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STUDY DESIGN A prospective, single-arm, pre-postintervention study. OBJECTIVE The aim of this study was to test the preliminary effectiveness of a patient-led goal-setting intervention on improving disability and pain in chronic low back pain. SUMMARY OF BACKGROUND DATA An effective intervention for the treatment of chronic low back pain remains elusive despite extensive research into the area.An intervention using patient-centered goal setting to drive intervention strategies and encourage self-management for patients suffering chronic low back was developed. METHODS A single group longitudinal cohort pilot study was conducted. Twenty participants (male = nine) experiencing chronic low back pain were involved in a patient-led goal-setting intervention, facilitated by a physiotherapist over a 2-month period with two monthly follow-up sessions after treatment conclusion. Participants, guided by the therapist, identified problem areas of personal importance, defined goals, and developed evidence-based strategies to achieve the goals. Participants implemented the strategies independently between sessions. Primary outcome measures of disability and pain intensity were measured at baseline, 2, and 4 months. Secondary measures of quality of life, stress and anxiety, self-efficacy, and fear of movement were also taken. RESULTS Significant improvements (repeated analysis of variance P

Background: Since Left Ventricular Assist Devices were approved in the US for destination therapy, there has been a rapid increase in their use. Information on the cost of advanced heart failure management (AHF), transplant (HTX) and VAD programs is variable across health systems, as most cost data is derived from casemix costing, charges or claims against insurers. This weakens comparative studies as eligible AHF patients are cost outliers in the broader heart failure population. We outline a cost effectiveness study of VAD therapy vs AHF as part of an HTX program, using Time Driven Activity Based Costing of identified models of care in an Australian setting. Methods: All patients activated to the HTX waitlist between 07/2009 and 06/2012 (n=101) were screened and 86 included (62 AHF, 24 VAD). Models of care were defined through 13/86 file reviews, clinician interviews and analysis of activity. Detailed costing was undertaken for 5 VAD and 8 AHF patients for 12 months pre and post HTX listing or VAD implant and included medical, allied health, nursing activities, inpatient care and clinic visits (ClinV), consumables, drugs, pathology, medical imaging, and prosthetics. Results: Mortality at 1 yr was 12% (3/24) for VADs post implant and 11% (7/62) for AHF post HTX activation. 148 service activities were identified in 13 file reviews ranging from basic documentation to ECMO insertion. The two groups were matched for age, AHF etiology and gender. In house database interrogation yielded a median pathology cost per patient of $4811 in 17/24 Pre VAD, and $12,294 in 20/24 Post VAD patients,. Median allied Health cost for 19/24 Pre VAD patients was $545 and in 23/24 Post VAD was $2938 ($AUD) Hospitalisations and costs borne beyond the transplant center made comparison between VAD therapy and AHF incomplete. Conclusion: The BTT VADs were sicker, with more days hospitalized pre and post VAD. From an institutional and health system perspective, correct identification of, and reimbursement for activities related to best practice models of care is crucial. Cost effectiveness, capturing costs borne at other hospitals as well as federal, drug and GP reimbursements should be addressed in this cohort.

Background and Purpose —Acute disruption of atherosclerotic plaques precedes the onset of clinical syndromes, and studies have implicated a role for matrix metalloproteinases (MMPs) in this process. The aim of this study was to establish the character, level, and expression of MMPs in carotid plaques and to correlate this with clinical status, cerebral embolization, and histology. Methods —Plaques were obtained from 75 consecutive patients undergoing carotid endarterectomy and divided into 4 groups according to symptomatology (group 1, asymptomatic; group 2, symptomatic >6 months before surgery; group 3, symptomatic within 1 to 6 months; group 4, symptomatic within 1 month). All patients underwent preoperative and intraoperative transcranial Doppler monitoring. Plaques were subjected to histological examination and quantification of MMPs by zymography and ELISA. Results —The level of MMP-9 was significantly higher in group 4 (median 125.7 ng/mL for group 4, median P =0.003), with no difference in the levels of MMPs 1, 2, or 3. Furthermore, the MMP-9 concentration was significantly higher in plaques undergoing spontaneous embolization ( P =0.019) and those with histological evidence of plaque instability ( P Conclusions —The concentration, production, and expression of MMP-9 is significantly higher in unstable carotid plaques. If this proves to be a causal relationship, MMP-9 may be a strong candidate for pharmacotherapy aimed at stabilizing plaques and preventing stroke.