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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been little basis on which to standardise a diagnosis of polymyalgia rheumatica (PMR), and so 11 rheumatology units in the south and west of Great Britain have collaborated in a study to evaluate possible criteria. Symptoms and laboratory findings claimed to be of diagnostic value in PMR were included in an analysis of the features of 236 patients considered to have unequivocal PMR and 70 patients thought to have possible PMR. The results were compared with similar information from 253 patients with conditions that mimic PMR and from 201 consecutive new presentations to outpatients. The 7 most valuable criteria for differentiation were bilateral shoulder pain or stiffness, onset of illness of less than 2 weeks' duration, initial ESR greater than 40 mm/h, duration of morning stiffness exceeding 1 hour, age 65 years or more, depression and/or weight loss, and bilateral tenderness in the upper arms. We suggest that a patient might be regarded as having probable PMR if any 3 or more of these criteria are fulfilled, or if at least 1 criterion coexists with a clinical or pathological abnormality of the temporal artery. A standardised therapeutic test with prednisolone has value in making the diagnosis of PMR more certain.
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PMID:An evaluation of criteria for polymyalgia rheumatica. 51 43

This self-directed learning module highlights new advances in the understanding of co-morbid conditions and medical complications of stroke. It is part of the chapter on stroke rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article covers co-morbid conditions of stroke patients, including cardiovascular disease, diabetes, and sleep apnea. It reviews recent information on complications of stroke, including deep venous thrombosis, dysphagia and aspiration, hospital-acquired infections, depression, falls, spasticity, shoulder pain, and seizures. Treatment advances in diabetes, depression, and spasticity are highlighted. Recent information is presented regarding exercise guidelines for the stroke patient with cardiovascular disease, the relationship between stroke and sleep apnea, prophylaxis of deep venous thrombosis, the changing spectrum of hospital-acquired infections, malnutrition in stroke patients, the problem of falls during rehabilitation, the evaluation and management of poststroke shoulder pain, and the risk of seizures after stroke.
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PMID:Stroke rehabilitation. 2. Co-morbidities and complications. 1032 98

Stroke is a common disease often requiring rehabilitation, which may be prolonged by shoulder pain. The true incidence of post stroke shoulder pain has not been fully evaluated. In order to establish this, we undertook a prospective study of 123 consecutive patients with a diagnosis of acute stroke during a 6-month period. Patients were assessed by interview, full rheumatological and neurological examination, 14 days post stroke, for a history of shoulder pain according to predetermined criteria. In addition, Barthel Index, HAD score and pain scores were also recorded. Twenty-five percent of patients developed shoulder pain within 2 weeks of their stroke. There was a statistically significant association with ipsilateral sensory impairment (p < 0.005), abnormal rheumatological examination (p < 0.001) and depression score (p < 0.005). We conclude that post stroke shoulder pain is more common than previously realized and in addition to abnormal shoulder joint examination may also be associated with upper limb sensory impairment. Thorough neurological examination is required to detect sensory loss and hence establish patients at risk. This is probably best done by a structured proforma.
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PMID:Post stroke shoulder pain: more common than previously realized. 1098 76

The National Clinical Guidelines for Stroke (1) cover the management of stroke from the acute illness through to transfer of care from hospital to the community, to longer-term problems including carer support and secondary prevention. They are designed to be read by all health and social service professionals, including those working in primary care. Since the guidelines were first published there have been some major developments in stroke research. These have now been incorporated into an updated supplement to the guidelines (2). The new updates include: The recommendation that specialist stroke services should include a neurovascular clinic to enable patients with transient ischaemic attack (TIA) and minor stroke, (where the patient has not been admitted to hospital), to be investigated and treated within a maximum of two weeks. Changes in the recommendations about the management of blood pressure after stroke following the publication of the HOPE and PROGRESS trials. Although advances in therapy research do not warrant radical alterations to practice, two changes have been made. These recommend the use of resisted exercise to improve motor function in targeted muscles and that patients should be given as much opportunity to practice tasks as possible. More precise recommendations on the management of depression. The withdrawal of some recommendations concerning the management of shoulder pain, deep venous thromboses and biofeedback. With the research evidence evolving at a rapid rate a new version of the complete guidelines will be published in 2003.
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PMID:National clinical guidelines for stroke: a concise update. 1210 73

Existing therapies for major depressive disorder (MDD) have either limited efficacy and/or poor tolerability. The present study examined the effects of duloxetine, a potent and balanced dual reuptake inhibitor of serotonin (5-HT) and norepinephrine (NE), in patients with MDD. Adult patients (N = 267) with MDD were randomly assigned to receive duloxetine (60 mg/day) or placebo in this 9-week, multi-center, double-blind, parallel-group clinical trial. Efficacy was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD(17)), Visual Analog Scales (VAS) for pain, Clinical Global Impression of Severity (CGI-S), Patient's Global Impression of Improvement (PGI-I), and Quality of Life in Depression Scale (QLDS). Safety was evaluated by assessing discontinuation rates, adverse event rates, vital signs, and laboratory tests. Duloxetine (60 mg QD) significantly reduced the HAMD(17) total score compared with placebo at the end of 9-week therapy. Estimated probabilities of response and remission were 65 and 43%, respectively, for duloxetine compared with 42 and 28% for placebo. Duloxetine also reduced overall pain, back pain, shoulder pain and time in pain while awake significantly more than placebo. Global measures of improvement, including PGI-I and QLDS, were significantly improved by duloxetine compared with placebo. Discontinuations due to adverse events were more frequent for duloxetine-treated patients (12.5%) than for placebo-treated patients (4.3%). Nausea, dry mouth, dizziness, and constipation were more frequent for duloxetine than placebo. There was no significant incidence of hypertension, nor any other safety issues. Duloxetine 60 mg administered once daily appears to be a safe and effective treatment for MDD.
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PMID:Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression. 1239 7

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.
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PMID:A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. 1584 Jun 17

This study has been conducted to describe the situation of long-term sick-listed persons employed in the public sector regarding the medical reasons of their sick leave, the duration of their problems, the duration of the actual sick leave, rehabilitation support, rehabilitation measures, and the persons expectations of the future. Response rate of a postal questionnaire, where 484 women and 51 men on long-term sick leave answered, was 69%. The study-group consisted of 90% women with a median age of 50 years. The most common reasons for sick listing were long-lasting musculoskeletal problems, especially neck/shoulder pain, low back pain and osteoarthritis or other joint problems and mental problems, especially depression and burn-out syndromes. Forty-seven procent of the men and 57% of the women had been on the sick list for more than a year. Only half of them had been subjected to the legally required rehabilitation investigation of the employer This half got access to rehabilitation programs and/or vocational rehabilitation to a greater extent than those who not had been subjected to rehabilitation investigation. Less than half had been in contact with the workplace-connected rehabilitation actors, the Occupational Health Service or the Trade Union. In spite of this the sick-listed persons had a positive view of their future return to work. For long-term sick-listed persons in the public sector, there is a great potential for improvements of the rehabilitation at the workplace arena, in the involvement and cooperation between the already existing rehabilitation actors, in order to promote return to work.
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PMID:Employer, insurance, and health system response to long-term sick leave in the public sector: policy implications. 1584 74

The aim of this study was to examine the longitudinal response for overall and individual symptoms during the treatment of major depressive disorder. Data were pooled from two 9-week trials, which compared duloxetine 60-mg QD (n=251) with placebo (n=261) in the treatment of MDD. Changes from baseline in the 17-item Hamilton Depression Rating Scale (HAMD17) and in the Visual Analog Scales for pain were analyzed. Compared to placebo-treated patients, duloxetine-treated patients experienced greater improvement (P<.05) in the HAMD17 total score at Week 2. The individual symptoms showing the most rapid improvements (Week 1) were depressed mood, guilt, suicidal ideation, work/activities, and psychic anxiety as well as VAS back pain and shoulder pain. At subsequent visits, significant improvements were observed in retardation (Week 2); hypochondriasis (Week 3); general somatic symptoms (Week 5); middle and late insomnia (Week 7); and gastrointestinal (GI) symptoms, genital symptoms (level of sexual interest or ease of sexual arousal), insight, and early insomnia (Week 9). Significant advantages for duloxetine were not achieved at any visit for agitation, somatic anxiety, or weight loss. At Weeks 1 and 2, placebo-treated patients had significantly lower GI symptoms and reported less weight loss compared with duloxetine-treated patients; however, differences were not significant at subsequent visits. Furthermore, duloxetine was superior to placebo on GI symptoms at endpoint compared to placebo-treated patients; duloxetine-treated patients had a significantly higher response rate at Week 2 and a higher remission rate at Week 5. These results may help clinicians establish more accurate expectations regarding treatment with duloxetine.
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PMID:Time course of depression-symptom improvement during treatment with duloxetine. 1603 56

The present study examined the relationship between common somatic symptoms and depression in samples of Japanese and American college students. Fifty Japanese and 44 American women completed the Beck Depression Inventory (BDI) and rated 56 somatic-distress items for 7 days. Japanese had higher levels of somatic distress than Americans. ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms (including stomach ache, dizziness, and shoulder pain) with significantly higher means when compared with the low BDI group. High BDI Americans had a significantly higher mean for joint pain compared to the Low BDI group. The importance of the body in transcultural psychiatry is explored, and implications for primary and mental health care are discussed.
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PMID:Somatic and depressive symptoms in female Japanese and American students: a preliminary investigation. 1689 76

Although the practice of neck dissection has greatly advanced from radical to function-preserving surgery, the impact of the sensory nerve-preserving neck surgery on the pain and quality of life (QOL) of patients has received little study. We evaluated neck morbidity and its impact on QOL associated with selective or modified radical neck dissection with or without preservation of cervical root branches. We conducted a retrospective cohort study comparing 24 patients who had their cervical root branches preserved to 29 patients whose root branches were removed during neck dissection. The spinal accessory nerve was preserved and sex, age, pathologic status, side and extent of neck dissection, and radiotherapy were comparable between groups. The groups were compared based on sensory and motor functions of the neck and shoulder and questionnaires on depression and QOL at follow-up of mean 18.7 (range 12-34) months after surgery. The nerve-preserved patients showed a low incidence and severity of neck and shoulder pain compared to the nerve-removed subjects (p<.05). Loss of sensation was more frequently experienced in the nerve-removed group on the earlobe and the lateral neck of the operated side (p<.05). Depression and QOL scores were higher in the nerve-removed group and significantly correlated with pain intensity. Preservation of the cervical root branches reduces postoperative pain as well as permanent anesthetic areas of the neck. This may also improve the mental state and QOL of patients undergoing neck dissection.
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PMID:Cervical sensory preservation during neck dissection. 1697 28


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