58 research outputs found
Nasal decongestants in monotherapy for the common cold
Background : Many treatments for the common cold exist and are sold over-the-counter. Nevertheless, evidence on the effectiveness and safety of nasal decongestants is limited.
Objectives : To assess the efficacy, and short-and long-termsafety, of nasal decongestants used inmonotherapy to alleviate symptoms of the common cold in adults and children.
Search methods : We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6, June 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Specialised Register, MEDLINE (1946 to July 2016), Embase (2010 to 15 July 2016), CINAHL (1981 to 15 July 2016), LILACS (1982 to July 2016), Web of Science (1955 to July 2016) and clinical trials registers.
Selection criteria : Randomised controlled trials (RCTs) and cluster-RCTs investigating the effectiveness and adverse effects of nasal decongestants compared with placebo for treating the common cold in adults and children. We excluded quasi-RCTs.
Data collection and analysis : Three review authors independently extracted and summarised data on subjective measures of nasal congestion, overall patient wellbeing score, objective measures of nasal airway resistance, adverse effects and general recovery. One review author acted as arbiter in cases of disagreement. We categorised trials as single and multi-dose and analysed data both separately and together. We also analysed studies using an oral or topical nasal decongestant separately and together.
Main results : We included 15 trials with 1838 participants. Fourteen studies included adult participants only (aged 18 years and over). In six studies the intervention was a single dose and in nine studies multiple doses were used. Nine studies used pseudoephedrine and three studies used oxymetazoline. Other decongestants included phenylpropanolamine, norephedrine and xylometazoline. Phenylpropanolamine (or norephedrine) is no longer available on the market therefore we did not include the results of these studies in the meta-analyses. Eleven studies used oral decongestants; four studies used topical decongestants.
Participants were included after contracting the common cold. The duration of symptoms differed among studies; in 10 studies participants had symptoms for less than three days, in three studies symptoms were present for less than five days, one study counted the number of colds over one year, and one study experimentally induced the common cold. In the single-dose studies, the effectiveness of a nasal decongestant was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days.
Most studies were conducted in university settings (N = eight), six at a specific university common cold centre. Three studies were conducted at a university in collaboration with a hospital and two in a hospital only setting. In two studies the setting was unclear.
There were large differences in the reporting of outcomes and the reporting of methods in most studies was limited. Therefore, we judged most studies to be at low or unclear risk of bias. Pooling was possible for a limited number of studies only; measures of effect are expressed as standardised mean differences (SMDs). A positive SMD represents an improvement in congestion. There is no defined minimal clinically important difference for measures of subjective improvement in nasal congestion, therefore we used the SMDs as a guide to assess whether an effect was small (0.2 to 0.49), moderate (0.5 to 0.79) or large (>= 0.8).
Single-dose decongestant versus placebo: 10 studies compared a single dose of nasal decongestant with placebo and their effectiveness was tested between 15 minutes and 10 hours after dosing. Seven of 10 studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion. Two studies recorded adverse events. Both studies used an oral decongestant and each of them showed that there was no statistical difference between the number of adverse events in the treatment group versus the placebo group.
Multi-dose decongestant versus placebo: nine studies compared multiple doses of nasal decongestants with placebo, but only five reported on the primary outcome, subjective symptom scores for nasal congestion. Only one study used a topical decongestant; none reported overall patient well-being. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately three hours after the last dose (SMD 0.49, 95% confidence interval (CI) 0.07 to 0.92; P = 0.02; GRADE: low-quality evidence). However, the SMD of 0.49 only indicates a small clinical effect. Pooling was based on two studies, one oral and one topical, therefore we were unable to assess the effects of oral and topical decongestants separately. Seven studies reported adverse events (six oral and one topical decongestant); meta-analysis showed that there was no statistical difference between the number of adverse events in the treatment group (125 per 1000) compared to the placebo group (126 per 1000). The odds ratio (OR) for adverse events in the treatment group was 0.98 (95% CI 0.68 to 1.40; P = 0.90; GRADE: low-quality evidence). The results remained the same when we only considered studies using an oral decongestant (OR 0.95, 95% CI 0.65 to 1.39; P = 0.80; GRADE: low-quality evidence).
Authors' conclusions : We were unable to draw conclusions on the effectiveness of single-dose nasal decongestants due to the limited evidence available. For multiple doses of nasal decongestants, the current evidence suggests that these may have a small positive effect on subjective measures of nasal congestion in adults with the common cold. However, the clinical relevance of this small effect is unknown and there is insufficient good-quality evidence to draw any firm conclusions. Due to the small number of studies that used a topical nasal decongestant, we were also unable to draw conclusions on the effectiveness of oral versus topical decongestants. Nasal decongestants do not seem to increase the risk of adverse events in adults in the short term. The effectiveness and safety of nasal decongestants in children and the clinical relevance of their small effect in adults is yet to be determined
What do consumers want to know about drugs (medication and lifestyle) in their pregnancy journey?
Oral Vitamin C supplements to prevent and treat acute upper respiratory tract infections
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of oral vitamin C supplements to prevent and treat acute upper respiratory tract infections in adults and children
Changing the antibiotic prescribing of general practice registrars: The ChAP study protocol for a prospective controlled study of a multimodal educational intervention
Background: Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis.
Methods/design: The intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings. We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training.
Discussion: Early-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost.
Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014)
Four screening instruments for frailty in older patients with and without cancer: a diagnostic study
Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands
<p>Abstract</p> <p>Background</p> <p>Cancer is mainly a disease of older patients. In older cancer patients, additional endpoints such as quality of survival and daily functioning might be considered equally relevant as overall or disease free survival. However, these factors have been understudied using prospective designs focussing on older cancer patients. Therefore, this study will focus on the impact of cancer, ageing, and their interaction on the long-term wellbeing of older cancer patients.</p> <p>Methods/Design</p> <p>This study is an observational cohort study. We aim to recruit 720 cancer patients above 70 years with a new diagnosis of breast, prostate, lung or gastrointestinal cancer and two control groups: one control group of 720 patients above 70 years without a previous diagnosis of cancer and one control group of 720 cancer patients between 50 - 69 years newly diagnosed with breast, prostate, lung or gastrointestinal cancer. Data collection will take place at inclusion, after six months, after one year and every subsequent year until death or end of the study. Data will be collected through personal interviews (consisting of socio-demographic information, general health information, a comprehensive geriatric assessment, quality of life, health locus of control and a loneliness scale), a handgrip test, assessment of medical records, two buccal swabs and a blood sample from cancer patients (at baseline). As an annex study, caregivers of the participants will be recruited as well. Data collection for caregivers will consist of a self-administered questionnaire examining depression, coping, and burden.</p> <p>Discussion</p> <p>This extensive data collection will increase insight on how wellbeing of older cancer patients is affected by cancer (diagnosis and treatment), ageing, and their interaction. Results may provide new insights, which might contribute to the improvement of care for older cancer patients.</p
A cohort study on the evolution of psychosocial problems in older patients with breast or colorectal cancer: comparison with younger cancer patients and older primary care patients without cancer
Geriatric screening tools are of limited value to predict decline in functional status and quality of life: results of a cohort study
De oudere patiënt met kanker: consequenties van kanker enveroudering
The increasing number of older cancer patients will become an important challenge for healthcare services, as older cancer patients often present with complex combinations of both cancer- and ageing-related problems. Older cancer patients represent the largest and fastest growing group of cancer patients, and despite overall agreement that –in addition to prolongation of survival– the main goal of treating older cancer patients is “quality of survival”, questions regarding the quality of survival of older cancer patients after initial treatment remain largely unanswered and unexplored.
The aim of this thesis was to gain a deeper insight into the impact of a diagnosis and treatment of cancer, ageing, and the interaction between both, on subsequent well-being of older cancer patients. Well-being was operationalized as comorbidity (an indicator of physical well-being), loneliness (an indicator of social well-being), depression, cognitive impairment, and fatigue (indicators of mental well-being). Subsequently, we explored ways to facilitate the identification of older cancer patients at risk for negative outcomes, focusing on functional decline, decline in quality of life, and the emergence of depression.
The majority of our research questions were addressed with data of the KLIMOP-study, an observational cohort study that includes Belgian and Dutch older cancer patients (≥70 years) with a new diagnosis of breast, prostate, lung or gastrointestinal cancer and two control groups: younger cancer patients (50 – 69 years) with a new diagnosis of breast, prostate, lung or gastrointestinal cancer were included to act as a control for ageing; older patients (≥70 years) without a previous diagnosis of cancer were included as a control for a diagnosis and treatment of cancer. The study on comorbidity was addressed with data from the Registration Network Family Practices of Maastricht University. This is a primary care database including a population of approximately 135,000 people. We also conducted a systematic literature review and meta-analysis on the topic of loneliness.
We found that the frequency of comorbidity in older cancer patients was high, but it appeared to be predominantly associated with high age, and the absolute increase in disease occurrence due to cancer was small. For loneliness we found that it is an important and common concern in cancer patients. We showed that at time of diagnosis, older cancer patients were less lonely compared to their peers without cancer, but over the course of one year, levels of loneliness –in particular emotional loneliness– significantly increased in cancer patients, young and old. Risk factors for loneliness were changes in fatigue, cognitive functioning, or having no partner. For other psychosocial problems we showed that within a one-year timeframe from cancer diagnosis, older as well as younger cancer patients experienced an increase in the frequency of depression, slight worsening of cognitive functioning, and relatively stable levels of fatigue, albeit more than half of the cancer patients reported fatigue. Multivariate analyses showed that the main risk factors for psychosocial problems were presence of the problem at baseline and functional impairment.
For the second objective of this thesis –to identify older cancer patients at risk for negative outcomes– we showed that in older persons with a relatively good prognosis, geriatric screening tools are of limited use in identifying those who are at risk for decline in functional status or quality of life after one year. Furthermore, we explored the added value of using fatigue severity as a cue to further investigate the presence of depression. We showed that fatigue severity cannot replace proper clinical assessment of depression, but it offers a useful trigger for increased alertness and additional testing for depression in older cancer patients.
In conclusion, the overall message of this thesis is rather optimistic: older cancer patients are doing better than expected. The amount of problems older cancer patients face is not disproportionate compared to the problems faced by younger cancer patients or older people without cancer. However, this is only true for the population described in this study: mainly female patients with breast or colorectal cancer with a good prognosis. Nonetheless these optimistic results, a diagnosis and treatment of cancer has a serious impact on a person’s life, and at an individual level there are persons who face enormous challenges. This was true for all three groups; older cancer patients, younger cancer patients and older persons without cancer. With those people who are vulnerable in mind, we believe that attention is needed especially for the social and mental aspects of functioning.status: publishe
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