Chronic cough and esomeprazole: A double-blind placebo-controlled parallel study

Background and objective: Gastro-oesophageal reflux has been implicated in the pathogenesis of chronic cough. Guidelines on management suggest a therapeutic trial of anti-reflux medication. Esomeprazole is a proton pump inhibitor licensed for the long-term treatment of acid reflux in adults and we compared the effects of esomeprazole and placebo on patients with chronic cough. Methods: This was a prospective, single-centre, randomized, double-blind, placebo-controlled, parallel group study conducted over 8 weeks. Fifty adult non-smokers with chronic cough and normal spirometry were randomized. Patients completed cough-related quality-of-life and symptom questionnaires and subjective scores of cough frequency and severity at the beginning and end of the study. They also kept a daily diary of symptom scores. Citric acid cough challenge and laryngoscopic examination were performed at baseline and the end of the study. The primary outcome was improvement in cough score. Results: There were no differences in cough scores in the placebo and treatment arms of the study although some significant improvements were noted when compared to baseline. In the cough diary scores there was a trend towards greater improvement in the treatment arm in patients with dyspepsia. Conclusions: Esomeprazole did not have a clinically important effect greater than placebo in patients with cough. It suggests a marked placebo effect in the treatment of cough. There is paucity of evidence on which to base the treatment of reflux-associated cough. We demonstrate that acid suppressive therapy does not lead to a significant clinical effect in these patients. There may be some improvement in those with coexisting dyspeptic symptoms and therapy should be restricted to this group. © 2011 Asian Pacific Society of Respirology

Народні формування на території України у початковий період Великої Вітчизняної війни (1941–1942 рр.)

Вивчення історії початкового періоду Великої Вітчизняної війни, участі народних формувань у обороні своєї Вітчизни ілюструє багатовимірний спектр її подій. Простежено процес формування винищувальних батальйонів і народного ополчення в найбільших містах України, їхню організаційну структуру, матеріально-технічне забезпечення, озброєння, чисельний склад. Виявлено ряд недоліків у процесі організації добровільних збройних формувань.Studying of the history of the initial period of the Great Patriotic war, taking part of the people’s formations in defense of the native land causes various judgments as to its events nowadays. The process of forming of punitive battalions and people’s formations in large cities of Ukraine, their structure and organization, material-technical securing, armament, numerical strength was observed. A number of weak points in the process of organizing of voluntary formations were revealed

Analysing the Role of Fusion Power in the Future Global Energy System

This work presents the EFDA Times model (ETM), developed within the European Fusion Development Agreement (EFDA). ETM is an optimization global energy model which aims at providing the optimum energy system composition in terms of social wealth and sustainability including fusion as an alternative technology in the long term. Two framework scenarios are defined: a Base case scenario with no limits to CO2 emissions, and a 450ppm scenario with a limit of 450ppm in CO2-eq concentrations set by 2100. Previous results showed that in the Base case scenario, with no measures for CO2 emission reductions, fusion does not enter the energy system. However, when CO2 emission restrictions are imposed, the global energy system composition changes completely. In a 450ppm scenario, coal technologies disappear in a few decades, being mainly replaced by nuclear fission technologies which experience a great increase when constrained only by Uranium resources exhaustion. Fission technologies are then replaced by the fusion power plants that start in 2070, with a significant contribution to the global electricity production by 2100. To conclude the work, a sensitivity analysis will be presented on some parameters that may affect the possible role of fusion in the future global energy system

Design characteristics of comparative effectiveness trials for the relief of symptomatic dyspepsia: A systematic review

Background: Dyspepsia represents a symptom domain rather than a diagnostic condition and covers a wide range of complex, underlying pathophysiologies that are not well understood. The review explores comparative effectiveness interventions for the treatment of symptomatic dyspepsia along a pragmatic-explanatory continuum. The aim is to identify relevant design characteristics applicable to future upper gastrointestinal comparative effectiveness research employing integrative medicine. Methods: Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and WHO Clinical Trials were systematically searched until January 2019. Included articles were original research with two or more comparative intervention arms for the primary outcome; relief of symptomatic dyspepsia. Evaluation of the studies was conducted using the pragmatic-explanatory continuum indicator summary (PRECIS-2) tool. Results: Thirty-six articles were included in the review. A total of 68 Patient Reported Outcome Measurements (PROMs), utilizing 50 different formats were deployed across the studies. The appraisal process revealed eligibility, flexibility in adherence, flexibility in delivery and organization domains further aligned towards an explanatory design. Conclusion: This review identified three design characteristics relevant for future comparative effectiveness research for the treatment of upper gastrointestinal disorders in a community setting. Extensive exclusion eligibility criteria limited the generalization of comparative effectiveness study results by removing sub-groups of the target populations more at risk of dyspeptic symptoms. The requirement for entry endoscopy was found to be common and not always pragmatically justifiable. Development of validated PROMs appropriate for a generic application to upper gastrointestinal disorders would be advantageous for future comparative effectiveness research within integrative medicine

Management of Gastroesophageal Reflux Disease: Lifestyle Modification and Alternative Approaches

The first step in the management of gastroesophageal reflux disease (GERD) is lifestyle modification, with dietary recommendations such as increasing fiber intake and lowering dietary fat. While there is some physiological evidence that various foods as well as alcohol and tobacco affect the pressure of the lower esophageal sphincter (LES), targeted interventions have not shown any benefit in clinical trials. The general recommendation is for the patient to avoid foods and beverages that in his or her experience trigger GERD symptoms. The only measures that have been shown with some degree of scientific evidence to be beneficial are weight loss on the part of obese patients and elevation of the head of the bed. We, in contrast, developed a training program that induces a change from thoracic to abdominal breathing. We hypothesized that this change in breathing actively trains the diaphragm, and so potentially strengthens the LES. In a randomized trial using breathing exercises as the intervention, we found an improvement in gastroesophageal reflux symptoms, assessed by quality of life, pH-metry and proton pump inhibitor use. Most patients would prefer to take proton pump inhibitors than to do exercises, but at least for a subgroup of highly motivated patients who would prefer an alternative to medication, structured physical exercises could offer new help with their GERD.</jats:p

Unterschiede in der Skala Arbeitsged\ue4chtnis und Sprachverst\ue4ndnis bei normalsehenden, sehbehinderten und blinden Kindern

vorgelegt von: Eherer SonjaGraz, Univ., Dipl.-Arb., 200