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Written by: NLH RSS Search results for 'Musculoskeletal Diseases'

Original Article: http://www.library.nhs.uk/rss/

The Scottish Medicines Consortium (SMC) has advised NHS Boards and Area Drug and Therapeutic Committees that glucosamine (as hydrochloride) (Alateris®) is not recommended for use within NHS Scotland for relief of symptoms in mild to moderate osteoarthritis of the knee.

The Committee states that no direct clinical trial evidence of the efficacy and safety of this specific product is available, and the manufacturer did not present a sufficiently robust economic analysis to gain acceptance by the SMC.

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Written by: NLH RSS Search results for 'Musculoskeletal Diseases'

Original Article: http://www.library.nhs.uk/rss/

The Scottish Medicines Consortium (SMC) has announced that in the absence of a submission from the holder of the marketing authorisation for teriparatide (Forsteo®) the drug is not recommended for use within NHS Scotland for the treatment of osteoporosis associated with sustained systemic glucocorticoid therapy in women and men at increased risk for fracture.

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Written by: NLH RSS Search results for 'Musculoskeletal Diseases'

Original Article: http://www.library.nhs.uk/rss/

Erratum: Clinical outcomes from a physiotherapist-led intra-articular hyaluronic acid injection clinicDue to an error, the email and correspondence addresses for Dolina Birchall were incorrectly published in Volume 6, Issue 3.Please find the corrected addresses below:Department of PhysiotherapyTrafford General HospitalMoorside RoadManchesterEnglandM41 5SLThis notice corrects the print version only.The Publisher apologises for this error. (Source: Musculoskeletal Care)

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Written by: Musculoskeletal Care

Original Article: http://www.medworm.com/rss/search.php?qu=Musculoskeletal+Care&t=Musculoskeletal+Care&s=Searc

Background: The FOOTSTEP self-management foot care programme is a clinical and cost-effective programme for basic foot care in the elderly. The aim of this study was to determine if patients with rheumatoid arthritis (RA) would be physically able to participate.Methods: A consecutive cohort of RA patients undergoing podiatry care underwent tests for sight, reach and grip strength to determine their physical ability to undertake self-managed foot care.Results: Thirty RA patients (10 male, 20 female), with a median age of 61 years (range 42 to 84) and disease duration of 10 years (range one to 40), were recruited. All patients passed the sight test, whereas the reach and grip tests were passed by 77% and 67% of patients, respectively. Only 57% of patients passed all the physical tests. Patients who failed the physical tests were older, and had longer disease duration and higher physical disability, pain and general health scores but these were not statistically different.Conclusions: Just over half the patients in this present cohort may be physically able to undertake some aspects of self-managed foot care, including nail clipping and filing, callus filing and daily hygiene and inspection. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

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Written by: Musculoskeletal Care

Original Article: http://www.medworm.com/rss/search.php?qu=Musculoskeletal+Care&t=Musculoskeletal+Care&s=Searc

Background: Communicating information about disease-modifying anti-rheumatic drugs (DMARDs) before patients start treatment is a key role for some rheumatology clinical nurse specialists. This is done in our unit to promote understanding of the risks and benefits of drug therapy and encourage timely and reliable use of DMARDs. Information is routinely provided individually but this can lead to delays in starting treatment because of limited nursing resources. In this randomized trial we tested the feasibility of giving patients, who were about to start on a DMARD, information about the drug in groups and compared this with information given individually.Methods: Adults with a clinical diagnosis of rheumatoid arthritis or psoriatic arthritis who were referred to the nursing team for counselling about starting on methotrexate, sulfasalazine or leflunomide were included. Patients who had previously taken a DMARD were not excluded and those consenting were randomized to receive drug information individually or in groups (of three to six patients). We provided all patients with written materials about the relevant drug and discussed the risks and benefits of drug use verbally. Patients allocated to group counselling received this intervention in a teaching room, with a slide presentation. The primary outcome was adherence with medication use, ascertained by pill counts, self-report diaries and prescription dispensation. Secondary outcomes included satisfaction with information about medicines (SIMS) by questionnaire; time taken to provide information; adherence to scheduled hospital appointments and blood monitoring schedules; and DMARD continuation rates at four and twelve months.Results: Of 127 eligible patients referred for counselling about DMARDs, 62 consented to take part: 32 were randomized to receive drug information individually and 30 to receiving it in groups. Patients allocated to the two different interventions were comparable for age and diagnoses at baseline but more patients allocated individual counselling had not taken a DMARD previously: 56% (18/32) versus 20% (6/30). More patients counselled in groups were adherent (27/30; 90%) compared with patients counselled individually (22/32; 69%; p = 0.06) by pill counts. However, on self-report diaries, similar proportions were adherent (group counselling 97% (29/30) versus individual 94% (30/32); p = 1.0). All but two prescriptions were dispensed. More patients allocated to individual counselling missed at least one blood monitoring visit (25% versus 17%; p = 0.54) and at least one scheduled clinic visit (19% versus 3%; p = 0.10). SIMS scores indicated high levels of patient satisfaction and were similar for both groups. The time taken to run group and individual counselling sessions were similar (median of 35 minutes versus 33 minutes, respectively). Nursing time per individual patient in those allocated group counselling was 11.6 minutes. Drug continuation rates were higher for those counselled in groups compared with those counselled individually: at four months, 73% versus 63 %; p = 0.42; at twelve months, 47% versus 38%; p = 0.61).Conclusions: Our pilot study demonstrated the feasibility of providing counselling on DMARDs to groups of patients with important time savings for specialist nurses and while maintaining high levels of patient satisfaction. There was a trend for better outcomes in terms of adherence and drug continuation rates for patients counselled in groups, indicating potential benefits from group interactions. However, these findings need to be investigated further in a larger, fully powered trial. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

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Written by: Musculoskeletal Care

Original Article: http://www.medworm.com/rss/search.php?qu=Musculoskeletal+Care&t=Musculoskeletal+Care&s=Searc

Objective: Consumers of healthcare can reveal important insights into the personal challenges they experience when negotiating their health needs. The National Rheumatoid Arthritis Society (NRAS) wanted to explore the experiences of those with rheumatoid arthritis (RA) in order to understand the impact on the individual and on healthcare resources and benchmark care against published standards and guidelines.Methods: A project was designed to explore the experiences of individuals with sero-positive RA who had been diagnosed for three years or less. Qualitative semi-structured interviews were used and combined with process mapping to explore the experiences of a purposeful sample of individuals with RA. The information generated was mapped and variances explored. Ethical approval was not required as the data were collected outside the National Health Service.Results: Twenty-two participants’ stories were mapped. Fifty per cent of participants sought a medical opinion within three weeks of symptom onset and the majority received a disease-modifying anti-rheumatic drug within six months from first presenting symptoms. Work-related issues were highlighted by 13 participants, and seven of these experienced job losses directly attributed to their diagnosis.Conclusions: This unique mapping approach used qualitative research and process mapping to compare patient experiences against recognized standards and guidelines. These twenty-two stories reveal important insights into the challenges experienced in negotiating these healthcare journeys and the impact upon the individual as a result of variances in standards of care received. The participants in this study were chiefly self-motivated, informed and articulate, and did not reflect the broad ethnic, social or cultural diversity in the UK. Limitations must also be considered in relation to perceptions and recall of participants over a three-year period, as these may have altered over time and illness experience. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

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Written by: Musculoskeletal Care

Original Article: http://www.medworm.com/rss/search.php?qu=Musculoskeletal+Care&t=Musculoskeletal+Care&s=Searc

According to a report by BioSpace, the FDA has broadened the US indication for once-yearly Reclast® (zoledronic acid) injection to include the prevention of new clinical fractures in patients who have recently had a low-trauma hip fracture.

This decision was based on safety and efficacy data from the HORIZON Recurrent Fracture Trial which was published in the New England Journal of Medicine in 2007 (537:1799-1809; see link above to view NeLM news item summary). Regulatory approval is currently being sought for Aclasta® in the EU for this broadened indication.

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Written by: NLH RSS Search results for 'Musculoskeletal Diseases'

Original Article: http://www.library.nhs.uk/rss/

Background: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.Aim: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.Method: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.Result: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).Conclusion: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients’ needs should constitute the basis for the nurse’s role in the provision of care. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

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Written by: Musculoskeletal Care

Original Article: http://www.medworm.com/rss/search.php?qu=Musculoskeletal+Care&t=Musculoskeletal+Care&s=Searc

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Written by: NLH RSS Search results for 'Musculoskeletal Diseases'

Original Article: http://www.library.nhs.uk/rss/