1. Knee pain sufferers can kick "ugly" shoes to the curb*
Unloading footwear and conventional walking shoes provide about equal relief from knee osteoarthritis
*image of footwear available
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0453
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-1459
URL goes live when the embargo lifts
Conventional walking shoes are about as effective as unloading shoes for improving pain and function in knee osteoarthritis. Results of a randomized, controlled trial are published in Annals of Internal Medicine.
Osteoarthritis of the knee results in pain, physical dysfunction, and reduced quality of life, and is one of the most common reasons for older people to see a doctor. Since there is no cure, self-management is the cornerstone of conservative treatment, along with exercise and weight control. Clinical guidelines for knee osteoarthritis recommend appropriate footwear as part of core treatment, which may include conventional walking shoes or unloading shoes. Unloading shoes have modified, stiffer soles designed to reposition the foot and reduce load to the knee. Currently, there is little evidence to determine which type of shoe is the better choice for relieving symptoms.
Researchers randomly assigned 160 persons with medial knee osteoarthritis to wear either unloading shoes (intervention) or conventional walking shoes (comparator) daily for 6 months. At 6 months, both groups were assessed for pain with walking and physical function, among other secondary measures of improvement. They found that changes in pain and function did not differ between the intervention and comparator groups, with both showing improvements that generally were clinically relevant.
The authors of an accompanying editorial point out that the patients in both treatment groups received new shoes to wear during the trial period. They write, "It has been said that 'Cinderella is proof that a new pair of shoes can change your life.' Wouldn't it be wonderful if a simple pair of new shoes could help your patients with knee osteoarthritis?"
Note: For an embargoed PDF or contact information for one of the authors, please contact Cara Graeff. To reach authors, Dr. Kim Bennell or Dr. Rana Hinman, please contact Liz Lopez at lopez.e@unimelb.edu.au or +61 3 834 42704.
2. Experts offer practical advice for reducing risk for Zika and other mosquito-borne illnesses
Free content: http://www.annals.org/article.aspx?doi=10.7326/M16-1397
URL goes live when the embargo lifts
Infectious disease experts offer advice for limiting mosquito-borne illnesses, such as Zika, dengue, and chikungunya viruses. Their tips are published in Annals of Internal Medicine with links to relevant websites where the public can access free, up-to-date information. In brief, the tips include:
- Limit travel to areas with active transmission of mosquito-borne illnesses. Pregnant women should avoid travel to areas with Zika transmission due to the risk for fetal microcephaly.
- Wear long sleeves and long pants and keep feet covered when outside.
- Consistently use Environmental Protection Agency-registered insect repellents with the active ingredients DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-3,8-diol.
- Use bed nets at night, especially in areas where malaria is present.
- Reduce mosquitoes outdoors by eliminating breeding areas, such as standing water. Use foggers or indoor insect sprays to kill mosquitoes inside the home.
The experts caution that persons who have been exposed to a mosquito-borne illness should continue to minimize the likelihood of being bitten by mosquitoes to reduce the possible transmission to household members or within the community. Travelers returning to the mainland United States from an area with Zika virus should take steps to prevent mosquito bites for 3 weeks after their return so they do not spread the virus to uninfected mosquitoes, even if they are not experiencing any symptoms. These persons should also follow the CDC's recommendations for limiting sexual transmission of Zika through abstinence or the consistent and correct use of condoms.
Note: For an embargoed PDF, please contact Cara Graeff. Interviews are being coordinated by Sue McGreevey at smcgreevey@mgh.harvard.edu or 617-724-2764.
3. Multicomponent quality improvement strategies double diabetes control
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2807
URL goes live when the embargo lifts
A multicomponent quality improvement (QI) strategy comprised of nonphysician care coordinators and decision-support electronic health records can help to improve achievement of diabetes care goals, even in resource-challenged clinics. Findings from the randomized, controlled trial are published in Annals of Internal Medicine.
Diabetes is one of the most prevalent and burdensome chronic disease worldwide. Diabetes management focuses on reducing patients' risk for complications through control of blood glucose levels, blood pressure, and lipid levels, and avoidance of tobacco. However, large gaps exist between achievement of care goals and actual practice worldwide. QI interventions directed at patients (reminders), providers (guideline prompts), and health systems (institutionalizing a "culture of quality") can improve adherence, risk factor control, and patient satisfaction, but has not been tested in South Asia.
Researchers compared the effect of a multicomponent diabetes QI strategy versus usual care in South Asia, where resources are limited and diabetes is prevalent. Approximately 1,150 patients with diabetes and poor cardiometabolic profiles were randomly assigned to a multicomponent QI strategy or usual care for 2.5 years. They found that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared with usual care. The authors suggest that implementation of multicomponent QI strategies could help to preserve quality of life for millions of diabetes sufferers.
Note: For an embargoed PDF, please contact Cara Graeff. Interviews are being coordinated by Holly Korschun at hkorsch@emory.edu or 404-727-3990.
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Also new in this issue:
Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care
Allan S. Detsky, MD, PhD, and Michael A. Gropper, MD, PhD
Ideas and Opinions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0820
Journal
Annals of Internal Medicine