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1701. Is lumbar puncture necessary for evaluation of early neonatal sepsis?

review, level 2b No of cases of meningitis, number of missed/partially treated cases of meningitis No cases of meningitis were found. No missed or partially treated cases were detected Uncontrolled cohort. Small study but only looking at BC positive cases. Babies were treated with antibiotic before CSF was obtained, so the early meningeal seeding could be missed. No mention about the timing of follow-up to detect missed cases Weiss et al, 1991 All infants admitted with respiratory distress

2007 BestBETS

1702. Myringotomy in traumatic haemotympanum

that this condition may be treated conservatively (Deguine and Pulec, 2003; Pulec and Deguine, 2001). Prophylactic antibiotics are recommended but a review of the evidence for this is beyond the scope of this BET. Clinical Bottom Line Patients with traumatic haemotympanum should be investigated for potential basal skull fracture. There is no published evidence of either benefit or harm with myringotomy, nor is there any evidence of harm following conservative management. Local advice should be followed

2006 BestBETS

1703. Does neonatal BCG vaccination protect against tuberculous meningitis?

August 2006 Last Modified: 30th August 2006 Status: Green (complete) Three Part Question In [children suspected of having mycobacterial meningitis] does [a history of BCG vaccination or presence of BCG scar] influence [the likelihood of tuberculous meningitis]? Clinical Scenario An 8 month old baby girl, of Eastern European parents, presents with a week long history of coryzal symptoms for which she has been taking oral antibiotics. She is pyrexial, irritable, and unwell on examination. She

2006 BestBETS

1704. How useful is C-reactive protein in detecting occult bacterial infection in young children with fever without apparent focus?

and a peripheral film negative for malarial parasites. Patients with underlying neoplastic or immunosuppressive condition or with a chronic liver, heart and renal disease and those who had already received antibiotics were excluded Exploratory prospective cohort study (level IIb) CRP, total and differential leucocyte count and ESR in children with laboratory or radiographically proven bacterial illness and non-bacterial illnesses The sensitivity of serum CRP >4 mg/dl for diagnosis of bacteraemia was 95 (...) but not proven bacterial infection (13%) were not included in statistical analysis Confidence interval of sensitivity and specificity values were not given Pulliam et al, 2001 77 children from 1 to 36 months of age with temperature >39°C and clinically undetectable source of fever. Children with acute otitis media, acute pharyngitis, clinical pneumonia, acute respiratory tract infection, acute gastroenteritis, those with a history of antibiotic use during the past 7 days, a known underlying immunologic

2006 BestBETS

1705. Review: several interventions prevent ventilator associated pneumonia in critically ill patients Full Text available with Trip Pro

and selective digestive decontamination is equivocal. Collard et al correctly attributed these conflicting findings to differences in inclusion criteria, outcome measures, and analyses used in individual studies. They also caution practitioners about the use of selective digestive tract decontamination because of uncertainties about effects of such treatment on antibiotic resistance, although no additional evidence to support this was included in the review. Although cost may be a barrier for many

2004 Evidence-Based Nursing

1706. A COPD self management programme reduced hospital use and improved health status Full Text available with Trip Pro

action plan for acute exacerbations linked with therapeutic actions (including a prescription for an antibiotic and oral corticosteroid to be initiated promptly for exacerbations characterised by specific symptoms), case manager availability by telephone, and exercise programme instruction (warm up and stretching, muscle, and cardiovascular exercises to be done ≥3 times/wk for 30–45 min/session). 95 patients were allocated to usual care (management by treating physician, free healthcare services

2004 Evidence-Based Nursing

1707. Review: evidence on the effectiveness of interventions to assist patients’ adherence to prescribed medications is limited Full Text available with Trip Pro

, information, counselling, reminders, self monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Simple interventions that received some support included simplified dosing regimens for patients taking antihypertensive and lipid lowering medications and counselling about the importance of full adherence to antibiotic regimens reinforced by written instructions. Effective interventions were not distinguished from ineffective interventions in terms of number

2004 Evidence-Based Nursing

1708. Fluconazole reduced the rate of recurrence of vulvovaginal candidiasis Full Text available with Trip Pro

been enrolled in the study. The authors refer to “clinical cure” of VC, which is perhaps more accurately referred to as “effective suppression” of symptoms and signs. It is unclear which specific symptoms and signs were present in women categorised as having “effective suppression” or “recurrence.” Also, clinicians should note that other variables commonly believed to predict VC, such as history of antibiotic and oral contraceptive use, were not associated with clinical response. Even with this low

2006 Evidence-Based Nursing

1709. Selective decontamination of the digestive tract reduced intensive care unit and hospital mortality in adults Full Text available with Trip Pro

at admission and twice weekly; ⩾1 occasion of positive sputum cultures for aerobic gram negative bacteria or yeasts was treated with nebulised polymyxin E, 80 mg, or amphotericin B, 5 mg, 4 times daily until cultures were negative. 553 patients were allocated to standard oropharyngeal care (mouth rinsing with water 4 times daily and tooth brushing twice daily; initiation of enteral feeding as early as possible, and systemic antibiotics for proven or suspected infections as clinically indicated). Outcomes (...) associated with SDD, its use in ICUs has been challenged. In particular, concerns have been raised about the increased risk of resistance to antibiotics and the added costs of treating resistant nosocomial infections. The important work by De Jonge et al , however, suggests that SDD reduces resistant organism colonisation and increases patient survival. A strength of the study is the heterogeneous sample of patients allocated to 2 units in the same centre. The same medical staff treated patients

2005 Evidence-Based Nursing

1710. Ear drops containing steroids were better than acetic acid for otitis externa Full Text available with Trip Pro

Guzman , RN(EC), BScN, PHCNP Statistics from Altmetric.com van Balen FA, Smit WM, Zuithoff NP, et al . Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial. BMJ 2003 ; 327 : 1201 –5. Q In patients with acute otitis externa, what is the relative effectiveness of ear drops containing acetic acid, steroids and acetic acid, and steroids and antibiotics? METHODS Design: randomised controlled trial. Allocation: concealed. Blinding: blinded (...) . Interventions: 3 ear drops 3 times daily of 7.2 mg of acetic acid per gram of propylene glycol (acetic acid group) (n = 71); 0.1% triamcinolone acetonide and acetic acid (steroid plus acetic acid group) (n = 63); or 0.66 mg of dexamethasone phosphate sodium, 5 mg of neomycin sulphate, and 10 000 IU of polymyxin B sulphate/ml (steroid plus antibiotic group) (n = 79). Outcomes: self reported duration of symptoms until recovery. Secondary outcomes were cure rate (proportion of patients recovered according

2005 Evidence-Based Nursing

1711. Patients with chronic asthma found medicine information to be unclear or confusing, did not receive complete information on medicine use and side effects, and found leaflets to be unhelpful Full Text available with Trip Pro

minute focus groups. After describing their medication related experiences, patients were asked to comment on 5 leaflets about asthma medicine (reliever and preventer inhalers, generic and branded broad spectrum antibiotics, and a generic oral steroid). Audiotapes were transcribed verbatim, and themes and categories were generated. MAIN FINDINGS 10 themes were identified. (1) Information experiences . Almost half of the patients felt that the information they received met their needs and helped them

2006 Evidence-Based Mental Health

1712. Review: adding non-invasive positive pressure ventilation to usual care reduces treatment failure in respiratory failure Full Text available with Trip Pro

and assessment: RCTs that compared usual care (including supplemental oxygen, antibiotics, bronchodilators, steroids, and respiratory stimulants) plus NPPV (applied by nasal or face mask) with usual care alone in adults with respiratory failure precipitated by an acute exacerbation of COPD. Exclusion criteria included studies of weaning, patients with pneumonia, or where continuous positive airway pressure or endotracheal intubation preceded enrolment. Study quality was assessed on the basis of concealment

2006 Evidence-Based Mental Health

1713. Review: chemotherapy plus supportive care improves survival and quality of life in advanced or metastatic gastrointestinal cancer more than supportive care alone Full Text available with Trip Pro

varied; however, SC included analgesics in 4 trials, antibiotics in 2 trials, and psychological support in 1 trial. Jadad scores ranged from 2–3 out of 5, and Rinck scores ranged from 4.5–5.5 out of 7. Meta-analysis was not done because of heterogeneity among studies. Each of the 4 trials showed that patients who received chemotherapy plus SC survived longer than those who received SC alone (table ). 2 of 3 trials that measured QOL showed a statistically significant difference for chemotherapy plus

2006 Evidence-Based Mental Health

1714. Review: probiotics reduced diarrhoea at 3 days in children and adults with proven or presumed infectious diarrhoea Full Text available with Trip Pro

(to minimise publication bias), non-blinded studies, and more detailed quality assessment. The reviewed studies included participants of all ages from developed and developing countries, some of whom might have received antibiotics before recruitment. The expansion of the inclusion criteria promotes greater clinical generalisability. The findings also are consistent with a review by D’Souza et al who found that probiotics prevented antibiotic associated diarrhoea. Allen et al identified significant (...) ediatrics 2002 ; 109 : 678 –84. D’Souza AL, Rajkumar C, Cooke J, et al . Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ 2002 ; 324 : 1361 . Footnotes For correspondence: Dr S J Allen, Swansea Clinical School, University of Wales Swansea, Swansea, UK. s.j.allenswansea.ac.uk Source of funding: Department for International Development UK. Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright

2005 Evidence-Based Nursing

1715. You can make a difference in 5 minutes Full Text available with Trip Pro

in the ICU by 6.1 days and hospitalisation by 10.5 days. This increase in length of stay and need for empiric antimicrobial treatment significantly impacts costs. The primary cause of healthcare associated pneumonia is mechanical ventilation. The estimated average costs associated with ventilator associated pneumonia are $29 369. ORAL CARE POLICY/PROCEDURE Appropriate oral care may be a preventative measure against acquiring VAP. A review of current practice demonstrated that foam swabs were the oral

2005 Evidence-Based Nursing

1716. Nurse led education plus direct access to imaging improved diagnosis and management of urinary tract infections in children Full Text available with Trip Pro

followed their standard practice. Outcomes: rate and quality of diagnosis of UTI, use of prophylactic antibiotics, and number of infants with vesicoureteric reflux in whom renal scarring could have been prevented. Patient follow up: all children were included in the intention to treat analysis. MAIN RESULTS The rate of diagnosis of UTIs was greater in the NLI group than in the UC group (6.42 v 3.45 cases/1000 children/y, relative benefit increase 86%, 95% CI 42% to 144%). More children in the NLI group (...) than in the UC group had bacteriologically proven UTIs (table ). Among children < 4 years of age, more children in the NLI group received prophylactic antibiotics than in the UC group (94% v 41%, p<0.001). 12 infants in the NLI group had reflux without scarring compared with none in the UC group (p>0.05). View this table: Nurse led education plus direct access to imaging v usual care for paediatric patients in general practices (subgroup analysis of children referred for imaging)* CONCLUSION Nurse

2005 Evidence-Based Nursing

1717. Review: silver alloy catheters are more effective than standard catheters for reducing bacteriuria in adults in hospital having short term catheterisation Full Text available with Trip Pro

parallel group RCTs [4237 patients] and 1 cluster randomised crossover trial [27 878 patients]) met the selection criteria. 11 trials compared antiseptic impregnated catheters with standard catheters, 1 trial compared antibiotic impregnated catheters with standard catheters, and 6 trials compared different standard catheters. 2 types of antiseptic catheters (silver alloy and silver oxide) were compared with a standard catheter. Silver alloy catheters reduced rates of asymptomatic bacteriuria compared (...) catheters reduced asymptomatic or symptomatic bacteriuria more than standard catheters; silver oxide catheters did not differ from standard catheters. Insufficient evidence exists on whether catheters impregnated with antibiotics or antiseptics reduce infection . Commentary Urinary tract infection is the most common hospital acquired infection, and is often associated with urinary catheters. It is a concern for all nurses. Brosnahan et al did a systematic review of existing research on the influence

2005 Evidence-Based Nursing

1718. Oral decontamination with chlorhexidine reduced ventilator associated pneumonia in patients needing mechanical ventilation for 48 hours Full Text available with Trip Pro

Club. View this table: Chlorhexidine (CHX) or CHX plus colistin (COL) v placebo in mechanically ventilated patients* Commentary Oropharyngeal colonisation with potential pathogens is central in the pathogenesis of VAP. Preventing VAP using oral decontamination with non-absorbable antibiotics is not widespread because of concerns about emergence of antibiotic resistance. Koeman et al used orally applied CHX or CHX plus COL as alternative agents and found both treatments to be effective in VAP

2008 Evidence-Based Nursing

1719. Mupirocin reduces infections in Staphylococcus aureus carriers

groups of patients. Local antibiotic treatment with mupirocin ointment is often used to eradicate S. aureus. Until now, routine use of mupirocin has not been applied in many hospitals, mainly due to concern about the development of mupirocin resistance and the absence of convincing evidence that it reduces the infection rate. Cochrane Systematic Review Van Rijen M et al. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Reviews 2008, Issue 4. Article

2008 Cochrane PEARLS

1720. Do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?

(proparacaine hydrochloride 0.5% solution), 2 drops of a topical antibiotic (gentamicin 0.3% solution), and either diclofenac or the control vehicle. Some patients also received 1 drop of a cycloplegic (cyclopentolate) at the discretion of the treating physician. Patients were discharged with a masked bottle of either diclofenac or the control vehicle (Natural Tears), with instructions to instill 1 drop every 6 hours while awake for 24 to 36 hours. Patients also received a bottle of topical gentamycin

2003 Evidence-Based Emergency Medicine

Evidence-based Synopses

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