Screening for problematic low back pain: STarT.
Screening for problematic low back pain: STarT.
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筛查有问题的腰痛：STarT。
DOI：
10.1016/j.pain.2012.07.018
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发表时间：
2012
期刊：
影响因子：
7.4
通讯作者：
George,StevenZ
中科院分区：
文献类型：
--
作者：
Robinson,MichaelE;George,StevenZ
Back pain continues to be a costly and vexing public health problem leading to considerable suffering and loss of productivity. The study from Wideman et al. in this issue of PAIN and the body of work with a screening tool for assessing risk and tailoring treatment for back pain (STarT Back Screening Tool) preceding it, represent an important advance in providing a tool with strong potential for predicting outcome based on brief assessment of risk factors associated with poor prognosis for back pain [6]. Perhaps what is most compelling about the STarT Back Tool is the opportunity to identify patients at high risk for poor outcomes and offer, tailored psychologically informed treatment that results in improved outcomes when compared to standard care approaches [3]. Wideman et al. provide additional support for the use of the 9 item STarT Back Tool over full length questionnaires for depressive symptoms, disability, fear, and catastrophizing (ranging from 7 to 24 items). The reference questionnaires represented similar constructs to those included in the STarT Back Tool, so this study represents another test of its construct validity. Their analyses set a relatively high bar for success by requiring that the STarT Back Tool predict outcomes beyond that captured by the longer reference questionnaires. The new tool did so, and when the other instruments were not included in the regression models, the STarT tool predicted substantially large and clinically meaningful proportions of variance in outcome measures. This is an important finding because the STarT Back Tool was designed as a quick screening tool for primary care settings. Though speed of administration is important, the shortened tool must still capture clinically relevant information. The STarT Back Tool appears to meet that goal. In settings where there are time constraints and reimbursement pressures, ease of use for both patient and provider is critical. The STarT Back Tool appears to meet these goals too, although the study itself does not provide a direct metric of time to complete, or ease of administration. The STarT Back Tool was originally designed for risk assessment but Wideman et al. addressed the sensitivity of the STarT Back Tool to treatment change in their current paper. Correlations of change scores between the STarT tool and longer measures of psychological distress indicated a sensitivity to change in disability, pain, and global improvement (particularly in the High Risk STarT subgroup). This suggests that the STarT Back Tool may have value for treatment monitoring in determining whether a favorable outcome is likely. The authors’ data indicated that a STarT Back Tool change of 3 to 5 points (or a one category improvement) was likely to result in clinically meaningful improvements providing a reasonable treatment target in response to initial treatment. Patients not improving this amount could be considered candidates for additional treatment focused on psychological distress to prevent transition to chronic stages of low back pain. Another notable strength of this study is the use of a primary care sample of patients with low back pain. Primary care settings represent the most likely medical setting for early intervention or referral of patients, and may provide an opportunity for altering the course of chronicity or reducing the high costs for chronic back pain. Though the primary care setting is a strength of the study, readers should realize that results of the present study may not generalize to other treatment settings that commonly encounter patients with low back pain. To this extent, additional work to establish the generalizability of the STarT Back Tool in other clinical settings would be helpful …
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钠离子刺激大鼠心房释放心钠素（ANP）。
DOI：
10.1016/0006-291x(85)91032-0
发表时间：
1985
影响因子：
3.1
作者：
O. Arjamaa;O. Vuolteenaho
通讯作者：
O. Vuolteenaho
心房钠尿因子释放的细胞机制。
DOI：
--
发表时间：
1984
期刊：
Biochemical and Biophysical Research Communications - BBRC
影响因子：
--
作者：
Harald Sonnenberg;A. Veress
通讯作者：
A. Veress
刺激分泌耦合：嗜铬细胞和其他细胞的概念和线索
影响因子：
7.3
作者：
W. Douglas
通讯作者：
W. Douglas
通过心房扩张从大鼠心肺制剂中释放钠尿因子。
DOI：
10.1152/ajpregu.1984.247.6.r1093
发表时间：
1984
期刊：
The American journal of physiology
影响因子：
--
作者：
Dietz,JR
通讯作者：
Dietz,JR
灌注大鼠分离垂体前叶细胞柱作为控制促肾上腺皮质激素释放的因子的生物测定：技术验证。
影响因子：
4.8
作者：
G. Gillies;P. Lowry
通讯作者：
P. Lowry