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Backg round. Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. Objective. The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. Design. A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. Methods. Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. Results. Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as 'very useful' or 'quite useful.' Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. Limitations. The survey sample was relatively small and did not directly assess patient outcomes. Conclusions. An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy., Rotator cuff and labral repairs represent 2 of the most commonly performed shoulder surgical procedures. (1-4) Postoperative rehabilitation must balance the restoration of motion and function while maintaining the desired [...]

Background: Many approaches exist for managing rotator cuff tears. Purpose: To compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears. Data Sources: 12 electronic databases (1990 to September 2009), gray literature, trial registries, and reference lists were searched. Study Selection: Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. Operative studies in English-language publications and nonoperative and postoperative rehabilitation studies in English, French, or German were considered. Studies were assessed in duplicate. Data Extraction: 2 reviewers assessed risk for bias by using the Cochrane Risk of Bias tool and the Newcastle--Ottawa Scale. One reviewer rated the evidence by using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data were extracted by one reviewer and verified by another. Data Synthesis: 137 studies met eligibility criteria. All trials had high risk for bias. Cohort and uncontrolled studies were of moderate quality. Reported functional outcomes did not differ between open versus mini-open repair, mini-open versus arthroscopic repair, arthroscopic repair with versus without acromioplasty, or single-row versus double-row fixation. Earlier return to work was reported for mini-open repair versus open repair and for continuous passive motion with physical therapy versus physical therapy alone. Open repairs showed greater improvement in function than did arthroscopic debridement. Complication rates were low across all interventions. Limitations: Limited evidence, which was often of low quality, precluded conclusions for most comparisons. Language restrictions may have excluded some relevant studies, and selective outcome reporting may have introduced bias. Conclusion: Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive. Primary Funding Source: Agency for Healthcare Research and Quality.

The effects of plasma lipids on the clinical and angiographic parameters of 134 patients, in whom coronary angioplasty was in 157 vessels, were prospectively examined. During a 6-month follow-up, restenosis was detected angiographically in 39 patients (29%; 45 vessels). None of the clinical, biochemical, or angiographic variables examined was predictive of stenosis and the tendency of a vessel to restenose was not patient-dependent but rather lesion-related. However, restenosis developed in 31 of 102 vessels (300A) in patients with high-density lipoprotein (HDL) cholesterol [less than or equal to] 40 mg/dl, compared with restenosis in 10 of 55 vessels (19%) in patients with HDL cholesterol >40 mg/dl (p = 0.092). No significant differences were observed when restenosis rates were compared in patients with total cholesterol levels >250 mg/dl or 160 mg/dl and

Electrophysiologic studies have shown that intravenous magnesium sulfate prolongs atrioventricular (AV) nodal conduction and refractoriness and thus could play a role in the management of patients with paroxysmal AV reentrant supraventricular tachycardia (SVT). The present study evaluates the clinical and electrophysiologic effects of intravenous magnesium sulfate in patients with SVT and compares them with those of adenosine triphosphate (ATP), one of the most potent drugs in the treatment of this arrhythmia. Patients with inducible sustained SVT were treated with ATP (10 or 20 mg) and magnesium sulfate (2 g over 15 seconds) during electrophysiologic study. If the tachycardia failed to terminate by the sixth minute, an additional 2 g dose of magnesium was given. ATP (10 or 20 mg) was significantly better than magnesium for terminating induced tachycardias (14 of 14 vs 6 of 14, p

Disease of the coronary arteries, the major blood vessels supplying the heart, frequently results in sudden death. Ventricular arrhythmias, or abnormal heart rhythms arising in the ventricles, are a common cause of sudden death, and may be the only symptom of coronary artery disease. Exposure to carbon monoxide, a common environmental pollutant, may cause ventricular arrhythmias and, thereby, contribute to the occurrence of sudden death in patients with coronary artery disease. Exposure to carbon monoxide leads to elevated blood levels of carboxyhemoglobin, the product of the interaction between carbon monoxide and hemoglobin, the oxygen-carrying pigment of the blood. Whether or not carbon monoxide-induced elevations in carboxyhemoglobin cause ventricular arrhythmias was assessed in 41 patients with coronary artery disease. Patients were exposed to room air, and to carbon monoxide levels which produced four and six percent carboxyhemoglobin. They were then required to perform exercise on a bicycle. The heart ventricles were X-rayed during exercise, and the electrical activity of the heart was recorded throughout the procedure to detect the occurrence of ventricular arrhythmias. During the exercise period, the frequency of single or multiple ventricular arrhythmias was greater after the patients were exposed to carbon monoxide producing six percent carboxyhemoglobin. This result did not occur at levels of four percent carboxyhemoglobin. The results also revealed that the patients who developed more frequent ventricular arrhythmias were older. In addition, patients who developed multiple or complex ventricular arrhythmias exercised longer and under greater workloads. These findings demonstrate that, during exercise, the number and complexity of ventricular arrhythmias increase in patients with coronary artery disease who achieve six percent carboxyhemoglobin after carbon monoxide exposure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aminophylline may be effective for the resuscitation of patients suffering from bradyasystolic cardiac arrest who have failed to respond to other drugs. Bradyasystolic cardiac arrest is a form of cardiac arrest characterized by bradyarrhythmia, or irregular heartbeat. A study examined the effect of aminophylline in 15 patients suffering bradyasystolic cardiac arrest who failed to respond to epinephrine or atropine. Eleven patients developed a stable heart rhythm within 30 seconds of treatment, and four did not respond to treatment. All the patients who responded to treatment were alive one hour later, but 10 died within four hours to 15 days after resuscitation. Eight patients died from cardiogenic shock after being resuscitated, and two died from brain damage caused by oxygen deficiency. Less than 3% of patients survive after suffering from bradyasystolic cardiac arrest.

To test the hypothesis that hypertension diminishes pain perception, a study was made that evaluated the relation between arterial blood pressure and thermal pain perception in human subjects. The average mean arterial pressure in all 20 men studied (10 hypertensive, 10 normotensive) proved to be significantly related to both thermal pain threshold (p = 0.05) and tolerance (p = 0.003). The difference between normotensive and hypertensive groups in baseline and posttest plasma levels of [beta] endorphin was also significant (p = 0.02) and indicated an interaction between endogenous opiods and blood pressure. Other recent studies af hypertension in relation to hypalgesia were also reviewed. An increased pain threshold was found in hypertensive versus normatensive rats. In cats, electrical stimulation of vagal afferent nerves (cardiopulmonary baroreceptors) suppresses nociceptive responses, and both pharmacologic elevation of blood pressure and vascular volume expansion produce antinociperception. Together with preliminary findings in human studies, these results indicate an interaction between pain-controlling and cardiovascular regulatory functions that is probably mediated by the baroreceptor system.

Two thousand seventy eight men and women with an acute myocardial infarction (AMI) participating in the Enhancing recovery in Coronary Heart Disease (ENRICHD) were examined for the association between self-reported physical exercise and all-cause mortality and cardiovascular morbidity. The potential value of exercise in reducing mortality and nonfatal reinfarction in AMI patients is demonstrated.

To compare the results of monitoring for ischemia with amplitude- modulated (AM) and frequency-modulated (FM) ambulatory recorders, 22 patients with coronary artery disease were monitored during exercise and during 24 to 48 hours of daily activities. Simultaneous recordings were obtained with Oxford Medilog 4000-II and Medilog MR-35 systems from the same 2 bipolar leads. Each potential ischemic episode was interpreted blindly by 2 investigators. Significant ST depression was strictly defined as [is greater than or equal to] 1 mm of horizontal or downsloping ST depression persisting for 0.06 second beyond the J point and lasting [is greater than or equal to] 1 minute. Of 82 episodes reviewed, 63 (77%) were either positive (37) or negative (26) for ischemia by both systems. However, 17 episodes were interpreted as positive on AM tracings but negative on FM tracings; the converse was true for only 2 episodes (p

The prevalence and type of ischemia (silent vs painful) in survivors of cardiac arrest not associated with acute myocardial infarction were studied to test the hypothesis that survivors may have an increased prevalence of silent ischemia. Of 48 survivors of cardiac arrest over a 4-year period who had undergone exercise testing, 24 met inclusion criteria. These 24 subjects had documented ventricular fibrillation and coronary artery disease proven by cardiac catheterization or a previous electrocardiographic pattern of myocardial infarction. Thirteen of 24 (54 %) had a positive treadmill stress test (greater than or equal) 1.0 mm flat or downsloping ST depression). The mean resting left ventricular ejection fraction was 43 %. Nine of 11 patients (82 %) who had exercise radionuclide studies performed had ischemic abnormalities ( (Am J Cardiol 1989;64:591-593), Individual who die suddenly of cardiac arrest are usually considered to be victims of immediate and critical loss of blood flow to their heart muscles, a condition known as myocardial ischemia. One study of 14 patients who died suddenly while wearing an electrocardiographic monitor demonstrated electrical irregularities associated with myocardial ischemia in 9 of them. Another study classified 15 patients who survived an out-of-hospital period of ventricular fibrillation as having a greater than 70 percent occlusion of the coronary vessels, which was usually painless. Twenty-four patients who survived a cardiac arrest and who had subsequently undergone treadmill testing were included in a study of myocardial ischemia. In this group 13 patients had irregularities on the treadmill test which correlated with known electrocardiographic aberrations associated with ischemia. Nine of 11 patients who underwent a nuclear scan, which allows the perfusion of the heart to be visualized, also had abnormalities of myocardial circulation during periods of exercise. In all, 16 of the 24 patients included in the study demonstrated objective changes in one or both tests indicative of ischemia, electrocardiography or nuclear scan. Surprisingly only 6 percent of these patients had pain associated with exercise-induced ischemia, a condition termed silent ischemia. It appears that survivors of cardiac arrest have a high association with ischemia which is silent in most cases.