Infection control in correctional facilities: a new challenge

The potential for communicable disease transmission in a prison setting is high. Infection control programs in correctional facilities must be designed (1) to develop effective systems for identification, prevention, and control of communicable diseases, (2) to collect data in a systematized way, and (3) to ensure follow-up and coordination of health care after release. The role and activities in which the infection control practitioner must engage include surveillance and reporting, administration, education, and consultation with correction personnel, local health agencies, and health care workers. Specific tasks within each of these areas require modification to meet the unique needs of correctional facilities.     

Biological therapy in rheumatoid vasculitis: a systematic review

Clinical Rheumatology - Rheumatoid vasculitis (RV) is one of the most severe extra-articular manifestations of rheumatoid arthritis, with significant morbidity and mortality, requiring aggressive...     

Intermittent pneumatic compression therapy: a systematic review

Intermittent pneumatic compression (IPC) therapy is an effective modality to reduce the volume of the lymphedematous limbs alone or in conjunction with other modalities of therapy such as decongestive therapy. However, there is no consensus on the frequency or treatment parameters for IPC devices. We undertook a systematic review of contemporary peer-reviewed literature (2004-2011) to evaluate the evidence for use of IPC in the treatment of lymphedema. In select patients, IPC use may provide an acceptable home-based treatment modality in addition to wearing compression garments.     

B-type natriuretic peptide-guided therapy: a systematic review

BNP/NT-proBNP measurement has not gained widespread use for the management of patients with heart failure (HF) despite several randomized controlled trials. A systematic review addressing the question of whether patients with HF benefit from BNP-assisted therapy or intensified therapy compared with usual care was undertaken. Relevant randomized controlled trial (RCTs) were selected by searching Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published from 1980 to 2012. Selected studies required patients to be treated for chronic HF with medical therapy based on BNP/NT-proBNP or usual care. There were no restrictions except that BNP/NT-proBNP measurement had to be done by an FDA approved method. Nine RCTs were identified with 2,104 patients with study duration that ranged from 3 to 18 months. Overall, there was a wide variation in study design and how parameters were reported including patient selection, baseline characteristics, therapy goals, BNP/NT-proBNP cutpoint, and outcome types. Meta-analysis was not appropriate given this study heterogeneity. The strength of evidence for the outcome of mortality, reported in seven studies, was found to be low due to inconsistency and imprecision. This systematic review showed that the evidence is of low quality and insufficient to support the use of BNP/NT-proBNP to guide HF therapy. Further trials with improved design are needed.     

Exercise therapy for spondyloarthritis: a systematic review

To evaluate the effects of therapeutic exercise on pain, stiffness, quality of life, physical function, disease activity, health-related fitness and cardiovascular risk factors in adults with spondyloarthritis (SpA). Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE/PubMed, PEDro, AMED, CINAHL) were systematically searched from inception to October 2013 using medical subject headings and keywords. This was supplemented by searching conference abstracts and a hand search of reference lists of included studies. Randomised and quasi-randomised studies of adults with SpA in which at least one of the comparison groups received an exercise intervention were included. Outcomes of interest were pain, stiffness, quality of life, physical function and disease activity. Secondary outcomes were health-related fitness and cardiovascular risk factors. Two reviewers independently screened studies for inclusion. Methodological quality was assessed by two reviewers using the Cochrane risk of bias tool and the PEDro scale. Twenty-four studies, involving 1,498 participants, were included. Meta-analyses were not undertaken due to clinical heterogeneity, and this review focuses on qualitative synthesis. Moderate evidence supports exercise interventions in improving physical function, disease activity and chest expansion compared to controls; there is low-level evidence of improved pain, stiffness, spinal mobility and cardiorespiratory function. Supervised group exercise yields better outcomes than unsupervised home exercise. The addition of aerobic components to flexibility programmes improves cardiorespiratory outcomes, but not cardiovascular risk factors. The most effective exercise protocol remains unclear. Current evidence suggests that therapeutic exercises are beneficial for adults with ankylosing spondylitis; effects on other SpA subtypes are unknown.     

Antiviral therapy in chronic hepatitis E: a systematic review

Hepatitis E viral infection can lead to a chronic infection in immunocompromised patients, resulting in progressive liver disease and cirrhosis. Isolated cases have shown that treatment with ribavirin or pegylated interferon‐α can result in viral eradication. This systematic review evaluated efficacy and safety of both treatments in chronic hepatitis E. A systematic literature search was performed on PubMed, Web of Science and clinicaltrials.gov for articles and abstracts. The keywords ‘“Hepatitis E” or HEV’ AND ‘ribavirin or Rebetol or Copegus’ OR ‘pegylated interferon OR peginterferon′ were combined. The primary outcome was sustained viral response (SVR). Secondary endpoints include rapid viral response (RVR), relapse rates and side effects. Twenty‐four studies matched our criteria, representing a total of 105 ribavirin‐treated and 8 pegylated interferon‐treated patients. The majority of patients had a solid organ transplant. Sixty‐four per cent of ribavirin‐treated patients achieved a SVR at 6 months after treatment cessation compared to 2/8 peginterferon‐treated patients. Ribavirin was relatively well tolerated with the main side effect being anaemia, requiring dose reduction in 28% of patients. Peginterferon leads to acute transplant rejection in 2/8 patients. Ribavirin monotherapy appears to be an effective and safe treatment in all immunocompromised patients with chronic hepatitis E. The use of pegylated interferon in transplant patients may lead to transplant rejection and is not recommended. Therefore, ribavirin should be the antiviral treatment of choice in chronic hepatitis E.     

Dynamic exercise therapy in rheumatoid arthritis: a systematic review

The aim of this systematic review was to determine the effectiveness of dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an increase in pain, disease activity and radiological progression were studied. A computer-aided search of the MEDLINE, Embase and SCISEARCH databases was performed to identify controlled trials on the effect of exercise therapy. Randomized trials were selected on the effect of dynamic exercise therapy in RA patients with an exercise programme fulfilling the following criteria: (a) intensity level such that heart rates exceeded 60% of maximal heart rate during at least 20 min; (b) exercise frequency > or = 2 a week; and (c) duration of intervention > or = 6 weeks. Two blinded reviewers independently selected eligible studies, rated the methodological quality and extracted data. Six out of 30 identified controlled trials met the inclusion criteria. Four of the six included studies fulfilled > or = 7/10 methodological criteria. Because of heterogeneity in outcome measures, data could not be pooled. The results suggest that dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength. No detrimental effects on disease activity and pain were observed. The effects of dynamic exercise therapy on functional ability and radiological progression are unclear. It is concluded that dynamic exercise therapy has a positive effect on physical capacity. Research on the long-term effect of dynamic exercise therapy on radiological progression and functional ability is needed.      

Isoniazid preventive therapy for tuberculosis. Are we losing our enthusiasm?

Contact investigation activities of the Tennessee Department of Health and Environment (TDHE) Tuberculosis (TB) Control Program from 1979 to 1985 were reviewed. Out of 32,722 identified contacts, 6,030 (20.1 percent) were infected (positive purified protein derivative [PPD]). Only 2,731 (45 percent) of the infected contacts were started on preventive therapy. Both the absolute number and the relative percentage of infected contacts starting on INH prevention therapy have gradually declined over the years. While 569 (67 percent) of the infected contacts were started on preventive treatment in 1979, only 296 (37.5 percent) received isoniazid (INH) preventive therapy in 1985. Although an increasing percentage of those starting preventive therapy completed the prescribed course, the enthusiasm for recommending preventive therapy has declined for the infected individuals above the age of 15. More enthusiasm and efforts are needed from physicians in initiating and maintaining INH preventive therapy to accomplish tuberculosis eradication.     

HIV in correctional facilities: role of self-report in case identification

For treatment of HIV/AIDS in jails and prisons to be effective, these institutions must identify as many HIV-positive inmates as they can. We compare HIV status among a drug-addicted jail population determined through a physical examination and a voluntary HIV testing program, with self-reported status in an interview. Of 360 subjects interviewed and given physical examinations, approximately one third (110) took the voluntary HIV test and all were negative, and only 1 was identified as HIV-positive in the physical. However, 7 (2%) stated in the interview that they were HIV positive, none of whom took the HIV test. Five of the 7 also self-reported injection drug use and having shared needles. We conclude that inmate self-report is an important pathway for HIV case finding in correctional institutions.     

光动力治疗Barrett's食管的系统评价

目的:系统评价光动力治疗Barrett's食管的有效性和安全性.方法:计算机全面检索Cochrane图书馆临床对照试验数据库(2009年第4期)、Medline或PubMed(1978-2010)、EMbase(1978-2010)、Ovid(1978-2010)、中国生物医学文献数据库(1978-2010)、维普中刊数据库(1989-2010)、中国期刊全文数据库(1979-2010)、万方学位论文数据库(1978-2010).手工检索<中华消化杂志>等4种相关中文期刊、相关会议论文集及所有检索到文献的参考文献.纳入光动力治疗Barrett's食管的所有随机对照试验(RCT),按Cochrane协作网推荐的方法进行系统评价.结果:共纳入10个RCT(包括731例患者),3个RCT结果显示,PDT治疗对消除轻度不典型增生安全有效(P<0.05),建议注射5-ALA后4-5h给予PDT治疗,认为低剂量PDT更为安全;3个RCT结果显示,PDT+奥美拉唑在消除Barrett's食管的重度不典型增生及减少腺癌发生上是有效的(P<0.05);3个RCT结果显示;PDT治疗Barrett's食管不典型增生效果优于APC治疗,但成本更高;1个RCT结果显示,PDT术后口服强的松不能减少食管狭窄的发生率.结论:基于目前的证据,我们认为,PDT治疗Barrett's食管的不典型增生、减少腺癌发生安全有效,推荐低剂量PDT治疗.但上述结果解释应慎重,有待进一步研究的证据.