Greater Mean Difference Research Articles

Value of Culdocentesis

<h3>Background</h3> Community pharmacists are well positioned to support patients’ minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared with usual pharmacist care (UC). <h3>Methods</h3> A cluster randomised controlled trial was conducted. Intervention patients received MAS, which included a consultation with the pharmacist. MAS pharmacists were trained in clinical pathways and communication systems mutually agreed with general practitioners and received monthly support. Control patients received UC. All patients were followed up by telephone at 14 days. Clinical and humanistic impact were defined by primary (appropriate referral rate and appropriate non-prescription medicine rate) and secondary outcomes (clinical product-based intervention rate, referral adherence, symptom resolution, reconsultation and EuroQol EQ-5D visual analogue scale (VAS)). <h3>Results</h3> Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow-up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% CI 1.07 to 2.11; p=0.018) and were five times more likely to adhere to referral, compared with UC (RR=5.08; 95%CI 2.02 to 12.79; p=0.001). MAS patients (94%) achieved symptom resolution or relief at follow-up, while this was 88% with UC (RR=1.06; 95% CI 1 to 1.13; p=0.035). MAS pharmacists were 1.2 times more likely to recommend an appropriate medicine (RR 1.20, 95% CI 1.1 to 1.3; p=0.000) and were 2.6 times more likely to perform a clinical product-based intervention (RR=2.62, 95% CI 1.28 to 5.38; p=0.009), compared with UC. MAS patients had a greater mean difference in VAS at follow-up (4.08; 95% CI 1.23 to 6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95% CI 0.75 to 1.28; p=0.89). <h3>Conclusion</h3> The study demonstrates improved clinical and humanistic outcomes with MAS. National implementation is a means to manage minor ailments more effectively in the Australian health system. <h3>Trial registration number</h3> ACTRN12618000286246.

Absence of Central Factors in Auditory Fatigue

At the last Society Meeting, Wernick and Tobias reported that listeners consistently showed greater temporary threshold shift (TTS) when a fatiguing tone was presented during a “mental task” than when they simply sat quietly (“reverie”). We cannot confirm this report. Twelve listeners were exposed to a 4000-cps tone at 100 dB SPL for 3 min under two conditions: (1) sitting quietly and (2) adding columns of figures. Pre- and post-exposure thresholds at 5600 cps were determined with Békésy audiometer, interrupted tones. Order was balanced, initial postexposure setting was at preexposure threshold, and instructions to the subjects were neutral in regard to expected outcome. Indeed, the person actually running the subjects was unaware of the outcome of Wernick and Tobias' study. No significant differences in TTS were found at any time after exposure; in fact, the greatest mean difference at any time was in the opposite direction: the TTS at 2 min 15 sec was 14 dB for the “reverie” condition, 12 dB for the “mental task.” It is concluded that the efferent system need not be invoked to account for any aspects of auditory fatigue. [Supported by grants from the Public Health Service, U. S. Department of Health, Education, and Welfare.]