Alternative Therapies for Bacterial Vaginosis a Literature Review and Acceptanility Survey
Mostrar: 20 | 50 | 100
Resultados i - 6 de 6
Filtrar
one.
Artigo em Inglês
| MEDLINE | ID: mdl-35057905
RESUMO
Groundwork: Bacterial vaginosis is a mutual and distressing condition associated with serious comorbidities. Antibiotic handling is usually clinically effective in the curt term, just recurrence is common and side effects can occur. OBJECTIVES: The objective is to assess whether or non intravaginal lactic acid gel is clinically effective and cost-effective for treating recurrent bacterial vaginosis compared with oral metronidazole (Flagyl, Sanofi). DESIGN: This was an open-label, multicentre, parallel-arm, randomised (1 : one) controlled trial. SETTING: This took place in one general practise and 19 sexual health centres in the UK. PARTICIPANTS: Women aged ≥ sixteen years with bacterial vaginosis symptoms and one or more episode(s) inside the past 2 years took role. INTERVENTIONS: The interventions were v ml of intravaginal lactic acid gel taken once daily for 7 days (intervention) or 400-mg oral metronidazole tablets taken twice daily for 7 days (control). Master Effect MEASURES: The principal issue was the resolution of bacterial vaginosis symptoms 14 days later on randomisation. The secondary outcomes were fourth dimension to first recurrence of symptoms; number of recurrences and treatment courses over half-dozen months; microbiological resolution on microscopy of vaginal smears at calendar week 2; fourth dimension to resolution of symptoms; tolerability, adherence and acceptability of the handling; prevalence of concurrent sexually transmitted infections; quality of life; and toll-effectiveness. RESULTS: Recruitment stopped prior to reaching the target of 1900 participants on recommendation from the Data Monitoring Committee and Trial Steering Committee after a planned review of the results indicated that the research question had been answered. Overall, 518 participants were randomised and primary issue data were available for 409 participants (79%; 204 in the metronidazole arm, 205 in the lactic acid gel arm). Participant-reported symptom resolution at week 2 was higher with metronidazole (143/204; 70%) than with lactic acrid gel (97/205; 47%) (adjusted adventure difference -23.2%, 95% conviction interval -32.3% to -fourteen.0%). Recurrence in 6 months in a subset of participants who had initial resolution and were available for follow-upwards was similar across arms (metronidazole arm: 51/72, 71%; lactic acid gel arm: 32/46, 70%). A college incidence of some side effects was reported with metronidazole than with lactic acid gel (nausea 32% vs. eight%; gustatory modality changes 18% vs. one%; diarrhoea 20% vs. 6%, respectively). At week ii, the boilerplate cost per participant with resolved symptoms was £86.94 (metronidazole), compared with £147.00 (lactic acrid gel). Some participants preferred using lactic acid gel even if they perceived it to be less constructive than metronidazole. LIMITATIONS: Loss to follow-upwardly for collection of the chief effect data was 21% and was like in both arms. In that location is a risk of bias attributable to missing effect data at 3 and 6 months mail service treatment. CONCLUSIONS: A higher initial response was seen with metronidazole than with lactic acid gel, simply subsequent treatment failure was common with both. Lactic acid gel was less price-effective than metronidazole. In general, women disliked taking repeated courses of metronidazole and preferred lactic acid gel, even when they were aware that it was less likely to provide symptom resolution. In the absence of effective curative therapy, further evaluation of non-antibiotic treatments to control the symptoms of recurrent bacterial vaginosis is required to better quality of life for these patients. Further microbiological assay of vaginal samples would be useful to identify additional factors affecting response to treatment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN14161293. FUNDING: This project was funded by the National Found for Health Research (NIHR) Health Technology Assessment programme and will be published in total in Health Technology Assessment; Vol. 26, No. two. Encounter the NIHR Journals Library website for further project information.
Bacterial vaginosis is a common cause of unpleasant vaginal discharge that is caused by an imbalance of vaginal bacteria. The usual treatment is an antibiotic called metronidazole (Flagyl, Sanofi). Although this by and large works in the short term, symptoms ofttimes return, leading to the repeated use of antibiotics; this tin cause side effects every bit well as increment the gamble of antibody resistance. Lactic acrid gel might exist an alternative handling, but previous studies have non confirmed how clinically effective it is. Nosotros wanted to detect out if lactic acid gel was better than metronidazole for treating recurrent bacterial vaginosis. Women with typical symptoms and a history of bacterial vaginosis who were taking function in our trial were selected randomly to receive either 7 days of treatment with lactic acid gel inserted into the vagina once per day or 7 days of treatment with metronidazole tablets taken by mouth twice per solar day. Overall, 518 women took part in the trial. We originally intended to recruit 1900 women but the trial was stopped early considering a planned review of the data showed which treatment was better. Almost of the women took all of their handling and seventy% reported that symptoms had cleared 2 weeks after taking metronidazole, compared with 47% after using lactic acid gel. Less than half of the women stayed in the trial for the full 6 months; however, the data suggested that the majority of those whose symptoms cleared inside 2 weeks with either treatment had symptoms return over the next 6 months. More side furnishings were reported for metronidazole than for lactic acid gel: nausea 32% compared with eight%, taste changes 18% compared with 1%, and diarrhoea 20% compared with half dozen%, respectively. Despite thinking that it was less constructive, women preferred lactic acid gel because it avoided the need to take an antibody and had a soothing effect. The toll-effectiveness assay found that lactic acid gel was less effective than metronidazole in clearing symptoms by 2 weeks and that the boilerplate costs for women whose symptoms resolved were higher (£86.94 with metronidazole vs. £147.00 with lactic acid gel).
Assuntos
Ácido Láctico , Metronidazol , Vaginose Bacteriana , Adolescente , Análise Custo-Benefício , Feminino , Humanos , Ácido Láctico/efeitos adversos , Metronidazol/efeitos adversos , Qualidade de Vida , Avaliação da Tecnologia Biomédica , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/microbiologia
2.
Artigo em Inglês
| MEDLINE | ID: mdl-34847808
RESUMO
Background: The scale and extent of sexual violence perpetrated in the United Kingdom is beingness increasingly acknowledged. Support afterwards the initial disclosure is often sought in NHS sexual health clinics. The purpose of this service evaluation was to explore patient satisfaction and experience among sexual wellness dispensary attendees who disclosed sexual violence and were later managed in a specialist sexual abuse survivors clinic. METHODS: Semi-structured interviews were conducted with 10 service users and interview transcripts were analysed using interpretative phenomenological assay (IPA) to assess users' experiences within the clinic. RESULTS: Participants were all female (aged 18-54 years) and had experienced sexual violence between 2 weeks and xv years prior to interview, and the majority self-identified as White British (six/10). IPA assay revealed three distinct overarching themes which were important to this group of patients when evaluating their care: delivery of care in the context of judgement and stigma, aspects of intendance identified equally healing or harmful to recovery, and the importance of the processes of providing care. Determination: Understanding the experiences of sexual violence survivors in healthcare settings can optimise the provision of patient-oriented care and support. This includes ensuring the service user is in control of the consultation, the risks of re-traumatisation are minimised, and individuals receive relevant and accurate information simply in a manageable volume and format.
3.
Artigo em Inglês
| MEDLINE | ID: mdl-31217323
RESUMO
Background: Obtaining perspectives from those seeking healthcare after sexual violence on care and how it is delivered is important. OBJECTIVES: To systematically identify whatever existing patient-reported consequence and experience measures (PROMs and PREMs) for patients attending healthcare services later on sexual violence. Also, to identify key themes regarded by patients as priorities for delivering a high-quality service. Design: Systematic review (PROSPERO registration RD42016050297). Information SOURCES: Eight electronic bibliographic databases from inception to March 2017. 'Grey' literature besides searched. Search words included patient view, patient feel, PROM/PREM, sexual violence, rape. REVIEW METHODS: Studies of whatsoever design, with participants of any gender and aged 13 years or older were included; studies simply assessing the views of service providers were excluded. Appraisement tools assessed for written report quality. Healthcare outcome data were assessed across the quantitative studies and key experiences across qualitative papers; Framework Analysis was used to synthesise the qualitative studies. RESULTS: From 4153 identified papers, 20 fulfilled criteria for inclusion: 10 qualitative, eight quantitative and two mixed methods. No validated measure of assessing patient experience or outcome was identified. The synthesis of qualitative studies led to the consignment of two overarching themes around the importance of patient-focused and trauma-focused advice, and of care which enhances patient empowerment. A paucity of research inside certain patient groups who feel sexual violence, in item men and LGBT (lesbian, gay, bisexual and trans) patients was noted. LIMITATIONS: A broad definition of 'healthcare setting' incorporated a wide variety of venues limiting the applicability of findings in specific settings. Decision: A validated and standardised approach to assess patient experience and result in healthcare settings after sexual violence is needed. Themes identified should be incorporated into PROM or PREM development. The review as well suggests the need for a change in approach towards those who nourish for healthcare subsequently sexual violence to ensure patient autonomy.
Assuntos
Pacientes/psicologia , Delitos Sexuais/psicologia , Adolescente , Adulto , Atenção à Saúde/estatística & dados numéricos , Empoderamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Delitos Sexuais/estatística & dados numéricos , Ferimentos e Lesões/psicologia , Adulto Jovem
four.
Artigo em Inglês
| MEDLINE | ID: mdl-31099330
RESUMO
Groundwork: Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, touch fertility in women and pb to epididymo-orchitis in men. Current treatment is with ceftriaxone, but in that location is increasing testify of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential culling treatment requiring further evaluation. OBJECTIVES: To appraise the clinical effectiveness and cost-effectiveness of gentamicin as an alternative handling to ceftriaxone in the treatment of gonorrhoea. Design: A multicentre, parallel-group, blinded, non-inferiority randomised controlled trial. SETTING: Fourteen sexual health clinics in England. PARTICIPANTS: Adults aged 16-70 years with a diagnosis of simple, untreated genital, pharyngeal or rectal gonorrhoea based on a positive Gram-stained smear on microscopy or a positive nucleic acid distension exam (NAAT). RANDOMISATION AND BLINDING: Participants were randomised using a secure web-based organization, stratified past clinic. Participants, investigators and research staff assessing participants were blinded to treatment allocation. INTERVENTIONS: Allocation was to either 240 mg of gentamicin (intervention) or 500 mg of ceftriaxone (standard treatment), both administered as a single intramuscular injection. All participants too received 1 g of oral azithromycin. Chief Effect MEASURE: The primary outcome measure was clearance of Neisseria gonorrhoeae at all infected sites, confirmed by a negative Aptima Combo 2® (Hologic Inc., Marlborough, MA, U.s.) NAAT, at 2 weeks post treatment. RESULTS: We randomised 720 participants, of whom 81% were men. There were 358 participants in the gentamicin group and 362 in the ceftriaxone group; 292 (82%) and 306 (85%) participants, respectively, were included in the main assay. Not-inferiority of gentamicin to ceftriaxone could non be demonstrated [adjusted hazard deviation for microbiological clearance -half-dozen.4%, 95% confidence interval (CI) -ten.four% to -2.4%]. Clearance of genital infection was similar in the ii groups, at 94% in the gentamicin group and 98% in the ceftriaxone grouping, but clearance of pharyngeal infection and rectal infection was lower in the gentamicin group (eighty% vs. 96% and 90% vs. 98%, respectively). Reported pain at the injection site was higher for gentamicin than for ceftriaxone. The side-outcome profiles were comparable between the groups. Only ane serious adverse event was reported and this was accounted not to be related to the trial medication. The economical assay found that treatment with gentamicin is not toll neutral compared with standard care, with average patient treatment costs college for those allocated to gentamicin (£13.90, 95% CI £two.47 to £37.34) than to ceftriaxone (£half-dozen.72, 95% CI £1.36 to £17.84). LIMITATIONS: Loss to follow-up was 17% just was similar in both treatment artillery. Twelve per cent of participants had a negative NAAT for gonorrhoea at their baseline visit but this was balanced between treatment groups and unlikely to have biased the trial results. CONCLUSIONS: The trial was unable to demonstrate non-inferiority of gentamicin compared with ceftriaxone in the clearance of gonorrhoea at all infected sites. Clearance at pharyngeal and rectal sites was lower for participants allocated to gentamicin than for those allocated to ceftriaxone, but was similar for genital sites in both groups. Gentamicin was associated with more astringent injection site pain. Withal, both gentamicin and ceftriaxone appeared to be well tolerated. Futurity WORK: Exploration of the genetic determinants of antibody resistance in N. gonorrhoeae volition aid to place accurate markers of decreased susceptibility. Greater agreement of the allowed response to infection tin can assist gonococcal vaccine development. TRIAL REGISTRATION: Electric current Controlled Trials ISRCTN51783227. FUNDING: This projection was funded by the National Establish for Health Enquiry Health Technology Assessment plan and will exist published in total in Health Technology Cess; Vol. 23, No. 20. Run across the NIHR Journals Library website for further project data.
Gonorrhoea is a common infection, spread by having sex, that causes genital pain and discomfort. In women it tin can atomic number 82 to pelvic inflammation and infertility, and in men it can atomic number 82 to swelling and pain in the testicles. Currently, an antibiotic called ceftriaxone is used to treat gonorrhoea. Even so, in that location is evidence that this is condign less effective over time and it could stop curing patients with gonorrhoea within the next few years. In this study, nosotros wanted to find out if some other antibiotic called gentamicin is as good equally ceftriaxone in the treatment of gonorrhoea and whether or not gentamicin could exist used to treat gonorrhoea if ceftriaxone stops being effective. We recruited 720 adults with gonorrhoea and randomly allocated them (by take chances) to receive treatment with an injection of either gentamicin (240 mg) or ceftriaxone (500 mg). They all also received a unmarried dose of azithromycin (ane g) taken by rima oris. Overall, 98% of participants given ceftriaxone had their gonorrhoea cured, compared with 91% of participants given gentamicin, a difference of 7%. Therefore, information technology is likely that doctors will continue to use ceftriaxone (plus azithromycin) every bit the preferred treatment. Gentamicin did have a cure rate of 94% for genital gonorrhoea and so it might be useful when ceftriaxone is not available or appropriate to use. Cure rates using gentamicin were lower than cure rates using ceftriaxone for gonorrhoea infecting the rectum (xc%) and throat (80%), and so it may be less useful for patients with infections at these sites. We also establish that gentamicin is likely to cost the NHS more than ceftriaxone. Gentamicin acquired few side effects and seems to be equally safe as ceftriaxone, which is reassuring.
Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Gentamicinas/uso terapêutico , Gonorreia/tratamento farmacológico , Adolescente , Adulto , Idoso , Análise Custo-Benefício , Resistência Microbiana a Medicamentos , Inglaterra , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Artigo em Inglês
| MEDLINE | ID: mdl-25052765
RESUMO
Background: Pelvic inflammatory illness (PID) is the consequence of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be primal to the development of tissue damage and associated reproductive complications. Nonsteroidal anti-inflammatory agents (NSAIDs) therefore accept the potential to reduce the sequelae associated with pelvic infection. METHODS: A search of four electronic reference databases, an internet search for relevant greyness literature and a review of the bibliographies of identified publications was used to identify studies evaluating NSAIDs in the management of PID. A predefined search strategy was used to identify studies that included women with PID aged over sixteen and diagnosed afterward 1980. Randomized controlled trials, nonrandomized controlled trials, and cohort studies with comparison group data were included without language brake. Two reviewers independently assessed the studies confronting agreed criteria and extracted relevant information using a standardized pro forma. A meta-analysis to calculate the relative risk associated with NSAID utilize was planned if advisable. RESULTS: Forty-three studies were identified. After reviewing abstracts or total texts, 2 randomized controlled trials were found to see the selection criteria for inclusion. The employ of NSAIDs was reported to improve tubal patency, reduce pelvic adhesions and reduce suprapubic pain but the studies were of poor quality with a loftier risk of bias. Meta-assay of the data was non performed. CONCLUSIONS: Insufficient data is bachelor to support or refute the efficacy of NSAIDs in the prevention of short or long-term complications of PID.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Inflamatória Pélvica/tratamento farmacológico , Feminino , Humanos , Resultado do Tratamento
6.
Artigo em Inglês
| MEDLINE | ID: mdl-24460561
RESUMO
AIM: To determine what encourages or discourages AIDS/HIV patients from completing questionnaires. Background: Information from surveys can provide important information but response rates can be poor. Factors that affect this in an HIV clinic population take not been assessed previously. REVIEW METHODS: The researchers used a qualitative approach and a structured interview schedule. Ten patients were recruited and participated in one-to-one interviews. Word: Most patients saw the potential value of completing a questionnaire in the clinic. Lack of privacy during completion was raised equally a concern, particularly if in that location were sensitive questions to respond to. Lack of technical competence was identified by some as a bulwark to participation in electronic surveys. Tickboxes were preferred over rating scales or open up answers. Participants did not expect a cash incentive or entry in a prize draw when asked to complete a questionnaire in-dispensary. Conclusion: Generally, AIDS/HIV patients were willing to participate in surveys. Availability of a private area to complete the questionnaire, avoiding complex electronic systems, completion in the dispensary, tickbox answers and a length of nether two sides of A4 were the well-nigh important features that improved acceptability of the questionnaire to patients. Implications for research Surveys that evaluate care demand to be short, easy to consummate and have clear relevance to the patients' feel.
Assuntos
Síndrome de Imunodeficiência Adquirida/psicologia , Infecções por HIV/psicologia , Pacientes Desistentes practise Tratamento/psicologia , Participação exercise Paciente/psicologia , Inquéritos e Questionários/normas , Síndrome de Imunodeficiência Adquirida/enfermagem , Coleta de Dados/normas , Infecções por HIV/enfermagem , Humanos , Pesquisa em Enfermagem/normas
ENVIAR RESULTADO:
DETALHE DA PESQUISA
Source: https://search.bvsalud.org/portal/?lang=pt&q=au:%22Ross,%20Jonathan%20Dc%22
0 Response to "Alternative Therapies for Bacterial Vaginosis a Literature Review and Acceptanility Survey"
Post a Comment