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Am Fam Physician. 1998;58(2):492-495

Early Treatment of Plantar Fasciitis May Eliminate Need for Surgery

(Annual Winter Meeting of the American Orthopaedic Foot and Ankle Society) Responding to plantar fasciitis quickly with a conservative care program can be an effective way to alleviate pain, according to results of a study of 120 patients with plantar fasciitis. The study evaluated a four-part care program that included stretching exercises, use of cushioned heel pads in shoes, oral anti-inflammatory medication and the use of a splint worn during sleep. The patients were taught an exercise regimen by a physical therapist. The regimen consisted of simple stretching exercises performed three times daily for 20 minutes. The patients were allowed to choose the treatment that suited them best. All of the patients reported doing the exercises, 95 percent used the splint during sleep, 48 percent took the medication, 44 percent used an over-the-counter shoe insert and 47 percent used a custom orthotic. Complete satisfaction was reported in 84 percent of the patients. The most important factor in the effective repair of plantar fasciitis was beginning treatment soon after the onset of symptoms. Patients who began treatment within one year of the onset of symptoms had better outcomes than those who waited longer to seek treatment.—steven conti, m.d., et al., University of Pittsburgh (Pennsylvania) School of Medicine.

Short Exercise Sessions May Be Effective in the Treatment of Obesity

(Annual Meeting of the Society of Behavioral Medicine) Results of a study of clinically obese women indicate that several 10-minute sessions of exercise at home with exercise training equipment may be the most effective exercise program for obese individuals. In the study, 139 sedentary, clinically obese women were randomly assigned to one of three behavioral weight-control programs that lasted for 20 weeks. The women were asked to reduce their fat and caloric intake. Each group exercised five days a week, gradually increasing the duration of exercise from 20 to 40 minutes daily. One group exercised in one continuous session, while the other two groups divided their exercise regimen into several 10-minute sessions. The women in one of the groups doing the short-duration exercise were provided with home exercise equipment. The women given the home exercise equipment maintained higher levels of exercise participation during the study. The investigators believe that short-duration exercise sessions at home are a good beginning for effective weight control.—john m. jakicic, ph.d., et al., University of Pittsburgh (Pennsylvania) School of Medicine.

Thrombolytic Therapy for Stroke Is Successful in a Community Setting

(50th Annual Meeting of the American Academy of Neurology) Results of an ongoing study at 31 hospitals in Minnesota indicate that the use of tissue-type plasminogen activator (tPA) in patients with acute stroke can be effective in a community setting as well as in large academic settings. The study was undertaken to determine if the clinical outcomes and the hemorrhagic complications in patients treated with tPA in community hospitals compared favorably with the outcomes observed in the National Institute of Neurological Disorders and Stroke (NINDS) study. The NINDS study included academic and community hospitals, many with specialized stroke programs. Of the 97 patients studied in Minnesota, 24 were treated at large academic hospitals and 73 were treated at community hospitals. Nine of the 97 patients had significant hemorrhages associated with the use of tPA, resulting in a worsening condition within 36 hours of treatment. Although this number of patients with significant hemorrhages is higher than the number in the NINDS study, the difference is not statistically significant. An unexpected finding in the study was that some of the patients with significant hemorrhages showed no or almost no signs of disability three months after the stroke. The specialties of the treating physicians in the Minnesota study included neurology, emergency department medicine and family practice. The investigators continue to collect information to further document the trends in clinical practice and outcomes of stroke patients treated with intravenous tPA.—sandra k. hanson, m.d., et al., Park Nicollet Clinic, Minneapolis, Minnesota.

Donepezil Improves Behavioral Symptoms in Alzheimer's Disease

(American Academy of Neurology) Use of donepezil improves behavioral symptoms as well as cognitive abilities in patients with Alzheimer's disease. This was the conclusion of an open-label treatment study of 40 consecutive patients (25 women and 15 men) with Alzheimer's disease in a university clinic. The study also showed a significant reduction in the stress levels of the patients' caregivers. The optimal dose of donepezil was determined by a standard dose titration schedule. Outcomes were assessed using the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory Severity (NPI-S) and Caregiver Distress (NPI-D) subscales and an abridged form of the Relatives' Stress Scale (RSS). Fourteen subjects had a 3-point or more increase in MMSE scores, and 15 subjects had a 4-point or more decrease in NPI-S scores. Among the five subjects who met both criteria, four had extrapyramidal features. Significant mean reduction in NPI-D and RSS scores were also observed in the caregivers. The investigators believe that an improvement in behavioral symptoms is important because behavioral symptoms are closely associated with caregiver distress.—daniel i. kaufer, m.d., et al., University of Pittsburgh (Pennsylvania) Alzheimer's Disease Research Center.

Study Evaluates Use of Metrifonate in Patients with Alzheimer's Disease

(American Academy of Neurology) A 26-week study of 1,218 persons with mild to moderate Alzheimer's disease found that metrifonate significantly improved patients' ability to perform basic and instrumental activities of daily living such as dressing and eating, as well as other activities such as making a telephone call and doing housework, when compared with patients given a placebo. The patients were randomly assigned to three double-blind placebo controlled arms of the study. A total of 411 patients received placebo once daily, 622 received low-dose metrifonate once daily (50-mg fixed dose or 30- to 60-mg dose, based on weight) and 185 received high-dose metrifonate (60 or 80 mg, based on weight). The efficacy of metrifonate was assessed using the Disability Assessment for Dementia (DAD). After 26 weeks of treatment, the composite DAD score was improved in both groups of patients receiving metrifonate, when compared with the group receiving placebo. In a dose-related manner, metrifonate enhanced the ability of patients to dress and to use the telephone. The higher dose also increased patients' ability to eat and to perform leisure and housework activities.—isabelle gelinas, ph.d., et al., McGill University, Montreal, Quebec, Canada.

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