RESUMEN
Musculoskeletal (MSK) conditions are the leading cause of disability, resulting in up to 40% of visits to family physicians. Current primary care workforce shortages in Canada require other providers to maximize scopes of practice. Few MSK providers have been trained in team-based primary care settings. Study objectives included: (1) educating participating primary care teams through synchronous education, (2) educating Canadian primary care providers through asynchronous education, and (3) integrating chiropractors into primary care teams, whilst evaluating team MSK care knowledge/attitudes and integration experience. Results indicated improvements in collaborative competency, improved understanding and attitudes to chiropractic, and the importance of providing MSK care within funded primary care. Teams employed unique approaches to integrating chiropractors and indicated high demand for their services by patients and providers. Provision of MSK care without economic barrier is desirable and highly valued by teams. Chiropractors are well suited to participate in funded primary care teams in Canada.
Asunto(s)
Quiropráctica , Competencia Clínica , Enfermedades Musculoesqueléticas , Grupo de Atención al Paciente , Atención Primaria de Salud , Humanos , Atención Primaria de Salud/organización & administración , Quiropráctica/educación , Canadá , Enfermedades Musculoesqueléticas/terapia , Grupo de Atención al Paciente/organización & administración , Femenino , Masculino , Adulto , Atención Integral de Salud/organización & administración , Relaciones Interprofesionales , Persona de Mediana EdadRESUMEN
BACKGROUND: Studies have evaluated the concomitant use of hyaluronan (HA) with steroids, anti-inflammatory drugs and analgesic agents in an attempt to magnify the extent and duration of pain relief due to knee osteoarthritis. To date there has not been an intra-articular combination therapy available for relief of knee osteoarthritis symptoms--one that combines the fast acting onset of symptom relief provided by a corticosteroid with the long-lasting symptom relief provided by HA in a single injection. The objective of this study was to evaluate the safety and preliminary performance of two new HA formulations, Hydros (hyaluronan-based hydrogel suspended in hyaluronan solution) and Hydros-TA (HA plus 10 mg of triamcinolone acetonide [TA]) in subjects with knee osteoarthritis. METHODS: We conducted a Phase 2 prospective, multicenter, randomized, double-blind feasibility trial. Participants (n = 98; mean age 60 years) with knee osteoarthritis (Kellgren-Lawrence grade 2 or 3) were randomized to three treatment groups: Hydros, Hydros-TA, and Synvisc-One® (hylan G-F 20). Participants received one 6 ml intra-articular injection in the treatment knee and were evaluated at 2, 6, 13, and 26 weeks post-treatment. Safety was assessed from adverse events at all study visits. The primary efficacy outcome was the change from baseline on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) A (Pain) score for the treatment knee. RESULTS: Adverse events were similar across treatment groups with the most common being arthralgia, joint swelling, back pain, and joint stiffness. Arthralgia was reported 5 times with Synvisc-One, 4 with Hydros, and 1 with Hydros-TA. Each group demonstrated a reduction in the WOMAC A (Pain) score over 26 weeks: [least-square mean (standard error)] 30.5 (5.1) mm for Hydros; 34.4 (4.7) mm for Hydros-TA; 28.0 (5.4) mm for Synvisc-One and an observed improvement of 2.5 mm (p = 0.64) and 6.4 mm (p = 0.24) over Synvisc-One for Hydros and Hydros-TA, respectively. CONCLUSIONS: A single injection of Hydros or Hydros-TA was well-tolerated and relieved pain associated with knee osteoarthritis over 26 weeks. Data indicate that Hydros-TA had a more rapid pain relief compared to Hydros alone. A Phase 3 trial is underway to confirm these preliminary results. TRIAL REGISTRATION NUMBER: NCT01134406.
Asunto(s)
Corticoesteroides/uso terapéutico , Ácido Hialurónico/análogos & derivados , Ácido Hialurónico/uso terapéutico , Hidrogeles/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Triamcinolona Acetonida/uso terapéutico , Viscosuplementos/uso terapéutico , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Artralgia/tratamiento farmacológico , Artralgia/fisiopatología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Quimioterapia Combinada , Estudios de Factibilidad , Femenino , Humanos , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/efectos adversos , Hidrogeles/administración & dosificación , Hidrogeles/efectos adversos , Inyecciones Intraarticulares , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Triamcinolona Acetonida/administración & dosificación , Triamcinolona Acetonida/efectos adversos , Viscosuplementos/administración & dosificación , Viscosuplementos/efectos adversosAsunto(s)
Internacionalidad , Especialización , Deportes Juveniles , Adolescente , Atletas , Traumatismos en Atletas/epidemiología , Niño , Humanos , Salud MentalRESUMEN
In September, the international sports medicine community lost one of its rising stars. Editorial board member Alexandra Kirkley, MD, (more commonly known as Sandy), 40, and her husband, Michael, 42, died when their small plane crashed en route to their home in London, Ontario, Canada, from a presentation she was giving at the West Point Academy in New Jersey. Their sons, Colin (age 8) and Connor (age 5), miraculously survived the crash through the heroic efforts of rescuers and others.