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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
Interacting bosons in an optical lattice: Bose-Einstein condensates and Mott insulator
A dense Bose gas with hard-core interaction is considered in an optical
lattice. We study the phase diagram in terms of a special mean-field theory
that describes a Bose-Einstein condensate and a Mott insulator with a single
particle per lattice site for zero as well as for non-zero temperatures. We
calculate the densities, the excitation spectrum and the static structure
factor for each of these phases.Comment: 17 pages, 5 figures; 1 figure added, typos remove
GUILT AND INNOCENCE ARE MATTERS OF DEGREE, DEATH IS FINAL: WHAT TO DO WHEN YOUR CLIENT PREFERS EXECUTION
Swine management : preventing diseases
"Many outbreaks of disease in swine herds can be avoided by using management practices directed at disease prevention. Disease control is only one facet of a successful management program."--First page.B.L. Moseley (School of Veterinary Medicine)Revised 2/84/5
Swine sanitation
5/79/8M"Sanitation is important to any swine production program but vital to an intensified program. If sanitation could be measured, the degree of success of the production program would be in direct proportion to degree of sanitation. Cleanliness and sanitation are commonly used as synonyms, but cleanliness is far from the entire picture of sanitation. It should include the entire management program directed toward the prevention and control of disease for the purpose of efficient swine production. The selection of lots and pastures, and the construction of houses and feeding floors should be directed toward easy and effective cleaning, ample drainage, and the provisions of a clean wholesome water supply. Pens and feeding floors should be preferably of an impervious material , such as concrete to facilitate proper cleaning."--First page.B. L. Moseley (School of Veterinary Medicine
Disease aspects of swine management
"Many outbreaks of disease in swine herds can be avoided by use of management practices directed at disease prevention. Disease control is only one facet of a successful management program. New disease problems confront the swine industry where none previously existed. Recent changes in management and nutrition pose new problems. Larger numbers of swine are being raised in smaller areas, rations are designed to attain maximum growth, and it is possible to transport diseases and diseased animals great distances in a short time. Treatment of disease is not as effective or as economical as prevention. Prevention can be attained through management, which should include strict sanitation and immunization programs . National mortality rates indicate that 40% of the pigs farrowed are not marketed, and one-third of those farrowed are not weaned. This indicates where the greatest death loss occurs and where the greatest effort should be directed. It is difficult to measure losses other than deaths, but they do occur-abortions, poor conception rates, and lack of maximum -+growth and efficiency."--First page.B. L. Moseley (School of Veterinary Medicine)Revised 12/7
No differences in cycling efficiency between world-class and recreational cyclists
Journal ArticleThe aim of this experiment was to compare the efficiency of elite cyclists with that of trained and recreational cyclists. Male subjects (N =69)performed an incremental exercise test to exhaustion on an electrically braked cycle ergometer. Cadence was maintained between 80-90rpm
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