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Routine Treatment (routine + treatment)
Selected AbstractsEffectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the LiteratureACADEMIC EMERGENCY MEDICINE, Issue 5 2010Andrew Wing Abstract Objectives:, The objective was to examine the effectiveness of corticosteroid treatment for the relief of pain associated with acute pharyngitis potentially caused by group A beta-hemolytic Streptococcus (GABHS). Methods:, This was a systematic review of the literature. Data sources used were electronic databases (Cochrane Library, MEDLINE, EMBASE, Biosis Previews, Scopus, and Web of Science), controlled trial registration websites, conference proceedings, study references, experts in the field, and correspondence with authors. Selection criteria consisted of randomized controlled trials (RCTs) in which corticosteroids, alone or in combination with antibiotics, were compared to placebo or any other standard therapy for treatment of acute pharyngitis in adult patients, pediatric patients, or both. Two reviewers independently assessed for relevance, inclusion, and study quality. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs). Results:, From 272 potentially relevant citations, 10 studies met the inclusion criteria. When compared to placebo, corticosteroids reduced the time to clinically meaningful pain relief (WMD = ,4.54 hours; 95% CI = ,7.19 to ,1.89); however, they provided only a small reduction in pain scores at 24 hours (WMD = ,0.90 on a 0,10 visual analog scale; 95% CI = ,1.5 to ,0.3). Heterogeneity among pooled studies was identified for both outcomes (I2 = 81 and 74%, respectively); however, the GABHS-positive subgroup receiving corticosteroid treatment did have a significant mean reduction in time to clinically meaningful pain relief of 5.22 hours (95% CI = ,7.02 to ,3.42; I2 = 0%). Short-term side effect profiles between corticosteroids and placebo groups were similar. Conclusions:, Corticosteroid administration for acute pharyngitis was associated with a relatively small effect in time to clinically meaningful pain relief (4.5-hour reduction) and in pain relief at 24 hours (0.9-point reduction), with significant heterogeneity in the pooled results. Decision-making should be individualized to determine the risks and benefits; however, corticosteroids should not be used as routine treatment for acute pharyngitis. ACADEMIC EMERGENCY MEDICINE 2010; 17:476,483 © 2010 by the Society for Academic Emergency Medicine [source] The effect of ultrasonically activated irrigation on reduction of Enterococcus faecalis in experimentally infected root canalsINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2010A. J. Harrison Harrison AJ, Chivatxaranukul P, Parashos P, Messer HH. The effect of ultrasonically activated irrigation on reduction of Enterococcus faecalis in experimentally infected root canals. International Endodontic Journal, 43, 968,977, 2010. Abstract Aim, To investigate the ability of an ultrasonically activated irrigating system to eliminate bacteria from the canal wall and dentinal tubules of extracted teeth. Methodology, One hundred and thirty roots of intact human teeth were inoculated with Enterococcus faecalis for 4 weeks. The straight roots were randomly allocated to a baseline group (n = 25) or subjected to routine cleaning and shaping procedures (n = 105). Two sub-groups of prepared canals were then additionally exposed either to ultrasonic irrigation with 1% sodium hypochlorite (NaOCl) for 1 min (n = 35) or to 1 week of intracanal medication with calcium hydroxide [Ca(OH)2] (n = 35). All roots were processed for light microscopy (Brown and Brenn stain) (n = 28) or scanning electron microscopy (n = 7). Triplicate histological sections from each of the apical, middle and coronal thirds were scored for bacterial presence using pre-defined criteria. Results, Baseline bacterial penetration resulted in an average depth of tubule invasion of 151 ,m. Routine canal preparation failed to eliminate bacteria consistently from either the canal wall or within tubules. Ultrasonic irrigation and medication with Ca(OH)2 consistently eliminated bacteria from the canal wall (P < 0.001) compared with baseline and routine treatment, and more frequently from dentinal tubules than routine canal preparation alone (P < 0.01). Ultrasonic irrigation was as effective in bacterial reduction as 1 week of intracanal medication with Ca(OH)2, but neither led to complete bacterial elimination in all roots. Conclusions, Ultrasonically activated irrigation for 1 min with 1% NaOCl after canal preparation in straight root canals is potentially an effective supplementary step in microbial control. [source] Gastrointestinal parasites of the grasscutter (Thryonomys swinderianus, Temminck 1827) on the Accra Plains of GhanaAFRICAN JOURNAL OF ECOLOGY, Issue 3 2009Theodora Kankam Abstract The gastrointestinal parasites of the grasscutter were investigated between 1996 and 2006 using 180 grasscutters from the Accra Plains. The aim of the study was to develop strategies for the control of the parasites under captive management. The gastrointestinal tracts of the animals were examined for the presence of both helminth and protozoan parasites with the aid of a hand lens, the direct smear and Willis Flotation techniques. In all, fourteen species of helminths were found including twelve nematodes and two cestodes. Trichuris muris was the most common nematode encountered, whilst Hepatocola hepatica was the least commonly encountered nematode. Three genera of protozoans, viz, Trichomonas spp, Giardia spp and Eimeria spp were also encountered, with Giardia spp and Trichomonas spp being reported for the first time in the grasscutter. Eimeria spp were the most prevalent protozoa. The widespread occurrence of protozoal and helminthic parasites in the grasscutter suggests that routine treatment of grasscutters with coccidiostats, anti-flagellates and anthelminthics such as dimetridazole and albendazole may contribute significantly to improve productivity of animals and reduce the pressure on wild populations. Résumé Les parasites gastro-intestinaux de l'aulacode ont étéétudiés entre 1996 et 2006 sur 180 animaux des plaines d'Accra. Le but de l'étude était de mettre au point des stratégies pour le contrôle des parasites en captivité. Le tractus gastro-intestinal des animaux fut examiné pour détecter la présence d'helminthes et de protozoaires parasites au moyen d'une lentille à main, par prélèvement direct et par la technique de flottaison de Willis. En tout, on a trouvé 14 espèces d'helminthes, y compris 12 nématodes et deux cestodes. Trichuris murisétait le nématode le plus commun tandis que Hepatocola hepaticaétait le nématode le moins observé. Trois genres de protozoaires, c.-à-d. Trichomonas spp, Giardia spp et Eimeriaspp furent aussi observés, Giardia spp et Trichomonas spp étant rapportés pour la première fois chez l'aulacode. Eimeria spp était le protozoaire le plus répandu. La large présence de protozoaires et d'helminthes parasites chez l'aulacode suggère que le traitement de routine des aulacodes avec des coccidiostats, des antiflagellés et des antihelmintiques tels que le dimétridazole et l'albendazole peut contribuer significativement à améliorer la productivité des animaux et à réduire la pression sur les populations sauvages. [source] A12. IPL therapy in the inflammatory stage of rosaceaJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2002M Rone The inflammatory stage of Rosacea iscommonly treated with topical or oral antibiotics. However, if additional erythema and telangiectasias are present, antibiotics are not successful. IPL (intense pulsed light) is mostly involved when only initial or residual telangiectasias are present. Application of IPL simultaneously with topical or oral medicine could be an effective form of treatment in the inflammatory stage of rosacea. This study was performed in order to detect the effect of IPL application with simultaneous topical antibiotics in inflammatory rosacea and to assess the efficacy of IPL therapy in routine treatment of rosacea. Twenty patients aged between 34 and 70 with papulopustular rosacea (14 female and 7 male) were included in the study. Ten patients (group I) were treated for 21 weeks with topical metronidazole. The other ten patients (group II) received an additional 3 sessions with IPL 515,755 nm Photoderm VL technology over 4 weeks. Treatment affectivity was recorded by digital visualisation and patient satisfaction scale before each IPL session. In all patients, significant reductions in papulopustular elements were observed. Eight out of 10 patients (group I) still showed permanent erythema and telangiectasias despite topical treatment. In 3/10 patients a few telangiectasias remained following the treatment in contrast to 5/10 satisfied group I patients. The most effective treatment was the application of 570 nm and 590 nm wavelength at a fluence of 25,55 J/cm2. Application of IPL in inflammatory rosacea is equally as safe and effective in residual or initial lesions. Moreover, in combination with antibiotics, it promotes reduction of all symptoms, is less time-consuming and is more successful for patients. The pathogenetic influence of IPL in rosacea seems not only to be limited to selective photothermolysis of dilated blood vessels, but may also have immunomodulatory effects on inflammatory processes and possibly on collagen remodelling. The combination of IPL and antibiotics from theoutset of rosacea therapy is considered to be highly effective. [source] Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and ImplementationALCOHOLISM, Issue 2 2010Shelly F. Greenfield Background:, While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods:, We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results:, Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions:, The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings. [source] Experience of implementing an adult educational approach to treating anxiety disordersJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2005S. D. WOOD rmn rgn dms bsc pgce Lecturer Practitioner This paper describes the background to the development and delivery of a self-help package for anxiety disorders. Evidence of effectiveness is summarized. The paper outlines the intervention and describes the experience of two mental health nurses, who set out to assess its acceptability, evaluate its outcomes in routine clinical practice and assess the feasibility of its delivery by mental health nurses. Acceptability of the intervention was high, judged by retention and attendance rates. The pilot study produced promising clinical outcomes, especially for people with depression secondary to anxiety. Clinical measures showed significant improvements from pre-course to 6-month follow-up in anxiety, psychological well-being and depression. The outcomes suggest that appropriately trained mental health nurses could deliver the intervention as a routine treatment. The paper concludes by discussing future plans, including a randomized controlled trial and implementation in primary care. [source] VENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKSJOURNAL OF RENAL CARE, Issue 4 2008Jean-Pierre Van Waeleghem SUMMARY Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008). [source] Current management of mucosal melanoma of the head and neckJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003Jesus E. Medina MD Abstract While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies. J. Surg. Oncol. 2003;83:116,122. © 2003 Wiley-Liss, Inc. [source] Efficacy and tolerability of peginterferon alfa-2a or alfa-2b plus ribavirin in the daily routine treatment of patients with chronic hepatitis C in Germany: The PRACTICE StudyJOURNAL OF VIRAL HEPATITIS, Issue 7 2010T. Witthoeft Summary., In randomized clinical trials, treatment with peginterferon plus ribavirin (RBV) results in a sustained virological response (SVR) in around half of hepatitis C virus genotype 1-infected and 80% of genotype 2/3-infected individuals. This study aimed to evaluate efficacy and tolerability of peginterferon alfa-2a plus RBV compared with peginterferon alfa-2b plus RBV for the treatment of chronic hepatitis C in routine clinical practice. The intent-to-treat cohort consisted of 3414 patients treated with either peginterferon alfa-2a plus RBV (Group A) or peginterferon alfa-2b plus RBV (Group B) in 23 centres participating in the large, multicentre, observational PRACTICE study. Collected data included baseline characteristics, treatment regimen, RBV dose and outcome. Rates of early virological response, end of treatment response and SVR were 76.6%, 75.7% and 52.9% in Group A, and 70.2%, 65.6% and 50.5% in Group B, respectively. In patients matched by baseline parameters, 59.9% of patients in Group A and 55.9% in Group B achieved an SVR (P , 0.051). In genotype 1-infected patients matched by baseline parameters and cumulative RBV dose, SVR rates were 49.6% and 43.7% for Group A and Group B, respectively (P , 0.047); when matched by baseline parameters and RBV starting dose, SVR rates were 49.9% and 44.6%, respectively (P = 0.068). Overall, 21.8% of group A and 29.6% of group B patients discontinued treatment (P , 0.0001). The efficacy and tolerability of peginterferon plus RBV in this large cohort of patients treated in routine daily practice was similar to that in randomized clinical trials. In matched pairs analyses, more patients achieved an SVR with peginterferon alfa-2a compared with peginterferon alfa-2b. [source] Acute kidney injury and renal replacement therapy in the intensive care unitNURSING IN CRITICAL CARE, Issue 4 2009Peter Faber Abstract Background:, Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof. Aims and objectives:, The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature. Search strategies:, Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review. Conclusion:, AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required. [source] Initial Clinical Experience With the HeartMate II Ventricular Assist System in a Pediatric InstitutionARTIFICIAL ORGANS, Issue 7 2010William R. Owens Abstract In many adult cardiac programs, intracorporeal mechanical circulatory support has become a routine treatment for end-stage cardiac failure. For the pediatric population, options are often limited by a small body habitus. Even when an adolescent's weight may suggest adequate space for device implant, most intracorporeal adult devices remain too large for adolescents. The Thoratec HeartMate II (HM II) (approved by the FDA in April of 2008) is a small, noiseless device that is easily operated and monitored. By having an uncomplicated operating system and small percutaneous drive line, the HM II provides an opportunity for these patients to aggressively rehabilitate to become a better transplant candidate and also provides the potential to be discharged home. The two youngest patients ever to utilize the HM II are also the first two cases of using the HM II at a freestanding pediatric hospital. A 12-year-old, 53 kg, girl with dilated cardiomyopathy was supported for 85 days before receiving her heart transplant. The second patient, a 13-year-old, 149 kg, Hispanic male suffering from morbid obesity and dilated cardiomyopathy, was supported for 128 days. The HM II allowed for rehabilitation and nutritional education, resulting in this patient losing 50 kg before heart transplant. Despite both of these patients' size, their thoracic cavities were that of a preadolescent and thus techniques were developed to avoid morbidities like chest wall abrasion and bleeding. Because of differences between adult and pediatric patients and institutions, these cases provided unique challenges. However, as pediatric device therapy is now maturing, pediatric programs such as Texas Children's Hospital have begun to develop strategies for mechanical support that factor in patient's size and need for long-term or temporary support, utilizing the growing number of devices (i.e., Jostra Rotoflow, Tandem Heart PTVA, Thoratec CentriMag, Berlin Heart EXCOR, etc.) that are now available to children. [source] | ||||||||||