Interventions for treating pain and disability in adults with complex regional pain syndrome - An overview of systematic reviews

This article is available open access through the publisher’s website at the link below. Copyright © 2013 The Cochrane Collaboration.Background - There is currently no strong consensus regarding the optimal management of complex regional pain syndrome although a multitude of interventions have been described and are commonly used. Objectives - To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the effectiveness of any therapeutic intervention used to reduce pain, disability or both in adults with complex regional pain syndrome (CRPS). Methods - We identified Cochrane reviews and non-Cochrane reviews through a systematic search of the following databases: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Ovid MEDLINE, Ovid EMBASE, CINAHL, LILACS and PEDro. We included non-Cochrane systematic reviews where they contained evidence not covered by identified Cochrane reviews. The methodological quality of reviews was assessed using the AMSTAR tool. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes of quality of life, emotional well being and participants' ratings of satisfaction or improvement. Only evidence arising from randomised controlled trials was considered. We used the GRADE system to assess the quality of evidence. Main results - We included six Cochrane reviews and 13 non-Cochrane systematic reviews. Cochrane reviews demonstrated better methodological quality than non-Cochrane reviews. Trials were typically small and the quality variable. There is moderate quality evidence that intravenous regional blockade with guanethidine is not effective in CRPS and that the procedure appears to be associated with the risk of significant adverse events. There is low quality evidence that bisphosphonates, calcitonin or a daily course of intravenous ketamine may be effective for pain when compared with placebo; graded motor imagery may be effective for pain and function when compared with usual care; and that mirror therapy may be effective for pain in post-stroke CRPS compared with a 'covered mirror' control. This evidence should be interpreted with caution. There is low quality evidence that local anaesthetic sympathetic blockade is not effective. Low quality evidence suggests that physiotherapy or occupational therapy are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control. For a wide range of other interventions, there is either no evidence or very low quality evidence available from which no conclusions should be drawn. Authors' conclusions - There is a critical lack of high quality evidence for the effectiveness of most therapies for CRPS. Until further larger trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult

Self reported aggravating activities do not demonstrate a consistent directional pattern in chronic non specific low back pain patients: An observational study

Question: Do the self-reported aggravating activities of chronic non-specific low back pain patients demonstrate a consistent directional pattern? Design: Cross-sectional observational study. Participants: 240 chronic non specific low back pain patients. Outcome measure: We invited experienced clinicians to classify each of the three self-nominated aggravating activities from the Patient Specific Functional Scale by the direction of lumbar spine movement. Patients were described as demonstrating a directional pattern if all nominated activities moved the spine into the same direction. Analyses were undertaken to determine if the proportion of patients demonstrating a directional pattern was greater than would be expected by chance. Results: In some patients, all tasks did move the spine into the same direction, but this proportion did not differ from chance (p = 0.328). There were no clinical or demographic differences between those who displayed a directional pattern and those who did not (all p > 0.05). Conclusion: Using patient self-reported aggravating activities we were unable to demonstrate the existence of a consistent pattern of adverse movement in patients with chronic non-specific low back pain

Reducing drug related deaths : a pre-implementation assessment of knowledge,barriers and enablers for naloxone distribution through general practice

Peer reviewedPublisher PD

FLICK: developing and running application-specific network services

Data centre networks are increasingly programmable, with application-specific network services proliferating, from custom load-balancers to middleboxes providing caching and aggregation. Developers must currently implement these services using traditional low-level APIs, which neither support natural operations on application data nor provide efficient performance isolation. We describe FLICK, a framework for the programming and execution of application-specific network services on multi-core CPUs. Developers write network services in the FLICK language, which offers high-level processing constructs and application-relevant data types. FLICK programs are translated automatically to efficient, parallel task graphs, implemented in C++ on top of a user-space TCP stack. Task graphs have bounded resource usage at runtime, which means that the graphs of multiple services can execute concurrently without interference using cooperative scheduling. We evaluate FLICK with several services (an HTTP load-balancer, a Memcached router and a Hadoop data aggregator), showing that it achieves good performance while reducing development effort

Reduced skin permeation and penetration of clobetasol propionate when Dermovate cream is applied at short time intervals with emollients

© 2023 The Authors. JEADV Clinical Practice published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. This is an open access article under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/Background: Dermovate cream containing 0.05% clobetasol propionate is a very potent topical corticosteroid (TCS) used in the treatment of severe inflammatory dermatoses. Regular emollient therapy should continue alongside clobetasol propionate treatment, however, the impact on drug delivery to the skin when both products are applied at similar times is unknown. Objectives: To assess whether application of emollients at similar times to Dermovate cream alter the delivery of clobetasol propionate to the skin. Methods: This study was conducted using ex vivo human skin mounted in Franz cells. Dermovate cream was applied before or after three different emollients, Hydromol Intensive cream, Doublebase gel, and Diprobase ointment at 5‐ or 30‐min intervals. Drug delivery to the skin was assessed up to 24 h using high‐performance liquid chromatography. Results: Significantly reduced clobetasol propionate delivery to the skin was observed when Dermovate cream was applied either before or after the three different emollients, compared to the application of Dermovate cream alone. The data suggest in situ formation of a mixed Dermovate cream and emollient layer which reduces clobetasol propionate delivery relative to the original product. Applying Dermovate cream after any emollient generally resulted in larger reductions in drug delivery to the skin, compared to when the steroid was applied first. This was attributed to the emollients forming an additional barrier to drug delivery at the skin‐formulation interface. Conclusions: These findings indicate that applying Dermovate cream at similar times as emollients can significantly reduce drug delivery to the skin and that separating the application of the two products by intervals of up to 30 min is not sufficient to mitigate this effect.Peer reviewe

Motivation profiles in sport: A self-determination theory perspective

The present study examined the link between motivation profiles among adult sports participants and the outcomes of enjoyment, effort, positive and negative affect, attitude toward sport participation, intention to continue sport participation, satisfaction, and persistence in sport. Two samples of participants (n = 590 and n = 555) completed the Sport Motivation Scale and a range of self-report measures to assess the outcome variables. Exploratory cluster analyses applied to Sample 1 and confirmatory cluster analysis applied to Sample 2 identified two clusters of sport participants. The first comprised participants with high scores on both non self-determined and self-determined motives. The second comprised participants with high scores on self-determined motives but low scores on non self- determined motives. Participants in the first cluster scored higher on all outcome variables. The results are discussed with reference to a more in-depth understanding of the motivation dynamics of sport participation based on Self-Determination Theory

Women, know your limits: Cultural sexism in academia

Despite the considerable advances of the feminist movement across Western societies, in Universities women are less likely to be promoted, or paid as much as their male colleagues, or even get jobs in the first place. One way in which we can start to reflect on why this might be the case is through hearing the experiences of women academics themselves. Using feminist methodology, this article attempts to unpack and explore just some examples of ‘cultural sexism’ which characterise the working lives of many women in British academia.This article uses qualitative methods to describe and make sense of just some of those experiences. In so doing, the argument is also made that the activity of academia is profoundly gendered and this explicit acknowledgement may contribute to our understanding of the under-representation of women in senior positions

Drugs-related death soon after hospital discharge among drug treatment clients in Scotland:record linkage, validation and investigation of risk factors.

We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29-90 days, 91 days-1 year, >1 year since most recent hospital discharge versus 'never admitted'. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0-1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients' high DRD-rate soon after hospital-discharge in 2006-2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006-2010, as in 1996-2006, especially for those with a history of injecting

Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study

INTRODUCTION: The purpose of this study was to determine if noninvasive transcranial oxygen saturation (StcO(2)) and Bispectral Index (BIS) correlate with severe traumatic brain injury intensive care unit (ICU) outcomes. METHODS: This is a prospective observational study. Values of intracranial pressure (ICP), mean arterial pressure (MAP), BIS, and StcO(2 )were recorded hourly for the first six, post-injury days in 18 patients with severe brain injury. Included in the analyses was the Cranial-Arterial Pressure (CAP) Index, which is ICP/(MAP - ICP). RESULTS: After 1,883 hours of data were analyzed, we found that StcO(2 )and BIS are associated with survival, good neurological outcome, ICP ≤20, cerebral perfusion pressure (CPP) ≥60, and CAP index ≤0.30 (p ≤ 0.001). Survival and good outcome are independently associated with BIS ≥60, StcO(2 )≥70, and ICP ≤20 (p < 0.0001). BIS ≥60 or StcO(2 )≥70 is associated with survival, good outcome, CPP ≥60, ICP ≤20, CAP index ≤0.30, and fewer ICP interventions (p < 0.0001). With BIS ≥60 or StcO(2 )≥70, the rate of CPP ≥60 is 97.2% and the rate of ICP≤ 25 is 97.1%. An increased CAP index is associated with death, poor neurological outcome, and increased ICP interventions (p < 0.0001). With CAP index >0.25, MAP is not related to ICP (p = 0.16). CONCLUSION: Numerous significant associations with ICU outcomes indicate that BIS and StcO(2 )are clinically relevant. The independent associations of BIS, StcO(2), and ICP with outcomes suggest that noninvasive multi-modal monitoring may be beneficial. Future studies of patients with BIS ≥60 or StcO(2 )≥70 will determine if select patients can be managed without ICP monitoring and whether marginal ICP can be observed. An increased CAP index is associated with poor outcome

The Big Ten IPE Academic Alliance: A regional approach to developing Interprofessional Education and practice

Interprofessional practice and education (IPE) efforts has greatly increased in the past few years, primarily through the leadership of several national and international organizations. These organizations have sponsored forums for information exchange and best practices, which has significantly influenced the development of programs across various educational institutions and practice environments. Several regional groups have emerged, organized around a common purpose and geographic proximity, to share ideas and implement new IPE programs across the cooperating organizations. This article describes the history and growth of one of the newer regional groups, the Big Ten IPE Academic Alliance. Included in this discussion is how the group was created, its governing structure and the various results of its efforts. The intent is to provide expanded guidance how to develop regional groups that are effective vehicles for the successful implementation of IPE within educational and health settings