proteins (analyzed in four studies); however, it did not improve growth (analyzed in one study); no other outcomes were available. One large randomized trial studied the effect of adding another chemical, N‐acetyl‐cysteine, to intravenous nutrition that already contained cysteine. This study showed no benefit and no toxicity of this intervention. We conclude that present data are insufficient to justify routine addition of cysteine to the intravenous nutrition of newborn infants that does not contain cysteine. Available evidence does not support routine addition of N‐acetylcysteine to intravenous nutrition of newborn infants containing cysteine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Intravenous N‐acetylcysteine compared to placebo for treatment of systemic inflammatory response syndrome and sepsis in seriously ill adults

Systemic inflammatory response syndrome (SIRS) is a complex response to an insult such as major surgery or trauma. It is called sepsis syndrome, or simply sepsis, when infection is present. The generalized inflammatory reaction involves activation of leukocytes and endothelial cells and the release of inflammatory mediators and toxic oxygen free radicals. Diffuse microthrombosis can result in localized tissue perfusion abnormalities and low oxygenation (hypoxia). Both SIRS and sepsis can be difficult to treat and are major causes of multiple organ failure and the death of patients in the intensive care unit. SIRS and sepsis both lead to a drop in the level of antioxidants normally present in the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services

The study found an insufficient evidence base to help identify, assess and manage risks for young people with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK

Health Services and Delivery Research - NIHR Journals Library.

Version: May 2015
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A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

Study reports that clinical consensus favours magnetic resonance imaging and computerised tomography for identifying patients with malignant spinal metastases who are at high risk of vertebral fracture and spinal cord compression.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013
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Ulcerative Colitis: Management in Adults, Children and Young People [Internet]

Ulcerative colitis is the most common type of inflammatory disease of the bowel. It has an incidence in the UK of approximately 10 per 100,000 people annually,and a prevalence of approximately 240 per 100,000. This amounts to around 146,000 people in the UK with a diagnosis of ulcerative colitis. The cause of ulcerative colitis is unknown. It can develop at any age, but peak incidence is between the ages of 15 and 25 years, with a second, smaller peak between 55 and 65 years (although this second peak has not been universally demonstrated). The British Paediatric Surveillance Unit reported an incidence of ulcerative colitis in children aged younger than 16 years in the United Kingdom, of 1.4 per 100,000 with a greater proportion of Asian children having ulcerative colitis than other children. The median age for diagnosis of ulcerative colitis overall in this childhood cohort was 11.7 years (range 9.3 to 13.7 years).

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2013
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Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

Study finds that there is a fine balance between the benefits and risks of regular aspirin use in the primary prevention of cardiovascular disease.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013
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Drugs for Chronic Hepatitis C Infection: Clinical Review [Internet]

The objective of this systematic review was to assess the comparative efficacy and safety of currently available and emerging regimens for the treatment of chronic hepatitis C (CHC) infection (genotypes 1 to 6).

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: January 2016
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The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation

Study assessing the diagnostic accuracy of magnetic resonance spectroscopy (MRS) and enhanced magnetic resonance imaging (MRI) techniques in aiding the localisation of prostate abnormalities for biopsy found that MRS had higher sensitivity and specificity than T2-weighted magnetic resonance imaging (T2-MRI) but produced no definitive conclusions on the cost-effectiveness of using different MRS/MRI sequences.

Health Technology Assessment - NIHR Journals Library.

Version: May 2013
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Evidence Map of Yoga for High-Impact Conditions Affecting Veterans [Internet]

Patient-centered care supports the active involvement of patients and their families in the decision-making process between options for treatment. Part of this mission is to identify, develop, and implement new practices and approaches that are found to be effective in promoting the transformation to a patient-centered model and improved patient care. Complementary and alternative medicine (CAM) strategies such as yoga are widely available in the private sector, and some Veterans would like access to these strategies through the Veterans Affairs (VA) system. Determining the state of evidence on the benefits and harms of yoga and other CAM modalities is a priority for the Veterans Health Administration (VHA).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: August 2014
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Patient safety in ambulance services: a scoping review

This study aimed to identify and map available evidence relating to patient safety when using ambulance services. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology. Patient safety needs to become a more prominent consideration for ambulance services and development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.

Health Services and Delivery Research - NIHR Journals Library.

Version: May 2015
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