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Biomedical subjects

P Garner

Publications and source records attributed to P Garner.

At least 55 records · Page 3Linked to original sources
PubMed2000

Interventions for promoting adherence to tuberculosis management.

BACKGROUND: Up to half the people with tuberculosis do not complete their treatment. Strategies to improve adherence to treatment can be targeted at the person with the disease or at health workers. OBJECTIVES: The objective of this review was to assess the effects of promoting adherence to anti-tuberculosis treatment and completion of diagnostic protocols for TB. SEARCH STRATEGY: We searched the Cochrane Collaboration Trials, the Cochrane Effective Professional Practice Group trials register, the Cochrane Infectious Diseases Group trials register, Medline, Embase, Lilacs and reference lists of articles. We contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of interventions to promote adherence with curative or preventive chemotherapy and diagnostic protocols for tuberculosis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Eleven trials were included. Reminder cards sent to defaulters, a combination package of a monetary incentive and health education and more supervision of tuberculosis clinic staff increased the number of people completing their tuberculosis treatment. Direct observation by clinic nurses of people swallowing their tuberculosis drugs did not increase the likelihood of treatment success. Return to the clinic for reading of a tuberculin skin test was enhanced by monetary incentives, assistance by lay health workers, contracts and telephone prompts but not by health education. REVIEWER'S CONCLUSIONS: We have found evidence of benefit for a number of specific interventions to improve adherence to anti-tuberculous therapy and completion of diagnostic protocols. These should be implemented by health care providers where appropriate to local circumstances. Future studies in low income countries are a priority and should measure adherence as well as clinical outcomes.

Antitubercular Agents↗
PubMed2000

Mefloquine for preventing malaria in non-immune adult travellers.

OBJECTIVES: Mefloquine has now largely replaced earlier malaria prophylaxis drugs which are no longer considered to be effective against all Plasmodium species, due to parasite resistance. However mefloquine may be associated with neuropsychological harmful effects. The objective of this review was to assess the effects of mefloquine in adult travellers. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase, Lilacs, Science Citation Index and reference lists of articles. We contacted researchers in the subject of malaria chemoprophylaxis, and drug companies. SELECTION CRITERIA: Randomised trials comparing mefloquine with other standard prophylaxis or placebo in non-immune adult travellers. DATA COLLECTION AND ANALYSIS: The two reviewers independently assessed trial quality and extracted data. Study authors were also contacted. MAIN RESULTS: Ten trials involving 2750 non-immune adult travellers were included. One trial comparing mefloquine with placebo showed mefloquine prevented malaria episodes in an area of drug resistance (odds ratio 0.04, 95% confidence interval 0.02 to 0.08). Withdrawals in the mefloquine group were consistently higher in four placebo controlled trials (odds ratio 3. 56, 95% confidence interval 1.67 to 7.60). In five trials comparing mefloquine with other chemoprophylaxis, no difference in tolerability was detected. REVIEWER'S CONCLUSIONS: Mefloquine prevents malaria, but there is not enough evidence to evaluate its tolerability and toxicity, particularly for general travellers.

Adult↗
PubMed2000

Prevention versus treatment for malaria in pregnant women.

OBJECTIVES: Malaria contributes to antenatal anaemia and slowing of fetal growth, especially in first-time mothers. It is thought that these effects harm the mother and baby, and interventions to prevent or mitigate the effects of malaria are often recommended. The objective of this review was to assess the effects of anti-malarial interventions in pregnant women living in malarial areas on the mother and the infant. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase. We contacted researchers in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials in pregnant women of interventions that aim to mitigate the effects of malaria in pregnancy, including drugs given routinely and mosquito control measures. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. Data extraction was done by two reviewers using standard criteria. MAIN RESULTS: Fifteen trials were included. Drugs given regularly and routinely were associated with fewer episodes of fever in the mother, fewer women with severe anaemia antenatally, and higher average birthweight in infants. These effects appear to be greater in primigravidae. No difference in perinatal, neonatal and infant mortality were detected in studies of prophylaxis in all parity groups, or studies confined to women of low parity. REVIEWER'S CONCLUSIONS: Drugs locally effective for malaria when given routinely for malaria during pregnancy may reduce the incidence of low birth weight and anaemia. This effect appears to be limited to low parity women. Given the costs and inputs required to effectively deliver widescale prophylaxis programmes, we believe a large simple placebo- controlled trial testing the impact of drugs given routinely on pregnancy outcome and neonatal/infant survival is warranted.

Antimalarials↗
PubMed2000

Steroids for treating cerebral malaria.

BACKGROUND: Cerebral malaria is associated with swelling of the brain. Corticosteroid drugs could reduce the harmful effects of this swelling, but could also suppress host immunity to infection. OBJECTIVES: This review aimed to assess the effects of steroids in patients with cerebral malaria in relation to survival and long-term disability. SEARCH STRATEGY: The Cochrane Controlled Trials Register, the Cochrane Infectious Diseases Group Trials Register, existing reviews, and contact with experts in the field. SELECTION CRITERIA: Randomised controlled trials comparing steroids and no steroids in otherwise identical treatments for patients with cerebral malaria. DATA COLLECTION AND ANALYSIS: Assessments of inclusion criteria, trial quality and data extraction were done by each author independently. The outcomes sought were death, death with life-threatening complications, other complications, and disability. MAIN RESULTS: Two trials met the inclusion criteria. Out of a total of 143 patients, there were 30 deaths, distributed evenly between the steroid and the comparator group. The researchers reported clinical complications as the number of events in each trial arm, and did not exclude complications occurring in fatalities. This makes it difficult to interpret the reports of significantly more episodes of gastro-intestinal bleeding and seizures in the steroid group. No studies examined disability. REVIEWER'S CONCLUSIONS: There is currently no evidence of benefit from steroids in this condition, but the small number of participants means it is difficult to exclude an effect on mortality in either direction. Data on clinical complications are difficult to assess.

Adrenal Cortex Hormones↗
PubMed2000

Topical umbilical cord care at birth.

BACKGROUND: Umbilical cord infection caused many neonatal deaths before aseptic techniques were used. OBJECTIVES: The objective of this review was to assess the effects of topical cord care in preventing cord infection, illness and death. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register (Cochrane Library issue 4, 1997) and Medline. We also contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of topical cord care compared with no routine care, and comparisons between different forms of care. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Ten studies were included, all from developed countries. No systemic infections or deaths were observed in any of the studies reviewed. Cord and other skin infections within six weeks of observation were not affected by use of antiseptics. There was a trend to reduced colonization with antibiotics compared to antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord. REVIEWER'S CONCLUSIONS: Simply keeping the cord clean appears to be as effective and safe as using antibiotics or antiseptics.

Anti-Bacterial Agents↗
PubMed2000

Mycobacterium vaccae immunotherapy for treating tuberculosis.

BACKGROUND: Mycobacterium vaccae has been advocated for immunotherapy in the treatment of tuberculosis and other infections caused by mycobacteria. OBJECTIVES: The objective of this review was to assess the effects of Mycobacterium vaccae for treating tuberculosis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials register, Medline, Embase and reference lists of articles. We also contacted organisations and individuals working in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of preparations of whole, killed Mycobacterium vaccae in patients with tuberculosis. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Four trials met the inclusion criteria. There was no effect on mortality (2 trials, RR 1.01, 95% CI 0.50 to 2.04); no consistent effect on sputum negativity or sputum culture; and a high level of adverse reactions. REVIEWER'S CONCLUSIONS: Immunotherapy with Mycobacterium vaccae does not appear to benefit patients with tuberculosis.

Humans↗
PubMed2000

Antibiotics for treating salmonella gut infections.

BACKGROUND: Antibiotic treatment of salmonella infections aims to shorten illness and prevent serious complications. There are also concerns about increasing antibiotic drug resistance. OBJECTIVES: The objective of this review was to assess the effects of antibiotics in adults and children with diarrhoea who have salmonella. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Science Citation Index, African Index Medicus, Lilacs, Extra Med and reference lists of relevant articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing antibiotic therapy with placebo or no antibiotic therapy for salmonella infections in symptomatic or asymptomatic adults or children. Typhoid and paratyphoid salmonella infections were excluded. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data were extracted independently by two reviewers. MAIN RESULTS: Twelve trials involving 778 participants (with at least 258 infants and children) were included. There were no significant differences in length of illness, diarrhoea or fever between any antibiotic regimen and placebo. The weighted mean difference for length of illness was -0.07 days, 95% confidence interval -0.55 to 0.40; diarrhoea -0.03 days, 95% confidence interval -0.53 to 0.48; fever -0.45 days, 95% confidence interval -0. 98 to 0.08. Antibiotic regimens resulted in more negative cultures during the first week of treatment. Relapses were more frequent in those receiving antibiotics, and there were more cases with positive cultures in the antibiotic groups after three weeks. Adverse drug reactions were more common in the antibiotic groups (odds ratio 1.67, 95% confidence interval 1.05 to 2.67). REVIEWER'S CONCLUSIONS: There appears to be no evidence of a clinical benefit of antibiotic therapy in otherwise healthy children and adults with non-severe salmonella diarrhoea. Antibiotics appear to increase adverse effects and they also tend to prolong salmonella detection in stools.

Adult↗
PubMed2000

Growth monitoring in children.

EDITORIAL NOTE: This review is superseded by the published Cochrane Review, Taylor 2023: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014785.pub2/full. BACKGROUND: Growth monitoring is widely accepted and strongly supported by health professionals, and is a standard component of community paediatric services throughout the world. We sought to evaluate research evidence of its impact. This requires definition, consideration of the setting, and discussion of the intended effects of this activity. In this review, we define growth monitoring as the regular recording of a child's weight, coupled with some specified remedial actions if the weight is abnormal in some way. Although the causes of growth faltering and the responses to it may be region specific, the process is the same, and we consider here growth monitoring in both the deprived and richer populations of the world. OBJECTIVES: Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. As primary care workers worldwide invest time in this activity, we sought evidence of its benefits and harms. The review objectives are to evaluate the effects of routine growth monitoring on: 1. The child, in relation to preventing death, illness or malnutrition; and referrals for medical care, medical specialist assessment or professional social support follow-up. 2. The mother, in relation to nutritional knowledge, anxiety or reassurance about the child's health, and satisfaction with services. SEARCH STRATEGY: Cochrane Controlled Trials Register; MEDLINE; EMBASE; CINAHL; World Health Organization and World Bank publications; specialists in this area; citations in existing reviews and identified studies. SELECTION CRITERIA: Randomised or quasi-randomised trials comparing routine growth monitoring (regular monitoring of growth, plotting on a chart, combined with referral or intervention when growth is abnormal) with no growth monitoring. DATA COLLECTION AND ANALYSIS: Trial quality was assessed, and data abstracted by both reviewers. MAIN RESULTS: Two studies included, both conducted in developing countries. In one, the nutritional status at 30 months in 500 children showed no difference between those allocated to growth monitoring and those not. The other study examined whether counselling improved mothers' knowledge of the growth chart, and reported better test scores at four months. REVIEWER'S CONCLUSIONS: Given the level of investment in growth monitoring worldwide, it is surprising there is so little research evaluating its potential benefits and harms.

Child, Preschool↗
PubMed2000

Treatments for toxoplasmosis in pregnancy.

BACKGROUND: Toxoplasmosis is a widespread parasitic disease and usually causes no symptoms. However, infection of pregnant women may cause congenital infection, resulting potentially in mental retardation and blindness in the infant. OBJECTIVES: The objective of this review was to assess whether or not treating toxoplasmosis in pregnancy reduces the risk of congenital toxoplasma infection and improves infant outcomes. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. An electronic search was performed using the key words 'congenital and toxoplasmosis' on the following databases: MEDLINE (1966-07/1997), Embase (1993-07/1997), Pascal (French) (1990-1997), Biological Abstracts (1993-1995) and the Cochrane Controlled Trials Register. There was also contact with experts in the field, including those in the European Research Network on Congenital Toxoplasmosis. SELECTION CRITERIA: Randomised controlled trials of antibiotic treatment versus no treatment of pregnant women with proven or likely acute Toxoplasma infection, with outcomes in the children reported. We also inspected relevant reports of less robust experimental studies in which there were (non randomly allocated) control groups, although it was not planned to include such data in the primary analysis. DATA COLLECTION AND ANALYSIS: Reports of possibly eligible studies were scrutinised by two investigators. MAIN RESULTS: Out of the 2591 papers identified, none met the inclusion criteria. REVIEWER'S CONCLUSIONS: Despite the large number of studies performed over the last three decades we still do not know whether antenatal treatment in women with presumed toxoplasmosis reduces the congenital transmission of Toxoplasma gondii. Screening is expensive, so we need to evaluate the effects of treatment, and the impact of screening programmes. In countries where screening or treatment is not routine, these technologies should not be introduced outside the context of a carefully controlled trial.

Female↗
PubMed2000

Antibiotics for treating scrub typhus.

BACKGROUND: Scrub typhus is a cause of fever in regions of Asia and the Pacific. Recently, resistance to antibiotics has been reported. OBJECTIVES: To assess treatment regimens for scrub typhus through time to fever resolution and incidence of relapse. SEARCH STRATEGY: Cochrane Controlled Trials Register, MEDLINE, EMBASE, and contacted individual researchers for unpublished data. SELECTION CRITERIA: Randomised and pseudorandomised studies; patients diagnosed with scrub typhus defined by authors; any comparison of antibiotic regimens for treating scrub typhus. DATA COLLECTION AND ANALYSIS: Trial quality was assessed, and data abstracted by both reviewers. MAIN RESULTS: Three trials met the inclusion criteria. One small trial compared tetracycline against chloramphenicol. The other two trials compared doxycycline with tetracycline, and showed little difference in the proportion febrile at 48 hours, with no relapses after either drug. REVIEWER'S CONCLUSIONS: Tetracycline and doxycycline seem to be effective in treating scrub typhus. Further research is required to identify appropriate treatment in areas where Orientia tsutsugamushi resistant to doxycycline has been reported.

Anti-Bacterial Agents↗
PubMed2000

Antipyretic measures for treating fever in malaria.

OBJECTIVES: Fever control measures are commonly used in treating malaria. Some researchers have suggested that fever reduction may prolong malaria illness. We aim to assess whether antipyretic measures in malaria influences outcome, measured by length of illness, parasitaemia, and occurrence of convulsions. SEARCH STRATEGY: We searched the Cochrane infectious Diseases Group Trial Register, the Cochrane Controlled Trial Register, and other electronic bibliographies, and contacted researchers and organizations working in this field. SELECTION CRITERIA: Randomised or pseudo-randomised trials which compared antipyretic drugs with mechanical or no antipyretic measures in patients with slide-confirmed malaria. DATA COLLECTION AND ANALYSIS: Inclusion criteria were independently applied by two reviewers. We extracted data from selected trials using a standard form. Weighted mean difference with 95% confidence interval was calculated for continuous data. MAIN RESULTS: Three randomised trials with pooled 128 adults and children with falciparum malaria; all unblinded; allocation concealment unclear in two. Inconsistent pattern of fever clearance between trials, but malaria cure rate reported to be similar between intervention and control in all trials. Mean parasite clearance time reported to be similar in one trial but longer in paracetamol group in two trials: sample size in one trial was too small to conclude anything (n=7), while the other trial was difficult to evaluate. REVIEWER'S CONCLUSIONS: There is no statistically significant data to draw any conclusions. The clinical significance of preliminary report suggesting that antipyretic drugs prolong malaria parasitaemia was not confirmed.

Analgesics, Non-Narcotic↗
PubMed2000

Interventions for preventing reactions to snake antivenom.

BACKGROUND: Antivenom is used to neutralise snake bite toxins in people showing evidence of envenomation. It is made from animal sera, and adverse effects, including life threatening anaphylaxis, are common. OBJECTIVES: To assess the effects of drugs given routinely with snake antivenom to prevent adverse effects. SEARCH STRATEGY: Cochrane controlled trials register; contact with researchers in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials testing routine adrenaline (epinephrine), antihistamines, or corticosteroids. DATA COLLECTION AND ANALYSIS: The two authors applied the inclusion criteria, assessed trial quality, and extracted the data. We sought additional data from trialists where required. MAIN RESULTS: One trial in Sri Lanka (n = 105) giving adrenaline with polyspecific antivenom showed fewer adverse reactions in the adrenaline group, and this effect was preserved when stratified for severity. One trial in Brazil (n = 101) using three types of Bothrops antivenom showed no benefit of antihistamine drugs. REVIEWER'S CONCLUSIONS: Routine prophylactic adrenaline for polyvalent antivenom known to have high adverse event rates seems sensible, based on this one trial. If clinicians believe local factors do not justify routine adrenaline, then they should test their belief in a randomised trial. Antihistamine appears to be of no obvious benefit in preventing acute reactions from antivenoms.

Antivenins↗
PubMed2000

Is routine growth monitoring effective? A systematic review of trials.

BACKGROUND: Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. It aims to improve nutrition, reduce the risk of death or inadequate nutrition, help educate carers, and lead to early referral for conditions manifest by growth disorders. As primary care workers world wide invest time in this activity, evidence for its benefits and harms was sort. INCLUSION CRITERIA STUDIES: randomised or quasi-randomised controlled trials of growth monitoring. INTERVENTIONS: regular growth monitoring, combined with some intervention targeted at abnormal growth, compared with controls. OUTCOMES: anthropometric measures; referrals to primary and specialist care, or community services; maternal knowledge, anxiety, and satisfaction; child morbidity and mortality. COMPARISONS: Routine growth monitoring compared with no routine growth monitoring; routine growth monitoring by plotting onto a standard chart compared with monitoring with no chart. SEARCH STRATEGY: Cochrane controlled trials register; World Health Organisation and World Bank publications; contact with specialist community paediatricians working in the field. RESULTS: Two trials met the inclusion criteria. One compared growth monitoring with no growth monitoring, in a cluster randomised trial nested in a nutritional intervention programme, and detected no difference in nutritional outcomes between the two groups. Another trial compared growth monitoring with and without a standard chart, measuring maternal knowledge of women about nutrition. It showed small numerical differences in test scores. DISCUSSION AND IMPLICATIONS: Current policies appear to be based on the opinion that investment in the activity has worthwhile health benefits, and does no harm. No reliable evidence was found to support or refute this.

Child↗
PubMed1999

Radical-based asymmetric synthesis: an iterative approach to 1, 3, 5, ... (2n + 1) polyols.

[formula: see text] A conceptually novel approach to 1, 3, 5, ... (2n + 1) polyols based on iterative stereo-controlled homologation of chiral hydroxyalkyl radicals is reported. Starting from alpha-keto ester precursors, the general sequence of (1) ketone reduction, (2) auxiliary attachment, (3) saponification, (4) Barton esterification, and (5) radical addition provided the two-carbon homologue in 70-80% overall yield. The simplicity and generality of this iterative strategy for 1, 3, 5, ... (2n + 1) polyol synthesis suggests an attractive alternative for the preparation of molecules containing this structural motif.

Molecular Structure↗
PubMed1999

Modular nucleic acid surrogates. Solid phase synthesis of alpha-helical peptide nucleic acids (alpha PNAs).

[formula: see text] The synthesis and characterization of prototype alpha-helical peptide nucleic acid (alpha PNA) modules 1-3 as well as disulfide dimers 4 and 5 are reported. These molecules combine an alpha-helical peptidyl scaffold with well-defined nucleobase molecular recognition patterns and could serve as a basis for novel antisense and/or antigene agents. Structure assignments for these alpha PNAs were supported by MALDI-TOF mass spectrometry, and the alpha-helical nature of 4 in water was confirmed by circular dichroism (CD) spectroscopy.

Circular Dichroism↗
PubMed1999

Congenital toxoplasmosis: systematic review of evidence of efficacy of treatment in pregnancy.

OBJECTIVE: To summarise the evidence that treating toxoplasmosis in pregnancy reduces the risk of congenital toxoplasma infection and improves infant outcomes. DESIGN: Systematic review of studies comparing at least two concurrent groups of pregnant women with proved or likely acute toxoplasma infection in which treatments were compared with no treatment and outcomes in the children were reported. SUBJECTS: Studies were identified from Medline (1966-97), Pascal (1990-7), Embase (1993-7), and Biological abstracts (1993-5) plus contact with experts in the field, including the European Research Network on Congenital Toxoplasmosis. MAIN OUTCOME MEASURE: Proportion of infected children at 1 year born to infected pregnant women who were or were not treated. RESULTS: Out of 2591 papers identified, nine met the inclusion criteria. There were no randomised comparisons, and control groups were generally not directly comparable with the treatment groups. Congenital infection was common in treated groups. five studies showed that treatment was effective and four that it was not. CONCLUSION: It is unclear whether antenatal treatment in women with presumed toxoplasmosis reduces congenital transmission of Toxoplasma gondii. Screening is expensive, so the effects of treatment and impact of screening programmes need to be evaluated. In countries where screening or treatment is not routine, these technologies should not be introduced outside carefully controlled trials.

Acute Disease↗