Is the gram stain useful in the microbiologic diagnosis of VAP? A meta-analysis.

In a meta-analysis examining respiratory specimen Gram stain for diagnosis of ventilator-associated pneumonia, absence of bacteria on Gram stain had a high negative predictive value, but a positive Gram stain correlated poorly with organisms recovered in culture. Rapid and accurate diagnosis of ventilator-associated pneumonia (VAP) is a major challenge and no generally accepted gold standard exists for VAP diagnosis. We conducted a meta-analysis to examine the role of respiratory specimen Gram stain to diagnose VAP, and the correlation with final culture results.

Evidence-based practice: justifying changes in clinical practice based upon the appraisal of evidence.

Patients with diabetes are known to be at higher risk of foot ulceration that can often lead to limb amputation. Anecdotal evidence suggested that the provision of a multidisciplinary foot clinic for patients with diabetes could improve outcomes. Although this approach appears common sense the author required evidence to support a bid for a change in practice.