Efficacy of fluticasone on cough: a randomised controlled trial.

Cough may be the consequence of bronchial hyperresponsiveness (BHR) and inflammation. This study was designed to investigate the short-term effects of an inhaled steroid (fluticasone propionate (FP)) on cough, and to determine the effects of smoking, BHR, allergy and forced expiratory volume in one second (FEV1) on the efficacy of FP. In a community-based primary healthcare centre, 135 previously healthy adults suffering from cough for > or =2 weeks were enrolled in a randomised, double-blind, placebo-controlled trial of inhaled FP 500 microg b.i.d. for 2 weeks. Participants completed daily diary cards of lower respiratory tract symptoms. The primary outcome measure was the decrease in mean total daily cough score (0-6) during the second week of treatment. In the FP group, the cough score decreased from 3.8 at baseline to mean+/-SEM 1.4+/-0.2 during the second week. In the placebo group, this decrease was from 3.8 to 1.9+/-0.1 and was statistically significantly less. A favourable effect of FP was only detectable in nonsmokers, in whom the score was 0.9 points lower compared with placebo. The clinical relevance of this finding has to be established further. Allergy, FEV1 and BHR at baseline did not affect the efficacy of FP. In conclusion, anti-inflammatory treatment with the inhaled steroid fluticasone propionate reduces cough in otherwise healthy adults who do not smoke.     

Physiotherapy for anterior knee pain: a randomised controlled trial

OBJECTIVE: To determine the efficacy of the individual components of physiotherapy in subjects with anterior knee pain. METHODS: An observer blind, prospective, factorial design randomised controlled trial. 81 young adults with anterior knee pain were randomly allocated to one of four treatment groups: (1) exercise, taping, and education; (2) exercise and education; (3) taping and education; and (4) education alone. Each group received six physiotherapist-led treatments over three months. Follow up took place at three months using the following outcome measures: patient satisfaction (discharge/refer for further treatment); a visual analogue pain score; the WOMAC lower limb function score; the Hospital Anxiety and Depression scale (HAD); and quadriceps strength. At 12 months the WOMAC and HAD were assessed by postal questionnaire. RESULTS: All groups showed significant improvements in WOMAC, visual analogue, and HAD scores; these improvements did not vary significantly between the four groups or between exercising/non-exercising and taped/non-taped patients at three and 12 months. However, patients who exercised were significantly more likely to be discharged at three months than non-exercising patients (chi(2), p<0.001). Taping was not significantly associated with discharge. Significantly greater improvements in WOMAC, visual analogue, and the anxiety score (but not the depression score) were seen in patients who were discharged than in those who were referred. CONCLUSIONS: The proprioceptive muscle stretching and strengthening aspects of physiotherapy have a beneficial effect at three months sufficient to permit discharge from physiotherapy. These benefits are maintained at one year. Taping does not influence the outcome.     

Mobility training after hip fracture: a randomised controlled trial

Objective: to compare the effects of two different exerciseprogrammes after hip fracture. Design: assessor-blinded randomised controlled trial. Setting: hospital rehabilitation units, with continued interventionat home. Subjects: 160 people with surgical fixation for hip fracturetransferred to inpatient rehabilitation. Method: in addition to other rehabilitation strategies, theintervention group received a higher dose (60 min/day) exerciseprogramme conducted whilst standing and the control group receiveda lower dose exercise programme (30 min/day) primarily conductedwhilst seated/supine. The primary outcome measures were kneeextensor muscle strength in the fractured leg and walking speed,measured at 4 and 16 weeks. Results: 150 participants (94% of those recruited) completedthe trial. There were no differences between the groups forthe two primary outcome measures. Post hoc analyses revealedincreased walking speed among those in the higher dose, weight-bearingexercise group with cognitive impairment at 4 and 16 weeks. Conclusions: there was no benefit (or harm) due to the higherdose, weight-bearing exercise programme with respect to theprimary outcome measures. However, people with hip fractureand cognitive impairment gained greater benefit from the higherdose programme than from the lower dose programme.     

Minilaparoscopic versus laparoscopic cholecystectomy: a randomised controlled trial.

Since its introduction in 1987, the technique of cholecystectomy has continued to undergo evolution. Surgeons have reduced the port size and number or both to achieve improvement in postoperative pain control, rapid return to activity and better cosmetic results. Therefore, this study was done to compare the standard 4 port laparoscopic cholecystectomy (LC) with the 3 port laparoscopic cholecystectomy using a 5 mm telescope instead of 10 mm telescope (mini laparoscopic cholecystectomy - MLC). Forty patients were randomised to each group. Mean operating time, intraoperative and postoperative complications, mean period to resume walking, eating and return to normal activities and mean hospital stay were similar in the two groups. The level of postoperative pain was significantly lower in the MLC group. Patients who underwent MLC required a significantly lower dose of analgesics. In conclusion mini laparoscopic cholecystectomy is a feasible and safe procedure with less postoperative pain and better cosmesis and without increased complications.     

Using child health outcomes to identify effective measures of handwashing

We assessed which practical handwashing indicators were independently associated with reduced child diarrhea or respiratory disease. Fieldworkers collected 33 indicators of handwashing at baseline in 498 households in 50 villages in rural Bangladesh. Community monitors visited households monthly and asked standard questions about diarrhea and symptoms of respiratory illness among children under 5 years of age. In multivariate analysis, three handwashing indicators were independently associated with less child diarrhea-mothers reporting usually washing hands with soap before feeding a child, mothers using soap when asked to show how they usually washed their hands after defecation, and children having visibly clean finger pads. Two indicators were independently associated with fewer respiratory infections-mothers allowing their hands to air dry after the handwashing demonstration and the presence of water where the respondents usually wash hands after defecation. These rapid handwashing indicators should be considered for inclusion in handwashing assessments.     

Effect of inhaled fluticasone on lung function in infants with recurrent wheezing: a randomised controlled trial

BackgroundInhaled corticosteroids are used to treat infants with troublesome asthma-like symptoms but their effect on the lung function of these young patients is controversial.Material and MethodsForty-four infants with recurrent wheezing (more than 3 episodes) and family history of asthma completed this randomised, parallel, double-blind, controlled trial to compare the effect on lung function (main endpoint) of once-daily inhaled fluticasone (375 μg) versus placebo for 3 months. Pulmonary function was measured while infants were asymptomatic, using the raised volume rapid thoracic compression technique (spirometry-like), and values were converted to z-scores.ResultsThe fluticasone group showed a significant increase in forced flows, (p < 0.001), a lower number of physician diagnosed wheezing episodes (p < 0.002), and a significant decrease in the parent-reported number of wheezing episodes per month (p < 0.03), as compared to placebo. One third of parents in the placebo group reported a clinical improvement in their infants. There was no significant difference in morning plasma cortisol between groups at entry or discharge.ConclusionsWe conclude that once-daily treatment with 375 μg fluticasone increased forced flows and controlled symptoms in infants with recurrent wheezing without altering plasma cortisol levels. The spirometry-like technique is a useful tool to objectively assess the efficacy of anti-asthma medications in infants with repeated troublesome asthma-like symptoms.     

Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomised controlled trial

OBJECTIVE: To determine whether a patient education programme (PE) would improve rates of adherence to a slow acting antirheumatic drug and to assess any subsequent effect on patient outcome. METHODS: A randomly controlled study comprising 100 patients with rheumatoid arthritis (49 control CG; 51 experimental EG) requiring D-penicillamine (DPA). The same practitioner saw patients on seven occasions, for the same length of time. The EG received 7 x 30 minute one to one sessions of PE, while the CG received standard management. The primary measure of adherence was a pharmacological marker (phenobarbitone) encapsulated with the DPA assayed at monthly intervals for six months. Plasma viscosity (PV), C reactive protein, articular index, morning stiffness, and pain score were used to assess outcome. RESULTS: 454 blood samples were collected and assayed and the pharmacological marker showed the EG to be significantly more adherent on more occasions than the CG (p<0.05). Patterns of adherence over time showed that at 12 weeks 86% (38/44) of those in the EG compared with 64% (29/45) of the CG remained adherent (p=0.01). These trends continued and by the end of the study 85% (29/34) of the EG compared with 55% (23/42) of the CG were taking their DPA as prescribed. Fifteen patients (12 from the EG) experienced side effects requiring study withdrawal and 14 patients requested study withdrawal (two from the EG). On study entry patients in the CG had significantly higher levels of PV than the EG and this remained so throughout the research. However, on completion, the health status of patients in both groups had improved significantly (p<0.01). CONCLUSIONS: PE significantly increased adherence to DPA and its effects persisted over a period of six months. No additional clinical benefit was detected in the EG in comparison with the CG.