PEER umbrella systematic review of systematic reviews: Management of osteoarthritis in primary care

ObjectiveTo determine how many patients with chronic osteoarthritis pain respond to various non-surgical treatments.Data sourcesPubMed and the Cochrane Library.Study selection Published systematic reviews of randomized controlled trials (RCTs) that included meta-analysis of responder outcomes for at least 1 of the following interventions were included: acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, cannabinoids, counseling, exercise, platelet-rich plasma, viscosupplementation, glucosamine, chondroitin, intra-articular corticosteroids, rubefacients, or opioids.Synthesis In total, 235 systematic reviews were included. Owing to limited reporting of responder meta-analyses, a post hoc decision was made to evaluate individual RCTs with responder analysis within the included systematic reviews. New meta-analyses were performed where possible. A total of 155 RCTs were included. Interventions that led to more patients attaining meaningful pain relief compared with control included exercise (risk ratio [RR] of 2.36; 95% CI 1.79 to 3.12), intra-articular corticosteroids (RR = 1.74; 95% CI 1.15 to 2.62), SNRIs (RR = 1.53; 95% CI 1.25 to 1.87), oral NSAIDs (RR = 1.44; 95% CI 1.36 to 1.52), glucosamine (RR = 1.33; 95% CI 1.02 to 1.74), topical NSAIDs (RR = 1.27; 95% CI 1.16 to 1.38), chondroitin (RR = 1.26; 95% CI 1.13 to 1.41), viscosupplementation (RR = 1.22; 95% CI 1.12 to 1.33), and opioids (RR = 1.16; 95% CI 1.02 to 1.32). Preplanned subgroup analysis demonstrated no effect with glucosamine, chondroitin, or viscosupplementation in studies that were only publicly funded. When trials longer than 4 weeks were analyzed, the benefits of opioids were not statistically significant.ConclusionInterventions that provide meaningful relief for chronic osteoarthritis pain might include exercise, intra-articular corticosteroids, SNRIs, oral and topical NSAIDs, glucosamine, chondroitin, viscosupplementation, and opioids. However, funding of studies and length of treatment are important considerations in interpreting these data.     

Targeting VPAC1 Receptors for Imaging Glioblastoma

Molecular Imaging and Biology - Scintigraphic imaging of malignant glioblastoma (MG) continues to be challenging. We hypothesized that VPAC1 cell surface receptors can be targeted for positron...     

Development of LactaPedia: A lactation glossary for science and medicine

During the last decade, there have been several publications highlighting the need for consistent terminology in breastfeeding research. Standard terms and definitions are essential for the comparison and interpretation of scientific studies that, in turn, support evidence‐based education, consistency of health care, and breastfeeding policy. Inconsistent advice is commonly reported by mothers to contribute to early weaning. A standard language is the fundamental starting point required for the provision of consistent advice. LactaPedia ( www.lactapedia.com ) is a comprehensive lactation glossary of over 500 terms and definitions created during the development of LactaMap ( www.lactamap.com ), an online lactation care support system. This paper describes the development of LactaPedia, a website that is accessible free of charge to anyone with access to the Internet. Multiple methodological frameworks were incorporated in LactaPedia's development in order to meet the needs of a glossary to support both consistent health care and scientific research. The resulting LactaPedia methodology is a six‐stage process that was developed inductively and includes framework to guide vetting and extension of its content using public feedback via discussion forums. The discussion forums support ongoing usability and refinement of the glossary. The development of LactaPedia provides a fundamental first step towards improving breastfeeding outcomes that are currently well below World Health Organisation recommendations globally.     

Sleep Questionnaire Versus Sleep Diary: Which Measure Is Better?

One questionnaire about a typical week's sleep is more convenient than asking individuals to complete daily sleep diaries. Yet, most clinical evaluations and much sleep and insomnia research rely upon self monitoring via daily sleep diaries. These are often problematic to administer and can be reactive. Therefore, we investigated comparability of two measurement modalities (self monitoring and questionnaire) in a sample of 156 community dwelling older adults, both good and poor sleepers. Results indicate significant and high correlations between corresponding scores on a retrospective sleep questionnaire and on 7 days of self monitoring on a daily sleep diary, thereby suggesting that the two measurement modalities are tapping the same domains. There were, however, significant differences between means on several variables, but there was no systematic pattern to the differences. These findings illustrate the need to tailor measurement modality—retrospective or ongoing—to the setting and the purpose of the evaluation.     

Barriers to the expression of sexuality in the older person: the role of the health professional

Sexuality is an important contributing factor to quality of life and sense of well-being. All adults have the right to express their sexuality, regardless of their age. Research indicates, however, that older people frequently experience barriers to the expression of their sexuality. Many of these barriers are influenced by the health professionals and services that care for them. This paper will outline these barriers and identify strategies that the healthcare professional can implement to help improve practice in this area.