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1561. Limited evidence suggests no difference in denture cleaning methods

information. The inclusion criteria were limited to randomized clinical trials (RCTs) comparing any mechanical method or chemical in adults over age 18 wearing removable partial or complete dentures. Studies were excluded if participants had implant-retained prostheses or a history of corticosteroid or antimicrobial use within 3 months. Primary outcomes considered included health of denture bearing areas and patient satisfaction and preference. Secondary outcomes included denture plaque coverage area

2010 ADA Center for Evidence-Based Dentistry

1562. Effectiveness of different treatment regimens for peri-implantitis

complex and expensive therapies for peri-implantitis Candice G. McMullan-Vogel DDS . Overview Systematic Review Conclusion Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis. Critical Summary Assessment There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis. Evidence Quality Rating Limited Evidence This summary is published in the Journal of the American Dental Association

2010 ADA Center for Evidence-Based Dentistry

1563. Patients may not need to stop oral anticoagulant therapy for simple oral surgical procedures

focused on clinically relevant outcomes of the studies, principally differences in postoperative bleeding rates and the control of any bleeding that did occur. Although the title implies that the dealt with the influence of OAT on oral implant therapy, all data provided relate only to simple oral surgical procedures. The authors recommended that drugs that may increase bleeding tendencies, aspirin and other NSAIDs, and antibiotics that can potentiate the anticoagulant effect of OAT be avoided prior

2010 ADA Center for Evidence-Based Dentistry

1564. Glycemic control of diabetics may improve slightly with periodontal treatment

levels. Main Results: The review included three RCTs and two CCTs, both of which totaled 199 treated patients and 183 control patients. All patients had type 2 diabetes and periodontitis. Periodontal treatment was scaling and root planning, with or without antibiotic therapy. All studies reported absolute change in A1C. A1C levels of 8 percent and less are considered good and 10 percent and above are considered poor. All studies showed an improved (decreased) A1C level in treated patients ranging (...) a lack of precision in the estimate of effect. The lacked robustness due to significant among the studies. The CCTs introduced by placing treatment avoiders in the control groups. Baseline A1C levels generally reflected poor glycemic control. However, some subjects in two of the RCTs had good control, which may have affected their treatment results. The studies used different or unstated definitions of periodontitis. When antibiotics were used, the protocols changed. Only two studies reported

2010 ADA Center for Evidence-Based Dentistry

1565. Some evidence shows that certain mouthrinses can reduce halitosis

Kumar DDS, MDSc . Overview Systematic Review Conclusion Mouthrinses containing antibacterial agents (chlorhexidine and cetylpyridinium chloride) or those containing chlorine dioxide and zinc can reduce halitosis to some extent. Critical Summary Assessment Although antibacterial mouthrinses can reduce halitosis, the extent of effectiveness is uncertain owing to incomplete reporting, possible study and variation in patients’ characteristics and assessment methods. Evidence Quality Rating Limited

2010 ADA Center for Evidence-Based Dentistry

1566. Rifadin infusion (rifampicin): new solvent formulation and changes to compatible diluents

chloride 0·9% solution Published 11 December 2014 From: Therapeutic area: Article date: April 2010 Rifadin 600 mg infusion (rifampicin) is used to treat various infections, including tuberculosis and leprosy. It is indicated for acutely ill patients who are unable to tolerate oral therapy. To prevent emergence of resistant strains, Rifadin should be used in combination with another appropriate antibiotic. New solvent formulation The solvent used in the preparation of Rifadin infusion has been

2010 MHRA Drug Safety Update

1567. Isotretinoin: risk of serious skin reactions

Isotretinoin (brand leader Roaccutane) is a treatment for severe acne that is resistant to adequate courses of standard antibacterial or topical therapy. Over the past 25 years in which isotretinoin has been on the market, it has been prescribed worldwide for approximately 16 million patients. Association with serious skin reactions The licence holder for Roaccutane identified a possible association between isotretinoin use and serious skin conditions including erythema multiforme (EM), Stevens Johnson

2010 MHRA Drug Safety Update

1568. Carbapenems: concomitant use with valproic acid not recommended

professionals should consider alternative antibacterial therapy Published 11 December 2014 From: Therapeutic area: , Article date: May 2010 Carbapenems are a class of beta-lactam antibiotics with broad-spectrum antibacterial activity. They are indicated for the treatment of the following infections when caused by susceptible bacteria: nosocomial pneumonia complicated intra-abdominal infections complicated urinary tract infections Valproic acid/sodium valproate is an anticonvulsant used for the treatment (...) that decreased valproic acid levels have also been reported when co-administered with other carbapenems, with 60–100% decreases in valproic acid levels being observed within about 2 days. This interaction is therefore likely to be a class effect. Concomitant use of carbapenems and valproic acid/sodium valproate is not recommended, and prescribers should consider alternative antibacterial therapy. Advice for healthcare professionals: a clinically significant interaction between carbapenems and valproic acid

2010 MHRA Drug Safety Update

1569. Steroids for PCP/PJ Pneumonia

defined as arterial oxygen partial pressure 35 mmHg on room air. The authors included six trials with 489 patients that randomized subjects to receive either corticosteroids or placebo as an addition to antimicrobials. The review reported outcomes for undeveloped nations with minimal access to antiretroviral therapy and for developed nations with access. Control group mortality rates were 25% and 10% in these two groups, respectively. Note that despite the greater number of patients

2010 theNNT

1570. What's the Best Vasopressor in Septic Shock?

al conclude that antimicrobial and cardiovascular and other therapies initiated earlier (preferably within 1 or 2 hours) result in the highest survival rates. Treatment initiated at an average of 12 hours after the onset of septic shock may be too late for any vasopressor agent to show a significant effect on mortality. Mortality rates did not differ between epinephrine and norepinephrine. In addition, rates of severe arrhythmias, stroke and myocardial events, limb ischemia, and other adverse (...) to another, so that at present no agent should be preferred over the other. If simplicity is best, then using one drug (epinephrine) over two (norepinephrine plus dobutamine) creates less opportunity for error. Data in this field to date suggest that it is the timing of vasopressor (and other) therapy, rather than the specific agent, that is decisive. In both clinical practice and clinical trials, once hypotension occurs in septic shock, clinicians need to initiate immediate antimicrobial therapy

2010 BestBETS

1571. Should hypertonic saline be used in patients with cystic fibrosis who respond unsatisfactorily to recombinant deoxyribonuclease?

with stable cystic fibrosis in your outpatient clinic and review her treatment regime with regard to lung function. Over the last 4 months she has been on nebulised recombinant deoxyribonuclease (rhDNase) 2.5 mg once daily, but her lung function has not shown any improvement. She has also had one pulmonary exacerbation requiring intravenous antibiotics over this period. You are aware that although rhDNase is widely used in the management of lung disease in cystic fibrosis, approximately 50% of patients (...) to rhDNase could not be carried out from the data provided Pulmonary exacerbations (over 48 weeks of treatment) Relative reduction of 56% in favour of HS group (p=0.02). Exacerbation-free survival after 48 weeks, as measured by requirement for antibiotic therapy, was significantly greater in HS group (76% of patients vs 62%, p=0.03). Effects of HS on either outcome did not differ between users and non-users of rhDNase. Donaldson et al, 2006 24 patients, ≥14 years of age with stable disease. FEV1 ≥50

2010 BestBETS

1572. Rapid Influenza Testing Of Febrile children in the Emergency Department

at an urban children’s hospital Retrospective case control study. RIT used to detect influenza A virus. RIT +ve as case control group and -ve as control group. Blood cultures used to confirm the results Antibiotic prescription,. Duration of antibiotic treatment In admitted pts: RIT +ve 43% vs 64% RIT -ve. p-0.04 Discharged pts RIT +ve 20% vs 53% RIT -ve p=0.04. RIT +ve 3.5 vs 5.4 days -ve p=0.03 Retrospective study Relied on electronic database for identifying pts who had RIT, then their medical records (...) for influenza A and B CBC requesting PA 0% vs 13% PUA (p Single influenza season results. Results not confirmed by blood cultures Blood cultures PA 0% vs 11% PUA (p CXR PA 7% vs 26% PUA (p=001) Financial costs of investigations PA $15 vs $92 PUA (p Antibiotic usage PA 7% vs 26% PUA (p Length of emergency department stay PA 25 vs 49 min PUA (p Benito-Fernández et al, 2006, USA 206 pts aged 0-36 months during two confirmed seasons at a tertiary care children’s hospital Prospective observational study. RIT

2010 BestBETS

1573. Normal CSF: Does it exclude meningitis?

glucose 4.8 mmol), protein 0.6 g/l, white blood cell count 4 with no bacteria on Gram staining. The child was observed with a diagnosis of viral illness without any antibiotics. We wondered: can meningitis occur with initial normal CSF? Search Strategy This review was aimed to obtain all available information with the intention of providing a perspective for resolving this issue. A non-systematic search of the world literature was carried out using English as the main language in July 2008 using (...) series and four case report publications were identified as eligible for analysis. All papers included children with culture-positive bacterial meningitis, and their charts were reviewed retrospectively to ascertain cases with initial normal CSF. We excluded publications where children had received antibiotic treatment before the lumbar puncture was undertaken. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Coll M-T et al

2010 BestBETS

1574. Do Portacaths or Hickman lines have a higher risk of catheter-related bloodstream infections in children with leukaemia?

(level 1b) CABSIs per 1000 line days Overall: 1.6 TE: 4.8 TID: 0.7 Well-defined sample Small size CABSI objectively defined by CDC guidelines Short follow-up of 1 year but complete First line antibiotic cefepime Multivariate analysis for prognostic factors supported increase risk of TE CABSIs over 1 year TE vs TID 7.1 (CABSI rate ratio) (95% CI 4.1 to 12.2) Adler et al, 2006 281 Paediatric oncology patients (mean age 9.07 years, 41% female). 419 catheters inserted: 173 Hickman and 246 TID. 86 (...) is consistent with the microbiological profile of CABSIs in children and adults in other studies (Grady). It is acknowledged that although variations in individual hospital practice may exist, according to choice of catheter devices, antibiotic use and decision to remove catheters, similarities and differences in practice in the appraised studies based in the USA and Israel, are consistent with variations seen in UK practice. The majority of the research comparing central venous access devices in children

2010 BestBETS

1575. Can pneumonia caused by penicillin-resistant Streptococcus pneumoniae be treated with penicillin?

with radiographically confirmed lobar pneumonia 3 days ago. She was started on intravenous penicillin and remains clinically stable but continues to be febrile. The laboratory informs you that Streptococcus pneumoniae has grown from her blood culture and that the isolate is penicillin-resistant (minimum inhibitory concentration (MIC) 1 μg/ml). You are uncertain whether this has any implications for her clinical course and wonder whether you should change her antibiotic treatment on the basis of this information (...) ) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Friedland et al, 1995 Children (age: 0–14 years) hospitalised with pneumococcal pneumonia (n = 78). Penicillin-susceptible: n = 53 (68%). Penicillin-resistant: n = 25 (32%). Definition of resistance intermediate: MIC >0.06–1.0 μg/ml, high-level resistance: MIC ≥2 μg/ml. Treatment: variety of antibiotic regimens; directed by attending physician Prospective cohort study (level 1b) Duration

2010 BestBETS

1576. Zinc Cold Remedies: Are They Safe and Effective?Who Nose?

the doctor with cold symptoms requesting antibiotics. Since the etiology of the common cold is viral, antibiotic therapy is ineffective and inappropriate, and only contributes to bacterial antibiotic resistance. More than 200 viruses can cause the common cold, including rhinoviruses, coronaviruses, adenoviruses, respiratory syncytial virus, and parainfluenza viruses.(2) Rhinovirus is the most common culprit.3 Although considered a self-limited benign illness, the common cold is not without complications

2010 Clinical Correlations

1577. Some gleanings from the meeting of the Infectious Diseases Society of America (IDSA)

multiple drug resistant gram-negative bacillary infections (especially, P. aeruginosa and Acinetobacter species infections) New information on the pharmacology of the polymyxins Information on some new antibiotics for methicillin resistant staph aureus (MRSA) and gram-negative bacterial infections and new assessments of some older antibiotics (vancomycin/daptomycin) that we have been increasingly using New information on the diagnosis and management of C. difficile infections. This high quality meeting

2010 Clinical Correlations

1578. Hypertonic saline therapy for cystic fibrosis

quality of life, lower lung exacerbations and lower need for antibiotic treatments among CF patients. BACKGROUND Cystic fibrosis is a genetic condition caused by defects in the Cystic Fibrosis Transmembrane Regulator (CTFR) gene. The disorder is recessive, thus both parents must be carriers of copies of the defective gene. CF affects the function of several organs including the lungs, pancreas, intestines, and liver. The CTFR gene is responsible for salt transport across cell membranes (...) and as such therapy is aimed at slowing the progression of the disease. CF patients often require intensive lifelong treatment such as physiotherapy, antibiotic treatment, dietary control, digestive enzyme capsules and other therapies. Additionally, it is believed that loss of lung function begins in infancy and continues throughout the patient’s life. The cause of death for CF patients is most predominantly loss of lung function (Cystic Fibrosis Australia 2009b). DIFFUSION While there is some evidence of usage

2009 Australia and New Zealand Horizon Scanning Network

1579. Diagnostic techniques for ventilator-associated pneumonia: Conflicting results from two trials Full Text available with Trip Pro

patients with suspected ventilator-associated pneumonia, testing the hypothesis that bronchoscopy with quantitative culture would be associated with lower mortality rates and less use of antibiotics. Design Multi-center non-blinded randomized controlled trial. Setting 28 intensive care units (ICUs) across Canada and the United States. Subjects 740 immunocompetent critically ill adult patients with suspected ventilator-associated pneumonia after 4 days in the ICU. Patients known to be colonized (...) or infected with Pseudomonas species or methicillin-resistant Staphylococcus aureus were excluded. Intervention Using a 2-by-2 factorial design, subjects were randomly assigned to a) undergo bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid or endotracheal aspiration with nonquantitative culture of the aspirate, and to b) receive empirical combination antibiotic therapy or monotherapy. Empirical antibiotic therapy was initiated in all patients until culture results were

2009 Critical Care - EBM Journal Club

1580. Mouthrinse as a Treatment for Halitosis

5 RCTs Systematic Review Key results Mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue (-1.13 (1.1) P #2) Shinada/2010 15 male patients Randomized, placebo-controlled, double-blind, crossover trial Key results After rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by organoleptic measurement and reduced

2010 UTHSCSA Dental School CAT Library

Evidence-based Synopses

Synopses are typically easily digested, critical commentaries of articles e.g. critically appraised topics.