Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking.

Background and purpose - Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and-if necessary-weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008-2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008-2012) compared with after (2012-2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods - Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results - Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2-5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs -8.6% (CI -9.6 to -7.6), weak opioids -6.8% (CI -7.7 to -5.9), glucosamine -9.5% (CI -9.8 to -8.8). and hyaluronic acid -1.6% (CI -1.8 to -1.5) but discordantly increased for strong opioids 2.8% (CI 2.1-3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0-3.1). Interpretation - In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes nonpharmacological before pharmacological interventions. Additional modest improvements occurred in the steppedcare prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.

Quantifying climate feedbacks in polar regions.

The concept of feedback is key in assessing whether a perturbation to a system is amplified or damped by mechanisms internal to the system. In polar regions, climate dynamics are controlled by both radiative and non-radiative interactions between the atmosphere, ocean, sea ice, ice sheets and land surfaces. Precisely quantifying polar feedbacks is required for a process-oriented evaluation of climate models, a clear understanding of the processes responsible for polar climate changes, and a reduction in uncertainty associated with model projections. This quantification can be performed using a simple and consistent approach that is valid for a wide range of feedbacks, offering the opportunity for more systematic feedback analyses and a better understanding of polar climate changes.

Patient perceptions of specialised hospital-based palliative home care: a qualitative study using a phenomenographical approach.

BACKGROUND: Specialised palliative care is given around the clock to palliative patients who have severe symptoms or special needs. AIM: The aim of this study was to describe patients' perceptions of what it is like to be cared for by a specialised palliative care team within hospital-based palliative home care (HPHC). METHOD: A qualitative method with semi-structured interviews was used. Fourteen patients enrolled in HPHC at a unit for specialised palliative care linked to the hospital in the southeast of Sweden participated. The analysis was performed with a phenomenographical approach. RESULTS: Four description categories were identified: 'it is safe to receive care at home,' 'support and commitment', 'having access to a multiprofessional team', and 'how HPHC changes everyday life'. To be cared for by HPHC was perceived as safe, and the patients thought that having access to competent staff who supported them around the clock had improved their care and daily life. CONCLUSION: The need for specialised palliative care will likely grow with an ageing population and this form of care was perceived as functioning well.

Select strengths and biases of models in representing the Arctic winter boundary layer over sea ice: the Larcform 1 single column model intercomparison.

Weather and climate models struggle to represent lower tropospheric temperature and moisture profiles and surface fluxes in Arctic winter, partly because they lack or misrepresent physical processes that are specific to high latitudes. Observations have revealed two preferred states of the Arctic winter boundary layer. In the cloudy state, cloud liquid water limits surface radiative cooling, and temperature inversions are weak and elevated. In the radiatively clear state, strong surface radiative cooling leads to the build-up of surface-based temperature inversions. Many large-scale models lack the cloudy state, and some substantially underestimate inversion strength in the clear state. Here, the transformation from a moist to a cold dry air mass is modelled using an idealized Lagrangian perspective. The trajectory includes both boundary layer states, and the single-column experiment is the first Lagrangian Arctic air formation experiment (Larcform 1) organized within GEWEX GASS (Global atmospheric system studies). The intercomparison reproduces the typical biases of large-scale models: Some models lack the cloudy state of the boundary layer due to the representation of mixed-phase micro-physics or to the interaction between micro-and macrophysics. In some models, high emissivities of ice clouds or the lack of an insulating snow layer prevent the build-up of surface-based inversions in the radiatively clear state. Models substantially disagree on the amount of cloud liquid water in the cloudy state and on turbulent heat fluxes under clear skies. Observations of air mass transformations including both boundary layer states would allow for a tighter constraint of model behaviour.

A structured physiotherapy treatment model can provide rapid relief to patients who qualify for lumbar disc surgery: a prospective cohort study.

OBJECTIVE: To evaluate a structured physiotherapy treatment model in patients who qualify for lumbar disc surgery. DESIGN: A prospective cohort study. PATIENTS: Forty-one patients with lumbar disc herniation, diagnosed by clinical assessments and magnetic resonance imaging. METHODS: Patients followed a structured physiotherapy treatment model, including Mechanical Diagnosis and Therapy (MDT), together with graded trunk stabilization training. Study outcome measures were the Oswestry Disability Index, a visual analogue scale for leg and back pain, the Tampa Scale for Kinesiophobia, the European Quality of Life in 5 Dimensions Questionnaires, the Zung Self-Rating Depression Scale, the Self-Efficacy Scale, work status, and patient satisfaction with treatment. Questionnaires were distributed before treatment and at 3-, 12- and 24-month follow-ups. RESULTS: The patients had already improved significantly (p < 0.001) 3 months after the structured physiotherapy treatment model in all assessments: disability, leg and back pain, kinesiophobia, health-related quality of life, depression and self-efficacy. The improvement could still be seen at the 2-year follow-up. CONCLUSION: This study recommends adopting the structured physiotherapy treatment model before considering surgery for patients with symptoms such as pain and disability due to lumbar disc herniation.

Patients' experience of health three years after structured physiotherapy or surgery for lumbar disc herniation.

OBJECTIVE: To describe the experience of health among patients 3 years after treatment with a structured physiotherapy model or surgery for lumbar disc herniation. DESIGN: A qualitative research study. SUBJECTS/PATIENTS: Patients were referred to the orthopaedic clinic at Sahlgrenska University Hospital with sciatica due to lumbar disc herniation. Twenty patients who were eligible for surgery were treated either with a structured physio-therapy model or with surgery. METHODS: Open-ended interviews were conducted and analysed using content analysis. RESULTS: Findings were grouped into two themes: feeling of well-being and feeling of ill-being. In the group treated with structured physiotherapy there were a high number of codes in the feeling of well-being theme. In the group treated with surgery there were a high number of codes in the feeling of ill-being theme. CONCLUSION: Patients treated with structured physiotherapy or surgery experienced feelings of well-being and ill-being 3 years after treatment. Patients treated with physiotherapy and surgery described varying experiences of health 3 years after treatment for lumbar disc herniation. It can be speculated that the experience of well-being may be explained by the ability of structured physiotherapy treatments to empower patients.

High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients .

BACKGROUND AND PURPOSE: Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. PATIENTS AND METHODS: 10-34 months after surgery, questionnaires were sent to 97 patients who had undergone standardized open discectomy. Outcome measures included Tampa scale for kinesiophobia (TSK); Oswestry disability index (ODI); European quality of life in 5 dimensions (EQ-5D); visual analog scale (VAS) for leg and back pain, work disability, and patient satisfaction; Zung self-rating depression scale (ZDS); pain catastrophizing scale (PCS); and a self-efficacy scale (SES). RESULTS: 36 of 80 patients reported having kinesiophobia. There were statistically significant differences in ODI, EQ-5D, VAS leg and back pain, ZDS, PCS, and SES between patients with and without kinesiophobia. INTERPRETATION: Half of the patients suffered from kinesiophobia 10-34 months after surgery for disc herniation. These patients were more disabled, had more pain, more catastrophizing thoughts, more symptoms of depression, lower self-efficacy, and poorer health-related quality of life than patients without kinesiophobia.

Vertical structure of recent Arctic warming.

Near-surface warming in the Arctic has been almost twice as large as the global average over recent decades-a phenomenon that is known as the 'Arctic amplification'. The underlying causes of this temperature amplification remain uncertain. The reduction in snow and ice cover that has occurred over recent decades may have played a role. Climate model experiments indicate that when global temperature rises, Arctic snow and ice cover retreats, causing excessive polar warming. Reduction of the snow and ice cover causes albedo changes, and increased refreezing of sea ice during the cold season and decreases in sea-ice thickness both increase heat flux from the ocean to the atmosphere. Changes in oceanic and atmospheric circulation, as well as cloud cover, have also been proposed to cause Arctic temperature amplification. Here we examine the vertical structure of temperature change in the Arctic during the late twentieth century using reanalysis data. We find evidence for temperature amplification well above the surface. Snow and ice feedbacks cannot be the main cause of the warming aloft during the greater part of the year, because these feedbacks are expected to primarily affect temperatures in the lowermost part of the atmosphere, resulting in a pattern of warming that we only observe in spring. A significant proportion of the observed temperature amplification must therefore be explained by mechanisms that induce warming above the lowermost part of the atmosphere. We regress the Arctic temperature field on the atmospheric energy transport into the Arctic and find that, in the summer half-year, a significant proportion of the vertical structure of warming can be explained by changes in this variable. We conclude that changes in atmospheric heat transport may be an important cause of the recent Arctic temperature amplification.

Model simulations of the Arctic atmospheric boundary-layer from the SHEBA year.

We present Arctic atmospheric boundary-layer modeling with a regional model COAMPS, for the Surface Heat Budget of the Arctic Ocean (SHEBA) experiment. Model results are compared to soundings, near-surface measurements and forecasts from the ECMWF model. The near-surface temperature is often too high in winter, except in shorter periods when the boundary layer was cloud-capped and well-mixed due to cloud-top cooling. Temperatures are slightly too high also during the summer melt season. Effects are too high boundary-layer moisture and formation of too dense stratocumulus, generating a too deep well-mixed boundary layer with a cold bias at the simulated boundary-layer top. Errors in temperature and therefore moisture are responsible for large errors in heat flux, in particular in solar radiation, by forming these clouds. We conclude that the main problems lie in the surface energy balance and the treatment of the heat conduction through the ice and snow and in how low-level clouds are treated.