Abstract. Objective: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis. Methods: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, outpatient clinical trial. After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10). All of the patients received injectable benzathine penicillin. If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE). Each patient was randomized to receive either IM betamethasone or IM placebo. All patients were contacted by telephone at 24 and 48 hours by one of the study investigators and asked to rate their pain based on another VAS. If their pain was not resolved by 48 hours, they were called again daily between the third and seventh days after the initial visit to determine the time of pain resolution. Results: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone. Eight patients were excluded from the statistical analysis because of inability to obtain follow-up. Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups. There were significantly better pain scores for the betamethasone group a t first follow-up ( p = 0.0005), at second followup ( p = 0.004), and in number of hours until relief of pain ( p = 0.004). When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score a t the first ( p = 0.006) and second ( p = 0.02) follow-up visits. Conclusion: Pain relief was greater and more rapid in patients treated with betamethasone as a n adjuvant therapy in acute exudative pharyngitis.

The importance of behavioural science in advancing health in low-and middle-income countries (LMICs) was highlighted in a journal funded by the US Agency for International Development (Global Health Science and Practice). [1] In particular, the authors outlined six domains of behaviour change that were building blocks of global health. One of these domains was 'provider behaviour' and included understanding healthcare workers' capabilities, opportunities and motivations to provide high-quality care. We propose that understanding provider behaviour is most urgent in the areas of healthcare that have been shown to impact greatly on patient mortality and morbidity, e.g. management of the critically ill patient. Management of the deteriorating and critically ill patient is a key activity in acute healthcare facilities. Firth and Ttendo [2] emphasised the need for recognition, assessment and management of the critically ill in Uganda and other low-income countries. This need is great because many patients present to hospital in a critical state owing to certain factors, including underlying health issues (e.g. malnutrition); present to hospital at a late stage owing to the time taken to travel to hospital; and seek help at a late stage of an illness because of the need to pay fees. A systematic review of critical care in LMICs found that many health professional students had limited training in the assessment and management of acutely ill patients. [3] It is clear, therefore, that there is a need to educate and train staff in the management of acute illness in LMICs. There are many courses that teach the recognition and management of acutely ill people. Examples are the 1-day Acute Illness Management (AIM) Background. Understanding the drivers of 'provider behaviour' has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems. Objectives. To assess changes in healthcare provider behaviour, i.e. use of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in acute illness management, after participating in a 1-day course on the assessment and management of acutely ill patients. We aimed to assess whether changes in psychological determinants of the ABCDE approach were associated with changes in the use of the approach. Methods. We used a pre-post design to study self-reported change in behaviour after a 1-day training course from pre-course to follow-up 1 month later. We also measured psychological determinants of behaviour immediately before and after and at 1-month follow-up. We explored if changes in psychological determinants were associated with change in practice 1 month later. Results. We found the following: firstly, use of the ABCDE approach increased at 1 month post-course from a median use of 50-90%. Secondly, the increase in the ABCDE approach was associated with a positive change in only one of the determinants of practice from pre-to post-course: perception of environmental determinants (r=0.323; p<0.05). Finally, there were no other significa...

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