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Day: October 26, 2016

[Lower limb occlusive arterial disease: Diagnosis problems in 2014.]

By wp_zaman

[Lower limb occlusive arterial disease: Diagnosis problems in 2014.]

Presse Med. 2014 May 30;

Authors: Constans J, Bura-Rivière A

Abstract
Diagnosis of peripheral occlusive arterial disease still raises many problems in 2014. Early detection is crucial and a very good tool is available: ankle brachial index. In some patients, toe systolic pressure measurement might be useful (patients with diabetes mellitus or renal failure). As far as walking symptoms are concerned, treadmill test usually gives the answer about the reason for pain. In some cases, other tests may be useful, i.e. treadmill TcPO2 in low back pain. Critical ischaemia is a major issue for treatment when revascularization has failed but diagnosis also raises concerns. Objective testing for ischaemia is mandatory (TcPO2, toe systolic pressure). Ankle pressure measurement is not sufficient in those patients. Patients suspected for critical limb ischaemia have to be investigated and treated in vascular centers. Many problems still concern diagnosis of peripheral occlusive arterial disease in 2014.

PMID: 24890636 [PubMed – as supplied by publisher]

Effectiveness of Back School program versus hydrotherapy in elderly patients with chronic non-specific low back pain: a randomized clinical trial.

By wp_zaman
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Effectiveness of Back School program versus hydrotherapy in elderly patients with chronic non-specific low back pain: a randomized clinical trial.

Acta Biomed. 2014;85(3):52-61

Authors: Costantino C, Romiti D

Abstract
Background and aim of the work: Chronic low back pain (CLBP) is a major cause of disability, for which clinical practice guidelines suggest exercise programs, such as Back School program (stretching and selective muscle reinforcement techniques) and Hydrotherapy technique, as an effective treatment to reduce pain intensity and disability. Methods: We enrolled 56 elderly individuals, affected by non-specific CLBP, whose pain had worsened in the last three months, which were randomly allocated to Back School (group A) or to Hydrotherapy program (group B). Each group underwent two one-hour-treatment sessions per week, over a 12-week period. Each patient was evaluated using the Roland Morris Disability Questionnaire (RMDQ) and the 36-Item Short Form Health Survey (SF-36) V2.0 at the beginning (T0), at the end of treatment (T1) and at the 3-month follow-up (T2). Results: At T1 and T2 we observed a highly significant statistical difference in the values measured  in both groups: at T1 in group A RMDQ improvement of 3.26±1.02 (p<0.001) and SF-36 of 13.30±1.44 (p<0.001); in group B RMDQ improvement of 4.96±0.71 (p<0.001) and SF-36 of 14.19±1.98 (p<0.001). We have also evaluated the difference in effectiveness of the two programs and no significant statistical differences were found between the two groups. Conclusions: Back School program and Hydrotherapy could be valid treatment options in the rehabilitation of non-specific CLBP in elderly people. Both therapies proved to be effective and can be used in association with other rehabilitation programs. We believe that Back School program should be favored for its simplicity and the small number of resources required. 

PMID: 25265444 [PubMed – as supplied by publisher]

Are spondyloarthropathies adequately referred from primary care to specialized care?

By wp_zaman
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Are spondyloarthropathies adequately referred from primary care to specialized care?

Reumatol Clin. 2013 Mar-Apr;9(2):90-3

Authors: López-González R, Hernández-Sanz A, Almodóvar-González R, Gobbo M, Grupo Esperanza

Abstract
OBJECTIVE: To evaluate the degree of agreement between primary care physicians and rheumatologists when evaluating the referral criteria in patients with suspected early spondyloarthropathy (Spa).
MATERIAL AND METHODS: Patients with suspected early Spa (according to predefined clinical referral criteria) were sent by primary care physicians to early Spa units (where a rheumatologist evaluated the same criteria and confirmed the diagnosis) through an on-line platform. We assessed the agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria among patients with definitive Spa using the kappa index (k).
RESULTS: Eight hundred and two patients were analysed, 8.31% of whom were incorrectly referred to the rheumatologist. The degree of agreement regarding the predefined clinical referral criteria was poor for inflammatory back pain (k=0,16; 95% confidence interval [95% CI] 0,09-0,23), radiographic sacroiliitis (k=0,31; 95% CI 0,211-0,428), back or joint pain (k=0,21; 95% CI 0,14-0,29); mild for asymmetric arthritis (k=0,51; 95% CI 0,43-0,59), positive HLA B27 (k=0,59; 95% CI 0,52-0,67) and family history (k=0,50; 95% CI 0,415-0,604); and it was good or very good for anterior uveitis (k=0,81; 95% CI 0,68-0,93), inflammatory bowel disease (k=0,87; 95% CI 0,79-0,96) and psoriasis (k=0,73; 95% CI 0,65-0,81),.
CONCLUSIONS: The degree of agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria was variable. Agreement was very poor for variables like inflammatory back pain, which are crucial for the diagnosis of Spa. Training programs for primary care physicians are important in order for them to correctly identify early Spa patients.

PMID: 23102828 [PubMed – indexed for MEDLINE]

Swing traction versus no-traction for complex intra-articular proximal inter-phalangeal fractures.

By wp_zaman
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Swing traction versus no-traction for complex intra-articular proximal inter-phalangeal fractures.

J Hand Ther. 2014 Jul 23;

Authors: O’Brien LJ, Simm AT, Loh IW, Griffiths KM

Abstract
INTRODUCTION: Traction orthoses are thought to optimize recovery from intra-articular finger fractures by restoring joint space and allowing early motion. Evidence to date has, however, consisted only of case series.
PURPOSE OF THE STUDY: To compare swing traction versus no-traction management of complex fractures of proximal inter-phalangeal (PIP) finger joints. We hypothesized that there is no long-term (i.e. >12 month) difference between swing traction and no-traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost.
METHODS: Adults with a history of complex PIP fractures affecting ≥30% of articular surface injury were identified from database searches at three public hospitals and a private clinic and invited to participate. X-rays taken at the time of injury were graded by two blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction at least one year post injury. Participant data were then were grouped by treatment provided. One group (N = 17) was treated with swing traction and the other group (N = 14) had no-traction. The primary outcome was combined motion of the PIP and distal inter-phalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group.
RESULTS: Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times, and the no-traction group attended 11.7 times. Average costs for swing traction were less than for surgical fixation with no-traction.
DISCUSSION: The significantly different range of motion found in our study did not translate to better DASH scores. The DASH is designed to measure global upper limb physical functioning and symptoms, but lacks sensitivity in populations with finger injuries.
CONCLUSIONS: Patients treated with the swing traction protocol had greater range of motion in the finger, however this did not translate to improved patient ratings of function, pain or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair. Level of evidence: 3.

PMID: 25158903 [PubMed – as supplied by publisher]

Fracture incidence after 3 years of aromatase inhibitor therapy.

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Fracture incidence after 3 years of aromatase inhibitor therapy.

Ann Oncol. 2014 Apr;25(4):843-7

Authors: Bouvard B, Soulié P, Hoppé E, Georgin-Mege M, Royer M, Mesgouez-Nebout N, Lassalle C, Cellier P, Jadaud E, Abadie-Lacourtoisie S, Tuchais C, Vinchon-Petit S, Audran M, Chappard D, Legrand E

Abstract
BACKGROUND: The purpose of this study was to describe the fracture incidence and bone mineral density (BMD) evolution in a large cohort of post-menopausal women with breast cancer after 3 years of aromatase inhibitor (AI) therapy.
PATIENTS AND METHODS: A prospective, longitudinal study in real-life setting. Each woman had an extensive medical assessment, a biological evaluation, a BMD measurement, and systematic spinal X-rays at baseline and after 3 years of AI therapy. Women with osteoporosis at baseline (T-score < -2.5 and/or non-traumatic fracture history) were treated by oral weekly bisphosphonates.
RESULTS: Among 497 women (mean age 63.8 ± 9.6 years) included in this study, 389 had a bone evaluation both at baseline and after 3 years of AI therapy: 267 women (mean age 61.2 ± 8.6) with no osteoporosis at baseline and 122 women (mean age 67.2 ± 9.1) with osteoporosis at baseline justifying a weekly oral bisphosphonate treatment. Women without bisphosphonates had a significant decrease in spine BMD (-3.5%, P < 0.01), neck BMD (-2.0%, P < 0.01), and total hip BMD (-2.1%, P < 0.01) over the 3 years but only 15 of them (5.6%) presented an incident vertebral or non-vertebral fracture. In osteoporotic women treated with bisphosphonates, spine and hip BMD were maintained at 3 years but 12 of them (9.8%) had an incident fracture. These fractured women were significantly older (74.1 ± 9.8 versus 66.5 ± 8.8) but also presented BMD loss during treatment suggesting poor adherence to bisphosphonate treatment.
CONCLUSION: This real-life study confirmed that AIs induced moderate bone loss and low fracture incidence in post-menopausal women without initial osteoporosis. In women with baseline osteoporosis and AI therapy, oral bisphosphonates maintain BMD but were associated with a persistent fracture risk, particularly in older women.

PMID: 24608193 [PubMed – indexed for MEDLINE]