Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Annals of Internal Medicine, Ahead of Print.

People with type 2 diabetes who ate a low-carbohydrate, high-fat (LCHF) diet for 6 months had better glycemic control than those who ate a high-carbohydrate, low-fat (HCLF) diet, a recent trial reported, but the differences weren’t sustainable 3 months after the intervention.

Stroke, Volume 54, Issue 2, Page 407-414, February 1, 2023. Current projections are that the already overwhelming burden of strokes and atherosclerotic cardiovascular diseases in low- and middle-income countries (LMICs) will continue to rise over the coming decades as the prevalence of traditional vascular risk factors burgeon in these countries. Cardiovascular polypills containing combinations of antihypertensive(s), a statin, with or without aspirin or folic acid in the form of a single pill, represent a viable strategy for both primary and secondary prevention of atherosclerotic cardiovascular diseases in LMICs. Large multicenter trials in LMIC and high-income country (HIC) settings have now clearly demonstrated the beneficial effects of the cardiovascular polypill versus placebo (or usual care) in reducing primary stroke risk by 50%. For survivors of a recent myocardial infarction residing in HICs, the polypill reduced risk of major cardiovascular events by 25% due to improved treatment adherence. Data on the clinical efficacy of the polypill for secondary stroke prevention are scanty both in HICs and LMICs. Cost-effectiveness analyses data from LMICs suggest cost savings with the polypill for primary and secondary prevention of stroke and atherosclerotic cardiovascular diseases. However, major contextual barriers in LMICs need to be surmounted through mixed methods research and hybrid clinical trials to assess its real-world effectiveness, before the adoption of the polypill for primary and secondary atherosclerotic cardiovascular disease prevention in routine clinical practice.

Storhaug IG, Lane C, Moore N, et al. Making the most of existing research: an evidence gap map of the effects of food systems interventions in low-income and middleincome countries. BMJ Open 2022;12:e055062. doi:10.1136/bmjopen-2021-055062
This article has been corrected since it was published online. Two authors (Amber Franich and Heike Rolker) have been added to the paper.

Introduction
Knee and hip osteoarthritis are two highly prevalent musculoskeletal pain conditions. Unsuccessful rates after hip/knee replacement range from 10% to 20%. Subjects with sensitisation manifestations are vulnerable to worse clinical outcomes. Most studies have analysed outcomes up to 1 year after surgery. The aim of this 2-year longitudinal study will be to evaluate sensory-related, psychological and psychophysical pain sensitisation manifestations and a potential epigenetic biomarker as prognostic clinical outcomes for the development of chronic postoperative pain after knee or hip replacement.

Methods and analysis
A prospective longitudinal study with a 2-year follow-up period will be conducted. The prognostic variables will include pain, function, related-disability, anxiety, depression, quality of life, sensitisation-associated symptoms, kinesiophobia, neuropathic pain and catastrophising, and expectative of the intervention will be assessed before surgery. We will also evaluate the presence of the Val158Met polymorphism as a possible epigenetic marker. Clinical outcomes including pain, related-disability and self-perceived satisfaction, sensitisation-associated symptoms and neuropathic pain will be assessed 3, 6, 12, 18 and 24 months after surgery. These variables will be used to construct three prediction models: (1) pain and function, (2) sensitisation-associated symptomatology and (3) neuropathic pain features classifying those patients in responders and non-responders. Data from knee or hip osteoarthritis will be analysed separately. Statistical analyses will be conducted with logistic regressions.

Ethics and dissemination
The study has been approved by the Ethics Committee of both institutions involved (Hospital Universitario Fundación Alcorcón (HUFA) 19–141 and Universidad Rey Juan Carlos (URJC) 0312201917319). Participants will sign the written informed consent before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Introduction
Around 30%–50% of adults suffer moderate to severe chronic pain not caused by cancer. Significant numbers are treated with opioids which over time may cease to be effective and produce side effects (eg, nausea, drowsiness and constipation). Stopping taking opioids abruptly can cause unpleasant withdrawal effects. Tapering in small steps is recommended, though some patients might struggle and need support, particularly if they have limited access to pain management alternatives. Awareness of the potential risks as well as benefits of tapering should be explored with patients.

Methods and analysis
A randomised controlled pilot feasibility study to investigate the effectiveness and feasibility of reducing high doses of opioids through a tapering protocol, education and support in primary care. Working with NHS Knowsley Place, we will identify patients taking 50 mg or above morphine equivalent dose of opioids per day to be randomly allocated to either the tapering group or tapering with support group. At an initial joint appointment with a pain consultant and General Practitioner (GP) GP tapering will be discussed and negotiated. Both groups will have their opioid reduced by 10% per week. The taper with support group will have access to additional support, including motivational counselling, realistic goal setting and a toolkit of resources to promote self-management. Some patients will successfully reduce their dose each week. For others, this may be more difficult, and the tapering reduction will be adjusted to 10% per fortnight. We assess opioid use, pain and quality of life in both groups at the start and end of the study to determine which intervention works best to support people with chronic pain who wish to stop taking opioids.

Ethics and dissemination
The Behavioural Intervention for Opioid Reduction feasibility study has been granted full approval by Liverpool Central Research Ethics Committee on 7 April 2022 (22/NW/0047). The current protocol version is V.1.1, date 6 July 2022. Results will be published in peer-reviewed journals and disseminated to patient stakeholders in a lay summary report available on the project website and in participating GP surgeries.

Trial registration number
ISRCTN 30201337.

New England Journal of Medicine, Volume 388, Issue 3, Page 203-213, January 2023.

L’Assimefac annuncia la pubblicazione della guida per i medici di medicina generale in merito alla terapia domiciliare del paziente Sars-Cov-2.

Introduction
Hospital-acquired thrombosis (HAT) is defined as any venous thromboembolism (VTE)-related event during a hospital admission or occurring up to 90 days post discharge, and is associated with significant morbidity, mortality and healthcare-associated costs. Although surgery is an established risk factor for VTE, operations with a short hospital stay (

Annals of Internal Medicine, Volume 176, Issue 1, January 2023.

Annals of Internal Medicine, Volume 176, Issue 1, January 2023.

Annals of Internal Medicine, Volume 176, Issue 1, January 2023.

To the Editor We have several comments about the recent study that found that intensity-modulated radiation therapy (IMRT) alone was not inferior for 3-year failure-free survival compared with concurrent chemoradiotherapy in patients with low-risk nasopharyngeal carcinoma (NPC).

To the Editor A recent study assessed the noninferiority of IMRT alone vs concurrent chemoradiotherapy for treating low-risk NPC. The noninferiority claim was based on a 3-year failure-free survival rate with a noninferiority margin of 10% for the absolute failure-free survival rate difference.

In Reply We agree with Ms Hu and Dr Kao that the current NCCN guidelines recommend definitive radiotherapy with or without concurrent chemotherapy for NPC with stage II and T3N0 disease, and in this subset, induction or adjuvant chemotherapy only for patients with high-risk features including bulky tumor volume or high serum EBV DNA copy number. Our study excluded patients who had NPC with high-risk features, so all patients with low-risk NPC were not treated with induction or adjuvant chemotherapy. Although triweekly delivery of cisplatin has been the standard regimen for concurrent chemotherapy, a phase 2 clinical trial comparing weekly and triweekly cisplatin during radiotherapy reported that the therapeutic effect and acute reactions of triweekly regimen were similar to that of the weekly regimen. However, other studies have reported significantly greater hematological toxicity but lower gastrointestinal reactions with a weekly cisplatin regimen.