The feeling of pain produced during medical treatment can be reduced through sophisticated virtual reality helmets, a simple computer game and the determined predisposition of the patient. According to research psychologists at the UAB, this type of distraction even reduces the dosage of sedatives. Their research suggests putting greater emphasis on methodology and on psychological aspects of this technique in order to improve its property.
General practitioners often prescribe antibiotics for respiratory tract infections when nasal discharge is purulent. Most guidelines recommend against their use for this condition, but this advice is based on one study that showed no effect.
So researchers in New Zealand searched the scientific literature for trials comparing antibiotics with placebo for acute purulent rhinitis (duration less than 10 days).
They identified seven trials. Pooling the results showed that antibiotics for acute purulent rhinitis may be beneficial. The numbers needed to treat ranged from 7 to 15, meaning that, at best, six patients get no benefit for every one who gets benefit.
Harms attributed to antibiotics were mainly vomiting, diarrhoea, and abdominal pain, but also included rashes and hyperactivity. The numbers needed to harm ranged from 12 to 78.
No serious harm occurred in the placebo arm in any of the trials. This fits with the medical view that this is not a serious condition, write the authorFor over a decade, the technique of distraction has been researched and successfully applied in clinical practice in order to reduce pain associated with certain medical procedures. The use of distraction is based on the assumption that there is an important psychological element in the perception of pain, with the amount of attention given to the harmful stimulus affecting the perception of the pain.
Distraction techniques are based on the patient’s limited capacity for attention, resulting in a reduction in the patient’s attention to the stimulus and therefore a reduction in the stimulus itself. It was assumed that the ideal distractor would require an optimum amount of attention involving various senses (visual, auditory and kinaesthetic), an active emotional involvement, and participation from the patient to compete with the signals of the harmful stimuli.
The advanced distraction techniques (ADTs) recently developed use 3D images combined with dynamic audio stimuli, making the techniques more likely to meet the requirements of an ideal distractor than the traditional distraction methods such as watching a film or playing a simple computer game.
The ADTs simulate real-life situations, and the possibilities are infinite. For example, until now users could choose between taking a flight, driving, downhill skiing, exploring buildings and many more activities.
In a new study by UAB researchers, peer-reviewed publications on ADTs and pain have been reviewed to determine the clinical effectiveness and importance of using these techniques as analgesic. The results suggest that the ADTs can significantly reduce the pain associated with medical treatment. The use of analgesic was clinically revealing in most cases, especially in patients with very high or unbearable levels of pain. It was found that levels of anxiety were reduced during the exposure, and the side effects, such as "simulator sickness", were hardly observed at all.
Although some studies continue to focus mainly on the technological aspects and the effectiveness of ADTs, greater consideration is being given to psychological aspects. Several personality traits (such as absorption and dissociation) have been identified as important factors for determining the level of involvement of the users, possibly modulating the effectiveness of technological progress. For example, some patients perceive a reduction in their visual field (due to the video helmet) and a loss of awareness of the activities of the medical practitioner, as well as a loss of control, leading to an increase in anxiety and pain; other patients see it as positive that they cannot see and perceive what the medical practitioner is doing.
The researchers conclude that ADTs are very useful as analgesic, and can reduce the amount of analgesic administered. This new field of study can begin to move forward beyond its current initial phase by placing more emphasis on methodology and psychological aspects, they say.
Antibiotics are probably effective for acute purulent rhinitis, say the authors. They can cause harm but most patients will get better without antibiotics.
So, although these findings differ from the guidelines in terms of the effectiveness of antibiotics for acute purulent rhinitis, the authors support the current "no antibiotic as first line" advice and suggest that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients.
