Exploring Patients' Experiences of Internet-Based Self-Management Support for Low Back Pain in Primary Care

OBJECTIVE: We explored patients' experiences of using Internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance. DESIGN: Exploratory descriptive qualitative study using thematic analysis, nested within a randomized feasibility trial. METHODS: Patients with LBP who participated in a feasibility trial of the SupportBack Internet intervention (ISRCTN: 31034004) were invited to take part in semistructured telephone interviews after the three-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range = 36-87 years, 66.7% female, characteristics representative of the trial population). Data were analyzed thematically. RESULTS: Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack's design (Clarity and ease of use, Variety and range of information provided, Need for specificity and flexibility), Engaging with the SupportBack intervention, Promoting positive thought processes (Reassurance, Awareness of self-management), Managing behavior with SupportBack (Motivation and goal setting, Using activity as a pain management strategy, Preferences for walking or gentle back exercises), Feeling supported by telephone physiotherapists (Provision of reassurances and clarity, Physiotherapists are motivating), Severity and comorbidity as barriers (Preexisting condition or severity acting as a barrier, Less useful for mild low back pain). CONCLUSIONS: The Internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and ongoing support to implement behavioral changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced the patient experience and the potential utility of the intervention

Using an internet intervention to support self-management of low back pain in primary care:Findings from a randomised controlled feasibility trial (SupportBack)

Introduction Low back pain (LBP) is a prevalent and costly condition. The majority of patients experiencing LBP are managed in primary care, where first-line care recommendations consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity.Methods/analysis This protocol describes a single-blind, randomised controlled feasibility trial of an internet intervention developed to support the self-management of LBP in primary care. Patients are being randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of an internet intervention or an internet intervention with physiotherapist telephone support. Patients are followed up at 3 months. Primary outcomes are the feasibility of (1) the trial design/methods, (2) the delivery of the internet intervention and (3) the provision of telephone support by physiotherapists. Secondary outcomes will include exploratory analysis of estimates and variation in clinical outcomes of pain and disability, in order to inform a future main trial.Ethics/dissemination This feasibility trial has undergone ethical scrutiny and been approved by the National Health Service (NHS) Research Ethics Committee, REC Reference 13/SC/0202. The feasibility findings will be disseminated to the research community through presentations at conferences and publication in peer review journals. Broader dissemination will come following a definitive trial

Genome-wide association study of classical Hodgkin lymphoma identifies key regulators of disease susceptibility

Several susceptibility loci for classical Hodgkin lymphoma (cHL) have been reported, however much of the heritable risk is unknown. Here, we perform a meta-analysis of two existing genome-wide association studies (GWAS), a new GWAS, and replication totalling 5,314 cases and 16,749 controls. We identify risk loci for all cHL at 6q22.33 (rs9482849, P=1.52 × 10-8) and for nodular sclerosis HL (NSHL) at 3q28 (rs4459895, P=9.43 × 10-17), 6q23.3 (rs6928977, P=4.62 × 10-55 11), 10p14 (rs3781093, P=9.49 × 10-13), 13q34 (rs112998813, P=4.58 × 10-8) and 16p13.13 (rs34972832, P=2.12 × 10-8). Additionally, independent loci within the HLA region are observed for NSHL (rs9269081, HLA-DPB1*03:01, Val86 in HLA-DRB1) and mixed cellularity HL (rs1633096, rs13196329, Val86 in HLA-DRB1). The new and established risk loci localise to areas of active chromatin and show an over-representation of transcription factor binding for determinants of B-cell development and immune response.In the United Kingdom, Bloodwise (LLR; 10021) provided principal funding for the study. Support from Cancer Research UK (C1298/A8362 supported by the Bobby Moore Fund) and the Lymphoma Research Trust is also acknowledged. A.S. is supported by a clinical fellowship from Cancer Research UK. For the UK-GWAS, sample and data acquisition were supported by Breast Cancer Now, the European Union and the Lymphoma Research Trust. The UK-GWAS made use of control genotyping data generated by the WTCCC. For further information, please visit the publishr's website

Nitric Oxide Protects Mouse Thymocytes from Apoptosis Induced by γ-Irradiation

INTRODUCTION. Nitric Oxide (NO) and its reactive products can either promote or prevent apoptosis depending upon the cell systems and conditions involved (1). We have previously reported that NO-induced mouse thymocyte apoptosis in vitro involves p53 upregulation and caspase-1 activation (2, 3). To further dissect the relationship between NO and thymocyte apoptosis, we investigated the effect of NO on Balb/c thymocytes exposed to γ-irradiation. We found that NO partially protects γ-irradiated thymocytes from apoptosis by preserving mitochondrial integrity and inhibiting caspase activity

Exploring patients’ experiences of internet-based self-management support for low back pain in primary care

Objective: We explored patients’ experiences of using internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance.Design: Exploratory descriptive qualitative study using thematic analysis, nested within a randomised feasibility trial. Methods: Patients with LBP who participated in a feasibility trial of the ‘SupportBack’ internet intervention (ISRCTN:31034004) were invited to take part in semi-structured telephone interviews after the 3-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range: 36-87, 66.7% female, characteristics representative of the trial population). Data were analysed thematically. Results: Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack’s design (Clarity and ease of use; Variety and range of information provided; Need for specificity and flexibility); Engaging with the SupportBack intervention; Promoting positive thought processes (Reassurance; awareness of self-management); Managing behaviour with SupportBack (Motivation and goal setting; Using activity as a pain management strategy; Preferences for walking or gentle back exercises); Feeling supported by telephone physiotherapists (Provision of reassurances and clarity; Physiotherapists are motivating); Severity and comorbidity as barriers (Pre-existing condition or severity acting as a barrier; Less useful for mild low back pain).Conclusions: The internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and on-going support to implement behavioural changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced patient experience and the potential utility of the intervention.<br/

Genome-wide association study of classical Hodgkin lymphoma identifies key regulators of disease susceptibility (vol 8, 1892, 2017)

The original version of this Article contained an error in the spelling of a member of the PRACTICAL Consortium, Manuela Gago-Dominguez, which was incorrectly given as Manuela Gago Dominguez. This has now been corrected in both the PDF and HTML versions of the Article.status: publishe