Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis.

BACKGROUND: The value of antibiotics in acute rhinosinusitis is uncertain. Although maxillary sinusitis is commonly diagnosed and treated in general practice, no effectiveness studies have been done on unselected primary-care patients. We used a randomised, placebo-controlled design to test the hypothesis that there would be an improvement associated with amoxycillin treatment for acute maxillary sinusitis patients presenting to general practice. METHODS: Adult patients with suspected acute maxillary sinusitis were referred by general practitioners for radiographs of the maxillary sinus. Those with radiographic abnormalities (n = 214) were randomly assigned treatment with amoxycillin (750 mg three times daily for 7 days; n = 108) or placebo (n = 106). Clinical course was assessed after 1 week and 2 weeks, and reported relapses and complications were recorded during the following year. FINDINGS: After 2 weeks, symptoms had improved substantially or disappeared in 83% of patients in the study group and 77% of patients taking placebo. Amoxycillin did not influence the clinical course of maxillary sinusitis nor the frequency of relapses during the 1-year follow-up. Radiographs had no prognostic value, nor were they an effect modifier. Side-effects were recorded in 28% of patients given amoxycillin and in 9% of those taking placebo (p < 0.01). The occurrence of relapses was similar in both groups (21 vs 17%) during the follow-up year. INTERPRETATION: Antibiotic treatment did not improve the clinical course of acute maxillary sinusitis presenting to general practice. For these patients, an initial radiographic examination is not necessary and initial management can be limited to symptomatic treatment. Whether antibiotics are necessary in more severe cases warrants further study.

[Effectiveness of validation. A literature study]. / De effectiviteit van validation. Eeen literatuuronderzoek.

This review-article reports on literature on the effectiveness of validation; and approach used for disoriented elderly. Literature has been searched for by means of several (computerized) indexes and references. By contacting Feil, who developed validation, unpublished articles and reports became available. This search resulted in 13 effect-studies, of which 7 are unpublished, 2 descriptive reports, and 1 research-proposal. The effect-studies have varying designs with different methodological restrictions causing bias. The analysis showed that the quality and therefore the evidential value of the effect-studies is limited. The better the study, the less validation appeared to be effective. It is concluded that the hypothesis, that validation has positive effects on disoriented elderly and their caregivers, has no or minimal scientific basis. Before validation is implemented more and more in Dutch health care, scientific research addressing its effects is indicated.

[Depressive symptoms in physically frail elderly]. / Depressieve klachten bij lichamelijk kwetsbare ouderen.

In 1988 a study aiming to evaluate the effectiveness of an outpatient geriatric clinic was started. Elderly persons (75-90 years) living at home or in the two old people's homes in the municipality Sittard (The Netherlands) were screened on physical vulnerability by means of oral interviews. It was possible to collect data about demographic variables and depressive complaints of 222 frail elderly. For this article the internal consistency of the Zung-depression scale (DSI) was tested for the study group. Relations between depression and the registered demographic variables are discussed. It showed that Cronbach's alpha of the depression scale is .82. A varimax rotated factor analysis resulted in six factors with a high percentage of explained variance on the first factor. This result indicates that the instrument is unidimensional. There was no systematic bias introduced by physical vulnerability. Of all frail elderly, 28% had depressive complaints. In general, women scored somewhat higher on the depression index than men. Only a slight relation between depression and age was found. Concerning household composition this study showed that frail elderly living alone and residents of old people's homes had significantly more depressive complaints than frail elderly living with others and independently living frail elderly respectively.