Question and Search Strategies: Womens who are to Suffer from Recurrent or Persistent Infections - Essay Example

PICOT Question and Search Strategies PICOT Question In females with recurrent bacterial vaginosis, do prophylactic antibiotics,compared to no treatment, reduce the recurrence rate? Background information The recurrent or persistent vaginal infections are associated with episodic or continuous symptoms of burning, irritation or itching (Bope, Kellerman, & Rakel, 2012). Not all women persistently produce discharge from the vagina. In fact, research supports that almost five percent of women are likely to suffer from recurrent or persistent infections. Bacterial vaginosis depicts a change in the vaginal ecosystem. It is not a real infection but represents an inequality in the bacterial setting (Center for Disease Control and Prevention, 2014). Bacterial vaginosis is not transmitted sexually, but has been characterized with sexual activity, chronic douching, IUD, young age, spermicides, and IUD. The infection is prevalent amongst African Americans. A good number of women experience vaginal irritation along with a thin, watery, yellow-green discharge. The infection is also associated with a bad smell. Research shows that although some sexual activities are involved, offering treatment to a sexual partner has never shown to prevent re-infection. In most cases, the treatment is via insertion of Flagyl (metronidazole) into the vaginal canal for a period of five to seven days. Flagyl (metronidazole) is an antibiotic. To date, very few studies have attempted to examine the application of prophylactic antibiotics for recurrent Bacterial vaginosis. The bottom line is that although Flagyl gel or antibiotic placed intravaginally for about twice in a week significantly reduced the recurrence rate, research has shown that women may continue suffering more yeast infections as result of using antibiotics. At the moment, yoghurt or capsule is one of the suggested and alternative treatments which has demonstrated to be less harmful and its efficiency has been proved in laboratory environment (Tafazzoli et al., 2014). An inclusion criterion for this study is a search literature of women with recurrent bacterial vaginosis and whether prophylactic antibiotics, compared to no treatment, reduce the recurrence rate. Inclusion Criteria for systematic Review Studies from 2010 to 2015 Studies published in English Studies that employed patient-level data Studies that used designs from our list of acceptable methodologies: randomized controlled policy trials pre/post studies with non-randomized comparison groups interrupted time series analyses with comparison groups interrupted time series analyses without comparison groups pre/post studies without a comparison group A Search Strategy There are a number of approaches that can be used to develop a search strategy. The approach that is presented here emphasizes the specificity as well as the sensitivity of the search strategy. The bottom line is that it is important to make the search specific, as it will help avoid things that are not necessary. In order to achieve this, the necessary criteria will be applied to accept the appropriate articles criteria are necessary for you to accept the article. This will help to identify and consider articles that only meet these criteria. Then, within those criteria, it will be decided which are either useful or searchable for limiting the search. In so doing, it likely to be established that some of the specific requirements, such as the period of study more than four weeks, may be involved during the selection process, although may sometimes not translate well into a search strategy. The search strategy will start with the PICOT elements of the generated question in order to determine which elements or components are searchable as well the ones that should be spread out into multiple terms.  For instance, the Population element will become a multiple search criteria. However, in the case where the interest will be in recurrent bacterial vaginosis, then recurrent and bacterial vaginosis will be both essential specific criteria for the search review, and they will treated as two separate searchable concepts in defining the desired search. Outcomes, on the other hand, may not be searchable particularly with specificity and as a result may be left out of the search strategy. However, it be kept in mind that it must be used during the selection step, that is, selecting articles for the systematic review.  Once all the specific concepts to be used have been determined, they will be combined with AND. This is because each one of the concepts or terms used is necessary to be interested in or to find the desired article. To enhance the sensitivity of the search process and not miss essential information, it will be important to take into consideration all the possible elements or “synonyms” for the specific terms or concepts. Other names for the concepts, such as different disease classifications, related names, acronyms, British spelling and even at times misspellings.  Other things to be considered will be specific concepts and terms, such as specific names of drugs and more general terms, such as classes of drugs.  The search approach will also consider searching both with MeSH terms and in text-word form. For instance, some terms to be used to search for Bacterial vaginosis (BV) include vaginal yeast and vaginal bacteria. The terms again will be eventually be combined with the OR concept.  For instance, in the case of searching for Bacterial vaginosis it will appear as follows: "bacterial vaginosis" OR "vaginal yeast" OR “vaginal bacteria.” Involving all Terms or Concepts When involving all of the terms for each element in the selected criteria, then they will be combined using both OR and AND. For instance, a search strategy that is specifically interested in randomized controlled trials of Bacterial vaginosis developed in such a fashion will appear like (bacterial vaginosis OR vaginal yeast) AND (prophylactic antibiotics OR bacterial antibiotics) AND (“Clinical trial” OR RCT OR "randomized controlled trial"). However, since the PICOT question has been developed, the following search strategies will also apply. The PICOT question: In females with recurrent bacterial vaginosis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate? Type of search Sensitive Specific Clinical decision rule Bacterial Vaginalis AND (predict$ OR clinical$ OR outcome$ OR risk$) predict$.ti. AND rule$ AND Bacterial Vaginalis Etiology Bacterial Vaginalis AND (exp cohort studies OR exp risk OR odds (tw) and ratio: (tw) OR relative (tw) and risk (tw) OR case (tw) and control: (tw))) Bacterial Vaginalis AND (case-control studies OR cohort studies) Diagnosis Bacterial Vaginalis AND (exp sensitivity a#d specificity OR sensitivity (tw) OR diagnosis& (sh) OR diagnostic use (sh) OR specificity (tw)) Bacterial Vaginalis AND (exp sensitivity a#d specificity OR predictive (tw) and value: (tw)) Treatment Bacterial Vaginalis AND (randomized controlled trial (pt) OR drug therapy (sh) OR therapeutic use (sh) OR random: (tw)) Bacterial Vaginalis AND ((double (tw) AND blind: (tw)) OR placebo: (tw)) Prognosis Bacterial Vaginalis AND (incidence OR exp mortality OR OR prognos: (tw) OR follow-up studies OR mortality (sh) OR predict: (tw) OR course: (tw)) Bacterial Vaginalis AND (prognosis OR survival analysis) Other search limits involved include: The publication date Language The type of Publication (case studies, RCTs, etc) Age groups Type of materials (journals, books, dissertations Critically appraising the articles In the article by Guédou, et al. (2013), the authors reviewed data on the treatment of bacterial vaginosis. The reviewed information was published from early 1990s to mid 1990s. For women who are non-pregnant, the authors have recommended the use of Clindamycin vaginal cream (two percent once daily in week), or oral metronidazole (500mg twice daily in one week), or metronidazole vaginal gel (one percent twice daily for five days) as the best intervention for bacterial vaginosis. Mostly, the authors reviewed articles utilized randomized controlled studies and cases studies. In terms of results, the authors found that Oral Metronidazole used for seven days had an efficacy rate of 82 percent. Treatment with Metronidazole vaginal gel applied for five days had an efficacy rate of 81 percent. With this statistics, it was agreed that antibiotics are effective in minimizing the symptoms associated with bacterial vaginosis in both pregnant and non-pregnant women. In the article by Hantoushzadeh, et al. (2012), the authors wanted to determine recurrence of bacterial vaginosis after treatment and to establish factors connected with recurrence. A randomized controlled trial was used. Women with BV infections were put on 400 mg of oral metronidazole for seven days. Results showed that 87 percent of women showed positive signs. Factors such as change or sexual partners or sexual partners themselves and hormonal contraception contributed to recurrence rate in BV women. The research is well supported by update information from academic and professional journal articles. In the article by Mitchell et al. (2012), the authors specifically wanted to evaluate different therapies and treatments recommended for BV in both Non-pregnant and Pregnant Women. The authors used retrogressive research in their study. The authors used search strategy as their methodology to find the articles needed. In their search, concepts such as “bacterial vaginosis,” “clindamycin” and “metronidazole,” was carried out to identify published articles that specifically evaluated the treatment of bacterial vaginosis, and the impact of treatment of pregnant women with clindamycin or metronidazole to reduce the occurrence of the infection. Results indicate that therapies differed in efficacy for cure from 48 percent to 85 percent. It was also established that intervention studies to reduce bacterial vaginosis -related adversarial outcomes of pregnancy differed in selected populations, used medication, timing of treatment and type of therapy (intravaginal or oral). The article shows that there are benefits associated with using oral metronidazole in treating women at high risk. However, the impact of treating women who have not previously had a prematurity is not clear. The authors also found that the use of intravaginal clindamycin therapy, particularly during pregnancy appears to increase infections of BV during the neonatal period. The authors used update information medical journal articles. Synthesis table Article Research question Methodology Results Review of Treatment options and potential clinical indications for therapy the efficacy of Clindamycin vaginal cream and oral metronidazole in the treatment of bacterial vaginosis A retrogressive review of past studies. Authors reviewed articles utilized randomized controlled studies and cases studies Cumulatively, the treatment had an efficacy of about 81 percent High BV Recurrence Rate after Metronidazole To determine recurrence of bacterial vaginosis after treatment and to establish factors connected with recurrence A randomized controlled trial was used. 87 percent of women showed positive signs. Use of contraceptives increased rate of recurrence. Change of partners contributed to infection Indications for Therapy and Treatment Recommendations for Bacterial Vaginosis in Non-pregnant and Pregnant Women: A Synthesis of Data to evaluate different therapies and treatments recommended for BV in both Non-pregnant and Pregnant Women Retrogressive research study was used. The authors used search strategy as their methodology to find the articles needed. therapies differed in efficacy for cure from 48 percent to 85 percent. oral metronidazole appropriate for women at high risk Recommendations As it has been found, prophylactic antibiotics reduce the recurrence rate in in females with recurrent bacterial vaginosis compared to the untreated cases (Tommy, 2014). It has also been found that treating a partner does not mean the infection will come down . Also, it has been established that use of contraceptives such as condoms increases the risk of BV recurrence. Therefore, is recommended that women should use prophylactic antibiotics as the best intervention for BV infections. References Bope, E., Kellerman, R., & Rakel, R. (2012). Conns current therapy 2012. Philadelphia, Pa.: Saunders. Center for Disease Control and Prevention. (2014). Bacterial vaginosis: CDC factsheet. Retrieved from http://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm. Guédou, F., Van Damme, L., Deese, J., Crucitti, T., Becker, M., Mirembe, F., et al. (2013). Behavioural and medical predictors of bacterial vaginosis recurrence among female sex workers: longitudinal analysis from a randomized controlled trial. BMC Infectious Diseases, 13(1), 1-11. Hantoushzadeh, S., Golshahi, F., Javadian, P., khazardoost, S., Aram, S., Hashemi, S., et al. (2012). Comparative efficacy of probiotic yoghurt and clindamycin in treatment of bacterial vaginosis in pregnant women: A randomized clinical trial. Journal of Maternal-Fetal & Neonatal Medicine, 25(1), 1021-1024. Mitchell, C., Manhart, L. E., Thomas, K., Fiedler, T., Fredricks, D. N., & Marrazzo, J. (2012). Behavioral Predictors of Colonization with Lactobacillus crispatus or Lactobacillus jensenii after Treatment for Bacterial Vaginosis: A Cohort Study. Infectious Diseases in Obstetrics & Gynecology, 1(1), 1-6. Tafazzoli, H. H., Amiraliakbari, S., Afrakhteh, M., AlaviMajd, H., & Nouraei, S. (2014). Comparison of Metronidazole versus a Combination of Metronidazole plus Probiotics in the Treatment of Bacterial Vaginosis. Journal of Women’s Health, Issues Care 3(3). doi.org/10.4172/2325-9795.1000146. Tommy, H. (2014). Treating Bacterial Vaginosis. V.T.: Oxford unversity Press. Read More