The late stage of Parkinson's –results of a large multinational study on motor and non-motor complications

IntroductionThere is little information on the late stages of parkinsonism.MethodsWe conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less.ResultsAverage disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment.ConclusionThese data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients.     

一起就餐后引起胃部不适症状投诉的调查及分析

目的 对一起就餐后引起胃部不适症状的投诉进行调查及分析. 方法 亚硝酸盐依据GB5009.33-2010进行检测,菌落总数、沙门菌、金黄色葡萄球菌依据GB4789.2,4,10-2010进行检测,大肠菌群、志贺菌依据GB4789.3,5-2003进行检测. 亚硝酸盐依据GB2760-2011《食品添加剂使用标准》进行判定. 结果 患者呕吐物亚硝酸盐含量为7.90 mg/kg,筒子骨炖萝卜样品中亚硝酸盐含量为29.84 mg/kg.样品中未检出致病菌.结论少量亚硝酸盐引起的轻度食物中毒症状不明显,容易出现误诊,要进一步加强对亚硝酸盐使用的监管.     

Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics

Objective. The aim was to study symptoms managed as the main problem by the general practitioner (GP) and to describe the frequencies and characteristics of presented symptoms when no specific diagnosis could be made. Design. Cross- sectional study. Setting. General practices in the Central Denmark Region. Subjects. In total, 397 GPs included patients with face-to-face contacts during one randomly assigned day in 2008–2009; 7008 patients were included and 5232 presented with a health problem. Main outcome measures. GPs answered a questionnaire after each patient contact. Symptoms and specific diagnoses were subsequently classified using the International Classification of Primary Care (ICPC). Symptom frequency, comorbidity, consultation length, and GP-assessed final outcome and burden of consultations were analysed. Results. The GPs could not establish a specific diagnosis in 36% of patients with health problems. GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients. Musculoskeletal (lower limb and back) and respiratory (cough) symptoms were most frequent. More GPs had demanding consultations when no specific diagnosis could be made. Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made. Conclusion. Interpretation and management of symptoms is a key task in primary care. As symptoms are highly frequent in general practice, symptoms without a specific diagnosis constitute a challenge to GPs. Nevertheless, symptoms have been given little priority in research. More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.