1,721,894 research outputs found
Advice to parents has limited effect—where next?
No full textThis study shows nicely that it may be possible to train doctors to inform mothers regarding danger signs, but that about half of mothers do not recall the information—and of those who recall the advice, many do not seem to act on it.Why do patients not follow doctors' advice? Several factors are likely to be operating. Advice from a health professional comes in the context of previous and subsequent experiences of illness and illness resolution, either personally or among family and friends, and these are likely to be strong modifiers of consultation behaviour. For example, parents may have experienced "danger signs" but nothing adverse happened, thus minimising the perceived threat. Furthermore, although doctors' advice is respected, lifestyle, demographic, and psychosocial factors and community support mechanisms are also likely to be important in determining consultation behaviour.Although the context is slightly different, the issues in developed and developing societies are similar: to help patients manage their own problems where appropriate, but to encourage seeking medical help where serious medical problems are more likely to arise. Several trials of providing information for parents in Western settings have shown that although patients like having information and feel more able to deal with minor illness, the effect on consultation behaviour are likely to be modest. This suggests that until more effective interventions are developed, information should probably be made available in line with patients' preferences, but should not be widely and routinely disseminated, given the attendant costs. In contrast to information provided outside the context of consultations, there is evidence that information provided to patients in a consultation—about the clinical course and self management of the presenting illness—may be helpful.Further research in this area could concentrate on using better established psychological models which engage with the antecedents of consultation behaviour, and identifying those patients who will selectively benefit from the provision of information
Penicillin for acute sore throat in children: randomised, double blind trial
No full textObjective: To assess the effectiveness of penicillin for three days
and treatment for seven days compared with placebo in
resolving symptoms in children with sore throat.Design: Randomised, double blind, placebo controlled trial.Setting: 43 family practices in the Netherlands.Participants: 156 children aged 4-15 who had a sore throat for
less than seven days and at least two of the four Centor criteria
(history of fever, absence of cough, swollen tender anterior
cervical lymph nodes, and tonsillar exudate).
Interventions Patients were randomly assigned to penicillin for
seven days, penicillin for three days followed by placebo for
four days, or placebo for seven days.Main outcome measures: Duration of symptoms, mean
consumption of analgesics, number of days of absence from
school, occurrence of streptococcal sequelae, eradication of the
initial pathogen, and recurrences of sore throat after six months.
Results Penicillin treatment was not more beneficial than
placebo in resolving symptoms of sore throat, neither in the
total group nor in the 96 children with group A streptococci. In
the groups randomised to seven days of penicillin, three days of
penicillin, or placebo, one, two, and eight children, respectively,
experienced a streptococcal sequela.Conclusion: Penicillin treatment had no beneficial effect in
children with sore throat on the average duration of symptoms.
Penicillin may, however, reduce streptococcal sequelae
Watchful waiting is useful for children with recurrent throat infections
No full textVan Staaij et al's study is a welcome addition to a controversial subject.1 It shows that for children with moderately frequent throat infections (on average three in the previous year) a "wait and see" approach results in acceptable control of symptoms and avoids postoperative pain and complications (1% requiring operative surgery for haemorrhage, and 2.6% having severe nausea or dehydration). The major limitation of the study is the large number of children from the watchful waiting group who had tonsillectomy (34%). Since a per protocol analysis was not done—that is, comparing those who had tonsillectomy with those who did not, controlling for severity indices—it cannot be concluded that tonsillectomy in itself is ineffective but simply that immediate tonsillectomy is not effective. The data from this trial, however, match data from a similar trial, which reported little symptomatic benefit and a significant rate of complications (7%) among children who had tonsillectomy for more severe symptoms.<br/
Otitis media with effusion: the long and winding road?
No full textOtitis media with effusion (OME) or glue ear has increased as a diagnosis in primary care over the past decade while grommet
rates have declined. When developmental concerns are raised by parents or the child is noted to have frequent ear related
problems, this often leads to referral and request for further expert assessment. Referral rates show more variability than
for other ENT conditions such as tonsillectomy, and may partly relate to the present relative lack of accurate structured
assessments in primary care
[Review]. Humidified air inhalation for treating croup
No full textBACKGROUND: Croup (laryngotracheobronchitis) is a common cause of upper airway obstruction in children with a peak incidence of 60 per 1000 child years in those aged between one and two years. It is characterised by hoarseness, a barking cough, and inspiratory stridor. These symptoms are thought to occur as a result of oedema of the larynx and trachea, which have been triggered by a recent viral infection. Para influenza virus type 1 is the agent most commonly identified in cases of croup. Severe cases are admitted to hospital and steroid treatment is established to reduce disease severity. Treatment with humidified air was previously widely used and is still commonly recommended as home treatment.OBJECTIVES: To assess the efficacy of humidified air in the treatment of croup.SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005), MEDLINE (1966 to January 2006) and EMBASE (1990 to January 2006).SELECTION CRITERIA: Randomised controlled trials (RCTs) involving children suffering from croup treated with humidified air. DATA COLLECTION AND ANALYSIS: Two authors independently identified potentially relevant abstracts identified from the search and then assessed the full papers for inclusion and methodological quality. Outcome measures included mortality, ventilation, admission to hospital, re-contact with medical services, number of days off school and relief of symptoms; these were separately analysed for the week following treatment. Data extraction was performed by the two authors then entered by one and checked by the second author. Missing data were obtained from trails authors where possible. Data were analysed using Review Manager version 4.2. Sensitivity and sub-group analysis were not possible due to the paucity of trials.MAIN RESULTS: Three studies in emergency settings provided data on 135 patients with moderate croup for the main outcome (croup score). The combined results from 20 to 60 minutes in the three studies marginally favoured the treatment group with a weighted standardised mean difference of -0.14 (95% confidence interval (CI) -0.75 to 0.47). No other outcomes were significantly different between the groups.AUTHORS' CONCLUSIONS: The croup score of children managed in an emergency setting with mild to moderate croup probably does not improve greatly with inhalation of humidified air. Further research is needed in primary care settings, using a wider range of more sensitive outcome measures
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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