Usual Medical Care (usual + medical_care)

Distribution by Scientific Domains


Selected Abstracts


Behavioral Sleep Modification May Revert Transformed Migraine to Episodic Migraine

HEADACHE, Issue 8 2007
Anne H. Calhoun MD
Background.,Sleep problems have been linked with headaches for more than a century, but whether the headaches are the cause or the result of the disrupted sleep is unknown. Objectives.,We previously reported that nonrestorative sleep and poor sleep habits are almost universal in a referral population of women with transformed migraine (TM). Since cognitive behavioral therapy is effective in improving sleep quality in individuals with poor sleep hygiene, we designed a randomized, placebo-controlled study to assess the impact of such treatment on TM. We hypothesized that behavioral sleep modification (BSM) would be associated with improvement in headache frequency and intensity and with reversion to episodic migraine. Methods.,Subjects were 43 women with TM referred to an academic headache center. After obtaining informed consent, patients were randomized to receive either behavioral sleep instructions or placebo behavioral instructions in addition to usual medical care. Subjects recorded headaches in standardized diaries. The first postintervention visit was scheduled at 6 weeks. At that visit, the blind was broken and all subjects received BSM instructions. A final visit was scheduled 6 weeks later. Results.,Compared to the placebo behavioral group, the BSM group reported statistically significant reduction in headache frequency [F (1, 33 = 12.42, P=.001)] and headache intensity [F(1, 33 = 14.39, P= .01)]. They were more likely to revert to episodic migraine ,2 (2, n = 43) = 7.06, P= .029. No member of the control group reverted to episodic migraine by the first postintervention visit. By the final visit, 48.5% of those who had received BSM instructions had reverted to episodic migraine. Conclusions.,In this pilot study of women with TM, we found that a targeted behavioral sleep invention was associated with improvement in headache frequency, headache index, and with reversion to episodic migraine. [source]


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PRESCRIBER, Issue 11 2006
Article first published online: 14 SEP 2010
NSAIDs linked to erectile dysfunction Use of NSAIDs may double the risk of erectile dysfunction, according to an observational study from Finland (J Urol 2006;175:1812-6). A survey of 1683 men aged 50-70 showed that, over a five-year period, the incidence of erectile dysfunction was 93 per 1000 person-years of NSAID use compared with 35 per 1000 person-years in nonusers. After controlling for risk factors and compared with nonusers of NSAIDs who did not have arthritis, the relative risk was greater in NSAID users whether they had arthritis (1.9, 95% CI 1.2-3.1) or not (2.0, 95% CI 1.2-3.5). The risk was somewhat higher in nonusers with arthritis (1.3, 95% CI 0.9-1.8). Inhaled steroids do not modify asthma course Fluticasone does not ameliorate the course of asthma in young children, say US investigators (N Engl J Med 2006;354:1985-97). Fluticasone 88,g twice daily controlled symptoms for two years in 285 children aged two to three. However, in the following treatment-free year there were no differences from placebo in asthma-free days, lung function or exacerbation frequency. Fluticasone was associated with a 1.1cm reduction in growth during treatment, though this decreased to 0.7cm after a year without treatment. A second study (N Engl J Med 2006;354:1998-2005) found that introducing an inhaled steroid after a three-day episode of wheezing in one-month-old infants did not prevent the development of persistent wheezing in the first three years of life. Prescribing for fracture prevention increases Prescribing of medicines to reduce fracture risk in post-menopausal women has tripled in the last five years, according to a PPA prescribing review (www.ppa.org.uk/news/pact-052006.htm). The change predates NICE guidance on secondary prevention, published in 2005. Approximately 480 000 women in the UK receive treatment. Alendronic acid accounts for almost a third of prescriptions and half of the £45 million spent in the last quarter of 2005. There was a two-fold variation in prescribing costs between strategic health authorities. Pharmacist prescribing for hypertension A survey of patients attending a pharmacist-led clinic for hypertension has found overwhelming support for pharmacist prescribing (Pharm J 2006;276:567-9). All 127 patients offered an appointment at a hypertension clinic run by pharmacist supplementary prescribers were surveyed; the response rate was 87 per cent. Eighteen respondents chose not to attend, of whom five preferred their usual medical care. Responses from 88 patients revealed that 57 per cent believed the standard of care was better than previously, and 86 per cent said they now understood more about their condition, felt more involved in treatment decisions and were able to make an appointment easily. Ninety-two per cent considered pharmacist supplementary prescribing a good idea. Anti-TNFs linked to malignancy/infections The anti-TNF monoclonals infliximab (Remicade) and adalimumab (Humira) are associated with an increased risk of cancer and serious infections in patients with rheumatoid arthritis (JAMA 2006;295:2275-85). A meta-analysis of nine randomised trials involving 3493 treated patients showed that, compared with placebo, these agents were associated with an odds ratio (OR) of 3.3 (95% CI 1.2-9.1) for malignancy, and there was evidence of a dose-response effect. The number needed to harm (NNH) for one additional malignancy in 6-12 months' treatment was 154. There was also an increased risk of serious infection (OR 2.0; 95% CI 1.3-3.1), for which the NNH was 59 for one case in 3-12 months' treatment. The authors say that the findings were based on low numbers of events and should be interpreted cautiously. Travelling abroad with CDs Aintree Hospitals NHS Trust has published a guide to help patients who travel abroad while taking controlled drugs (www.aintree hospitals.nhs.uk/publications/file.aspx?int_version_id=912). The leaflet explains the need for a licence and provides contact details for relevant organisations. New PCTs announced The government has announced the long-awaited reorganisation of PCTs in England (www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleases Notices/fs/en?CONTENT_ID=4135001&chk=j12UcL). The current total will be reduced from 303 to 152 from 1 October. More than 70 per cent will be co-terminous with local authorities in the hope that services will be delivered more efficiently. The changes will reduce administrative costs, with anticipated savings of £250 million in the next two years. The reorganisation of PCTs follows a restructuring of strategic health authorities and was the subject of a major public consultation exercise in 2005/06. There will also be a reorganisation of ambulance trusts, reducing the number from 29 to 12. Regional maps of the new PCT boundaries are available atwww.dh.gov.uk/ NewsHome/NewsArticle/fs/en?CONTENT_ID=4135088&chk=oJufTo. New and updated guides New medicines guides for GI disease have been published by the Medicines Information Project at http://medguides.medicines.org.uk. PRODIGY has issued 11 updated and five new full guides and has also updated five of its quick reference guides (www.prodigy.nhs.uk). [source]


Trial of nurse-run asthma clinics based in general practice versus usual medical care

RESPIROLOGY, Issue 3 2004
Louis S. PILOTTO
Objective: The aim of this study was to assess the ability of nurse-run asthma clinics based in general practice compared with usual medical care to produce at least a moderate improvement in the quality of life of adults with asthma. Methodology: A randomized controlled trial involving 80 asthma clinic and 90 usual medical care asthma participants, aged 18 years and older was conducted in 11 general practices in Adelaide. The main outcome measure was the St George's respiratory questionnaire (SGRQ), from which quality-of-life scores were used to assess therapeutic benefit. Lung function measurements and health services utilization data were also collected. Results: One hundred and fifty-three participants (90%) were reviewed at follow up after 6,9 months. There was little difference between groups in baseline measures or for the 6-month follow-up, outcomes,, including, the, mean, difference, in, total, SGRQ, scores, (,0.5,, 95%, confidence, interval, (CI) ,4.0, 2.9) and the mean difference in percentage predicted FEV1 (2.3%, 95% CI ,0.7, 5.3 pre-bronchodilator; 0.4%, 95% CI ,5.1, 5.9 post-bronchodilator). Trends in health services utilization were noted. Conclusions: Nurse-run asthma clinics based in general practice and usual medical care were similar in their effects on quality of life and lung function in adults. These findings cannot be generalized to hospital outpatients and other clinics that manage more severe asthmatic patients. [source]


Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm

ARTHRITIS & RHEUMATISM, Issue 11 2006
Claudia M. Witt
Objective To investigate the effectiveness of acupuncture in addition to routine care, compared with routine care alone, in the treatment of patients with chronic pain due to osteoarthritis (OA) of the knee or hip. Methods In a randomized, controlled trial, patients with chronic pain due to OA of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization underwent acupuncture treatment. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months. Results Of 3,633 patients (mean ± SD age 61.8 ± 10.8 years; 61% female), 357 were randomized to the acupuncture group and 355 to the control group, and 2,921 were included in the nonrandomized acupuncture group. At 3 months, the WOMAC had improved by a mean ± SEM of 17.6 ± 1.0 in the acupuncture group and 0.9 ± 1.0 in the control group (3-month scores 30.5 ± 1.0 and 47.3 ± 1.0, respectively [difference in improvement 16.7 ± 1.4; P < 0.001]). Similarly, quality of life improvements were more pronounced in the acupuncture group versus the control group (P < 0.001). Treatment success was maintained through 6 months. The changes in outcome in nonrandomized patients were comparable with those in randomized patients who received acupuncture. Conclusion These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA,associated pain of the knee or hip. [source]