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Topical antibiotics for acute bacterial conjunctivitis: a systematic review.
There has been uncertainty about whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of acute bacterial conjunctivitis. Using standard Cochrane search methods, we identified double-blind randomised controlled trials in which any form of antibiotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extraction and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Six published trials were identified, of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days 2 to 5: relative risk (RR) = 1.31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission, and early and late microbiological remission. Since trials to date have been conducted in selected specialist care patient populations, generalisation of these results to a primary care-based population should be undertaken with a degree of caution.
Long-acting beta-2-agonists for bronchiectasis.
BackgroundSymptoms of bronchiectasis include chronic productive cough, wheeze, breathlessness and recurrent infections of the lower respiratory tract. Long-acting bronchodilators are being used more frequently in the management of people with this condition.ObjectivesTo determine the effectiveness of long-acting bronchodilators in the management of bronchiectasis that is not due to cystic fibrosis.Search strategyWe searched the Cochrane Airways Group Bronchiectasis Database made up of trials identified from searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE and hand-searches of leading respiratory journals. The latest searches were performed in May 2001.Selection criteriaRandomised controlled trials, with or without masking.Data collection and analysisThe results of searches were reviewed against pre-specified criteria.Main resultsWe were unable to identify any randomised controlled trials investigating the effectiveness of long-acting bronchodilator therapy in the management of bronchiectasis.Reviewer's conclusionsFurther research is needed to establish if long-acting bronchodilators have a role in the management of people with bronchiectasis.
Medical ethics and Islam: principles and practice.
A minimum level of cultural awareness is a necessary prerequisite for the delivery of care that is culturally sensitive. In this paper we simplify and highlight certain key teachings in Islamic medical ethics and explore their applications. We hope that the insights gained will aid clinicians to better understand their Muslim patients and deliver care that pays due respect to their beliefs.
Ethical and research dilemmas arising from a questionnaire study of psychological morbidity among general practice managers.
A questionnaire-based research project enquiring into the psychological health of general practice managers found that 5% of managers admitted to suicidal ideas. This paper explores the moral issues raised when research conducted at a distance uncovers information about participants which indicates that they may be at increased risk of harm. It examines whether the authors of such studies have responsibilities towards their research participants beyond those of analysing and properly interpreting the data supplied to them. The paper is an exercise in self-reflection and self-criticism; not all the questions posed and explored by it can be answered definitively. Implications for planning studies of this kind are discussed.
Setting up a database of medical error in general practice: conceptual and methodological considerations.
Though common and the cause of much morbidity and health cost, medical error has until recently attracted little attention from primary care workers. A database that logs medical error, operating within the context of clinical governance initiatives at the level of Primary Care Groups, could provide an appropriate framework within which to scrutinise and identify systematic organisational features associated with risk of serious adverse events. This paper discusses some of the key conceptual and methodological issues that need to be resolved before such a database can be implemented in general practice and considers these deliberations in the light of the Chief Medical Officer for England's recent report, An organisation with a memory.
Pharmacist integration into the discharge process: A qualitative and quantitative impact assessment
Objective - To determine whether a discharge pharmacist can improve the timeliness of patient discharge. Method - Following a pilot phase on an acute admissions ward to assess the suitability of data collection forms (DCFs), patients were assigned to have their discharge medication organised either by a pharmacist (intervention group) or by the existing system (control group). Information relating to a variety of prescription processing times, together with data on clinical interventions and use of patient's own drugs (PODs), was recorded for each group. Setting - Sixty-eight patients were recruited from one surgical ward and one medical ward at Bristol Royal Infirmary. Findings - Median discharge prescription processing time (time from discharge decision to patient discharge) was significantly less in the intervention group than in the control group (322 versus 460 minutes, P=0.0056). The median discharge prescription dispensing time was significantly greater with the existing system than when prescriptions were transcribed by the discharge pharmacist (240 versus 177 minutes, P=0.005). A cost-saving of £6 per patient by the reuse of PODs was calculated for the intervention group. No PODs were documented in the control group. Conclusion - Our study demonstrates that integration of a pharmacist into the discharge system improves the timeliness of discharge, benefiting hospital bed management. Significant reductions in drug wastage and release of medical time are also apparent with this modified discharge process.
Publication ethics and the research assessment exercise: reflections on the troubled question of authorship.
The research assessment exercise (RAE) forms the basis for determining the funding of higher education institutions in the UK. Monies are distributed according to a range of performance criteria, the most important of which is "research outputs". Problems to do with publication misconduct, and in particular, issues of justice in attributing authorship, are endemic within the research community. It is here argued that the research assessment exercise currently makes no explicit attempt to address these concerns, and indeed, by focusing attention on research outputs, may actually be fostering such ethical problems.