1,721,193 research outputs found
Antibiotics for preventing respiratory tract infections in adults receiving intensive care
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Antibiotic prophylaxis in intensive therapy. Results of a systematic review of the literature and their implications for clinical practice
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Meta-analysis of clinical trials with copolymer 1 in multiple sclerosis
No full textGlatiramer acetate (copolymer 1) was licensed in the USA in 1996 for the treatment of relapsing-remitting multiple sclerosis. In order to assess its efficacy, a meta-analysis of all randomized controlled trials was performed. Two double-blind studies, accounting for a total number of 299 patients, contribute to this analysis. Patients undergoing the treatment have decreased probability of relapse at 12 months (OR 0.17, 95% CI 0.05-0.51, p = 0.002) and of unsustained progression of disability at 24 and 35 months (OR 0.57, 95% CI 0. 34-0.95, p = 0.031, and OR 0.50, 95% CI 0.28-0.90, p = 0.019). These data suggest that glatiramer acetate represents an alternative to interferon treatment in relapsing-remitting multiple sclerosis. However, further evidence of efficacy is required to justify its use in clinical practice
Antibiotic prophylaxis can lead to contamination with Clostridium difficile - Reply
No full textAuthors' replyEDITOR---Unlike Sanderson, we find it interesting rather than ironic that our review was in the same issue of the House of Lords' report that was aimed at stimulating critical thinking against generalised fears of antimicrobial resistance. Critically ill patients undergoing ventilation are at high risk of pneumonia and death, and the issue whether or not they should be routinely treated with antimicrobials deserves great attention.We accessed data on individual patients, which allowed us to ascertain that most patients in all trials were treated with antimicrobials at some point during their stay in an intensive care unit, regardless of the initial policy of the unit. The question is thus no longer whether, but rather when, they should be treated---immediately, as a policy, or only once their infection becomes clinically evident
Numbers needed to treat derived from meta-analysis. Length of follow up is poorly reported
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Involving patients in setting the research agenda in drug addiction
No full textBiomedical Research; Humans; Patient Participation; Patient-Centered Care; Substance-Related Disorder
Effect of arterial revascularis on survival: a systematic review of studies comparing bilateral and single internal mammary arteries
No full textBACKGROUND:Coronary artery bypass grafting (CABG) is the commonest major operation in most developed countries. A single internal mammary artery (IMA) graft has proven survival benefits, but the additional survival advantage of a second graft is unknown. We systematically reviewed published studies of bilateral versus single IMA grafts in CABG to assess any differences in survival.METHODS:We identified from Medline all studies in which single and bilateral IMA grafts were compared. We included studies in which at least 100 patients in each group had been followed up for at least 4 years. We assessed study quality on the basis of patient selection, comparability of intervention groups (especially for age, sex, ventricular function, and diabetes status), outcome assessment, and completeness of follow-up. Our primary outcome was survival. Estimates of treatment effect (single versus bilateral) expressed as hazard ratios were pooled across studies.FINDINGS:None of the studies was a randomised trial, but nine cohort studies met our inclusion criteria. Seven studies yielded survival data for meta-analysis, and included 15962 patients: 11269 single and 4693 bilateral IMA grafts. The bilateral group had significantly better survival than the single group (hazard ratio for death 0.81; 95% CI 0.70-0.94). Exclusion of methodologically weak studies improved survival rates with bilateral IMA grafts.INTERPRETATION:Because no study was a randomised trial, our results are more uncertain than is indicated by the 95% CI. Nevertheless, bilateral IMA grafts seem to give better survival rates than single grafts
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