This Month's Clinical
Focus: MULTI-SPECIALTY CROSS-OVER
ALLERGY /
Infectious Disease / ONCOLOGY
Tool Pegs Effect of Acute Sinusitis
Tx
Aptly named tool can
accurately assess changes in QOL related to therapeutic interventions for
acute rhinosinusitis, researchers
found.
The modified sinonasal outcome test (SNOT-16) scale identified significant differences in the hypothesized direction for those reporting more or less severe symptoms (P<0.001), Jane Garbutt, MB, ChB, of Washington University in St. Louis, and colleagues reported in the August issue of Archives of Otolaryngology -- Head and Neck Surgery.
"The instrument performed well in this patient group and can be used to assess change in disease-specific quality of life in studies evaluating management of adults with acute rhinosinusitis," they wrote. The modified SNOT-16, a disease-specific quality of life instrument, is one of several sinonasal outcome tests derived from the Rhinosinusitis Outcome Measure (RSOM-31), which also includes SNOT-20 and SNOT-22.
These tools have been found to be reliable and valid for assessing outcomes in chronic rhinosinusitis patients, but there are currently no clinical objective measures of disease resolution of acute rhinosinusitis for use in clinical trials. Thus, tools to assess outcomes in these patients are needed, the researchers said.
To determine the reliability, validity, responsiveness, and minimal important difference (the smallest change that would be detected as an improvement) for SNOT-16 in assessing quality of life in acute disease, the researchers conducted a randomized controlled trial at 10 community practices in St. Louis.
Patients received a 10-day course of either placebo or amoxicillin (500 mg three times per day). All patients also received symptomatic treatments to be used as needed, including acetaminophen, guaifenesin, dextromethorphan hydrobromide, psuedoephedrine, and saline spray.
The SNOT-16 tool included four domains -- rhinologic symptoms, ear/facial symptoms, sleep symptoms, and psychological function -- and was completed at baseline (either face-to-face or over the phone) and by phone at 3, 7, and 10 days.
Patients rated how much they were bothered by 16 sinus-related symptoms using a four-point scale. A total of 166 patients ages 18 to 70 who had acute rhinosinusitis participated in the study between Nov. 1, 2006 and May 1, 2009. Their median age was 32, the majority (78%) were white, and 36% were male. Overall, Garbutt and colleagues said the tool was easy to use and took less than five minutes to complete.
They found that it identified statistically significant differences in the hypothesized direction for those reporting more or less severe symptoms (P=0.02) and for those who were more or less bothered by their symptoms (P<0.001), "demonstrating construct-related validity," they wrote.
The SNOT-16 tool also demonstrated "high internal consistency," they said, with Cronbach-alpha scores ranging from 0.82 to 0.91. As well, there was a significant decrease in scores over time (P<0.001), with effect sizes of 1.45, 2.34, and 2.90 at days three, seven, and 10, respectively, indicating a "highly responsive instrument," they wrote. And the minimal important difference was 0.5 units, which "may not represent meaningful change at the level of the individual ... [but] suggests that a patient with a change in SNOT-16 score of less than 0.5 is unlikely to perceive any benefit from treatment."
Garbutt and colleagues noted that scores assessed in the office during a face-to-face interview differed significantly from those obtained from the phone interview done the same day, within 12 hours of each other. Thus, they wrote, if telephone follow-up is planned, the initial SNOT assessment should also be measured by phone.
The study was limited because the researchers didn't repeat the previous work that was a part of developing the SNOT instruments, and because they did not evaluate the validity of the test in patients with acute sinusitis. Still, they concluded that the SNOT-16 tool "is a valid instrument to assess effectiveness of interventions to improve disease-specific quality of life in adults with acute rhinosinusitis."
The study was supported by a grant from the National Institute of Allergy and Infectious Diseases. SNOT-16 is intellectual property of Washington University.
SOURCE: Primary
source: Archives of Otolaryngology -- Head and Neck Surgery
Source
reference: Garbutt J, et al "Use of the modified SNOT-16 in primary care
patients with clinically diagnosed acute rhinosinusitis" Arch Otolaryngol
Head Neck Surg 2011; 137(8): 792-797. Original article by Kristina Fiore,
Staff Writer, MedPage Today Published: August 16, 2011
Contact Allergies Associated With Lower Rates of Some
Cancers
Sensitivity to chemicals, metals may prime
immune system against certain tumors, research suggests, but more study
needed.
The study was conducted by Kaare Engkilde of the National Allergy Research Centre at Copenhagen University, Gentoffe Hospital in Hellerup, Denmark, and colleagues. The immune systems of people with contact allergies may be primed to protect against certain types of cancer, including breast and brain cancers, new research suggests.
Contact allergies occur due to direct contact with chemicals and common metals such as nickel.
In the new study, researchers looked at
almost 17,000 Danish adults who were tested for contact allergies between
1984 and 2008. About one-third (35 percent) tested positive for at least
one contact allergy. Women were
more likely than men to have a contact allergy -- 41 percent versus 26
percent.
When the study
authors examined cancer cases among the participants over the long term,
they found that men and women with contact allergies had significantly
lower rates of breast and non-melanoma skin cancer, and women with contact
allergies also had lower rates of brain cancer compared to those without
contact allergies. But people with
contact allergies had higher rates of bladder cancer, which may be due to
higher levels of chemical metabolites accumulated in the blood, the
researchers suggested.
The findings did not allow the researchers to come to any conclusions about cause and effect, and more study is needed, they noted in a journal news release. "However, if these relations are etiological, there are implications for understanding how contact allergy can affect cancer development and vice versa," Engkilde's team wrote in the report.
SOURCE: BMJ Open, news release. Original article by Robert Preidt
Tuesday, July 12, 2011
http://www.nlm.nih.gov/medlineplus/news/fullstory_114193.html
(URL expires after 10/10/2011).
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