Effects of Antibiotic Prophylaxis in Patients with Open Fracture of the Extremities: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: The purpose of the present study was to perform a systematic review and meta-analysis of the use of alternative antibiotic regimens-including (A) antibiotic prophylaxis versus no prophylaxis, (B) longer versus shorter duration of antibiotic prophylaxis, and (C) alternative drugs-for patients with open fracture of the extremities. METHODS: Data sources included CINAHL, EMBASE, MEDLINE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane database of systematic reviews from 1965 to December 2013. All randomized controlled trials comparing the effectiveness of antibiotic prophylaxis in patients with open fracture of the extremities were eligible. RESULTS: We identified 329 potentially eligible articles, of which seventeen proved to be eligible. In four randomized controlled trials involving 472 patients, we found a significantly lower infection rate in patients receiving antibiotic prophylaxis compared with those not receiving antibiotic prophylaxis (risk ratio = 0.37 [95% confidence interval, 0.21 to 0.66]; absolute risk reduction = 9.6% [95% confidence interval, 5.2% to 12.1%]). In three studies involving 1104 patients, we found no difference in the infection rate when a longer duration of antibiotics (three to five days) was compared with a shorter duration (one day) (risk ratio = 0.97; 95% confidence interval, 0.69 to 1.37). Confidence in the estimates for both questions was low to moderate. Individual comparisons of alternative drugs yielded estimates warranting only low to very low confidence. CONCLUSIONS: Results of randomized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days, although the evidence warrants only low to moderate confidence. Given current practice, a large, multicenter, low risk of bias, randomized controlled trial enrolling representative populations and addressing the duration of antibiotics may be the next optimum step in investigation. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparing the efficacy of team based learning strategies in a problem based learning curriculum.

We introduced two variants of team based learning (TBL) strategies in pathology course to seek their efficacy in a problem based learning (PBL) curriculum. The TBL strategy was adopted in two different sessions. One during regular resource session (RS-TBL) and other during a weekly review session (RVS-TBL) of the PBL curriculum. The study involved 104 second year students during their 8 weeks of cardiovascular-respiratory units and 3 weeks of hematology units. RS-TBL was adopted for cardiovascular-respiratory unit and RVS-TBL for hematology unit. The first 8 weeks of the course were implemented as RS-TBL and the last 3 weeks as RVS-TBL. The results showed that the group performance was markedly improved than individual performance in both RS-TBL and RVS-TBL (p < 0.001). Comparison between the RS-TBL and RVS-TBL revealed that individual student and group performance was better in the RVS-BL (p < 0.001). The result of the student attitudinal survey indicated an 88% agreement that TBL enhanced their understanding of pathology concepts and critical analysis. Most of the participants (85%) found RVS-TBL to be more useful. Post-TBL, end of semester examination results proved beneficial for the students in risk. The study demonstrated that RVS-TBL may be preferably adopted to enhance the philosophy of TBL in a PBL curriculum.

Health related quality of life in pregnant women: a comparison between urban and rural populations.

OBJECTIVE: To study mental and physical health of pregnant women and compare the differences between those residing in urban and rural settings. METHODS: A Cross-Sectional Survey was conducted on pregnant women (n=179) in urban and rural areas of Islamabad in January 2009. SF-12, a validated instrument for mental and physical health assessment was used and translated into Urdu. Responses were decoded as per SF-12 analysis protocol. Independent sample t-test was done to compare the quantitative variables. The level of statistical significance was p<0.05. The survey was filled either by the participant or the research team and was anonymous. All the researchers were trained in the interview technique in order to make sure that each question carried the same meaning during the actual survey. This was done to standardize the survey methodology. RESULTS: A total of 179 survey forms were collected, 83 and 96 from both rural and urban areas respectively. Role Limitations because of Physical Problems (p=0.020), General Health Perceptions (p=0.001) and Role Limitations because of Emotional Problems (p=0.023) had statistically significantly lower scores in rural women as compared to urban women. CONCLUSION: Self-perceived mental and physical health was better in urban pregnant women than in rural women.