A qualitative exploration of GPs’perspectives on managing chronic nonspecific musculoskeletal pain in Australian general practice-a focus group study

Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully understood,which makes diagnosis and management challenging.As general practitioners(GPs)are central to the management of chronic pain,their perspectives on managing CNMP are important.Purpose:To explore the clinical reasoning GPs use when diagnosing and managing CNMP.Methods:A qualitative study design using focus group discussion was conducted with Australian GPs.Five focus group discussion were conducted across Adelaide.All focus group discussions were audio-recorded,and transcripts were coded and analyzed thematically with the program NVivo.Results:The main themes remained consistent across the five focus group discussion’s:the ambiguous cause of CNMP;sex differences;developing the“right strategy”;patient-centered care;and verifying vitamin D levels.Conclusion:The findings show that GPs use a patient-centered approach tailored to indi-vidual patients’medical history,physical examination findings,and psychosocial health.There was general concern about low levels of vitamin D in patients with CNMP,and vitamin D supplements were recommended if indicated by a patient’s history.

Enhanced Gene Expression Following Vaccination in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Vaccines have been shown to cause differential expression of genes and increase antibody titers against antigens. Influenza vaccines may have an effect on unexplained disorders such as Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Immunological changes have been identified following immunization with trivalent influenza vaccine (TIV). The objective of this pilot study was to examine the consequences of TIV on cytokine and cytotoxic genes in CFS/ME. Peripheral blood mononuclear cells were preferentially isolated from whole blood of 7 CFS/ME patients and 8 controls. Following total RNA extraction and synthesis of cDNA, reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) was used to determine the expression levels of mRNAs for cytotoxic genes (perforin (PRF1), granzyme A (GZMA), granzyme B (GZMB) and cytokine genes. GZMB was significantly increased overall in the CFS/ME patients compared to the controls. GZMA was significantly increased 28 days after vaccination while PRF1 was reduced prevaccination but increased 14 days post-vaccination in the CFS/ME patients. There were no significant changes in cytokine genes pre or post vaccination. Administration of TIV may increase the expression of lytic genes in CFS/ME and this may contribute to the increase in cytotoxic activity we observed in these patients post vaccination.

Staying psychologically safe as a doctor during the COVID-19 pandemic

INTRODUCTION As we face the ongoing global pandemic of COVID-19,doctors,nurses,ambulance officers,paramedics and many other health workers answer the call to serve in time-pressured,unfamiliar,chaotic and often-traumatic environments.1 We know how to look after ourselves in an infectious physical environment,but it is equally important to look after ourselves psychologically at this time.