Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: The UK Chiropractors,Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761]

Background  

Low back pain (LBP) is a common and costly problem. Initiatives designed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence-based clinical guidelines. The three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines. Even so, many seem unaware that such guidelines exist. Furthermore, the behaviour of at least some of these practitioners differs from that recommended in these guidelines.     

Preclinical toxicity and efficacy testing of RiVax, a recombinant protein vaccine against ricin

Ricin toxin is a plant-derived ribosome inactivating protein (RIP) of extraordinary toxicity. Vaccination using ricin toxoid or its A chain (RTA) is protective in animals but both vaccines have two potential toxicities, RIP and vascular leak syndrome (VLS). Previously we described three recombinant RTA constructs from which both toxicities were eliminated by site-specific mutations. One mutant, V76M/Y80A, RiVax, has now been further characterized for immunogenicity and toxicity in animals. We have found that RiVax is safe at doses of at least 8 mg in mice, 800-fold higher than the protective dose, and induces neutralizing antibodies in both mice and rabbits.     

Cushing's Syndrome — A Review of the Response to Treatment in 42 Patients

The course after treatment of 42 patients suffering from Cushing's syndrome is reviewed, the follow-up period being from twelve months to twelve years. In 30 instances the syndrome was due to bilateral adrenal hyperplasia, in five to adrenal carcinoma, in four to unilateral adenoma, and in three to non-endocrine carcinoma. Treatment was mainly by adrenal resection—total in the hyperplasia group, unilateral for the adenoma patients. During the follow-up period 16 patients (38%) have died. These include all eight with carcinoma and eight of the 30 suffering from adrenal hyperplasia. Whilst most of the 26 survivors can be regarded subjectively as being in good health, only ten patients have no clinical abnormality. Hypertension has persisted in nine patients and diabetes in two. Eleven patients have presumed pituitary dysfunction: six of these have pituitary tumours, while a further five have pigmentation only at present. Growth has been interrupted in the two children treated. The psychiatric changes, where present, improved slowly after treatment and three deaths in the hyperplasia group were due to suicide within six months of treatment.