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Effectiveness of eHealth Interventions for HIV Prevention and Management in Sub-Saharan Africa: Systematic Review and Meta-analyses. AIDS Behav 2022; 26:457-469. [PMID: 34427813 PMCID: PMC8813706 DOI: 10.1007/s10461-021-03402-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
HIV is still the leading cause of death in Sub-Saharan Africa (SSA), despite medical advances. eHealth interventions are effective for HIV prevention and management, but it is unclear whether this can be generalised to resource-poor settings. This systematic review aimed to establish the effectiveness of eHealth interventions in SSA. Six electronic databases were screened to identify randomised controlled trials (RCTs) published between 2000 and 2020. Meta-analyses were performed, following Cochrane methodology, to assess the impact of eHealth interventions on HIV-related behaviours and biological outcomes. 25 RCTs were included in the review. Meta-analyses show that eHealth interventions significantly improved HIV management behaviours (OR 1.21; 95% CI 1.05-1.40; Z = 2.67; p = 0.008), but not HIV prevention behaviours (OR 1.02; 95% CI 0.78-1.34; Z = 0.17; p = 0.86) or biological outcomes (OR 1.17; 95% CI 0.89-1.54; Z = 1.10; p = 0.27) compared with minimal intervention control groups. It is a hugely important finding that eHealth interventions can improve HIV management behaviours as this is a low-cost way of improving HIV outcomes and reducing the spread of HIV in SSA. PROSPERO registration number: CRD42020186025.
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Smith JA, Harle A, Dockry R, Holt K, Russell P, Molassiotis A, Yorke J, Robinson R, Birrell MA, Belvisi MG, Blackhall F. Aprepitant for Cough in Lung Cancer. A Randomized Placebo-controlled Trial and Mechanistic Insights. Am J Respir Crit Care Med 2021; 203:737-745. [PMID: 32966755 PMCID: PMC7958516 DOI: 10.1164/rccm.202006-2359oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 01/26/2023] Open
Abstract
Rationale: Effective cough treatments are a significant unmet need in patients with lung cancer. Aprepitant is a licensed treatment for nausea and vomiting, which blocks substance P activation of NK-1 (neurokinin 1) receptors, a mechanism also implicated in cough.Objectives: To assess aprepitant in patients with lung cancer with cough and evaluate mechanisms in vagal nerve tissue.Methods: Randomized double-blind crossover trial of patients with lung cancer and bothersome cough. They received 3 days of aprepitant or matched placebo; after a 3-day washout, patients crossed to the alternative treatment. The primary endpoint was awake cough frequency measured at screening and Day 3 of each treatment; secondary endpoints included patient-reported outcomes. In vitro, the depolarization of isolated guinea pig and human vagus nerve sections in grease-gap recording chambers, indicative of sensory nerve activation, was measured to evaluate the mechanism.Measurements and Main Results: Twenty patients with lung cancer enrolled, with a mean age 66 years (±7.7); 60% were female and 80% had non-small cell cancer, 50% had advanced stage, and 55% had World Health Organization performance status 1. Cough frequency improved with aprepitant, reducing by 22.2% (95% confidence interval [CI], 2.8-37.7%) over placebo while awake (P = 0.03), 30.3% (95% CI, 12.7-44.3) over 24 hours (P = 0.002), and 59.8% (95% CI, 15.1-86.0) during sleep (P = 0.081). Patient-reported outcomes all significantly improved. Substance P depolarized both guinea pig and human vagus nerve. Aprepitant significantly inhibited substance P-induced depolarization by 78% in guinea pig (P = 0.0145) and 94% in human vagus (P = 0.0145).Conclusions: Substance P activation of NK-1 receptors appears to be an important mechanism driving cough in lung cancer, and NK-1 antagonists show promise as antitussive therapies.
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Affiliation(s)
- Jaclyn A. Smith
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Amélie Harle
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Rachel Dockry
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Philip Russell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Ryan Robinson
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Mark A. Birrell
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria G. Belvisi
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Fiona Blackhall
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, Wang Q, Wang C, Lin J, Hao C, Kong L, Zhang S, Chen Y, Luo W, Jiang M, Xie J, Zhong N. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis 2018; 10:6314-6351. [PMID: 30622806 PMCID: PMC6297434 DOI: 10.21037/jtd.2018.09.153] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Huahao Shen
- The Second Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310009, China
| | - Xin Zhou
- Shanghai Jiaotong University Affiliated Shanghai No. 1 People’s Hospital, Shanghai 200080, China
| | - Zhongmin Qiu
- Tongji Affiliated Tongji Hospital, Shanghai 200065, China
| | - Shaoxi Cai
- Southern Medical University Affiliated Nanfang Hospital, Guangzhou 510515, China
| | - Kewu Huang
- Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing 100020, China
| | | | - Changzheng Wang
- Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jiangtao Lin
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Chuangli Hao
- Children’s Hospital of Soochow University, Suzhou 215025, China
| | - Lingfei Kong
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Shunan Zhang
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Yaolong Chen
- Evidence-based Medical Center of Lanzhou University, Lanzhou 730000, China
| | - Wei Luo
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jiaxing Xie
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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Simoff MJ, Lally B, Slade MG, Goldberg WG, Lee P, Michaud GC, Wahidi MM, Chawla M. Symptom Management in Patients With Lung Cancer. Chest 2013; 143:e455S-e497S. [DOI: 10.1378/chest.12-2366] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Wee B, Browning J, Adams A, Benson D, Howard P, Klepping G, Molassiotis A, Taylor D. Management of chronic cough in patients receiving palliative care: review of evidence and recommendations by a task group of the Association for Palliative Medicine of Great Britain and Ireland. Palliat Med 2012; 26:780-7. [PMID: 21993808 DOI: 10.1177/0269216311423793] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic cough is a disruptive and exhausting symptom, reported as very distressing in a quarter of those in their last year of life. Existing guidelines for management of chronic cough primarily deal with the commonest benign causes of cough: asthma; eosinophilic bronchitis; gastro-oesophageal reflux disease; rhinosinusitis. AIM/DESIGN to examine what literature evidence exists and formulate recommendations for managing chronic cough in patients with advanced, progressive, life-limiting illnesses. DATA SOURCES Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, Google Scholar); hand-search; grey literature. RESULTS Of 11 initially eligible studies, 5 provided evidence at level 2 or better. The small size of these studies, heterogeneity of study population and diversity of interventions and outcome measures used meant that comparison across studies and compilation of guidelines based on high-quality evidence was not possible. Pragmatic recommendations based on available evidence were formulated, drawing on the included studies and, in addition, extrapolating from two other well-designed studies involving patients with chronic cough. They also took into consideration convenience, toxicity and minimizing burden and harm of intervention, as well as considering the potential for disease-directed treatment and the possibility of pharmacological and co-existing benign causes of chronic cough. CONCLUSIONS These recommendations (Grade D) include simple linctus, therapeutic trial of sodium cromoglycate and then prescription of an opioid or opioid derivative (dextromethorphan, morphine or codeine). Further research is clearly and urgently required in this area for more effective approaches to managing cough, tested in trials that have sufficient size, power and validity.
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Affiliation(s)
- Bee Wee
- Oxford University Medical School and Fellow of Harris Manchester College, University of Oxford, Sir Michael Sobell House, Churchill Hospital, Oxford OX3 7LJ, UK.
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Considerations in developing and delivering a non-pharmacological intervention for symptom management in lung cancer: the views of health care professionals. Support Care Cancer 2012; 20:2565-74. [DOI: 10.1007/s00520-011-1362-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022]
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Molassiotis A, Lowe M, Ellis J, Wagland R, Bailey C, Lloyd-Williams M, Tishelman C, Smith J. The experience of cough in patients diagnosed with lung cancer. Support Care Cancer 2011; 19:1997-2004. [PMID: 21107612 DOI: 10.1007/s00520-010-1050-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/11/2010] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to explore the patient experience of cough in a population of patients with lung cancer. METHODS A qualitative exploratory study design was developed and elicited the views of 26 patients with lung cancer who had current or past experience with cough. RESULTS The data's four themes highlight the complex and distressing nature of cough, including its interaction with other symptoms, such as breathlessness, fatigue and sleep disturbance. A theme around descriptions of cough suggests typically a dry tickly cough and highlights mechanical and environmental triggers for cough. The theme around the effects of cough in daily life shows the impact of cough in socialising, the embarrassment from cough and the psychological effects experienced by patients. The last theme focuses on strategies for coping with and managing cough, showing the perceived ineffectiveness of current antitussives and the patients' use of a variety of approaches on an ad hoc basis to try to manage their cough often unsuccessfully. CONCLUSION Cough has not received the same attention as other cancer symptoms, which means that patients' experience of a distressing and difficult symptom is often unnoticed by health care professionals. More clinical and research attention in this debilitating symptom is necessary.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, University Place, Block 3, Manchester M13 9PL, UK.
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Molassiotis A, Smith JA, Bennett MI, Blackhall F, Taylor D, Zavery B, Harle A, Booton R, Rankin EM, Lloyd-Williams M, Morice AH. Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough. Cough 2010; 6:9. [PMID: 20925935 PMCID: PMC2978117 DOI: 10.1186/1745-9974-6-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 10/06/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice. METHODS Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions. RESULTS A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches. CONCLUSION The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations.
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Affiliation(s)
| | - Jaclyn A Smith
- School of Translational Medicine, University of Manchester, UK
| | | | - Fiona Blackhall
- Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK
| | - David Taylor
- Department of Thoracic Medicine, Wycombe Hospital, Buckinghamshire, UK
| | - Burhan Zavery
- Oncology Pharmacy, Clatterbridge Centre for Oncology NHS Foundation Trust, Bebington, UK
| | - Amelie Harle
- Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK
| | - Richard Booton
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester, UK
| | - Elaine M Rankin
- Department of Cancer Medicine, Ninewells Hospital, Dundee, UK
| | - Mari Lloyd-Williams
- School of Population, Community and Behavioural sciences, University of Liverpool, UK
| | - Alyn H Morice
- Department of Academic Medicine (Chest), University of Hull, UK
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