SUMMARYBackground: Nutcracker oesophagus is characterized by high-amplitude oesophageal contractions. Recent data have shown a high prevalence of gastro-oesophageal acid reflux in patients with nutcracker oesophagus and, in open-label trials, patients seemed to benefit from acid suppression. Therefore, it has been suggested that noncardiac chest pain in patients with nutcracker oesophagus may be related to reflux rather than to the motor abnormality itself. Aims: To investigate the effect of intensive acid-suppressive treatment on chest pain in patients with nutcracker oesophagus. Methods: Nineteen patients with nutcracker oesophagus received lansoprazole or placebo in a double-blind, randomized, cross-over study.
Objectives To investigate (1) the cumulative incidence proportion and the most common anatomical locations of running-related injuries in recreational runners, and (2) the associations between running-related injuries and previous injury, running experience, weekly running distance, age, sex, and body mass index. Design A 1-year prospective cohort study. Methods Two hundred twenty-four recreational runners (average weekly running distance for the past 12 months, 15 km) were included (89 women, 135 men). Pain information was reported weekly for 1 year, and all running-related injuries that resulted in time loss or medical consultation were recorded. We accounted for censoring when calculating cumulative incidence proportion, and used crude Cox proportional hazards regression to evaluate whether the variables of interest were associated with running-related injuries. Results The 1-year cumulative incidence proportion of running-related injuries was 45.9% (95% confidence interval [CI]: 38.4%, 54.2%). The most common anatomical locations were the knee (20/75, 27%) and Achilles tendon/calf (19/75, 25%). Previous injury was associated with a higher injury rate (hazard rate ratio = 1.9; 95% CI: 1.2, 3.2), while the other variables had no statistically significant association with injury. Conclusion There were 75 running-related injuries during the 1-year surveillance period, for a cumulative incidence proportion of 46%. The most common injuries were to the knee and Achilles tendon/calf. Recreational runners with a previous injury were twice as likely to sustain a running-related injury as runners with no previous injury. J Orthop Sports Phys Ther 2021;51(3):144–150. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9673
Background
Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies.
Method
In order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing.
Conclusion
Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.
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