Lynn Kilbride

Many patients with metastatic spinal cord compression (MSCC) have spinal instability but are determined, by their clinician, to be unsuitable for surgical internal fixation due to their advanced disease. Mobilisation may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (or mobilisation) and spinal bracing is contradictory. To investigate the correct positioning (or mobilisation) and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse and PEDro database were searched; the last search was run in February 2012. We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning or mobilisation and bracing. Two review authors independently assessed each possible study for inclusion and quality. One thousand, six hundred and eleven potentially relevant studies were screened. No studies met the inclusion criteria. Many papers identified the importance of mobilisation but no RCTs have been undertaken. No RCTs of bracing in MSCC were identified. There is lack of evidence based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area. Positionnement (mobilisation) et corsetage du patient pour le soulagement de la douleur et la stabilisation de la colonne vertébrale dans la compression médullaire métastatique chez l'adulte De nombreux patients souffrant de compression médullaire métastatique (CMM) ont une instabilité vertébrale mais leur médecin les considère inaptes à une fixation chirurgicale interne en raison du stade avancé de leur maladie. En cas d'instabilité vertébrale la mobilisation peut être dangereuse car un tassement vertébral supplémentaire pourrait se produire. Les directives actuelles sur le positionnement (ou la mobilisation) et les corsets vertébraux sont contradictoires. Rechercher le positionnement (ou la mobilisation) correct et examiner les effets du corsetage vertébral dans le soulagement de la douleur ou la prévention de tassements vertébraux supplémentaires chez les patients souffrant de CMM. Nous avons effectué une recherche dans le registre Cochrane des essais contrôlés (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse et la base de données PEDro ; la dernière recherche a été menée en février 2012. Nous avons sélectionné des essais contrôlés randomisés (ECR) d'interventions de positionnement ou mobilisation et corsetage sur des adultes atteints de CMM. Deux auteurs ont évalué de manière indépendante l'éligibilité à l'inclusion et la qualité de chaque étude possible. Mille six cent onze études potentiellement pertinentes ont été examinées. Aucune étude ne remplissait les critères d'inclusion. De nombreux articles avaient noté l'importance de la mobilisation, mais aucun ECR n'a été entrepris. Aucun ECR sur le corsetage pour CMM n'a été identifié. On manque de données factuelles pour définir des directives concernant la façon de positionner et quand mobiliser les patients atteints de CMM, et pour établir si le corsetage est une technique efficace pour réduire la douleur ou améliorer la qualité de vie. Des ECR sont nécessaires sur cet important sujet.

Aims and objectives.  To enable people with Type 1 diabetes to exercise safely by investigating the reproducibility of the glucose response to an algorithm for carbohydrate and insulin adjustment during and after exercise compared to their self‐management strategies.Background.  Difficulties in managing blood glucose levels in Type 1 diabetes whilst exercising is known to deter people from exercise. Currently there is a limited evidence base to aid health care professionals enable people with diabetes to exercise safely. This study seeks to address this gap.Design.  A quasi‐experimental study was undertaken amongst people with Type 1 diabetes.Methods.  Over 14 days, 14 participants undertook four exercise sessions (40 minutes at 50%VO_2max). Two sessions were undertaken in week 1 self‐managing their diabetes and two sessions in week 2 using an algorithm for carbohydrate and insulin adjustment.Results.  The mean reduction of glucose levels detected by Continuous Glucose Monitoring during exercise was 3·1 (SD 2·03) mmol/l. Time spent within the range of 4–9 mmol/l during exercise was not significantly different between the self‐managed and the algorithm weeks (−3–22·4 min). The mean reduction of blood glucose for each individual over all four exercise sessions ranged between 0·8–5·95 mmol/l. The technical error between days one and two was 2·4 mmol/l (CV = 33·2%) and between days 3–4 the technical error was 2·7 mmol/l (CV = 33·7%).Conclusions.  The results provide useful data about the reproducibility of the blood glucose response to moderate intensity exercise, despite the variability of individual responses 40 minutes of moderate intensity exercise decreases Continuous Glucose Monitoring glucose by 3 mmol/l with or without a 30% decrease of insulin before exercise.Relevance to clinical practice.  This information provides valuable baseline information for people with diabetes and health care professionals who wish to encourage physical activity and undertake further research in this area.

If you wish to read an English version of this article please contact Siew Hwa Lee. Aim and objectives - The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background - Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment. Design - A structured literature review to synthesise the available evidence about the management of MSCC. Methods - The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included. Results - The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. Conclusion - Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. Relevance to clinical practice - Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit

Introduction Between surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy. Methods A prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively. Results Analysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients. Conclusion Anxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms.