Post-surgical physiotherapy in frozen shoulder: A review

2020 ◽  
pp. 175857322096587
Author(s):  
Elaine G Willmore ◽  
Neal L Millar ◽  
Daniëlle van der Windt
Keyword(s):  
Patient Outcome ◽  
Best Practice ◽  
Frozen Shoulder ◽  
Optimal Management ◽  
Persistent Symptoms ◽  
Best Practice Guidelines ◽  
Arthroscopic Capsular Release ◽  
Surgical Options ◽  
Affect Patient Outcome ◽  
Surgical Release

Despite its prevalence, the optimal management of frozen shoulder is unclear. A range of conservative measures are often undertaken with varying degrees of success. In cases of severe and persistent symptoms, release procedures which could include any combination of manipulation under anaesthetic, arthroscopic capsular release or hydrodilatation are frequently offered, none of which has been shown to offer superior outcome over the others. When surgical release is performed a period of rehabilitation is normally recommended but no best practice guidelines exist resulting in considerable variations in practice which may or may not directly affect patient outcome. During this narrative review, we hypothesise that these differing responses to treatment (both conservative and surgical options) are potentially the result of different causal mechanisms for frozen shoulder and may also suggest that post-release rehabilitation may need to take this into account.

scholarly journals What Is Unique about the New Canadian COPD Guidelines?

2004 ◽  
Vol 11 (3) ◽  
pp. 200-203 ◽  
Author(s):  
Denis E O'Donnell
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Older Women ◽  
Family Physician ◽  
Best Practice ◽  
State Of The Art ◽  
Chronic Obstructive ◽  
Optimal Management ◽  
Obstructive Pulmonary Disease ◽  
Death Rates ◽  
Best Practice Guidelines

The prospect of digesting yet another set of ?best practice? guidelines is not an appealing one for the overwrought family physician. The Canadian Thoracic Society (CTS) panel, charged with the enormous task of developing new evidencebased recommendations, was acutely aware of this. Nevertheless, they were convinced that the time was right to tackle this important educational initiative, and somehow managed to summon considerable reserves of energy and enthusiasm to produce an excellent, state-of-the-art compendium on the optimal management of this condition (1). Faced with the evidence that death rates from chronic obstructive pulmonary disease (COPD) continue to escalate in Canada and that its prevalence has risen to unprecedented levels (particularly in older women), the panel believed that there was an urgent need to raise awareness of this disease, and to optimize diagnosis and management (2).

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals Introducing New Guidelines on Geoheritage Conservation in Protected and Conserved Areas

Geoheritage ◽  
2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Roger Crofts ◽  
Dan Tormey ◽  
John E. Gordon
Keyword(s):  
Practice Guidelines ◽  
Best Practice ◽  
Communication To The Public ◽  
The Public ◽  
Best Practice Guidelines ◽  
The World ◽  
New Guidelines ◽  
The Many ◽  
Ethical Basis ◽  
Improve Practice

AbstractThis paper introduces newly published guidelines on geoheritage conservation in protected and conserved areas within the “IUCN WCPA Best Practice Guidelines” series. It explains the need for the guidelines and outlines the ethical basis of geoheritage values and geoconservation principles as the fundamental framework within which to advance geoheritage conservation. Best practice in establishing and managing protected and conserved areas for geoconservation is described with examples from around the world. Particular emphasis is given to the methodology and practice for dealing with the many threats to geoheritage, highlighting in particular how to improve practice for areas with caves and karst, glacial and periglacial, and volcanic features and processes, and for palaeontology and mineral sites. Guidance to improve education and communication to the public through modern and conventional means is also highlighted as a key stage in delivering effective geoconservation. A request is made to geoconservation experts to continue to share best practice examples of developing methodologies and best practice in management to guide non-experts in their work. Finally, a number of suggestions are made on how geoconservation can be further promoted.

scholarly journals Development of the “Hamburg Best Practice Guidelines for ICV−Enzyme Replacement therapy (ERT) in CLN2 Disease” Based on 6 Years Treatment Experience in 48 Patients

2021 ◽  
pp. 088307382198915
Author(s):  
Christoph Schwering ◽  
Gertrud Kammler ◽  
Eva Wibbeler ◽  
Martin Christner ◽  
Johannes K.-M. Knobloch ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Practice Guidelines ◽  
Best Practice ◽  
Vision Loss ◽  
Neuronal Ceroid Lipofuscinosis ◽  
Enzyme Replacement ◽  
Best Practice Guidelines

Intracerebroventricular enzyme replacement therapy (ICV-ERT) for CLN2 disease represents the first approved treatment for neuronal ceroid lipofuscinosis (NCL) diseases. It is the first treatment where a recombinant lysosomal enzyme, cerliponase alfa, is administered into the lateral cerebral ventricles to reach the central nervous system, the organ affected in CLN2 disease. If untreated, CLN2 children show first symptoms such as epilepsy and language developmental delay at 2-4 years followed by rapid loss of motor and language function, vision loss, and early death. Treatment with cerliponase alfa has shown to slow the rapid neurologic decline. However, the mode of administration by 4 hour-long intracerebroventricular infusions every 14 days represents a potentially greater risk of infection compared to intravenous enzyme replacement therapies. The Hamburg NCL Specialty Clinic was the first site worldwide to perform intracerebroventricular enzyme replacement therapy in children with CLN2 disease. In order to ensure maximum patient safety, we analysed data from our center from more than 3000 intracerebroventricular enzyme replacement therapies in 48 patients over 6 years with regard to the occurrence of device-related adverse events and device infections. Since starting intracerebroventricular enzyme replacement therapy, we have also developed and continuously improved the “Hamburg Best Practice Guidelines for ICV–Enzyme Replacement Therapy (ERT) in CLN2 Disease.” Results from this study showed low rates for device-related adverse events and infections with 0.27% and 0.33%, respectively. Therefore, following our internal procedural guidelines has shown to improve standardization and patient safety of intracerebroventricular enzyme replacement therapy for CLN2 disease.

scholarly journals Global leadership in IPECP research; an intro to co-creation of best practice guidelines

2021 ◽  
pp. 100445
Author(s):  
Hossein Khalili ◽  
Anthony Breitbach ◽  
Gail Jensen ◽  
Sharla King ◽  
Barbara Maxwell ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Best Practice ◽  
Global Leadership ◽  
Best Practice Guidelines
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