Low back pain and best practice care: A survey of general practice physicians.
Arch Intern Med. 2010 Feb 8;170(3):271-7
Authors: Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, Fahridin S, Harrison C, Latimer J
BACKGROUND: Acute low back pain (LBP) is primarily managed in general practice. We aimed to describe the usual care provided by general practitioners (GPs) and to compare this with recommendations of best practice in international evidence-based guidelines for the management of acute LBP. METHODS: Care provided in 3533 patient visits to GPs for a new episode of LBP was mapped to key recommendations in treatment guidelines. The proportion of patient encounters in which care arranged by a GP aligned with these key recommendations was determined for the period 2005 through 2008 and separately for the period before the release of the local guideline in 2004 (2001-2004). RESULTS: Although guidelines discourage the use of imaging, over one-quarter of patients were referred for imaging. Guidelines recommend that initial care should focus on advice and simple analgesics, yet only 20.5% and 17.7% of patients received these treatments, respectively. Instead, the analgesics provided were typically nonsteroidal anti-inflammatory drugs (37.4%) and opioids (19.6%). This pattern of care was the same in the periods before and after the release of the local guideline. CONCLUSIONS: The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time. The unendorsed care may contribute to the high costs of managing LBP, and some aspects of the care provided carry a higher risk of adverse effects.
PMID: 20142573 [PubMed - indexed for MEDLINE]
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Long-term improvement in mdx cardiomyopathy after therapy with peptide-conjugated morpholino oligomers.
Cardiovasc Res. 2010 Feb 1;85(3):444-53
Authors: Jearawiriyapaisarn N, Moulton HM, Sazani P, Kole R, Willis MS
AIMS: The cardiomyopathy found in Duchenne muscular dystrophy (DMD) is responsible for death due to heart failure in approximately 30% of patients and additionally contributes to many DMD morbidities. Strategies to bypass DMD-causing mutations to allow an increase in body-wide dystrophin have proved promising, but increasing cardiac dystrophin continues to be challenging. The purpose of this study was to determine if therapeutic restoration of cardiac dystrophin improved the significant cardiac hypertrophy and diastolic dysfunction identified in X-linked muscular dystrophy (mdx) dystrophin-null mouse due to a truncation mutation over time after treatment. METHODS AND RESULTS: Mice lacking dystrophin due to a truncation mutation (mdx) were given an arginine-rich, cell-penetrating, peptide-conjugated phosphorodiamidate morpholino oligomer (PPMO) that delivered a splice-switching oligonucleotide-mediated exon skipping therapy to restore dystrophin in mdx mice before the development of detectable cardiomyopathy. PPMO successfully restored cardiac dystrophin expression, preserved cardiac sarcolemma integrity, and prevented the development of cardiac pathology that develops in mdx-null mice over time. By echocardiography and Doppler analysis of the mitral valve, we identified that PPMO treatment of mdx mice prevented the cardiac hypertrophy and diastolic dysfunction identified in sham-treated, age-matched mdx mice, characteristic of DMD patients early in the disease process, in as little as 5-6 weeks after the initiation of treatment. Surprisingly, despite the short-term replacement of cardiac dystrophin (<1% present after 12 weeks by immunodetection), PPMO therapy also provided a durable cardiac improvement in cardiac hypertrophy and diastolic dysfunction for up to 7 months after the initiation of treatment. CONCLUSION: These results demonstrate for the first time that PPMO-mediated exon skipping therapy early in the course of DMD may effectively prevent or slow down associated cardiac hypertrophy and diastolic dysfunction with significant long-term impact.
PMID: 19815563 [PubMed - indexed for MEDLINE]
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Long-term improvement in mdx cardiomyopathy after therapy with peptide-conjugated morpholino oligomers.
Chronic kidney disease: whom to screen and how to treat, part 1: definition, epidemiology, and laboratory testing.
South Med J. 2010 Feb;103(2):140-6
Authors: Brosnahan G, Fraer M
Chronic kidney disease has become a major public health problem due to its high prevalence, its exorbitant cost, and large reductions in life expectancy and quality of life of affected people. Seventy percent of cases of end-stage renal disease are due to diabetes and hypertension, conditions which are usually managed by primary care providers. Other risk factors are cardiovascular disease, obesity, smoking, family history of kidney disease, and age greater than 55 years. Patients with these risk factors should be evaluated for the presence of chronic kidney disease during their primary care visits, because effective treatments for slowing progression are available, particularly if instituted early. Chronic kidney disease can be diagnosed by simple blood and urine tests, as recommended in guidelines issued by the National Kidney Foundation. This article begins with a case vignette, representing a common clinical scenario from a general internist’s practice. We then review the definition and classification of chronic kidney disease, the epidemiology, etiology, and interconnections with cardiovascular disease. We discuss the guidelines for screening and laboratory testing, as well as the limitations of current assessment tools. A subsequent article will review evidence-based management of chronic kidney disease.
PMID: 20065899 [PubMed - indexed for MEDLINE]
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