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Qureshi N.,University of Nottingham | Armstrong S.,University of Nottingham | Dhiman P.,University of Nottingham | Saukko P.,Loughborough University | And 3 more authors.
Annals of Internal Medicine

Background: Evidence of the value of systematically collecting family history in primary care is limited. Objective: To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment. Design: Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542). Setting: 24 family practices in the United Kingdom. Participants: 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009. Intervention: Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation. Measurements: The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk ≥20%). Other measures included questionnaire completion rate and anxiety score. Results: 98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups. Limitations: Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores. Conclusion: Systematically collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety. Primary Funding Source: Genetics Health Services Research program of the United Kingdom Department of Health. © 2012 American College of Physicians. Source

Posadzki P.,Peninsula Medical School | Lizis P.,Institute of Physiotherapy | Hagner-Derengowska M.,Nicolaus Copernicus University
Complementary Therapies in Clinical Practice

Objective: The aim of this paper is to systematically review all controlled clinical trials of Pilates to treat low back pain. Data sources: A systematic review of nine databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Pedro, Rehadat, Rehab Trials) was conducted and the reference lists of all the papers were checked for further relevant publications until May 2010. Study selection: A first selection was performed by means of title and abstract. A second selection was made by means of predefined inclusion criteria: randomized controlled clinical trials testing Pilates in patients of any age or sex with low back pain. Data extraction: Data relating to changes in body function, quality of life and pain from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the Oxford scale. Data synthesis: Four eligible randomized controlled clinical trials (n = 4) involving Pilates for the management of low back pain were included. The methodological quality of the RCTs was relatively low, varying from 1-4 on the Oxford scale. All studies were heterogeneous in terms of population of patients, control groups, inclusion and exclusion criteria, and outcome measures making a meta-analysis not feasible. Although there is some evidence supporting the effectiveness of Pilates in the management of low back pain, no definite conclusions can be drawn except that further research is needed with larger samples and using clearer definitions of the standard care and comparable outcome measures. Conclusions: There is a wide diversity in research investigating the clinical and cost-effectiveness of Pilates in patients with low back pain. © 2010. Source

Campanelli G.,University of Insubria | Pascual M.H.,Hospital Universitario 12 Of Octubre | Hoeferlin A.,Hernienpraxis Mainz | Rosenberg J.,Copenhagen University | And 3 more authors.
Annals of Surgery

Objective: Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50% compared with sutures for repair of inguinal hernias using the Lichtenstein technique. Background: Inguinal hernia repair is the most common procedure in general surgery, thus improvements in surgical techniques, which reduce the burden of undesirable postoperative outcomes, are of clinical importance. Methods: A randomized, controlled, patient-and evaluator-blinded study (Tissucol/Tisseel for MEsh fixation in LIchtenstein hernia repair [TIMELI]; trial NCT00306839) was conducted among patients eligible for Lichtenstein repair of uncomplicated unilateral primary inguinal small-medium sized hernia. Patients were subject to mesh fixation with either fibrin sealant or sutures. Main outcome measures were visual analogue scale (VAS) assessments for "pain," "numbness," and "groin discomfort" on a scale of 0 = best and 100 = worst outcome. The primary endpoint was a composite that evaluated the prevalence of chronic disabling complications (VAS score >30 for pain/numbness/groin discomfort) at 12 months after surgery. Results: In total, 319 patients were randomized between January 2006 and April 2007 (159 fibrin sealant, 160 sutures). At 12 months, the prevalence of 1 or more disabling complication was significantly lower in the fibrin sealant group than in the sutures group (8.1% vs 14.8%; P = 0.0344). Less pain was reported in the fibrin sealant group than in the sutures group at 1 and 6 months (P = 0.0132; P = 0.0052), as reflected by a lower proportion of patients using analgesics in the fibrin group over the study duration (65.2% vs 79.7%; P = 0.0009). Only 3 of 316 patients (0.9%) experienced recurrence. The incidences of wound-healing complications and other adverse events were comparable between groups. Conclusions: Fibrin sealant for mesh fixation in Lichtenstein repair of small-medium sized inguinal hernias is well tolerated and reduces the rate of pain/numbness/groin discomfort by 45% relative to sutures without increasing hernia recurrence (NCT00306839). © 2012 Lippincott Williams & Wilkins. Source

Hunter J.G.,Peninsula Medical School
Journal of the Royal Army Medical Corps

To determine the strength of evidence supporting the battlefield use of Continual Peripheral Nerve Blocks (CPNBs). Publication review identifying 380 potentially relevant papers. CPNBs have been well trialled and are used routinely in civilian hospitals. The procedure is not without acute and chronic complications related to agents used, catheters themselves and infection risks. These techniques are being used increasingly in military field hospitals to manage pain, however research concerning their use on the battlefield is limited and further trials are required to confidently conclude efficacy. CPNBs are just one component within military medicine of a rapidly evolving polymodal system of pain management. Common combat wounds, namely traumatic amputations, are compatible with this technique, however current evidence concerning their battlefield use is limited. Extensive UK military trials are ongoing and the results of which are expected to clarify questions regarding complication rate and efficacy. Source

Wylde V.,University of Bristol | Hewlett S.,University of the West of England | Learmonth I.D.,University of Bristol | Dieppe P.,Peninsula Medical School

Persistent postsurgical pain is a prevalent but underacknowledged condition. The aim of this study was to assess the prevalence, sensory qualities, and postoperative determinants of persistent pain at 3 to 4 years after total knee replacement (TKR) and total hip replacement (THR). Patients completed a questionnaire with included the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) Pain Scale, PainDetect Questionnaire, Short-Form McGill Pain Questionnaire, and questions about general health and socioeconomic status. A total of 632 TKR patients and 662 THR patients completed a questionnaire (response rate of 73%); 44% of TKR patients and 27% of THR patients reported experiencing persistent postsurgical pain of any severity, with 15% of TKR patients and 6% of THR patients reporting severe-extreme persistent pain. The persistent pain was most commonly described as aching, tender, and tiring, and only 6% of TKR patients and 1% of THR patients reported pain that was neuropathic in nature. Major depression and the number of pain problems elsewhere were found to be significant and independent postoperative determinants of persistent postsurgical pain. In conclusion, this study found that persistent postsurgical pain is common after joint replacement, although much of the pain is mild, infrequent, or an improvement on preoperative pain. The association between the number of pain problems elsewhere and the severity of persistent postsurgical pain suggests that patients with persistent postsurgical pain may have an underlying vulnerability to pain. A small percentage of patients have severe persistent pain after joint replacement, and this is associated with depression and the number of pain problems elsewhere. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Source

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