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Biomedical subjects

M Winnem

Publications and source records attributed to M Winnem.

15 recordsLinked to original sources
PubMed2004

Bed rest for acute low-back pain and sciatica.

BACKGROUND: Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain. OBJECTIVES: To assess the effects of advice to rest in bed for patients with acute LBP or sciatica. SEARCH STRATEGY: We searched the Cochrane Back Group Specialized Registry, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to March 2003, reference lists of relevant articles, and contacted authors of relevant articles. SELECTION CRITERIA: Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, where the effectiveness of advice to rest in bed was evaluated. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS: Eleven trials (1963 patients) were included in this updated version. There is high quality evidence that people with acute LBP who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain [SMD -0.03 (95% CI: -0.24, 0.18)] or functional status [SMD 0.19 (95% CI: -0.02, 0.41)] between bed rest and staying active. For patients with acute LBP, there is moderate quality evidence of little or no difference in pain intensity or functional status between bed rest and exercises. For patients with sciatica, there is moderate quality evidence of little or no difference in pain intensity between bed rest and physiotherapy, but small improvements in functional status [Weighted Mean Difference 6.9 (on a 0-100 scale) (95% CI: 1.09, 12.74)] with physiotherapy. There is moderate quality evidence of little or no difference in pain intensity or functional status between two to three days and seven days of bed rest. REVIEWERS' CONCLUSIONS: For people with acute LBP, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active. There is little or no difference in the effect of bed rest compared to exercises or physiotherapy, or seven days of bed rest compared with two to three.

Acute Disease↗
PubMed2002

Advice to stay active as a single treatment for low back pain and sciatica.

BACKGROUND: Low back pain is one of the most common conditions managed in primary care. Restricted activity, rest, and symptomatic analgesics are the most commonly prescribed treatment for low back pain and sciatica. OBJECTIVES: To assess the effects of advice to stay active as single treatment for patients with low back pain. SEARCH STRATEGY: Computerised searches in MEDLINE, EMBASE, Sport, The Cochrane Controlled Trials Register, Musculoskeletal Group's Trials Register and Scisearch, and scanning of reference lists from relevant articles were undertaken. Relevant studies were also traced by contacting authors. Date of the most recent searches: December 1998. SELECTION CRITERIA: We included all randomised trials or quasi-randomised trials where the study population consisted of adult patients with low back pain or sciatica, in which one comparison group was advised to stay active. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to collect missing data or for clarification when needed. MAIN RESULTS: Four trials, with a total of 491 patients, were included. Advice to stay active was compared to advice to rest in bed in all trials. Two trials were assessed to have low risk of bias and two to have moderate to high risk of bias. The results were heterogeneous. Results from one high quality trial of patients with acute simple LBP found small differences in functional status [Weighted Mean Difference (on a 0-100 scale) 6.0 (95% CI: 1.5, 10.5)] and length of sick leave [WMD 3.4 days (95% CI: 1.6, 5.2)] in favour of staying active compared to advice to stay in bed for two days. The other high quality trial compared advice to stay active with advice to rest in bed for 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high quality trials also compared advice to stay active with exercises for patients with acute simple LBP, and found improvement in functional status and reduction in sick leave in favour of advice to stay active. REVIEWER'S CONCLUSIONS: The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

Bed Rest↗
PubMed2000

Bed rest for acute low back pain and sciatica.

BACKGROUND: Low back pain is a common reason for consulting a general practitioner, and advice on daily activities constitutes an important part in the primary care management of low back pain. OBJECTIVES: To assess the effects of bed rest for patients with acute low back pain or sciatica. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trial register, Cochrane Controlled Trials Register, MEDLINE, Embase, Sport, Scisearch, and reference lists of relevant articles. We also contacted authors of relevant articles. Date of the most recent searches: December 1998. SELECTION CRITERIA: We included all randomised studies or quasi randomised studies where at least one comparison group of adult patients with acute low back pain with or without radiation of pain below the knee was advised to rest in bed for at least two days and one group was not, or where comparison groups were advised to stay in bed for different lengths of time. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS: Nine trials with a total of 1435 patients were included. Five trials met all four validity criteria and were assessed to have low risk of bias, while four trials were assessed to have moderate to high risk of bias. Four trials compared bed rest with advice to stay active, and overall the results were heterogeneous. Overall results from two high quality studies indicate no difference in pain intensity at three weeks follow-up [Standardized Mean Difference 0.0 (95%CI: -0.3, 0.2)], and a small difference in functional status in favour of staying active [Weighted Mean Difference 3.2 (on a 0-100 scale) (95%CI 0.6, 5.8)]. Two high quality trials reported no differences in pain intensity between two to three days of bed rest and seven days of bed rest. Another two high-quality trials found no differences between bed rest and exercises in pain intensity or functional status. REVIEWER'S CONCLUSIONS: Bed rest compared to acvice to stay active will at best have small effects, and at worst might have small harmful effects on acute LBP. Differences in effects of advice to stay in bed compared with advice to stay active are small for patients with low back pain with or without sciatica. There is not an important difference in the effects of bed rest compared with exercises in the treatment of acute low back pain, or seven days compared with two to three days of bed rest in patients with low back pain of different duration with and without radiating pain.

Acute Disease↗
PubMed1999

Questions you didn't ask? COOP/WONCA Charts in clinical work and research. World Organization of Colleges, Academies and Academic Associations of General Practitioners/Family Physicists.

OBJECTIVE: COOP/WONCA Functional Assessment Charts are widely in use in research and clinical work. They originally evolved from Dartmouth COOP Functional Assessment Charts. Our objective is to describe our experiences with COOP/WONCA Charts and to provide data on reliability and reference data from a normal population. METHOD: A test-retest study comprising 40 randomly selected patients attending GPs' surgeries was conducted. Eight GPs took part in this study. The response rate for the questionnaire was 100%. In a second study, 245 asthma patents who consulted 53 different GPs were consecutively included; 171 of these repeated completion of the charts after 6 months. Mean scores from a random sample of 2864 persons in the total population of the municipality of Ullensaker in Norway are given as reference values. There was a postal return rate of 64%. RESULTS AND CONCLUSIONS: The reliability of the charts is good, and nine out of ten of the patients gave clinically meaningful answers after 2-3 days. The scores of the 171 asthma patients were nearly identical after 6 months. The reference values are presented. A standardized method for reliability testing is discussed, and the use of COOP/WONCA Functional Assessment Charts is commented on.

Adult↗
PubMed1997

[Assessment of one's own functional status. COOP-WONCA questionnaire charts in clinical practice and research].

Primary health care has needed an instrument that can be used to assess patients functional health status. Since 1988 the Classification Committee of WONCA, the World Organisation of Family Doctors, has been working on a revised edition of the Dartmouth COOP Functional Status Assessment Charts. The six COOP-WONCA Charts are described: physical fitness, feelings, daily activities, social activities, change in health and overall health. The charts have been tested against many other instruments and the validity has been found to be good. A Norwegian test-retest reliability study, the first on the revised COOP-WONCA Charts, showed good reliability. For 35 out of 40 of the office patients included in the study, either the answers were the same at test-retest, or "change of health" was consistent with changes in other variables. A study in a group of 171 asthma patients showed unchanged mean scores after six months. The results from a population study in the municipality of Ullensaker, comprising 2,864 persons, are presented as a basis for comparison. The COOP-WONCA instrument is simple and easy to use and understand. It meets the requirements for a useful tool in clinical practice and research and seems to provide valuable, additional information in daily practice. The COOP-WONCA Charts represent a simple and good method for assessing functional status.

Activities of Daily Living↗
PubMed1994

[Sumatriptan in the treatment of migraine in general practice].

Approximately 5% of the adult Norwegian population suffer from migraine. Sumatriptan is a new anti-migraine drug which has been shown in clinical studies to be efficacious in up to 80% of attacks treated. These early clinical studies have all been carried out at specialist centres and the present study was planned to see if migraine patients treated by general practitioners would also benefit from this new therapy. This placebo controlled, randomized, double blind study was carried out by 50 general practitioners and two neurologists, and included 294 patients. A total of 1,485 migraine attacks were treated. The results show that Sumatriptan is equally efficacious and well tolerated when used to treat patients in general practice as at specialist clinics. Sumatriptan was efficacious in relieving pain and other migraine symptoms in 76% of the migraine attacks treated, while placebo had the desired effect in 29% of attacks.

Adolescent↗
PubMed1993

[Diagnosis of migraine in general practice].

195 patients with headache were examined by general practitioners and neurologists, and their diagnoses were compared. The general practitioners diagnosed migraine in 116 cases, the neurologists in 144 cases, and in 104 cases their diagnoses agreed. Thus, migraine can be difficult to diagnose, and this study indicates underdiagnosis of this common condition by general practitioners. This may result in overuse of analgesics and alternative therapies, and too little prescription of specific migraine medication. Greater familiarity with the diagnostic criteria of the International Headache Society should make it easier to arrive at a correct migraine diagnosis.

Adolescent↗
PubMed1993

[Short-term absenteeism in Norwegian industry].

The purpose of this study was to investigate the reasons for short-term absence from work on medical grounds, and because of headache in particular, for periods of 1 to 3 days. The causes of short-term absence from work, both self-reported or as stated on a doctor's certificate, were studied prospectively among 2,600 employees in five Norwegian factories. It was found that the main reason for short-term absence was intercurrent self-limiting disease, such as respiratory infections, gastrointestinal upsets, musculoskeletal pain and headache. Among this particular group, injuries or the need to care for a sick child were seldom the cause of the absence.

Absenteeism↗
PubMed1993

[Diagnosis of migraine in general practice].

195 patients with headache were examined by general practitioners and neurologists, and their diagnoses were compared. The general practitioners diagnosed migraine in 116 cases, the neurologists in 144 cases, and in 104 cases their diagnoses agreed. Thus, migraine can be difficult to diagnose, and this study indicates underdiagnosis of this common condition by general practitioners. This may result in overuse of analgesics and alternative therapies, and too little prescription of specific migraine medication. Greater familiarity with the diagnostic criteria of the International Headache Society should make it easier to arrive at a correct migraine diagnosis.

Adolescent↗
PubMed1988

Young patients with cystic fibrosis: attitude toward physical activity and influence on physical fitness and spirometric values of a 2-week training course.

The purpose of this investigation was to study the attitude toward physical activity in young patients with cystic fibrosis (CF) and the influence of 2 weeks of training on physical fitness and spirometric values. Two groups of CF patients with mean ages of 11 and 15 years, respectively (total of 13 patients, range 9-21 years), participated in the study. Two healthy control groups with mean ages of 11 and 14 years, respectively, performed the same tests as the CF patients. The CF patients answered questionnaires regarding their attitude toward the activities both during the camp and at home and accomplished spirometric and exercise tests. The CF childrens' parents were interviewed concerning their children's attitude toward physical activity. The attitude toward physical activity of the CF children was very positive both during the camps and at home. The CF patients had at least as good a motivation for exercise as the healthy controls. The physical fitness of the CF patients was reduced, but improved during the training period. The spirometric tests were unchanged during the first course, but increased significantly during the other camp, even if lung physiotherapy was stopped during the training period. The study indicates that CF patients can be motivated for physical exercise, even for training for endurance and at a high enough level to replace lung physiotherapy, at least for shorter periods.

Adolescent↗
PubMed1986

Left ventricular end-systolic pressure volume relations in healthy young men.

The purpose of the present study was to establish the relationship of left ventricular end-systolic volume vs. mean systemic pressure in variously afterloaded beats in a group of healthy, young, men (n = 6, age 24 +/- 0.9 years). The relationship was expressed by the slope (Emax) of the line connecting pressure-volume co-ordinates and its extrapolated intercept (Vd) of the volume axis. The slope was calculated by linear regression of mean systemic arterial pressure (mean SAP, measured by catheter in the radial artery) vs. end-systolic left ventricular volume (ESV, estimated from cross-sectional, 4-chamber echocardiographic images). Recordings were obtained at resting, reduced (nitroglycerin infusion), and elevated (metaoxedrin infusion) blood pressure. Individual Emax values ranged from 1.05 to 2.01 mmHg ml-1; Vd was consistently found to be negative, ranging from -4.7 to -54.8 ml. All individual relations were statistically significant (P less than 0.05 to P less than 0.001). Group values were Emax = 1.27 +/- 0.25 (SE) mmHg ml-1, Vd = -43.3 +/- 7.5 (SE) ml, and Emax indexed for body surface area, Emax ind = 2.54 +/- 0.49 (SE) mmHg ml-1 m-2. We further examined the validity of proposed optimal relations among Emax, heart rate (HR) and systemic resistance (Rs): Emax/HR = Rs, and among ejection fraction (EF), EDV and Vd: EF = 0.5 (1 - EDV/Vd). For the group Emax/HR = 0.023 +/- 0.003 and Rs = 0.016 +/- 0.004 (mmHg ml-1 min-1), i.e., a deviation from equivalence of 30% (P less than 0.001). EF (= 0.72 +/- 0.02) deviated by 18% (P less than 0.001) from its proposed optimum (0.5 (1 - Vd/EDV) = 0.61 +/- 0.06).

Adult↗
PubMed1979

An atypical manifestation of multiple myeloma in a 24-year-old male.

A structurally unusual, B-cell-derived malignant tumour is reported in a 24-year-old male. The gross autopsy findings were those of classical myelomatosis, with extensive and centrally located skeletal infiltrates and typical myeloma kidneys. The tumour cells were, however, morphologically very unusual. All elements were markedly pyroninophilic, indicating active protein synthesis, but typical plasma cell characteristics were lacking. The cells were ultrastructurally characterized by large and distended vacuoles, often with ribosomal granules attached, and containing an amorphous material. Virtually all tumour elements were found to be heavily loaded with IgG(kappa) in immunofluorescence studies. IgG paraprotein was also found in serum, and kappa light chains in the urine. It is concluded that the tumour represents an intermediate form between multiple myeloma and a tumour originating from the large pyroninophilic, immunoglobulin-secreting lymphocytes.

Adult↗