Every week, we will provide a brief summary and a link to the published abstract of newly published papers selected from the worldwide literature as being of particular interest to the SelfCare community.
HIGH VISIBILITY WARNING LABELS ON PARACETAMOL-CONTAINING PRODUCTS DO NOT PREVENT SUPRA-THERAPEUTIC INGESTION IN A SIMULATED SCENARIO
By: Rotella JA, Wong A, Howell J, Robotham A, Greene S.
Clinical Toxicology 2015; 53: 935-940
Summary: Participants undertook a simulated scenario in which they chose a paracetamol-containing product for dental pain on six occasions. They were randomized to one of three groups with different labeling: 1) standard package labeling, 2) standard package plus a warning label, and 3) standard packaging plus a large warning label. The primary outcome was whether these 118 subjects would administer >4 g within a 24-hour period. Approximately 24%, 37%, and 48% of the groups, respectively, ingested >4 g of paracetamol, suggesting that the extra warning labels were not helpful.
NON-PRESCRIPTION (OTC) ORAL ANALGESICS FOR ACUTE PAIN – AN OVERVIEW OF COCHRANE REVIEWS
By: Moore RA, Wiffen PJ, Derry S, Maguire T, Roy YM, Tyrrell L
Cochrane Database Syst Rev 2015; Nov 4; 11 :CD010794
Summary: Thirty-nine Cochrane reviews of randomized trials have examined the analgesic efficacy of individual drug interventions in acute post-operative pain. Headache and migraine were not included in this overview. They found information on 21 different OTC analgesics, doses, and formulations. The lowest (best) NNT values were for combinations of ibuprofen + paracetamol, with NNT values below 2. Analgesics with values close to 2 included fast-acting formulations of ibuprofen 200 mg and 400 mg, ibuprofen 200 mg + caffeine 100 mg, and diclofenac 50 mg. Combinations of ibuprofen + paracetamol had success rates of almost 70%, with dipyrone 500 mg, fast-acting ibuprofen formulations 200 mg and 400 mg, ibuprofen 200 mg + caffeine 100 mg, and diclofenac 50 mg having success rates above 50%. Paracetamol and aspirin at various doses had NNT values of 3 or above, and success rates of 11% to 43%. Participants experiencing an adverse event were generally not different from placebo, except for aspirin 1000 mg and (barely) ibuprofen 200 mg + caffeine 100 mg. For ibuprofen + paracetamol, adverse event rates were lower than with placebo.
CONSTIPATION: ADVANCES IN DIAGNOSIS AND TREATMENT
By: Wald A
Journal of the American Medical Association 2016; 315: 185-91.
Summary: The author notes there is strong evidence for the efficacy of stimulant and osmotic laxatives, in addition to other agents. When used appropriately, stimulant laxatives such as senna and bisacodyl are both safe and effective when used long-term.
DO MEN KNOW WHICH LOWER BOWEL SYMPTOMS WARRANT MEDICAL ATTENTION: A WEB-BASED VIDEO VIGNETTE SURVEY OF MEN IN WESTERN AUSTRALIA
By: Oberoi DV, Jiwa M, McManus A, Parsons R
Am J Mens Health. 2015 Mar 10. pii: 1557988315574739. [Epub ahead of print]
Summary: Participants viewed 8 of 28 assigned videos displaying men with various combinations of one or more lower bowel symptoms. Participants were asked if the person in the vignette should seek health advice. There was a trend to consider unintentional weight loss and diarrhea as minor symptoms not requiring medical attention. Of the 3259 vignette assessments, 2076 were assessed as requiring advice-seeking. Nearly 50% of participants disagreed with an expert panel with respect to seeking medical advice for rectal bleeding lasting 3 weeks.
CHANGES IN THE PATTERN OF PARACETAMOL USE IN THE PERICONCEPTION PERIOD IN A DANISH COHORT
By: Ersboll AS, Hedegaard M, Damm P, Johansen M, Tabor A, Hegaard HK
Acta Obstet Gynecol Scand. 2015 Aug;94(8):898-903.
Summary: Paracetamol is the most commonly used OTC medicine in pregnancy. This report described the pattern of paracetamol use with a focus on frequent ingestion (more than once a week), 3 months before, and in early pregnancy.
LOPERAMIDE DEPENDENCE AND ABUSE
By: MacDonald R, Heiner J, Villarreal J, Strote J.
BMJ Case Reports May 2015, article 209705.
Summary: The authors describe the first case of a patient with loperamide dependence via intake of 800 mg per day.
REASONS FOR ATTENDING AN URBAN URGENT CARE CENTRE WITH MINOR ILLNESS: A QUESTIONNAIRE STUDY
By: Amiel C, Williams B, Ramzan F, Islam S, Ladbrooke T, Jajeed A, Gnani S.
Emergency Medicine Journal 2014; 31 (Oct): e71-5.
Summary: 649 adults presenting to an urgent care centre with a minor illness are described. Access to care was a key reason for choosing this route. Physician dissatisfaction influenced 10 percent of participant decisions. Patients were generally young and rated themselves as healthy.
MANAGEMENT OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN GERMANY – A SURVEY AMONG GASTROENTEROLOGISTS.
By: Malfertheiner P, Monnikes H, Muller-Lissner S, Brignull E, Weller U.
Z Gastroenterol. 2005 Jun;43(6):575-80
Summary: GERD is one of the most common diseases seen by gastroenterologists globally, yet the management strategies for patients with GERD differ vastly among countries. This report sought to understand how gastroenterologists in Germany manage patients with GERD symptoms in clinic and private care and the strategies employed to deal with patients with residual symptoms despite PPI therapy. Of the 771 gastroenterologists that responded, nearly all reported that about 80% of their patients had two or more reflux episodes per week and one fifth of patients suffered from heartburn daily. Prior to referral to the gastroenterologist, nearly 90% of patients had consulted with their primary care physician, over 50% had self-medicated, 25% had used treatments recommended by pharmacists and up to 60% of patients had modified their diets. PPIs are prescribed as first-line therapy for 97% of gastroenterologists. In up to 40% of patients, this treatment is continuously needed. In the cases in which PPIs are not prescribed as first-line therapy, antacids are primary choice, followed by H2-receptor antagonists. Alginates are rarely used in first line treatment. For nearly all respondents the percentage of patients not sufficiently responsive to PPIs is around 20%.