Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection

Measurements of Airborne Influenza Virus in Aerosol Particles from Human Coughs

Influenza is thought to be communicated from person to person by multiple pathways. However, the relative importance of different routes of influenza transmission is unclear. To better understand the potential for the airborne spread of influenza, we measured the amount and size of aerosol particles containing influenza virus that were produced by coughing. Subjects were recruited from patients presenting at a student health clinic with influenza-like symptoms. Nasopharyngeal swabs were collected from the volunteers and they were asked to cough three times into a spirometer. After each cough, the cough-generated aerosol was collected using a NIOSH two-stage bioaerosol cyclone sampler or an SKC BioSampler. The amount of influenza viral RNA contained in the samplers was analyzed using quantitative real-time reverse-transcription PCR (qPCR) targeting the matrix gene M1. For half of the subjects, viral plaque assays were performed on the nasopharyngeal swabs and cough aerosol samples to determine if viable virus was present. Fifty-eight subjects were tested, of whom 47 were positive for influenza virus by qPCR. Influenza viral RNA was detected in coughs from 38 of these subjects (81%). Thirty-five percent of the influenza RNA was contained in particles \u3e4 µm in aerodynamic diameter, while 23% was in particles 1 to 4 µm and 42% in particles \u3c1 µm. Viable influenza virus was detected in the cough aerosols from 2 of 21 subjects with influenza. These results show that coughing by influenza patients emits aerosol particles containing influenza virus and that much of the viral RNA is contained within particles in the respirable size range. The results support the idea that the airborne route may be a pathway for influenza transmission, especially in the immediate vicinity of an influenza patient. Further research is needed on the viability of airborne influenza viruses and the risk of transmission

The applicability and utilization of systematic reviews for clinical practice

The aims of this thesis are to examine the applicability and utilization of systematic reviews in health care, and to identify barriers and provide insights for integrating systematic reviews more effectively into clinical practice in order to positively affect the health of patients. For the purposes of this thesis, applicability refers to whether a systematic review is relevant or appropriate for clinical decision-making. Utilization is defined as the actual use of systematic reviews in practice. The first part of this thesis assesses the extent to which systematic reviews are being used to inform clinical practice guidelines (Chapter 2). Subsequent chapters investigate specific challenges and potential solutions for incorporating systematic reviews, or evidence synthesis research generally, into health care decision-making (Chapters 3-7). The final chapter summarizes the work presented in this thesis and provides implications for practice and research (Chapter 8)

Pruebas clínicas preoperatorias sistemáticas para la cirugía de catarata

Antecedentes: La cirugía de catarata se practica ampliamente y en los países en vías de desarrollo se destinan recursos significativos a una tasa creciente de cirugía de catarata. Con la cantidad actual de cirugías de catarata y su incremento en el futuro, es fundamental optimizar la seguridad y la relación entre costo y efectividad de este procedimiento. La mayoría de las cataratas se realizan en personas mayores que, en consecuencia, presentan altas tasas de comorbilidad sistémica y ocular. Es probable que las pruebas clínicas preoperatorias sistemáticas detecten trastornos médicos, sin embargo, es cuestionable si estos trastornos deben excluir a ciertos individuos de la cirugía de catarata o modificar su tratamiento perioperatorio Objetivos: (1) Examinar la evidencia sobre la disminución de los eventos adversos mediante las pruebas clínicas preoperatorias y (2) realizar una estimación del costo promedio de practicar pruebas clínicas sistemáticas. Estrategia de búsqueda: Se hicieron búsquedas en CENTRAL, MEDLINE, EMBASE y LILACS sin restricciones de fecha o de idioma. Se utilizaron las listas de referencias y el Science Citation Index para buscar estudios adicionales. Criterios de selección: Se incluyeron los ensayos clínicos aleatorios que compararon pruebas clínicas preoperatorias sistemáticas con pruebas preoperatorias selectivas o ninguna prueba preoperatoria antes de la cirugía de catarata senil. Obtención y análisis de los datos: Dos autores de la revisión evaluaron de forma independiente los resúmenes para identificar posibles ensayos para la inclusión. Dos revisores, de forma independiente, documentaron las características del estudio, extrajeron los datos y evaluaron la calidad metodológica de cada uno de los estudios incluidos. Resultados principales: Los tres ensayos clínicos aleatorios incluidos en esta revisión presentaron los resultados de un total de 21 531 cirugías de catarata, con un total de 707 eventos adversos clínicos asociados con la cirugía, incluidas 61 hospitalizaciones y tres muertes. De los 707 eventos adversos clínicos que se informaron, 353 se produjeron en el grupo de pruebas preoperatorias y 354 en el grupo de ninguna prueba. La mayoría de los eventos fueron cardiovasculares y se produjeron durante el período intraoperatorio. Las pruebas clínicas preoperatorias sistemáticas no redujeron el riesgo de eventos adversos clínicos intraoperatorios (OR 1,02; IC del 95%: 0,85 a 1,22) o posoperatorios (OR 0,96; IC del 95%: 0,74 a 1,24) en comparación con las pruebas selectivas o ninguna prueba. El ahorro en los costos fue evaluado en un estudio, que calculó que los costos eran 2,55 veces mayores en el caso del grupo de pruebas clínicas preoperatorias, en comparación con el grupo sin pruebas clínicas preoperatorias. Dos estudios informaron que no hubo diferencias en la cancelación de la cirugía entre los grupos de pruebas clínicas preoperatorias y los de ninguna o limitadas pruebas preoperatorias. Conclusiones de los autores: Esta revisión indica que las pruebas preoperatorias sistemáticas no aumentan la seguridad de la cirugía de catarata. Se han propuesto alternativas a las pruebas clínicas preoperatorias sistemáticas, entre ellas, cuestionarios de salud autoadministrados, que para el proveedor de servicios sanitarios podrían sustituir los antecedentes y la exploración física.Tales medidas podrían constituir medios efectivos, en relación con los costos, para identificar a las personas con mayor riesgo de presentar eventos adversos clínicos por cirugía de catarata. Sin embargo, a pesar de su infrecuente aparición, los eventos adversos clínicos ocasionados por la cirugía de catarata siguen siendo un motivo de preocupación, debido al gran número de pacientes de edad avanzada, con comorbilidades clínicas múltiples, que son sometidos a cirugía de catarata en diversos contextos. Los estudios resumidos en esta revisión deberían contribuir a las recomendaciones para las normas de atención de la cirugía de catarata, al menos en contextos de los países desarrollados. Lamentablemente, en contextos de los países en vías de desarrollo, los cuestionarios sobre los antecedentes clínicos no serían útiles para detectar el riesgo, ya que pocas personas han concurrido alguna vez al médico y mucho menos han sido diagnosticadas con una enfermedad crónica

Missed opportunity from randomised controlled trials of medical interventions for open-angle glaucoma.

PURPOSE: To evaluate the extent to which intraocular pressure and visual field have been reported as outcomes in randomised controlled trials (also referred to as 'trials') of medical treatments for open-angle glaucoma. METHODS: We identified published reports of trials in a systematic review of medical interventions for open-angle glaucoma our group conducted. We assessed whether intraocular pressure and visual field were reported as trial outcomes and classified them to be either completely or incompletely reported for meta-analysis. We also collected data on the length of time patients were followed and source of funding for the trial. RESULTS: As of March 2014, we identified 401 trials that had enrolled 76 861 participants. Eighty per cent of 401 trials provided complete information on intraocular pressure and 11% of the 401 trials provided complete information on visual field. Only a minority of trials followed patients for at least 1 year. About half of all reports in our study stated that receiving funding from the industry. CONCLUSIONS: Although the vast majority of trials provided sufficient data for meta-analysis of the effect of medical management of open-angle glaucoma on intraocular pressure, relatively few provided data for analysing the effect on visual field. We considered this as missed opportunity because the data were not available for evidence synthesis. Investigators have an obligation to patients and providers to determine the comparative effectiveness of glaucoma interventions in terms of patient-important outcomes and not to waste data that could have been collected in trials

Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis

Objectives: the clinical impact of rapid sample-to-answer ‘syndromic’ multiplex polymerase chain reaction (PCR) testing for respiratory viruses is not clearly established. We performed a systematic literature review and meta-analysis to evaluate this impact for patients with possible acute respiratory tract infection in the hospital setting.Methods: we searched EMBASE, MEDLINE, and Cochrane databases from 2012 to present and conference proceedings from 2021 for studies comparing clinical impact outcomes between multiplex PCR testing and standard testing.Results: twenty-seven studies with 17,321 patient encounters were included in this review. Rapid multiplex PCR testing was associated with a reduction of -24.22 hours (95% CI -28.70 to -19.74 hours) in the time to results. Hospital length of stay was decreased by -0.82 days (95% CI -1.52 to -0.11 days). Among influenza positive patients, antivirals were more likely to be given (RR 1.25, 95% CI 1.06 to 1.48) and appropriate infection control facility use was more common with rapid multiplex PCR testing (RR 1.55, 95% CI 1.16 to 2.07). Conclusions: our systematic review and meta-analysis demonstrates a reduction in time to results and length of stay for patients overall along with improvements in appropriate antiviral and infection control management among influenza positive patients. This evidence supports the routine use of rapid sample-to-answer multiplex PCR testing for respiratory viruses in the hospital setting.<br/

Treatment regimens for administration of anti-vascular endothelial growth factor agents for neovascular age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of permanent blindness worldwide. The current mainstay of treatment for neovascular AMD (nAMD) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents: aflibercept, ranibizumab, and off-label bevacizumab. Injections can be given monthly, every two or three months ('extended-fixed'), or as needed (pro re nata (PRN)). A variant of PRN is 'treat-and-extend' whereby injections are resumed if recurrence is detected and then delivered with increasing intervals. Currently, injection frequency varies among practitioners, which underscores the need to characterize an optimized approach to nAMD management