Effects of specific medical nutrition on retinal fundus changes in diabetes

Diabetic retinopathy is a frequent complication of longstanding diabetes mellitus. While using a specialized medical nutrition therapy plus a blend of arginine, glutamine and β-hydroxy-β-metilbutyrate proven to be effective to normalize the body composition in diabetics and improve the rate of healing of the foot ulcers (DFU), we observed a marked improvement in some markers of retinopathy progression.     

Tolerance of low‐frequency ultrasound sonophoresis: a double‐blind randomized study on humans

Background: Sonophoresis [low‐frequency ultrasound (US)] has been used in animals and in vitro to investigate enhanced percutaneous absorption of drugs. No study focused on its clinical human tolerance has been published as yet. Methods: We aimed to assess the bioeffects of low‐frequency US in vivo on human skin in a double‐blind randomized‐controlled study. We applied pulse‐mode US at 36 kHz for 5 min in a step procedure of increasing dosage, from 1.57 to 3.50 W/cm², and placebo. The primary outcome was toxic effects of the procedure, defined as a pain score >40 on a 0–100 mm visual analogue scale or necrosis. Erythema (scored from 0 to 3 in severity) was also evaluated. The secondary outcomes were measurements of skin thickness by high‐resolution skin imaging, of skin capacitance and temperature. Results: We included 34 healthy volunteers. We found no pain score >38 and no skin necrosis with either US or placebo. Erythema was systematically observed immediately after US application, but after 1 day, we observed three cases in the knee group. The most frequent adverse effect was tinnitus. We observed no marked increase in temperature or cutaneous thickness after US or placebo. Cutaneous capacitance increased immediately after both applications. Conclusion: Such data demonstrating good tolerance of sonophoresis can be useful before the initiation of a clinical trial of the therapeutic use of low‐frequency sonophoresis in humans.     

Measuring disability: An agreement study between two disability measures

BackgroundThe Washington Group Short Set (WGSS) is increasingly being included in surveys worldwide to improve the quality and comparability of disability data within and between nations. However, compared to commonly employed binary impairment measures, the WGSS appears to have a relatively high threshold for disability indication. Empirical evidence is required to quantify this potential difference and its impact.ObjectiveTo determine the agreement between a binary disability question (BDQ) and the WGSS measure administered concurrently in a large representative survey of adults. Two WGSS indication scenarios were considered: one using the recommended threshold to indicate disability (WGSS1); and another using a lower threshold (WGSS2).MethodsA cross-sectional agreement study nested within the 2018 Canterbury Wellbeing Survey of randomly selected adults aged ≥18 years resident in the greater Christchurch region.ResultsFrom 2807 valid observations, 493 (17.6%), 259 (9.1%), and 822 (28.7%) participants were identified as having a disability by the BDQ, WGSS1 and WGSS2 measures, respectively. While concordance was high between BDQ and WGSS1 measures (85.3%), agreement was only fair (κ = 0.37) and discordance was significantly asymmetrical (p < 0.001). Participants were more likely to be indicated as ‘disabled’ using the BDQ but not indicated using the WGSS1 than vice versa.ConclusionsDifferent WGSS thresholds produce widely varying disability estimates, and the recommended WGSS1 resulted in an importantly reduced disability prevalence compared to a binary impairment measure when administered concurrently. This has profound implications for inclusivity and policy for people living with disability.     

Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution

Targeted biologic therapies have revolutionised treatment of immune-mediated inflammatory diseases (IMIDs) due to their efficacy, speed of onset and tolerability. The discovery that clinically unrelated conditions, such as rheumatoid arthritis and Crohn's disease, share similar immune dysregulation has led to a shift in the management of IMIDs from one of organ-based symptom relief to mechanism-based treatment. The fact that anticytokine therapy has been effective in treating multiple orphan inflammatory conditions confirms the IMID paradigm. In this review we examine the biologic agents currently licensed for use in the US and Europe: infliximab, etanercept, adalimumab, rituximab, abatacept, anakinra, alefacept and efalizumab. We also discuss the rationale behind the management of IMIDs using rheumatoid arthritis, Crohn's disease, psoriasis and psoriatic arthritis as examples. For the medical profession, IMID represents a breakthrough in the way pathology is classified. In this burgeoning era of biologic therapy the prospect of complete disease remission is conceivable.     

Case-based interprofessional learning for undergraduate healthcare professionals in the clinical setting

Interprofessional learning (IPL) within the healthcare setting has well documented positive outcomes for patients, yet it is not widely offered at the undergraduate level, particularly in a clinical setting. We set up case-based teaching scenarios involving a real patient, aimed at small groups of four students representing two or more healthcare professions. The aim of the sessions was to give students a greater awareness of the roles of all the different healthcare professions involved in patient care in a hospital setting. Weekly sessions were offered on six wards covering different clinical specialties. Three hundred and twenty-nine undergraduate students from different healthcare professions (nursing, medicine, pharmacy, midwifery, physician associate, physiotherapy, occupational therapy, speech, and language therapy) each attended one IPL session during the current academic year. Students were given an evaluation sheet at the end of each session to be filled out anonymously. Forty per cent of the students reported experiencing interprofessional case-based learning for the first time. Over 90% of students agreed or strongly agreed with a list of statements promoting the advantages and benefits of case-based IPL for undergraduate students and many of them requested more sessions. Seventy per cent of all respondents stated they would alter their future professional behaviour as a result of this session. We propose to introduce the sessions into the undergraduate curriculum across all healthcare related professions.