mercredi 31 juillet 2013
mardi 30 juillet 2013
Souffrant de douleurs lombaires peut être évaluée avec précision Via la téléréadaptation
Également inclus dans : Réhabilitation / physiothérapie
L'article Date : 22 mai 2013 - 1:00 PDT courants nominaux pour :
Souffrant de douleurs lombaires peut être évaluée avec précision Via la téléréadaptation
Une nouvelle approche « téléréadaptation » permet des physiothérapeutes évaluer les patients atteints de douleurs lombaires (LBP) sur Internet, avec une bonne précision par rapport aux examens en personne, rapporte une étude dans le journal de la colonne vertébrale. La revue est publiée par Lippincott Williams & Wilkins, une partie de Wolters Kluwer Health.
Profitant de Skype et autres services largement utilisé peut faire téléréadaptation une alternative plus réaliste aux visites à la clinique en personne, selon la nouvelle recherche par Prof. Manuel Arroyo-Morales et ses collègues de l'Université de Grenade, Espagne. Ils croient leurs résultats « donne support préliminaire à la mise en œuvre des systèmes d'évaluation LBP sur le web à l'aide d'enregistrements vidéo qui peuvent être évaluées par différents thérapeutes. »
Évaluation des maux de dos peuvent être effectuées sur Internet ?
Les chercheurs ont conçu et évalué un système basé sur le web téléréadaptation permettant d'effectuer des évaluations cliniques courantes des personnes atteintes LBP. Le programme d'installation de téléréadaptation exploité à travers une connexion Internet bas entre deux ordinateurs personnels équipés de webcams.
Le système comprenait le populaire service de vidéoconférence Skype, permettant au patient et le thérapeute en réadaptation physique pourraient voir et parler entre eux en temps réel. Le thérapeute guidé le patient en effectuant des mouvements spécifiques et capture des clips vidéo pour analyse à l'aide du logiciel d'analyse de mouvement vidéo (Kinovea). Le thérapeute et le patient ont été également en mesure de remplir les questionnaires de maux de dos standard en utilisant le système basé sur le web.
Quinze patients avec LBP chronique ont subi deux évaluations dans un ordre aléatoire : une fois en face à face et une fois que le programme d'installation de la téléréadaptation. Exactitude a été évaluée en comparant les résultats de l'évaluation de la téléréadaptation avec ceux de l'évaluation en personne.
Les résultats ont montré la bonne concordance entre les deux évaluations, justifiant l'utilisation de téléréadaptation pour l'évaluation clinique de la LBP. Il y a bonne corrélation des mesures faites sur l'analyse de mouvement vidéo, tels que la mobilité de la colonne vertébrale et l'endurance des muscles dorsaux ; ainsi que des évaluations basées sur le questionnaire comme handicap, douleur et qualité de vie liée à la santé.
Skype et autres outils rendre téléréadaptation plus réalisable
Le programme d'installation de téléréadaptation a montré des résultats cohérents pour le thérapeute même à des moments différents (fiabilité intra-évaluateur) ainsi que pour l'évaluation par des thérapeutes indépendants (objectivité).
Il est de plus en plus intérêt dans les systèmes Internet pour l'évaluation des personnes atteintes de troubles musculo-squelettiques. Téléréadaptation approches pourraient être particulièrement utiles pour les patients dans les régions rurales ou éloignées, qui n'ont pas un accès facile aux fournisseurs de soins de santé.
Dans le passé, l'utilisation de téléréadaptation a été limitée par les coûts d'équipement élevés. La nouvelle étude montre l'utilisation réussie de téléréadaptation utilisant la technologie largement disponible et familier, y compris l'utilisation des logiciels libres tels que Skype.
Le système de téléréadaptation évalué dans la nouvelle étude peut être utile pour évaluer les patients avec le problème très commun de LBP, montrant la bonne concordance avec les résultats de l'évaluation en face à face. Cependant, il sont a encore certains facteurs limitant l'utilisation plus répandue - y compris la nécessité pour les logiciels de sécurité « potentiellement lourd » protéger les renseignements personnels des patients.
Prof. Arroyo-Morales et ses coauteurs également notent que beaucoup de patients qui aurait autrement été admissibles à l'étude n'étaient pas inclus en raison d'un manque de connaissance et d'expérience avec les ordinateurs. Les chercheurs appellent pour d'autres études dans les grands groupes de patients - en se concentrant sur ceux qui n'ont pas un accès facile aux évaluations en personne.
Article adapté par Medical News Today de communiqué de presse original. Cliquez sur « références » onglet ci-dessus pour la source.Visitez notre section de maux de dos pour les dernières nouvelles sur ce sujet. Veuillez utiliser un des formats suivants pour citer cet article dans votre essai, le papier ou le rapport :
MLA
29 Juin 2013.
Veuillez noter : si aucune information de l'auteur est indiquée, la source est citée à la place.
« Patients présentant une lombalgie peuvent être évaluées avec précision Via téléréadaptation »
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dimanche 28 juillet 2013
jeudi 25 juillet 2013
mercredi 24 juillet 2013
lundi 22 juillet 2013
A Back Brace That Can Measure How Long It Is Worn Benefits Children With Curvature Of The Spine
Main Category: Back Pain
Also Included In: Medical Devices / Diagnostics; Pediatrics / Children's Health; Compliance
Article Date: 01 Jun 2012 - 0:00 PDT Current ratings for:
A Back Brace That Can Measure How Long It Is Worn Benefits Children With Curvature Of The Spine
Scoliosis (curvature of the spine) affects three or four per thousand children and as many as seven out of ten older adults. While there is still controversy about the efficacy of back braces for children this is often considered a problem of compliance - if the children do not wear their braces the treatment does not work. New research published in BioMed Central's open access journal Scoliosis demonstrates that a brace that contains a tiny heat sensor and is able to monitor how long it is worn, and that kids are also happy to wear, means that overall compliance with doctors recommended prescription was over 90%.
In many cases of childhood scoliosis, treatment is not required because the condition corrects itself as the child grows. However for the remainder their scoliosis can be successfully treated using a back brace, or in severe cases surgery, which prevents the spine from curving further. While a brace is worn under their clothes and should not stop the child from joining in sports or any other activities nevertheless it can still be difficult to persuade a child that the brace must be worn for all the hours prescribed by their doctor.
Researchers from ISICO in Milan investigated the use of a Thermobrace which from measuring temperature changes in the brace is able to identify when it is being worn. The Thermobrace was used in conjunction with the unit's normal care. The families involved in the study were all aware that the brace was monitoring its use and results showed that the more a brace was prescribed the more it was worn. The doctors involved also discovered that use of Thermobrace led to an increased patient-physician relationship because it allowed open discussions about real data.
Dr Sabrina Donzelli, who led this research, explained, "It is difficult to compare this study to others because all the families involved knew that the child was using a Thermobrace. Consequently, although there was some overestimation their self reported times for wearing the brace were very similar to the actual time measured by the brace. However we were able to demonstrate that children can be persuaded to wear their back braces as long as they have enough help and support."
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our back pain section for the latest news on this subject. Maternal In defense of adolescents: They really do use braces for the hours prescribed, if good help is provided. Results from a prospective everyday clinic cohort using Thermobrace. 2011 SOSORT Award winner. Sabrina Donzelli, Fabio Zaina and Stefano Negrini Scoliosis (in press)
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18 Nov. 2012.
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'A Back Brace That Can Measure How Long It Is Worn Benefits Children With Curvature Of The Spine'
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samedi 20 juillet 2013
News From The Annals Of Family Medicine: March/April 2013
Parameter name: request
Main Category: Breast Cancer
Also Included In: Hypertension; Diabetes; Back Pain
Article Date: 19 Mar 2013 - 2:00 PDT
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News From The Annals Of Family Medicine: March/April 2013
False-Positive Mammography Results Cause Significant Long-Term Psychological Harm
False-positive results are a common unintended harmful effect of breast cancer screening mammography - the cumulative risk in Europe and the United States of false positives in 10 screening rounds ranges from 20 to 60 percent - and they have long-term psychosocial consequences. In a longitudinal cohort study of 1,310 women, 454 of whom had abnormal findings on screening mammography, researchers found even three years after being declared free of suspected cancer, women who had a false-positive result consistently reported greater negative psychosocial consequences compared with women with normal test findings. Specifically, they found six months after final diagnosis, women with false-positive findings reported changes in existential values and inner calmness as great as those reported by women with a true diagnosis of breast cancer (?=1.15; P=.0145 and ?=0.13; P=.4232, respectively). Three years after being declared free of cancer, women with false-positive results reported more negative psychosocial consequences compared with women who had normal findings in all 12 psychosocial outcomes (?>0 for 12 of 12 outcomes; P<.01 for 4 of 12 outcomes). The pattern of the 12 psychosocial outcomes was consistent at the time of screening and at one, six and 18 months after screening and final diagnosis: women with breast cancer experienced more negative psychosocial consequences than women with false-positive findings, and these women experienced more negative psychosocial consequences than women with normal findings. That women with false positives reported changes just as great in existential values and inner calmness as women with breast cancer in the first half-year after final diagnosis indicates the significant psychological harm caused by false-positive diagnoses. Long-Term Psychosocial Consequences of False-Positive Screening Mammography
By John Brodersen, PhD and Volkert Dirk Siersma, PhD
University of Copenhagen, Denmark
Researchers Propose Annual Blood Pressure Screening Instead of Checking at Every Visit
Checking blood pressure annually instead of at every outpatient office visit may improve the screening test's ability to correctly identify those without hypertension (specificity) without sacrificing its ability to identify those with hypertension (sensitivity). Comparing the usual screening practice of checking blood pressure at every visit with a second strategy that used only annual blood pressure measurements in a group of 440 adults over a five year study period, researchers found the reduced frequency of screening produced a significant decrease in the false-positive rate from 30 percent to 18 percent of nonhypertensive patients. They found no statistically significant difference in sensitivity between the two methods. In their analysis, the authors point out that when applied to the roughly 2,000 healthy adults cared for by a typical family physician, the annual screening strategy results in 232 fewer patients needing further workup over five years. They conclude that in addition to improving the false-positive rate, reducing the number of unnecessary blood pressure screenings in healthy adults provides other benefits, including increasing clinic efficiency, reducing clerical burdens, and allowing sufficient clinical staff time to more accurately measure blood pressures. Screening For Hypertension Annually Compared With Current Practice
By Gregory M. Garrison, MD, MS and Sara Oberhelman, MDMayo Clinic, Rochester, Minn.
Largest Study of Osteopathic Manual Treatment Shows Regimen Offers Short-Term Relief of Chronic Low Back Pain But Ultrasound Therapy Does Not
With low back pain responsible for more than 20 million office visits and $100 billion dollars in health care costs annually in the United States, researchers examine the efficacy of osteopathic manual treatment and ultrasound therapy in the largest such trial ever conducted. The randomized controlled trial involving 455 patients with chronic low back pain found OMT offered effective short-term pain relief; by contrast, ultrasound therapy was not effective in relieving patients' chronic low back pain. Randomizing patients to receive OMT (n=230), sham OMT (n=225), UST (n=233) or sham UST (n=222) for six treatment sessions over eight weeks, the researchers found 145 (63 percent) OMT patients vs. 103 (46 percent) sham OMT patients reported moderate improvement at week 12. Similarly, 114 (50 percent) OMT patients vs. 79 (35 percent) sham OMT patients reported substantial improvement. By contrast, moderate improvement was observed in 128 (55 percent) UST patients vs. 120 (54 percent) sham UST patients. Substantial improvement was observed in 103 (44 percent) UST patients vs. 90 (41 percent) sham UST patients. The OMT treatment effects met or exceeded the Cochrane Back Review Group criterion for a medium size effect for both moderate and substantial improvements in low back pain, making the findings clinically relevant. The authors add that the less frequent use of drugs for low back pain reported by OMT patients further corroborates the clinical relevance of the findings. They assert these results may begin to explain why one-third of ambulatory, chronic problem visits for low back pain in the United States are provided by osteopathic physicians and why they less frequently prescribe medications, such as nonsteroidal anti-inflammatory drugs, than allopathic physicians during such visits. Because the OMT regimen was found to be effective, safe, parsimonious and well accepted by patients, the authors call for a larger trial to assess the efficacy and cost-effectiveness of OMT at long-term endpoints. Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial
By John C. Licciardone, DO, MS, MBA, et al
The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, Texas
Researchers Find Small Benefit from Antibiotics for Patients with Respiratory Infections
Assessing the risks and benefits of antibiotic use in a large cohort of patients consulting their physicians for respiratory infections, researchers find a small reduction in subsequent hospitalization for pneumonia and no increase in severe adverse drug reactions for those prescribed antibiotics. Analyzing data on more than 1.5 million patient visits for nonspecific respiratory infections, researchers found antibiotics were prescribed in 65 percent of cases. The adjusted risk difference for treated versus untreated patients per 100,000 visits was 1.07 fewer adverse events and 8.16 fewer pneumonia hospitalizations within 15 days following the visit. The number needed to treat was 12,255 patients to prevent one hospitalization. The authors conclude this small benefit from antibiotics for a common ambulatory diagnosis creates a persistent tension; at the societal level, physicians are compelled to reduce antibiotic prescribing, thus minimizing future resistance, whereas at the encounter level, they are compelled to optimize the benefit-risk balance for that patient. Risks and Benefits Associated With Antibiotic Use for Acute Respiratory Infections: A Cohort Study
By Sharon B. Meropol, MD, PhD, et al
Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
Redesigned Diabetes Care Using a Care Management Team Improves Glycemic Control Among Rural African-American Patients
Redesigning diabetes care to incorporate interprofessional care management results in significantly improved glycemic control among rural, low-income African-American patients, a group traditionally found to have poorer clinical outcomes. Analyzing data on 727 diabetic patients at three rural primary care practices, researchers found patients in the intervention group who received point-of-care education, coaching and medication intensification from a care management team comprised of a nurse, pharmacist and dietician had significantly greater reduction in mean hemoglobin A1c levels than those receiving usual care at the 18-month (-0.5 percent vs. -0.2 percent) and 36-month follow-ups (-0.5 percent vs. -0.1 percent). Moreover, a significantly greater percentage of patients in the intervention practices achieved a hemoglobin A1c value near 7 percent at the final assessments (68 percent vs. 59 percent), and the proportion achieving a systolic blood pressure of less than 140 mm Hg was also substantially greater in the intervention group (69 percent vs. 57 percent). The authors conclude their findings suggest that a portion of chronic diabetes management can be accomplished with an interprofessional team operating as a patient-centered medical home, potentially making physicians and extenders more available for acute problems. Using an interprofessional team, they add, may help to address the primary care provider shortage in rural areas.
Improved Outcomes in Diabetes Care for Rural African Americans
By Paul Bray, MA, LMFT, et al
Vidant Health, Greenville, N.C.
Peer Health Coaches Improve Diabetes Control in Low-Income Patients Clinic-based peer health coaching improves the glycemic control of patients with poorly controlled diabetes seen in urban public health clinics. A randomized controlled trial involving almost 300 low-income patients with poorly controlled type 2 diabetes found patients who receive one-on-one coaching and self-management support from volunteer peer coaches (trained patient volunteers who themselves have diabetes) saw a greater reduction in HbA1c levels than those in the usual care arm at 6 months follow-up (1.07 percent reduction vs. 0.3 percent reduction - a 0.77 percent difference in favor of coaching). HbA1c levels decreased 1 percent or more in 50 percent of coached patients versus 32 percent of usual care patients, and levels at six months were less than 7.5 percent for 22 percent of coached versus 15 percent of usual care patients. The authors note that because peer coaches experience similar challenges of living with the same chronic condition as the patients they assist, they are uniquely poised to engage and motivate them in self-management. Peer coaches, they conclude, represent a potential resource to increase primary care capacity and remove some of the burdens of patient-self-management support from primary care clinicians and staff. Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial
By David H. Thom, MD, PhD, et al
University of California, San Francisco
Telenephrology Improves Care for Patients With Chronic Kidney Disease
A Web-based consultation system between family physicians and nephrologists has the potential to reduce the number of referrals and appears to improve treatment appropriateness among patients with chronic kidney disease. Analyzing 122 telenephrology consultations involving 116 patients, researchers found that in the absence of telenephrology, 43 patients (35 percent) would have been referred by their family physicians, whereas the nephrologist considered referral necessary in only 17 patients (14 percent) - an 84 percent reduction. The opposite was seen in 10 patients, who according to clinicians could be treated in primary care but for whom the nephrologist deemed referral necessary. The researchers note the time investment per consultation, most of which were performed during office hours, amounted to less than 10 minutes, and nephrologists' average response time was 1.6 days. The authors assert these findings support the introduction of telenephrology in primary care as a means of delivering higher quality, more convenient care at a lower cost. They conclude that on a broader scale, e-consultation has the potential to break down walls between primary and specialty care.
Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease
By Nynke Scherpbier-de Haan, MD, et al
Radboud University Nijmegen Medical Centre, The Netherlands
Numerous Barriers to Prescribing of IUDs and Implantable Contraception to Adolescents
Despite their safety and efficacy, only 3 percent of adolescents who use contraceptives have an IUD, and far fewer use implantable contraception. Through in-depth interviews with 28 New York City-based family physicians, pediatricians and obstetrician-gynecologists, researchers identify multiple factors affecting their likelihood of prescribing long-acting reversible contraception to adolescents, and they find numerous barriers, including financial concerns, the clinical environment, and physicians' knowledge, attitudes and beliefs. In short, the authors found physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the devices (opportunity). Notably, many physicians, in particular pediatricians, did not know that girls who have not previously given birth can be appropriate candidates for IUDs and consequently never counsel about this option. The authors found specific enablers to counseling included the availability of the device in the clinic, a "culture" within the clinic supportive of adolescent contraception provision, and the ability to insert IUDs or easy access to someone able to insert the device. Factors enabling motivation included a belief in the positive consequences of IUD use, which was particularly influenced by physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease. Asserting that a concrete step to addressing the persistent public health issue of adolescent pregnancy is optimizing access to reliable, forgettable forms of reversible contraception, the researchers call for future research to explore strategies to increase adolescents' LARC access in primary care.
New York City Physicians' Views of Providing Long-Acting Reversible Contraception to Adolescents
By Susan E. Rubin, MD, MPH, et al
Albert Einstein College of Medicine, Bronx, New York
To Speed Health Reform, Policy Leaders Must Fund the Primary Care Extension Program Authorized by the Affordable Care Act
Researchers explain how critical the Primary Care Extension Program, which was authorized but not funded by the 2010 Affordable Care Act, is to enhancing primary care effectiveness, to the integration of primary care and public health and to translating research into practice. They contend that much like the Cooperative Extension Program of the U.S. Department of Agriculture sped the modernization of farming a century ago, the PCEP could speed the transformation of primary care through local deployment of community-based Health Extension Agents. The authors call for $120 million in annual federal funding for the PCEP, with a target of $500 million for future appropriations. They conclude that the rapid pace of change in health care demands that a PCEP be viewed as an essential, not optional, ingredient for transformation of primary care and improvement of population health.
The Primary Care Extension Program: A Catalyst For Change
By Robert L. Phillips Jr., MD, MSPH, et al
The American Board of Family Medicine, Washington, D.C.
Enhanced Communication Skills Training Associated with Reduced Antibiotic Prescribing for Respiratory Tract Infections
Assessing the long-term effects of family physicians' use of C-reactive protein point-of-care testing, a widely used and acknowledged means of diagnosing and monitoring infections, and their training in enhanced communication skills, on office visit rates and antibiotic prescribing for patients with respiratory tract infections, researchers found mixed results. While neither intervention had an effect on the rate of office visits for respiratory tract infection episodes during the subsequent 3.5 years, patients managed by a physician trained in enhanced communication skills were less likely to be prescribed antibiotics for episodes of respiratory tract infection for which they consulted during the 3.5 year follow-up. Specifically, family physicians trained in communication skills treated 26 percent of all episodes of respiratory tract infection with antibiotics compared with 39 percent treated by family physicians without training in communication skills. The cluster-randomized controlled trial included 379 patients at 20 family practices in the Netherlands. The authors call for implementation of both interventions on a larger scale, noting that training physicians on the use of enhanced communication skills may have a wider longer-term effect on the treatment of respiratory tract infections beyond acute cough to include reduced antibiotic prescribing.
Enhanced Communication Skills and C-reactive Protein Point-of-Care Testing in the Management of Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Controlled Trial
By Jochen W. L. Cals, MD, PhD, et al
Maastricht University, The Netherlands
Improving the Peer-Review Process in Medical Publishing
Researchers propose streamlining the review process for rejected manuscripts by including the initial reviews when submitting the revised manuscript to another journal, reasoning this would expedite the decision process and decrease the burden on peer reviewers. In their analysis of the practices of 51 general medical journals surveyed online, researchers find that a quarter of journals at least occasionally receive previous peer-review reports from authors submitting manuscripts, and about one-half indicated an interest in the idea. Editors reported both pros and cons. They reasoned that including pervious reviews may reduce reviewers' workload, improve transparency, prevent duplication of efforts, and shorten the decision process; however, they expressed concerns about the introduction of bias and reluctance of authors to submit unfavorable reviews. They also expressed concerns that the practice of using previous peer reports could create lazy reviewers and editors and prohibit the manuscript from receiving an objective fresh start.
In an accompanying editorial, two associate editors of Annals of Family Medicine discuss the growing challenges of reviewers and journal editors whose essential behind-the-scenes work often goes unrecognized and unpaid, but who now serve larger and broader audiences. The choice of what to publish in medical research publishing, they assert, has higher stakes and is faster paced than ever and has economic and political effects that extend far beyond the laboratory and examination room. They acknowledge the importance of the fresh perspective reviewers bring to the marketplace of medical publishing, and they call on journals to find ways to reward them for their valuable contribution.
Should Authors Submit Previous Peer-Review Reports When Submitting Research Papers? Views of General Medical Journal Editors
By Jochen W. L. Cals, MD, PhD, et al
Maastricht University, The Netherlands
Publishing Medical Research: A Marketplace on the Commons
By John J. Frey III, MD, and William R. Phillips, MD, MPH
University of Wisconsin - Madison and University of Washington, Seattle
Visit our breast cancer section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:
MLA
6 May. 2013.
Please note: If no author information is provided, the source is cited instead.
'News From The Annals Of Family Medicine: March/April 2013'
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