New guideline on pelvic girdle pain during pregnancy

Pelvic girdle pain (PGP) is a common condition that causes pain and physical impairment, most frequently during the antepartum (before delivery) period. A new guideline for evidence-based physical therapy practice for PGP during pregnancy appears in the Journal of Women’s Health Physical Therapy, official  (SOWH) of the American Physical Therapy Association. The journal is published by Wolters Kluwer.

Created by the authors for the SOWH and Orthopedic Section of the APTA, the new document presents a clinical practice guideline for physical therapy management for PGP in the antepartum population. The lead author is Susan C. Clinton, PT, DScPT, COMT, OCS, WCS, FAAOMPT, of Embody Physiotherapy & Wellness, LLC, Sewickley, Pa.

Antepartum Pelvic Girdle Pain – Guideline for Physical Therapy Management

Pelvic girdle pain is estimated to occur in up to 70 percent of women sometime during pregnancy. Women with PGP develop pain in the pelvic region, which sometimes brings changes in posture, gait, and activity level. These symptoms can cause significant impairment in several areas of patients’ lives.

Symptoms of PGP may be severe in 20 percent of women, and in some cases may persist after delivery. Physical therapists play an important role in assessment and management of women with patients with PGP during and after pregnancy.

The new guideline makes recommendations for physical therapy management in key areas. Recommendations are ranked by strength of supporting evidence and address specific categories of impairment based on body function, body structure, and activities/participation. Topics include:

• Risk factors. Based on strong evidence, risk factors for the development of or more severe PGP include previous pregnancy, orthopedic dysfunction (such as hip and/or leg dysfunction), increased body mass index, and smoking. Risk is also higher for patients with work dissatisfaction and those who don’t believe that their condition will improve.
• Clinical course. Several factors can help to identify women who will have persistent problems. These include PGP developing early in pregnancy, multiple pain locations, and abnormal results on multiple physical therapy assessments.
• Examination and diagnosis. The guideline highlights the importance of recognizing other pregnancy-related conditions that may appear similar to PGP. Important clinical tests and outcome questionnaires for assessing women with PGP are identified as well.
• Physical therapy interventions. Physical therapy recommendations for PGP may include the use of a support belt, exercise programs, or manual therapy techniques. Yet so far there is only weak or conflicting evidence to support these recommendations. While strong evidence shows that women with PGP are at high risk of falls, there is little evidence on measures to assess balance or reduce the risk of falls, including activity limitations.

The new document is part of the SOWH’s ongoing effort to create evidence-based practice guidelines for women’s health and orthopedic physical management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The full guideline is available on the Journal of Women’s Health Physical Therapy and the Section on Women’s Health websites.

The authors believe their research review and evidence-based guideline will provide a useful guide to diagnosis, management, and outcomes assessment for the common problem of PGP, with interventions guided by the individual patient’s physical impairment. Susan Clinton adds, “The creation of this guideline also has a very important role in informing research where evidence is sparse in the literature.”

To read the full article click on the following link : http://journals.lww.com/jwhpt/Fulltext/2017/05000/Pelvic_Girdle_Pain_in_the_Antepartum_Population__.7.aspx

Research Finds a Powerful Weapon To Control Malaria

Malaria is a life-threatening disease that's typically transmitted through the bite of an infected Anopheles mosquito. Study has found that removing the flowers of an invasive shrub from mosquito-prone areas might be a simple way to help reduce malaria transmission.
 The study carried out in the Bandiagra District in Mali showed that removing the flowers from villages in Mali decreased the local mosquito vector population by nearly 60%. Lead author Gunter Muller from Hebrew University Hadassah Medical School said: "Mosquitos obtain most of their energy needs from plant sugars taken from the nectar of flowers so we wanted to test the effect removing the flowers of the shrub Prosopis juliflora would have on local mosquito vector populations."

‘Malaria is usually found in tropical and subtropical climates where the parasites that cause it live. Removal of flowers from an invasive shrub could help reduce malaria transmission.’

Muller added, "Our results show that removal of this particular shrub reduces total population levels of mosquitoes and reduces the number of older female mosquitoes in the population, which are known to transmit malaria parasites to humans. This suggests that removal of the flowers could be a new way to shift inherently high malaria transmission areas to low transmission areas, making elimination more feasible."

 The study focused on the removal of the flowers of the invasive shrub Prosopis juliflora, which is native to Central and South America but was introduced to new areas in the late 1970's and early 1980's as an attempt to reverse deforestation. Prosopis juliflora is a robust plant that grows rapidly and has become one of the worst invasive plants in many parts of the world. The shrub now occupies millions of hectares on the African continent, including countries such as Mali, Chad, Niger, Ethiopia, Sudan and Kenya. Light traps to catch mosquitoes were set up across nine villages in the Bandiagra District, six of which were home to flowering Prosopis juliflora and three that had no presence of the shrub.

After a first round of analysis was conducted to assess mosquito populations, the researchers cut all the flowering branches from Prosopis juliflora in three of the six infested villages, before setting up light traps to determine the effect removal of the shrub had on mosquito vector populations. The researchers found that villages where they removed the flowers saw mosquito numbers collected in the traps fall from an average of 11 to 4.5 for females, and 6 to 0.7 for male mosquitoes.

The total number of mosquitoes across these villages decreased by nearly 60% after removal of the flowers. After flower removal, the number of older more dangerous vector females in the population dropped to levels similar to those recorded in the villages that had no presence of the shrub. Villages infested with Prosopis juliflora also had a higher proportion of mosquitoes with a sugar meal in their gut, which enhances their survival.

This proportion was reduced 5-fold following removal of the flowers. According to the researchers, it may be worthwhile to abstain from the introduction of exotic plants that have the potential to become invasive, not only because of their potential negative impacts on the environment and livelihoods, but because some of them may have negative significant consequences for public health and specifically for malaria. The study is published in the open access Malaria Journal.

Source: ANI

Consent Revisited: Inability to manage complications leads to violence

Consent, as we know, is the authorization or grant of permission by the patient for treatment or any diagnostic, surgical or therapeutic procedure to be carried out by the doctor. A doctor has to take consent from the patient before proceeding with his treatment. It is ethical and in today's scenario, a legal requirement. Any act done without permission is "battery" or physical assault and is liable for punishment.

A valid consent has three components: Disclosure, Capacity and Voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information without force or coercion. This is informed consent. Any permission given under any unfair or undue pressure makes the consent invalid.

The Hon'ble Supreme Court of India has defined 'adequate information' in the landmark case of Samira Kohli vs Dr Prabha Manchanda. This includes "(a) nature and procedure of the treatment and its purpose, benefits and effect (b) alternatives if any available (c) an outline of the substantial risks and (d) adverse consequences of refusing treatment."

No doctor practices medicine without taking informed consent. Yet we read and hear of incidents of violence against doctors from all parts of the country. So, are we going wrong somewhere? Are we doing something wrong somewhere?

                                                                                                         eMediNews

DPP: Lifestyle Change Reduces Risk of Progression to Diabetes

The latest statistics from the Centers for Disease Control and Prevention (CDC) show that 37% of American adults over age 20 and 51% of adults over age 65 have prediabetes. A promising report based on early results from the CDC’s National Diabetes Prevention Program (DPP), now shows that prescribed lifestyle changes may successfully reduce the risk for progression to frank diabetes among those with prediabetes.

The results, published in the April 2017 issue of Diabetes Care, come after the first 4 years of the program, with more benefits observed for those who participate at higher levels.

The National DPP, launched in 2010, is a US-wide effort to prevent T2DM in those at risk through structured lifestyle change programs. One of the program’s goals is to help participants with prediabetes lose between 5% and 7% of body weight. Evidence shows this reduction in body weight greatly reduces the likelihood of progression to T2DM.

The National Institutes of Health developed the program and published the results from a clinical trial on its effects in 2002. Those results showed that people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing T2DM by 58% (71% for people over 60 years old). The program helped people reach the weight loss goal of 5% to 7% of their body weight through healthier eating and 150 minutes of physical activity a week.

In the new study, researchers led by Elizabeth K. Ely performed a descriptive analysis on data from 14,747 adults enrolled in year-long T2DM prevention programs during the period of February 2012 through January 2016. The researchers summarized data on attendance, weight, and physical activity minutes and examined predictors of weight loss.

The participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, more than one-third (35.5%) achieved the 5% weight loss goal. The average weight loss was 4.2%, with a median of 3.1%.

The participants reported that they had engaged in a weekly average of 152 minutes of physical activity (median 128 minutes). Some 41.8% met the physical activity goal of 150 minutes per week.

Importantly, for every additional session attended and every 30 minutes of activity reported, the participants lost 0.3% of body weight, which was statistically significant.

“During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups,” stated the researchers.

They noted that a focus on retention may reduce disparities and improve overall program results. “Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally,” they stated.