Intra-articular injection with platelet-rich plasma compared to triamcinolone hexacetonide or saline solution in knee osteoarthritis: A double blinded randomized controlled trial with one year follow-up.

OBJECTIVES: To compare the effectiveness of intra-articular injection (IAI) of Platelet-Rich Plasma (PRP) with Triamcinolone Hexacetonide (TH) and Saline Solution (SS), in patients with knee osteoarthritis (OA). DESIGN: A randomized controlled trial, with blinded patients and assessor. SETTING: Outpatient rheumatology service. SUBJECTS: Patients with knee osteoarthritis grades II and III. INTERVENTIONS: Patients received IAI with PRP, 40 mg TH, or SS. METHODS: Patients were assessed at baseline and after 4, 8, 12 e 52 weeks with: visual analogue scale (VAS) for pain at rest and movement, WOMAC questionnaire, Timed to Up and Go test, 6-min walk test, percentage of improvement, goniometry, quality of life SF-36 questionnaire, Likert scale and Kelgreen & Lawrence (KL) radiographic scale (only at baseline and 52 weeks). RESULTS: 100 patients were studied, with a mean age of 67.13(6.56) years. The TH group was superior for: percentage of improvement (versus SS group from 4 to 52 weeks); WOMAC total and pain (versus PRP group at 4 weeks); and WOMAC stiffness (versus SS group at 12 weeks). The SS group was inferior for WOMAC function (from 8 to 52 weeks). The PRP group showed lowest radiographic progression [TH 17 (51.51%) to 24 (72.72%); SS 17 (51.51%) to 30 (90.90%); PRP 20 (58.82%) to 21 (61.76%)]. CONCLUSION: The Triamcinolone Hexacetonide group was superior for percentage of improvement and WOMAC, pain and stiffness. For the WOMAC function, the Platelet-Rich Plasma group and Triamcinolone Hexacetonide group were superior to the Saline group. The Platelet-Rich Plasma group showed the lowest radiographic progression at 52 weeks of follow-up.

The SPIKES protocol does not influence the tolerance or effectiveness of intra-articular corticosteroid injection in the knees of osteoarthritis patients: A prospective, controlled, randomized single-blinded trial.

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

The SPIKES protocol does not influence the tolerance or effectiveness of intra-articular corticosteroid injection in the knees of osteoarthritis patients: A prospective, controlled, randomized single-blinded trial

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of intra-articular injection (IAI) with Botulinum toxin type A (BTA), triamcinolone hexacetonide (TH), and saline in primary knee osteoarthritis. DESIGN: A randomized controlled trial, with blinded patients and assessor. SETTING: Outpatient rheumatology service. SUBJECTS: Patients with knee osteoarthritis grades II and III. INTERVENTIONS: Patients received IAI with 100 IU BTA, 40 mg TH, or isotonic saline solution (SS) 0.9%. MAIN MEASURES: Patients were assessed at baseline and at 4, 8, and 12 weeks with the following instruments: visual analog scale for pain during movement (VASm; primary outcome) and visual analog scale for pain at rest (VASr), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, 6-minute walk test, Timed Up and Go test, Short Form (SF)-36 questionnaire, range of motion of knee, and ultrasound (US) measurement of synovial hypertrophy. RESULTS: In total, 105 patients were randomized, with 35 in each group; 96 were female (91.4%) and 9 were male (8.6%), with a mean age of 64.2 years (±6.9). At 12 weeks, the TH group showed better results only for VASm. At four weeks, the TH group showed better results than the BTA and SS groups for VASm (-68.9% (37.8) vs. -35.3% (40.3) vs. -35.9% (51.4)), WOMAC pain (-56.0% (30.7) vs. -30.8% (34.3) vs. -30.0% (39.9)), WOMAC stiffness (-53.4% (38.4) vs. -17.2% (59.3) vs. -17.3% (78.1)), WOMAC function (-48.2% (34.6) vs. 30.8% (33.6) vs. -13.6% (64.9)), WOMAC total score (-51.2% (31.0) vs. -30.9% (30.0) vs. -18.8% (54.8)), and US measurement of synovial hypertrophy (-11.6% (44.9) vs. -1.5% (47.9) vs. +28.6% (81.3)). CONCLUSION: IAI with TH had a higher effectiveness than that with TBA or SS in the short-term assessment (four weeks) for pain in movement, WOMAC, and US measurement of synovial hypertrophy.

O enfermeiro nos programas de gerenciamento do uso de antimicrobianos: revisão integrativa / El enfermero en los programas de optimización del uso de antimicrobianos: revisión integrativa / Participation of nurses in antimicrobial stewardship programs: an integrative review

RESUMO Objetivo: investigar na literatura publicações acerca da participação do enfermeiro nos programas de gestão do uso de antimicrobianos. Método: revisão integrativa com busca nas bases de dados: Medical Literature Analysis and Retrieval System on Line, Literatura Latino-Americana de Ciências da Saúde e Cumulative Index to Nursing and Allied Health Literature. Como critérios de inclusão, foram selecionados artigos disponíveis na íntegra, publicados entre janeiro de 2007 e maio de 2018, nos idiomas português, inglês ou espanhol. Resultados: foram encontrados 140 artigos, 12 atenderam aos critérios de inclusão, e foram organizados em três categorias: "competências do enfermeiro nos programas de gestão do uso de antimicrobianos" (cinco artigos), "déficit de conhecimento e necessidade de capacitação" (seis artigos) e "ação sistêmica" (um artigo). Conclusão: os enfermeiros podem contribuir de forma substancial com os Programas de Gerenciamento do uso de Antimicrobianos, porém são necessárias ações educacionais, pesquisas e políticas públicas para que a sua participação seja efetiva.

RESUMEN Objetivo: Investigar publicaciones sobre la participación del enfermero en programas de optimización del uso de antimicrobianos. Método: Revisión integrativa con búsqueda en bases Medical Literature Analysis and Retrieval System on Line, Literatura Latinoamericana en Ciencias de la Salud y Cumulative Index to Nursing and Allied Health Literature. Para inclusión, fueron seleccionados artículos disponibles integralmente, publicados entre enero de 2007 y mayo de 2018, publicados en portugués, inglés o español. Resultados: Se encontraron 140 artículos, 12 atendían los criterios de inclusión. Fueron organizados en tres categorías: "competencias del enfermero en los programas de optimización del uso de antimicrobianos" (cinco artículos), "déficit de conocimiento y necesidad de capacitación" (seis artículos), y "acción sistémica" (un artículo). Conclusión: Los enfermeros pueden contribuir sustancialmente con los Programas de Optimización del Uso de Antimicrobianos, resultando necesarias acciones educativas, investigaciones y políticas públicas para que su participación resulte efectiva.

ABSTRACT Objective: To investigate publications in the literature on the participation of nurses in antimicrobial stewardship programs. Method: Integrative review with search in the following databases: the Medical Literature Analysis and Retrieval System Online, the Latin American and Caribbean Center on Health Sciences Information, and the Cumulative Index to Nursing and Allied Health Literature. As inclusion criteria, full articles in Portuguese, English, or Spanish published between January 2007 and May 2018 were selected. Results: Of the 140 articles found, 12 met the inclusion criteria, and were organized into the following three categories: "nurses' competencies in antimicrobials stewardship programs" (five articles), "lack of knowledge and need for training" (six articles), and "systemic action" (one article). Conclusion: Nurses may contribute significantly to antimicrobial stewardship programs; however, educational actions, studies, and public policies are necessary for their effective participation.

Measurement of upper limb ulcers in patients with systemic sclerosis: reproducibility and correlation with pain, function, and quality of life.

BACKGROUND: There are a large number of studies addressing the treatment and assessment of chronic ulcers. Despite the fact that ischemic ulcers are frequent and difficult to manage in cases of systemic sclerosis, there is minimal literature on assessment measures regarding these wounds or on their reproducibility. OBJECTIVES: The aim of this study was to investigate intraobserver and interobserver reproducibility regarding ulcer dimension measurements in patients with systemic sclerosis. Correlations between pain, upper limb function, pinch strength, and quality of life were also determined. METHODS: A prospective 11-week follow-up study was carried out to assess active upper limb ulcers. Ulcer diameter, ulcer area, and interobserver reproducibility were performed weekly. Quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), upper limb function (disabilities of the arm, shoulder, and hand), pinch strength, pain, visual analog scale, and intraobserver reproducibility were assessed at baseline, 3, 7, and 11 weeks. RESULTS: Fifty-one active ulcers were recorded. Larger ulcer diameter, smaller ulcer diameter, and ulcer area demonstrated excellent intraobserver (r > .81, p < .001) and interobserver reproducibility (r > .76, p < .001). There was significant correlation between ulcer dimension and visual analog scale scores for pain (r = .42; p < .001) and some Medical Outcomes Study 36-Item Short-Form Health Survey; pinch strength; and disabilities of the arm, shoulder, and hand domains (r >or= .40; p < .01). DISCUSSION: Simple measurement instruments for the assessment of ischemic ulcers were reproducible in patients with SSc and correlated to other variables of interest for these wounds.