Will the GP commissioner role make a difference? Exploratory findings from a pilot project offering complementary therapy to people with musculo-skeletal problems

The paper focuses on the interprofessional relationships which developed between general practitioners (GPs) and complementary practitioners (CPs) during a pilot project where GPs referred to acupuncturists, osteopaths and chiropractors. It is based on interviews with GPs and CPs, that took place at the beginning and end of an evaluative study on patients referred with musculoskelal conditions. Referrals to hospital orthopaedic outpatients departments and pain clinics were also examined. The most common relationship that developed was where the GP delegated responsibility for treatment to the CP. One CP and GP developed a more interactive relationship which included a shared diagnostic role. The NHS reforms offer opportunities for different types of working relationships to develop between health professionals. They also offer opportunities for professionals who have not traditionally worked in the NHS to do so. The findings discussed here are exploratory. Further research to identify the types of relationships developing between CPs and GPs and to establish whether the type of relationship has an impact on secondary referrals and treatment outcomes is recommended.     

Preferred sleep position and gross motor achievement in early infancy

The aim of this study was to assess the effect of an infant’s favoured position on their motor development at the age of six months. Seventy-five full-term infants were prospectively observed at home for their preferred sleep, awake, play and uninterrupted positions. A parental log was completed daily and then weekly up to the age of six months, when the Alberta Infant Motor Scale (AIMS) was administered. No significant relationship between the preferred or sleep positions as well as the awake and mutual play positions and gross motor developmental attainment at six months of age was noted. A significant change in the preferred recumbent posture with increased prone positioning both during sleep and awake time over the first six months was noted. A balanced positioning policy while awake, regardless of the infant’s preference while recumbent, is not associated with gross motor delay.     

Three paediatric patients with oral self-mutilation--a report

Oral self-mutilation, although thought to be uncommon, is quite widespread. Practitioners should carefully consider self-mutilation as part of their differential diagnosis in unexplainable oral conditions. We report three paediatric cases of oral self-mutilation. Clinical Relevance: Deliberate self-mutilation, although practised in certain parts of the world, is relatively rare in western cultures. Although uncommon, Altom and DiAngelis believe oral self-mutilation is probably more widespread than is recognized. Self-mutilation of the oral soft and hard tissues can include gingival, mucosal and periodontal damage, glossectomy, auto extraction and the insertion of foreign bodies.     

Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review

Purpose

The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review.

Methods

Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery.

Results

Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent.

Conclusion

Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

     

**-Postprandial pancreatic [<Superscript>11</Superscript>C]methionine uptake after pancreaticoduodenectomy mirrors basal beta cell function and insulin release

Purpose

[S-methyl-¹¹C]-L-methionine ([¹¹C]MET) uptake in the pancreas might be a central indicator of beta cell function. Since gastric emptying was recently shown to influence glycemic control in subjects after pancreaticoduodenectomy (PD, the surgical treatment of neoplasms of the pancreas head), we looked for imaginable relationships between gastric emptying, pre- and postprandial insulin concentrations, and [¹¹C]MET uptake.

Methods

Nineteen tumor-free survivors after PD (age mean?±?SD: 61?±?8.7 yrs.; 10 male, 9 female) and 10 healthy controls (age: 27?±?8.7 yrs.; 7 male, 3 female) were given a mixed test meal. One gram of paracetamol was ingested with the meal to evaluate the speed of gastric emptying. Insulin, glucose, and paracetamol plasma concentrations were measured before and over 180 minutes after ingestion. Beta cell function was calculated from fasting glucose and insulin plasma concentrations. Simultaneously, 800 MBq of [¹¹C]MET were administered and the activity (maximum tissue standardized uptake values [SUVmax]) over the pancreas was measured at 15, 30, and 60 minutes after injection. Total integrated SUVmax (area under the curve [AUC]) and incremental SUVmax were calculated.

Results

The uptake of [¹¹C]MET in the pancreas was significantly higher (p?<?0.0001) in controls compared to the PD group. Gastric emptying was significantly slower in controls compared to pancreatectomy subjects (p?<?0.0001). Paracetamol AUC₃₀ correlated with the SUVmax increment between 15 and 30 minutes (R²?=?0.27, p?< 0.0001) in patients after PD. Multivariate regression analysis revealed insulin AUC₆₀ and beta cell function, calculated from the fasting insulin to glucose ratio, as independent predictors of ¹¹C-methionine uptake, i.e. total integrated SUVmax, in patients after PD (R²?=?0.78, p?< 0.0001).

Conclusion

Postprandial [¹¹C]MET uptake may represent basal and postprandial beta cell function. The findings suggest a possible usefulness of this imaging procedure for further studying beta cell function.

     

Lasertherapy efficacy in temporomandibular disorders: control study

Temporomandibular dysfunction is characterized by the presence of painful joint/muscular symptoms muscle in the face. The main justification for the use of lasers in laser therapy dysfunction is its analgesic effect, which was observed in most studies in the literature.Aim: We evaluated the effectiveness of laser therapy in the treatment of temporomandibular disorders.Methods: 50 volunteers with temporomandibular disorders were divided into two groups (control and experimental) had amplitudes of movements of mouth opening, right and left laterality recorded before and after laser application. Was also recorded, the score the individual gave to pain by visual analog scale and, through physical examination, the pain points. We used the AsGaAl laser with a 40mW power, with 80J/cm2 for 16 seconds at four selected points for just one session with reassessment after a week. Study design: Clinical.Results: It was noted that laser therapy increased the mean amplitude of mandibular movements (p = 0.0317) and decreased significantly (43.6%) the pain intensity measured by the visual analog scale.Conclusions: The laser decreases the painful symptoms of the patient after application through its analgesic and/or a placebo effect.