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1721. 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 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

1722. 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

1723. 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

1724. 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

1725. 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. 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

1726. 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

1727. 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

1728. 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

1729. 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

1730. 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 Publication 410

1731. 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

1732. Prevention and Treatment of Influenza A and B

of efficacy is based on all trial participants. In pooled data from 2 RCTs zanamivir reduced the primary outcome by a median of 0.9 days , and oseltamivir by 0.8 days. , Symptom severity was not significantly different between zanamivir and placebo. Symptom severity was not adequately reported apart from duration for oseltamivir. , No significant difference was seen in use of acetaminophen, cough syrup or antibiotics with either drug versus placebo. Serious complications leading to hospitalization

2000 Therapeutics Letter

1733. New Drugs VI ? Rosiglitazone (Avandia®), Tolterodine (Detrol®), Bupropion (Wellbutrin SR®, Zyban®), Doxazosin (Cardura®)

. Long term compliance is poor, even in a trial setting. Gatifloxacin (Tequin ® ) and Moxifloxacin (Avelox ® ) Approved indications for both: “acute sinusitis, community-acquired pneumonia (CAP) and acute exacerbation of chronic bronchitis (AECB). Additional indications for gatifloxacin are uncomplicated and complicated UTI, pyelonephritis and uncomplicated gonorrhoea.” Mechanism of action: Similar to other fluroquinolone antibiotics. Pharmacokinetics: Both are well absorbed with half-lives of 12 (...) hours. Gatifloxacin is eliminated by the kidney and moxifloxacin is metabolized by the liver. Evidence of effectiveness: Gatifloxacin has been compared with other antibiotics in 9 double blind RCTs. Eight of these trials show clinical efficacy ranging from 88 to 98%, which was not different from levofloxacin, ofloxacin, clarithromycin and erythromycin in the treatment of acute sinusitis, CAP, AECB, UTI and gonorrhoea. In one trial, gatifloxacin was significantly more effective than cefuroxime axetil

2000 Therapeutics Letter

1734. Asymptomatic Bacteriuria in Pregnancy: Rapid answers using the Cochrane Library

confirm that she has no urinary symptoms. You remember that she should probably be treated with an antibiotic, but when you suggest this, she says she does not want to expose her fetus to any drugs unless it is absolutely necessary. In fact, she asks you, “Why do I need to take an antibiotic and what is the potential harm?” She also asks if cranberry juice would suffice. In order to buy some time, you suggest she repeat the urine culture and arrange to see her in one week at which time you promise (...) in the Cochrane Database of Systematic Reviews, 9 complete reviews and 5 protocols (reviews in progress). When you double click on the reviews, you find 5 titles that are possibly relevant to this case: 1) Antibiotics for asymptomatic bacteriuria in pregnancy, 2) Duration of treatment for asymptomatic bacteriuria in pregnancy, 3) Treatment for symptomatic urinary tract infections during pregnancy, 4) Cranberries for treating urinary tract infections, and 5) Cranberries for preventing urinary tract infections

2001 Therapeutics Letter

1735. Do Single Stereoisomer Drugs Provide Value?

, it can be remarketed as a single enantiomer under a new patent. Are single enantiomers better? a) Esomeprazole (Nexium ® ) Esomeprazole (Nexium ® ), licensed in 2001, is the S-enantiomer of racemic S,R-omeprazole (Losec ® , Prilosec ® in the US). Approved Indications: Reduction of gastric acid secretion including reflux esophagitis, gastroesophageal reflux disease and in combination with antibiotics for eradication of H. pylori associated with peptic ulcer disease. Alternative proton pump inhibitors (...) ), licensed in 1998, is the pure L-form of the racemic mixture, ofloxacin (see ). The L-form contains the antimicrobial activity; the D-form is pharmacologically inert. Brand name racemic ofloxacin (Floxin ® , same manufacturer) was similarly priced, offering no cost advantage. Generic ofloxacin is now available and less expensive at comparable doses (800 mg ofloxacin contains 400 mg levofloxacin) (see ). Since once-daily levofloxacin has been proven effective, ofloxacin could be prescribed similarly

2002 Therapeutics Letter

1736. Do Statins have a Role in Primary Prevention?

drugs without assistance often deprive themselves of needed therapy due to cost. It’s for this reason that I am virulently opposed to a National Drug Plan! Canadians have become too complacent about medical costs and the addition of such a plan would undoubtedly break the bank. We need much more in the way of patient education in order to reduce our unnecessary pharmaceutical costs. You wouldn’t believe the number of times I have had a mother in the ER at night demanding an antibiotic

2003 Therapeutics Letter

1737. Pre-hospital administration of antibiotics by paramedics for suspected cases of meningococcal disease

Pre-hospital administration of antibiotics by paramedics for suspected cases of meningococcal disease National Horizon Scanning Unit Horizon scanning prioritising summary Volume 14, Number 6: Pre-hospital administration of antibiotics by paramedics for suspected cases of meningococcal disease September 2006 © Commonwealth of Australia 2006 [add ISSN] [add Publications Approval Number] This work is copyright. You may download, display, print and reproduce this material in unaltered form only (...) summary was prepared by Linda Mundy and Tracy Merlin from the National Horizon Scanning Unit, Adelaide Health Technology Assessment, Discipline of Public Health, Mail Drop 511, University of Adelaide, South Australia, 5005. PRIORITISING SUMMARY REGISTER ID: 000229 NAME OF TECHNOLOGY: PRE-HOSPITAL ADMINISTRATION OF ANTIBIOTICS BY PARAMEDICS PURPOSE AND TARGET GROUP: FOR SUSPECTED CASES OF MENINGOCOCCAL INFECTION STAGE OF DEVELOPMENT (IN AUSTRALIA): Yet to emerge Established Experimental ? Established

2006 Australia and New Zealand Horizon Scanning Network

1738. Risk of Hemolytic Uremic Syndrome After Antibiotic Treatment of Escherichia coli O157:H7 Enteritis. A Meta-analysis

Risk of Hemolytic Uremic Syndrome After Antibiotic Treatment of Escherichia coli O157:H7 Enteritis. A Meta-analysis Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2008 PedsCCM Evidence-Based Journal Club

1739. Mad CAP Antics: Antibiotics Within 4 Hours

Mad CAP Antics: Antibiotics Within 4 Hours Mad CAP Antics: Antibiotics Within 4 Hours « Sinai EM Journal Club Emergency Medicine Discussion Forum Mad CAP Antics: Antibiotics Within 4 Hours Jack tackled a controversial topic at this month’s Journal Club — what’s the evidence for giving antibiotics within four hours for CAP patients? It’s a good question, because how well we perform at this task is a big part of how our hospitals are measured. Ineed, pneumonia antibiotic timing is one of JCAHO’s (...) to administration of antibiotics, this study can’t ethically be done prospectively. Their retrospective sample is worth noting, however: They took their numbers from a database of Medicare (over 65) with a primary or secondary ICD-9 code of pneumonia sampled from July 1- Dec 31, 1998, or Sept 1, 1998-March 31, 1999 (this database had 346,105 patients, though it seems possible they sampled the same patients twice). The authors randomly selected up to 850 cases from each state (more like the Senate than the House

2007 Sinai EM Journal Club

1740. No clear evidence of benefit for antimicrobial interventions in atopic eczema

were trialled - oral antibiotics, antibacterial soaps, topical steroids combined with antibacterials, antibacterial bath additives, topical antiseptic/antibiotic creams and silver- impregnated textiles. None of the trials showed any clear benefit in terms of short term eczema control, although several interventions were associated with decreased numbers of SA on the skin.There was no clear evidence that widely-used topical steroid/antibiotic combinations were better than use of the topical steroid (...) No clear evidence of benefit for antimicrobial interventions in atopic eczema PEARLS Practical Evidence About Real Life Situations PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They No clear evidence of benefit for antimicrobial interventions in atopic eczema Clinical question How effective are interventions to reduce Staphylococcus aureus (SA) in treating infected or non-infected atopic eczema? Bottom line A range of anti-staphylococcal treatments

2008 Publication 410

Evidence-based Synopses

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