Methodological Considerations in the Assessment of Effectiveness of Homeopathic Care: A Critical Review of the EPI3 Study

Homeopathy ◽  
2021 ◽  
Author(s):  
Yola Moride
Keyword(s):  
Critical Review ◽  
Patient Characteristics ◽  
Upper Respiratory Tract ◽  
Specific Patient ◽  
Outcome Measurements ◽  
Apparent Loss ◽  
Therapeutic Opportunity ◽  
Methodological Considerations ◽  
Tract Infections ◽  
And Control

Abstract Background  EPI3 is an observational study of a representative sample of general practitioners (GPs) and patients in France, demonstrating that patient characteristics differ according to the prescribing preferences of their GPs for homeopathy. For selected conditions (musculoskeletal disorders, sleep disorders, anxiety/depression, upper respiratory tract infections), progression of symptoms and adverse events over follow-up in the homeopathy preference group did not significantly differ from other practice preferences, but there was a two-fold to four-fold lower usage of conventional medicines. The EPI3 study's validity was challenged due to absence of head-to-head comparison of medicines to conclude on a causal association between homeopathy and outcomes. Methods A critical review of the nine EPI3 publications was conducted, focusing on generalizability, selection bias, outcome measurements and confounding. Results The conceptual framework of EPI3 rests on a systemic construct, i.e., the homeopathic treatment concept assessed using the type of GP prescribing preference, taking into account the clinical, human and social aspects. The enrollment process enhanced the generalizability of findings. Validated instruments for outcome measurements were used for three conditions, and control of confounding was rigorous. Conclusion EPI3 was conducted according to best practices. Homeopathy prescribing preference met specific patient needs with less use of conventional medicines and without an apparent loss in therapeutic opportunity.

scholarly journals Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244810
Author(s):  
Dorine M. Borensztajn ◽  
Nienke N. Hagedoorn ◽  
Irene Rivero Calle ◽  
Ian K. Maconochie ◽  
Ulrich von Both ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Disease Severity ◽  
Severe Disease ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Upper Respiratory Tract ◽  
Admission Rates ◽  
Patient Groups ◽  
Tract Infections

Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1). Conclusions Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.

Infection prevention and control challenges in Flemish homecare nursing: a pilot study

2020 ◽  
Vol 25 (3) ◽  
pp. 114-121
Author(s):  
Karel Maelegheer ◽  
Irina Dumitrescu ◽  
Nele Verpaelst ◽  
Hanna Masson ◽  
Caroline Broucke ◽  
...  
Keyword(s):  
Pilot Study ◽  
Home Care ◽  
Wound Care ◽  
Patient Characteristics ◽  
Personal Hygiene ◽  
Infection Prevention And Control ◽  
Surveillance Program ◽  
National Surveillance ◽  
Tract Infections ◽  
And Control

Home nursing is evolving towards more invasive care. Nevertheless, no national data are available on the prevalence of HAI in this setting. The aim of this pilot study is to explore the Flemish home care setting as a first step toward a national surveillance program. A survey, focused on patient characteristics and HAI, was conducted between 7 May and 20 July 2018 on 711 Flemish patients. Most of the patients (74%) are 65 years or older and half of them had a form of comorbidity. Assisting with personal hygiene and wound care were the most frequent services delivered by home care nurses. A comparison of the prevalence of infections diagnosed by a physician or applying uniform criteria (ECDC), revealed a similar prevalence of skin and soft tissue infections (9% vs. 8.5%) and urinary tract infections (4% vs. 4.5%). A positive MDRO-screening was found in 6% of the patients. This pilot study is a first step towards a standardized national surveillance in home care to collect information on the prevalence of HAI and it reveals several interesting facts and study pitfalls for this setting.

scholarly journals Effect of the “Normalized Epidemic Prevention and Control Requirements” on hospital-acquired and community-acquired infections in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caiyun Chen ◽  
Ping Zhu ◽  
Yongxiang Zhang ◽  
Bo Liu
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Prevention And Control ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections ◽  
Hospital Acquired ◽  
And Control ◽  
Over Time

Abstract Background No studies have yet reported the effect of prevention and control measures, which were implemented to combat COVID-19, on the prevention and control of common HAIs. We aimed to examine the effect of the “Normalized Epidemic Prevention and Control Requirements” (implemented in May 2020) by comparison of hospital-acquired infections (HAIs) and community-acquired infections (CAIs) in China during 2018, 2019, and 2020. Methods Data of inpatients before and after implementation of new requirements were retrospectively analyzed, including infection rate, use of alcohol-based hand cleaner, anatomical sites of infections, pathogen species, infection by multi-drug resistant species, and use of different antibiotics. Results The HAI rate was significantly higher in 2020 than in 2018 and 2019 (P < 0.05), and the CAI rate was significantly higher in 2019 and 2020 than in 2018 (P < 0.001). Lower respiratory tract infections were the most common HAI during all years, with no significant changes over time. Lower respiratory tract infections were also the most common CAI, but were significantly more common in 2018 and 2019 than 2020 (P < 0.001). There were no changes in upper respiratory tract infections among HAIs or CAIs. Most HAIs and CAIs were from Gram-negative bacteria, and the percentages of fungal infections were greater in 2019 and 2020 than 2018. MRSA infections were more common in 2020 than in 2018 and 2019 (P < 0.05). The utilization rate and usage days of antibiotics decreased over time (P < 0.001) and the culture rate of microbial specimens before antibiotic usage increased over time (P < 0.001). Conclusions The new prevention and control requirements provided important benefits during the COVID-19 pandemic. However, their effects on HAIs were not obvious.

Real-world mapping of allergy immunotherapy in the United States: The argument for improving adherence

2021 ◽  
Vol 42 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Brian Stone ◽  
Karen Rance ◽  
Douglas Waddell ◽  
Mark Aagren ◽  
Eva Hammerby ◽  
...  
Keyword(s):  
United States ◽  
Real World ◽  
Index Date ◽  
Patient Characteristics ◽  
The United States ◽  
Care Utilization ◽  
Upper Respiratory Tract ◽  
Allergy Immunotherapy ◽  
Related Service ◽  
Tract Infections

Background: There is a dearth of real-world evidence studies focused on allergy immunotherapy (AIT) use among patients with allergic rhinitis (AR). Objective: This study examined claims data of AR patients residing in the United States to assess patient characteristics and health outcomes. Methods: AR patients were identified in the IBM MarketScan database between January 1, 2014, and March 31, 2017. Patients receiving AIT were identified with relevant billing codes (earliest AIT claim for vaccine as the index date); patients without AIT were identified with claims that contained a diagnosis code for AR (earliest AR claim as the index date). All the patients were required to have continuous enrollment 12 months prior to and following their index date. AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. Patients were assessed for demographic characteristics, comorbid conditions, and health care utilization. Results: A total of 2,334,530 AR patients were included; 103,207 had at least one AIT claim, with 45,279 (43.9%) of these patients reaching maintenance. Patients who reached AIT maintenance presented higher rates of baseline comorbidities than both the full AIT cohort and the patients with no AIT claims, including asthma (34.6% versus 30.1% versus 7.5%) and upper respiratory tract infections (63.1% versus 60.3% versus 34.2%). From baseline to follow-up, maintenance AIT patients demonstrated reductions in all AR-related comorbidities assessed, along with reductions in all-cause and AR-related service utilization. Conclusion: Patients initiating AIT presented the greatest need for therapeutic intervention, as evidenced by higher allergy-related comorbidities; those who reached maintenance demonstrated improved outcomes following the initiation of therapy. Continued efforts to increase patient awareness and adherence to AIT are needed.

scholarly journals Determinants of Quinolone versus Trimethoprim-Sulfamethoxazole Use for Outpatient Urinary Tract Infection

2012 ◽  
Vol 56 (3) ◽  
pp. 1359-1363 ◽  
Author(s):  
Anna K. Stuck ◽  
Martin G. Täuber ◽  
Maria Schabel ◽  
Thomas Lehmann ◽  
Herbert Suter ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Prescribing Patterns ◽  
Uncomplicated Urinary Tract Infection ◽  
Upper Respiratory Tract ◽  
Tract Infections ◽  
And Control ◽  
To Receive ◽  
National Sentinel Surveillance

ABSTRACTQuinolones are increasingly favored over trimethoprim-sulfamethoxazole (TMP-SMX) for empirical treatment of uncomplicated urinary tract infection (UTI). This is associated with increasing resistance toward this broad-spectrum group of antibiotics. Our objective is to describe the prescribing patterns and identify determinants of the choice between TMP-SMX and quinolones for outpatient UTI treatment in Switzerland. An ongoing national Sentinel surveillance system was used to study 11,799 antibiotic prescriptions for UTI in adult outpatients and associated physician and patient factors between 2006 and 2008, to compare the prescription of quinolones versus that of TMP-SMX for treatment of UTI. Most UTI episodes were diagnosed as cystitis (90%). TMP-SMX was prescribed for one-fifth (22%) of UTIs. Independent predictors for prescribing quinolones were pyelonephritis and physicians with low thresholds for prescribing antibiotics for upper respiratory tract infections (“high prescribers”), whereas female patients were more likely to receive TMP-SMX. High-prescribing physicians also more often cared for patients who themselves favor antibiotic treatment (P< 0.001). Quinolones are commonly prescribed to outpatients with UTI. Nonclinical factors influence the choice of quinolones versus TMP-SMX, which may provide opportunities for interventions to improve prescribing patterns and control quinolone resistance.

scholarly journals 443. Comparison of Clinical Characteristics of Endemic vs. SARS-CoV-2 Coronavirus Infection in Patients Admitted to a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S288-S289
Author(s):  
Paula Ann Politis ◽  
Michael J Oravec ◽  
Lisa Hoisington ◽  
Michael Tan ◽  
Shanu Agarwal ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Gastrointestinal Symptoms ◽  
Care Facility ◽  
Patient Characteristics ◽  
Smoking History ◽  
Upper Respiratory Tract ◽  
Significant Difference ◽  
Pcr Method ◽  
Serious Disease ◽  
Tract Infections

Abstract Background Endemic coronaviruses [EC] (NL63, 229E, OC43, HKU1) have been identified in humans since the 1960s. Most are associated with mild upper respiratory tract infections (RTIs) but can be associated serious disease. More recently, novel coronaviruses associated with SARS, MERS, and COVID-19 caused by SARS-CoV-2 have emerged and are often associated with serious disease and death. With this report, we compare presenting clinical characteristics and some outcomes of patients hospitalized with RTIs caused by ECs or by SARS-CoV-2 (COVID-19). Methods Patients admitted to the Summa Health System with RTIs associated with EC were identified via multiplex PCR method (BioFire™). Patients admitted with COVID-19 were identified by real-time, reverse transcriptase-PCR method using one of several platforms. Patients were selected from two existing quality improvement registries encompassing EC and COVID-19 cases. We compared clinical characteristics and outcomes of EC patients to those of COVID-19 patients using chi-squared tests for proportions and independent samples t-tests for means. Results Shown in Table 1. Significant differences in patient characteristics with EC vs. COVID-19 included: older age, primarily Caucasian, smoking history, requiring O2 supplementation on admission, and having chronic heart, lung, or renal disease. Significant differences in patient characteristics with COVID-19 vs. EC included: admission from extended care facility, obesity, presenting with fever, gastrointestinal symptoms and/or myalgia, presence of radiographic infiltrates, abnormal liver tests, and longer length of stay (LOS). A non-significant difference was noted in 30 day mortality rates. Coronavirus OC43 accounted for 54% of EC strains. Conclusion There were significant differences in clinical characteristics between the two groups with EC patients more likely to have lung disease (often COPD) and requiring admission for need of O2 supplementation. COVID-19 patients were more likely to present with a febrile illness associated with pneumonia and require longer LOS (often requiring O2 supplementation later in hospitalization). Patients admitted with COVID-19 present with different clinical characteristics than those with EC with numerically higher mortality rate. Disclosures All Authors: No reported disclosures

The Efficacy and Safety of Andrographis paniculata Extract for the Treatment of Acute Nonspecific Upper Respiratory Tract Infections: A Randomized Double Blind Placebo Controlled Trial

2021 ◽  
Vol 104 (7) ◽  
pp. 1204-1213
Keyword(s):  
Respiratory Tract ◽  
Crude Extract ◽  
Respiratory Tract Infections ◽  
Andrographis Paniculata ◽  
Upper Respiratory Tract ◽  
Efficacy And Safety ◽  
Control Groups ◽  
Upper Respiratory ◽  
Tract Infections ◽  
And Control

Background: The efficacy and safety of Andrographis paniculata (Burn.f.) Wall. ex Nees in the treatment of acute nonspecific upper respiratory tract infection (NS-URI) are still less clear due to the diversity of herbal preparations, dosages, and few large clinical trials. The authors aimed to investigate the therapeutic efficacy and safety of the crude extract from A. paniculata in acute NS-URI. Materials and Methods: Patients aged 18 to 60 years old from government hospitals, with acute NS-URI were enrolled between January 2018 and August 2019. Drug allocation was randomized in block of six. The crude extract of A. paniculata was packed in capsules containing 20 mg of andrographolide andgiven thrice daily for four days. The placebo capsules were physically identical. Ten tablets of paracetamol were also given as symptom-rescue drug. They were followed at days 4 to 7, and 14 to 30. Results: Eight hundred sixty-two patients were enrolled between January 2018 and August 2019. Thirty-three patients withdrew from the study, therefore, 829 patients remained in the final analysis. Four hundred nineteen cases (50.5%) received the crude extract, and 410 cases (49.5%) received the placebo. The demographic data, clinical manifestation, and laboratory findings at the enrollment were similar in both groups. At the first follow-up, the rates of severity of each and combined symptoms decreased similarly, and almost all patients felt much better or recovered on day 7. Paracetamol was used by 205 (48.9%) and 185 (45.1%) patients in the experimental and control groups, respectively, and about three tablets taken in each group. Patient satisfaction rates were also similar in both groups. Adverse effects were mild and self-limited in 18 (4.3%) and 9 (2.2%) patients in the experimental and control groups, respectively. Conclusion: The therapeutic efficacy of the crude extract or active ingredient from A. paniculata for acute NS-URI was not confirmed. Both groups showed similarly mild and few adverse drug reactions.Trial registration: The present study protocol was registered at the Thai Clinical Trials Registry (TCTR 20170329002; date: March 26, 2017). Keywords: Andrographis paniculata; Andrographolide; Acute nonspecific upper respiratory tract infections; Common cold; Pharyngitis; URI

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