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1.
Vestn Otorinolaringol ; 85(5): 40-43, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140932

RESUMO

The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease. METHODS: Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics¼, «thiamphenicol glycinate acetylcysteine¼ «biofilm¼, «respiratory tract infection¼, «N-acetylcysteine¼. RESULTS: The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.


Assuntos
Infecções Respiratórias , Sinusite , Acetilcisteína , Doença Aguda , Antibacterianos/uso terapêutico , Combinação de Medicamentos , Humanos , Infecções Respiratórias/tratamento farmacológico , Sinusite/tratamento farmacológico
3.
Am J Respir Cell Mol Biol ; 63(5): 707-709, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32857620
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32747473

RESUMO

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.


Assuntos
Antibacterianos/uso terapêutico , Educação a Distância/organização & administração , Prescrição Inadequada/prevenção & controle , Atenção Primária à Saúde , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Bronquite/tratamento farmacológico , Bronquite/virologia , Chicago , Criança , Pré-Escolar , Comunicação , Intervalos de Confiança , Educação a Distância/métodos , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Modelos Logísticos , Masculino , Razão de Chances , Otite Média/tratamento farmacológico , Pacientes Ambulatoriais , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/estatística & dados numéricos , Pediatras/educação , Pediatras/estatística & dados numéricos , Faringite/tratamento farmacológico , Faringite/microbiologia , Faringite/virologia , Desenvolvimento de Programas , Melhoria de Qualidade , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Sinusite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico
5.
BMJ Case Rep ; 13(7)2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690571

RESUMO

A 45-year-old man presented with acute sinusitis. He was treated with a 10-day course of trimethoprim/sulfamethoxazole, and a subsequent 14-day course of amoxicillin-clavulanate with no improvement in symptoms. Culture of purulent nasal secretions revealed the rare enterobacter Cedecea lapagei The patient had complete resolution of his symptoms after a 14-day course of gentamicin/dexamethasone nasal rinses. Emerging pathogens have been a timeless concern for physicians, as witnessed by the current SARS-CoV-2 outbreak. C. lapagei has been reported to cause human infection only a dozen times since its discovery, all in severely compromised patients. This is the first documented case of sinusitis reported with C. lapagei and may portend a rising prevalence of disease burden in the general population. This case demonstrates the necessity of obtaining cultures when standard antibiotics result in treatment failure.


Assuntos
Dexametasona/administração & dosagem , Infecções por Enterobacteriaceae/tratamento farmacológico , Gentamicinas/administração & dosagem , Sinusite/tratamento farmacológico , Doença Aguda , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Dexametasona/uso terapêutico , Quimioterapia Combinada/métodos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sinusite/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
7.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32616629

RESUMO

OBJECTIVES: To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care. METHODS: We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting. RESULTS: Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; P ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; P ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites. CONCLUSIONS: School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.


Assuntos
Corticosteroides/uso terapêutico , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Sinusite/tratamento farmacológico , Adolescente , Assistência Ambulatorial , Criança , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Medicaid , Guias de Prática Clínica como Assunto , South Carolina , Estados Unidos
8.
Rev Chilena Infectol ; 37(1): 77-81, 2020 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-32730404

RESUMO

The episodes of febrile neutropenia are severe cases that require an exhaustive etiological study and a quick start of antimicrobial agents. Within the possible microorganisms, fungal origins are also found, and depending on its tissue invasion, they can reach a high mortality rate. A case of a pediatric patient who suffered from acute myeloid leukemia is reported, and after his induction chemotherapy, the patient showed an episode of febrile neutropenia, which matches a rhinosinusal infection caused by Exserohilum rostratum, a filamentous fungi that is uncommonly associated with pathological cases. An antifungal therapy and an early surgical treatment were started, which lead to a positive response, without complications to the patient. After the monitoring and receiving secondary prophylaxis during the episodes of neutropenia, the patient hasn't presented new injuries nor rhinosinusal damage.


Assuntos
Antifúngicos , Ascomicetos , Leucemia Mieloide Aguda , Micoses , Sinusite , Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Criança , Humanos , Leucemia Mieloide Aguda/complicações , Micoses/complicações , Micoses/tratamento farmacológico , Neutropenia/etiologia , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/microbiologia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(23): e20611, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502036

RESUMO

BACKGROUND: Sinusitis is a common condition worldwide, significantly affecting the quality of life of patients. Due to the limitations of conventional medicines, such as serious side effects and low efficacies, Gelomyrtol may be a promising treatment for sinusitis. As no related systematic review has been published, the purpose of this study will be to evaluate the safety and efficacy of Gelomyrtol for acute or chronic sinusitis. METHODS: PubMed, EMBASE, the Cochrane Library, the Web of Science, the Chinese National Knowledge Infrastructure Database, the Chinese Biomedical Literature Database, the Wan Fang Database, and the Chongqing VIP Chinese Science, and Technology Periodical Database will be searched from their commencement until July 2020. Randomized controlled trials of Gelomyrtol for acute or chronic sinusitis will be selected in any language. Primary outcomes will include the Sino-Nasal Outcome Test-22 (SNOT-22) score, quality of life score as measured by SF-36, and the change in computed tomography (CT) score. Study selection, data extraction, and deviation risk assessment will be carried out by 2 investigators independently. RevMan V.5.3 software will be used to analyze the study data. RESULTS: The study will provide high-quality evidence for estimating the efficacy and safety of Gelomyrtol in the treatment of acute or chronic sinusitis. CONCLUSIONS: This systematic review will explore whether Gelomyrtol is an effective and safe intervention in the treatment of acute or chronic sinusitis. ETHICS AND DISSEMINATION: As no patient data will be used in this study, ethical approval will not be required. The review will be published as an article or a conference presentation in a peer-reviewed journal. REGISTRATION: OSF registration number: DOI 10.17605/OSF.IO/MTEU2.


Assuntos
Mentol/análogos & derivados , Sinusite/tratamento farmacológico , Doença Aguda/terapia , Doença Crônica/tratamento farmacológico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Mentol/uso terapêutico , Metanálise como Assunto , Revisões Sistemáticas como Assunto
12.
Medicine (Baltimore) ; 99(22): e20354, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481416

RESUMO

BACKGROUND: Chronic rhinosinusitis and nasal polyps (CRNP) is a common public health concern for general population, and is thought to negatively impact their quality of life. Although previous studies have reported that nasal nebulization inhalation of budesonide (NNIB) can benefit patients with such condition, its conclusions are still inconsistent. Thus, this study will assess the efficacy and safety of NNIB for the treatment of CRNP. METHODS: To identify any associated studies, we will comprehensively and systematically search Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search all electronic databases from inception to the present with no limitations of language and publication status. Two independent reviewers will undertake selection of study, data collection, and study quality evaluation, respectively. Another reviewer will help to settle down any different opinions between both of them. Study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will assess the efficacy and safety of NNIB for the treatment of CRNP through assessing primary outcomes of nasal symptoms and polyp sizes, and secondary outcomes of serum cortisol levels, health-related quality of life, and any expected and unexpected adverse events. CONCLUSION: The results of this study will summarize the up-to-date evidence on assessing the efficacy and safety of NNIB for the treatment of CRNP. STUDY REGISTRATION NUMBER: INPLASY202040108.


Assuntos
Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Administração Intranasal , Anti-Inflamatórios/administração & dosagem , Budesonida/administração & dosagem , Doença Crônica , Humanos , Nebulizadores e Vaporizadores
13.
Am J Otolaryngol ; 41(5): 102604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32563787

RESUMO

OBJECTIVES: The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. MATERIALS AND METHODS: This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). RESULTS: Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. CONCLUSIONS: In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.


Assuntos
Antibacterianos/uso terapêutico , Mupirocina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Povidona-Iodo/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Anti-Infecciosos Locais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Rinite/diagnóstico , Rinite/etiologia , Solução Salina , Método Simples-Cego , Sinusite/diagnóstico , Sinusite/etiologia , Irrigação Terapêutica
14.
Am J Otolaryngol ; 41(5): 102564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32593046

RESUMO

Acute rhinosinusitis (ARS) can be characterized as bacterial (ABRS) and require antibiotic therapy only in 0.5-5% of cases. In most cases, the disease is in a viral and post-viral form, which requires pathogenetic and symptomatic treatment. The study objective was to determine the efficacy of BNO 1012 extract in the technology of delayed antibiotic prescribing in children with acute rhinosinusitis. METHODS: 292 children aged 6 to 11 years with ARS were randomized in the multicenter, comparative study. They received an extract of five medicinal plants in addition to standard symptomatic therapy or standard therapy only. EVALUATION CRITERIA: reduction of the sinusitis severity according to a 4-point medical assessment scale (nasal congestion, severity of anterior and posterior rhinorrhea) at each visit, dynamics of self-scoring of rhinorrhea and headache (according to a 10-point visual analogue scale), "therapeutic benefit" in days, frequency of antibiotic prescriptions due to the use of an extract of five plants. RESULTS: The use of the 5-plant extract BNO 1012 in addition to the standard symptomatic treatment of acute rhinosinusitis provides a clinically significant, adequate reduction in the severity of rhinorrhea, nasal congestion and post-nasal drip, assessed by a physician at V2 (p < 0.005). Significant differences are noted in the patient's self-scoring of rhinorrhea on the second or third day in viral RS, and from the fourth to the eighth day in post-viral RS. Symptoms of similar intensity in control group were observed at V3. Thus, in the first week of treatment, the treatment group compared to the control one showed a "therapeutic benefit" of three days. The use of BNO 1012 in patients with acute rhinosinusitis can 1.81-fold reduce the prescription of antibacterial drugs. CONCLUSION: The combination of five medicinal plants is effective for the treatment of acute rhinosinusitis in children aged 6 to 11 years. Its use provides a significant "therapeutic benefit" when administered in addition to standard symptomatic therapy, reducing the need for antibiotic use.


Assuntos
Antibacterianos/administração & dosagem , Sobremedicalização/prevenção & controle , Fitoterapia , Extratos Vegetais/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Administração Oral , Criança , Feminino , Humanos , Masculino , Obstrução Nasal/tratamento farmacológico , Obstrução Nasal/etiologia , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Rinite/complicações , Rinite/microbiologia , Rinite/virologia , Sinusite/complicações , Sinusite/microbiologia , Sinusite/virologia
15.
Laryngorhinootologie ; 99(7): 483-493, 2020 07.
Artigo em Alemão | MEDLINE | ID: mdl-32585720

RESUMO

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal mucosa, lasting for more than 12 weeks. By now approximately 15 % of the European and American population are affected, which indicates that CRS is a serious health problem. Beside other subgroups the most important classification is CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). Standard-of-care therapies include nasal saline solution as well as topic or systemic corticosteroids. If this does not lead to a sufficient recovery, surgical therapy is a good option. A new therapy option is represented by biologics, particularly monoclonal antibodies (mAB). They are well-established for treatment of asthma bronchiale. Due to the fact that asthma is often associated with nasal polyps, and mAB may could also lead to improvements in CRS, studies were conducted. In the meantime there is a number of mAB which have emerged as an alternative treatment for patients with CRSwNP.


Assuntos
Produtos Biológicos , Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
16.
J Fam Pract ; 69(5): 244-250, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32555754

RESUMO

Yes, the majority of antibiotics prescribed for acute rhinosinusitis are unnecessary, but when should you prescribe one and which one(s) should you use?


Assuntos
Antibacterianos/uso terapêutico , Padrões de Prática Médica , Rinite/tratamento farmacológico , Rinite/etiologia , Sinusite/tratamento farmacológico , Sinusite/etiologia , Doença Aguda , Humanos , Rinite/diagnóstico , Sinusite/diagnóstico
18.
Ann Otol Rhinol Laryngol ; 129(10): 969-976, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456442

RESUMO

OBJECTIVE: Previous investigations suggest the use of extract from the root of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated acute upper airway inflammations, due to its strong antimicrobial and immunomodulatory effect. We aimed to compare clinical efficacy, safety and bactericidal effect of EPs 7630 and amoxicillin monotherapy in treatment of patients with mild to moderate acute bacterial rhinosinusitis (ABRS). METHODS: Fifty ABRS patients were divided into two groups by randomization. Group 1 (n = 25) received EPs 7630 tablets, 3 × 20 mg/day per os for 10 days. Group 2 (n = 25) received amoxicillin tablets 3 × 500 mg/day per os, for 10 days. We assessed total symptom score (TSS), individual symptom scores for each symptom (nasal obstruction, rhinorrhea, postnasal drip, facial pain/pressure, loss of the sense of smell), endoscopic findings, including total endoscopic score (TES) and individual endoscopic signs (mucosal edema, mucopurulent secretion), before and after treatment. Samples of discharge taken from the middle meatus of all patients were cultivated for bacteria before and after therapy. RESULTS: Higher absolute improvement after treatment was found for TSS, nasal obstruction, facial pain/pressure, impaired sense of smell, TES, mucosal edema and mucopurulent secretion in EPs 7630 group compared to amoxicillin group (P < .001 for all parameters). However, there were no differences in absolute improvement of rhinorrhea score and postnasal drip score between groups (P = .248; P = .679, respectively). Fewer types of bacteria grew on culture from middle meatal samples in EPs 7630 group compared to amoxicillin group. There were no reported adverse events from patients from either group. CONCLUSION: Our results demonstrated better clinical and antimicrobial efficacy of EPs 7630 than amoxicillin. EPs 7630 was shown as a potent agent and good alternative to antibiotic treatment of uncomplicated ABRS.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Infecções Bacterianas/fisiopatologia , Edema/fisiopatologia , Dor Facial/fisiopatologia , Feminino , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae , Humanos , Masculino , Pessoa de Meia-Idade , Moraxella catarrhalis , Infecções por Moraxellaceae/tratamento farmacológico , Mucosa Nasal , Obstrução Nasal/fisiopatologia , Transtornos do Olfato/fisiopatologia , Infecções Pneumocócicas/tratamento farmacológico , Rinite/fisiopatologia , Sinusite/fisiopatologia , Streptococcus pneumoniae , Adulto Jovem
19.
Ann Otol Rhinol Laryngol ; 129(10): 988-995, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456500

RESUMO

OBJECTIVE: To examine the use of intramuscular corticosteroid (IMCS) injections for treatment of acute upper respiratory infections (URI) and the influence on healthcare utilization. METHODS: This retrospective cohort study used patient encounter data from a large multicenter regional health care system between 2013 and 2017. Adult patients diagnosed with acute URI (acute pharyngitis, acute sinusitis, acute otitis media, and URI not otherwise specified) during ambulatory encounters were included. Follow-up encounters for a diagnosis of acute URI within 60 days were identified and patient characteristics, encounter details, and procedure codes were retrieved. Frequency data was used to calculate IMCS injection administration prevalence, utilization trends, and associations with covariates. Follow-up data for return encounters within 60 days for the same diagnosis was examined. RESULTS: Of the 153 848 initial encounters, 34 600 (22.5%) patients received IMCS injection for acute URI. Injection rates varied from 0.85% to 49.1% depending on specialty and practitioner type. Internal medicine, family medicine, urgent care, and otorhinolaryngology clinics most commonly administered IMCS. 3788 patients returned for a second encounter of which 751 (19.8%) received an injection. IMCS injection during the first encounter was associated with increased odds of repeat visit within 60 days (OR: 1.74; 95% CI: 1.61-1.88). CONCLUSION: IMCS use in the treatment of acute URI is highly prevalent despite lack of evidence for impact and safety. Prevalence is variable across multiple medical and surgical specialties including otorhinolaryngology. Administration of IMCS injection may contribute to the likelihood of a subsequent healthcare visit for the same indication.


Assuntos
Corticosteroides/uso terapêutico , Assistência Ambulatorial/estatística & dados numéricos , Otite Média/tratamento farmacológico , Faringite/tratamento farmacológico , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Adulto , Idoso , Medicina de Família e Comunidade , Feminino , Humanos , Injeções Intramusculares , Medicina Interna , Masculino , Pessoa de Meia-Idade , Otolaringologia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos
20.
Value Health ; 23(5): 632-641, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389229

RESUMO

OBJECTIVES: To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP). METHODS: A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period. RESULTS: A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP. CONCLUSIONS: Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.


Assuntos
Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Recidiva , Rinite/complicações , Sinusite/complicações , Atividades Cotidianas , Adulto , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/tratamento farmacológico , Pesquisa Qualitativa , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Estados Unidos
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