Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review

BACKGROUND: Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. Currently, there is no consensus on the route and duration of antimicrobial therapy to treat AHO. METHODS: We conducted a systematic review of a short versus long course of treatment for AHO due primarily to Staphylococcus aureus in children aged 3 months to 16 years. We searched Medline, Embase and the Cochrane trials registry for controlled trials. Clinical cure rate at 6 months was the primary outcome variable, and groups receiving less than 7 days of intravenous therapy were compared with groups receiving one week or longer of intravenous antimicrobials. RESULTS: 12 eligible prospective studies, one of which was randomized, were identified. The overall cure rate at 6 months for the short course of intravenous therapy was 95.2% (95% CI = 90.4, 97.7) compared to 98.8% (95% CI = 93.6, 99.8) for the longer course of therapy. There was no significant difference in the duration of oral therapy between the two groups. CONCLUSIONS: Given the potential increased morbidity and cost associated with longer courses of intravenous therapy, this finding should be confirmed through a randomized controlled equivalence trial

The role of national registries in improving patient safety for hip and knee replacements

Background The serious adverse events associated with metal on metal hip replacements have highlighted the importance of improving methods for monitoring surgical implants. The new European Union (EU) device regulation will enforce post-marketing surveillance based on registries among other surveillance tools. Europe has a common regulatory environment, a common market for medical devices, and extensive experience with joint replacement registries. In this context, we elaborate how joint replacement registries, while building on existing structure and data, can better ensure safety and balance risks and benefits. Discussion Actions to improve registry-based implant surveillance include: enriching baseline and diversifying outcomes data collection; improving methodology to limit bias; speeding-up failure detection by active real-time monitoring; implementing risk-benefit analysis; coordinating collaboration between registries; and translating knowledge gained from the data into clinical decision-making and public health policy. Summary The changes proposed here will improve patient safety, enforce the application of the new legal EU requirements, augment evidence, improve clinical decision-making, facilitate value-based health-care delivery, and provide up-to-date guidance for public health

Conceitos de espaço na análise de políticas de saúde Concepts of space in the analysis of health policies

A incorporação da dimensão espacial na análise de políticas de saúde, com todas as suas conseqüências práticas, vem assumindo crescente importância, sustenta a autora com base num amplo levantamento de fontes na literatura especializada. Há um avanço real na passagem da atenção ao território para a atenção ao espaço, com suas tensões internas. A ênfase na heterogeneidade do espaço urbano permite dirigir-se de maneira mais informada e rigorosa para as questões centrais da justiça e da cidadania.<br>The incorporation of the spatial dimension in the analysis of health policies, with all its practical consequences, shows a growing importance, holds the author on the basis of a wide survey of sources in the specialized literature. There is a real advance in the passage from the attention to territory to the attention to space, with its internal tensions. The emphasis on the heterogeneity of urban space allows addressing in a more informed and rigorous way the central questions of justice and citizenship