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D’Agostino I, Marelli F. Chronic E. Coli Drug-Resistant Cystitis Treated with a Sequence of Modulated Extremely Low-Frequency Electromagnetic Fields: A Randomized Study of 148 Cases. J Clin Med 2024; 13:2639. [PMID: 38731168 PMCID: PMC11084708 DOI: 10.3390/jcm13092639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/28/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: This study investigated the effects of sequenced electromagnetic fields, modulated at extremely low frequencies and intensities, in the treatment of drug-resistant Escherichia coli (E. coli)-induced chronic bacterial cystitis. (2) Methods: A total of 148 female participants, aged 18 to 80 years diagnosed with chronic bacterial cystitis caused by drug-resistant E. coli, were recruited for this study. Participants were randomly assigned to two groups: an experimental group (n = 74) with osteopathic palpation and assessment treated with a sequence of electromagnetic fields, and a control group (n = 74) receiving a placebo treatment. Both groups were assessed at this study's outset, 4 weeks after eight applications, and at 12 weeks for symptomatic presentation and laboratory parameters. (3) Results: After 4 weeks of treatment, a significant difference was observed between the two groups regarding D-DIMER levels, IL-6 levels, erythrocyte levels, leukocyte levels, and E. coli levels (p < 0.001). By the 12th week, the experimental group continued to exhibit a significant reduction in the examined parameters compared to the control group (p < 0.001). Additionally, the treatment did not induce any side effects in the patients in the experimental group. (4) Conclusions: Treatment with coherently sequenced electromagnetic fields, modulated at an extremely low frequency and intensity, not only appears to provide an effective alternative for the symptoms of chronic bacterial cystitis caused by drug-resistant E. coli but also demonstrates a potent antibacterial effect.
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Affiliation(s)
| | - F. Marelli
- Independent Researcher, CRESO LLCs, 6830 Chiasso, Switzerland
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2
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Beecher C, Duane S, Vellinga A, Murphy AW, Cormican M, Smyth A, Healy P, Moore M, Little P, Geoghegan C, Devane D. COSUTI: A Core Outcome Set (COS) for Interventions for the Treatment of Uncomplicated Urinary Tract Infection (UTI) in Adults. Antibiotics (Basel) 2022; 11:antibiotics11121846. [PMID: 36551503 PMCID: PMC9774367 DOI: 10.3390/antibiotics11121846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Uncomplicated urinary tract infections (UTIs) are among the most common presentations of bacterial infections in the outpatient setting. The variation of outcomes reported in trials to assess the most effective treatment interventions for uncomplicated UTIs has meant that comparing and synthesising the outcomes across trials is challenging and limits the reliability of evidence which would otherwise inform healthcare decisions. Objective: Develop a Core Outcome Set (COS) for interventions for the treatment of uncomplicated UTIs in otherwise healthy adults. Methods: The COS development consisted of three phases: (1) A systematic review to identify outcomes reported in randomised trials and systematic reviews of randomised trials comparing the effectiveness of any interventions for the treatment of uncomplicated UTI in otherwise healthy adults; (2) Outcomes identified in the systematic review were prioritised in an online 3-round modified Delphi survey with healthcare practitioners (n = 68), researchers (n = 5), and people who have experienced or cared for someone experiencing a UTI (n = 180); (3) An online consensus meeting to determine the final COS with healthcare practitioners and policymakers (n = 9), researchers (n = 4), and people who have experienced or cared for someone experiencing a UTI (n = 7). Results: We identified a large number of outcomes. Through the use of robust consensus methods, those outcomes were reduced to a core set of six outcomes that should, at a minimum, be measured and reported in randomised trials and systematic reviews of interventions treating uncomplicated UTIs in adults.
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Affiliation(s)
- Claire Beecher
- HRB Trials Methodology Research Network, School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
- School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
- Correspondence:
| | - Sinead Duane
- HRB Trials Methodology Research Network, School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
- Discipline of Marketing, J.E. Cairnes School of Business and Economics, University of Galway, H91 TK33 Galway, Ireland
| | - Akke Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Andrew W. Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trial Network Ireland, College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
- Discipline of General Practice, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Martin Cormican
- Discipline of Bacteriology, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, University of Galway, H91 TK33 Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
| | - Michael Moore
- Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Paul Little
- Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | | | - Declan Devane
- HRB Trials Methodology Research Network, School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
- School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
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Neill R, Gillespie D, Ahmed H. Variation in Antibiotic Treatment Failure Outcome Definitions in Randomised Trials and Observational Studies of Antibiotic Prescribing Strategies: A Systematic Review and Narrative Synthesis. Antibiotics (Basel) 2022; 11:antibiotics11050627. [PMID: 35625271 PMCID: PMC9137992 DOI: 10.3390/antibiotics11050627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/10/2022] Open
Abstract
Antibiotic treatment failure is used as an outcome in randomised trials and observational studies of antibiotic treatment strategies and may comprise different events that indicate failure to achieve a desired clinical response. However, the lack of a universally recognised definition has led to considerable variation in the types of events included. We undertook a systematic review of published studies investigating antibiotic treatment strategies for common uncomplicated infections, aiming to describe variation in terminology and components of the antibiotic treatment failure outcomes. We searched Medline, Embase, and the Cochrane Central Register of Clinical trials for English language studies published between January 2010 and January 2021. The population of interest was ambulatory patients seen in primary care or outpatient settings with respiratory tract (RTI), urinary tract (UTI), or skin and soft tissue infection (SSTI), where different antibiotic prescribing strategies were compared, and the outcome was antibiotic treatment failure. We narratively summarised key features from eligible studies and used frequencies and proportions to describe terminology, components, and time periods used to ascertain antibiotic treatment failure outcomes. Database searches identified 2967 unique records, from which 36 studies met our inclusion criteria. This included 10 randomised controlled trials and 26 observational studies, with 20 studies of RTI, 12 of UTI, 4 of SSTI, and 2 of both RTI and SSTI. We identified three key components of treatment failure definitions: prescription changes, escalation of care, and change in clinical condition. Prescription changes were most popular in studies of UTI, while changes in clinical condition were most common in RTI and SSTI studies. We found substantial variation in the definition of antibiotic treatment failure in included studies, even amongst studies of the same infection subtype and study design. Considerable further work is needed to develop a standardised definition of antibiotic treatment failure in partnership with patients, clinicians, and relevant stakeholders.
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Affiliation(s)
- Rebecca Neill
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK;
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK;
- Correspondence:
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Duane S, Beecher C, Vellinga A, Murphy AW, Cormican M, Smyth A, Healy P, Moore M, Little P, Devane D. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac025. [PMID: 35350132 PMCID: PMC8944192 DOI: 10.1093/jacamr/dlac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Uncomplicated urinary tract infections (UTIs) are amongst the most frequent infections presenting in the outpatient setting. A growing number of clinical trials are assessing the most effective treatment interventions for uncomplicated UTI. Due to the heterogeneity of the outcomes reported in these trials, however, comparing these outcomes is challenging. Objectives Identify the core outcomes that have been reported in trials and systematic reviews of interventions treating uncomplicated UTI in adults. Methods We conducted a systematic search for core outcomes used to evaluate treatments of UTIs. We searched the Cochrane Database of Systematic Reviews, PubMed and Embase. One researcher independently screened each article for inclusion, and the Core Outcome Set for treatment of Urinary Tract Infections (COSUTI) team acted as second reviewers. All included articles were screened by two reviewers. All outcomes were extracted verbatim, and similar outcomes were grouped into domains and subdomains. Results In total, 334 outcomes were reported across 41 papers, the average number of outcomes reported being 8. Outcomes were categorized across 18 domains, the majority of which were related to clinical cure outcomes. Many outcomes varied in the timepoints within which the outcome was measured and reported. Conclusions Comparing the outcomes of trials investigating uncomplicated UTI treatment remains challenging due to the difference in outcomes currently reported. Consistency of reporting of outcomes would be improved by developing a minimum number of consistent outcomes that should be reported in all trials.
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Affiliation(s)
- Sinead Duane
- Discipline of Marketing, J. E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
- Ryan Institute, Environmental, Marine, and Energy Research, Martin Ryan Building, National University of Ireland Galway, Galway, Ireland
- Corresponding author. E-mail: ; @smduane, @decdevane, @beecherclaire1, @Dr_Akke, @CormicanMartin, @pmrycaretrials1, @patriciahealy12
| | - Claire Beecher
- HRB TMRN, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Akke Vellinga
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Andrew W. Murphy
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Martin Cormican
- Discipline of Bacteriology, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Patricia Healy
- Primary Care and Population Sciences, Primary Care and Population Sciences, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Michael Moore
- Primary Care and Population Sciences, Primary Care and Population Sciences, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, Primary Care and Population Sciences, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Declan Devane
- HRB TMRN, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Vellinga A, Farrell K, Fallon R, Hare D, Sutton-Fitzpatrick U, Cormican M. Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study. J Med Internet Res 2021; 23:e25364. [PMID: 34477567 PMCID: PMC8449294 DOI: 10.2196/25364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/04/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients. Objective The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs. Methods A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution. Results A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1%), and 38.7% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made. Conclusions Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research.
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Affiliation(s)
- Akke Vellinga
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Karen Farrell
- School of Medicine, Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Roisin Fallon
- School of Medicine, Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Daniel Hare
- Department of Clinical Microbiology, University Hospital Galway, Galway, Ireland
| | | | - Martin Cormican
- Health Service Executive, Antimicrobial Resistance and Infection Control Team, Dublin, Ireland.,Discipline of Bacteriology, National University of Ireland Galway, Galway, Ireland
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Coyle ME, Zhang AL, Xue CC. Authors' reply re: Acupuncture for recurrent urinary tract infection in women: A systematic review and meta-analysis. BJOG 2020; 127:1441. [PMID: 32725747 DOI: 10.1111/1471-0528.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Meaghan E Coyle
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Anthony L Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Cl Xue
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Qin X, Coyle ME, Yang L, Liang J, Wang K, Guo X, Zhang AL, Mao W, Lu C, Xue CC, Liu X. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis. BJOG 2020; 127:1459-1468. [PMID: 32406571 DOI: 10.1111/1471-0528.16315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI). OBJECTIVES To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women. SEARCH STRATEGY Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included. DATA COLLECTION AND ANALYSIS Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I2 = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I2 = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92). CONCLUSIONS Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture. TWEETABLE ABSTRACT This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.
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Affiliation(s)
- X Qin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - M E Coyle
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - L Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - J Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - K Wang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - X Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - A L Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - W Mao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C C Xue
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - X Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Keller LJ, Glauser J. Urinary Tract Infection Updates and Recent Developments. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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