Background and objectives: The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of antibiotics has led to widespread antimicrobial resistance and the emergence of multi drug resistant strains of bacteria. The main aim of this work was to determine whether there is a genuine need for antibiotic prophylaxis in two common dental procedures; dental implants and tooth extractions. Methods: Electronic searches were conducted across databases such as Cochrane Register of Controlled Trials, the UK National Health Service, Centre for reviews, Science Direct, PubMed and the British Dental Journal to identify clinical trials of either dental implants or tooth extractions, whereby the independent variable was systemic prophylactic antibiotics used as part of treatment in order to prevent postoperative complications such as implant failure or infection. Primary outcomes of interest were implant failure, and postoperative infections which include systemic bacteraemia and localised infections. The secondary outcome of interest was adverse events due to antibiotics. The Critical Appraisal Skills Programme tool was used to assess the risk of bias, extract outcomes of interest and to identify studies for inclusion in the meta-analysis. Results: Seven randomised clinical trials (RCTs) were included in the final review comprising n = 1368 patients requiring either tooth extraction(s) or dental implant(s). No statistically significant evidence was found to support the routine use of prophylactic antibiotics in reducing the risk of implant failure (p = 0.09, RR 0.43; 95% CI 0.16–1.14) or post-operative complications (p = 0.47, RR: 0.74; 95% CI 0.34–1.65) under normal conditions. Approximately 33 patients undergoing dental implant surgery need to receive antibiotics in order to prevent one implant failure from occurring. Conclusions: There is little conclusive evidence to suggest the routine use of antibiotic prophylaxis for third molar extractive surgery in healthy young adults. There was no statistical evidence for adverse events experienced for antibiotics vs. placebo. Based on our analysis, even if financially feasible, clinicians must carefully consider the appropriate use of antibiotics in dental implants and extraction procedures due to the risk of allergic reactions and the development of microbial drug resistance.

BackgroundTo date, the majority of studies on hyponatremia focussed on hyponatremia at admission, and came from developed countries. This study aimed to identify the prevalence of hyponatremia during hospitalization in patients hospitalized for HF and its association with in-hospital mortality.MethodsThis was an observational study using retrospective data from patients’ records between 2010–2013. It focused on those patients carrying an ICD-10 code of 150.0(Congestive Heart Failure) as their primary diagnosis.Hyponatremia during hospitalization was defined as serum sodium level lower than 135 mEq/L obtained from a blood chemistry measurement on the next days after admission. Patients’ characteristics were examined and the association between hyponatremia during hospitalization and in-hospital mortality was analyzed.ResultsAmong 464 patients hospitalized for HF, hyponatremia during hospitalization was observed in 22 % of patients with 44 % of this group had normal serum sodium level on admission.Hyponatremia during hospitalization was associated with lower blood pressure on admission, both systolic and diastolic, peripheral oedema, ascites and fatigue. Patients having history of hospitalization for cardiac diseases and renal failure were higher in patients developing hyponatremia during hospitalization. In this group, amiodarone, heparin, insulin and antibiotics were administered more frequently. Factors potentially increase the risk of hyponatremia during hospitalization include history of fatigue (OR = 3.23, 95 % CI 1.79–5.82), presence of ascites (4.14, 1.84–9.31), and administration of heparin (3.85, 1.78–8.31) and antibiotics (3.08, 1.71–5.53). Length of hospital stay was significantly longer in patients with hyponatremia during hospitalization and in-hospital mortality was also higher compared to non-hyponatremic patients, 7.7 % and 29.1 %, respectively.ConclusionThis study found that the prevalence of hyponatremia during hospitalization in patients hospitalized for HF was almost the same as hyponatremia on admission and administration of heparin and antibiotics can potentially worsen hyponatremia during hospitalization. In this study population, hyponatremia during hospitalization was found to be associated with in-hospital mortality.

Introduction Micronutrients (vitamins and trace elements) are essential to all nutrition. For children and neonates who are dependent upon nutrition support therapies for growth and development, the prescribed regimen must supply all essential components. This paper aims to facilitate interpretation of existing clinical guidelines into practical approaches for the provision of micronutrients in pediatric parenteral nutrition. Methods An international, interdisciplinary expert panel was convened to review recent evidence‐based guidelines and published literature to develop consensus‐based recommendations on practical micronutrient provision in pediatric parenteral nutrition. Results The guidelines and evidence have been interpreted as answers to 10 commonly asked questions around the practical principles for provision and monitoring of micronutrients in pediatric patients. Conclusion Micronutrients are an essential part of all parenteral nutrition and should be included in the pediatric nutrition therapy care plan.

There is insufficient evidence to support or negate the current enoxaparin health outcomes in obese and very obese patients due to the lack of post-discharge follow-up from hospitals. Further research is required to compare long-term outcomes after fixed and weight-based dosing of enoxaparin. The optimal dose of enoxaparin per kilogram of body weight for prophylaxis remains to be determined.

No abstract

The aim of this project was to explore whether fourth-year pharmacy students in England are prepared to communicate with mental health patients. Mental health problems are rising in the United Kingdom, affecting around one in four people. A questionnaire-based study measured the knowledge about and attitude toward mental health problems. Participants were fourth-year pharmacy students from two west midlands universities. More males than females correctly answered the "attitude towards mental health" questions. However, overall, only 45.5% of students answered the "attitude towards mental health problems" questions correctly. Males demonstrated a better level of knowledge than females, with 33% overall answering 6 or more questions of the 13 knowledge questions correctly. Sixty-five percent of participants scored under 50%. The highest total score was 81%, and the lowest was 19%, three people did not answer any questions. In conclusion, a gap in knowledge was identified within the fourth-year pharmacy student cohort, and more intervention will be required to improve knowledge and attitudes such as the Mental Health First Aid courses.

An O−carboxymethylated chitosan (O− CMCh) water solution (I) and N,N‐dimethylacetamide (DMAc) emulsion (II) were blended with a cellulose LiCl/DMAc solution, and corresponding polyblends (Polyblends I and II) were obtained. The rheology of the three fluids, that is, the cellulose solution and Polyblends I and II, was investigated. The cellulose solution was characterized by a power‐law fluid. When an O‐CMCh water solution or DMAc emulsion was added to the cellulose solution, the power‐law curve was preserved. The power‐law indexes (n) of all three fluids increased along with the temperature. Polyblend I displays an n close to but a little higher than that of the cellulose solution, while Polyblend II shows a much higher power index than those of the other two fluids. The values of the apparent viscosity (ηa) for all the three fluids are close and decrease along with an increase in the temperature. Adding O‐CMCh microparticles into Polyblends I and II results in a decrease in the structural viscosity index (Δη) in comparison to that of the cellulose solution, and this effect is very obvious for Polyblend I. A cellulose solution's Δη declines with the augmentation of temperature, while the Δη's of both Polyblends I and II show minimum values at about 323 K. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 88: 1719–1725, 2003

Aim To determine the anticholinergic burden (ACB) of an Australian primary care population. Method A cross‐sectional study was undertaken of medication data from 11 general practices. Participants were active patients aged 65 years and over seen at least 3 times in the last 2 years (n = 4853). The ACB score was calculated based on a UK peer‐reviewed scoring system (Fox) and a modified scale (Fox‐plus) that included medications not present in the Fox scale. The main outcome measure was total ACB from prescribed medications. Results A Fox ACB score ≥ 4 is associated with increased risk of morbidity and mortality, 249 (9%) females, 130 (6%) males and 379 (8%) overall fell in this category. Applying the Fox‐plus ACB scale, 983 (36%) females, 630 (30%) males and 1613 (33%) overall fell in this category. Conclusion A large proportion of the elderly population may have cognitive impairment because of their therapy. Alternative medications or strategies are needed to maintain therapeutic benefits with a low ACB.