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1581. Direct versus indirect pulp capping in maintaining pulp vitality

accepted conventional practice procedures when the pulp of the carious tooth is considered. Materials used in capping treatment includes: Ledermix, glycerrhetinic acid/antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec, Life, Dycal, potassium nitrate, dimethyl isosorbide, and polycarboxylate cement. Evidence Search "Dental Pulp"[Mesh] AND "Dental Caries"[Mesh] Comments on The Evidence There were limited articles that compared direct to indirect pulp capping. I also searched under the Mesh

2010 UTHSCSA Dental School CAT Library

1582. Comparison of endodontic sealers with or without bactericidal effect

in the study-designs. It would be desirable to standardize aspects of study-design, data recording and presentation format of outcome data in the much needed future outcome studies. Evidence Search antimicrobial"[All Fields] AND "Root Canal Therapy"[Mesh] AND "sealer"[All Fields]("root canal therapy"[MeSH Terms] OR ("root"[All Fields] AND "canal"[All Fields] AND "therapy"[All Fields]) OR "root canal therapy"[All Fields]) AND ("humans"[MeSH Terms] AND Meta-Analysis[ptyp] Comments on The Evidence

2010 UTHSCSA Dental School CAT Library

1583. Adjunctive use of minocycline with traditional non-surgical periodontal therapy in patients with chronic periodontitis produces increased attachment

, the minocycline gel was applied to the bottom of the pocket and withdrawn in a zigzag motion until the gel flowed over the gingival margin. The study authors concluded that “gingival crevicular fluid is relatively isolated from saliva,” and thus the antibiotic effect was not carried over from the minocycline treated half of the mouth to the untreated part of the mouth. Applicability Adult patients with chronic periodontitis and pocket depths of at least 5 mm. Minocycline is not currently available in the U.S

2010 UTHSCSA Dental School CAT Library

1584. Diabetes and The Dental Patient

Diabetes and The Dental Patient UTCAT580, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Preoperative Antibiotics To Prevent Infection In Diabetics: An Expert Opinion Clinical Question In diabetic dental patients, does routine use of antibiotics better prevent infection as opposed to no antibiotic use? Clinical Bottom Line There appears to be no difference in susceptibility to infection between diabetic patients who (...) received antibiotics prior to routine dental procedures and those who did not. (See Comments on the CAT below) Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Alexander/1999 Diabetic dental patients Expert opinion Key results There is no evidence to suggest that well-controlled diabetic patients are more prone to infection than other dental patients. For this reason, antibiotics should only be administered

2010 UTHSCSA Dental School CAT Library

1585. From The Archives: Is Prescribing Placebos An Ethical Practice?

a research article entitled “Prescribing placebo treatments: results of a national survey of US internists and rheumatologists.” Of 679 physicians who responded to a cross sectional mailed survey, over 50% reported having prescribed placebos on a regular basis. Placebos included varied from saline (3%), sugar pills (2%), OTC analgesics (41%), vitamins (38%), antibiotics (13%) and sedatives (13%). According to the authors’ definition, the placebo effect refers to positive clinical outcomes caused (...) by a treatment that is not attributable to its known physical properties or mechanism of action, but rather to positive expectations or hopes in patients, derived from the clinical encounter. Placebo treatments, however, are quite different from each other, as saline injections or sugar pills are considered inert substances, while prescribing antibiotics or sedatives may carry adverse consequences for individual patients as well as for public health. In the survey, physicians prescribing placebo treatments

2010 Clinical Correlations

1586. From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus? ” Given the most serious nature of the USA 300 clone CA MRSA, it is imperative that we now require, on an emergency basis, 24/7, 365 day pharmaceutical reserch aimed at developing effective medicinal treatment, including the development of multiple new antibiotics which can be used with a minimum of testing. Currently, with respect to this particilar strain of MRSA, we are at the same

2010 Clinical Correlations

1587. Give us the trial data

-gain are listed separately. (P.S. I am aware of the link between obesity/diabetes and why. I was curious on another point). skyesteve said, August 20, 2010 at Sorry eponymous85 but have to agree with Mike – when you say things like “schizophrenia is not a disease like diabetes” and “you can’t die from it” your aren’t just talking nonsense but your actually contributing to the ongoing prejudice that surrounds mental illness. With the exception of antimicrobials there are very few medicines

2010 Bad Science

1588. Can throat examination distinguish between bacterial and viral infective agents?

in inappropriate antibiotic prescription in 4.8% (discussed in another BET). Therefore a compromise is to rapid test all and treat positive reults without culture confirmation of negative results. For children the best option was to rapid test all and treat those with positive results and culture negative results. References Ebell MH, Smith MA, Henry BC et al. Does This Patient Have Strep Throat? JAMA 2000;284:2912–18. Schwartz RH, Gerber MA, McKay K. Pharyngeal findings of Group A Streptococcal Pharyngitis

2010 BestBETS

1589. Clindamycin phosphate 2% vaginal cream (Clindesse) for the treatment of bacterial vaginosis

alkali. For diagnosis in asymptomatic women and for clinical trials the FDA also requires use of the Nugent score which requires the use of a gram stained vaginal smear where the vaginal flora are examined and graded as: 0–3 normal (lactobacillus predominant), 4–6 intermediate, 7+ indicative of BV. Once diagnosis is confirmed the mainstay of treatment is antibiotic therapy. Antimicrobials, which include the 5-nitroimidazoles (metronidazole, tinidazole, secnidazole), and the lincosamide clindamycin (...) with bacterial vaginosis. Drug Clindesse is a semi-solid white cream containing 2% clindamycin phosphate, which is a water-soluble ester of the semi-synthetic antibiotic produced by a 7 (S)-chloro-substitution of the 7(R)-hydroxyl group of the parent antibiotic, lincomycea. The recommended dose is a single intravaginal administration on one day. Disease Bacterial vaginosis is a common vaginal infection caused by an imbalance in the vaginal flora. In bacterial vaginosis there is suppression of lactobacilli

2010 Therapeutics Letter

1590. The Polymyxins: Why am I using them all the time, and what are they?

cultures return ESBL Klebsiella with susceptibility only to polymyxin. I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘ polymyxin’ like an endless antimicrobial mantra. What strange dosing it has, and an even more peculiar name. [1]. In the long evolutionary struggle between gram positives and gram negatives, Bacillus Polymyxa (a gram positive) began secreting cyclic peptides with long hydrophobic chains that selectively bind to gram (...) , recent pharmacodynamic studies with Pseudomonas suggest that the bacteriocidal activity of Polymyxin B is related to the ratio of the area under the concentration-time curve to MIC [6]. This suggests that it may be the total daily dose, and not the frequency of administration that is important (1). As the mechanism of action detailed above alluded, synergism between the polymyxins and other antibiotics [5]. The overuse of broad-spectrum antibiotics has led to increasing antibiotic resistance

2010 Clinical Correlations

1591. Off Label

medicines and found that 31 were for indications not approved by the FDA [5]. A more recent analysis of prescribing practices in 2001 showed that 21% of all prescriptions filled for 160 common drugs were for off-label indications. The proportions were even higher for anticonvulsants (74%), antipsychotics (60%), and antibiotics (41%) [6]. The problem with wide spread off-label use is that there is often little or no evidence to support it. In fact, in a study of office based physician practices, Radley

2010 Clinical Correlations

1592. The year in nonsense

companies are to say that cigarettes prevent Alzheimer’s, and we saw the first describing how academics routinely mislead readers about their negative results in academic papers, by spinning them as positive. Dodgy facts aren’t the only reason clever people believe stupid things, as demonstrated by a gale of research on irrationality. Superstitious rituals . What affects listeners’ assessment of their skill. Antibiotics don’t work for a sore throat, but if you’re prescribed them, you come away . You can

2010 Bad Science

1593. Helping former smokers stay on the wagon: insufficient evidence regarding relapse prevention interventions for smoking cessation

are the strongest resources to aid dental professionals in clinical decision making and help incorporate evidence gained through scientific investigation into patient care. Guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Antibiotics for Dental Pain and Swelling Guideline A panel of experts convened by the ADA Council on Scientific Affairs presents clinical (...) recommendations concerning the use of antibiotics for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. This guideline updates the 1997 recommendations by the American Heart Association for the prevention of infective endocarditis (IE). The committee concluded that IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcomes from IE. A panel of experts convened

2010 ADA Center for Evidence-Based Dentistry

1594. Helping former smokers stay on the wagon: insufficient evidence regarding relapse prevention interventions for smoking cessation

are the strongest resources to aid dental professionals in clinical decision making and help incorporate evidence gained through scientific investigation into patient care. Guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Antibiotics for Dental Pain and Swelling Guideline A panel of experts convened by the ADA Council on Scientific Affairs presents clinical (...) recommendations concerning the use of antibiotics for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. This guideline updates the 1997 recommendations by the American Heart Association for the prevention of infective endocarditis (IE). The committee concluded that IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcomes from IE. A panel of experts convened

2010 ADA Center for Evidence-Based Dentistry

1595. Randomised controlled trial: Preoperative skin cleansing with chlorhexidine-alcohol reduces surgical site infection after clean-contaminated surgery compared with povidone-iodine

procedures are performed each year in the USA. 1 Despite the implementation of a bundle of preventive measures such as preoperative use of hair clippers or no hair removal (as opposed to shaving), initial administration of perioperative antibiotics within 1 hour before surgery, and maintenance of normothermia, normoglycaemia and hyperoxia during surgery and for the first 2 hours after surgery, between 300 000 and 500 000 patients develop a surgical site infection (SSI). These infections increase length

2010 Evidence-Based Nursing

1596. Manuka honey improved wound healing in patients with sloughy venous leg ulcers

: randomised controlled trial. Allocation: concealed.* Blinding: blinded (statistician).* Study question Setting: vascular centres, leg ulcer clinics, and acute and community care hospitals. Patients: 108 patients >18 years of age (mean age 68 y) who had a venous leg ulcer (VLU) <100 cm 2 with ⩾50% of the wound bed covered in slough. Exclusion criteria were malignant ulcer, wound infection, presence of a cavity wound, use of antibiotics or oral immunosuppressants, poorly controlled diabetes, pregnancy

2009 Evidence-Based Medicine

1597. 1 day of nitrofurantoin was not as effective as 7 days for asymptomatic bacteriuria in pregnancy

bacteriuria caused by a micro-organism sensitive to nitrofurantoin. Women with symptoms of urinary tract infection (UTI), treatment of UTI in the current pregnancy, a condition requiring continuous steroid or antibiotic therapy, antibiotic hypersensitivity, or haematological disease (including glucose-6-phosphate dehydrogenase deficiency) were excluded. Intervention: nitrofurantoin, 100 mg orally twice daily, for 1 day (n = 386) or 7 days (n = 392). The 1-day group received placebo tablets after day 1

2009 Evidence-Based Medicine

1598. Urethral catheter or suprapubic aspiration to reduce contamination of urine samples in young children?

. 3/13 contaminated (23.1%) No significant difference in contamination between UC and SPA More success in getting adequate urine volumes in babies over 34 weeks If the child was better by the time the result was available then it was considered as contaminant but we assumed all patients were started on empirical antibiotics (not specified in paper) which could have changed clinical outcome Babies were cleaned with aqueous chlorhexidine before catheter and SPA samples were taken Study terminated

2009 BestBETS

1599. Calcific Uremic Arteriolopathy (CUA)

, violaceous skin lesions with ulceration on both thighs. The lesions worsened and became increasingly painful over the last 6 months. Her extensive four month hospital course has been complicated by numerous episodes of superinfection and sepsis with methicillin resistant Staph aureus treated by intravenous antibiotics and wound debridement and negative pressure wound dressings. Over the last several weeks, her exquisitely painful skin ulcerations continue to worsen and have expanded to involve her trunk (...) spectrum antibiotics, anti-thrombolytic therapy, and sevelemar, our patient S.J. eventually succumbed to her CUA, likely secondary to sepsis as a result of wound superinfection. Unfortunately, none of the therapies for CUA offer a definitive cure or are consistently successful. The number of randomized controlled trials looking at outcomes also continues to be very limited. One hopes that some of the recent discoveries related to the pathogenesis of CUA will lead to the development of new strategies

2009 Clinical Correlations

1600. Salmonella Update

with fever and gastrointestinal symptoms within hours to days of exposure, and lasts days, and up to one week. The illness may be self-limiting or require supportive hydration. In certain populations, such as the very young or very old, or those who are immunocompromised, there is higher risk of systemic infection, which can be fatal if not treated promptly with antibiotics. There are also connections between Salmonella infection and development of reactive arthritis in Reiter’s syndrome (...) foods to their origin. Dr. Maki goes on further to call for the discontinuation of antibiotics in animal feeds which leads to microbial resistance, more hygienic food preparation, as well as routine irradiation of high risk foods. References CDC. Investigation Update: Outbreak of Salmonella Typhimurium Infections, 2008–2009. http://www.cdc.gov/salmonella/typhimurium/update.html FDA. Peanut Product Recalls: Salmonella Typhimurium. Rabin, RC. Peanut Plant Had History of Health Lapses. New York Times

2009 Clinical Correlations

Evidence-based Synopses

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