Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children <1 year admitted for bronchiolitis in a tertiary hospital during two consecutive respiratory syncytial virus seasons were randomised to group 1 with CP (prolonged slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9 months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8 days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patients.     

The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals

Background

Media awards to encourage responsible reporting of suicide have been introduced in several countries, including Australia, Belgium and Denmark.

Aims

This study aimed to examine the experiences of Australian, Belgian and Danish award recipients in preparing stories on suicide, and consider the impacts of the awards for these recipients and for media professionals more broadly.

Method

We conducted semi-structured telephone interviews with the majority (14 out of 15) of past recipients of the awards in the three countries of interest.

Results

Media awards appear to show promise as a method of reinforcing national and international media guidelines on reporting suicide. The recipients of awards were proud to have had their achievements recognized in this way, and had developed a heightened awareness of the issues inherent in reporting suicide. Although relatively few had prepared subsequent stories on suicide, a number had been given opportunities to provide advice to other media professionals about how best to approach this sensitive topic. Recipients viewed the awards as an important means by which good quality reporting can be rewarded, and a springboard for raising community awareness about suicide.

Conclusion

The experience from Australia, Belgium and Denmark suggests that media awards which recognize responsible reporting of suicide are extremely worthwhile.     

Relative socioeconomic advantage and mood during advanced pregnancy in women in Vietnam

Background  

Mental health during pregnancy has not been investigated in Vietnam. Antenatal depression is an established risk factor for postpartum mood disturbance and two representative cohort studies have found rates of depression after childbirth in Vietnam two to three times higher than those in high income countries.     

Low concentrations of amitriptyline inhibit nicotinic receptors in unmyelinated axons of human peripheral nerve

Background and purpose:

Amitriptyline is often prescribed as a first-line treatment for neuropathic pain but its precise mode of analgesic action remains uncertain. Amitriptyline is known to inhibit voltage-dependent ion channels and also to act as an antagonist at ligand-gated ion channels, such as nicotinic acetylcholine receptors (nAChRs). In the present study, we tested the effect of amitriptyline on nicotinic responses of unmyelinated axons in isolated segments of human peripheral nerve. In particular, a comparison was made between the concentrations of amitriptyline necessary for inhibition of nAChRs and those required for inhibition of the compound C-fibre action potential.

Experimental approach:

Isolated axon fascicles were prepared from short segments of human sural nerve, and multiple measures of axonal excitability were recorded using computer-controlled threshold tracking software.

Key results:

Amitriptyline (EC₅₀ 2.6 µM) reduced the nicotine-induced increase in C-fibre excitability but only slightly altered the amplitude and latency to onset of the compound action potential. In contrast, tetrodotoxin produced a clear reduction in the amplitude and a prolongation of action potential onset latency but was without effect on the nicotine-induced increase in axonal excitability.

Conclusions and implications:

These data demonstrate that low concentrations of amitriptyline suppress the response of human peripheral C-type axons to nicotine by directly inhibiting nAChRs. Blockade of tetrodotoxin-sensitive, voltage-dependent sodium channels does not contribute to this effect. An inhibitory action of amitriptyline on nAChRs in unmyelinated nociceptive axons may be an important component of amitriptyline''s therapeutic effect in the treatment of neuropathic pain.     

Longitudinal analysis of community health workers' adherence to treatment guidelines, Siaya, Kenya, 1997-2002

OBJECTIVES: To investigate community health workers' (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence. METHODS: Analysis of 7151 ill-child consultations performed by 114 CHWs in their communities from March 1997-May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training. RESULTS: The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training. CONCLUSIONS: The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.     

Mid-term biochemical recurrence-free outcomes following robotic versus laparoscopic radical prostatectomy

We compared 5-year biochemical recurrence (BCR)-free rates for robotic-assisted laparoscopic prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP). Three hundred and twelve consecutive patients who underwent RALP from 2003 to 2008 were compared to 97 consecutive LRP patients from 1999 to 2004. All laparoscopic surgeries were performed by one surgeon and robotic surgeries were performed by this surgeon or a laparoscopically na?ve surgeon. Both groups were evaluated for perioperative outcome, pathologic status, and mid-term oncologic outcomes (5-year BCR-free rates at prostate-specific antigen [PSA] cutoffs of <0.4, <0.2, or <0.1 ng/ml). Baseline characteristics were equivalent except for age (61.9 years vs. 65.1 years, P < 0.0001). RALP operating time was shorter (215.5 min vs. 305.3, P < 0.0001), and resulted in fewer complications (3.8% vs. 10.3%, P = 0.0214) and blood transfusions (2.9% vs. 13.4%, P = 0.0003). Positive surgical margins were equivalent (pT2 20.9% vs. 28.8%, P = 0.1818). Overall 5-year BCR-free rates were comparable for RALP (97.6, 93.4, and 85.1%) and LRP (97.7, 89.7, and 79.7%) at PSA cutoff levels of <0.4, <0.2, and <0.1 ng/ml, respectively. There was a significant difference in BCR-free rates between the RALP and LRP groups for patients with organ-confined (pT2) disease at 0.2 ng/ml (96.4% vs. 88.7%, P = 0.0373) and 0.1 ng/ml (91.0% vs. 83.0%, P = 0.0470). We report lower morbidity, comparable pathologic outcome and improved mid-term oncologic results in patients with organ-confined disease after RALP in comparison to LRP.     

Quantitation of membrane glycoprotein IIIa on intact human platelets using the monoclonal antibody, AP-3

A murine monoclonal antibody specific for glycoprotein (GP)IIIa was prepared by immunization with a GPIIb- and GPIIIa-enriched Triton X-114 extract of platelet membranes. This antibody, designated AP-3, was shown by indirect immunoprecipitation to react solely with GPIIIa derived from either P1A1-positive or -negative individuals. The epitope on GPIIIa recognized by AP-3 is expressed on dissociated GPIIIa as well as on Ca+2-dependent complexes of GPIIb and GPIIIa, as shown by crossed immunoelectrophoresis in the presence or absence of EDTA. A previously described monoclonal antibody specific for the GPIIb/IIIa complex (AP- 2) inhibited platelet aggregation induced by ADP, thrombin, collagen, or arachidonic acid (Pidard et al, J Biol Chem 258:12582-12586, 1983). In contrast, AP-3 had no effect on aggregation induced by any of these reagents, a finding similar to that previously reported for the GPIIb- specific monoclonal antibody, Tab (McEver et al, J Clin Invest 66:1311- 1318, 1980). At saturation, 40,200 AP-3 molecules were bound per platelet, a value similar to that obtained for AP-2 or Tab. Thus, data derived using AP-3 indicate that significant amounts of free GPIIIa are not present, thereby supporting the hypothesis that GPIIb and GPIIIa exist complexed in a 1:1 stoichiometry in the plasma membrane of intact, nonactivated platelets.