Counselling, case management and health promotion for people living with HIV/AIDS: an overview of systematic reviews.

Our objective was to identify all existing systematic reviews related to counselling, case management and health promotion for people living with HIV/AIDS. For the reviews identified, we assessed the quality and local applicability to support evidence-informed policy and practice. We searched 12 electronic databases and two reviewers independently assessed the 5,398 references retrieved from our searches and included 18 systematic reviews. Each review was categorized according to the topic(s) addressed, quality appraised and summarized by extracting key messages, the year searches were last completed and the countries in which included studies were conducted. Twelve reviews address topics related to counselling and case management (mean quality score of 6.5/11). Eight reviews (mean quality score of 6/11) address topics related to health promotion (two address both domains). The findings from this overview of systematic reviews provide a useful resource for supporting the development and delivery of evidence-informed support services in community settings.

PsycINFO search strategies identified methodologically sound therapy studies and review articles for use by clinicians and researchers.

OBJECTIVE: This study evaluated search strategies for finding high-quality studies on treatment and systematic reviews in PsycINFO. STUDY DESIGN AND SETTING: Sixty-four journals were hand searched at McMaster University. Methodologic criteria were applied to clinically relevant articles to identify "pass" and "fail" articles; 4,985 candidate terms were compiled, 7,463 combinations for therapy articles, and 5,246 combinations for reviews. Candidate search strategy results were compared with hand searches. The proposed strategies served as "diagnostic tests" for sound studies; the hand searches were the "gold standard." Sensitivity, specificity, precision, and accuracy were calculated. RESULTS: Of 716 treatment articles, 233 (32.5%) met criteria for scientific merit, and 58 (11.5%) of 506 review articles met criteria for systematic reviews. For treatment studies, combined terms had a peak sensitivity of 97.9% (specificity 52.2%). Maximum specificity was 97.7% (sensitivity 51.5%). Sensitivity and specificity were each 79% when optimizing both while minimizing their difference. For review articles, combined terms had a peak sensitivity of 81.0% (specificity 54.4%). Maximum specificity was 98.1% (sensitivity 51.7%). Sensitivity and specificity were each 65% when optimizing both while minimizing their difference. CONCLUSIONS: Empirically derived search strategies can achieve high sensitivity and specificity for retrieving sound treatment studies and review articles from PsycINFO.

Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization.

BACKGROUND: Eradication strategies for methicillin-resistant Staphylococcus aureus (MRSA) are variable. We sought to summarize the evidence for use of antimicrobial agents to eradicate MRSA. OBJECTIVES: To describe the effects of topical and systemic antimicrobial agents on nasal and extra-nasal MRSA carriage, adverse events, and incidence of subsequent MRSA infections. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group's trials register (August 2003), the Cochrane Central Register of Controlled Trials (Issue 3, 2003), MEDLINE (1966 to 2003), EMBASE (1988 to 2003), handsearched relevant literature, and contacted MRSA experts and the manufacturer of mupirocin. SELECTION CRITERIA: Randomized controlled trials of patients colonized with MRSA comparing topical or systemic antimicrobials to placebo or no treatment, and trials comparing various combinations of topical or systemic agents to no treatment, placebo, or to topical or systemic agents. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied inclusion criteria to potentially relevant trials, assessed trial methodological quality, and extracted data. Primary outcomes included eradication of MRSA, infection due to MRSA, and adverse events. MAIN RESULTS: Six trials (384 participants) met the inclusion criteria. No difference in MRSA eradication was detected in four studies: one that compared mupirocin to placebo, two that compared one systemic agent to no treatment (fusidic acid in one and rifampin or minocycline in the other) and one that compared mupirocin to topical fusidic acid and oral trimethoprim-sulfamethoxazole, examining nasal MRSA eradication as an outcome. One study compared minocycline to rifampin, with rifampicin being more effective in relation to eradication of MRSA from all sites at day 30 (relative risk 0.16; 95% confidence intervals 0.02 to 1.00), but the difference at 90 days was not statistically significant (n = 18). Two studies (one testing novobiocin and rifampin, the other ciprofloxacin and rifampin, versus trimethoprim-sulfamethoxazole and rifampin) did not demonstrate a difference in eradication of MRSA at all sites (n = 94). Adverse events with systemic agents occurred in up to 20% of participants, however reporting was sporadic and denominators small. All trials reported development of resistance to antimicrobial agents used. REVIEWER'S CONCLUSIONS: There is insufficient evidence to support use of topical or systemic antimicrobial therapy for eradicating nasal or extra-nasal MRSA. There is no demonstrated superiority of either topical or systemic therapy, or of combinations of these agents. Potentially serious adverse events and development of antimicrobial resistance can result from therapy.

Interventions to prevent aspiration pneumonia in older adults: a systematic review.

A systematic review was conducted to assess the effectiveness of the following interventions for prevention of aspiration pneumonia (AP) in older adults: compensatory strategy/positioning changes, dietary interventions, pharmacologic therapies, oral hygiene, and tube feeding. Data sources included a key word search of the MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases and hand searches of six journals. Reference lists of relevant primary and review articles were searched. Studies included were randomized, controlled trials (RCTs) enrolling adults aged 65 and older at risk of and assessed for AP. Two investigators extracted data on population, intervention, outcomes, and methodological quality. Of the 17 identified RCTs, eight met the selection criteria, two addressed dietary management or compensatory swallowing, two assessed pharmacological therapies, one assessed oral hygiene, and three assessed tube feeding. None of the eight trials reported use of blinding, and allocation concealment was unclear in five. Use of amantadine prevented pneumonia in one trial of nursing home residents. The antithrombotic agent cilostazol prevented AP in another trial but resulted in excessive bleeding. Insufficient data exist to determine the effectiveness of positioning strategies, modified diets, oral hygiene, feeding tube placement, or delivery of food in preventing AP. Considering how common the problem of AP is in older adults, larger, high-quality RCTs on the effectiveness of preventive interventions are warranted.