Guideline-based development and practice test of quality indicators for physiotherapy care in patients with neck pain.

By London Spine
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Guideline-based development and practice test of quality indicators for physiotherapy care in patients with neck pain.

J Eval Clin Pract. 2013 Dec;19(6):1044-53

Authors: Oostendorp RA, Rutten GM, Dommerholt J, Nijhuis-van der Sanden MW, Harting J

Abstract
RATIONALE, AIMS AND OBJECTIVES: Little is currently known about the quality of physiotherapy care for patients with musculoskeletal pain. Neck pain was used as an example. The aim is to develop a set of quality indicators, including a practice test.
METHODS: A systematic method is used to develop potential process and outcome indicators. An expert and user panel is used to appraise the potential quality indicators regarding clarity, relevancy, feasibility, acceptability and improvement potential. An invitation to participate in the practice test was sent to physiotherapy practices. The resulting algorithm is used to calculate the degree to which physiotherapists met these indicators (0-100%). Differences in valid outcomes are tested for significance (Student’s t-test; α = 0.05) and compared with established values for clinical relevance [minimal clinically important change (MCIC)].
RESULTS: A representative set of 40 quality indicators (28 process indicators and 12 outcome indicators) is selected from 44 initial guidelines and literature-based recommendations. The process indicators (n = 28) are classified per step of the clinical reasoning process of physiotherapy care. Of the 106 potential participants from 27 practices, 38 physiotherapists (35.8%) submitted data on 96 patients with non-specific neck pain. On average, the participating physiotherapists showed a 55.6% adherence to process indicators with a great variation in scores per step of the clinical reasoning process. The outcomes for ‘pain’, ‘headache’ and ‘daily functioning’ were significantly better compared with baseline, and the mean differences exceeded established values for MCICs.
CONCLUSION: Guardedly, we can conclude that a systematic approach is a valuable means to develop a preliminary set of process and outcome indicators for physiotherapy care for patients with non-specific neck pain, and a practice test should be an intrinsic part of such a systematic approach as it provides valuable information on the key attributes of the set indicators.

PMID: 23510397 [PubMed – indexed for MEDLINE]

Statins and postoperative infections: a randomized clinical trial.

By London Spine
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Statins and postoperative infections: a randomized clinical trial.

Jundishapur J Microbiol. 2014 Apr;7(4):e9456

Authors: Shokouhi S, Alavi Darazam I, Sharifi G, Gachkar L, Amirsardari A, Samadian M

Abstract
BACKGROUND: Observational studies, rather than randomized trials, revealed that statins might be associated with other benefits.
OBJECTIVES: The present study aimed at evaluating the preventive effects of lovastatin when used as a prophylactic agent for early and late infective complications after surgery.
PATIENTS AND METHODS: A total of 149 patients undergoing elective intracranial and spinal surgeries, were enrolled in a double- blind randomized clinical trial in the department of neurosurgery of a teaching hospital. An amount of 20 mg lovastatin and the same dose of placebo, one day before the operation and three days after the surgery, were used for cases and controls, respectively. The patients were evaluated for local and systemic infections during hospitalization and 10, 30, 60 and 90 days after discharge.
RESULTS: A total of 149 patients, 78 men and 71 women with a mean age of 40.3 ± 16.5, were assigned to prophylactic protocols. 46 and 103 patients were in the case and control groups, respectively. Eight episodes of infection were detected, including six bacterial meningitis and two episodes of hospital- acquired pneumonia. All of the patients with documented postoperative infections were part of the placebo group, however, there were no significant statistical differences between the groups (P = 0.059).
CONCLUSIONS: In spite of the differences between the two groups, the results did not significantly support the preventive effect of statins in postoperative infections.

PMID: 25147705 [PubMed]

Impacts of anti-nerve growth factor antibody on pain-related behaviors and expressions of opioid receptor in spinal dorsal horn and dorsal root ganglia of rats with cancer-induced bone pain.

By London Spine
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Impacts of anti-nerve growth factor antibody on pain-related behaviors and expressions of opioid receptor in spinal dorsal horn and dorsal root ganglia of rats with cancer-induced bone pain.

Mol Pain. 2016;12

Authors: Yao P, Ding Y, Wang Z, Ma J, Hong T, Zhu Y, Li H, Pan S

Abstract
OBJECTIVE: To investigate the impacts of anti-nerve growth factor antibody on pain-related behaviors and expressions of μ-opioid receptor in spinal dorsal horn and dorsal root ganglia of rats with cancer-induced bone pain.
METHODS: The rats were randomly grouped and then injected with 10 μl of phosphate buffer saline or Walker256 tumor cells into the upper segment of left tibia. Thirteen days after the injection, the intrathecal catheterization was performed, followed by the injection of saline, anti-nerve growth factor, nerve growth factor, and naloxone twice a day. The pain ethological changes were measured at the set time points; the expression changes of μ-opioid receptor protein and mRNA in spinal dorsal horn and dorsal root ganglia were detected on the 18th day.
RESULTS: After the tumor cells were injected into the tibia, hyperalgesia appeared and the expression of μ-opioid receptor protein and mRNA in spinal dorsal horn and dorsal root ganglia was increased, compared with the sham group; after intrathecally injected anti-nerve growth factor, the significant antinociceptive effects appeared, and the μ-opioid receptor expression was increased, compared with the cancer pain group; the μ-opioid receptor expressions in the other groups showed no statistical significance. The naloxone pretreatment could mostly inverse the antinociception effects of anti-nerve growth factor.
CONCLUSIONS: Anti-nerve growth factor could reduce hyperalgesia in the cancer-induced bone pain rats, and the antinociceptive effects were related with the upregulation of μ-opioid receptor.

PMID: 27118770 [PubMed – in process]

PTEN regulates AMPA receptor-mediated cell viability in iPS-derived motor neurons.

By London Spine
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PTEN regulates AMPA receptor-mediated cell viability in iPS-derived motor neurons.

Cell Death Dis. 2014;5:e1096

Authors: Yang DJ, Wang XL, Ismail A, Ashman CJ, Valori CF, Wang G, Gao S, Higginbottom A, Ince PG, Azzouz M, Xu J, Shaw PJ, Ning K

Abstract
Excitatory transmission in the brain is commonly mediated by the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors. In amyotrophic lateral sclerosis (ALS), AMPA receptors allow cytotoxic levels of calcium into neurons, contributing to motor neuron injury. We have previously shown that oculomotor neurons resistant to the disease process in ALS show reduced AMPA-mediated inward calcium currents compared with vulnerable spinal motor neurons. We have also shown that PTEN (phosphatase and tensin homolog deleted on chromosome 10) knockdown via siRNA promotes motor neuron survival in models of spinal muscular atrophy (SMA) and ALS. It has been reported that inhibition of PTEN attenuates the death of hippocampal neurons post injury by decreasing the effective translocation of the GluR2 subunit into the membrane. In addition, leptin can regulate AMPA receptor trafficking via PTEN inhibition. Thus, we speculate that manipulation of AMPA receptors by PTEN may represent a potential therapeutic strategy for neuroprotective intervention in ALS and other neurodegenerative disorders. To this end, the first step is to establish a fibroblast-iPS-motor neuron in vitro cell model to study AMPA receptor manipulation. Here we report that iPS-derived motor neurons from human fibroblasts express AMPA receptors. PTEN depletion decreases AMPA receptor expression and AMPA-mediated whole-cell currents, resulting in inhibition of AMPA-induced neuronal death in primary cultured and iPS-derived motor neurons. Taken together, our results imply that PTEN depletion may protect motor neurons by inhibition of excitatory transmission that represents a therapeutic strategy of potential benefit for the amelioration of excitotoxicity in ALS and other neurodegenerative disorders.

PMID: 24577094 [PubMed – indexed for MEDLINE]