Quality of life in elderly subjects with pain in the hip or knee

This study examines the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic pain in the hip or knee and of a reference group without pain (total n=306). Firstly, it was hypothesized that the experienced QOL is lower in people with more chronic pain. Secondly, the potential mediating and moderating roles of disability and of coping with problems in general on the relationship between pain chronicity and QOL were assessed. A Visual Analogue Scale was used to assess global QOL. Physical as well as psychosocial disability was assessed with the Sickness Impact Profile (SIP). Coping with problems in general was assessed with the Utrecht Coping List. As expected, a significantly lower QOL was found in people with more chronic pain (p=0.045). The difference in QOL between the group with chronic pain and a reference group without pain was 10%. A multivariate regression model showed that physical and especially psychosocial disability are mediators in the relationship between pain chronicity and QOL and that seeking social support as a coping style is a more important predictor of the experienced QOL than either pain chronicity or physical disability. No moderating role of the style of coping with problems was found.     

Further definition of the role of COX-2 inhibitors and NSAIDs in patients with nociceptive pain

New information has been reported regarding the effects of cyclo-oxygenase(COX)-2 inhibitors on renal function and cardiac arrhythmia, indicating that the incidence of peripheral oedema, hypertension and renal failure is different for the different selective COX-2 inhibitors. The estimated renal risk due to valdecoxib/parecoxib, etoricoxib and lumiracoxib is essentially unchanged, the risk due to rofecoxib is increased, while the risk due to celecoxib in low dosage is decreased. New data have also been reported on the cardiovascular risk due to cyclo-oxygenase inhibition, indicating that the relative risk due to naproxen, piroxicam, ibuprofen, celecoxib and meloxicam is essentially unchanged while the risk due to indomethacin, diclofenac and rofecoxib is increased. Recent studies show that the cardiovascular risk of etoricoxib is comparable to that ofdiclofenac. For daily practice, the following actions should be taken: (a) determine whether a prostaglandin synthetase inhibitor is needed; (b) consider the gastrointestinal as well as the cardiovascular risk profile ofthe patient; (c) if the gastrointestinal risk is above normal, a selective COX-2 inhibitor or a classical NSAID with a proton-pump inhibitor may be used; (d) in patients with renal disease, heart failure or hypertension without arteriosclerosis, the choice is between a classical NSAID, notably naproxen and ibuprofen, and low-dose celecoxib (200 mg per day); (e) in patients with arteriosclerosis in whom secondary cardiovascular prophylaxis with low-dose aspirin is indicated, celecoxib has no added value.     

Meloxicam and selective COX-2 inhibitors in the management of pain in the palliative care population

This paper discusses the treatment of pain in the palliative care patient, specifically the use of meloxicam and recent advances in agents with cyclooxygenase-2 (COX-2) selectivity. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that preferentially inhibits COX-2 more than cyclooxygenase-1 (COX-1), especially at low doses, thereby offering advantages over traditional nonselective NSAIDs. New COX-2 selective agents are discussed, including valdecoxib, parecoxib, etoricoxib, and COX-189.     

Cyclooxygenase-1/2 (COX-1/COX-2) and 5-lipoxygenase (5-LOX) inhibitors of the 6,7-diaryl-2,3-1H-dihydropyrrolizine type

A series of 6,7-diaryl-2,3-1H-dihydropyrrolizines was prepared as COX-1/COX-2 and 5-LOX inhibitors. The inhibition of COX-1 was evaluated using intact bovine platelets as the enzyme source, whereas LPS-stimulated human monocytes served as the enzyme source for inducible COX-2. The determination of arachidonic metabolites was performed by HPLC for COX-1 and RIA for COX-2. The balance between COX-1/COX-2 and 5-LOX inhibition can be shifted by modifying the substitution pattern of the phenyl moiety at the 6- and 7-position of the pyrrolizine nucleus. Structure-activity relationships are discussed.     

Synthesis and biological evaluation of N-substituted-3,5-diphenyl-2-pyrazoline derivatives as cyclooxygenase (COX-2) inhibitors

Eighteen new 1-N-substituted-3,5-diphenyl-2-pyrazoline derivatives have been synthesized and cyclooxygenase (COX-1 and COX-2) inhibitory activities have been evaluated. The results of these biological assays showed that all of new derivatives are not endowed with improved anti-inflammatory activity against COX-1, but some of them showed a good activity against COX-2. To evaluate the binding mode of the most significative compounds (2d, 2f, 2g and 2k) docking studies were carried out. These studies confirmed biological data, in fact these compounds were able to fit into the active site of COX-2.     

Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus

A wide variety of bacterial species, many usually regarded as of low pathogenicity, were isolated from septic joints after operation for total hip or knee joint replacement in a multi-centre trial of ultraclean air in operating rooms. The prophylactic antibiotics generally used appeared to reduce considerably the rates of infection with most species but to be ineffective against 'gut' organisms. For about half the septic infections involving Staphylococcus aureus nasal swabs had been obtained from the patient and operating staff at the time of operation for insertion of the prosthesis. Strains of Staph, aureus isolated from these and from the infected joints were phage typed and tested for antibiotic sensitivity. A probable source among the carriers was found for seven out of the 14 infections and a possible source for another five. Very small numbers of Staph. aureus were needed to initiate infection.     

Synthesis of heteroaromatic analogues of (2-aryl-1-cyclopentenyl-1-alkylidene)-(arylmethyloxy)amine COX-2 inhibitors: effects on the inhibitory activity of the replacement of the cyclopentene central core with pyrazole,thiophene or isoxazole ring

Several heteroaromatic analogues of (2-aryl-1-cyclopentenyl-1-alkylidene)-(arylmethyloxy)amine COX-2 inhibitors, in which the cyclopentene moiety was replaced by pyrazole, thiophene or isoxazole ring, were synthesized, in order to verify the influence of the different nature of the central core on the COX inhibitory properties of these kinds of molecules. Among the compounds tested, only the 3-(p-methylsulfonylphenyl) substituted thiophene derivatives 17 and 22, showed a certain COX-2 inhibitory activity, accompanied by an appreciable COX-2 versus COX-1 selectivity. Only one of the 1-(p-methylsulfonylphenyl)pyrazole compounds (16) displayed a modest inhibitory activity towards both type of isoenzymes, while the pyrazole 1-(p-aminosulfonylphenyl) substituted 12 proved to be significantly active only towards COX-1. All the isoxazole derivatives were inactive on both COX isoforms.     

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors

Background

Sexually transmitted infection (STI) prevention programs can mitigate the health and economic burden of STIs. A tool to estimate the economic benefits of STI programs could prove useful to STI program personnel.

Methods

We developed formulas that can be applied to estimate the direct medical costs and indirect costs (lost productivity) averted by STI programs in the United States. Costs and probabilities for these formulas were based primarily on published studies.

Results

We present a series of formulas that can be used to estimate the economic benefits of STI prevention (in 2006 US dollars), using data routinely collected by STI programs. For example, the averted sequelae costs associated with treating women for chlamydia is given as (C_w)(0.16)(0.925)(0.70)($1,995), where C_w is the number of infected women treated for chlamydia, 0.16 is the absolute reduction in the probability of pelvic inflammatory disease (PID) as a result of treatment, 0.925 is an adjustment factor to prevent double-counting of PID averted in women with both chlamydia and gonorrhea, 0.70 is an adjustment factor to account for the possibility of re-infection, and $1,995 is the average cost per case of PID, based on published sources.

Conclusion

The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their program and can facilitate the assessment of the cost-effectiveness of their activities.     

Comparative validation of the WOMAC osteoarthritis and Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis

Purpose

To comparatively evaluate the reliability and validity of the Western Ontario and McMaster (WOMAC) and the Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis (OA).

Methods

The Greek versions of WOMAC LK 3.1 and Lequesne indices were administered to 97 outpatients with OA. Internal consistency reliability was assessed by Cronbach’s alpha and item–scale correlations. Test–retest reliability was examined with intraclass correlations. Patients were also asked to complete the Short Form 36 (SF-36) and a Visual Analog Scale capturing strength of pain, in order to assess construct validity. Additional demographic and clinical data were also recorded to evaluate further associations.

Results

Cronbach’s alpha values of the WOMAC ranged between 0.92 and 0.98 for hip and 0.89–0.97 for knee OA. The respective values for Lequesne were 0.63–0.74 and 0.74–0.80. Item–scale correlations confirmed the superiority of WOMAC with respect to internal consistency reliability. Intraclass correlations were 0.79–0.97 and 0.57–0.98 for hip and 0.86–0.97 and 0.82–0.97 for knee OA, for WOMAC and Lequesne, respectively. The two indices showed high correlations with comparable subscales of SF-36 and the Visual Analog Scale. Significant relationships were identified for age, body mass index, duration of disease, duration of stiffness and radiographic classification.

Conclusions

Our findings, in samples of knee and hip OA patients, indicate that the WOMAC index demonstrates better internal consistency reliability than the Lequesne counterpart, as well as equivalent test–retest reliability and construct validity.     

Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers

Objective

The prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples’ functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands.

Methods

Self-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p₅ of reference data were calculated.

Results

Compared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (n = 78) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands.

Conclusions

Functional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands.     

Can an intervention on clinical inertia have an impact on the perception of pain,functionality and quality of life in patients with hip and/or knee osteoarthritis? Results from a cluster randomised trial

ObjectivesEvaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis.DesignThis was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not.SettingPrimary Care Health centers representative of the entire Spanish territory.Participants329 general practitioners of primary healthcare centre.InterventionsThe intervention consists of a motivational session to propose a proactive care, based on current recommendations.MeasurementsVisual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart.ResultsA total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p < 0.001), WOMAC (p < 0.0001) and SF-12v2 (p < 0.001) questionnaires in Visit 2 compared to Visit 1.ConclusionsThe results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL.     

彻底清创持续灌注冲洗引流治疗化脓性膝关节炎

目的:探讨对关节腔彻底清创后持续灌注冲洗引流治疗化脓性膝关节炎的方法与疗效。方法:采用关节腔清创后实施持续灌洗引流的术后处理方法,结合抗生素使用以及术后康复训练治疗48例化脓性膝关节炎患者。结果:术后Noyes膝关节功能评分:优31例,良10例,差7例,优良率85%。所有患者均获随访,平均随访时间12.7个月,无1例复发。结论:采用关节腔清创、置管及术后持续灌注冲洗引流,结合全身抗生素使用及早期康复训练治疗化脓性膝关节炎,患者损伤小,病程短,术后恢复效果好,是一种较为理想的手术方法。     

从医保核减分析医疗行为监管

我国已建立覆盖12.8亿人口的医疗保险网,医保核减作为医疗保险机构对医疗机构医疗行为监管手段成为一项常规性工作。该文就某市城镇职工住院医保核减情况进行分析,探讨造成医保核减原因及其对医疗行为影响,并提出相关管理对策。