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PubMed2006

From presentation to publication: the natural history of orthopaedic abstracts in the United Kingdom.

BACKGROUND: Up to 63% of the chapters in major orthopaedic textbooks use the results from abstracts that have been presented at international orthopaedic meetings. METHODS: Orthopaedic abstracts were reviewed that were presented at the 1997 and 1998 meetings of the British Orthopaedic Association and other specialist orthopaedic meetings. The number of abstracts that had gone on to a full text publication was assessed and changes in study design or outcome were determined. RESULTS: Of the 415 abstracts 137 (33.0%) went on to full text publication. Abstracts presented at the British Orthopaedic Association were significantly more likely to go on to full text publication than abstracts from the other meetings studied. The mean time to publication was 15.6 months. Sample sizes in unpublished studies were smaller (mean 129.8 subjects compared with a mean of 191.4 subjects for published studies). Of full text papers, 19.0% differed regarding study design from the abstract presented at the initial meeting and 10.9% had published different results. Randomised controlled trials had the highest rate of later full text publication (53.6%) followed by observational studies (32.8%), basic science studies (31.4%), and case reports (6.7%). CONCLUSIONS: In comparison with a study from North America, similar numbers of abstracts presented at meetings finally became published as full text articles, the abstracts had fewer authors, more often included randomised controlled trials and follow up data, and had fewer changes to the results. It is questionable whether the inclusion of such results from abstracts presented at international meetings by major orthopaedic textbooks should be undertaken before full text publication.

Authorship↗
PubMed1984

Our experience with Solcoseryl Eye-Gel in the treatment of corneal lesions. A randomised double-blind study (with 1 color plate).

A comparative study of Solcoseryl Eye-Gel versus a 2.4% cysteine eye-gel was carried out under controlled conditions (randomised and double-blind) on a total of 61 patients with corneal lesions (52 foreign body injuries, 9 corneal erosions). The results showed a marked superiority of Solcoseryl Eye-Gel with respect to more rapid healing and also with respect to the possible subsequent development of a corneal macula.

Actihaemyl↗
PubMed2000

Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures.

BACKGROUND: In fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head. OBJECTIVES: To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised trials in elderly people. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten-item checklist, and extracted data. MAIN RESULTS: One study of 94 patients studied the effect of impaction of the fracture at the time of surgery. The only outcome measure was bone scintimetry. There was no difference in scintimetry for the 29 undisplaced fractures but in displaced fractures treated with impaction the scintimetry appearances were significantly reduced implying a reduction of blood flow to the femoral head. One study of 220 patients compared the results of fractures treated with compression against those without compression. Results for 156 patients at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression. One study of 49 patients noted a tendency to a reduced mortality for closed reduction of the fracture as opposed to open reduction. Non-union of the fracture was more common after closed reduction. REVIEWER'S CONCLUSIONS: Insufficient evidence exists from randomised trials to confirm the benefits of open or closed reduction or for intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.

Aged↗
PubMed2001

Surgery versus radiotherapy for muscle invasive bladder cancer.

BACKGROUND: Muscle invasive bladder cancer is a serious clinical problem and is fatal for the majority of patients. Alternative treatments for this condition are radical cystectomy or radical radiotherapy. The choice of treatment varies according to the resident country. The ideal treatment would be a bladder preserving therapy with total eradication of the tumour without compromising survival. OBJECTIVES: The objective of this review was to compare the survival after radical surgery (cystectomy) versus radical radiotherapy in patients with muscle invasive cancer. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (July 2000), Medline (July 2000), EMBASE (July 2000), Cancerlit (July 2000), Healthstar (July 2000) and the Database of Abstracts of Reviews of Effectiveness (July 2000). Attempts to contact authors of unpublished data were undertaken. SELECTION CRITERIA: Randomised trials comparing surgery versus radiotherapy were eligible for assessment. DATA COLLECTION AND ANALYSIS: Three reviewers assessed trial quality based on the Cochrane Guidelines. Data was extracted from the text of the article or extrapolated from the Kaplan-Meier plot. The Peto odds ratio was determined to compare the overall-survival and disease-specific survival. Analysis was performed on an intention-to-treat basis and treatment actually received. MAIN RESULTS: Three randomised trials comparing pre-operative radiotherapy followed by radical cystectomy (surgery) versus radical radiotherapy with salvage cystectomy (radical radiotherapy) were eligible for assessment. These trials represented a total of 439 patients, 221 randomised to surgery and 218 to radical radiotherapy. Peto odds ratio analysis consistently favoured surgery in terms of survival. It was significant at 3 (OR = 2.11, 95% CI 1.10,4.07) and 5 years (OR = 2.40, 95% CI 1.35, 4.29) for overall survival and at 3 years (OR = 1.96, 95% CI 1.06,3.65) for disease-specific survival for patients that actually received the protocol treatment. On an intention-to-treat analysis for disease-specific survival, the results were significantly in favour of surgery at 3 years (OR = 1.96, 95% CI 1.06,3.65) but not at 5 years. REVIEWER'S CONCLUSIONS: The evidence from this review suggests that there is no overall statistically significant benefit to radiotherapy or surgery ( with pre-operative radiotherapy) in muscle invasive bladder cancer in terms of survival, but the trends consistently favour surgery.

Confidence Intervals↗
PubMed2006

Psychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy.

BACKGROUND: Excessive daytime sleepiness is a common symptom of myotonic dystrophy. Psychostimulants are drugs increasingly used to treat hypersomnia in myotonic dystrophy. OBJECTIVES: To search systematically for, and combine all evidence from, randomised trials relating to the effects of psychostimulants in myotonic dystrophy patients with hypersomnia. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Trials Register (January 2006), MEDLINE (from January 1966 to January 2006) and EMBASE (from January 1980 to January 2006) for randomised trials concerning psychostimulants in myotonic dystrophy, checked the bibliographies of identified papers and made enquiries of the authors of the papers. The search for relevant studies was updated in January 2006. SELECTION CRITERIA: We considered all randomised or quasi randomised trials that have evaluated any type of psychostimulants (versus a placebo or no treatment) in children or adults with proven myotonic dystrophy and hypersomnia. DATA COLLECTION AND ANALYSIS: Potentially relevant papers were scrutinised by two authors and the selection of eligible studies was agreed by them and a third author. Data were extracted by one author and checked by a second author. MAIN RESULTS: Primary outcome. One trial using a modified maintenance of wakefulness test showed an improvement by 5.70 (95% confidence intervals 0.1 to 11.3) minutes more in the modafinil than the control group. Secondary outcomes. In a double-blind crossover study of 10 participants with myotonic dystrophy, there was no difference between the selegiline and placebo periods in mean improvement in the multiple sleep latency test. Two trials, involving 60 participants in total, evaluated the efficacy and safety of modafinil in adults with myotonic dystrophy-related daytime sleepiness. The weighted mean difference on the Epworth Sleepiness Scale was -1.59 (95% confidence intervals, -2.77 to -0.42) in favour of modafinil. AUTHORS' CONCLUSIONS: There is no evidence to support the routine use of psychostimulants to treat hypersomnia in myotonic dystrophy. There is some evidence from two studies that modafinil may improve daytime sleepiness. More randomised trials are needed to evaluate the efficacy and safety of psychostimulants.

Benzhydryl Compounds↗
PubMed2004

Non-surgical interventions for eosinophilic oesophagitis.

BACKGROUND: Patients with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, chest and/or abdominal pain. People with EO frequently fail to respond to treatment with gastric acid suppressants or anti-reflux surgery. OBJECTIVES: To evaluate the benefits and harms of medical interventions for eosinophilic oesophagitis. SEARCH STRATEGY: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group trials register (The Cochrane Library Issue 1, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004). SELECTION CRITERIA: Randomised controlled trials were included if they compared a medical or dietary intervention for eosinophilic oesophagitis with a placebo or one medical intervention with another medical intervention. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened the title of abstracts. MAIN RESULTS: No completed RCTs were found in the published literature. We found one abstract reporting preliminary data from an RCT (not completed) comparing oral prednisolone with topical (swallowed metered dose) fluticasone in children. In this study (50 children enrolled to date) healing rates of oesophagitis and symptom resolution with fluticasone were similar to those with prednisolone. For another ongoing RCT, comparing the efficacy of swallowed fluticasone with placebo for eosinophilic oesophagitis in males and females aged 3 to 21 years no results are available. REVIEWERS' CONCLUSIONS: The lack of completed RCT's makes it impossible to compare the relative benefits and harms of the wide range of medical interventions currently used for treating EO. Published case series suggest that an elemental diet, oral steroids and topical steroids all offer some benefits. However, lack of a comparison group in these studies makes it impossible to evaluate the effect of these interventions.

Androstadienes↗
PubMed2005

Ketamine and postoperative pain--a quantitative systematic review of randomised trials.

Ketamine, an N-methyl-D-aspartate receptor antagonist, is known to be analgesic and to induce psychomimetic effects. Benefits and risks of ketamine for the control of postoperative pain are not well understood. We systematically searched for randomised comparisons of ketamine with inactive controls in surgical patients, reporting on pain outcomes, opioid sparing, and adverse effects. Data were combined using a fixed effect model. Fifty-three trials (2839 patients) from 25 countries reported on a large variety of different ketamine regimens and surgical settings. Sixteen studies tested prophylactic intravenous ketamine (median dose 0.4 mg/kg, range (0.1-1.6)) in 850 adults. Weighted mean difference (WMD) for postoperative pain intensity (0-10 cm visual analogue scale) was -0.89 cm at 6 h, -0.42 at 12 h, -0.35 at 24 h and -0.27 at 48 h. Cumulative morphine consumption at 24 h was significantly decreased with ketamine (WMD -15.7 mg). There was no difference in morphine-related adverse effects. The other 37 trials tested in adults or children, prophylactic or therapeutic ketamine orally, intramuscularly, subcutaneously, intra-articulary, caudally, epidurally, transdermally, peripherally or added to a PCA device; meta-analyses were deemed inappropriate. The highest risk of hallucinations was in awake or sedated patients receiving ketamine without benzodiazepine; compared with controls, the odds ratio (OR) was 2.32 (95%CI, 1.09-4.92), number-needed-to-harm (NNH) 21. In patients undergoing general anaesthesia, the incidence of hallucinations was low and independent of benzodiazepine premedication; OR 1.49 (95%CI 0.18-12.6), NNH 286. Despite many published randomised trials, the role of ketamine, as a component of perioperative analgesia, remains unclear.

Adult↗
PubMed2004

Does human milk reduce infection rates in preterm infants? A systematic review.

One of the reasons for advocating human milk (HM) feeding for preterm infants is the belief that this provides the infant with a degree of protection from infection. Providing fresh HM for such infants is challenging for mothers and staff, and consequently it is important that its benefits are rigorously evaluated. Therefore a systematic review was undertaken to assess all publications concerned with human milk feeding and infection in very low birth weight (VLBW) preterm infants. Nine studies--six cohort and three randomised controlled trials (RCT)--were assessed using predefined criteria. Methodological problems included poor study design, inadequate sample size, failure to adjust for confounding variables, and inadequate definitions of HM feeding and outcome measures. In conclusion, the advantage of HM in preventing infection in preterm, (VLBW) infants is not proven by the existing studies. Recommendations are made regarding the methodology required for further study of this important topic.

Breast Feeding↗
PubMed2000

Chemotherapy-induced oral mucositis. Prevention and management.

Oral mucositis is a frequent and potentially severe complication of chemotherapy which has a considerable impact on patient quality of life. While the management of other chemotherapy-related toxicities has improved, the incidence of mucositis is increasing. A critical review of the literature published between 1985 and 1999 reveals very few strategies or agents with proven efficacy, leaving few recommendations for the standard care in the prevention and treatment of mucositis at this time. Recommendations that can be made include: reducing patient risk factors, implementing proven preventative interventions such as utilising oral ice chips with fluorouracil chemotherapy, and optimising supportive care practices individualised to the patients' needs and symptoms. Progress in understanding the pathophysiology of mucositis at the molecular level has led to the evaluation of a number of new investigational agents, specifically those directed to the epithelial mucosa, such as mitogens and epithelial growth factors. These appear to be very promising in preclinical studies. Randomised clinical trials with these agents may finally demonstrate an impact on the clinical practice of mucositis management in the coming years.

Antineoplastic Agents↗
PubMed2001

Pain management for neonatal circumcision.

Circumcision is the most common surgical procedure performed in the neonatal period in North America. If untreated, the pain of circumcision causes both short and long term changes in infant behaviours. The most widely studied pharmacological intervention for pain management during circumcision is dorsal penile nerve block (DPNB) by injected lidocaine (lignocaine). Randomised controlled trials have demonstrated its efficacy; infants premedicated with lidocaine have significantly smaller changes in physiological and pain-related behaviours compared with infants who are not given analgesics. A meta-analysis of injection-related adverse effects (bruising/haematoma) yielded a risk of 6.7% (95% confidence interval, 0.5 to 12.9%). Systemic toxicity from injected local anaesthesia has not been reported. Less effective modalities include topical anaesthesia with lidocaine-prilocaine cream [Eutectic Mixture of Local Anaesthetics (EMLA)], lidocaine cream and oral administration of sucrose. The good tolerability of lidocaine-prilocaine cream has been demonstrated by a lack of clinically significant methaemoglobinaemia when used appropriately. Nonpharmacological interventions (pacifier, specially designed restraint chair) reduce distress during the procedure, and paracetamol (acetaminophen) may provide postoperative analgesia. No single agent has been demonstrated to ameliorate pain for all infants undergoing circumcision. A multimodal approach of pharmacotherapy is currently recommended. Studies evaluating the efficacy of combined analgesia have demonstrated significant benefits for combinations of 2 or more forms of treatment (such as DPNB and sucrose-dipped pacifier) compared with single interventions. The instrument used to perform the circumcision is also important. The Mogen clamp has been shown to be associated with a shorter procedure time and less pain compared with the Gomco clamp. If circumcision is to be performed on infants, it is, therefore, recommended that combined analgesia and the Mogen clamp technique are used, and nonpharmacological stress reducing interventions such as pacifiers and comfortable restraining chairs should also be employed.

Acetaminophen↗
PubMed2000

The effects of dietary supplementation on growth and adult mortality: a re-analysis and follow-up of a pre-war study.

The aim of this study was to re-analyse a diet supplementation study conducted in the 1930s and investigate the effects of food supplementation on children's growth and later adult mortality. A non-randomised controlled trial was carried out in eight of the sixteen centres participating in the Carnegie Survey of Diet and Health in pre-war Britain (1937-39). Food supplements were given for 12 months either at school or as food parcels sent to the family home. 545 children aged 2-14 received food supplements and 494 children of a similar age acted as their controls. The children came from 465 families. The increase in childhood height and its components-leg length and trunk length-over 12 months follow-up were measured. Mortality from all causes over 60 years follow-up to 1998 was also assessed. There were important differences between fed and control children at baseline. Supplemented children came from larger families with poorer diets and most were examined, on average, 12 days later than control children. After adjustment for baseline imbalances those receiving supplements increased in height by 3.7 mm (95% CI 1.9-5.5) more than the controls. After adjustment, most of the difference in growth appeared to arise as a result of increases in leg length. After adjustment for confounding factors measured in childhood, no significant effect of childhood food supplements on adult mortality was seen. The age-adjusted hazard ratio for all cause mortality was higher in the supplemented compared to control subjects: 1.13 95% CI (0.77-1.64). We found that provision of childhood food supplements led to increased growth amongst supplemented children. The increases in height in this study were mainly as a result of increases in leg length and are similar to those found in a more recent randomised trial in South Wales. Whilst other analyses suggest that childhood height is important in predicting adult mortality patterns, we found no significant effect of childhood food supplements on adult mortality patterns in this study, although the study lacked statistical power to detect small but, nevertheless, important differences in mortality. Larger randomised trials with long term follow-up would be required to investigate the impact of childhood food supplementation on adult health.

Adolescent↗
PubMed1986

Interferon therapy of chronic hepatitis B virus infection in Chinese.

Hepatitis B virus (HBV) infection is prevalent in Chinese populations. 40.4% of 383 Chinese HBV carriers studied were HBeAg-positive. The annual rate of spontaneous clearance of HBeAg was 11%. Twenty-six patients with HBsAg- and HBeAg- and HBeAg-positive non-malignant chronic liver disease randomised to receive recombinant alpha-2 interferon or no treatment have been followed for 6 months or longer. Seven of the 20 treated patients cleared HBeAg during or shortly after treatment but this was sustained in only 1 patient. One of the 6 controls had transient loss of HBeAg. It is too early to conclude whether interferon has any long-term effect on the suppression of HBV replication in Chinese patients. Sixty-nine patients with histologically proven hepatocellular carcinoma were randomised to receive adriamycin or interferon. Although there was no significant benefit on survival, interferon therapy was associated with greater than 25% regression in tumor size in 12.5% of patients and less toxicity.

Carcinoma, Hepatocellular↗
PubMed2005

School-based prevention for illicit drugs' use.

BACKGROUND: Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions. OBJECTIVES: To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention . SEARCH STRATEGY: MEDLINE , EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drug and Alcohol Group Register, updated to February 2004, were searched. Bibliography of papers was checked and personal contacts were made to identify other relevant studies. SELECTION CRITERIA: RCTs, CCTs or Controlled Prospective Studies (CPS) evaluating school-based interventions designed to prevent substance use. DATA COLLECTION AND ANALYSIS: Data were selected and extracted independently by two reviewers. Quality was assessed with the CDAG checklist. Interventions were classified as skills, affective, knowledge-focused and other characteristics were also studied (teaching, follow-up implementation, context activation). MAIN RESULTS: 32 studies (29 RCTs and 3 CPSs) were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. RCTs: (1) Knowledge vs usual curricula: Knowledge focused programs improve drug knowledge (SMD=0.91; 95% CI: 0.42, 1.39).(2) Skills vs usual curricula: Skills based interventions increase drug knowledge (WMD=2.60; 95% CI: 1.17-4.03), decision making skills (SMD=0.78; CI95%: 0.46-1.09), self-esteem (SMD=0.22; CI95%: 0.03-0.40), peer pressure resistance (RR=2.05; CI95%: 1.24-3.42), drug use (RR=0.81; CI95%: 0.64, 1.02), marijuana use (RR=0.82; CI95%: 0.73, 0.92) and hard drug use (RR=0.45; CI95%: 0.24-0.85). (3) Skills vs knowledge: No differences are evident.(4) Skills vs affective: Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; CI95%: 0.25, 3.55). (5) Affective vs usual curricula: Affective interventions improve drug knowledge (SMD=1.88; CI95%: 1.27, 2.50) and decision making skills (SMD=1.35; CI95%: 0.79, 1.9). (6) Affective vs knowledge: Affective interventions improve drug knowledge (SMD=0.60; CI95%: 0.18,1.03), and decision making skills (SMD=1.22; CI95%: 0.33, 2.12). Results from CPSs: No statistically significant results emerge from CPSs. AUTHORS' CONCLUSIONS: Skills based programs appear to be effective in deterring early-stage drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.

Adolescent↗
PubMed2003

Adenotonsillectomy for obstructive sleep apnoea in children.

BACKGROUND: Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children. OBJECTIVES: To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children. SEARCH STRATEGY: The Cochrane Airways group specialised register was searched with pre-specified terms. SELECTION CRITERIA: Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea. DATA COLLECTION AND ANALYSIS: A total of 196 references were identified from electronic searching. Twenty studies were retrieved and none met the inclusion criteria of the review. MAIN RESULTS: Due to the absence of randomised trial data, no results could be ascertained. REVIEWER'S CONCLUSIONS: At present there is still debate as to the polysomnographic criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of obstructive sleep apnoea with adenotonsillectomy in children and, therefore, further research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated.

Adenoidectomy↗
PubMed2004

Delayed antibiotics for symptoms and complications of respiratory infections.

BACKGROUND: The use of antibiotics for upper respiratory tract infections is controversial. Any benefits have to be weighed against common adverse reactions (including rash, abdominal pain, diarrhoea and vomiting), cost and antibacterial resistance. There has been interest in ways to reduce antibiotic prescribing for acute respiratory infections. One is delaying the use of prescribed antibiotics by more than 48 hours for acute upper respiratory tract infections. Such methods have been shown to reduce prescribing. This review asks what effect this practice has on the clinical course of the illness. OBJECTIVES: To evaluate the clinical effect of delayed antibiotic use in acute upper respiratory tract infections compared to immediate use of antibiotics SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004) which includes the Acute Respiratory Infection Groups' specialised register; MEDLINE (January 1966 to January Week 1 2004), EMBASE (1990 to September 2003) and Current Contents (1998 to 2003). The search was carried out by an expert librarian. Abstracts of identified articles were used to determine which studies were trials. SELECTION CRITERIA: Randomised controlled trials involving patients of all ages defined as having acute otitis media, acute pharyngitis, sore throat, common cold, a viral upper respiratory tract infection, acute sinusitis, and acute bronchitis were included in which delayed antibiotics are compared to antibiotics used immediately. Delayed antibiotic use was defined as the use of or advice to use antibiotics more than 48 hours after the initial consultation. 'Immediate antibiotic use' was defined as the immediate use of oral antibiotics given at the initial consultation. Clinical outcomes measured included: the presence or absence of fever, cough, pain, duration and severity of illness, complications of the disease, adverse effects from the antibiotics. Trial quality was assessed independently by two reviewers who were blinded to the author, journal and results of each study. DATA COLLECTION AND ANALYSIS: Data was collected by two reviewers who were blinded to the author and journal. Data were analysed and reported using RevMan. MAIN RESULTS: Seven trials were eligible on the basis of design and all reported patient-centred outcomes. Methodological quality of included trials was generally high. There was no difference between immediate and delayed antibiotic groups for symptoms on day one and day seven. For most symptom measures there was no significant difference between the immediate and delayed antibiotic groups. Missing data and marked heterogeneity between study outcomes prevented pooling of results as a meta-analysis. Three studies out of six reporting fever, all involving patients with sore throat, indicated that there was more fever in the delayed antibiotic group. The remaining three studies showed no difference. There was no significant symptom difference for patients with cough or the common cold between the two intervention groups. Pain and malaise severity scores at day three significantly favoured the immediate antibiotic group in children with acute otitis media (Little 2001). In this study by Little 2001 of children with otitis media proxies for other malaise related outcomes were reported, including 'last day of crying' which favoured the immediate antibiotic group by approximately 16 hours (0.69 days; 95% CI 0.31 to 1.07). In the same study, just over half a spoon of paracetamol a day less was used in the immediate antibiotic group (0.59; 95% CI 0.25 to 0.93). There was no significant difference between the intervention groups for the adverse outcome of rash. Two studies reported the outcome of vomiting which was reduced in the immediate antibiotic group in children with suspected streptococcal pharyngitis in El-Daher 1991 but there was no difference in children with sore throat in Little 1997. Diarrhoea was reported by three studies of which two showed no difference Little 1997; Arroll 2002a while Little 2001 reported less diarrhoea in the delayed antibiotic group in children with otitis media. REVIEWERS' CONCLUSIONS: When considering treatment options for upper respiratory tract infections, the option of delayed antibiotics has been used in an attempt to reduce the use of antibiotic prescriptions. This review shows that for all symptom scores the evidence varies between trials. Most symptom outcomes show no difference between immediate and delayed antibiotic groups. Three of the six studies, all involving patients with sore throat, indicated that patients in the delayed antibiotic group had significantly more fever that their counterparts in the immediate antibiotic group. The other three showed no difference for the outcome of fever. There is evidence indicating that for children with otitis media, pain and malaise scores are worse in the delayed antibiotic group compared to the immediate antibiotic group. This price must be weighed up against the benefits of reduced antibiotic prescribing. Future randomised controlled trials of delaying antibiotics as an intervention should fully report symptoms as well as changes of prescription rates.

Anti-Bacterial Agents↗
PubMed2005

A systematic review for effective management of central venous catheters and catheter sites in acute care paediatric patients.

BACKGROUND: Central venous catheters (CVCs) have provided many benefits in modern-day medical practice; however, they also put patients at risk of catheter-related complications. Numerous studies have been carried out in relation to the management of central venous catheters with conflicting results. While there were several systematic reviews of central venous catheter-related issues, it is clear that there was no systematic review of CVC-related studies specific to the paediatric population in the acute care setting. OBJECTIVE: To present the best available evidence for effective management of central venous catheters and catheter sites in the prevention and/or reduction of catheter-related complications in hospitalised paediatric patients. METHODS: A systematic review was undertaken according to the approach of the Centre for Reviews and Dissemination (CRD; http://www.york.ac.uk/inst/crd). DATA SOURCE: Literature was identified by electronic searching of Cochrane Library, MEDLINE, CINAHL, HealthSTAR, and CancerLit; checking references of all review articles; hand searching of key relevant journals and conference proceedings; and contact with expert informants, medical suppliers, and pharmaceutical companies. INCLUSION/EXCLUSION CRITERIA: The review included randomised and non-randomised controlled trials conducted with hospitalised paediatric patients. Studies that included mixed adult and paediatric populations and mixed hospitalised and home care settings were excluded. DATA EXTRACTION: Two independent reviewers extracted data onto a standard data extraction form, with differences resolved by discussion. QUALITY ASSESSMENT: The quality assessment of retrieved studies included: study design, the degree to which systematic bias was avoided or minimised, the degree to which the assessment was "blind," the degree to which follow up was completed. DATA SYNTHESIS: Quantitative pooling of studies was not feasible due to the diversity of interventions and outcome measures between similar studies. A narrative account of the study characteristics and results was therefore undertaken. RESULTS: Thirty-eight randomised and quasi-randomised controlled trials were retrieved for critical appraisal. Of these, 32 were excluded from the review because the studies did not meet the inclusion criteria and some lacked reporting of appropriate data. Six studies met the criteria with interventions such as antibiotic flushes, antiseptic skin preparations, and dressing materials. CONCLUSION: Quality of reporting was generally lacking. Statistical pooling of results was not possible due to diversity in the reporting of outcomes. There was no evidence to make recommendations on the degree of barrier precautions and the type of aseptic technique to be used at the time of catheter insertion in the paediatric population to prevent catheter-related infection. There was insufficient evidence to support the routine use of an antibiotic flushing solution. There was a lack of randomised controlled trial (RCT) evidence on the benefit of heparin flushes, the use of in-line filters, the frequency of fluid administration set changes, or the type of dressing to use and the frequency of dressing changes. There was some evidence to suggest that chlorhexidine lotion is superior to povidone iodine as a cutaneous antiseptic at the catheter insertion site. However, no recommendation can be made for the use of chlorhexidine in neonates less than 2 weeks old or in premature infants. This systematic review concluded that there is an urgent need for well-designed randomised controlled trials with sufficient power to determine the effectiveness of various interventions in relation to management of CVCs.

Adolescent↗
PubMed2001

[Carcinoma of the nasopharynx. Radiotherapy modalities and combined radiotherapy and chemotherapy: state of the art and perspectives].

Nasopharyngeal carcinoma (NPC) is a highly radiosensitive and chemosensitive. In the patient with locally advanced tumours, the results of conventional radiotherapy are unsatisfactory with significant rates of both local recurrences and distant metastases. The aim of this review is to report the innovative strategies for treatment of the nasopharyngeal carcinoma. Altered fractionation techniques can improve local control. The impact of the innovative techniques, including conformal radiation, stereotactic radiation and IMRT, on survival, must be evaluated in randomised trials. The encouraging early results obtained with concurrent (more than sequential) chemotherapy and radiotherapy must be confirmed in prospective randomized trial in endemic areas.

Carcinoma↗