Time to stop glucosamine and chondroitin for knee OA?

Review of: Roman-Blas JA, Castañeda S, Sánchez-Pernaute O, et al. Combined treatment with chondroitin sulfate and glucosamine sulfate shows no superiority over placebo for reduction of joint pain and functional impairment in patients with knee osteoarthritis: a six-month multicenter, randomized, double-blind, placebo-controlled clinical trial. Arthritis Rheumatol. 2017;69:77-85.Time to stop glucosamine and chondroitin for knee OA? Prior studies provided conflicting results regarding the efficacy of these medications. This study offers evidence for discontinuing them. Practice changer: Tell patients with moderately severe osteoarthritis to stop taking their glucosamine and chondroitin as it is less effective than placebo. Stength of recommendation: B: Based on single, good-quality randomized controlled trial.Corey Lyon, DO; Rebecca Mullen, MD; Drew Ashby, MD (University of Colorado Family Medicine Residency, Denver

Developing a Counterfactual Comparative Account of Harming by Omission

The goal of this paper is to defend the counterfactual, comparative account of harm by developing an account of when an omission harms someone. Intuitively, it seems as though omissions on the part of moral agents do sometimes count as a harm against someone else, as when a parent fails to feed their child. There are also other cases in which denying that an omission causes harm seems more natural, such as cases involving agents who could not have done otherwise or for whom acting to prevent the harm would be supererogatory. I examine several possible candidates for explaining the difference between cases in which an omission counts as a harm and those in which it doesn’t. I conclude that a proper account of harming by omission should be normative; it should appeal to the agent’s prima facie moral obligations to perform the relevant action. Finally, I defend this account against several potential objections

Is it time to approach spontaneous pneumothorax more conservatively?

A recent study provides modest evidence for observational management over interventional treatment, sparing patients from invasive procedures.Gregory Jones, MD; Jeremias Georgiadis, MD; Valerie Staples, DO (South Baldwin Regional Medical Center, Foley, AL), Rebecca Mullen, MD, MPH (University of Colorado, Family Medicine Residency, Denver). Deputy Editor: Anne Mounsey, MD (Department of Family Medicine, University of North Carolina, Chapel Hill)Includes bibliographical reference

Does exercise relieve vasomotor menopausal symptoms?

Q: Does exercise relieve vasomotor menopausal symptoms? A: NO. Exercise doesn't decrease the frequency or severity of vasomotor menopausal symptoms (VMS) in perimenopausal and postmenopausal women (strength of recommendation: A, systematic review of randomized controlled trials [RCTs] and consistent RCT).Authors: Corey Lyon, DO; Rebecca Mullen, MD; Brandy Deffenbacher, MD; Alex Reed, PhD University of Colorado Family Medicine Residency, Denver; Joan Nashelsky, MLS Family Physicians Inquiries Network, Iowa City

Leishmaniosis causing chronic diarrhoea in a dog

A 10-year-old, male, neutered Podenco Canario was presented for investigation of chronic mixed intestinal diarrhoea and weight loss. The dog was imported from Spain seven years earlier and had not subsequently travelled outside of the UK. Clinical investigations also revealed a lingual mass, right hindlimb lameness, splenomegaly, a non-regenerative anaemia and hyperglobulinaemia. Histopathology of endoscopic gastrointestinal biopsies revealed neutrophilic and histiocytic enteritis and colitis with high numbers of intracytoplasmic organisms suggestive of Leishmania. Similar organisms were identified on cytology from the spleen, bone marrow aspirate and lingual mass. Leishmania PCR was positive on a bone marrow aspirate. Clinical signs resolved with miltefosine and allopurinol treatment. This case describes an atypical presentation of leishmaniosis with chronic diarrhoea which presented for veterinary investigation and treatment, seven years after moving from a Leishmania endemic area to the UK

Nuclear small-subunit ribosomal RNA gene-based characterization, molecular phylogeny and PCR detection of the Neoparamoeba from western Long Island Sound lobster

Author Posting. © National Shellfisheries Association, 2005. This article is posted here by permission of National Shellfisheries Association for personal use, not for redistribution. The definitive version was published in Journal of Shellfish Research 24 (2005): 719-731, doi:10.2983/0730-8000(2005)24[719:NSRRGC]2.0.CO;2.Western Long Island Sound (LIS) lobsters collected by trawl surveys, lobstermen and coastal residents during 2000 to 2002 were identified histologically as infected with a parasome-containing amoeba. Primers to conserved SSU rRNA sequences of parasome-containing amoebae and their nonparasome-containing relatives were used to amplify overlapping SSU rRNA fragments of the presumptive parasite from gill, antenna, antennal gland and ventral nerve cord of infected lobsters. The consensus sequence constructed from these fragments had 98% or greater nucleotide sequence identity with SSU rRNA gene sequences of strains of Neoparamoeba pemaquidensis and associated with high confidence in distance- and parsimony-based phylogenetic analyses with strains of Neoparamoeba pemaquidensis and not members of the family Paramoebidae, e.g., Paramoeba eilhardi. Primers designed to SSU rRNA sequences of the lobster amoeba and other paramoebid/vexilliferid amoebae were used in a nested polymerase chain reaction (PCR) protocol to test DNA extracted from formalin-fixed paraffin-embedded tissues of lobsters collected during the 1999 die-off, when this amoeba initially was identified by light and electron microscopy and reported to be a paramoeba of the genera Paramoeba or Neoparamoeba (Mullen et al. 2004). All sequences amplified from 1999 lobsters, with the exception of one, had 98% to 99% identity to each other, and the 1999 PCR product consensus had 98% identity to Neoparamoeba pemaquidensis strains CCAP 1560/4 (AF371969.1) and 1560/5 (AF371970.1). Molecular characterization of the amoeba from western LIS lobsters by direct amplification circumvents a collective inability to culture the organism in vitro, provides insight into the molecular epidemiology of neoparamoebiasis in American lobster, and allows for PCR-based detection of infected lobsters for future research and diagnostics.Funding for this work was provided by the Connecticut Department of Environmental Protection under Long Island Sound Research Fund Grant No. CWF 333-R to S. Frasca; and by the Connecticut Sea Grant College Program, Grants No. LR/LR-4 to R. Gast and No. LR/LR-5 to P. Gillevet and C. O’Kelly, through the US Department of Commerce, National Oceanic and Atmospheric Administration (NOAA), Award NA16RG1364

Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design

Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced

An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: The role of written and spoken communication

We tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing

A Minimal Intervention to Promote Smoke-Free Homes among 2-1-1 Callers: North Carolina Randomized Effectiveness Trial

This study examined the extent to which delivery of the minimal Smoke-Free Homes intervention by trained 2-1-1 information and referral specialists had an effect on the adoption of home smoking bans in low-income households. A randomized controlled trial was conducted among 2-1-1 callers (n = 500) assigned to control or intervention conditions. 2-1-1 information and referral specialists collected baseline data and delivered the intervention consisting of 3 mailings and 1 coaching call; university-based data collectors conducted follow-up interviews at 3 and 6 months post-baseline. Data were collected from June 2013 through July 2014. Participants were mostly female (87.2%), African American (61.4%), and smokers (76.6%). Participants assigned to the intervention condition were more likely than controls to report a full ban on smoking in the home at both 3- (38.1% vs 19.3%, p = < .001) and 6-month follow-up (43.2% vs 33.2%, p = .02). The longitudinal intent-to-treat analysis showed a significant intervention effect over time (OR = 1.31, p = .001), i.e. OR = 1.72 at 6 months. This study replicates prior findings showing the effectiveness of the minimal intervention to promote smoke-free homes in low-income households, and extends those findings by demonstrating they can be achieved when 2-1-1 information and referral specialists deliver the intervention. Findings offer support for this intervention as a generalizable and scalable model for reducing secondhand smoke exposure in homes

Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial

Replication of intervention research is reported infrequently, limiting what we know about external validity and generalisability. The Smoke Free Homes Program, a minimal intervention, increased home smoking bans by United Way 2-1-1 callers in randomised controlled trials in Atlanta, Georgia and North Carolina