21 research outputs found
Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children
BACKGROUND:
Upper respiratory tract infections (URTIs), including rhinitis, nasopharyngitis, tonsillitis and otitis media (OM), comprise of 88% of total respiratory infections, especially in children. Therefore effective prevention and treatment of RTIs remain a high priority worldwide. Preclinical and clinical data highlight the rationale for the use and effectiveness of immunity-targeted approaches, including targeted immunisations and non-specific immunomodulation in the prevention and management of recurrent upper RTIs.
OBJECTIVE OF REVIEW:
The idea of this review was to summarise the current evidence and address key questions concerning the use of conservative and immunity-targeted approaches to recurrent and chronic URTIs, with a focus on the paediatric population.
SEARCH STRATEGY/EVALUATION METHOD:
Literature searches were conducted in March 2017 and updated in September 2017 using: Academic Search Complete; CENTRAL; Health Source: Nursing/Academic Edition; MEDLINE; clinicaltrials.gov; and Cochrane databases. In total, 84 articles were retrieved and reviewed. Two independent researchers focused on primary and secondary endpoints in systematic reviews, meta-analyses and randomised, controlled trials, using immunity-directed strategies as the control group or within a subpopulation of larger studies. Existing guidelines and interventional/observational studies on novel applications were also included.
RESULTS:
Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, as well as other potential predisposing factors such as day care attendance and/or toxic environmental factors (eg increased pathogenic microbial exposure and air pollutants). Recurrent URTIs can affect otherwise healthy children, leading to clinical sequelae and complications, including the development of chronic conditions or the need for surgery. Available pre-clinical and clinical data highlight the rationale for the use and effectiveness of immunity-targeted approaches, including targeted immunisations (flu and pneumococcal vaccines) and non-specific immunomodulation (bacterial lysates), in the prevention and management of recurrent croup, tonsillitis, otitis media, recurrent acute rhinosinusitis and chronic rhinosinusitis.
CONCLUSIONS:
In this review, we summarise the current evidence and provide data demonstrating that some immunity-targeted strategies, including vaccination and immunomodulation, have proved effective in the treatment and prevention of recurrent and chronic URTIs in children.info:eu-repo/semantics/publishedVersio
Nutzung von Deximed als evidenzbasiertes, unabhĂ€ngiges Online-Nachschlagewerk fĂŒr HausĂ€rzte
Die Bestimmung der Nierenfunktion und Konsequenzen fĂŒr die Medikation bei hochbetagten Patienten
E-Learning-Plattform Allgemeinmedizin: Entwicklung von Kursmodulen in Zusammenarbeit mit der DEGAM
Was sind die Voraussetzungen fĂŒr eine erfolgreiche Zusammenarbeit zwischen Pflegeeinrichtung und Ărzten? - Ergebnisse einer Mixed Methods Querschnittserhebung in bayerischen Pflegeeinrichtungen
Zufriedenheit mit ihrer Weiterbildungssituation und Niederlassungsbereitschaft bei Ărzten in Weiterbildung im Fach Allgemeinmedizin
Predictors of a positive attitude of medical students towards general practice - a survey of three Bavarian medical faculties
Objective: Germany is witnessing an increasing shortage of general practitioners (GPs). The aim was to determine predictors of the job-related motivation of medical students of three medical faculties with different institutionalisation of general practice as an academic discipline.Methods: Medical students were surveyed with a standardised questionnaire about their attitudes towards general practice and their motivation to work as a GP in different working conditions. Predictors for positive attitudes and motivation were calculated using logistic regression models.Results: 940 (15.2%) out of 6182 medical students from three Bavarian medical faculties participated in an online survey. 585 (62.7%) were female, and the average age was 25.0 (standard deviation 3.7). The average grade of a university-entrance diploma was 1.6 (standard deviation 0.5). 718 (76.4%) could imagine working as a GP. However, they favoured being employed within another organisation and not having their own private practice (65.5% vs. 35.1%). "Presence of a professorship of general practice" was associated with a positive attitude towards general practice (OR 1.57; 95%CI 1.13-2.417). Motivation for working as a GP was associated with "being female" (OR 2.56; 95%CI 1.80-3.56) and "presence of a professorship of general practice" (OR 1.68; 95%CI 1.14-2.46). Having a lower grade for one's university-entrance diploma was associated with a higher preference to work in one's own practice (OR 1.39; 95%CI 1.02-1.90).Conclusion: A high amount of medical students were open-minded towards general practice. However, they favoured employment within an organization over working in their own practice. Institutionalisation of general practice as an academic discipline might be of importance to gain positive attitudes towards general practice and motivate medical students to work as a GP.Zielsetzung: Der zunehmende HausĂ€rztemangel wird immer mehr zu einem realen Versorgungsproblem. Ziel war es, an drei UniversitĂ€ten mit unterschiedlichem Grad der Institutionalisierung des Fachs Allgemeinmedizin Einflussfaktoren zu ermitteln, die die Motivation fĂŒr eine spĂ€tere hausĂ€rztliche TĂ€tigkeit begĂŒnstigen. Methodik: In einem standardisierten Fragebogen wurde die Haltung gegenĂŒber dem Fach Allgemeinmedizin und die Bereitschaft zur Niederlassung in eigener hausĂ€rztlicher Praxis bzw. Motivation zur Arbeit in AnstellungsverhĂ€ltnissen erfasst. Einflussfaktoren auf Haltung und Motivation fĂŒr eine spĂ€tere hausĂ€rztliche TĂ€tigkeit wurden mittels binĂ€r logistischer Regression berechnet.Ergebnisse: 940 (15,2%) Studierende von insgesamt 6182 Studierenden aus drei bayerischen UniversitĂ€ten (Erlangen, LMU und TUM) haben sich an einer internetbasierten Umfrage beteiligt. 585 (62,7%) waren weiblich. Das Durchschnittsalter betrug 25,0 Jahre (Standardabweichung 3,7). Die durchschnittliche Abiturnote war 1,6 (Standardabweichung 0,5). 718 (76%) der Studierenden könnten sich eine hausĂ€rztliche Arbeit vorstellen, wobei die Anstellung der SelbststĂ€ndigkeit vorgezogen wird (65,5 vs. 35,1%). FĂŒr die wertschĂ€tzende Haltung gegenĂŒber der Allgemeinmedizin zeigt sich die "Existenz eines Lehrstuhls" als stĂ€rkster PrĂ€diktor (OR 1,57; 95%CI 1,13-2,417). Die stĂ€rksten PrĂ€diktoren fĂŒr die Motivation zu einer spĂ€teren hausĂ€rztlichen TĂ€tigkeit sind "weibliches Geschlecht" (OR 2,56; 95%CI 1,80-3,56) und die "Existenz eines Lehrstuhls" (OR 1,68; 95%CI 1,14-2,46). Eine weniger gute Abiturnote war mit einer höheren Bereitschaft zur SelbstĂ€ndigkeit assoziiert (OR 1.39; 95%CI 1.02-1.90).Schlussfolgerung: Diese Studie zeigt, dass durchaus viele Studierenden gegenĂŒber einer hausĂ€rztlichen TĂ€tigkeit aufgeschlossen sind, allerdings prĂ€ferenziell im AngestelltenverhĂ€ltnis und nicht in selbststĂ€ndiger Niederlassung. Eine Institutionalisierung der Allgemeinmedizin scheint bedeutsam zu sein fĂŒr eine positive Einstellung zum Fach und zur Motivation fĂŒr eine spĂ€tere hausĂ€rztliche TĂ€tigkeit
Messung des exhalierten Stickstoffmonoxids (FeNO) zur Diagnose eines Asthma bronchiale - ein systematischer Review
Accuracy of FE<sub>NO</sub> for diagnosing asthma: A systematic review.
BACKGROUND: Measurement of FENO might substitute bronchial provocation for diagnosing asthma. We aimed to investigate the diagnostic accuracy of FENO measurement compared with established reference standard. METHODS: Systematic review and diagnostic meta-analysis. Data sources were Medline, Embase and Scopus up to 29 November 2015. Sensitivity and specificity were estimated using a bivariate model. Additionally, summary receiver-operating characteristic curves were estimated. RESULTS: 26 studies with 4518 participants (median 113) were included. Risk of bias was considered low for six of seven items in five studies and for five items in seven studies. The overall sensitivity in the meta-analysis was 0.65 (95% CI 0.58 to 0.72), the overall specificity 0.82 (0.76 to 0.86), the diagnostic OR 9.23 (6.55 to 13.01) and the area under the curve 0.80 (0.77 to 0.85). In meta-regression analyses, higher cut-off values were associated with increasing specificity (OR 1.46 per 10â
ppb increase in cut-off) while there was no association with sensitivity. Sensitivities varied significantly within the different FENO devices, but not specificities. Neither prevalence, age, use of bronchoprovocation in >90% of participants or as exclusive reference standard test, nor risk of bias were significantly associated with diagnostic accuracy. CONCLUSIONS: There appears to be a fair accuracy of FENO for making the diagnosis of asthma. The overall specificity was higher than sensitivity, which indicates a higher diagnostic potential for ruling in than for ruling out the diagnosis of asthma