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1641. Brahms PCT assays for the diagnosis of systemic bacterial infection (update)

guided diagnosis on the treatment of 234 patients admitted to hospital with suspected lower respiratory tract infections. Patients assessed with the assistance of KRYPTOR PCT assays received significantly fewer antibiotics (49% reduction, p < 0.0001) than patients receiving standard care (Christ-Crain et al 2004). In Australia Brahms supplies the PCT-Q and PCT LIA formats. The Brahms PCT LIA luminometer system is currently available commercially and is the most commonly used method in Australia (...) -Molecule and Kinetics. Brahms PCT [Internet] Brahms Aktiengesellchaft, Hennigsdorf, Germany. Availabe at : http:www.procalcitonin.com [Accessed March 11, 2004]. Christ-Crain, M., Jaccard-Stolz, D. et al (2004). 'Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single- blinded intervention trial', Lancet, 363 (9409), 600-607. Meisner, M. (2002). 'Pathobiochemistry and clinical use of procalcitonin', Clin Chim Acta, 323 (1-2

2007 Australia and New Zealand Horizon Scanning Network

1642. MRI guided high intesity focused ultrasound

to treatment 0 vs 4.8%, and interventional treatment 0 vs 2.4%. Antibiotic use was high in the hysterectomy group compared to the ExAblate ® group 24-hours post-treatment (36.1 vs 2.8%). In addition, 14 (12.8%) patients treated with ExAblate ® experienced leg pain or nerve tingling, eight of which were deemed to be sonication-related. Symptoms resolved after 3-days in all but one patient, who reported severe sciatic pain which did not resolve until 11-months post- treatment. There were five cases of first

2007 Australia and New Zealand Horizon Scanning Network

1643. Screening for Chlamydia in pharmacies

be returned to the pharmacy within six hours after collection, and are then sent on to an accredited diagnostic laboratory for testing. Test results are delivered to the individual either by phone, text or letter. Individuals testing positive receive a single dose of antibiotic treatment from the pharmacist and are advised to receive testing for any other sexually transmitted diseases. Sexual partners of positive individuals are offered free chlamydia testing regardless of age (DoH (UK) 2007

2007 Australia and New Zealand Horizon Scanning Network

1644. Screening & Eradication of Helicobacter Pylori for Gastric Cancer

at Screening and eradication of Helicobacter pylori: November 2008 1 eradicating H pylori, usually consisting of two antibiotics and a proton pump inhibitor 1 taken in combination. Vaccines against H pylori are in development in several laboratories. There are currently calls in the medical literature to investigate the role of screening for H pylori with the aim of eradicating it in certain populations and preventing gastric cancer (Talley 2008). CLINICAL NEED AND BURDEN OF DISEASE The prevalence of H

2008 Australia and New Zealand Horizon Scanning Network

1645. CoughAssist inexsufflator

of days spent in hospital (20.5 ± 20 vs 19.8 ± 17 days) or for the number of patients who received antibiotics (100% vs 81%). On the whole, treatment with MI-E was well tolerated by patients, with only two adverse events recorded. One patient experienced stomach distension at +20 to -35 cm H 2 O but continued treatment. One patient developed mild nasal bleeding which resolved without specific treatment (Vianello et al 2005). 3 Vital capacity = is the maximum volume of air that a person can exhale

2008 Australia and New Zealand Horizon Scanning Network

1646. Rapid Test for Helicobacter Pylori

intensive and expensive. In addition several factors such as bleeding ulcers, or antibiotic treatments Helicobacter pylori rapid tests: November 2008 2 reduce the effectiveness of the UBT resulting in false negatives (Stenstrom et al 2008). Compared to histology it is estimated that the UBT is 95% sensitive and 95% specific when diagnosing H pylori infections (Vaira & Vakil 2001). SAFETY AND EFFECTIVENESS ISSUES There is a significant amount of recent literature published evaluating

2008 Australia and New Zealand Horizon Scanning Network

1647. Earpopper for the treatment of otitis media in children (update)

is considered distinct from acute otitis media (AOM), which is defined as a history of acute onset of signs and symptoms. OME may occur spontaneously because of poor eustachian tube function, or as an inflammatory response following AOM. The EarPopper ™ is a non-invasive device for treating conditions such as otitis media with effusion, middle ear effusion, aerotitis/barotitis and eustachian tube dysfunction, without the need for surgery or antibiotics (Micromedics 2005). The EarPopper ™ device delivers (...) (tympanic membrane retraction pockets, erosion of portions of the ossicular chain and cholesteatoma), language delays and behavioural problems. DIFFUSION The EarPopper ™ is not currently available in Australia. COMPARATORS Alternative methods of managing persistent OME include observation, medical or surgical approaches. Medical approaches include administration of decongestants, antihistamines, corticosteroids, and antimicrobial agents. Surgical approaches may include myringotomy, a surgical incision

2007 Australia and New Zealand Horizon Scanning Network

1648. ZstatFlu point of care influenza tests (Update)

different (P < 0.01) Age in months (SD) 6.86 (6.3) 6.55 (6.8) NS Mean temperature in C° (SD) 39.38 (0.6) 39.3 (0.8) NS Blood tests 33.3% 100% Yes urinalysis 80.9% 100% Yes chest roentgenogram 14.2% 32% Yes cerebrospinal fluid analysis 1.33% 21.3% Yes mean length of stay in the ED in minutes(SD) 116.2 (75.5) 192.9 (76.3) Yes admission to the ED observation ward 8.3% 21.3% Yes inpatient care 2.3% 16.4% Yes antibiotic treatment 0% 38.5% Yes Adapted from (Benito-Fernandez et al 2006), NS = not significant (...) diagnostic tests versus patients in the standard test only group (39% vs. 52%, p = 0.03). Tests such as chest radiographs, blood cultures, and/or complete blood counts were reduced in the QuickVue ® Influenza Test tested group. For the clinic patients there was no difference in the rate of diagnostic tests ordered, or prescription of antivirals and antibiotics between the QuickVue ® Influenza Test and standard diagnostic methods groups (Poehling et al 2006)(level III-2 diagnostic evidence). A study

2007 Australia and New Zealand Horizon Scanning Network

1649. Genetic testing for Long QT syndrome to identify individuals at high-risk of sudden cardiac death

describes the rate of survival of LQTS patients who don’t receive treatment. Patients diagnosed with LQTS are advised to avoid competitive sports and vigorous activity, such as swimming, is contraindicated. In addition, some medications should be avoided in patients with LQTS including some antibiotics, antihistimines, vasodilators and decongestants (CIDG 2006). Figure 2 Long QT survival after first syncope (Schwartz & Locati 1985) CLINICAL NEED AND BURDEN OF DISEASE It is difficult to estimate

2006 Australia and New Zealand Horizon Scanning Network

1650. EarPopper for the treatment of otitis media with effusion in children

distinct from acute otitis media (AOM), which is defined as a history of acute onset of signs and symptoms. OME may occur spontaneously because of poor eustachian tube function, or as an inflammatory response following AOM. The EarPopper ™ is a non-invasive device for treating conditions such as otitis media with effusion, middle ear effusion, aerotitis/barotitis and eustachian tube dysfunction, without the need for surgery or antibiotics (Micromedics 2005). The EarPopper ™ device delivers a constant (...) delays and behavioural problems. DIFFUSION The EarPopper ™ is not currently available in Australia. COMPARATORS Alternative methods of managing persistent OME include observation, medical or surgical approaches. Medical approaches include administration of decongestants, antihistamines, corticosteroids, and antimicrobial agents. Surgical approaches may include myringotomy, a surgical incision into the eardrum (to relieve pressure or release pus from the middle ear) with or without tympanostomy tube

2005 Australia and New Zealand Horizon Scanning Network

1651. Foramen Ovale Closure devices for the treatment of migrane

a catheter introduced from the right femoral vein under local anaesthesia. The catheter is advanced across the foramen into the left atrium where the closure device, a small umbrella-like implant is opened, closing the defect. The same steps are followed to close the right side of the defect. The closure device is released from the catheter and over time, tissue grows in and around the framework of the device, securing it in place (Figure 1). Patients are prescribed antiplatelet drugs and antibiotics

2006 Australia and New Zealand Horizon Scanning Network

1652. Rapid point-of-care for the detection of Chlamydia in individuals at risk of trachoma

Australia 2006; Kasi et al 2004; Wright et al 2006). Figure 1 The natural history of trachoma (Printed with permission Wright 2006) The World Health Organization (WHO) recommends the SAFE strategy (Surgical, Antibiotics, Facial cleanliness and Environmental improvement), which focuses on the prevention of trachoma. Trachomatous trichiasis is associated with an increased risk of blindness and a variety of surgical procedures can relieve the trichiasis, preventing or slowing progression towards blindness (...) . Individuals with active infection are treated with antibiotics; either oral doses of azithromycin or tetracycline eye ointment. If prevalence of trachoma is greater than 10 percent in a community, antibiotics should be provided to the whole, or at least 80 per cent of the community. Antibiotic administration should continue for at least three years and should not stop until prevalence is below five per cent. Clean-face campaigns have been initiated in some communities as children with dirty faces are two

2006 Australia and New Zealand Horizon Scanning Network

1653. MRI - guided high intensity utrasound - uterine fibroids

, both at and beyond 3-months post MRgFUS treatment. Patients in the high NPV ratio group (>20%) reported a significantly greater improvement on the SSS than patients in the low NPV ratio group (p 38°C for two consecutive days 2.8 vs 14.5%, transfusion rates were 2.8 vs 7.2%, unintended surgical procedure related to treatment 0 vs 4.8%, and interventional treatment 0 vs 2.4%. Antibiotic use was high in the hysterectomy group compared to the ExAblate ® group 24-hours post-treatment (36.1 vs 2.8

2008 Australia and New Zealand Horizon Scanning Network

1654. Transvaginal pelvic reconstruction using mesh for genitourinary prolapse (Update)

case series (Nicita 1998, Shah et al. 2004). Choe et al. (1999) used an antimicrobial Mycromesh and compared this with a vaginal wall sling. Patients allocated to receive the Mycromesh had a significantly shorter operative time and lower blood loss (p stage II) were included in the study with some stage I patients being circumstantially enrolled. Concomitant procedures were performed in 53 patients (72.6%), and included hysterectomy, anterior colporrhaphy, sacrospinous ligament fixations (...) Report ? Full Health Technology Assessment 5 Monitor ? Archive References: Choe JM, Ogan K, Battino BS. Antimicrobial mesh versus vaginal wall sling:: A comparative outcomes analysis. The Journal of Urology 1999; 163(6): 1829-34. eMedicine. Last updated 2004. http://www.emedicine.com [Accessed March 2004] Jackson S, Smith P. Diagnosing and managing genitourinary prolapse. British Medical Journal 1997; 314(7084): 875-880. Julian T. The efficacy of Marlex mesh in the repair of severe, recurrent vaginal

2008 Australia and New Zealand Horizon Scanning Network

1655. Ciprofloxacin hydrochloride & dexamethasone otic suspension - Otitis media with otorrhea & otitis externa, acute

/dexamethasone (Ciprodex ® ) costs $25.20 for a 7.5 mL bottle which is more expensive than other topical otic antibiotic/corticosteroid combination products: framycetin/gramicidin/dexamethasone cost $7.84 for 8 mL, polymixin/neomycin/hydrocortisone costs $10.14 for 10 mL and gentamicin/betamethasone costs $8.97 for 7.5 mL. Of Note: 1. Both published and unpublished data were reviewed and taken into consideration in making this recommendation. 2. The Committee considered data on the ototoxicity of various

2007 Canadian Agency for Drugs and Technologies in Health - Common Drug Review

1656. Daptomycin - Skin and Skin Structure Infections & Bacteremia

Daptomycin - Skin and Skin Structure Infections & Bacteremia Common Drug Review CEDAC Meeting – July 16, 2008; CEDAC Reconsideration – September 17, 2008 Page 1 of 3 Notice of CEDAC Final Recommendation – September 24, 2008 © 2008 CADTH CEDAC FINAL RECOMMENDATION on RECONSIDERATION and REASONS for RECOMMENDATION DAPTOMYCIN (Cubicin ® – Oryx Pharmaceuticals Inc.) Description: Daptomycin is a parenteral cyclic lipopeptide antimicrobial agent with bactericidal properties against Gram positive (...) those with right-sided infective endocarditis. Recommendation: The Canadian Expert Drug Advisory Committee (CEDAC) recommends that daptomycin not be listed. Reasons for the Recommendation: 1. Based on the results of three open-label randomized controlled trials (RCTs) (designed as non-inferiority trials), the Committee felt that there was no therapeutic advantage of daptomycin as a first-line agent over other antimicrobial agents. Moreover, the Committee had concerns with the design, conduct

2008 Canadian Agency for Drugs and Technologies in Health - Common Drug Review

1657. Hydrocortisone infusion may improve survival in patients with severe community-acquired pneumonia Full Text available with Trip Pro

equivalent (such as acute asthma and COPD) were excluded. Intervention Subjects were randomly assigned to receive hydrocortisone infusion or placebo in addition to protocol guided antimicrobial therapy. Hydrocortisone was given as an intravenous 200 mg bolus followed by infusion at a rate of 10 mg/hour for 7 days. Outcomes The primary end-points of the study were improvement in PaO 2 :FiO 2 (PaO 2 :FiO 2 >300 or ≥100 increase from study entry) and multiple organ dysfunction syndrome (MODS) score by Study

2005 Critical Care - EBM Journal Club

1658. Early recognition and treatment of non-traumatic shock in a community hospital Full Text available with Trip Pro

, such as antibiotics and vasopressors; and disease specific interventions. Outcomes The primary endpoint was hospital mortality. Secondary endpoints were the identification of shock patients, times to interventions, length of stay, and discharge location. Results Eighty-six and 103 patients were in the control and protocol groups, respectively. Baseline characteristics were similar. The protocol group had significant reductions in the median times to interventions, as follows: intensivist arrival, 2:00 h to 50 min

2006 Critical Care - EBM Journal Club

1659. Gingival and plaque decontamination: Can we take a bite out of VAP? Full Text available with Trip Pro

[ ]. Although evidence from more than 50 clinical trials and ten meta-analyses demonstrate that selective decontamination of the digestive tract (SDD) using topical antibiotics (+/- systemic antibiotics) is associated with decreased incidence of VAP, routine implementation of SDD has not been adopted by most intensivists because of concerns about the emergence of antibiotic-resistant pathogens. Topical application of an antiseptic , such as chlorhexidine, could be an attractive alternative for oropharyngeal (...) pneumonia, a number of methodological limitations may have reduced the likelihood of showing an impact for the intervention. Because rates of VAP were much lower than anticipated, the study was underpowered. Two-thirds of the subjects were considered infected at the time of ICU admission (primarily bronchitis and community-acquired pneumonia) and prior antibiotic usage was not an exclusionary criterion for entry into the study, making interpretation of rates of new respiratory infections challenging

2006 Critical Care - EBM Journal Club

1660. PICCing the best access for your patient Full Text available with Trip Pro

not know many details of the parent trials that might help in our interpretation of the data, such as how long subjects were in the hospital or ICU, what antibiotics they received prior to PICC insertion, or how long antibiotics were given. Some patients in the parent trials received conventional CVCs. Rates of CVC-related BSI for these subjects were not reported and instead the authors provide reported rates from the literature to put the observed PR-BSI rates in perspective. PICC-related risks

2006 Critical Care - EBM Journal Club

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