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Biomedical subjects

J Cave

Publications and source records attributed to J Cave.

10 recordsLinked to original sources
PubMed2000

Antibiotics for acute bacterial conjunctivitis.

BACKGROUND: There are concerns regarding whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. OBJECTIVES: The aim of this review is to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH STRATEGY: We searched the Cochrane Eyes and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials. The most recent searches were carried out in September 1998. SELECTION CRITERIA: We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic usage. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and the accuracy was checked by a second reviewer. Relative risks were summarised. We tested for heterogeneity between studies. MAIN RESULTS: Six published trials were identified of which three fulfilled the eligibility criteria for inclusion in this review. One trial was single masked and therefore excluded. A second report, when translated, was found to have no placebo group and was therefore excluded. One trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. All the trials thus far identified appear to have been conducted on a selected specialist care patient population. 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 (cure or significant improvement) occurred by days two to five in 64% (95% confidence interval (CI) 57% to 71%) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days two to five: relative risk (RR) 1.31 95% CI 1.11 to 1.55, NNT=5) with a suggestion that this benefit was maintained for late clinical remission (days six to 10: RR 1.27 95% CI 1.00 to 1.61, NNT=5). Antibiotic treatment was associated with rates of microbiological remission (pathogen eradication or reduction). No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence. REVIEWER'S CONCLUSIONS: 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 these results may not necessarily be generalisable to a primary care based population. A trial based in primary care designed to assess the cost-effectiveness of commonly prescribed antibiotic(s) versus placebo in acute bacterial conjunctivitis is warranted.

Acute Disease↗
PubMed2000

Should weaker study designs ever be preferred over randomised controlled trials.

Randomised controlled trials are typically cited as the 'best' form of study design to be used when comparing the efficacy or effectiveness of different devices such as pressure-redistributing beds and mattresses. This article presents a RCT that compared two forms of alternating pressure air mattress. No statistically significant differences were found between the incidence of sores upon the two mattresses. However the study was under-powered, and so was unlikely to identify differences in efficacy should they have existed. In discussion it is suggested that randomised controlled trials may be less useful to those purchasing mattresses than 'weaker' study designs that capture the experience of the users of such devices.

Adult↗
PubMed1992

A narrow window of intracellular calcium concentration is optimal for neurite outgrowth in rat sensory neurones.

We have examined neurite outgrowth in rat sensory neurones when cytosolic free calcium concentration ([Ca2+]i) was varied in the range 0-60 nM. Neurite outgrowth was maximal at 35 nM [Ca2+]i and was reduced at higher and lower values of [Ca2+]i. These results provide direct evidence for Mattson and Kater's suggestion of an optimal calcium range for growth cone function.

Animals↗
PubMed1988

Nosocomial enterococcal infections: association with use of third-generation cephalosporin antibiotics.

Enterococcal infections consistently account for approximately 10% of all nosocomial infections reported to the Centers for Disease Control. There is concern that an increase in nosocomial enterococcal infection is due to the increased severity of inpatient illnesses and to the widespread use of broad-spectrum beta-lactam antibiotics. Nosocomial enterococcal infections were analyzed at our medium-sized community hospital over a time period spanning 9 years. A significant increase in the infection rate was detected during the latter half of 1986. This increase was due primarily to a disproportionate rise in the incidence of the urinary tract as a site of infection. There were no associated clusters of infection, no predilection for certain patient care areas, and no preceding change in the hospital infection control policies and procedures. Total hospital use of cephalosporins remained stable during the period of increased enterococcal infections, but use of third-generation cephalosporins almost doubled in 1986 compared with the 4 preceding years. Selective pressure of third-generation cephalosporin use appeared to be a factor in the increased incidence of nosocomial enterococcal urinary tract infection.

Aged↗
PubMed1985

Characterization of cells with high alkaline phosphatase activity derived from human bone and marrow: preliminary assessment of their osteogenicity.

Confluent cellular layers are reproducibly obtained (from 21 of 24 specimens) by outgrowth from composite pieces of human trabecular bone and marrow. The cells resemble fibroblasts in terms of morphology, esterase profile, and production of collagen type 1. However, the cells displayed some osteoblastlike features. Both the primary outgrowths and passaged cultures had high alkaline phosphatase activities (37 nmols min-1 X microgram DNA-1) in the range displayed by embryonic osteoblastlike cells. The cellular alkaline phosphatase activity, which showed similarity to the bone isoenzyme on kinetic criteria, was stimulated by 1,25-dihydroxyvitamin D3 but decreased by PTH (1-34). In addition, the cell preparations were shown to increase osteocalcin (bone Gla protein) production in response to 1,25-dihydroxyvitamin D3. The osteogenic potential of the bone and marrow-derived cells has been assessed in an in vivo diffusion chamber assay in which congenitally athymic (nude) mice were used as hosts. None of the 25 chambers examined showed evidence of osteogenesis, although the cells remained viable and fibroblastlike. The alkaline phosphatase activities decreased to less than 1% of the original, high in vitro values. The findings question the hypothesis that bone and marrow-derived cells are osteoblasts or osteoblastlike cells, rather than a mixture of cell lines of the bone and marrow stromal system.

Adolescent↗