31,774 research outputs found

    Management of gout in a South Auckland general practice

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    BACKGROUND AND CONTEXT: In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB) has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. ASSESSMENT OF PROBLEMS: The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. RESULTS: The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. STRATEGIES FOR IMPROVEMENT: A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. LESSONS: Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care

    Effect of tart cherry juice on risk of gout attacks: protocol for a randomised controlled trial

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    Introduction: Gout is a painful form of inflammatory arthritis associated with several comorbidities, particularly cardiovascular disease. Cherries, which are rich in anti-inflammatory and antioxidative bioactive compounds, are proposed to be efficacious in preventing and treating gout, but recommendations to patients are conflicting. Cherry consumption has been demonstrated to lower serum urate levels and inflammation in several small studies. One observational case cross-over study reported that cherry consumption was associated with reduced risk of recurrent gout attacks. This preliminary evidence requires substantiation. The proposed randomised clinical trial aims to test the effect of consumption of tart cherry juice on risk of gout attacks. Methods and analysis: This 12-month, parallel, double-blind, randomised, placebo-controlled trial will recruit 120 individuals (aged 18–80 years) with a clinical diagnosis of gout who have self-reported a gout flare in the previous year. Participants will be randomly assigned to an intervention group, which will receive Montmorency tart cherry juice daily for a 12-month period, or a corresponding placebo group, which will receive a cherry-flavoured placebo drink. The primary study outcome is change in frequency of self-reported gout attacks. Secondary outcome measures include attack intensity, serum urate concentration, fractional excretion of uric acid, biomarkers of inflammation, blood lipids and other markers of cardiovascular risk. Other secondary outcome measures will be changes in physical activity and functional status. Statistical analysis will be conducted on an intention-to-treat basis. Ethics and dissemination: This study has been granted ethical approval by the National Research Ethics Service, Yorkshire and The Humber—Leeds West Research Ethics Committee (ref: 18/SW/0262). Results of the trial will be submitted for publication in a peer-reviewed journal. Trial registration number: NCT03621215

    Patients\u27 knowledge and beliefs concerning gout and its treatment: a population based study

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    BACKGROUND: For patients to effectively manage gout, they need to be aware of the impact of diet, alcohol use, and medications on their condition. We sought to examine patients\u27 knowledge and beliefs concerning gout and its treatment in order to identify barriers to optimal patient self-management. METHODS: We identified patients (\u3e/=18 years of age) cared for in the setting of a multispecialty group practice with documentation of at least one health care encounter associated with a gout diagnosis during the period 2008-2009 (n = 1346). Patients were sent a questionnaire assessing knowledge with regard to gout, beliefs about prescription medications used to treat gout, and trust in the physician. Administrative electronic health records were used to identify prescription drug use and health care utilization. RESULTS: Two hundred and forty patients returned surveys out of the 500 contacted for participation. Most were male (80%), white (94%), and aged 65 and older (66%). Only 14 (6%) patients were treated by a rheumatologist. Only a minority of patients were aware of common foods known to trigger gout (e.g., seafood [23%], beef [22%], pork [7%], and beer [43%]). Of those receiving a urate-lowering medication, only 12% were aware of the short-term risks of worsening gout with initiation. These deficits were more common in those with active as compared to inactive gout. CONCLUSION: Knowledge deficits about dietary triggers and chronic medications were common, but worse in those with active gout. More attention is needed on patient education on gout and self-management training

    Impact of gout on the risk of atrial fibrillation

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    OBJECTIVES: To examine the risk of atrial fibrillation (AF) at the time of first diagnosis of gout compared with matched controls and to follow incident gout patients and their matched controls after diagnosis to compare their subsequent risk of AF. METHODS: From the UK Clinical Practice Research Data-link, 45 378 incident gout patients and 45 378 age-, sex-, practice-, registration year- and index year-matched controls were identified. Index dates were initial diagnosis date for gout patients and their matched controls. The risk of AF at diagnosis [odds ratios (ORs), using conditional logistic regression] and after the diagnosis of gout [hazard ratios (HRs), using Cox proportional models] were estimated, adjusted for BMI, smoking, alcohol consumption, ischaemic heart disease, heart failure, heart valve disease, hyperthyroidism and other comorbidities and medications. RESULTS: The prevalence of AF at index date in gout patients (male, 72.3%; mean age, 62.4 +/- 15.1 years) was 7.42% (95% CI 7.18, 7.66%) and in matched controls 2.83% (95% CI 2.67, 2.98%). The adjusted OR (95% CI) was 1.45 (1.29, 1.62). The cumulative probability of AF at 1, 2, 5 and 10 years after index date was 1.08, 2.03, 4.77 and 9.68% in gout patients and 0.43, 1.08, 2.95 and 6.33% in controls, respectively (log-rank test, P < 0.001). The adjusted HR (95% CIs) was 1.09 (1.03, 1.16). CONCLUSION: This population-based study indicates that gout is independently associated with a higher risk of AF at diagnosis and the risk is also higher after the diagnosis

    ANALYSIS OF INFORMATION VALUE CHAINS FOR GOUT SELF-CARE MANAGEMENT

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    This value chain analysis study sought to identify information needed by gout patients to successfully manage their disease, leading to a model for information extraction from patient health records. A scoping review was conducted to identify the types of information needed by gout patients. The findings of each included study were divided and analyzed according to the stages of the care delivery value chain. The results of the review were then used to create a gout information value chain as criteria for annotating the information deemed important for gout patients contained in publicly available patient education materials according to the stages of care delivery. The resulting annotations were used to develop a named entity recognition model capable of automatically labelling medical concepts from clinical notes by value chain stage. To identify concepts specifically relevant to gout patients, the concepts extracted from patient notes were used as candidate features in a phenotyping algorithm to identify concepts associated with gout flares. While this study was able to develop a model for identifying information relevant to gout flares, the findings suggest that there is information missing from patient education materials and their clinical notes that could be valuable to gout patients for self-management

    Management of Gout

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    Gout is an important health concern for old age people. People who are affected this disease are mostly at 40 or older. Physicians prescribed many drugs for the management of gout i.e. Uric acid lowering agent, NSAIDs etc. This study was designed to develop best medication plan to manage the gout. This study was carried out from May 2014 to September 2014.For this purpose I visited many hospitals and clinics to check the patients record and medication prescribed, also ask to patients which drug response to best and read different literatures. Then I made a plan of medication for the management of gout which is effective and economic for the patients. Keywords: Gout, Management/Treatmen
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