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Although the possible efficacy and adverse effects of paracetamol and ibuprofen on dementia are of global clinical and public health importance, to date, the relationship of the use of paracetamol and ibuprofen with incident dementia remains uncertain. We aimed to assess the prospective association of regular use of ibuprofen and paracetamol with new-onset dementia in an older population. This study included 212,968 participants from the UK Biobank, aged ≥60 years, with available data of ibuprofen, paracetamol use and without dementia at baseline. The primary outcome was new-onset all-cause dementia. The secondary outcomes included new-onset Alzheimer's disease and new-onset vascular dementia. During a median follow-up of 12.3 years, 6407 (3.0%) participants developed new-onset all-cause dementia. Participants who regularly used paracetamol had a significantly higher risk of new-onset all-cause dementia (adjusted HR, 1.18; 95%CI: 1.10–1.26), compared with non-users. However, there was no significant association between regular use of ibuprofen and new-onset all-cause dementia (users vs. non-users; adjusted HR, 1.06; 95%CI: 0.97–1.16). Furthermore, APOE ε4 dosage and genetic risk scores (GRS) of Alzheimer's disease calculated by 25 single nucleotide polymorphisms did not significantly modify the relationship of regular use of paracetamol and ibuprofen with new-onset all-cause dementia (Both P -interactions >0.05). Similar results were found in the propensity score analysis. Similar findings were also observed for new-onset Alzheimer's disease and new-onset vascular dementia. Regular use of paracetamol, but not ibuprofen, was associated with a significantly higher risk of new-onset dementia in the old population, regardless of genetic risks of dementia. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the prevalence and pathophysiology of snake bites • To enable you to recognise the signs and symptoms of snake bites and how to determine their severity • To understand the steps that need to be taken when assessing and managing patients with a suspected or confirmed snake bite Snake bites are a relatively rare presentation to emergency departments in the Western world. In the UK, there were 510 cases of snake bites between 2004 and 2010. However, it is important that nurses are aware of how to assess and manage these presentations and understand the importance of ascertaining information on factors such as the type of snake involved and how long the snake was biting the patient for. This article uses a case study to discuss the assessment and management of snake bites, and provides information on the steps nurses should take to manage patients presenting with a snake bite. [ABSTRACT FROM AUTHOR]

Aims: Royal College of Paediatrics and Child Health subspecialist training in Paediatric Clinical Pharmacology and Therapeutics has been delivered in the UK for 20 years, but no specialist clinical services have been set up previously. Methods: Prospective audit and service evaluation of paediatric clinical pharmacology service pilot phase and dedicated service at a UK children's hospital. Results: Pilot scheme (May–October 2019), then weekly service (established June 2020). Service covers the High Dependency Unit, and inpatients with polypharmacy. The pilot demonstrated high levels of acceptance, with 89% of suggested medication changes agreed by lead clinical team, and success, with 97.5% of suggested changes continued until discharge/pilot completion. Economic analysis estimated direct annualised cost savings on medications of up to £10 000. After 20 ward rounds of the established service, 270 potential medication changes were identified, 213 were carried out (78.9%). The most common were deprescribing (n = 143), prescribing (n = 47) and dose adjustment (n = 8). Seventy‐five different medications were deprescribed, most commonly chloral hydrate (n = 12), Lactulose, ibuprofen, Bio‐Kult and sodium alginate (all n = 4). The percentage of inpatients prescribed ≥10 medications decreased from 38.5 to 32.1%, while the subset prescribed ≥20 medications decreased from 11.0 to 5.67%. The mean number of medicines prescribed decreased from 9.0 to 8.0, while the median was unchanged at 7. Annual Yellow Card reports of suspected adverse drug reactions more than doubled (n = 66). Conclusion: A UK model for subspecialist paediatric clinical pharmacology service delivery has demonstrated a positive clinical impact and could be replicated at other UK secondary/tertiary children's hospitals. [ABSTRACT FROM AUTHOR]

Background: The question of whether to treat patent ductus arteriosus (PDA) early or wait until symptoms appear remains high on the research agenda for neonatal medicine. Around 7000 extremely preterm babies under 29 weeks' gestation are born in the UK every year. In 40% of cases the PDA will fail to close spontaneously, even by 4 months of age. Untreated PDA can be associated with several serious and life-threatening short and long-term complications. Reliable data to support clinical decisions about PDA treatment are needed to prevent serious complications in high risk babies, while minimising undue exposure of infants. With the availability of routine bedside echocardiography, babies with a large PDA can be diagnosed before they become symptomatic. Methods: This is a multicentre, masked, randomised, placebo-controlled parallel group trial to determine if early-targeted treatment of a large PDA with parenteral ibuprofen in extremely preterm babies (23+ 0–28+ 6 weeks' gestation) improves short and long-term health and economic outcomes. With parental informed consent, extremely preterm babies (born between 23+ 0–28+ 6 weeks' gestation) admitted to tertiary neonatal units are screened using echocardiography. Babies with a large PDA on echocardiography, defined by diameter of at least 1.5 mm and unrestricted pulsatile PDA flow pattern, are randomly allocated to either ibuprofen or placebo within 72 h of birth. The primary endpoint is the composite outcome of death by 36 weeks' postmenstrual age or moderate or severe bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age. Discussion: Prophylactic pharmacological treatment of all preterm babies unnecessarily exposes them to potentially serious side effects of drug treatment, when their PDA may have closed spontaneously. However, delaying treatment until babies become symptomatic could result in loss of treatment benefit as irreversible damage may have already been done. Targeted, early pharmacological treatment of PDA in asymptomatic babies has the potential to overcome the disadvantages of both prophylactic (overtreatment) and symptomatic approaches (potentially too late). This could result in improvements in the clinically important short-term clinical (mortality and moderate or severe BPD at 36 weeks' postmenstrual age) and long-term health outcomes (moderate or severe neurodevelopment disability and respiratory morbidity) measured at 2 years corrected age. Trial registration: ISRCTN84264977. Date assigned: 15/09/2010. [ABSTRACT FROM AUTHOR]

Concern about the appropriate role of nonsteroidal anti-inflammatory drugs (NSAIDs) in COVID-19 speculate that NSAIDs, in particular ibuprofen, may upregulate the entry point for the virus, the angiotensin-converting enzyme (ACE) 2 receptors and increase susceptibility to the virus or worsen symptoms in existing disease. Adverse outcomes with COVID-19 have been linked to cytokine storm but the most effective way to address exaggerated inflammatory response is complex and unclear. The Expert Working Group on the Commission of Human Medicines in the UK and other organizations have stated that there is insufficient evidence to establish a link between ibuprofen and susceptibility to or exacerbation of COVID-19. NSAID use must also be categorized by whether the drugs are relatively low-dose over-the-counter oral products taken occasionally versus higher-dose or parenteral NSAIDs. Even if evidence emerged arguing for or against NSAIDs in this setting, it is unclear if this evidence would apply to all NSAIDs at all doses in all dosing regimens. Paracetamol (acetaminophen) has been proposed as an alternative to NSAIDs but there are issues with liver toxicity at high doses. There are clearly COVID-19 cases where NSAIDs should not be used, but there is no strong evidence that NSAIDs must be avoided in all patients with COVID-19; clinicians must weigh these choices on an individual basis. [ABSTRACT FROM AUTHOR]

Children with red swollen eyes frequently present to emergency departments. Some patients will have orbital cellulitis, a condition that requires immediate diagnosis and treatment. Orbital cellulitis can be confused with the less severe, but more frequently encountered, periorbital cellulitis, which requires less aggressive management. Delayed recognition of the signs and symptoms of orbital cellulitis can lead to serious complications such as blindness, meningitis and cerebral abscess. This article describes the clinical features, epidemiology and outcomes of the condition, and discusses management and treatment. It also includes a case study. [ABSTRACT FROM AUTHOR]

Paul Bates, Senior Lecturer/Advanced Nurse Practitioner, University of Lincoln, pbates@lincoln.ac.uk, explains the most common symptoms, triggers and treatments of migraine, and the role of the nurse in patient care [ABSTRACT FROM AUTHOR]

The article offers information on croup, a laryngotracheobronchitis which is an inflammation of the larynx, trachea and bronchi. The viral condition is caused by the parainfluenza and influenza viruses and commonly affects infants and children. It also notes that the annual incidence of croup varies depending on the seasonal prevalence of viral infections in children. Also mentioned are the symptoms of croup including runny nose, raised temperature and barking cough.

The relation of regular ibuprofen or paracetamol use with the risk of type 2 diabetes (T2DM) remained undetermined. We aimed to evaluate the prospective association between regular ibuprofen or paracetamol use and incidence of T2DM. This cohort included 372,843 participants with available data of ibuprofen, paracetamol use and without diabetes at baseline from the UK Biobank. The primary outcome was incident T2DM. Cox proportional hazards models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of T2DM. During a median of 12.1 years' follow-up, 11,527 (3.1%) participants developed T2DM. Overall, participants with regular use of paracetamol showed a significantly higher risk of incident T2DM (adjusted HR, 1.25; 95%CI: 1.19,1.31), compared with non-users. Moreover, a stronger positive association of paracetamol use with incident T2DM was found among those aged <60 years (vs. ≥60 years, P -interaction =0.008), free of cardiovascular diseases (CVD) (vs. CVD patients, P -interaction =0.01), and without the use of anti-hypertensive drugs (vs. users, P -interaction =0.016) at baseline. However, there was no significant association between regular use of ibuprofen (users vs. non-users; adjusted HR, 1.05; 95%CI: 0.99,1.12) and incident T2DM. More importantly, genetic risks of T2DM did not significantly modify the relations of ibuprofen, or paracetamol use with incident T2DM (Both P -interactions >0.05). Regular use of paracetamol, but not ibuprofen, was associated with a significantly higher risk of incident T2DM among middle aged UK adults. Our current findings highlight the need for greater consideration in the clinical selection of paracetamol or ibuprofen. [ABSTRACT FROM AUTHOR]

smith c.j., sammons h.m., fakis a. & conroy s. (2013) A prospective study to assess the palatability of analgesic medicines in children. Journal of Advanced Nursing 69(3), 655-663. doi: 10.1111/j.1365-2648.2012.06050.x Abstract Aim. This study examined children's opinions on the taste of three analgesic medicines: paracetamol, ibuprofen and codeine. Background. Many medicines for children are unpleasant and unacceptable. Research has shown that children's taste preferences differ to adults, in whom palatability is often tested. Little British research exists on children's opinions on the palatability of medicines. This study aimed to address this gap in knowledge. Design. Prospective observational study. Methods. Between May-September 2008, hospital inpatients aged 5-16 years rated the taste of required analgesics on a 100-mm visual analogue scale. This incorporated a 5-point facial hedonic scale. They were also asked their favourite flavour and colour for a medicine. Results. A total of 159 children took part. Eighty-five males (53·5%) and 74 females (46·5%). The median age was 8 years (Inter-quartile range 6-11). The taste of ibuprofen was significantly preferred to paracetamol or codeine. Significant differences were observed depending if the medicine rated was taken first or second (for example pre-medication with paracetamol and ibuprofen). Younger children (5-8 years) were more likely to choose the extremes of the scale when grading than older children were. Preferred flavours on questioning were strawberry 44% and banana 17%. Favourite colours were pink 25·8% and red 20·8%, with girls more likely to choose pink and boys blue. Conclusion. Ibuprofen was the most palatable analgesic medicine tested. Children reported they preferred fruit flavours and colour was sex dependent. Nurses when administering two medicines together should consider giving the least palatable first, for example paracetamol before ibuprofen for pre-medication. [ABSTRACT FROM AUTHOR]

Aim: Paracetamol (acetaminophen) is a common cause of liver failure due to overdose. Legislation introduced in the UK in 1998 to limit pack sizes of paracetamol has had limited impact on the overall number and severity of paracetamol overdoses. This may be because people have large amounts of paracetamol stored at home, but no previous studies have explored this question.Methods: Individuals who regularly take part in market research surveys were invited to take part in an Internet survey. They were asked to supply demographic details, the frequency with which they use paracetamol and ibuprofen, and details of the amount and location of these drugs that they possessed.Results: The mean age of respondents was 43.3 years (standard deviation 14.5 years), and 49.9% were female. People with both ibuprofen and paracetamol tended to have more packs and tablets of paracetamol (P < 0.001) and over a third had 32 or more paracetamol tablets. The most common pack size was 16 tablet packs (44.8% of all packs), which accounted for 39.4% of tablets. The most common site of paracetamol storage in the home was the kitchen (63.8% of people, 95% confidence interval 60.7, 66.7).Conclusions: This study suggests that pack size legislation in the UK has had limited effect on the amount of paracetamol that individuals have access to in the home. This may explain, at least in part, the limited impact of the pack size legislation on paracetamol overdoses in the UK. [ABSTRACT FROM AUTHOR]

A series of sample stability tests has been undertaken to support a large UK-based survey of trace substances in wastewater. This program aims to quantify the input of priority chemicals to the aquatic environment via sewage effluent. The stability tests have demonstrated that, in most cases, the proposed approach of chilling samples meets the target that sample concentrations should not change by more than 25%, provided samples are analyzed or otherwise stabilized within 3–5 d. Substances tested fall into three main classes: Instability in effluents greater than the project-based threshold of 25% over 3–5 d can be ruled out provided samples are chilled for: DEHP (DEHA), glyphosate, AMPA, bentazone, mecoprop, ofloxacin, erythromycin, and ibuprofen; Some indication of possible instability up to 25% provided chilled storage periods do not extend beyond 3–5 d for: mercury (note requires acid dichromate preservation on site or as soon as possible), tributyltin, bisphenol A, reactive aluminum (in effluents, note requires filtration on sampling), oxytetracycline, and propranolol; and Clear stability problems are demonstrated for salicylic acid (effluents and influents), with indications of important instability (>25%) for bisphenol (effluents) AMPA and glyphosate (influents). [ABSTRACT FROM AUTHOR]

Information on dietary supplements, medications, and other xenobiotics in epidemiologic surveys is usually obtained from questionnaires and is subject to recall and reporting biases. The authors used metabolite data obtained from hydrogen-1 (or proton) nuclear magnetic resonance (1H NMR) analysis of human urine specimens from the International Study of Macro-/Micro-Nutrients and Blood Pressure (INTERMAP Study) to validate self-reported analgesic use. Metabolic profiling of two 24-hour urine specimens per individual was carried out for 4,630 participants aged 40–59 years from 17 population samples in Japan, China, the United Kingdom, and the United States (data collection, 1996–1999). 1H NMR-detected acetaminophen and ibuprofen use was low (∼4%) among East Asian population samples and higher (>16%) in Western population samples. In a comparison of self-reported acetaminophen and ibuprofen use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 496 participants from Chicago, Illinois, and Belfast, Northern Ireland, the overall rate of concordance was 81%–84%; the rate of underreporting was 15%–17%; and the rate of underdetection was approximately 1%. Comparison of self-reported unspecified analgesic use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 2,660 Western INTERMAP participants revealed similar levels of concordance and underreporting. Screening for urinary metabolites of acetaminophen and ibuprofen improved the accuracy of exposure information. This approach has the potential to reduce recall bias and other biases in epidemiologic studies for a range of substances, including pharmaceuticals, dietary supplements, and foods. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the evidence surrounding the use of combinations of paracetamol and ibuprofen in the treatment of fever. Design Systematic narrative review of randomised controlled trials using the UK Economic and Social Research Council guidance on the conduct of narrative synthesis. Setting Inpatient, outpatient and home care. Patients Children with fever. Main outcome measures The effect of combination treatments of paracetamol and ibuprofen on fever and comfort, and identification of side effects. Results Seven studies were identified, six of which provided useful data for the evaluation of the effect of treatment on temperature. Overall these studies showed limited benefit from the combined treatment until around 4 h, after which there was a statistically but only marginally clinically significant benefit. Two studies contained data directly relating to comfort; these suggest a marginal benefit from the combined treatment, but the clinical significance of this was limited. There was no evidence of greater side effects or toxicities associated with the combined treatment. However, it is important to note that these studies were small, short term, and not conducted in the normal setting in which these treatments are given. Conclusions There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist. [ABSTRACT FROM AUTHOR]

The author summarizes the history of the discovery of ibuprofen at the Boots Co. in Great Britain. He notes that the discovery of the drug was based on the need to have a safer form of aspirin without its gastrointestinal effects and also without the serious adverse effects of phenylbutazone and corticosteroids. He also cites that the initial discovery of the effects of ibuprofen was made in guinea pigs by Dr. Stewart Adams and colleagues.

The pervasiveness of pharmaceuticals such as nonsteroidal anti-inflammatory drugs (NSAIDs) in the aquatic ecosystem through the discharge of wastewater, and their potential to biomagnify within this ecosystem, is now recognised. Residues of diclofenac and ibuprofen are currently being detected in surface waters and aquatic organisms throughout the UK and Europe. However, the levels of these residues in fish and other aquatic organisms, particularly lower trophic level prey species, have not yet been determined. While exposure to diclofenac is known to adversely affect fish, the degree to which other aquatic organisms are exposed and impacted through continuous ingestion of contaminated prey and interaction with the aquatic habitat remains unknown. The extent and effects of exposure to ibuprofen also remain largely unknown. As an exploratory subset of a broader study to investigate the detectability of diclofenac in alternative biological matrices, we analysed hair samples from Eurasian otters (Lutra lutra, n = 28) for residues of the two NSAIDs using GC-MS. The otters were collected from six counties in England as part of an ongoing otter health monitoring project at the Wildlife Veterinary Investigation Centre in Chacewater, UK. Diclofenac was qualitatively detected in five hair wash and 15 extract samples, and ibuprofen was determined to be present in at least two of the hair extract samples. Here, we provide preliminary evidence that otters are exposed to both NSAIDs and argue for further studies to identify residue loads in the otters and their prey to fully assess the pervasiveness of these compounds and potential risks of ongoing exposure to them. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are widely used analgesics in the prescription and non-prescription settings. Although both classes of drug are generally well tolerated, they can lead to well-characterized adverse effects. Both drugs are widely co-prescribed and it is of interest to understand better safety outcomes when the two drugs are taken concomitantly. WHAT THIS STUDY ADDS? Relative rates and hazard ratio patterns of safety outcomes were broadly similar for patients prescribed ibuprofen alone, paracetamol alone and concomitant ibuprofen and paracetamol. The risks of the various safety outcomes examined do not appear to be modified by concomitant use of ibuprofen and paracetamol compared with paracetamol or ibuprofen alone. AIMS To evaluate and compare the risk of specific safety outcomes in patients prescribed ibuprofen and paracetamol concomitantly with those in patients prescribed ibuprofen or paracetamol alone. The outcomes were evaluated according to dose, duration and exposure. METHODS The study used a retrospective longitudinal cohort design with data from the UK General Practice Research Database (GPRD). The study population included patients aged 18 years or over who were prescribed ibuprofen alone, paracetamol alone or concomitant ibuprofen and paracetamol (tablets or capsules only). The safety outcomes evaluated were upper gastrointestinal events, myocardial infarction, stroke, renal failure (excluding chronic), congestive heart failure, intentional or accidental overdose, suicidal behaviour and mortality. Time-dependent Cox regression was used to estimate relative rates for the safety outcomes, by treatment group. A further analysis evaluated whether the hazard rates (i.e. absolute risks) varied over time with changes in drug exposure. RESULTS The study population included 1.2 million patients. There was considerable heterogeneity in both patient and exposure characteristics. When comparing with past users, for most safety outcomes, current users of concomitant paracetamol and ibuprofen had relative rates between those for current users of ibuprofen alone and paracetamol alone. The hazard rates were generally proportional over time, from current to past exposure, following a prescription for concomitant paracetamol and ibuprofen compared with ibuprofen alone or paracetamol alone. CONCLUSIONS The known risk of the safety outcomes examined does not appear to be modified by concomitant use of ibuprofen and paracetamol compared with paracetamol or ibuprofen alone. [ABSTRACT FROM AUTHOR]

The article discusses the association between ibuprofen, a non-steroidal anti-inflammatory drugs (NSAID), and cardiovascular (CV) diseases. It says that varying degrees of cyclo-oxygenase (COX)-1/COX-2 selectivity are believed to be linked to the effects of NSAIDs on CV system. Analysis of the British General Practice Research database revealed the relationship between high-dose and long-term intake of ibuprofen and a 1.4 risk of heart failure hospitalization. Also stressed is the need to consider potential gastrointestinal (GI) risks with NSAID use.

Examines the distinction between glucosamine therapy and ibuprofen therapy to pain reduction in patients with oeteoathritis in Great Britain. Effectiveness of oral glucosamine; Use of standard analgesic therapy; Alteration of proteoglycan molecules..

The article investigates whether combinations of ibuprofen and paracetamol are more effective than, and as safe as, monotherapy in children with fever. Safety concerns include increased risk of renal toxicity and risk of infection with invasive group A streptococci. It references findings from two studies, and guidelines from the British National Institute for Health and Clinical Excellence (NICE). It presents recommendations for resolving some of the uncertainties surrounding the efficacy and safety of combined or alternating antipyretic regimens.

Reviews several medical research from clinical journals in Great Britain. Reduction in hip surgery due to ultrasound screening for hip dysplasia in early infancy, from the 2003 issue of the "Lancet"; Increase in the cost of depression treatment in the nation, from the 2003 issue of the "British Journal of Psychiatry"; Combination of aspirin and ibuprofen for the treatment of coronary heart disease, from the 2003 issue of the "British Medical Journal."

Background A rheumatology service evaluation was carried out in 2016 whereby we sought to understand whether children and young people (CYP) are receiving appropriate pain relief post-administration of steroid intra-articular injections (IAI's) and whether extended time waiting for IAI's increases CYP experience of pain. The British Society for Rheumatology BSPAR section Standard of Care for children and young people with JIA recommends 4 weeks or less waiting time for steroid IAI under general anaesthetic (GA) and 10 days or less for steroid IAI under entonox. Methods Data collection was obtained by patient questionnaire over a 4-month period. Parents/carers and CYP were asked to complete a questionnaire pre-steroid IAI (by a member of staff on the day of the IAI) and the same questionnaire post-steroid IAI (by telephone by the author within 2 weeks of the date of the IAI). Twenty parents/carers or CYP completed the questionnaires. Sixteen of the CYP were female and 4 were male. Median age was 3 years. Eighty percent had a diagnosis of oligoarticular juvenile idiopathic arthritis (JIA). Seventy-five percent had IAI's under GA and 25% with Entonox. Fifty-four percent had knee(s) injected and 23.5% had ankle(s) injected. Results Sixty percent of CYP waited for 4 weeks or less for steroid IAI under GA. Twenty percent of CYP waited for less than 10 days for steroid IAI under entonox. The range of pain scores for CYP pre IAI was 0-10 and the median was 5. Post IAI the range of pain scores was 0-8 and the median was 3. A positive correlation was found between those waiting longer for IAI's and higher pain scores. P17 Table 1: CYP experience of pain   Pre IAI  Post IAI  Pain in joints injected or due to be injected  95%  55%  CYP taking pain medication  85%  55%  Type of pain medication:      Diclofenac  10%  10%  Ibuprofen  25%  10%  Naproxen  5%  5%  Naproxen & codeine  5%  0%  Naproxen & oramorph  0%  5%  Paracetamol  10%  10%  Paracetamol & ibuprofen  30%  15%  None  15%  40%  Refusing  0%  5%  General activity affected  90%  60%  Pain medication required  80%  50%  Pain medication effective  80% (100% of CYP requiring medication)  50% (100% of CYP requiring medication)    Pre IAI  Post IAI  Pain in joints injected or due to be injected  95%  55%  CYP taking pain medication  85%  55%  Type of pain medication:      Diclofenac  10%  10%  Ibuprofen  25%  10%  Naproxen  5%  5%  Naproxen & codeine  5%  0%  Naproxen & oramorph  0%  5%  Paracetamol  10%  10%  Paracetamol & ibuprofen  30%  15%  None  15%  40%  Refusing  0%  5%  General activity affected  90%  60%  Pain medication required  80%  50%  Pain medication effective  80% (100% of CYP requiring medication)  50% (100% of CYP requiring medication)  P17 Table 1: CYP experience of pain   Pre IAI  Post IAI  Pain in joints injected or due to be injected  95%  55%  CYP taking pain medication  85%  55%  Type of pain medication:      Diclofenac  10%  10%  Ibuprofen  25%  10%  Naproxen  5%  5%  Naproxen & codeine  5%  0%  Naproxen & oramorph  0%  5%  Paracetamol  10%  10%  Paracetamol & ibuprofen  30%  15%  None  15%  40%  Refusing  0%  5%  General activity affected  90%  60%  Pain medication required  80%  50%  Pain medication effective  80% (100% of CYP requiring medication)  50% (100% of CYP requiring medication)    Pre IAI  Post IAI  Pain in joints injected or due to be injected  95%  55%  CYP taking pain medication  85%  55%  Type of pain medication:      Diclofenac  10%  10%  Ibuprofen  25%  10%  Naproxen  5%  5%  Naproxen & codeine  5%  0%  Naproxen & oramorph  0%  5%  Paracetamol  10%  10%  Paracetamol & ibuprofen  30%  15%  None  15%  40%  Refusing  0%  5%  General activity affected  90%  60%  Pain medication required  80%  50%  Pain medication effective  80% (100% of CYP requiring medication)  50% (100% of CYP requiring medication)  Conclusion In our small cohort, fifty percent of CYP required no pain medication post-IAI, and fifty percent of CYP who did require pain medication post-IAI perceived the pain medication they were receiving was adequate (Table 1). A positive correlation was found between CYP waiting longer for IAI's and CYP experiencing higher pain scores therefore, accepting our modest sample size, this service evaluation supports ensuring timely access to IAI and the avoidance of longer waiting times. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to investigate if offering symptomatic therapy (Uva-ursi or ibuprofen) alongside a delayed prescription would relieve symptoms and reduce the consumption of antibiotics for adult women presenting with acute uncomplicated urinary tract infection (UTI)., Methods: A 2 × 2 factorial placebo controlled randomized trial in primary care. The participants were 382 women aged 18-70 years with symptoms of dysuria, urgency, or frequency of urination and suspected by a clinician to have a lower UTI. The interventions were Uva-ursi extract and/or ibuprofen advice. All women were provided with a delayed or 'back-up' prescription for antibiotics. Missing data were imputed using multiple imputation methods (ISRCTN registry: ISRCTN43397016)., Results: An ITT analysis of mean score for frequency symptoms assessed on Days 2-4 found no evidence of a difference between Uva-ursi vs. placebo -0.06 (95% CI -0.33 to 0.21; p 0.661), nor ibuprofen vs. no ibuprofen advice -0.01 (95% CI -0.27 to 0.26; p 0.951). There was no evidence of a reduction in antibiotic consumption with Uva-ursi (39.9% vs. placebo 47.4%; logistic regression odds ratio (OR) 0.59 (95% CI 0.22-1.58; p 0.293) but there was a significant reduction for ibuprofen advice (34.9% vs. no advice 51.0%; OR 0.27 (95% CI 0.10 to 0.72; p 0.009). There were no safety concerns and no episodes of upper tract infection were recorded., Conclusions: We found no evidence of an effect of either intervention on the severity of frequency symptoms. There is evidence that advice to take ibuprofen will reduce antibiotic consumption without increasing complications. For every seven women given this advice, one less will use antibiotics., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The article reports that the Great Britain Advertising Standards Authority has banned a television advertisement for Reckitt Benckiser's ibuprofen product Neurofen Joint and Back Pain Relief for misleading claims about the product.

Reports on an overdose case of ibuprofen in Great Britain. Presentation of the case; Side effects of an overdose intake of ibuprofen; Treatment applied to the patient.

Objectives: Sickle With Ibuprofen and Morphine (SWIM) trial was designed to assess whether co-administration of ibuprofen (a non-steroidal anti-inflammatory drug) resulted in a reduction of opioid consumption delivered by patient-controlled analgesia (PCA) for acute pain in sickle cell disease., Design: A randomised, placebo-controlled, double-blind trial., Setting: UK multicentre trial in acute hospital setting., Participants: Adults with sickle cell disease of any gender and phenotype aged 16 years and over., Interventions: Oral ibuprofen at a dose of 800 mg three times daily or placebo in addition to opioids (morphine or diamorphine) administered via PCA pump for up to 4 days., Main Outcome Measures: The primary outcome measure was opioid consumption over 4 days following randomisation., Results: The SWIM trial closed early because it failed to randomise to its target of 316 patients within a reasonable time., Conclusions: The key issues identified include the unanticipated length of time between informed consent and randomisation, difficulties in randomisation of patients in busy emergency departments, availability of trained staff at weekends and out of hours, fewer centres than expected using PCA routinely for sickle cell pain treatment, lack of research staff and support for participation, and the trial design. There are implications for future UK trials in sickle cell disease., Trial Registration Number: ISRCTN97241637, NCT00880373; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective. Advice to use topical or oral NSAIDs is equally effective for the treatment of knee pain in older people. The ingredient cost of topical preparations is typically more than oral preparations, but could save costs because they have fewer adverse effects. A cost–utility study is needed to decide on their comparative cost effectiveness. Methods. We recruited 585 people aged ≥50 yrs with knee pain; 282 participated in a randomized controlled trial and 303 in a patient preference study from 26 MRC General Practice Research Framework practices in the UK. They received advice to preferentially use topical or oral NSAIDs for knee pain. We calculated the comparative cost per quality-adjusted life year (QALY) from both a National Health Service (NHS) and a societal perspective over 12 and 24 months. Results. Compared with the topical route, oral NSAIDs cost the NHS £191 and £72 more over 1 yr in the randomized trial and preference study, respectively. The cost per QALY, from an NHS perspective, was in the range of £9000–£12 000 in the randomized trial. In the preference study, it was £2564 over 1 yr, but over 2 yrs the oral route was dominant. Conclusions. Our cost–effectiveness analysis supports the use of oral NSAIDs in selected patients. Nevertheless, deciding to recommend oral NSAIDs in preference to topical NSAIDs could have a substantial impact on NHS costs because of the uncertainty in the cost–effectiveness estimate. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to nursing of older people in Great Britain. The King's College hospital conducted clinical trials for the treatment for wet age-related macular degeneration (AMD). Researchers from Boston University found that long-term use of ibuprofen could reduce the risk of developing Alzheimer's disease. The Medicines and Healthcare products Regulatory Agency released an alert report over the safety of walking frames manufactures by Trulife Ltd.

Reports on the results of a study on the linkage of painkillers with an increased risk of heart attacks for patients in Great Britain. Number of patients who participated in the study; Percentage of an increase in heart attacks of ibuprofen and diclofenac recipients; Comments of Peter Weissberg, medical director of the British Heart Foundation, on the prescription of cyclooxygenase 2 inhibitors.