Treating carpal tunnel syndrome.

UNLABELLED: BACKGROUND CTS is a common problem caused by compression of the median nerve at the wrist resulting in hand numbness, loss of dexterity, muscle wasting, and decreased functional ability at work. This study investigated the efficacy of a corticosteroid injection just proximal (not into) the carpal tunnel for CTS. POPULATION STUDIED: Study participants included 60 patients referred to a neurology clinic in Amsterdam, Netherlands, with CTS symptoms for longer than 3 months' duration and confirmed with electrophysiological tests. Patients in the intervention and control groups had symptoms for an average of 32 months and 25 months, respectively. In patients with bilateral symptoms, the arm with the most severe symptoms was chosen for randomization. Patients aged younger than 18 years and those who had previous treatment for CTS were excluded. STUDY DESIGN AND VALIDITY: Patients were randomized to receive an injection of either lignocaine (Lidocaine 10 mg) and methylprednisolone 40 mg or a lignocaine 10-mg injection only. The site of injection was proximal to the carpal tunnel on the volar side of the forearm 4 cm proximal to the wrist crease, between the tendon of the radial flexor muscle and the long palmar muscle. Injections were given at a 10 degrees to 20 degrees angle with a 3-cm needle. At baseline, there were no significant differences between the control group and the intervention group. The study was performed at one clinic where one neurologist performed all injections. Thus, we do not know if the results of this technique can be consistently reproduced. No patients were reported lost to follow-up at 1 year. To ensure blinding of the treatment assignment, a pharmacist wrapped the syringes in paper and a second neurologist performed outcomes assessment interviews. One month after the initial injection, patients were asked whether they had no symptoms or only minor symptoms that they considered so much improved that they felt no further treatment was necessary. Investigators broke the trial code at follow-up assessment visits to offer nonresponders an injection with methylprednisolone or surgery. OUTCOMES MEASURED: Patients were considered improved if they self-reported no symptoms or only minor symptoms needing no additional treatment. Other symptoms (weakness, nighttime pain) or impact on lifestyle and occupation were not reported. RESULTS: At 1 month, 20% of the patients in the control group had improved compared with 77% of patients in the intervention group (P <.001; number needed to treat = 1.8). After 1 year, 8 of the 23 patients (35%) who initially responded to methylprednisolone required a second injection. A total of 86% of nonresponders in the control group improved after receiving a methylprednisolone injection, but 50% of these patients went on to need surgical treatment within 1 year. The investigators reported no side effects to the injection.

An office-based Internet patient education system: a pilot study.

BACKGROUND: Patients' use of the Internet to find medical information is increasing, and physicians are exploring ways to incorporate the Internet into patient education programs and physician-patient encounters. We performed a pilot study of an Internet patient education system to obtain information on the usefulness of, feasibility of, and patient satisfaction with this type of information. METHODS: We developed a hypertext Web page directory to patient education sites on the Internet and made it available to patients in a community-based family practice residency clinic during their office visit. During a 1-month period, a medical student assisted patients with using the Internet, answered questions, interviewed patients, and collected data. Information was collected on sites visited, level of assistance required, amount of time spent "surfing" on-line versus intense reading on-line, quality of the experience, perceived usefulness of the educational materials, and patients' satisfaction with the materials. RESULTS: Fifty patients participated in the study. Forty-seven patients (94%) found the Internet information helpful. Most patients spent their time on-line intensely reading, and men spent significantly more time on-line (P = .007). Thirty-seven patients (77%) stated they would change a health behavior because of information they had read on the Internet; 45 (90%) were more satisfied with their visit than usual, and 46 (92%) would use the Internet center at the clinic again. CONCLUSIONS: Patients can obtain useful information from moderated Internet patient education systems and may plan to change health behaviors on the basis of that information. Internet patient information in the physician's office can improve patient satisfaction with clinic visits.

Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis.

OBJECTIVE: We conducted this meta-analysis to determine the magnitude of risk conferred by bacterial vaginosis during pregnancy on preterm delivery. SEARCH STRATEGY: We selected articles from a combination of the results of a MEDLINE search (1966-1996), a manual search of bibliographies, and contact with leading researchers. SELECTION CRITERIA: We included case control and cohort studies evaluating the risk of preterm delivery, low birth weight, preterm premature rupture of membranes, or preterm labor for pregnant women who had bacterial vaginosis and those who did not. DATA COLLECTION AND ANALYSIS. Two investigators independently conducted literature searches, applied inclusion criteria, performed data extraction, and critically appraised included studies. Summary estimates of risk were calculated as odds ratios (ORs) using the fixed and random effects models. MAIN RESULTS: We included 19 studies in the final analysis. Bacterial vaginosis during pregnancy was associated with a statistically significant increased risk for all outcomes evaluated. In the subanalyses for preterm delivery, bacterial vaginosis remained a significant risk factor. Pooling adjusted ORs yielded a 60% increased risk of preterm delivery given the presence of bacterial vaginosis. CONCLUSIONS: Bacterial vaginosis is an important risk factor for prematurity and pregnancy morbidity. Further studies will help clarify the benefits of treating bacterial vaginosis and the potential role of screening during pregnancy.

Smoking cessation intervention: the practices of maternity care providers.

BACKGROUND: Little is known about the actual smoking intervention practices of maternity care providers. This study examines smoking intervention practices of maternity care providers in a large Midwestern city. METHODS: A telephone survey was used to collect information on the care of pregnant patients who smoke (n = 73). RESULTS: After brief counseling during the first prenatal care visit (98 percent), 84 percent of providers readdressed smoking at follow-up visits. Family physicians were significantly more likely than obstetricians to provide further counseling (97 versus 72 percent, P < 0.005). Common cessation interventions included provider counseling (99 percent) and recommending smoking cessation classes (26 percent). Reasons cited by providers for patients' inability to stop smoking during pregnancy included addiction, habit, and environment or family. Methods used to encourage smoking cessation did not correlate with those known to be effective for treating addiction, modifying behavior, or responding to family or social system problems. CONCLUSION: Maternity care providers underutilize effective methods of smoking cessation for their patients who smoke and rely on less effective methods.

Promotion of women physicians in academic medicine. Glass ceiling or sticky floor?

OBJECTIVE: To assess possible explanations for the finding that the percentage of women medical school faculty members holding associate or full professor rank remains well below the percentage of men. DESIGN: Cross-sectional survey of physician faculty of US medical schools using the Association of American Medical Colleges (AAMC) database. SUBJECTS: Surveyed were 153 women and 263 men first appointed between 1979 and 1981, matched for institutions of original faculty appointment. MAIN OUTCOME MEASURES: Academic rank achieved, career preparation, academic resources at first appointment, familial responsibilities, and academic productivity. RESULTS: After a mean of 11 years on a medical school faculty, 59% of women compared with 83% of men had achieved associate or full professor rank, and 5% of women compared with 23% of men had achieved full professor rank. Women and men reported similar preparation for an academic career, but women began their careers with fewer academic resources. The number of children was not associated with rank achieved. Women worked about 10% fewer hours per week and had authored fewer publications. After adjustment for productivity factors, women remained less likely to be associate or full professors (adjusted odds ratio [OR] = 0.37; 95% confidence interval [CI], 0.21 to 0.66) or to achieve full professor rank (adjusted OR = 0.27; 95% CI, 0.12 to 0.63). Based on the AAMC database, 50% of both women and men originally appointed as faculty members between 1979 and 1981 had left academic medicine by 1991. CONCLUSION: Women physician medical school faculty are promoted more slowly than men. Gender differences in rank achieved are not explained by productivity or by differential attrition from academic medicine.