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Volume 148, No. 4344

Published October 22, 2018

Original article

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    Paul Sebo, Dagmar M. Haller, Johanna Sommer, Sophie Excoffier, Yoann Gaboreau, Hubert Maisonneuve (Author)

    General practitioners’ perspectives on the use of nonpharmacological home remedies in two regions in Switzerland and France

    BACKGROUND

    Nonpharmacological home remedies offer the potential for easily accessible and well-accepted management of common disorders in general practice. We aimed to assess general practitioners’ (GPs’) perspectives on these remedies in two French-speaking European countries.

    METHODS

    In 2017, we conducted a cross-sectional study among community-based GPs in the Geneva (Switzerland) and Grenoble (France) regions. They completed an anonymous questionnaire about forty common home remedies. We asked how often they prescribed each type of remedy and how effective they found them. Descriptive statistics (proportions with 95% confidence intervals [CIs]) were used to summarise the data.

    RESULTS

    349 GPs returned the questionnaire (172 of 500 Swiss and 177 of 500 French; participation rate 35%; male:female ratio 1:1). In the week before the study, GPs had advised 8.2% patients to use at least one remedy. The remedies that were most frequently prescribed were saline water to treat common colds (69%), mobilising and/or stretching exercises for low back pain (67%) and applying cold water or cold pads for burns (60%). The remedies that were perceived to be most effective were squatting during defaecation as a treatment for constipation (89%), phoning a traditional healer to treat skin diseases or burns (84%) and applying cold water or pads for burns (82%).

    CONCLUSIONS

    These findings suggest that GPs find certain nonpharmacological remedies very useful, even though they do not frequently prescribe them in practice. These remedies should receive more attention from researchers, as they could be considered by GPs as useful to treat a large number of benign conditions in primary care.

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    Katrin E. Hostettler, Florent Baty, Rebekka Kleiner, Lilian Junker, Michael Tamm, Martin H. Brutsche (Author)

    Bosentan for patients with steroid-resistant pulmonary sarcoidosis: a randomised controlled trial

    BACKGROUND

    Sarcoidosis is a disorder of unknown aetiology. Most patients have steroid-responsive disease, but side effects and steroid resistance may necessitate alternative treatments. Endothelin has in-vitro fibrogenic activity and the endothelin system is activated in sarcoidosis.

    OBJECTIVES

    We studied the efficacy and safety of the endothelin receptor antagonist bosentan in sarcoidosis patients.

    METHODS

    In a prospective 12-month, double-blind, 1:1-randomised, placebo-controlled phase II trial, we assessed the effect of bosentan in patients with steroid-resistant sarcoidosis and with impaired exercise capacity and/or resting lung function. Primary endpoints were safety and overall response rate of total lung capacity, diffusion capacity, peak oxygen uptake, 6-minute walking distance and chest computed tomography score. Secondary endpoints included adverse events and quality of life.

    MAIN RESULTS

    Twenty patients were randomised. Three patients discontinued the study medication prematurely. No serious drug-related adverse events occurred. At 12 months no statistically significant differences were observed in the primary endpoints including total lung capacity, diffusion capacity, 6-minute walking distance, peak oxygen uptake, and computed tomography-score. Sixty-three percent of the patients treated with bosentan showed an increase of 10% in at least one of the primary endpoints, compared with 67% in the placebo group (p = 1).

    CONCLUSIONS

    There is no evidence to support efficacy of bosentan as an antifibrotic treatment for patients with steroid-resistant pulmonary sarcoidosis. Bosentan was well tolerated and no drug-related adverse effects were observed within the study population.

    Trial registration

    ISRCTN registry, ISRCTN73579020.

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    Michelle Seiler, Sandra Letizia Massaro, Georg Staubli, Clemens Schiestl (Author)

    Tongue lacerations in children: to suture or not?

    AIMS OF THE STUDY

    Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children.

    METHODS

    This retrospective study was conducted to assess tongue lacerations at the ED of a University Children’s Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed.

    RESULTS

    A total of 73 children with tongue lacerations were included (75.3% boys, mean age ± standard deviation 4.0 ± 2.6 years). The mean size of the lacerations was 12.4 ± 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 ± 10 mm compared to 10.8 ± 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%).

    CONCLUSIONS

    Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.

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    Ellen Keizer, Linda Huibers, Morten Bondo Christensen, Oliver Senn (Author)

    Impact of alternative healthcare plans on out-of-hours help-seeking intentions in Switzerland

    INTRODUCTION

    In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general practitioner (GP) or a medical call centre (Telmed) acting as gatekeeper.

    AIM

    To examine the impact of alternative HCPs on patients’ intended help-seeking behaviour out-of-hours (OOH) in Switzerland.

    METHODS

    A secondary analysis of the Swiss data collected for the EurOOHnet survey on help-seeking behaviour in Denmark, the Netherlands and Switzerland was made. The survey used hypothetical scenarios for measuring two outcome measures: intended help-seeking for (1) OOH care and (2) OOH face-to-face care. Binomial regression analyses were used to test the influence of HCPs on intended OOH help-seeking, adjusted for other (population) characteristics.

    RESULTS

    Telmed-insured persons were more inclined to OOH help-seeking than persons with a standard HCP (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.91–2.72; controlled for other population factors), mainly driven by contact with the medical call centre (31 vs 5%), and were less inclined to have an OOH face-to-face contact (OR 0.69, 95% CI 0.55–0.87). Persons with a GP HCP had a lower intended use of face-to-face OOH care contacts than persons with a standard plan (OR 0.74, 95% CI 0.63–0.86).

    CONCLUSION

    Alternative HCPs on a voluntary basis seem to influence the use of OOH care. These results could be relevant for policy makers, especially from non-gatekeeping countries, to reduce irrelevant use and subsequent costs of emergency and OOH care services.

Special article