General practitioners' satisfaction with and attitudes to out-of-hours services

Background  

In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.     

Intraarticular injection of anakinra in osteoarthritis of the knee: A multicenter,randomized, double‐blind,placebo‐controlled study

Objective

To evaluate the clinical response, safety, and tolerability of a single intraarticular injection of anakinra in patients with symptomatic osteoarthritis (OA) of the knee.

Methods

Patients with OA of the knee were enrolled in a multicenter, double‐blind, placebo‐controlled study and randomized 2:1:2 to receive a single intraarticular injection of placebo, anakinra 50 mg, or anakinra 150 mg in their symptomatic knee. Patients were evaluated for 12 weeks postinjection. The primary end point was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from baseline to week 4. Safety assessments included the evaluation of adverse events (AEs), laboratory tests, and vital signs. Pharmacokinetic parameters were assessed in a subset of patients.

Results

Of 170 patients who enrolled, 160 (94%) completed the study. The mean improvements from baseline to week 4 in the WOMAC score were not statistically different between the placebo group and the patients who received 50 mg of anakinra (P = 0.67) or 150 mg of anakinra (P = 0.77). Anakinra was well tolerated. No withdrawals due to AEs or serious AEs, and no serious infections or deaths were reported. No clinically significant trends were noted in laboratory values or vital signs. Pharmacokinetic parameters demonstrated that the mean terminal half‐life of anakinra in serum after intraarticular injection was ∼4 hours.

Conclusion

Anakinra was well tolerated as a single 50‐mg or 150‐mg intraarticular injection in patients with OA of the knee. However, anakinra was not associated with improvements in OA symptoms compared with placebo.

     

2010年欧洲神经病学联盟阿尔茨海默病诊疗指南

一、概述 (一)目的 2008年成立工作组的目的是修改前一版欧洲神经病学联盟(EFNS)的阿尔茨海默病(AD)诊疗指南.前一版指南采用了第4版诊断和统计手册(DSM Ⅳ)及美国国立神经病学、语言障碍和脑卒中研究所-阿尔茨海默病及相关疾病学会(NINCDS-ADRDA)对痴呆综合征和AD的诊断标准.     

CT模拟结肠镜在结肠病灶诊断中的应用

结肠癌是常见的消化道肿瘤,上海等地区的发病率有明显增高的趋势。在发达国家,结肠癌占肿瘤死亡率第二位,且与大肠腺瘤关系密切。如能早期发现有恶变先兆的息肉并切除之,可以预防结肠癌发生。目前,对结肠癌发病高危人群并未作大规模普查,部分由于患者缺乏早期主诉,或是由于现有普查手段不够有效。大便隐血试验只能发现３０％～４０％结肠肿瘤,乙状结肠镜不能进入近端结肠,并有１０％～１５％乙状结肠肿瘤漏诊。钡剂灌肠和结肠镜能检查全结肠,但有１０％～１５％患者行结肠镜检查失败,并且结肠镜可能使１０％～２０％病灶遗漏,尚…     

Intraarticular corticosteroids,supervised physiotherapy,or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo‐controlled trial

Objective

To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder.

Methods

Ninety‐three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score.

Results

At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P = 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures.

Conclusion

A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.

     

创伤患者输血与供者白细胞微嵌合的相关性

输血是挽救创伤患者生命而普遍使用的治疗方法,但其又存在着明显和潜在的危险性。当今,经血液传播传染病和输血反应很少发生,但仍然存在。尽管在临床治疗中试图控制创伤患者休克的发展及损伤的严重度,但其输血后细菌感染、多脏器功能衰竭、死亡的发生率仍较高。