Survey of Spanish general practitioners' attitudes toward management of sore throat: an internet-based questionnaire study

BACKGROUND: The management of sore throat varies widely in Europe. The objective of this study was to gain insight into clinicians' perceptions on the current management of sore throat in Spain. METHODS: Cross-sectional, internet-based questionnaire study answered from July to September 2013. General practitioners (GPs) affiliated with the two largest scientific societies of primary care were invited to participate in the study. Questions were asked about physician knowledge, the use of current national guidelines for sore throat management, and management in two clinical scenarios, depicting a young adult with sore throat and: 1. cough, coriza with or without fever, and 2. fever without cough and coriza. RESULTS: The questionnaire was completed by 1476 GPs (5%) and 12.7% declared using rapid antigen detection tests. Antibiotics were considered by 18.8% of the GPs in the first scenario and by 32% in the second scenario (p < 0.001). The antibiotics most commonly mentioned by GPs were amoxicillin and amoxicillin + clavulanate (52.7 and 31.2%, respectively) whereas penicillin V was only prescribed in 11.9% of the cases. The drugs most commonly considered in both scenarios were analgesics and anti-inflammatory drugs. Antitussives, decongestants and expectorants were more commonly prescribed in cases of suspected viral infection (p < 0.001). CONCLUSIONS: GPs have misconceptions as to the indications for using rapid antigen detection tests and prescribing drugs in the management of sore throat. These results suggest that guidelines are seldom followed since one in five GPs declared giving antibiotics for patients with a suspected viral infection and the use of second-choice antibiotics seems considerable

Tratamiento de la hiperhidrosis craneofacial y el rubor mediante el bloqueo del ganglio esfenopalatino por vía endoscòpica trasnasal

[cat] Introducció: la hiperhidrosi craniofacial i el rubor manifesten una disfunció del sistema nerviós autònom. Segons les referències disponibles a data d’avui, hi ha una mancança d’adherència als tractaments realitzats, potencialment a causa de falta d’eficàcia. Objectiu: L’objectiu d’aquest estudi va ser determinar l’eficàcia del tractament de la hiperhidrosi craniofacial i el rubor mitjançant un bloqueig del gangli esfenopalatí comparant dues tècniques diferents. Metodologia: Tots els pacients amb hiperhidrosi craniofacial o rubor (n=25) varen ser aleatoritzats en una proporció de 1:3 en dos grups diferents; 1) aplicació de lidocaïna tòpica (LT) sota visió endoscòpica a l’àrea de projecció del gangli esfenopalatí (n=7); ó 2) injecció de lidocaïna (LI) al gangli esfenopalatí sota visió endoscòpica (n=18). La hiperhidrosi craniofacial, el rubor, la rinorrea, l’obstrucció nasal i la detecció de pèrdues del gust i olfacte varen ser valorades per escala visual analògica (EVA). Es van emprar endoscòpia nasal, rinometria acústica, test de transport mucociliar, test de gust i olfacte, test de Schirmer i tests de qualitat de vida a les visites de seguiment als 0, 1, 3 i 6 mesos respectivament. Resultats: De forma basal, ambdós grups d’estudi varen demostrar EVA similars d’hiperhidrosi craniofacial (LT: 89,3 ± 17,5 mm; LI: 85,7 ± 22,1 mm) o de rubor (LT: 52,7 ± 30 mm; LI: 59 ± 33,8 mm). Als 6 mesos, la mitjana de mínims quadrats de l’EVA d’hiperhidrosi craniofacial va ser de -38,1 (-47,3 a -28,9; p<0,001) per al grup LI i de 1,9 (-12,2 a 15,9; p<0,001) per al grup LT. Tot i això, l’EVA del rubor no va millorar de manera significativa. Ni els resultats de les proves rinològiques, ni els tests de qualitat de vida varen mostrar canvis significatius. Un pacient del grup LI va presentar un episodi d’epistaxi que fou controlat durant l’acte quirúrgic. Conclusions: Aquest estudi demostra que el bloqueig del gangli esfenopalatí mitjançant injecció (grup LI) és un procediment segur i eficaç. Els pacients amb hiperhidrosi craniofacial o rubor varen mostrar millora dels seus símptomes després del bloqueig del gangli esfenopalatí per injecció de lidocaïna i aquest efecte va durar els 6 mesos de seguiment.[eng] Introduction: craniofacial hyperhidrosis and flushing express a dysfunction of the autonomic nervous system. According to the current knowledge, there is poor adherence to the offered treatments, potentially due to lack of efficacy. Objective: The aim of this study was to determine the efficacy of treatment of craniofacial hyperhidrosis and flushing by using sphenopalatine ganglion blockade and comparing two different techniques. Methodology: All patients with craniofacial hyperhidrosis or flushing (n=25) were randomized in a proportion of 1: 3 in two different groups; 1) application of topical lidocaine (TL) under endoscopic vision to the sphenopalatine ganglion projection area (n=7); or 2) lidocaine injection (IL) to the sphenopalatine ganglion under endoscopic vision (n=18). Craniofacial hyperhidrosis, flushing, rhinorrhea, nasal obstruction, and detection of loss of taste and loss of smell were assessed by visual analogue scale (VAS). Nasal endoscopy, acoustic rhinometry, mucociliary transport test, taste and smell tests, Schirmer test and quality of life tests were performed at the follow-up visits at 0, 1, 3, and 6 months respectively. Results: At baseline, both groups showed similar VAS in terms of craniofacial hyperhidrosis (TL: 89.3 ± 17.5 mm; IL: 85.7 ± 22.1 mm) or flushing (TL: 52.7 ± 30 mm; IL: 59 ± 33.8 mm). At 6 months of follow-up, the mean of the least squares mean change of the VAS of craniofacial hyperhidrosis was for IL -38.1 (-47.3 to -28.9; p<0.001) in the IL group, and that of TL 1.9 (-12.2 to 15.9; p<0.001) in the TL group. However, the flushing VAS did not improve significantly. Neither the results of the rhinological tests nor the quality of life tests showed significant changes. One IL patient presented an episode of epistaxis that was completely controlled during the procedure. Conclusions: This study demonstrates that sphenopalatine ganglion blockade by transnasal injection (IL group) is an effective and safe procedure. Patients with craniofacial hyperhidrosis or flushing showed improvement of their symptoms after sphenopalatine ganglion blockade by lidocaine injection and those effects lasted for the whole follow-up period (6 months)

Tratamiento de la hiperhidrosis craneofacial y el rubor mediante el bloqueo del ganglio esfenopalatino por vía endoscòpica trasnasal

Programa de Doctorat en Medicina i Recerca Translacional[cat] Introducció: la hiperhidrosi craniofacial i el rubor manifesten una disfunció del sistema nerviós autònom. Segons les referències disponibles a data d’avui, hi ha una mancança d’adherència als tractaments realitzats, potencialment a causa de falta d’eficàcia. Objectiu: L’objectiu d’aquest estudi va ser determinar l’eficàcia del tractament de la hiperhidrosi craniofacial i el rubor mitjançant un bloqueig del gangli esfenopalatí comparant dues tècniques diferents. Metodologia: Tots els pacients amb hiperhidrosi craniofacial o rubor (n=25) varen ser aleatoritzats en una proporció de 1:3 en dos grups diferents; 1) aplicació de lidocaïna tòpica (LT) sota visió endoscòpica a l’àrea de projecció del gangli esfenopalatí (n=7); ó 2) injecció de lidocaïna (LI) al gangli esfenopalatí sota visió endoscòpica (n=18). La hiperhidrosi craniofacial, el rubor, la rinorrea, l’obstrucció nasal i la detecció de pèrdues del gust i olfacte varen ser valorades per escala visual analògica (EVA). Es van emprar endoscòpia nasal, rinometria acústica, test de transport mucociliar, test de gust i olfacte, test de Schirmer i tests de qualitat de vida a les visites de seguiment als 0, 1, 3 i 6 mesos respectivament. Resultats: De forma basal, ambdós grups d’estudi varen demostrar EVA similars d’hiperhidrosi craniofacial (LT: 89,3 ± 17,5 mm; LI: 85,7 ± 22,1 mm) o de rubor (LT: 52,7 ± 30 mm; LI: 59 ± 33,8 mm). Als 6 mesos, la mitjana de mínims quadrats de l’EVA d’hiperhidrosi craniofacial va ser de -38,1 (-47,3 a -28,9; p<0,001) per al grup LI i de 1,9 (-12,2 a 15,9; p<0,001) per al grup LT. Tot i això, l’EVA del rubor no va millorar de manera significativa. Ni els resultats de les proves rinològiques, ni els tests de qualitat de vida varen mostrar canvis significatius. Un pacient del grup LI va presentar un episodi d’epistaxi que fou controlat durant l’acte quirúrgic. Conclusions: Aquest estudi demostra que el bloqueig del gangli esfenopalatí mitjançant injecció (grup LI) és un procediment segur i eficaç. Els pacients amb hiperhidrosi craniofacial o rubor varen mostrar millora dels seus símptomes després del bloqueig del gangli esfenopalatí per injecció de lidocaïna i aquest efecte va durar els 6 mesos de seguiment.[eng] Introduction: craniofacial hyperhidrosis and flushing express a dysfunction of the autonomic nervous system. According to the current knowledge, there is poor adherence to the offered treatments, potentially due to lack of efficacy. Objective: The aim of this study was to determine the efficacy of treatment of craniofacial hyperhidrosis and flushing by using sphenopalatine ganglion blockade and comparing two different techniques. Methodology: All patients with craniofacial hyperhidrosis or flushing (n=25) were randomized in a proportion of 1: 3 in two different groups; 1) application of topical lidocaine (TL) under endoscopic vision to the sphenopalatine ganglion projection area (n=7); or 2) lidocaine injection (IL) to the sphenopalatine ganglion under endoscopic vision (n=18). Craniofacial hyperhidrosis, flushing, rhinorrhea, nasal obstruction, and detection of loss of taste and loss of smell were assessed by visual analogue scale (VAS). Nasal endoscopy, acoustic rhinometry, mucociliary transport test, taste and smell tests, Schirmer test and quality of life tests were performed at the follow-up visits at 0, 1, 3, and 6 months respectively. Results: At baseline, both groups showed similar VAS in terms of craniofacial hyperhidrosis (TL: 89.3 ± 17.5 mm; IL: 85.7 ± 22.1 mm) or flushing (TL: 52.7 ± 30 mm; IL: 59 ± 33.8 mm). At 6 months of follow-up, the mean of the least squares mean change of the VAS of craniofacial hyperhidrosis was for IL -38.1 (-47.3 to -28.9; p<0.001) in the IL group, and that of TL 1.9 (-12.2 to 15.9; p<0.001) in the TL group. However, the flushing VAS did not improve significantly. Neither the results of the rhinological tests nor the quality of life tests showed significant changes. One IL patient presented an episode of epistaxis that was completely controlled during the procedure. Conclusions: This study demonstrates that sphenopalatine ganglion blockade by transnasal injection (IL group) is an effective and safe procedure. Patients with craniofacial hyperhidrosis or flushing showed improvement of their symptoms after sphenopalatine ganglion blockade by lidocaine injection and those effects lasted for the whole follow-up period (6 months)

Survey of Spanish general practitioners' attitudes toward management of sore throat: an internet-based questionnaire study

BACKGROUND: The management of sore throat varies widely in Europe. The objective of this study was to gain insight into clinicians' perceptions on the current management of sore throat in Spain. METHODS: Cross-sectional, internet-based questionnaire study answered from July to September 2013. General practitioners (GPs) affiliated with the two largest scientific societies of primary care were invited to participate in the study. Questions were asked about physician knowledge, the use of current national guidelines for sore throat management, and management in two clinical scenarios, depicting a young adult with sore throat and: 1. cough, coriza with or without fever, and 2. fever without cough and coriza. RESULTS: The questionnaire was completed by 1476 GPs (5%) and 12.7% declared using rapid antigen detection tests. Antibiotics were considered by 18.8% of the GPs in the first scenario and by 32% in the second scenario (p < 0.001). The antibiotics most commonly mentioned by GPs were amoxicillin and amoxicillin + clavulanate (52.7 and 31.2%, respectively) whereas penicillin V was only prescribed in 11.9% of the cases. The drugs most commonly considered in both scenarios were analgesics and anti-inflammatory drugs. Antitussives, decongestants and expectorants were more commonly prescribed in cases of suspected viral infection (p < 0.001). CONCLUSIONS: GPs have misconceptions as to the indications for using rapid antigen detection tests and prescribing drugs in the management of sore throat. These results suggest that guidelines are seldom followed since one in five GPs declared giving antibiotics for patients with a suspected viral infection and the use of second-choice antibiotics seems considerable

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments

To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. Background: To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. Methods: Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. Results: The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. Conclusions: Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS