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1.  Diet, Fluid, or Supplements for Secondary Prevention of Nephrolithiasis: A Systematic Review and Meta-Analysis of Randomized Trials 
European urology  2009;56(1):72-80.
Context
Although numerous trials have evaluated efficacy of diet, fluid, or supplement interventions for secondary prevention of nephrolithiasis, few are included in previous systematic reviews or referenced in recent nephrolithiasis management guidelines.
Objective
To determine efficacy and safety of diet, fluid, or supplement interventions for secondary prevention of nephrolithiasis.
Evidence acquisition
Systematic review and meta-analysis of trials published January 1950 to March 2008. Sources included Medline and bibliographies of retrieved articles. Eligible trials included adults with a history of nephrolithiasis; compared diet, fluids, or supplements with control; compared relevant outcomes between randomized groups (eg, stone recurrence); had ≥3 mo follow-up; and were published in the English language. Data were extracted on participant and trial characteristics, including study methodologic quality.
Evidence synthesis
Eight trials were eligible (n = 1855 participants). Study quality was mixed. In two trials, water intake >2 l/d or fluids to achieve urine output >2.5 l/d reduced stone recurrence (relative risk: 0.39; 95% confidence interval: 0.19–0.80). In one trial, fewer high soft drink consumers assigned to reduced intake had renal colic than controls (34% vs 41%, p = 0.023). Content and results of multicomponent dietary interventions were heterogeneous; in one trial, fewer participants assigned increased dietary calcium, low animal protein, and low sodium had stone recurrence versus controls (20% vs 38%, p = 0.03), while in another trial, more participants assigned diets that included low animal protein, high fruit and fiber, and low purine had recurrent stones than controls (30% vs 4%, p = 0.004). No trials examined the independent effect of altering dietary calcium, sodium, animal protein, fruit and fiber, purine, oxalate, or potassium. Two trials showed no benefit of supplements over control treatment. Adverse event reporting was poor.
Conclusions
High fluid intake decreased risk of recurrent nephrolithiasis. Reduced soft drink intake lowered risk in patients with high baseline consumption. Data for other dietary interventions were inconclusive, although limited data suggest possible benefit from dietary calcium.
doi:10.1016/j.eururo.2009.03.031
PMCID: PMC2925677  PMID: 19321253
2.  Practising evidence-based medicine: the design and implementation of a multidisciplinary team-driven extubation protocol 
Critical Care  2001;5(6):349-354.
Background
Evidence from recent literature shows that protocol-directed extubation is a useful approach to liberate patients from mechanical ventilation (MV). However, research evidence does not necessarily provide guidance on how to implement changes in individual intensive care units (ICUs). We conducted the present study to determine whether such an evidence-based strategy can be implemented safely and effectively using a multidisciplinary team (MDT) approach.
Method
We designed a MDT-driven extubation protocol. Multiple meetings were held to encourage constructive criticism of the design by attending physicians, nurses and respiratory care practitioners (RCPs), in order to define a protocol that was evidence based and acceptable to all clinical staff involved in the process of extubation. It was subsequently implemented and evaluated in our medical/ surgical ICU. Outcomes included response of the MDT to the initiative, duration of MV and stay in the ICU, as well as reintubation rate.
Results
The MDT responded favourably to the design and implementation of this MDT-driven extubation protocol, because it provided greater autonomy to the staff. Outcomes reported in the literature and in the historical control group were compared with those in the protocol group, and indicated similar durations of MV and ICU stay, as well as reintubation rates. No adverse events were documented.
Conclusion
An MDT approach to protocol-directed extubation can be implemented safely and effectively in a multidisciplinary ICU. Such an effort is viewed favourably by the entire team and is useful in enhancing team building.
PMCID: PMC83857  PMID: 11737924
extubation protocol; mechanical ventilation; multidisciplinary team; spontaneous breathing trial; weaning

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