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Specific and Nonspecific Low Back Pain —Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist
Years ago, at a spine conference, I came across one of the authors of several landmark studies on the causes of low back pain (LBP) published in the mid-90s. During the coffee break, I casually asked the author's opinion on how often we could identify a pain generator in LBP with certainty. The answer was, “in about half of the cases.” We face this challenge every time we encounter patients with LBP. Our patients often ask us the same question, “Doc, what is causing my back pain?”
Source: The Spine Journal - April 26, 2023 Category: Orthopaedics Authors: Mustafa Farooque Tags: Perspective Source Type: research

Patient and public involvement to inform the protocol of a clinical trial comparing total hip arthroplasty with exercise: an exploratory qualitative case study
Conclusions Based on key stakeholder treatment expectations and beliefs, we implemented three main strategies to improve the methodological rigorousness of our trial protocol. First, we added an observational study investigating the generalisability to address a potential low enrolment rate. Second, we developed an enrolment procedure using generic guidance and balanced narrative conveyed by an independent clinician to facilitate communication of clinical equipoise. Third, we adopted change in hip pain and function as the primary outcome. These findings highlight the value of patient and public involvement in the developme...
Source: BMJ Open - April 24, 2023 Category: General Medicine Authors: Frydendal, T., Thomsen, K. S., Mechlenburg, I., Mikkelsen, L. R., Overgaard, S., Ingwersen, K. G., Myburgh, C. Tags: Open access, Qualitative research Source Type: research

Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol
Introduction Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation. M...
Source: BMJ Open - April 21, 2023 Category: General Medicine Authors: Leung, K. K., Carr, F. M., Kennedy, M., Russell, M. J., Sari, Z., Triscott, J. A., Korownyk, C. Tags: Open access, Geriatric medicine Source Type: research

Health conference asks why ambulance staff aren ’ t an emergency service
The final day of UNISON’s annual health conference in Bournemouth opened with delegates standing in a minute’s silence to mark the upcoming International Workers’ Memorial Day on 28 April (above). Moving to the business of the day, debates were heard on a variety issues. Retirement age parity A motion submitted by the ambulance occupational group highlighted the disparity in retirement age between police, fire service and ambulance staff. Peter Steventon, South East central ambulance, opened the motion saying: “You would assume that NHS ambulance staff would be recognised as an ‘emergency service’. You ...
Source: UNISON meat hygiene - April 20, 2023 Category: Food Science Authors: Simon Jackson Tags: Article 2023 National Health Conference Ambulance ambulance strikes fighting cuts and privatisation in the NHS Source Type: news

P23 Piracetam for breath-holding spells
Conclusion Our experience of piracetam in one patient with BHS shows that it can be used safely; however, this should be used on an individual case basis after discussion with the MDT. Further research is required in BHS and, in particular, the need for treatment guidelines. References Flodine T, Mendez M. Breath Holding Spells [Internet]. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539782/ [Accessed March 2022] Winblad B. Piracetam: a review of pharmacological properties and clinical uses. CNS Drug Reviews 2006;11:169–182. Abbaskhanian A, Ehteshami S, Sajjadi S, Rezai M. Effects of piracetam on pe...
Source: Archives of Disease in Childhood - April 19, 2023 Category: Pediatrics Authors: Shah, N., Gandhi, H., Tan, H.-L., Healy, M., Makhecha, S. Tags: Abstract from the Neonatal and Paediatric Pharmacists Conference 2022 Source Type: research

P39 Current sedation practice in a paediatric intensive care unit in a UK hospital
Conclusions Most of the sedation prescribed in the PICU appear to be within safe ranges and the cumulative doses were under safe thresholds documented in the literature. The main sedation agents used in PICU at the participated hospital are morphine and midazolam. Although the study shows that patients were ‘adequately sedated’, the current NISS scoring system used is not reliable alone4 and therefore, the implementation of a more accurate scoring such as Comfort-B is recommended for more reliable interpretations and better control of sedation. References Twite MD, Rashid A, Zuk J, Friesen RH. Sedation, analge...
Source: Archives of Disease in Childhood - April 19, 2023 Category: Pediatrics Authors: Abou Daya, M., Rashed, A., Benn, C., Shah, L. Tags: Abstract from the Neonatal and Paediatric Pharmacists Conference 2022 Source Type: research

P41 Pharmacists input in managing paediatric patients on the ketogenic diet
Conclusion The ketogenic diet is an effective nonpharmacological treatment for intractable childhood epilepsy.1 For a ketogenic diet to be effective a strict control of carbohydrate intake is essential. Many of these patients are only allowed 5–15 g of carbohydrates per day. Careful consideration of carbohydrate content and drug formulation of medications are vital whilst on this diet. Pharmacists play an integral role in minimising amount of carbohydrate in medicines and recommending the use of low or no carbohydrate preparations where suitable.2 This can only be achieved by having a reference list. Unfortunately, t...
Source: Archives of Disease in Childhood - April 19, 2023 Category: Pediatrics Authors: Deane, L. Tags: Abstract from the Neonatal and Paediatric Pharmacists Conference 2022 Source Type: research

P44 Alfentanil for analgesia and sedation in childrens critical care
Introduction Safe and effective sedation and analgesia in children’s critical care is a complex area of medicines use. Analgesia and sedation are needed to treat any pain during a critical care stay, and also to facilitate the delivery of invasive interventions such as mechanical ventilation and intravenous access devices. Strong opioids are a group of medicines often used to achieve good sedation and pain relief. In adult critical care, alfentanyl has become the opioid of choice as it reduces the length of stay.1 2 This could be attributed to the pharmacokinetic profile of alfentanyl. Alfentanyl does not distribute ...
Source: Archives of Disease in Childhood - April 19, 2023 Category: Pediatrics Authors: Morris, S., Brooks, T. Tags: Abstract from the Neonatal and Paediatric Pharmacists Conference 2022 Source Type: research

P46 Review of medications/supportive care items prescribed at discharge for paediatric frame patients
Conclusion Although many patients were prescribed appropriate medications and supportive care items at discharge, the audit demonstrated essential items are omitted and that there is great variation in supply of these items. Patients received from as little as a 5-day supply of tramadol to 4 weeks’ worth, and just under half of all patients did not have a request for their GP to continue supplying tramadol if needed. If a patient is not seen by their GP within 2 weeks of being discharged, this may lead to patients not being prescribed adequate analgesia. In addition, although many patients were prescribed diazepam at...
Source: Archives of Disease in Childhood - April 19, 2023 Category: Pediatrics Authors: Sinclair, F., Stillwagon, O. Tags: Abstract from the Neonatal and Paediatric Pharmacists Conference 2022 Source Type: research

XRHealth and Amelia Virtual Care Announce Merger, Creating the Largest XR Therapeutics Platform in the World
Both Companies will Be merged Under the XRHealth Brand Name and By the End of the Year Are Forecasted to Have over 500K VR Treatments, Exceed 25K Patients Treated, and Be Deployed by Over 2500 Clinicians XRHealth, a Boston-based developer and operator of virtual treatment rooms, and Amelia Virtual Care, a global leading virtual reality platform for mental health professionals based in Barcelona, Spain, today announced their intention to merge into one company, which will remain called XRHealth. The union aims to create an XR therapeutic powerhouse, uniquely capable of addressing both physical and mental health issues. The...
Source: EMR and HIPAA - April 18, 2023 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT 2023 HIMSS Global Health Conference & Exhibition Amelia Virtual Care Amelia VR Asabys Asabys Partners Augmented Reality CBT Cognitive Behavioral Therapy Cognitive-Behavioral VR Therapy Eran Orr Guill Source Type: blogs

Innovation in Targeted Intra-articular Therapies for Osteoarthritis
AbstractOsteoarthritis is the most common chronic joint disease characterized by progressive damage to the joints, leading to pain and loss of function. There is currently no cure or disease-modifying therapy for osteoarthritis. Hence, the increasing disease prevalence linked with ageing and obesity represents a substantial socio-economic burden. Intra-articular therapy by injection of drugs into affected joints can optimize local drug bioavailability, while reducing risks of systemic toxicity, a concern in an ageing patient population. In this review, we investigate the current landscape of intra-articular drug therapies ...
Source: Drugs - April 17, 2023 Category: Drugs & Pharmacology Source Type: research

An unusual case of a tibial metastasis as the first clinical presentation of a serous papillary carcinoma of the ovarian epithelial type of the testis
We describe the case of an 82-year-old man, presented with complaints of right leg pain and difficulty walking, who was found to have a large right tibial metastasis of unknown primary origin. Whole body CT scan did not reveal any cranial, thoracic or abdominal tumor masses, but it showed abnormal para-aortic lymph nodes and right spermatic cord swelling. An extemporary ultrasound examination found a right testicular mass. The patient underwent radical orchiectomy, and the diagnosis of a serous papillary carcinoma of the ovarian epithelial type of the testis was made. To the best of our knowledge, this is the first case in...
Source: International Cancer Conference Journal - April 13, 2023 Category: Cancer & Oncology Source Type: research

The effectiveness of the manual pressure points technique for hemorrhage control-The 2022 THOR pre-conference meeting experience
CONCLUSION: The MPP technique was highly effective in occluding distal palpable pulses in healthy volunteers when applied to the supraclavicular and femoral arteries. Brief instruction on the technique can potentially improve the chances of achieving hemorrhage control within 5 s. Further research is required to determine efficacy among different populations and providers with varying experience levels.PMID:37042672 | DOI:10.1111/trf.17350
Source: Transfusion - April 12, 2023 Category: Hematology Authors: Patrick Thompson Elon Glassberg Yuval Alon Christopher K Bjerkvig Hakon S Eliassen Irina Radomislensky Geir Strandenes Tomer Talmy Ofer Almog Source Type: research

Investigating the hypoalgesic effects of spinal manipulative therapy using hidden pain conditioning and positive expectation in patients with chronic low back pain: protocol for a randomised controlled trial
This study aims to identify whether a conditioning procedure with positive induced expectations about spinal manipulative therapy (SMT) will result in greater hypoalgesic effects in adults with chronic low back pain (CLBP) in a clinical trial design. Methods and analysis This trial will enrol 264 patients with non-specific CLBP, aged 18–60 years. Patients will undergo a calibration test to determine the thermal pain threshold for the hidden pain conditioning procedure. Afterward, they will be randomised to one of the three groups: hidden pain conditioning with positive induced expectations—group one (G1); posi...
Source: BMJ Open - April 12, 2023 Category: General Medicine Authors: Nogueira Carrer, H. C., Lima, T. C. d., George, S. Z., Reis, F. J. J. d., Dias, D. L. C., Campanha, B. E. S., Chaves, T. C. Tags: Open access, Rehabilitation medicine Source Type: research