BackgroundNeck and shoulder disorders may be linked to the presence of myofascial trigger points (MTrPs). These disorders can significantly impact a person’s activities of daily living and ability to work. MTrPs can be involved with pain sensitization, contributing to acute or chronic neck and shoulder musculoskeletal disorders. The aim of this review was to synthesise evidence on the prevalence of active and latent MTrPs in subjects with neck and shoulder disorders.MethodsWe conducted an electronic search in five databases. Five independent reviewers selected observational studies assessing the prevalence of MTrPs (active or latent) in participants with neck or shoulder disorders. Two reviewers assessed risk of bias using a modified Downs and Black checklist. Subject characteristics and prevalence of active and latent MTrPs in relevant muscles was extracted from included studies.ResultsSeven articles studying different conditions met the inclusion criteria. The prevalence of MTrPs was compared and analysed. All studies had low methodologic quality due to small sample sizes, lack of control groups and blinding. Findings revealed that active and latent MTrPs were prevalent throughout all disorders, however, latent MTrPs did not consistently have a higher prevalence compared to healthy controls.ConclusionsWe found limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders. Point prevalence estimates of MTrPs were based on a small number of studies with very low sample sizes and with design limitations that increased risk of bias within included studies. Future studies, with low risk of bias and large sample sizes may impact on current evidence.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2157-9) contains supplementary material, which is available to authorized users.

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Pain was controlled in 20 post-thoracotomy patients using a continuous infusion of 0.25% bupivacaine through an extradural or para-vertebral catheter. Both techniques provided good analgesia. Hypotension and urine retention occurred significantly less frequently in the paravertebral than in the extradural group.

Great pressure has recently been put on clinicians by hospital managers and politicians to reduce waiting times. Unfortunately, the emphasis of current initiatives on waiting lists tends to be on reducing the wait for surgery rather than the waiting time for an appointment at an outpatient clinic. We report the potential dangers of long waiting times for a routine outpatient appointment at a urology clinic. Patients, methods, and resultsOver the past three years 55 patients with symptoms of bladder outflow obstruction were recruited for two clinical trials. These patients were recruited from the waiting list of new patients which comprised patients who had been classified as having routine conditions by the consultant on the basis of the information in the referral letter. Recruitment into the trials depended on patients satisfying the entry criteria and giving their informed consent. The protocols for the trials were approved by the ethical committee. The average wait for these patients who were seen outside the normal times of outpatient clinics, was 13 (range 3-104) weeks. All Correspondence to:Dr Compston. BMJ 1993;306:429-30 Effect oflong term tamoxifen treatment on bone turnover in women with breast cancerThe non-steroidal antioestrogen tamoxifen is widely used to treat breast cancer, predominantly in postmenopausal women.

Introduction: Continuous positive airway pressure (CPAP) improves outcomes in patients with respiratory distress. Additional benefits are seen with CPAP application in the prehospital setting. Theoretical safety concerns regarding Basic Life Support (BLS) providers using CPAP exist. In Delaware's (USA) two-tiered Emergency Medical Service (EMS) system, BLS often arrives before Advanced Life Support (ALS). Hypothesis: This study fills a gap in literature by evaluating the safety of CPAP applied by BLS prior to ALS arrival. Methods: This was a retrospective, observational study using Quality Assurance (QA) data collected from October 2009 through December 2012 throughout a state BLS CPAP pilot program; CPAP training was provided to BLS providers prior to participation. Collected data include pulse-oximetry (spO2), respiratory rate (RR), heart rate (HR), skin color, and Glasgow Coma Score (GCS) before and after CPAP application. Pre-CPAP and post-CPAP values were compared using McNemar's and t-tests. Advanced practitioners evaluated whether CPAP was correctly applied and monitored and whether the patient condition was "improved," "unchanged," or "worsened." Results: Seventy-four patients received CPAP by BLS; CPAP was correctly indicated and applied for all 74 patients. Respiratory status and CPAP were appropriately monitored and documented in the majority of cases (98.6%). A total of 89.2% of patients improved and 4.1% worsened; CPAP significantly reduced the proportion of patients with SpO2 < 92%, RR > 24, and cyanosis (P < .01). The GCS improved from mean (standard deviation [SD]) 13.9 (SD = 1.9) to 14.1 (SD = 1.9) after CPAP (mean difference [MD] = 0.17; 95% CI, -0.49 to 0.83; P = .59). The HR decreased from 115.7 (SD = 53) to 105.1 (SD = 37) after CPAP (MD = -10.9; 95% CI, -3.2 to -18.6; P < .01). The SpO2 increased from 80.8% (SD = 11.4) to 96.9% (SD = 4.2) after CPAP (MD = 17.8; 95% CI, 14.2-21.5; P < .01). Conclusion: The BLS providers were able to determine patients for whom CPAP was indicated, to apply it correctly, and to appropriately monitor the status of these patients. The majority of patients who received CPAP by BLS providers had improvement in their clinical status and vital signs. The findings suggest that CPAP can be safely used by BLS providers with appropriate training.Sahu N, Matthews P, Groner K, Papas MA, Megargel R. Observational study on safety of prehospital BLS CPAP in dyspnea. Prehosp Disaster Med. 2017;32(6):610-614. IntroductionRespiratory distress often results from conditions such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma exacerbation, and pneumonia.