How a bundle kills Cochrane – or not?

Nice paper this week in JAMA Internal Medicine. How to treat patients hospitalized with Community-Acquired Pneumonia (CAP)? Antibiotics, sure, but can you do more to improve outcome and shorten length of stay (LOS)? You could choose any of 4 evidence-based interventions, that, according to (Cochrane) meta-analyses, improve patient outcome. Or decide to include all 4 in a bundle, as the Australian investigators did. And then the bundle fails to provide benefit and increases harm. Valentijn Schweitzer and I tried to explain. Continue reading

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How a bundle kills Cochrane – or not?

Nice paper this week in JAMA Internal Medicine. How to treat patients hospitalized with Community-Acquired Pneumonia (CAP)? Antibiotics, sure, but can you do more to improve outcome and shorten length of stay? You could choose any of 4 evidence-based interventions, that, according to (Cochrane) meta-analyses, improve patient outcome. Or decide to include all 4 in a bundle, as the Australian investigators did. And then the bundle fails to provide benefit and increases harm. Valentijn Schweitzer and I tried to explain. Continue reading

It (the flu) came from the desert

We tend to find that the flu season in Australia is an early predictor for the severity of the coming flu season in the Europe. And the early indications are the flu in Aus this year is bad – unprecedentedly bad. So, let’s get our flu vaccination campaign planning hats on!

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What does good surgical wound closure look like?

I love and hate SSI prevention in equal measure. On the one hand, we have good evidence and strong guidelines around SSI prevention – but on the other hand, implementing these interventions to prevent SSI can be enormously tricky in practice. One key factor in preventing SSI is creating a well-closed wound in theatre. Surprisingly, there’s precious little data on how to measure what a well-closed surgical wound looks like. This qualitative study presents some potential indicators to measure good surgical wound closure in order to prevent SSI.

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Studying bacteriophages: catch-22

As posted previously, bacteriophage therapy is making a remarkable come-back, if measured in media attention. It is portrayed as safe and effective in treating infections where antibiotics fail. Yet, well-designed controlled studies either lack or failed to demonstrate benefits. All we have are case reports, with – with no exception – spectacular results. But that doesn’t make bacteriophages part of our daily options for treatment. And thus, desperate patients pay thousands of euros for bacteriophages in Georgia, Poland and Belgium for self-treatment, while – at the same time – all of us seem to agree that efficacy and safety should be determined. Continue reading