The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.

The Pharmacological Basis of Therapeutics

https://research.vu.nl/ws/files/118982316/Hartvigsen2018_What_low_back_pain_is_and_why_we_need_to_pay_attention.pdf

What low back pain is and why we need to pay attention

Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

Reliability and validity

Background The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115-1119. Objectives To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD. Search strategy The 14 randomized controlled trials (RCTs) included in the original meta-analysis were included. Additional RCTs were identified from the Cochrane Airways Group's registry of COPD RCTs using the strategy: [exp, lung diseases, obstructive] and [exp, rehabilitation or exp, exercise therapy] and [research design or longitudinal studies or evaluation study or randomized controlled trial]. Abstracts presented at American Thoracic Society 1980-2000, American College of Chest Physicians 1980-2000 and European Respiratory Society 1987-2000 were also searched. Selection criteria RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least 4 weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation. Data collection and analysis Weighted mean differences (WMD) were calculated using a random-effects model. Missing data from the primary study reports were requested from the authors. Main results 23 RCTs met the inclusion criteria. Statistically significant improvements were found for all the outcomes. In three important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units using this instrument. For example Dyspnoea score: WMD 0.98 units, 95% Confidence Interval (95% CI) 0.74 - 1.22 units; n=9 trials. For FEC and MEC, the effect was small and a little below the threshold of clinical significance for the 6- minute walking distance: WMD 49 m, 95% CI: 26 - 72 m; n=10 trials. Reviewer's conclusions Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD.

Pulmonary rehabilitation for chronic obstructive pulmonary disease

Objective To evaluate new classifi cation criteria for peripheral spondyloarthritis (SpA) in patients with SpA with peripheral manifestations only. Methods In this Assessment of SpondyloArthritis international Society (ASAS) study, two prespecifi ed sets of criteria were compared against the European Spondylarthropathy Study Group (ESSG) and Amor criteria in newly referred consecutive patients with undiagnosed peripheral arthritis, and/or enthesitis, and/ or dactylitis that usually began before 45 years of age. The clinical diagnosis (SpA vs no SpA) made by the ASAS rheumatologist served as reference standard. Results In all, 24 ASAS centres included 266 patients, with a fi nal diagnosis of SpA being made in 66.2%. After adjustments a fi nal set of criteria showed the best balance between sensitivity (77.8%) and specifi city (82.9%): arthritis and/or enthesitis and/or dactylitis plus (A) one or more of the following parameters: psoriasis, infl ammatory bowel disease, preceding infection, human leucocyte antigen B27, uveitis, sacroiliitis on imaging, or (B) two or more other parameters: arthritis, enthesitis, dactylitis, infl ammatory back pain in the past, family history of SpA. The new criteria performed better than modifi ed versions of the ESSG (sensitivity 62.5%, specifi city 81.1%) and the Amor criteria (sensitivity 39.8%, specifi city 97.8%), particularly regarding sensitivity. In the entire ASAS population of 975 patients the combined use of ASAS criteria for axial SpA and ASAS criteria for peripheral SpA also had a better balance (sensitivity 79.5%, specifi city 83.3%) than the modifi ed ESSG (sensitivity 79.1%, specifi city 68.8%) and Amor criteria (sensitivity 67.5%, specifi city 86.7%), respectively. Conclusions The new ASAS classifi cation criteria for peripheral SpA performed well in patients presenting with peripheral arthritis, enthesitis and/or dactylitis.

https://ard.bmj.com/content/annrheumdis/70/1/25.full.pdf

The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general

Background Immobility and secondary complications, including cardiopulmonary disease, pressure ulcers, and pain, occur in patients with spinal cord injury (SCI). These patients also have difficulty coping with the strain of daily activities. Thus, it is important for SCI patients to engage in aerobic exercise in order to be able to cope adequately with the strain of activities and SCI-related complications. Aim The aim of this study was to investigate the effects of arm aerobic exercise on the parameters of cardiopulmonary function, quality of life, degree of disability, psychological state, and metabolic syndrome. Design This study was a single blind, randomized, controlled trial. Setting This study was conducted in a university hospital. Population SCI patients were randomly assigned to an intervention group (N.=17) or a control group (N.=16). Arm ergometer exercises (three days/week; 1.5 hours/week 50-70% pVO2) and general exercises (two sessions/day; 5 days/week), were assigned to the intervention group for 12 weeks. The control group was assigned general exercises only during this trial. Methods Before the rehabilitation (Week 0), after six weeks, and after the rehabilitation (Week 12), all patients were evaluated for functional status (maximal oxygen uptake [pVO2], power output [PO], and Functional Independence Measurement), pulmonary function (FEV1%, FVC%, FEV1/FVC%), quality of life (World Health Organization Measure of Quality of Life, short form, Turkish version), metabolic syndrome parameters (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood sugar, waist circumference, and systolic and diastolic blood pressure), degree of disability (Craig Handicap Assessment and Reporting Technique, short form), and psychological status (Center for Epidemiologic Studies Depression Scale and Hospital Anxiety and Depression Scale). Results At the end of the study, increases of 39.6% and 45.4% in the pVO2 and PO levels, respectively, were found. Additionally, no statistically significant difference was found in the intervention group after the rehabilitation compared to the levels before rehabilitation (P 0.05). The control group, on the other hand, showed no clinically significant differences in any of the parameters (P>0.05). Conclusions Short-term arm aerobic exercise performed by patients with SCI improves their exercise capacities. These patients require longer rehabilitation programs to receive more benefits from aerobic exercise training. Clinical rehabilitation impact Adding arm cranking exercise training to the rehabilitation program of patients with spinal cord injury demonstrated improved exercise capacity; however, further studies are needed to assess the effects of exercise training on other health issues.

The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study.

The aim of this study is to evaluate the internal consistency, test-retest reliability, construct validity, and sensitivity to change of the Activities-specific Balance Confidence Scale (ABC) in people with peripheral vestibular disorder. Thirty-three patients with unilateral peripheral vestibular disease were included in the study. Patients were also evaluated with the Visual Analog Scale, the Romberg test (eyes open, closed), the tandem Romberg test (eyes open, closed), standing on foam (eyes open, closed), static posturography, Five Times Sit to Stand test, Timed Up to Go test, gait speed, Dynamic Gait Index, Functional Gait Assessment, and Dizziness Handicap Inventory. To assess sensitivity to change, 27 patients were involved in a 4-week customized vestibular rehabilitation program and then reassessed at the end of 4 weeks. The individual item intraclass correlation coefficient ranged from 0.67 to 0.92 and Crohnbach alpha ranged from 0.67 to 0.93. The Crohnbach a value for whole scale was determined as 0.95. Although the Dizziness Handicap Inventory showed significant correlation with the Turkish ABC Scale (r= 0.51 - 0.54, P 0.05). Both Turkish ABC Scale and the other parameters assessed showed significant improvement after 4-week customized exercise program (P< 0.05). The Turkish ABC Scale is a culturally relevant, reliable, and sensitive to change tool for measuring self-perceived balance confidence in unilateral peripheral vestibular disease.

Reliability, validity, and sensitivity to change of Turkish Activities-specific Balance Confidence Scale in patients with unilateral peripheral vestibular disease.

Intrafusal effects of botulinum toxin injections for spasticity: revisiting a previous paper.

https://www.archives-pmr.org/article/S0003-9993(04)00666-5/pdf

Erdheim-Chester Disease: The Effect of Bisphosphonate Treatment—A Case Report

Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. Design : Serial clinical and electromyographic assessments were performed. Settings : Physical Medicine and Rehabilitation Department of a university hospital. Subjects : Thirty patients with acute complete idiopathic facial paralysis were included. Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa (κ) statistics were performed to measure the agreement between clinical and electromyographic assessments. Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicul...

Yesim Kirazli

Papers

The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study.

Reliability, validity, and sensitivity to change of Turkish Activities-specific Balance Confidence Scale in patients with unilateral peripheral vestibular disease.

Intrafusal effects of botulinum toxin injections for spasticity: revisiting a previous paper.

Erdheim-Chester Disease: The Effect of Bisphosphonate Treatment—A Case Report

Agreement between clinical and electromyographic assessments during the course of peripheric facial paralysis