Wasim Baqir, William K. Gray, Alistair Blair, Shona Haining, Fraser Birrell
Background
Group consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.
Objective
To show effectiveness in other musculoskeletal conditions with other professionals.
Hypothesis
Group consultations as effective as one-to-one consultations for treating patients at risk of osteoporotic fracture, defined by 10-year fracture risk.
Design
Randomized controlled non-inferiority trial, with parallel groups randomized by patient
Setting
Three primary care practices, Northumberland, United Kingdom
Patients
A total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10-year fracture risk group.
Interventions
Pharmacist-led clinic appointment either in one of four 90-min group consultations (n = 75) or comparator usual care consultation (n = 83).
Measurements
Primary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.
Results
Ten-year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23-0.92) for group and 0.54 (IQR = 0.15-0.92) for usual care (confirmed as non-inferior).
Limitations
Single pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.
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Thomas R. Wood BM, BCh, PhD, Guðmundur F. Jóhannsson MD
The recent impact of SARS-CoV-2 and coronavirus disease 2019 (COVID-19) has shown major differences in infrastructure and approach across healthcare systems worldwide. One thing we can already be certain of is that governments and policy makers worldwide will place a greater focus on pandemic preparedness in the future. However, as well as ensuring that robust pipelines for rapid test, highly effective treatment or vaccine, and personal protective equipment (PPE) production are in place, we must address underlying resilience and susceptibility of our populations to infectious disease. Although the true spread and case fatality rate of SARS-CoV-2 may not be known for several months or even years, what is becoming increasingly clear is the significant degree to which underlying conditions associated with suboptimal metabolic health appear to be associated with poor outcomes in those with COVID-19. Considering the nature of these underlying conditions, such as obesity and hypertension, lifestyle-based approaches are likely to be one of our best tools in order to address ongoing and future disease burden during pandemics.
{"title":"Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness","authors":"Thomas R. Wood BM, BCh, PhD, Guðmundur F. Jóhannsson MD","doi":"10.1002/lim2.2","DOIUrl":"10.1002/lim2.2","url":null,"abstract":"<p>The recent impact of SARS-CoV-2 and coronavirus disease 2019 (COVID-19) has shown major differences in infrastructure and approach across healthcare systems worldwide. One thing we can already be certain of is that governments and policy makers worldwide will place a greater focus on pandemic preparedness in the future. However, as well as ensuring that robust pipelines for rapid test, highly effective treatment or vaccine, and personal protective equipment (PPE) production are in place, we must address underlying resilience and susceptibility of our populations to infectious disease. Although the true spread and case fatality rate of SARS-CoV-2 may not be known for several months or even years, what is becoming increasingly clear is the significant degree to which underlying conditions associated with suboptimal metabolic health appear to be associated with poor outcomes in those with COVID-19. Considering the nature of these underlying conditions, such as obesity and hypertension, lifestyle-based approaches are likely to be one of our best tools in order to address ongoing and future disease burden during pandemics.</p>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lim2.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44347854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When first drafting this inaugural editorial in November 2019, events were already starting to unfold on the other side of the world, which would lead to the current pandemic, transform all of our lives and cause a still-mounting death toll. We now know that the first case of what is now named COVID-19 was traced back to 17 November 2019 in Wuhan, Hubei province, China and that at least 266 people were infected last year,1 despite initial reports suggesting the very end of December for case zero. However, this version of events was inconsistent with a case identified retrospectively from a retained swab in France taken 27 December 2019 (BBC, 2020)2, although this report is awaiting confirmation from the French Government. Sequencing supports a current scientific consensus that the SARS-CoV2 coronavirus is of natural origin, with 96% homology with a bat coronavirus (RaTG13) and all six key residues from the pangolin spike receptor-binding domain.3 We know the SARS virus had further outbreaks after the initial outbreak on at least four occasions at three labs in China, Taiwan, and Singapore.4 However, in May 2020 speculation continues about whether patterns of mobile phone activity in October 2019 indicate a “hazardous event” between 6 and 11 October causing a shutdown of the Wuhan Institute of Virology.5
There have been a variety of commentators, with academic leadership from the New England Journal,6JAMA,7 and Lancet,8 with Richard Horton critical about the unheeded timely warnings about testing and personal protective equipment (PPE) requirements. Changes in UK advice on staff use of PPE in hospital outpatients in May, plus patients and other visitors and public transport users using face coverings from June have brought guidance in line with the practice of those of us informed by both the ecological evidence from countries who have coped well with the pandemic and the precautionary principle. Trish Greenhalgh has been highly influential on Twitter and in print on the revision of this guidance (Greenhalgh et al, 2020).9 However, some of the most useful literature has been open access and online. For example, Tomas Pueyo is a Silicon Valley online educator, who rose to international prominence with a razor-sharp, insightful, comparative international analysis on the causes and consequences of failing to arrest spread of such an infectious and relatively deadly pathogen10 and the subsequent impact of relaxing control measures.11 As I write the first revision, these articles have been viewed 40 million and 10 million times, respectively, with a total of 60 million by the time of publication. The reasons why this was so powerful include it being a fresh persp
当2019年11月首次起草这篇就职社论时，世界另一端的事件已经开始展开，这将导致当前的疫情，改变我们所有人的生活，并造成仍在增加的死亡人数。我们现在知道，第一例现在被命名为新冠肺炎的病例可追溯到2019年11月17日，发生在中国湖北省武汉市，去年至少有266人感染，1尽管最初的报告表明12月底为零病例。然而，这一版本的事件与2019年12月27日在法国采集的保留拭子中回顾性发现的病例不一致（BBC，2020）2，尽管该报告正在等待法国政府的确认。测序支持了目前的科学共识，即SARS-CoV2冠状病毒是自然起源的，与蝙蝠冠状病毒（RaTG13）和穿山甲刺突受体结合结构域的所有六个关键残基具有96%的同源性。3我们知道，在最初爆发后，SARS病毒在中国、台湾和新加坡的三个实验室至少四次进一步爆发。4然而，2020年5月，关于2019年10月手机活动模式是否表明10月6日至11日发生了导致武汉病毒研究所关闭的“危险事件”的猜测仍在继续，8 Richard Horton对有关测试和个人防护装备（PPE）要求的未被注意的及时警告提出批评。5月份，英国对医院门诊患者员工使用个人防护装备的建议发生了变化，从6月份开始，患者和其他访客以及公共交通工具使用者使用口罩，这使指导与我们这些从应对疫情良好的国家获得的生态证据和预防原则中获得的指导一致。Trish Greenhalgh在推特和印刷品上对本指南的修订具有很大影响力（Greenhalgh等人，2020）。8然而，一些最有用的文献是开放获取和在线的。例如，托马斯·普约（Tomas Pueyo）是一位硅谷的在线教育工作者，他凭借对未能阻止这种传染性和相对致命的病原体传播的原因和后果10以及放松控制措施的后续影响的敏锐、深刻、可比的国际分析而在国际上崭露头角，这些文章的浏览量分别为4000万次和1000万次，截至《公共报》时，总浏览量为6000万次-
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Pub Date : 2019-04-17DOI: 10.1201/9781315201108-33
D. Bruno, N. Berger
{"title":"Lifestyle Approaches Targeting Obesity to Reduce Cancer Risk, Progression, and Recurrence","authors":"D. Bruno, N. Berger","doi":"10.1201/9781315201108-33","DOIUrl":"https://doi.org/10.1201/9781315201108-33","url":null,"abstract":"","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43310344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9781315201108-57
K. Carlson
{"title":"Prevention, Screening, and Treatment of Sexually Transmitted Infections","authors":"K. Carlson","doi":"10.1201/9781315201108-57","DOIUrl":"https://doi.org/10.1201/9781315201108-57","url":null,"abstract":"","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43270219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9781315201108-60
O. Bilen, N. Wenger
{"title":"Medication Dosing and Adherence in Secondary Prevention","authors":"O. Bilen, N. Wenger","doi":"10.1201/9781315201108-60","DOIUrl":"https://doi.org/10.1201/9781315201108-60","url":null,"abstract":"","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42107717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9781315201108-107
J. Ellery, P. Ellery
{"title":"The Community as a Catalyst for Healthier Behaviors","authors":"J. Ellery, P. Ellery","doi":"10.1201/9781315201108-107","DOIUrl":"https://doi.org/10.1201/9781315201108-107","url":null,"abstract":"","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49303228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9781315201108-31
G. Guthrie
{"title":"Implementing Nutritional Lifestyle Treatment Programs in Type 2 Diabetes","authors":"G. Guthrie","doi":"10.1201/9781315201108-31","DOIUrl":"https://doi.org/10.1201/9781315201108-31","url":null,"abstract":"","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49605451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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