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Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain

This meta-analysis involved reviewing information from 47 randomised controlled trials involving more than 9,000 patients. Studies exclusively dealing with sciatica were excluded.

Spinal manipulative therapy (SMT) was defined as any hands-on treatment of the spine including manipulation and mobilisation. Recommended control therapies included exercise and drug treatments (eg, non-steroidal anti-inflammatory agents or analgesics).

The conclusions reached were that SMT has similar effects to recommended therapies, although it seems to be better for short-term improvement in function. Serious adverse effects appear to be rare and include case reports of cauda equina syndrome, fractures and neurological or vascular compromise. The researchers recommend that clinicians should inform patients of these potential risks.

BMJ 2019; 364:1689

Drug-eluting or bare-metal stents for percutaneous coronary intervention

First-generation drug-eluting stents (DES) has been shown to reduce the need for repeat revascularisation compared with bare-metal stents (BMS). In this report the authors have meta-analysed the performance of new-generation DES. They defined new-generation as any DES subsequent to sirolimus or paclitaxel eluting stents.

New-generation DES have involved the use of glycoprotein receptor inhibitors or ticagrelor or prasugrel. Data from 26,616 patients in 20 randomised trials was evaluated.

The risk of the primary outcome (a composite of cardiac death or myocardial infarction) was reduced in the DES group compared with the BMS cohort (P<0.001). It was concluded that the use of BMS should no longer be considered the gold standard.

Lancet 2019; 393:2503–10

C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations

The Global Initiative guidelines on the management of COPD notes that patients with an exacerbation and a CRP level lower than 20mg/L are unlikely to be benefited by treatment with antibiotics. Those with purulent sputum and a level of CRP between 20 and 40mg/L are likely to benefit and those with levels of 40mg/L or more will probably benefit.

In this study 653 appropriate patients with an exacerbation of their COPD were randomised to receive usual care or usual care plus antibiotics on the basis of their CRP result.

It was concluded that CRP guided prescription of antibiotics for such patients resulted in a lower percentage of antibiotic use (57% vs 77.4%) with no evidence of harm.

N Engl J Med 2019; 381:111–20

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain

This meta-analysis involved reviewing information from 47 randomised controlled trials involving more than 9,000 patients. Studies exclusively dealing with sciatica were excluded.

Spinal manipulative therapy (SMT) was defined as any hands-on treatment of the spine including manipulation and mobilisation. Recommended control therapies included exercise and drug treatments (eg, non-steroidal anti-inflammatory agents or analgesics).

The conclusions reached were that SMT has similar effects to recommended therapies, although it seems to be better for short-term improvement in function. Serious adverse effects appear to be rare and include case reports of cauda equina syndrome, fractures and neurological or vascular compromise. The researchers recommend that clinicians should inform patients of these potential risks.

BMJ 2019; 364:1689

Drug-eluting or bare-metal stents for percutaneous coronary intervention

First-generation drug-eluting stents (DES) has been shown to reduce the need for repeat revascularisation compared with bare-metal stents (BMS). In this report the authors have meta-analysed the performance of new-generation DES. They defined new-generation as any DES subsequent to sirolimus or paclitaxel eluting stents.

New-generation DES have involved the use of glycoprotein receptor inhibitors or ticagrelor or prasugrel. Data from 26,616 patients in 20 randomised trials was evaluated.

The risk of the primary outcome (a composite of cardiac death or myocardial infarction) was reduced in the DES group compared with the BMS cohort (P<0.001). It was concluded that the use of BMS should no longer be considered the gold standard.

Lancet 2019; 393:2503–10

C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations

The Global Initiative guidelines on the management of COPD notes that patients with an exacerbation and a CRP level lower than 20mg/L are unlikely to be benefited by treatment with antibiotics. Those with purulent sputum and a level of CRP between 20 and 40mg/L are likely to benefit and those with levels of 40mg/L or more will probably benefit.

In this study 653 appropriate patients with an exacerbation of their COPD were randomised to receive usual care or usual care plus antibiotics on the basis of their CRP result.

It was concluded that CRP guided prescription of antibiotics for such patients resulted in a lower percentage of antibiotic use (57% vs 77.4%) with no evidence of harm.

N Engl J Med 2019; 381:111–20

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain

This meta-analysis involved reviewing information from 47 randomised controlled trials involving more than 9,000 patients. Studies exclusively dealing with sciatica were excluded.

Spinal manipulative therapy (SMT) was defined as any hands-on treatment of the spine including manipulation and mobilisation. Recommended control therapies included exercise and drug treatments (eg, non-steroidal anti-inflammatory agents or analgesics).

The conclusions reached were that SMT has similar effects to recommended therapies, although it seems to be better for short-term improvement in function. Serious adverse effects appear to be rare and include case reports of cauda equina syndrome, fractures and neurological or vascular compromise. The researchers recommend that clinicians should inform patients of these potential risks.

BMJ 2019; 364:1689

Drug-eluting or bare-metal stents for percutaneous coronary intervention

First-generation drug-eluting stents (DES) has been shown to reduce the need for repeat revascularisation compared with bare-metal stents (BMS). In this report the authors have meta-analysed the performance of new-generation DES. They defined new-generation as any DES subsequent to sirolimus or paclitaxel eluting stents.

New-generation DES have involved the use of glycoprotein receptor inhibitors or ticagrelor or prasugrel. Data from 26,616 patients in 20 randomised trials was evaluated.

The risk of the primary outcome (a composite of cardiac death or myocardial infarction) was reduced in the DES group compared with the BMS cohort (P<0.001). It was concluded that the use of BMS should no longer be considered the gold standard.

Lancet 2019; 393:2503–10

C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations

The Global Initiative guidelines on the management of COPD notes that patients with an exacerbation and a CRP level lower than 20mg/L are unlikely to be benefited by treatment with antibiotics. Those with purulent sputum and a level of CRP between 20 and 40mg/L are likely to benefit and those with levels of 40mg/L or more will probably benefit.

In this study 653 appropriate patients with an exacerbation of their COPD were randomised to receive usual care or usual care plus antibiotics on the basis of their CRP result.

It was concluded that CRP guided prescription of antibiotics for such patients resulted in a lower percentage of antibiotic use (57% vs 77.4%) with no evidence of harm.

N Engl J Med 2019; 381:111–20

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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