An educational intervention to improve diagnosis and management of suspicious skin lesions Lesional characteristics and histopathology in paucibacillary leprosy patients with 2 or 3 skin lesions: comparison between ROM and PB-MDT regimens. A comparative clinico-pathological study of single dose ROM in paucibacillary leprosy patients with 1-3 skin lesions. Improving primary care residents’ proficiency in the diagnosis of skin cancer An evaluation of method reporting and use in clinical trials in dermatology. How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews Clinician-reported lesion measurements in skin infection trials: Definitions, reliability, and association with patient-reported pain. Rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy: a comprehensive systematic review protocol Chemoprophylaxis against leprosy: expectations and methodology of a trial. [Effect of zinc oxide tape on plantar ulcers in leprosy patients in Indonesia]. A pilot randomized controlled trial to examine the feasibility and efficacy of an educational nursing intervention to improve self-management practices in patients with mild-moderate psoriasis. The quality of reporting and outcome measures in randomized clinical trials related to upper-extremity disorders. A randomized survey of the preference of gastroenterologists for a Cochrane review versus a traditional narrative review. Uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): Results of an open label, randomized and controlled clinical trial, among multibacillary patients Primary results of clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): reactions frequency in multibacillary patients. Consensus document on controversial issues in the treatment of complicated skin and skin-structure infections. Patient-related factors predicting the effectiveness of rifampicin chemoprophylaxis in contacts: 6 year follow up of the COLEP cohort in Bangladesh.
Background : Family physicians have an important clinical role in assessment and management of  suspicious skin lesions .  As a result of a previous needs assessment study , an educational intervention based on audit and feedback with opportunity for reflection on practice was introduced to 46 family physicians r and omly allocated to either an intervention ( 23 ) or control group ( 23 ) . As an educational tool , audit allows doctors to systematic ally review their practice and establish the quality of care they provide . When combined with feedback and comparison of clinical performance with peers or st and ards , it has been shown to increase learning and change behavior . Methods : Data based on their own patients , on the correlation between clinical and histologic diagnosis , and excisions of skin lesions were collated and reported to the intervention group . Results : Despite r and omization of the doctors , the patient population of doctors in the intervention and control groups were significantly different in key characteristics , including the types of skin lesions treated . The intervention group of doctors showed improved performance in providing clinical information on pathology requests and in adequate surgical excision of skin lesions . Diagnostic performance did not improve significantly , but physicians ' certainty of diagnosis did . Implication s : This study design has highlighted the difficulty in balancing the use of evidence ‐based educational strategies in an equivalent setting to normal practice with evaluation of performance using measures that include characteristics of practitioners ' patients that can not be controlled Paucibacillary ( PB ) patients form a large segment of newly diagnosed leprosy patients and those who present with only two or three skin lesions could have problems with compliance . With prolonged anti-leprosy drug regimens that last over six months . ROM therapy , a one-dose regimen , offers an attractive alternative in treating such patients . We conducted a longitudinal study of 51 such PB patients , placing them in two groups at r and om : one receiving the st and ard PB-MDT regimen , and the other the ROM regimen . Patients were followed up for 2 years , with a comprehensive clinical examination done every six months . 14 patients , 7 in each group , also had their skin biopsies evaluated histopathologically at recruitment , at 6 months and at the end of 2 years . There was a consistent improvement of lesions in both the groups over time . The fall in granuloma fraction and the clearance of the initial bacterial index were seen in the histopathology of both groups . Although the PB-MDT regimen is an effective and robust one , the operational convenience and drug compliance with ROM could make it an acceptable , parallel regimen for PB patients when the disease is localized to 2 or 3 skin lesions A controlled clinical and histopathological study was carried out to compare the efficacy of a combination of rifampicin 600 mg plus ofloxacin 400 mg plus minocycline 100 mg ( ROM ) administered as a single dose with that of st and ard WHO/MDT-PB six months ' regimen with regard to resolution of lesion clinical ly and histopathologically . Skin biopsy was performed at the intake and at 6 months . The study subjects were 32 previously untreated , smear-negative patients , without nerve trunk involvement and having 1 - 3 skin lesions . The results were analyzed for mean clinical score for marked , moderate and no improvement and mean histopathological score was grade d as active , resolving and complete resolution , according to granuloma fraction at the end of 6 months . Marked clinical improvement was seen in 25 % and 12 % , moderate improvement in 50 % and 56 % patients treated with ROM and st and ard regimens respectively . Histopathologically , activity was seen in 62.5 % and 43.7 % and resolution of granuloma in 25 % and 31.2 % in the ROM and st and ard regimens respectively . Both the regimens were equally efficacious in the reduction of clinical score and granuloma fraction . No adverse drug reactions or reversal reactions were seen during the study period in both the groups OBJECTIVE : To determine whether a brief , multicomponent intervention could improve the skin cancer diagnosis and evaluation planning performance of primary care residents to a level equivalent to that of dermatologists . PARTICIPANTS : Fifty-two primary care residents ( 26 in the control group and 26 in the intervention group ) and 13 dermatologists completed a pretest and posttest . DESIGN : A r and omized , controlled trial with pretest and posttest measurements of residents ’ ability to diagnose and make evaluation plans for lesions indicative of skin cancer . INTERVENTION : The intervention included face-to-face feedback sessions focusing on residents ’s performance deficiencies ; an interactive seminar including slide presentations , case examples , and live demonstrations ; and the Melanoma Prevention Kit including a booklet , magnifying tool , measuring tool , and skin color guide . MEASUREMENTS AND MAIN RESULTS : We compared the abilities of a control and an intervention group of primary care residents  , and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer — malignant melanoma , squamous cell carcinoma , and basal cell carcinoma . At posttest , both the intervention and control group demonstrated improved performance , with the intervention group revealing significantly larger gains . The intervention group showed greater improvement than the control group across all six diagnostic categories ( a gain of 13 percentage points vs 5 , p<.05 ) , and in evaluation planning for malignant melanoma ( a gain of 46 percentage points vs 36 , p<.05 ) and squamous cell carcinoma ( a gain of 42 percentage points vs 21 , p<.01 ) . The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma . CONCLUSIONS : Primary care residents can diagnose and make evaluation plans for cancerous skin lesions , including malignant melanoma , at a level equivalent to that of dermatologists if they receive relevant , targeted education In a survey of 62 clinical trials published in four dermatology journals , recommended methodology was reported 41 % of the time . Of the 62 trials , 31 were open drug trials and 27 were controlled trials . Forty-one percent of 13 recommended method ologic items were reported in these articles . The rate of reporting for these items ranged from 3 % for power and method of r and omization to 76 % for loss to follow-up and the use of a control group . There were no differences among journals in reporting methods used . Investigators and editors are encouraged to improve the reporting and use of recommended methodology in clinical trials published in the dermatologic literature Background In contemporary medical research , r and omised controlled trials are seen as the gold st and ard for establishing treatment effects where it is ethical and practical to conduct them . In palliative care such trials are often impractical , unethical , or extremely difficult , with multiple method ological problems . We review the utility of Cochrane review s in informing palliative care practice . Methods Published review s in palliative care registered with the Cochrane Pain , Palliative and Supportive Care Group as of December 2007 were obtained from the Cochrane Data base of Systematic Review s , issue 1 , 2008 . We review ed the quality and quantity of primary studies available for each review , assessed the quality of the review process , and judged the strength of the evidence presented . There was no prior intention to perform any statistical analyses . Results 25 published systematic review s were identified . Numbers of included trials ranged from none to 54 . Within each review , included trials were heterogeneous with respect to patients , interventions , and outcomes , and the number of patients contributing to any single analysis was generally much lower than the total included in the review . A variety of tools were used to assess trial quality ; seven review s did not use this information to exclude low quality studies , weight analyses , or perform sensitivity analysis for effect of low quality . Authors indicated that there were frequently major problems with the primary studies , individually or in aggregate . Our judgment was that the review ing process was generally good in these review s , and that conclusions were limited by the number , size , quality and validity of the primary studies .We judged the evidence about 23 of the 25 interventions to be weak . Two review s had stronger evidence , but with limitations due to method ological heterogeneity or definition of outcomes . No review provided strong evidence of no effect . Conclusion Cochrane review s in palliative care are well performed , but fail to provide good evidence for clinical practice because the primary studies are few in number , small , clinical ly heterogeneous , and of poor quality and external validity . They are useful in highlighting the weakness of the evidence base and problems in performing trials in palliative care OBJECTIVES Outcome assessment s as clinical trial endpoints should be well-defined , reliable , and reflect meaningful treatment benefits . For acute bacterial skin and skin structure infections ( ABSSSI ) trials , recent recommendations suggest a primary endpoint of reduction in skin lesion area . Objectives were : evaluate ABSSSI lesion area measurement reliability , evaluate impact of various lesion area definitions on treatment effect size , and explore relationships between lesion area and pain . METHODS Data from two r and omized , double-blinded Phase 3 trials comparing tedizolid to linezolid in ABSSSI and one open-label , non-comparative Phase 2 study of tedizolid in cellulitis/erysipelas and skin abscess were analyzed . Repeated lesion area measurements were prospect ively obtained in all studies . In the open-label study , lesion area was measured by two investigators , using four different definitions . Repeated pain assessment s using two patient-reported outcome instruments ( Visual Analog Scale [ VAS ] and Faces Rating Scale [ FRS ] ) were elicited in the r and omized trials . RESULTS At baseline , lesion size did not correlate with pain intensity : r=0.02 for VAS and r<0.01 for FRS pain scores . However , decreasing lesion size and decreasing pain were strongly associated over time , regardless of initial lesion size or pain intensity ( r=0.20 for VAS and r=0.21 for FRS scores at Day 10 - 13 ) . Each lesion area definition demonstrated high inter-observer reliability ( intra-class correlation coefficient>0.95 ) . CONCLUSIONS Decreasing lesion area ( indirect clinician-reported measure of benefit ) and pain ( direct patient-reported measure of benefit ) were strongly associated over time , and lesion area measurements were reliable , regardless of their definition . These findings support both measures as outcome assessment s in ABSSSI clinical trials . REGISTRATION Clinical trials.govNCT01519778 , NCT01170221 , and NCT01421511 Review question / objective What is the effectiveness of rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy ? What are the experiences and acceptability with the use of rifampin chemoprophylaxis in the prevention of disease from contacts with patients who have leprosy , in patients with leprosy following treatment and in family and health care professionals ? Background Leprosy is globally acknowledged as a millenary and stigmatizing disease and a condition with attributed consequences such as physical deformities and disabilities . From a multi‐causal perspective , there is evidence that leprosy occurs more often in men than in women , is distributed across all age groups and occurs mainly among people living in unfavorable socioeconomic circumstances , who are also the most affected by public segregation policies . 1–4 In 2013 , a total of 215,656 new cases of leprosy were detected worldwide . Regions with the highest number of cases are Southeast Asia ( 72.1 % ) the Americas ( 15.3 % ) . Whereas the countries with the highest prevalence were India ( 58.8 % ) and Brazil ( 14.4 % ) . 5 Hansen 's bacillus ( Mycobacterium leprae ) is considered a microorganism of high infectivity and low pathogenicity and virulence . It is transmitted via nasal oropharyngeal secretions and breaks in the skin of infected patients . Therefore , the main form of transmissibility is inter‐human and the greatest risk of contagion is cohabitation with these patients .1–3 It is estimated that most individuals have a natural resistance to Mycobacterium leprae ( M. leprae ) and that some are prone to developing a severe form of the disease , the multibacillary forms . Studies on exogenous reinfection and endogenous reactivation in chronic diseases , such as tuberculosis and leprosy , show that susceptible individuals become infected by the bacillus through contact with multibacillary patients .1–3,6,7 The surveillance of leprosy contacts is a priority action for control of the disease . Children are exposed to the highest risk of becoming infected by being in contact with a family member or anyone close to them who has the disease . Having a current case of leprosy in the family is associated with a 2.9 times greater risk of a healthy family member becoming infected , and that risk increases when the family has a history of the disease.3,6–9 Bakker et al.7 reported that household contacts of multibacillary patients presented a four times greater risk of becoming infected with the disease compared to non‐contacts . For Ximenes et al.,10 the condition of being a contact of individuals with leprosy represented twice the risk of retreatment due to recurrence in relation to the control group . Therefore , alternative or complementary strategies , such as chemoprophylaxis , must be sought as a form of prevention of the disease . Chemoprophylaxis is defined as the administration of drugs capable of preventing an infection or keeping infected individuals from falling ill . In leprosy , the preventive strategy consists of employing medications to prevent the infection by M. leprae in people with a higher risk of exposure to the disease , i.e. those in contact with the patient . Therefore , chemoprophylaxis plays an important role in the protection of individuals vulnerable to the disease . However , studies regarding its effective utilization are inconclusive.11–15 The first investigations of the utilization of prophylaxis in leprosy contacts in the 1960s and 1970s included dapsone and acedapsone and later in the 1980s and 1990s rifampicin . However , interest in this type of research decreased after 1982 when the World Health Organization ( WHO ) introduced multidrugtherapy ( MDT ) for the treatment of leprosy.16–19 Multidrugtherapy is a combination of three drugs , dapsone , rifampicin and clofazimine , to prevent the selection of resistant strains . As of 1997 , the WHO adopted the alternative rifampicin , ofloxacin and minocycline ( ROM ) regimen , recommended for paucibacillary cases with a single lesion without the involvement of nerve stems.19,20 Adoption of these measures was expected to result in a reduction in the incidence of leprosy as a public health problem ; however , the observed result was not significant in terms of reducing the incidence of newly detected cases . Furthermore , considering the evidence of resistance to monotherapy with dapsone , there was a rise in interest in intervention studies , particularly using rifampicin in household and community contacts.1,2,5,11,12 However , some studies have indicated little or no protection against the disease through the use of rifampicin . While Moet et al.14 and Feenstra et al.21 observed protection of two years in household contacts with a single dose of rifampicin , Bakker et al.13 showed no difference between the experimental group and the control group with two doses of rifampicin , 600 mg for adults and 300 mg for children . Another study of people at high risk of contracting the disease that used a single dose of ROM and rifampicin showed that there was a reduction of type immunoglobulin M antibodies among adults in both interventions .22 Meta‐analyis of dapsone , acepdapsone and rifampicin compared with placebo showed that chemoprophlasys is an effective measure to prevent leprosy . 12 Currently , strategies using a combination of the Bacillus Calmette‐Guérin ( BCG ) and chemoprophylaxis with rifampicin in leprosy contacts appear to be complementary measures for protection against the disease . This strategy showed a protective effect of 80%.23 Studies of acceptability and experience of chemoprophylaxis to control leprosy with individuals and health professionals are scarce . In a qualitative study , Feenstra et al.24 concluded that chemoprophylaxis for household contacts of leprosy patients is an effective and socially acceptable addition to the current leprosy control program . A preliminary search of the Joanna Briggs Data base of Systematic Review s and Implementation Reports , the Cochrane Library , CINAHL , PubMed and PROSPERO has revealed that there are no systematic review s ( either published or underway ) on this topic . In this context , it is un question ably useful to integrate the scientific evidence from studies that evaluated the effectiveness of the rifampicin chemoprophylaxis in leprosy contacts , the experiences and acceptability of contacts of leprosy patients , patients with leprosy following treatment and family and health care professionals about this strategy for the prevention of the disease . This knowledge can support the measures adopted to reduce endemicity , which strengthens the quality of the care delivered to the population most vulnerable to becoming ill . Operational definitions : Leprosy patients : individuals who present one or more of the following cardinal signs and who require multidrugtherapy : lesion(s ) and /or skin areas with altered sensitivity ; affected peripheral nerve(s ) , with or without thickening , associated with sensitive and /or motor and /or autonomic changes ; and a positive skin smear bacilloscopy . Cases are classified as paucibacillary or multibacillary based on the number of lesions and /or bacilloscopy when available ; cases are considered paucibacillary when patients present five or fewer skin lesions and /or negative bacilloscopy , corresponding to the undetermined and tuberculoid clinical forms ; multibacillary cases are when patients present more than five skin lesions and positive bacilloscopy , corresponding to the dimorphous and Virchow 's forms of the disease.1–4,25 Leprosy case : term used in epidemiology to identify individuals with leprosy for purpose s of monitoring the health conditions of a population .2,26 Chemoprophylaxis : the administration of drugs capable of preventing the infection or keeping infected individuals from falling ill.11,12 Contacts : those who cohabit or have cohabited with leprosy patients .12,14,21 Index case : the first case of the disease among several similar cases that are epidemiologically related with the secondary case ( index case contacts).21 Recurrence : the reappearance of signs and symptoms of the disease after recuperation from a first occurrence of the disease , usually within five years.6,10,27 Treatment ab and onment : interrupting treatment for over twelve months.6,10 Therapeutic regimen established for confirmed leprosy cases : for paucibacillary ( PB ) cases , six monthly supervised doses of rifampicin ( RFM ) 450‐600 mg , and daily self‐administered doses of dapsone ( DDS ) 50‐100 mg , for up to nine months ; for multibacillary ( MB ) cases , twelve supervised monthly doses of rifampicin ( RFM ) 450‐600 mg and clofazimine ( CFZ ) 100‐300 mg , associated to daily self‐administered doses of dapsone ( DDS ) 50‐100 mg and CFZ 50 mg , for up to 18 months . An alternative treatment for MB is 24 doses within 36 months.1,2,19 Rifampicin chemoprophylaxis regimens : single‐dose rifampicin of 25 mg/kg or monthly dose for six months ; double‐dose rifampicin or combined regimens of ROM ‐ rifampicin ( 600 mg ) , ofloxacin ( 400 mg ) and minocycline ( 100 mg ) , according to body weight.13–15,21 Efficacy/effectiveness : proof ( or not ) of successful intervention . Efficacy is the result of an intervention performed under ideal , well‐controlled conditions , such as in r and omized clinical trials . Effectiveness refers to the result of an intervention applied under usual medical practice conditions.28 Operational classification : paucibacillary and multibacillary.1,2 , 25 Comorbidities : morbidities possibly associated with leprosy , such as tuberculosis , diabetes , HIV/AIDS , and others.1,2  BCG vaccination scar : result ing from the intradermal injection of Bacillus Calmette‐Guérin ( BCG ) vaccine on the deltoid , used to prevent tuberculosis and leprosy.23,29 Adverse events : negative effects result ing from the actions of drugs.1,2 Incidence rate : measures the frequency or likelihood of new cases of diseases occurring in a population .30 Estimated effect of an intervention : shows the theoretical distribution of possible effects Because of the great efficacy of multidrug therapy ( MDT ) , it had been hoped that the widespread use of MDT would bring about a rapid decrease of the incidence of leprosy . To the present , a decrease of incidence has not been observed , possibly because of the long incubation period of the disease , and because general implementation of MDT is still recent . Other reasons , such as environmental sources of infection or the role of healthy carriers in transmitting Mycobacterium leprae , can not be excluded . Therefore , one must seek alternative or supplementary strategies , such as chemoprophylaxis . Household contacts of leprosy patients are at greater risk of developing leprosy than is the general population . Therefore , a r and omized , controlled trial of chemoprophylaxis , using a single 10 mg/kg dose of rifampicin , or a placebo , is planned in nine projects in India , among the household contacts of newly detected leprosy patients . Based upon assumptions of a protective efficacy of the chemoprophylaxis of 50 % , an annual incidence of 2 per 1000 contacts , a desired power of the study of 90 % , and a level of significance of 95 % , 15,000 household contacts will be allocated r and omly by household to each arm of the study , and followed for 5 years . Considered as household contacts will be all persons living in the same household as an index case and sharing the same kitchen . Pregnant women and infants will be excluded . To be certain that transmission of the organisms from the index case can not occur once the prophylaxis is administered , rifampicin will be administered 2 months after diagnosis of the index case . Diagnosis of leprosy will be clinical , and confirmed independently . Although household contacts usually constitute only a small proportion of the new patients detected in a control programme , their high-risk status makes them particularly appropriate for a study of the potential effect of chemoprophylaxis . Following the trial , one could evaluate the usefulness and feasibility of using the same strategy in other population -groups , based on the number of persons necessary to treat to prevent one case In this investigation the effectiveness was studied of adhesive zinc oxide tape , as additional therapy to the usual application of povidone iodine ( 10 % ) , for leprosy patients with plantar ulcers in Sulawesi Tengah , Indonesia . The effectiveness ( degree of wound healing measured as surface reduction ) of this experimental therapy was compared with that of the usual therapy alone . At the same time the influence of the physical activity level on the effectiveness of both therapies was studied . During six weeks 38 leprosy patients with simple ulcers were treated with either one of the therapies . The average wound healing of the experimental group and the control group was 388 mm2 ( SD 498 ) and 260 mm2 ( SD 260 ) respectively . Using the t-test , there was no statistically significant difference in wound healing between the two therapies ( p = 1.7 ) . The average wound healing of the experimental group with a high and a low activity level was 342 mm2 ( SD 226 ) and 405 mm2 ( SD 571 ) respectively . The average wound healing of the control group with a high and low activity level was 246 mm2 ( SD 289 ) and 275 mm2 ( SD 232 ) respectively . Using analyses of variance , there was no statistically significant influence on the effectiveness of the therapies ( p greater than 0.1 ) . Method ological problems possibly influenced on the results . Different problems which may be encountered during research in third world countries are mentioned BACKGROUND Large numbers of people are expected to self-manage their skin condition , but limited attention has been given to studies of self-management in psoriasis , neither clearly highlighting the challenge nor seeking to develop interventions to support its effectiveness . OBJECTIVES 1 . To test the feasibility of a new educational intervention to enable people with psoriasis to self-manage more effectively an adequately powered multi-centred trial design through piloting . METHOD Pilot r and omized controlled trial with adults ( n = 64 ) with mild-moderate psoriasis in Primary Care in the United Kingdom . Both groups continued with usual treatment . A theory-based educational intervention was design ed . The primary outcome measure was the Dermatology Life Quality Index ( DLQI ) . Secondary measures included the Psoriasis Area and Severity Index ( PASI ) and qualitative feedback from participants . Assessment of the feasibility of the intervention included recruitment and acceptability to participants . RESULTS Delivery of the intervention was feasible and positively evaluated . Recruitment strategies and the intervention need minor modification . As a pilot study there was insufficient power to detect significant score changes . Sub group analysis of participants with a PASI or DLQI of > 6 indicated a modest reduction in PASI in the intervention group which demonstrates a trend that may indicate that this intervention has potential value for people with moderate psoriasis when combined with qualitative data . CONCLUSION This study highlights the feasibility of delivering a self-efficacy based educational intervention for people with mild-moderate psoriasis in primary care establishing the numbers and design required for an adequately powered multi-centred trial PURPOSE R and omized clinical trials can provide strong evidence regarding effective treatment options . The quality of reporting and the type of outcome measures used are important when judging whether results justify change in clinical practice . The aim of this study was to assess the quality of reporting of  r and omized clinical trials related to treatment of upper-extremity disorders , published in 4 h and surgical and orthopedic journals during an 11-year period , and assess the type of outcome measures used in the trials . METHODS Eligible articles were identified by review ing all abstract s published in the 4 journals from 1992 through 2002 . The quality of reporting was assessed by a modified Jadad scale that consisted of 3 items ( r and omization , blinding , and withdrawals/dropouts ) . A higher score ( 0 - 5 ) indicated higher quality . The outcome measures were classified according to the International Classification of Functioning , Disability and Health into the levels of body function and structure , activity , and participation . RESULTS Of 92 articles reporting r and omized clinical trials , 40 articles described appropriate r and omization method that implied they were truly r and omized studies , 31 articles did not describe the r and omization method , and 21 articles ( 23 % ) described inappropriate r and omization methods . Double or single blinding was reported in 33 articles . Absence or description of withdrawals/dropouts was shown in 77 articles . The median quality score calculated for all 92 articles was 2 ( range , 0 - 5 ) points . The median score for the 28 articles published 1992 through 1996 was 1 ( range , 0 - 5 ) points and for the 64 articles published from 1997 through 2002 was 3 ( range , 0 - 5 ) points . All trials used outcome measures on body function and structure level ; 41 % used measures of activity and /or participation . CONCLUSIONS There is a need to improve the quality of reporting of upper-extremity r and omized clinical trials and to increase the use of outcome measures covering different aspects of disability BACKGROUND Clinicians often rely on review material rather than analysis of primary research to guide therapy . Systematic review s use methods to insure thoroughness and to minimize bias , but many clinicians are not familiar with systematic review s and continue to rely on narrative review s. OBJECTIVES To determine whether a traditional narrative review or a systematic review is perceived to be more useful . METHODS A clinical scenario ( patient with chronic Crohn 's disease considered for azathioprine therapy )  was circulated to gastroenterologists , along with a narrative review of therapy ( including azathioprine ) for inflammatory bowel disease written by an acknowledged expert , or with a systematic Cochrane review of the use of azathioprine for this disease . Whether knowledge of authors hip and journal source influences the perception of usefulness of a narrative review was investigated . RESULTS The Cochrane review was rated significantly more highly than the narrative review on a 100 mm visual analogue scale ( 21.3 mm ; 95 % CI 14.5 to 28 mm ) . The proportion of respondents who considered the review to be a useful guide was also higher in the group that received the Cochrane review ( 91 % ) than in the group that received the narrative review , with author and journal concealed ( 62 % ) or identified ( 70 % ) ( P<0.001 for both comparisons ) . Ratings from the two groups that received the narrative review were not significantly different . CONCLUSIONS The focused systematic review was perceived to be more useful than a traditional broad narrative review as a guide to making a decision concerning the use of specific therapy . The possible strengths of systematic review s should be more fully investigated . If there is additional evidence supporting their greater value to clinicians , they should be made more widely available to clinicians and their strengths should be publicized Background Leprosy control is based on early diagnosis and multidrug therapy . For treatment purpose s , leprosy patients can be classified as paucibacillary ( PB ) or multibacillary ( MB ) , according to the number of skin lesions . Studies regarding a uniform treatment regimen ( U-MDT ) for all leprosy patients have been encouraged by the WHO , rendering disease classification unnecessary . Methodology and findings An independent , r and omized , controlled clinical trial conducted from 2007 to 2015 in Brazil , compared main outcomes ( frequency of reactions , bacilloscopic index trend , disability progression and relapse rates ) among MB patients treated with a uniform regimen/U-MDT ( dapsone+rifampicin+clofazimine for six months )  versus WHO regular-MDT/R-MDT ( dapsone+rifampicin+clofazimine for 12 months ) . A total of 613 newly diagnosed , untreated MB patients with high bacterial load were included . There was no statistically significant difference in Kaplan-Meyer survival function regarding reaction or disability progression among patients in the U-MDT and R-MDT groups , with more than 25 % disability progression in both groups . The full mixed effects model adjusted for the bacilloscopic index average trend in time showed no statistically significant difference for the regression coefficient in both groups and for interaction variables that included treatment group . During active follow up , four patients in U-MDT group relapsed representing a relapse rate of 2.6 per 1000 patients per year of active follow up ( 95 % CI [ 0·81 , 6·2 ] per 1000 ) . During passive follow up three patients relapsed in U-MDT and one in R-MTD . As this period corresponds to passive follow up , sensitivity analysis estimated the relapse rate for the entire follow up period between 2·9- and 4·5 per 1000 people per year . Conclusion Our results on the first r and omized and controlled study on U-MDT together with the results from three previous studies performed in China , India and Bangladesh , support the hypothesis that UMDT is an acceptable option to be adopted in endemic countries to treat leprosy patients in the field worldwide . Trial registration Clinical Trials.gov : SETTING S Many believe that the regular treatment for multibacillary ( MB ) leprosy cases could be shortened . A shorter treatment , allowing for uniform treatment for all cases , makes case classification superfluous and therefore simplifies leprosy control . OBJECTIVE To evaluate the association of the treatment duration with the frequency of reactions among MB patients . METHODS An open-label r and omised clinical trial to compare the present routine treatment with one lasting six months . Patients were recruited between March 2007 and February 2012 . We analysed the frequency of first reaction with the Kaplan-Meier method and of recurrent reaction with a Poisson regression , using the treatment group and baciloscopic index level ( BI ) as independent variables . Logistic regression was used to evaluate the statistical association of different reaction types and the treatment group . RESULTS Among those with BI < 3 , we found a statistical significant difference of reaction frequencies between the treatment groups from 6 to 18 months since the beginning of treatment . This difference disappears at 2 years after the start of treatment . Multiple reactions were associated with the treatment group and with BI > or = 3 . No specific types of reactions were associated with treatment duration . CONCLUSION Although this is the first report of U-MDT/CT-BR , the results presented here support the possibility of use of UMDT in the field BACKGROUND Complicated skin and skin-structure infections ( cSSSI ) , including surgical site infections ( SSI ) , cellulitis , and abscesses , have been extensively studied , but controversial issues still exist . CONTROVERSIAL ISSUES The aim of this GISIG ( Gruppo Italiano di Studio sulle Infezioni Gravi ) working group - a panel of multidisciplinary experts - was to define recommendations for the following controversial issues : ( 1 ) What is the efficacy of topical negative pressure wound treatment as compared to st and ard of care in the treatment of severe surgical site infections , i.e. , deep infections , caused by Gram-positive microorganisms ? ( 2 ) Which are the most effective antibiotic therapies in the treatment of cSSSI , including SSI , due to methicillin-resistant staphylococci ? Results are presented and discussed . METHODS A systematic literature search using the MEDLINE , EMBASE , Cochrane Central Register of Controlled Trials , and www . clinical trials.gov data bases of r and omized controlled trials and /or non-r and omized studies was performed . A matrix was created to extract evidence from original studies using the CONSORT method to evaluate r and omized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies , longitudinal cohorts , and retrospective studies . The GRADE method was used for grading quality of evidence . An analysis of the studies published between 1990 and 2008 is presented and discussed in detail OBJECTIVES The COLEP trial in Bangladesh showed a 57 % reduction in leprosy incidence among contacts of newly diagnosed patients in the first 2 years after chemoprophylaxis with single dose rifampicin ( SDR ) . We assessed the impact of this intervention after 6 years and identified characteristics of the leprosy index patients predicting the effectiveness of this intervention . DESIGN The cohort of 1037 patients and their 28 092 contacts that participated in the r and omised placebo controlled field trial with single dose rifampicin was followed for 6 years . The leprosy status of contacts was established at 2 , 4 and 6 years after the intervention . We assessed the association between characteristics of the index leprosy patients  and the development of clinical leprosy among their contacts using logistic regression . RESULTS The protective effect of SDR  was seen only in the first 2 years , with no additional effect after 4 and 6 years . However , the total impact of the intervention was still statistically significant ( P = 0.025 ) after 6 years and no excess cases were observed in the SDR arm at a later stage . The intervention prevented leprosy in contacts that actually received SDR , but did not offer protection to members of the same contact group who did not take chemoprophylaxis . The intervention was most effective in contact groups of female index patients , an enhanced effect was also observed in contact groups of patients belonging to a cluster of two or more leprosy patients at intake as well . CONCLUSION These easy to recognise patient characteristics indicate a possible enhanced risk of transmission of Mycobacterium leprae to contacts in the vicinity of patients and are useful for deciding about preventive measures , such as early detection or chemoprophylaxis
The most under-reported items were concealment of allocation , blinding of patients and outcome assessors , intention to treat and validation of outcomes .
BACKGROUND In the process of conducting a systematic review on interventions for skin lesions due to neuritis in leprosy , we assessed several primary papers with respect to the quality of reporting and methods used in the studies .
Awareness of what constitutes weak points in previously conducted studies may be used to improve the planning , conducting and reporting of future clinical trials .
AIMS To assess the quality of reporting and of methodology  in studies of interventions for skin lesions due to neuritis in leprosy .