79 research outputs found
The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain
Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be.
Methods Aims and objectives
To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care.
Study design
Face-to-face interview-based survey.
Setting
Three general practices in North Staffordshire.
Participants
Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year.
Results
138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used.
Conclusion
We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety. The observation that most users of conventional medicine also used CAM suggests a continuing need for more investigation of effective pain management in primary care
Risk of acute kidney injury and survival in patients treated with Metformin:an observational cohort study
Background: Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains
under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury
(AKI) as a proxy for lactic acidosis and whether survival among those with AKI varied by metformin exposure.
Methods: All individuals with type 2 diabetes and available prescribing data between 2004 and 2013 in Tayside,
Scotland were included. The electronic health record for diabetes which includes issued prescriptions was linked to
laboratory biochemistry, hospital admission, death register and Scottish Renal Registry data. AKI events were defined
using the Kidney Disease Improving Global Outcomes criteria with a rise in serum creatinine of at least 26.5 μmol/l or
a rise of greater than 150% from baseline for all hospital admissions. Cox Regression Analyses were used to examine
whether person-time periods in which current metformin exposure occurred were associated with an increased rate of
first AKI compared to unexposed periods. Cox regression was also used to compare 28 day survival rates following first
AKI events in those exposed to metformin versus those not exposed.
Results: Twenty-five thousand one-hundred fourty-eight patients were included with a total person-time of
126,904 person years. 4944 (19.7%) people had at least one episode of AKI during the study period. There
were 32.4 cases of first AKI/1000pyrs in current metformin exposed person-time periods compared to 44.9
cases/1000pyrs in unexposed periods. After adjustment for age, sex, diabetes duration, calendar time, number
of diabetes drugs and baseline renal function, current metformin use was not associated with AKI incidence,
HR 0.94 (95% CI 0.87, 1.02, p = 0.15). Among those with incident AKI, being on metformin at admission was
associated with a higher rate of survival at 28 days (HR 0.81, 95% CI 0.69, 0.94, p = 0.006) even after
adjustment for age, sex, pre-admission eGFR, HbA1c and diabetes duration.
Conclusions: Contrary to common perceptions, we found no evidence that metformin increases incidence of
AKI and was associated with higher 28 day survival following incident AKI
Metformin treatment in diabetes and heart failure: when academic equipoise meets clinical reality
<p>Abstract</p> <p>Objective</p> <p>Metformin has had a 'black box' contraindication in diabetic patients with heart failure (HF), but many believe it to be the treatment of choice in this setting. Therefore, we attempted to conduct a pilot study to evaluate the feasibility of undertaking a large randomized controlled trial with clinical endpoints.</p> <p>Study Design</p> <p>The pilot study was a randomized double blinded placebo controlled trial. Patients with HF and type 2 diabetes were screened in hospitals and HF clinics in Edmonton, Alberta, Canada (population ~1 million). Major exclusion criteria included the current use of insulin or high dose metformin, decreased renal function, or a glycosylated hemoglobin <7%. Patients were to be randomized to 1500 mg of metformin daily or matching placebo and followed for 6 months for a variety of functional outcomes, as well as clinical events.</p> <p>Results</p> <p>Fifty-eight patients were screened over a six month period and all were excluded. Because of futility with respect to enrollment, the pilot study was abandoned. The mean age of screened patients was 77 (SD 9) years and 57% were male. The main reasons for exclusion were: use of insulin therapy (n = 23; 40%), glycosylated hemoglobin <7% (n = 17; 29%) and current use of high dose metformin (n = 12; 21%). Overall, contraindicated metformin therapy was the most commonly prescribed oral antihyperglycemic agent (n = 27; 51%). On average, patients were receiving 1,706 mg (SD 488 mg) of metformin daily and 12 (44%) used only metformin.</p> <p>Conclusion</p> <p>Despite uncertainty in the scientific literature, there does not appear to be clinical uncertainty with regards to the safety or effectiveness of metformin in HF making a definitive randomized trial virtually impossible.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: NCT00325910</p
Immunological Tolerance to Muscle Autoantigens Involves Peripheral Deletion of Autoreactive CD8+ T Cells
Muscle potentially represents the most abundant source of autoantigens of the body and can be targeted by a variety of severe autoimmune diseases. Yet, the mechanisms of immunological tolerance toward muscle autoantigens remain mostly unknown. We investigated this issue in transgenic SM-Ova mice that express an ovalbumin (Ova) neo-autoantigen specifically in skeletal muscle. We previously reported that antigen specific CD4+ T cell are immunologically ignorant to endogenous Ova in this model but can be stimulated upon immunization. In contrast, Ova-specific CD8+ T cells were suspected to be either unresponsive to Ova challenge or functionally defective. We now extend our investigations on the mechanisms governing CD8+ tolerance in SM-Ova mice. We show herein that Ova-specific CD8+ T cells are not detected upon challenge with strongly immunogenic Ova vaccines even after depletion of regulatory T cells. Ova-specific CD8+ T cells from OT-I mice adoptively transferred to SM-Ova mice started to proliferate in vivo, acquired CD69 and PD-1 but subsequently down-regulated Bcl-2 and disappeared from the periphery, suggesting a mechanism of peripheral deletion. Peripheral deletion of endogenous Ova-specific cells was formally demonstrated in chimeric SM-Ova mice engrafted with bone marrow cells containing T cell precursors from OT-I TCR-transgenic mice. Thus, the present findings demonstrate that immunological tolerance to muscle autoantigens involves peripheral deletion of autoreactive CD8+ T cells
Sotrovimab restores neutralization against current Omicron subvariants in patients with blood cancer
Prevalence of hallux valgus in the general population: a systematic review and meta-analysis
BACKGROUND: Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender. METHODS: Electronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model. RESULTS: A total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis. CONCLUSIONS: Notwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research
Seabird colony effects on soil properties and vegetation zonation patterns on King George Island, Maritime Antarctic
Short-term variability of the Sun-Earth system: an overview of progress made during the CAWSES-II period
Evaluation of appendicitis risk prediction models in adults with suspected appendicitis
Background
Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.
Methods
A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).
Results
Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent).
Conclusion
Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified
Validation of a score tool for measurement of histological severity in juvenile dermatomyositis and association with clinical severity of disease.
Objectives To study muscle biopsy tissue from patients
with juvenile dermatomyositis ( JDM) in order to test the
reliability of a score tool designed to quantify the
severity of histological abnormalities when applied to
biceps humeri in addition to quadriceps femoris.
Additionally, to evaluate whether elements of the tool
correlate with clinical measures of disease severity.
Methods 55 patients with JDM with muscle biopsy
tissue and clinical data available were included. Biopsy
samples (33 quadriceps, 22 biceps) were prepared and
stained using standardised protocols. A Latin square design
was used by the International Juvenile Dermatomyositis
Biopsy Consensus Group to score cases using our
previously published score tool. Reliability was assessed by
intraclass correlation coefficient (ICC) and scorer agreement
(\u3b1) by assessing variation in scorers\u2019 ratings. Scores from
the most reliable tool items correlated with clinical
measures of disease activity at the time of biopsy.
Results Inter- and intraobserver agreement was good or
high for many tool items, including overall assessment of
severity using a Visual Analogue Scale. The tool functioned
equally well on biceps and quadriceps samples. A modified
tool using the most reliable score items showed good
correlation with measures of disease activity.
Conclusions The JDM biopsy score tool has high interand
intraobserver agreement and can be used on both
biceps and quadriceps muscle tissue. Importantly, the
modified tool correlates well with clinical measures of
disease activity. We propose that standardised assessment
of muscle biopsy tissue should be considered in diagnostic
investigation and clinical trials in JDM
- …