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Practice Guidelines
Gatekeeper:
British Infection Society
British Infection Society Guidelines: UK malaria treatment guidelines Journal of Infection 2007; 54(2):111-21
Gatekeeper:
Osteoarthritis Research Society International (OARSI)
New Guidelines Issued for Management of Hip and Knee Osteoarthritis
Study Highlights
The optimal management of OA of the hip and knee combines both nonpharmacologic and pharmacologic treatment modalities (SOR, 96%).
The initial treatment of OA should focus on patient empowerment and self-driven therapies. All patients should receive education on lifestyle changes, exercise, pacing of activities, and weight reduction (SOR, 97%).
Monthly telephone contact, even by lay personnel, can improve the clinical status of patients with OA (SOR, 66%).
A physical therapy consultation focusing on appropriate exercises may benefit patients with OA, although this recommendation is largely based on expert opinion. The physical therapy visit may also include advice regarding assistive devices for ambulation (SOR, 89%).
Weight loss is encouraged and can relieve pain and stiffness and improve function (SOR, 96%).
Assistive devices for ambulation can reduce pain associated with OA. Frames or wheeled walkers are preferable for patients with bilateral disease (SOR, 90%).
Among patients with knee OA and mild or moderate valgus or varus instability, a knee brace can reduce pain, improve stability, and reduce the risk of falling (SOR, 76%).
Insoles can also reduce pain among patients with knee OA (SOR, 77%).
Thermal modalities may improve knee OA, but there is less evidence that ice may be effective (SOR, 64%).
Transcutaneous electrical nerve stimulation can help with short-term pain control among patients with hip or knee OA (SOR, 58%).
Acupuncture can relieve symptoms of knee OA (SOR, 59%).
Acetaminophen is the first choice for pharmacologic treatment of OA. Doses up to 4 g/day may be initiated before the use of other medications (SOR, 92%).
NSAIDs may be used at their lowest effective dose, and long-term use should be avoided if possible. Among patients at an increased risk for gastrointestinal tract bleeding, clinicians should prescribe either a COX-2 selective agent or a nonselective NSAID with co-prescription of a proton pump inhibitor or misoprostol. NSAIDs should be used with caution among patients with cardiovascular risk factors (SOR, 93%).
Topical NSAIDs and capsaicin can be effective as monotherapy or adjunctive treatment for OA of the knee (SOR, 85%).
Patients with moderate to severe pain associated with knee OA that is not responding to oral therapy can be treated with intra-articular injections (SOR, 78%).
Intra-articular injections of hyaluronate are associated with delayed onset of analgesia but a prolonged duration of action vs injections of corticosteroids (SOR, 64%).
Treatment with glucosamine and chondroitin may relieve symptoms of OA, but treatment should be discontinued if there is no relief after 6 months of therapy (SOR, 63%).
Unicompartmental knee replacement is effective among patients with knee OA restricted to a single compartment (SOR, 76%).
Osteotomy may be considered for young adults with symptomatic hip OA, whereas high tibial osteotomy may reduce the need for joint replacement among young adults with knee OA (SOR, 75%).
Joint fusion of the knee can be performed to salvage a failed joint replacement (SOR, 69%).
Pearls for Practice
The current recommendations for nonpharmacologic treatment of OA of the hip and knee include regular telephone calls from the clinician's office; self-driven therapies; and education on lifestyle changes, exercise, and weight reduction. For patients with knee OA, a knee brace for varus or valgus instability, insoles for appropriate patients, acupuncture, and thermal therapy are recommended. However, the topical application of ice is less proved.
The current guidelines for pharmacologic treatment of OA of the hip and knee recommend acetaminophen as the first choice. Other treatments include NSAIDs and glucosamine and chondroitin, but long-term use of these medications should be avoided.
eliastheod:
Guidelines Issued for Acute Otitis Externa
Otolaryngol Head Neck Surg. 2006;134(suppl):24-48
eliastheod:
New Guidelines for Lyme Disease Prevention
Clin Infect Dis. 2006;43:000-000
Argirios Argiriou:
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή ΕίσοδοςNew Guidelines for Lyme Disease Prevention
Clin Infect Dis. 2006;43:000-000
--- Τέλος παράθεσης ---
Στην Σουηδία που δούλευα η νόσος Lyme ήταν ενδημική σε ορισμένες περιοχές.
Τί ισχύει στην Ελλάδα; Εννοώ, γνωρίζει κανείς αν υπάρχει η νόσος του Lyme ενδημικά στην Ελλάδα;
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