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Are infections increased in rheumatoid arthritis (RA) prior to diagnosis? Results of a case control study of RA compared to non-inflammatory musculoskeletal disorders.

https://arctichealth.org/en/permalink/ahliterature174736
Source
Scand J Rheumatol. 2005;34(1):74-5
Publication Type
Article
Date
2005

Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial.

https://arctichealth.org/en/permalink/ahliterature86913
Source
BMC Musculoskelet Disord. 2008;9:40
Publication Type
Article
Date
2008
Author
Stochkendahl Mette J
Christensen Henrik W
Vach Werner
Høilund-Carlsen Poul Flemming
Haghfelt Torben
Hartvigsen Jan
Author Affiliation
Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark. m.jensen@nikkb.dk
Source
BMC Musculoskelet Disord. 2008;9:40
Date
2008
Language
English
Publication Type
Article
Keywords
Acute Disease
Chest Pain - etiology - physiopathology - prevention & control
Cost-Benefit Analysis
Diagnosis, Differential
Heart Diseases - diagnosis
Humans
Manipulation, Chiropractic - economics
Musculoskeletal Diseases - complications - diagnosis - physiopathology - therapy
Pain Clinics
Pain Measurement
Patient satisfaction
Prospective Studies
Questionnaires
Recovery of Function
Research Design
Single-Blind Method
Treatment Outcome
Abstract
BACKGROUND: Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. METHODS/DESIGN: We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a) a self-report questionnaire; b) a semi-structured interview; c) a general health examination; and d) a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with regards to ischemic heart disease, and to compare and indirectly validate the musculoskeletal diagnosis, myocardial perfusion scintigraphy is performed in all patients 2-4 weeks following discharge. Descriptive statistics including parametric and non-parametric methods will be applied in order to compare patients with and without musculoskeletal chest pain in relation to their scintigraphic findings. The decision making process of the chiropractor will be elucidated and reconstructed using the CART method. Out of the 300 patients 120 intended patients with suspected musculoskeletal chest pain will be randomized into one of two groups: a) a course of chiropractic treatment (therapy group) of up to ten treatment sessions focusing on high velocity, low amplitude manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect, and cost-effectiveness. DISCUSSION: This study may potentially demonstrate that a chiropractor is able to identify a subset of patients suffering from chest pain predominantly of musculoskeletal origin among patients discharged from an acute chest pain clinic with no apparent cardiac condition. Furthermore knowledge about the benefits of manual treatment of patients with musculoskeletal chest pain will inform clinical decision and policy development in relation to clinical practice. TRIAL REGISTRATION: NCT00462241 and NCT00373828.
PubMed ID
18377636 View in PubMed
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Pediatric malignancies presenting as a possible infectious disease.

https://arctichealth.org/en/permalink/ahliterature77118
Source
BMC Infect Dis. 2007;7:44
Publication Type
Article
Date
2007
Author
Forgie Sarah E
Robinson Joan L
Author Affiliation
Department of Pediatrics and Stollery Children's Hospital, Edmonton, Alberta, Canada. sarahforgie@cha.ab.ca
Source
BMC Infect Dis. 2007;7:44
Date
2007
Language
English
Publication Type
Article
Keywords
Adolescent
Alberta
Child
Child, Preschool
Communicable Diseases - complications - diagnosis - physiopathology
Databases, Factual
Diagnosis, Differential
Diagnostic Errors
Female
Fever
Humans
Infant
Male
Musculoskeletal Diseases - complications - diagnosis - physiopathology
Neoplasms - complications - diagnosis - physiopathology
Pain
Abstract
BACKGROUND: The clinical, laboratory, and radiological features of malignancy can overlap with those of infection. The purpose of this study was to determine the findings in children who were initially thought to have an infectious disease but ultimately proved to have a malignancy. METHODS: The database of patients diagnosed with a malignancy in the Northern Alberta Children's Cancer Program (NACCP) January 1, 1993 to December 31, 2003 was merged with the database of inpatients referred to the infectious diseases service at the Stollery Children's Hospital and charts were reviewed on all patients referred to the infectious diseases consult service prior to the diagnosis of malignancy. RESULTS: An infectious diseases consultation for diagnosis was requested in 21 of 561 patients prior to the confirmation of malignancy, and 3 of these 21 patients had both infection and malignancy (leukemia (N = 13), lymphoma (N = 3), rhabdomyosarcoma (N = 1), Langerhan's cell histiocytosis (N = 1), fibrous histicocytosis (N = 1), ependymoma (N = 1), and neuroblastoma (N = 1). The most common reason for infectious diseases consultation was suspected muskuloskeletal infection (N = 9). A palpable or radiographically enlarged spleen was noted in 11 patients (52%). All but 2 patients had abnormal hematologic parameters while an elevated lactate dehydrogenase (LDH) occurred in 10 patients (48%). Delay of diagnosis because of investigation or therapy for an infectious disease occurred in only 2 patients. CONCLUSION: It is not common for treatment of pediatric malignancies to be delayed because infection is thought to be the primary diagnosis. However, pediatric infectious diseases physicians should consider malignancy in the differential diagnosis when they see patients with fever and bone pain, unexplained splenomegaly or abnormal complete blood cell counts. Other clues may include hepatomegaly or elevated LDH.
PubMed ID
17519036 View in PubMed
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