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Items 1 - 27 of 27 |
One page. |
Urachal abscess: A cause of adult abdominal pain that cannot be ignored.
Hsu CC, Liu YP, Lien WC, Lai TI, Chen WJ, Wang HP.
PMID: 15765359 [PubMed - in process]
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A comparison of emergency department versus inhospital chest pain observation units.
Jagminas L, Partridge R.
Abstract US hospitals use observation units (OUs) for safe and cost-effective management of low-risk to moderate-risk patients presenting to the ED with chest pain. This study retrospectively compared the utility of an ED observation unit (EDOU) with an inhospital observation unit (IHOU) for chest pain at the same institution. A 5-month period during which patients with chest pain were admitted to the EDOU was compared with a 5-month period during which patients with chest pain were admitted to the IHOU. During the 5-month EDOU period, 440 (36.9%) of 1190 patients with chest pain presenting to the ED were admitted for observation. During the IHOU period, 973 (69.3%) of 1404 patients with chest pain presenting to the ED were admitted for observation ( P < .0001). Fewer patients with chest pain were converted to full inpatient admission from the EDOU, 35 (7.9%) of 440, when compared with the IHOU, 187 (19.2%) of 973 ( P < .0001). Mean cost for each patient was US$889.87 (95% CI 862.8-916.9) versus US$1039.70 (95% CI 991.7-1087.7) for each IHOU patient. We conclude that the EDOUs are more cost-effective than IHOUs for management of low-risk to moderate-risk patients with chest pain.
PMID: 15765325 [PubMed - in process]
Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery.
Mannion S, Hayes I, Loughnane F, Murphy DB, Shorten GD.
Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland. mannionstephen@hotmail.com
We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. In a randomized, prospective, double-blind trial, 36 patients requiring hip fracture surgery received PCB and general anesthesia. Patients were randomized into three groups. Each patient received PCB with 0.4 mL/kg of levobupivacaine 0.5%. The control group (group L) received IV saline, the systemic clonidine group (group IC) received IV clonidine 1 mug/kg, and the peripheral clonidine group (group C) received IV saline and PCB with clonidine 1 microg/kg. The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L (mean +/- sd, 13.4 +/- 6.1 versus 7.3 +/- 3.6 h; P = 0.03). There was no difference between group C and group L (10.3 +/- 5.9 versus 7.3 +/- 3.6 h; P > 0.05). The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption. There were no significant differences among groups regarding postoperative adverse effects (bradycardia, hypotension, sedation, and nausea). We conclude that IV but not perineural clonidine (1 microg/kg) prolongs analgesia after PCB without increasing the incidence of adverse effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728081 [PubMed - indexed for MEDLINE]
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Adding clonidine to the induction bolus and postoperative infusion during continuous femoral nerve block delays recovery of motor function after total knee arthroplasty.
Casati A, Vinciguerra F, Cappelleri G, Aldegheri G, Fanelli G, Putzu M, Chelly JE.
Department of Anesthesiology, University of Parma, Italy. acasati.@ao.pr.i
We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.2% ropivacaine (group control; n = 20); block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine (group cloni-bolus; n = 20), and block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine with 1 microg/mL clonidine (group cloni-infusion; n = 20). After surgery, continuous femoral infusion was provided with a patient-controlled infusion pump (basal infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min). The median (range) onset time of surgical block was 15 min (5-30 min) in group control, 10 min (5-35 min) in group cloni-bolus, and 10 min (5-30 min) in group cloni-infusion (P = 0.07). No differences were reported among groups in the degree of pain measured with the visual analog scale. The total consumption of local anesthetic solution after a 24-h infusion was 170 mL (144-220 mL) in group control, 169 mL (144-260 mL) in group cloni-bolus, and 164 mL (144-248 mL) in group cloni-infusion (P = 0.51); after the second day of infusion, total consumption was 168 mL (144-200 mL) in group control, 156 mL (144-288 mL) in group cloni-bolus, and 150 mL (144-210 mL) in group cloni-infusion (P = 0.48). Hemodynamic profiles and sedation were similar in the three groups. Motor function impairment after 48 h of infusion was observed in 27% of cloni-infusion patients but in only 6% of both the control and cloni-bolus groups (P = 0.05). We conclude that adding clonidine 1 microg/mL to local anesthetic for continuous femoral nerve block does not improve the quality of pain relief but has the potential for delaying recovery of motor function.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728080 [PubMed - indexed for MEDLINE]
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The clinical effect of small oral clonidine doses on perioperative outcomes in patients undergoing abdominal hysterectomy.
Hidalgo MP, Auzani JA, Rumpel LC, Moreira NL Jr, Cursino AW, Caumo W.
Psychiatric Service, Hospital Materno Infantil Presidente Vargas, Brazil.
We assessed the effect of small clonidine doses on anxiolysis, analgesia, and hemodynamic stability in patients undergoing abdominal hysterectomy. A total of 61 patients, ASA status I-II, were randomly assigned to receive either oral clonidine 100 microg (n = 29) or placebo (n = 32) before surgery and 24 h after surgery. The use of clonidine resulted in anxiolysis and analgesia throughout the 72 h after surgery, although the subjects who received clonidine were sleepier than the control group for the first 6 h after surgery. The number needed to treat was 3 (95% confidence interval [CI], 1.72-9.42) to prevent intense anxiety in patients with moderate to intense postoperative pain, compared with 40 (95% CI, 18.79-99.68) in the absence of pain or with mild pain. In the treated patients, 68% had an average heart rate less than 70 bpm during surgery, compared with 21.40% in the placebo group (number needed to treat, 2; 95% CI, 1.29-2.80). The clonidine patients required small ropivacaine doses during the surgery but not less morphine by patient-controlled analgesia. A clinically relevant anxiolytic effect was found in patients who received oral clonidine in the perioperative period, and this suggests that clonidine might be a useful therapeutic alternative to other preoperative sedatives.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728070 [PubMed - indexed for MEDLINE]
Comment on:
Preemptive analgesia at the crossroad.
Kissin I.
Publication Types:
PMID: 15728065 [PubMed - indexed for MEDLINE]
Comment on:
United Kingdom back pain exercise and manipulation (UK BEAM) trial: what happened to participants who were not included in analysis?
Tillett R.
Publication Types:
PMID: 15775016 [PubMed - indexed for MEDLINE]
Comment on:
United Kingdom back pain exercise and manipulation (UK BEAM) trial: is manipulation the most cost effective addition to "best care"?
Tveito TH, Eriksen HR.
Publication Types:
PMID: 15775015 [PubMed - indexed for MEDLINE]
Comment on:
United Kingdom back pain exercise and manipulation (UK BEAM) trial: manipulation alone costs more than other options so why is it recommended?
Church TR.
Publication Types:
PMID: 15775014 [PubMed - indexed for MEDLINE]
Comment on:
Managing osteoarthritis of the knee: opioids help manage pain in osteoarthritis.
Johnson M.
Publication Types:
PMID: 15775011 [PubMed - indexed for MEDLINE]
Comment on:
United Kingdom back pain exercise and manipulation (UK BEAM) trial: touch may have had non-specific effect, among other things.
Ernst E.
Publication Types:
PMID: 15775010 [PubMed - indexed for MEDLINE]
Evaluation of the quality of radiotherapy randomized trials for painful bone metastases.
Shakespeare TP, Thiagarajan A, Gebski V.
Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore.
BACKGROUND: The quality of randomized radiotherapy studies investigating the palliation of painful bone metastases has been questioned, with some authors recognizing the potential impact of bias on result interpretation. However, there has been no published comprehensive evaluation of quality assessment. The goals of the current study were to evaluate the quality of randomized studies using a validated checklist and to discuss implications and future directions. METHODS: The authors performed a search for studies that could be reliably assessed using the validated quality assessment instrument. Independent assessors scored study quality using the instrument. RESULTS: The median quality score of the 17 identified randomized studies was 1 of 5 (range, 0-3). The majority (71%) of points were awarded for the authors describing the study as "randomized." The method of randomization and description of withdrawals and dropouts were scored poorly for most studies. None of the studies were awarded points for allocation concealment (blinding). The overall quality was deemed poor (a score of 0-2) for 16 of 17 (94%) studies. CONCLUSIONS: The quality of published randomized evidence comparing efficacy of fractionation schedules for the palliation of bone metastases was suboptimal. As a result of the potential biases present, subjective end points (e.g., retreatment rates) cannot be reliably evaluated. Greater efforts are required by radiation oncology trial groups to improve quality, with a particular focus on developing methods of allocation concealment and comprehensively reporting results. Cancer 2005. (c) 2005 American Cancer Society.
PMID: 15772960 [PubMed - as supplied by publisher]
Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches.
Mauskop A.
State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
Anticonvulsant and antidepressant medications have demonstrated efficacy in migraine treatment. Vagus nerve stimulation (VNS) is an effective treatment for drug-refractory epilepsy and possibly depression and it also has documented analgesic effects. These observations suggested a possible role for VNS in treating severe refractory headaches, and led to a trial of VNS in patients with such headaches. VNS was implanted in four men and two women with disabling chronic cluster and migraine headaches. In one man and one woman with chronic migraines VNS produced dramatic improvement with restoration of ability to work. Two patients with chronic cluster headaches had significant improvement of their headaches. VNS was well tolerated in five patients, while one developed nausea even at the lowest current strength. In conclusion, VNS may be an effective therapy for intractable chronic migraine and cluster headaches and deserves further trials.
Publication Types:
- Case Reports
- Clinical Trial
PMID: 15658944 [PubMed - indexed for MEDLINE]
Comment on:
Bilateral paroxysmal hemicrania or bilateral paroxysmal cephalalgia, another novel indomethacin-responsive primary headache syndrome?
Matharu MS, Goadsby PJ.
Publication Types:
PMID: 15658943 [PubMed - indexed for MEDLINE]
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Endoscopic partial laminectomy for cervical myelopathy.
Yabuki S, Kikuchi S.
Department of Orthopaedic Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan. yabuki@fmu.ac.jp
OBJECT: The authors report the results of endoscopic partial laminectomy performed in 10 patients with degenerative cervical compressive myelopathy. METHODS: Endoscopic partial laminectomy was performed safely in 10 patients with cervical myelopathy. All of the patients experienced symptomatic improvement with slight postoperative wound pain. The mean operative duration was 164+/-35 minutes and the mean intraoperative blood loss was 45.5+/-27 ml. CONCLUSIONS: Endoscopic partial laminectomy may be used as a minimally invasive alternative for the treatment of cervical compressive myelopathy.
PMID: 15739529 [PubMed - indexed for MEDLINE]
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Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.
Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP.
Institute for Spinal Disorders, Cedars Sinai Medical Center, Los Angeles, California, USA. afiller@nervemed.com
OBJECT: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement. METHODS: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR-guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%. CONCLUSIONS: This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.
PMID: 15739520 [PubMed - indexed for MEDLINE]
Barriers to effective symptom management in hospice.
Johnson DC, Kassner CT, Houser J, Kutner JS.
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
The barriers to effective symptom management in hospice are not well described. We surveyed nurses of hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) to identify barriers to the effective management of common symptoms in terminally ill patients. 867/1710 (51%) nurses from 67 hospices in 25 U.S. States returned surveys. Of 32 symptoms, nurses reported agitation (45%), pain (40%), and dyspnea (34%) as the 'most difficult to manage.' The most common perceived barriers to effective symptom management were inability of family care providers to implement or maintain recommended treatments (38%), patients or families not wanting recommended treatments (38%), and competing demands from other distressing symptoms (37%). Patterns of barriers varied by symptom. These nurses endorsed multiple barriers contributing to unrelieved symptom distress in patients receiving hospice care. Interventions to improve symptom management in hospice may need to account for these differing barrier patterns.
PMID: 15652440 [PubMed - indexed for MEDLINE]
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The syringe driver and the subcutaneous route in palliative care: the inventor, the history and the implications.
Graham F, Clark D.
International Observatory on End-of-Life Care, Institute for Health Research, Lancaster University, Lancaster, United Kingdom.
Since the early 1980s, the syringe driver has become a commonly used technology in British palliative care, used to administer continuous subcutaneous infusions (CSCI) for symptom management. Although the device itself has not been adopted universally, it has stimulated interest in the use of CSCI in palliative care and played a significant role in the modern history of this approach. This historical case study of the syringe driver examines the life and work of its inventor, explores its development for use in childhood thalassemia, and analyzes the circumstances surrounding its adoption in palliative care. We conclude by considering the reasons for the continued popularity of the syringe driver, despite problems in its use, and reflect on the lessons which can be learned about the use of CSCI in palliative care internationally.
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15652437 [PubMed - indexed for MEDLINE]
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Pathogenesis and management of pain in osteoarthritis.
Dieppe PA, Lohmander LS.
MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. p.Dieppe@bristol.ac.uk
The term osteoarthritis describes a common, age-related, heterogeneous group of disorders characterised pathologically by focal areas of loss of articular cartilage in synovial joints, associated with varying degrees of osteophyte formation, subchondral bone change, and synovitis. Joint damage is caused by a mixture of systemic factors that predispose to the disease, and local mechanical factors that dictate its distribution and severity. Various genetic abnormalities have been described, but most sporadic osteoarthritis probably depends on minor contributions from several genetic loci. Osteoarthritic joint damage may be associated with clinical problems, but the severity of joint disease is only weakly related to that of the clinical problem. For this reason the associations and pathogenesis of pain are in as much need of investigation as joint damage. Subchondral bone and synovium may be responsible for nociceptive stimuli, and peripheral neuronal sensitisation is an important feature, and can result in normal activities (such as walking) causing pain. Central pain sensitisation can also occur, and psychosocial factors are important determinants of pain severity. We present a stepwise approach to the management of osteoarthritis.
PMID: 15766999 [PubMed - in process]
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The opiate of the masses.
[No authors listed]
Publication Types:
PMID: 15721819 [PubMed - indexed for MEDLINE]
A multimodal approach to managing the symptoms of multiple sclerosis.
Crayton H, Heyman RA, Rossman HS.
Georgetown University Multiple Sclerosis Center, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA. craytonh@georgetown.edu
Multiple sclerosis (MS) is a disease of the CNS with a challenging clinical course characterized by heterogeneous symptoms related to inflammation and demyelination. Disease-modifying agents (DMAs) are used to treat the related neuronal degradation. Certain symptoms occur regularly, although with variable frequency, regardless of treatment with DMAs. Because there is no cure for MS at this time, symptom management is critically important to quality of life. Symptoms commonly seen are spasticity, fatigue, sexual dysfunction, bladder dysfunction, pain, and cognitive dysfunction. Other symptoms include depression, bowel dysfunction, paroxysmal symptoms, and weakness. The symptom management model that provides optimal results for patients with MS is a multimodal approach using effective communication, patient education, physical modalities and activities, occupational and other therapies, and pharmacologic interventions. Individualizing treatment for each patient involves gaining control of symptoms as early as possible to prevent cycles of symptoms from developing.
Publication Types:
PMID: 15596731 [PubMed - indexed for MEDLINE]
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Pain medicine and the injectionist: We need to preserve our specialty.
Ackerman WE, Ahmad M.
PMID: 15765469 [PubMed - in process]
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Dealing with difficult patients in your pain practice.
Wasan AD, Wootton J, Jamison RN.
Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. This article helps practitioners to identify those pain patients who would be prone to difficult behavior and sheds light on some of the reasons behind the behavior that give rise to difficult feelings. Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.
PMID: 15765460 [PubMed - in process]
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Decreased postpartum use of oral pain medication after a single dose of epidural morphine.
Goodman SR, Drachenberg AM, Johnson SA, Negron MA, Kim-Lo SH, Smiley RM.
Background Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery. We hypothesized that a small dose of epidural morphine would be an effective strategy for postpartum analgesia. Methods Eighty-one healthy parturients receiving epidural analgesia for labor were enrolled. Patients were randomized in double-blind fashion to 1 of 3 groups: all groups received a 4-mL volume of epidural solution consisting of saline (group 1, control), 1 mg (group 2), or 2 mg morphine (group 3) after vaginal delivery. During the first 24 hours postpartum, patients were evaluated for the amount of oral pain medication requested; visual analog scale scores for pain at rest and with movement; satisfaction with postpartum pain treatment; and opioid side effects including nausea, pruritus, urinary retention, and respiratory depression. Results Patients who received 2 mg of epidural morphine used an average of 0.7 (0--1, interquartile range) opioid-containing pain pills (acetaminophen with codeine or oxycodone) compared with 1.2 (0-2) in the 1-mg group and 1.9 (0-3) in the control group ( P = .07). There was a statistically significant difference in oral drug usage between those who received epidural morphine and those who did not ( P < .03). There were no differences in side effects except that at 12 hours postpartum there was an increase in Foley catheterization in the 1-mg morphine group ( P = .007). Conclusions These results suggest that epidural morphine decreases the need for oral pain medication in the first 24 hours postpartum. No significant dose-dependent side effects were found.
PMID: 15765455 [PubMed - in process]
Back pain claim rates in Japan and the United States: framing the puzzle.
Volinn E, Nishikitani M, Volinn W, Nakamura Y, Yano E.
Pain Research Center, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT 84108, USA. Epaulv@yahoo.com
STUDY DESIGN: This is a cross-national comparison of workers' compensation claims for back pain in Japan and the United States (US). OBJECTIVES: The main objective is to juxtapose rates of back pain claims in Japan and Washington state. Because the Washington state rate closely matches rates for other US states as well as the rate for the US as a whole, it is used to represent the US rate. A puzzle is to be framed: Why are back pain claim rates in Japan and the United States so disparate? SUMMARY OF BACKGROUND DATA: Occupational back pain is common among workers in both Japan and the United States. Wage compensation for time off work is also substantial in both countries and potentially induces time off work at least as much in Japan as in the United States. Accordingly, back pain claim rates in Japan seemingly would be on the same order of magnitude as rates in the United States. METHODS: Washington state rates are based on data from its state fund. Both Japan and Washington state rates are composed of the number of workers eligible to file worker compensation claims in a given year (denominator) and the number of back pain claims accepted during that year (numerator). Because rates may fluctuate from year-to-year, 5 years of data on rates are presented, 1995-1999. Central to the comparison are Japanese and Washington state rates of workers' compensation claims for back pain with more than 3 days compensated time loss from work. RESULTS: The back pain claim rate in 1999 was 60 times higher in Washington state than in Japan. The disparity in rates for the other years in the study (1995-1998) was similar. CONCLUSION: Back pain is common among workers both in Japan and the United States, but there is no simple or necessary relationship between that symptom and how it manifests itself in one country or another. Rather, the symptom is protean in its social manifestations. As for what shapes those manifestations-or, more specifically, what causes the startling disparity in back pain claim rates between Japan and the United States-that is a puzzle. Various solutions to the puzzle are discussed, but it remains essentially unsolved.
PMID: 15770188 [PubMed - in process]
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Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial.
Engers AJ, Wensing M, van Tulder MW, Timmermans A, Oostendorp RA, Koes BW, Grol R.
Center for Quality of Care Research, University Medical Center Nijmegen, The Netherlands. a.engers@planet.nl
STUDY DESIGN: Cluster randomized controlled trial for a multifaceted implementation strategy. OBJECTIVES: To assess the effectiveness of tailored interventions (multifaceted implementation strategy) to implement the Dutch low back pain guideline for general practitioners with regard to adherence to guideline recommendations. SUMMARY OF BACKGROUND DATA: Guidelines for the management of low back pain in primary care have been developed in various countries, but little is known about the optimal implementation strategy. A multifaceted implementation strategy was developed to overcome identified barriers to the implementation of the Dutch low back pain guideline for general practitioners. METHODS: General practitioners were randomized to an intervention or a control group. The general practitioners in the intervention group (n = 21) received tailored interventions consisting of the Dutch low back pain guideline for general practitioners, a 2-hour educational and clinical practice workshop; two scientific articles on low back pain management; the guideline for occupational physicians; a tool for patient education; and a tool for reaching agreement on low back care with physical, exercise, and manual therapists. The control group (n = 20) received no intervention. The participating general practitioners were asked to recruit consecutive patients with a new episode of low back pain as the main reason for consultation. General practitioners completed registration forms of each individual consultation with regard to the main outcome measures: advice and information, referral to other health-care providers, and prescription of medication. RESULTS: Forty-one of the 67 randomized general practitioners reported on a total of 616 consultations for 531 patients with nonspecific low back pain. The advice and explanation provided by the general practitioners, the prescription of paracetamol or nonsteroidal anti-inflammatory drugs, and prescription of pain medication on atime contingent or a pain contingent basis showed no statistically significant differences between the intervention and control groups. There were also no differences in overall referral rate. However, in follow-up consultations fewer patients were referred to a physical or exercise therapist by the general practitioners in the intervention group than in the control group. CONCLUSIONS: The multifaceted intervention strategy modestly improved implementation (for parts of the recommendations in) the Dutch low back pain guideline by general practitioners and produced small concomitant changes in patient management. The implementation strategy produced fewer referrals to therapists during follow-up consultations.
PMID: 15770171 [PubMed - in process]
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Neuroreflexotherapy for nonspecific low back pain: a systematic review.
Urrutia G, Burton K, Morral A, Bonfill X, Zanoli G.
Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain. gurrutia@hsp.santpau.es
STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effectiveness of neuroreflexotherapy (NRT) for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few of the alternatives for the management of LBP have a firm base of evidence for their effectiveness. Recently, a new intervention known as NRT has been developed in Spain and has been reported to have favorable results. METHODS: Searches were undertaken according to Cochrane Collaboration guidelines, and randomized controlled trials that evaluated NRT as treatment for patients with nonspecific LBP were included. A qualitative synthesis and an assessment of methodological quality were undertaken. RESULTS: Three randomized controlled trials were included, with 125 and 148 subjects in control and intervention groups, respectively. NRT was compared with sham in two trials and standard care in one. Individuals receiving active NRT showed significantly better outcomes for pain, mobility, disability, medication use, consumption of resources, and costs. No major side effects were reported by those receiving active NRT. CONCLUSIONS: NRT appears to be a safe and effective intervention for nonspecific LBP. This conclusion is limited to three trials conducted by a small number of experienced clinicians. Further trials in other settings are needed to determine whether these favorable results can be generalized.
PMID: 15770167 [PubMed - in process]
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