"Guidelines prescribed by General Practitioners to patients with acute low back pain regarding ""return to work """

BackgroundThe traditional treatment protocol for acute low back pain (ALBP) primarily used by healthcare professionals has in the past decade been strict bed rest; corsets; traction and `back schools'. However; current research has led to dramatic changes in the traditional treatment protocol. The literature suggests that the protocol should be replaced by parsimonious imaging; early return to normal activities and greater emphasis on exercise to prevent recurrences of ALBP and to treat chronic pain. The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding `return to work'.MethodsA systematic sample of 212 GPs; selected from a list supplied by the Health Professions Council of South Africa (HPCSA); was selected to complete questionnaires. The highest qualifications of the GPs were MBChB or MFamMed; and all of them practise in the Bloemfontein area.ResultsSixty-three respondents stated that 40of ALBP patients returned for follow-up consultations. Of the 63 respondents; eight GPs had not consulted ALBP patients in the preceding two years; and thus were excluded from the final number of respondents. Bed rest is still prescribed by 67.27of GPs and; although 47.27of the GPs were aware of the change in protocol; only 9prescribe `return to work'. A total of 18.18are aware of evidence-based guidelines and 10of the GPs prescribe these. Among the guidelines defined by the GPs are lifestyle changes; rest and stabilisation. Only 18.18of ALBP patients are referred to occupational therapy for treatment.ConclusionOnly 47.27of the GPs knew about the new ALBP protocol; and even fewer had any knowledge of the content of the new protocol. Also; the guidelines prescribed by the GPs concerning `return to work' were indefinite. The researchers hypothesised that the reasons for this were a lack of awareness of the change in the acute low back pain protocol suggested by the Agency for Healthcare Research and Quality; as well as a lack of knowledge of the evidence-based guidelines suggested for their profession

Cellular localization of atrial natriuretic peptide and tissue kallikrein in the human hypothalamus

In the kidney, renal atrial natriuretic peptide (ANP) is considered to play an important role wter and salt homeostasis. Immunoreactive ANP in the brain of lower invertebrates, such as the rat, has been shown to be localizaed in the hypothalamus and septum. Several studies have investigated the possibility of a regulatory system in the brain similar to that of the kidney. Since neuronal function is acutely sensitive to disturbances of the intracranial water and salt balance we have attempted to immunolocalize ANP-containing cells in the normal human hypothalamus, using a polyclonal antiserum specific to ANP. Also, we have observed tissue kallikrein (TK), using a polylonal antiserum specific to TK, in the same areas as ANP. A regulatory role for TK on prolactin has been suggested as the rationale for the co-localization of these two hormones in human prolactinomas. Therefore, it could be suggested that TK plays a similar role in the processing of precursor ANP in the brain. It is contemplated to examine the status of these peptides in patients with cerebral oeodema