In the Cone of Concern: Preparing Stroke Survivors for Extreme Hurricanes.

ABSTRACT: When disasters strike, individuals living with stroke-related disability experience unique challenges and hardships. Climate change is contributing to the increasing frequency and severity of extreme weather events, including major hurricanes. Cyclonic storms that threaten the health and safety of residents living in coastal and island communities may disproportionately impact stroke survivors. Stroke sequelae may impede individuals' abilities to engage in timely preparedness and self-protective actions when such storms approach. As such, it is imperative that physiatrists and other health care professionals caring for patients living with stroke proactively assist them in identifying their needs and in developing tailored, comprehensive emergency preparedness plans. In this paper, we examine the special needs of and considerations for persons living with stroke sequelae in the times leading up to, during, and after a major hurricane. We also put forward recommendations, specific to the phases of a disaster, regarding how physiatrists can assist patients living with stroke, and their caregivers, to optimize preparedness in advance of a hurricane, and facilitate effective response during storm impact and in the aftermath.

Effectiveness of 3 Weekly Injections Compared With 5 Weekly Injections of Intra-Articular Sodium Hyaluronate on Pain Relief of Knee Osteoarthritis or 3 Weekly Injections of Other Hyaluronan Products: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate whether the number of hyaluronic acid (HA) injections in a sodium hyaluronate (Hyalgan) course of therapy alters effectiveness in reducing knee osteoarthritis (OA) pain. DATA SOURCES: Electronic databases, including PubMed and Embase, were searched from January 1980 until November 2015. STUDY SELECTION: We included clinical studies that evaluated the effectiveness of a course of 3 or 5 weekly intra-articular injections of Hyalgan to treat knee OA pain. We also included clinical studies evaluating the effectiveness of a 3-week course of other Food and Drug Administration-approved HA treatments of knee OA pain. Twenty-four studies were identified, comprising 2168 study participants in 30 treated cohorts. DATA EXTRACTION: We determined effect sizes for selected studies by extracting knee OA pain scores before and after HA or control treatments. Meta-regressions were implemented to determine whether the number of weekly injections in a course of Hyalgan therapy modified outcomes. DATA SYNTHESIS: The pooled estimate for relief from baseline pain was -31.4 (SE, 5.46; 95% confidence interval [CI], -45.5 to -17.4) with a 3-week course of Hyalgan and -32.2 (SE, 5.25; 95% CI, -45.6 to -18.7) with a 5-week course of Hyalgan. Findings from the meta-analysis indicate relief of knee OA pain with a 3-week course of Hyalgan is similar to that with a 5-week course of Hyalgan (P=.916). The pooled estimate for relief from baseline pain with a 3-week course of other HA products was -29.4 (SE, 4.98; 95% CI, -42.2 to -16.6), also indicating pain relief with a 3-week course of Hyalgan is similar to that with a 3-week course of other HA products (P=.696). CONCLUSIONS: There was no statistical difference between reduction in knee OA pain with a 3-week course of Hyalgan compared with reduction in knee OA pain with a 5-week course of Hyalgan or a 3-week course of other HA products. These findings demonstrate that comparable knee OA pain relief is achieved with a 3-week course of Hyalgan and the 2 control groups.