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There is uncertainty whether postoperative application of paper tape (PT) improves scar aesthetics and reduces wound closure complications. This study aimed to review and assess the quality of applicable findings from studies investigating PT’s efficacy. We queried PubMed and SCOPUS using the search terms “((“paper tape”) AND (wound OR closure OR heal* OR complication OR skin OR prevent* OR scar*)).” We excluded articles that were duplicates, basic science, or not clinically relevant. We assessed the level of evidence for each article using the American Society of Plastic Surgeons (ASPS) Rating Levels of Evidence and Grading Recommendations for Therapeutic Studies, ranging from I (highest) to V (lowest). Of 186 publications reviewed, we included eight studies in the literature review. Five of these studies reported statistically significant positive outcomes on scar aesthetics and wound closure associated with using PT. Using the ASPS rating system, we found that two studies were Level I, three studies were Level II, two studies were Level IV, and one study was Level V. Notably, heterogeneity in the study designs limited outcome comparison. The data from the studies included in this literature review support using PT to optimize scar and wound management. The lack of higher levels of evidence, however, suggests the need for additional randomized controlled trials to rigorously evaluate patient outcomes when using PT compared with other forms of adhesive dressings. [ABSTRACT FROM AUTHOR]

Background: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. Methods: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results: A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion: This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research. [ABSTRACT FROM AUTHOR]

While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. This was a consensus paper via the modified Delphi approach. A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA. • A consensus paper using a modified Delphi process to determine consensus on non-surgical assessment and treatment of thumb CMC OA. • Assessment recommendations: evaluate clinical signs/testing, pain, thumb range of motion grip and tripod pinch, a region-specific PROM, environmental factors, outcome expectation, and illness perception. • Treatment: orthosis during painful activities as needed, a dynamic stability program, patient education, joint protection techniques, adaptive equipment, and functional based intervention. • Findings provide a clinical reference tool on hand therapy assessment and treatment of non-surgical CMC joint OA. [ABSTRACT FROM AUTHOR]

Purpose: This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach. Method: This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis. Results: The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps. Conclusions: CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution‐informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis. [ABSTRACT FROM AUTHOR]

Bookkeeper, the most widely used deacidification process based on MgO particles, was systematically evaluated on two sets of nonvaluable historical paper samples. Established analytical methods, such as pH and alkaline reserve determination, were used, as well as SEM EDS analyses to evaluate the distribution of Mg-rich particles on the paper surface and in the cross-section of the paper. The degradation rate constants of untreated and deacidified paper samples after accelerated thermal degradation were calculated based on weight average molecular mass determination to evaluate the lifetime extension of paper. The efficiency factors determined after accelerated thermal degradation of untreated and treated paper showed that paper lifetime prolongation after Bookkeeper deacidification treatment is highly limited for most of the investigated paper samples. No correlation was found between the alkaline reserve content or the pH and the degradation rate constants of the deacidified paper samples, but the paper degradation rate correlated with the paper samples pH before deacidification treatment. SEM EDS analysis showed that Mg-rich particles remained on the paper surface, which explains the limited effectiveness of the treatment. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services (CMS) introduced the Severe Sepsis/Septic Shock Management Bundle (SEP-1) as a pay-for-reporting measure in 2015 and is now planning to make it a pay-for-performance measure by incorporating it into the Hospital Value-Based Purchasing Program. This joint IDSA/ACEP/PIDS/SHEA/SHM/SIPD position paper highlights concerns with this change. Multiple studies indicate that SEP-1 implementation was associated with increased broad-spectrum antibiotic use, lactate measurements, and aggressive fluid resuscitation for patients with suspected sepsis but not with decreased mortality rates. Increased focus on SEP-1 risks further diverting attention and resources from more effective measures and comprehensive sepsis care. We recommend retiring SEP-1 rather than using it in a payment model and shifting instead to new sepsis metrics that focus on patient outcomes. CMS is developing a community-onset sepsis 30-day mortality electronic clinical quality measure (eCQM) that is an important step in this direction. The eCQM preliminarily identifies sepsis using systemic inflammatory response syndrome (SIRS) criteria, antibiotic administrations or diagnosis codes for infection or sepsis, and clinical indicators of acute organ dysfunction. We support the eCQM but recommend removing SIRS criteria and diagnosis codes to streamline implementation, decrease variability between hospitals, maintain vigilance for patients with sepsis but without SIRS, and avoid promoting antibiotic use in uninfected patients with SIRS. We further advocate for CMS to harmonize the eCQM with the Centers for Disease Control and Prevention's (CDC) Adult Sepsis Event surveillance metric to promote unity in federal measures, decrease reporting burden for hospitals, and facilitate shared prevention initiatives. These steps will result in a more robust measure that will encourage hospitals to pay more attention to the full breadth of sepsis care, stimulate new innovations in diagnosis and treatment, and ultimately bring us closer to our shared goal of improving outcomes for patients. [ABSTRACT FROM AUTHOR]

Brachytherapy is a type of radiation therapy, in which a radiation source is placed directly or close to a tumor. It is commonly used to treat skin cancer, and enables precise irradiation treatment of affected area (planning target volume - PTV) while minimizing exposure dose to surrounding healthy tissue (organs at risk - OARs). Recently, the use of 3D printing has begun revolutionizing brachytherapy, as it allows manufacturing of custom-designed applicators for unique shape of skin topography, tumor, and surrounding tissues. Outcome of the combination of 3D printing and brachytherapy has several advantages over traditional treatment planning methods. Some of the advantages are intuitive, whereas others can be concluded from a literature overview as follows: 1) Possibility of developing patient-specific applicators that precisely match the shape of tumor area; 2) Reduction of the time required for applicator production, especially when custom-made devices are needed; 3) Reduction of manufacturing costs; 4) Treatment procedures improvement; 5) Improvement of safety measures accelerated by the development of smart materials (e.g., polymer filaments with admixture of heavy elements); 6) Possibility of nearly instant adjustment into tumor treatment (applicators can be changed as the tumor is changing its shape); and 7) Applicators designed to securely fit to treatment area to hold radioactive source always in the same place for each fraction. Consequently, tumor-provided dose is accurate and leads to effective treatment. In this review paper, we investigated the current state-of-the-art of the application of 3D printing in brachytherapy. A number of existing reports were chosen and reviewed in terms of printing technology, materials used, treatment effectiveness, and fabrication protocols. Furthermore, the development of future directions that should be considered by collaborative teams bridging different fields of science, such as medicine, physics, chemistry, and material science were summarized. With the indicated topics, we hope to stimulate the innovative progress of 3D printing technology in brachytherapy. [ABSTRACT FROM AUTHOR]

The article focuses on the evaluation of cognitive behavioural therapy (CBT) combined with best-evidence pain management for patients with chronic spinal pain and insomnia. Topics include the comparison of treatment efficacy, the potential benefits of CBT in managing pain and insomnia, and the implications for clinical decision-making in pain management.

The article focuses on evaluating the effectiveness of cognitive behavioural therapy (CBT) combined with best-evidence pain management for patients with chronic spinal pain and insomnia. Topics include the comparison of treatment outcomes, the role of CBT in pain and insomnia management, and the implications for clinical practice in treating this patient population.

The degradation of paper-based materials involves several and complex mechanisms, such as hydrolysis and oxidation. The behaviour of different types of pulps can be very variable. In this study, the difference upon oxidation of contemporary non-recycled and recycled papers, which now constitute a considerable fibre source, is investigated. A 0.015 M potassium periodate solution is used to oxidise five types of paper, two non-recycled and three recycled, for 0.5, 1, 2 and 4 h. The effects of such oxidation treatments are evaluated in terms of carbonyl content and degree of polymerisation (DP). A modified procedure of the Szabolcs's method and viscometry are used to measure the carbonyl content and DP, respectively. The carbonyl groups are found to increase more rapidly in the recycled papers than in the non-recycled ones. On the contrary, oxidation causes a larger decrease of the DP values in the non-recycled papers, the paper made of pure cellulose being the most sensitive in terms of depolymerisation. The DP values measured for pure cellulose paper are in line with previously reported data. Moreover, in accordance with the Ekenstam equation, the plots of the reciprocal of DP as a function of oxidation time show good linear correlations for all types of paper investigated. Pseudo rate constants are thus calculated from the slopes of these plots, those of the non-recycled papers being found to be higher than those of the recycled papers. [ABSTRACT FROM AUTHOR]

The article investigates whether Intensive Mobility training with Variability and Error (iMOVE) therapy is as effective as conventional therapist-directed (CONV) therapy in enhancing gross motor development in young children with cerebral palsy.

The article examines the effects of aerobic exercise and tai chi on sleep quality, depression, and exercise capacity in people with advanced lung cancer, compared to physical activity advice.

The article evaluates the effectiveness of high-intensity interval training (HIIT) compared to moderate-intensity locomotor training in improving walking capacity for individuals with chronic stroke.

The article evaluates the benefits of high-intensity interval training (HIIT) compared to moderate-intensity locomotor training in improving walking capacity for individuals with chronic stroke.

South Africa developed the differentiated service delivery (DSD) model to improve access to healthcare for people living with HIV (PLHIV), especially key populations (KPs) including female sex workers (FSWs) who often face barriers in accessing HIV services. The DSD model, aims to reduce the burden on healthcare users, healthcare workers, and the healthcare system, can significantly benefit this group. However, the success of the DSD model in achieving the desired HIV treatment outcomes for FSWs has been barely evaluated. This paper describes the protocol for evaluation of the DSD model in improving HIV treatment outcomes among FSWs in Gauteng Province of South Africa. Both qualitative and quantitative methods will be utilized to address three study objectives: stakeholder analysis, mapping, and in-depth interviews (objective 1); programme evaluation of the DSD model in selected sites (objective 2); and development of a framework for optimizing the DSD model in improving HIV treatment outcomes (objective 3). Quantitative statistical analysis will be performed using STATA version 17 (College Station, TX, USA). Qualitative analysis will be performed using ATLAS.ti. This study will provide new insights into the utilization of the DSD model among FSWs in South Africa. It will also inform new strategies for the DSD model's implementation in the country. This study will contribute towards the development of a framework for strengthening the DSD model in improving HIV treatment outcomes among FSWs in Gauteng Province. [ABSTRACT FROM AUTHOR]

Introduction: In allergic asthma patients, one of the more common phenotypes might benefit from allergen immunotherapy (AIT) as add‐on intervention to pharmacological treatment. AIT is a treatment with disease‐modifying modalities, the evidence for efficacy is based on controlled clinical trials following standardized endpoint measures. However, so far there is a lack of a consensus for asthma endpoints in AIT trials. The aim of a task force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) is evaluating several outcome measures for AIT in allergic asthma. Methods: The following domains of outcome measures in asthmatic patients have been evaluated for this position paper (PP): (i) exacerbation rate, (ii) lung function, (iii) ICS withdrawal, (iv) symptoms and rescue medication use, (v) questionnaires (PROMS), (vi) bronchial/nasal provocation, (vii) allergen exposure chambers (AEC) and (viii) biomarkers. Results: Exacerbation rate can be used as a reliable objective primary outcome; however, there is limited evidence due to different definitions of exacerbation. The time after ICS withdrawal to first exacerbation is considered a primary outcome measure. Besides, the advantages and disadvantages and clinical implications of further domains of asthma endpoints in AIT trials are elaborated in this PP. Conclusion: This EAACI‐PP aims to highlight important aspects of current asthma measures by critically evaluating their applicability for controlled trials of AIT. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: Is there evidence to suggest that transcranial direct current stimulation improves clinical and patient-reported outcomes in patients with chronic ankle instability? Clinical Bottom Line: Evidence from two clinical studies supports the use of transcranial direct current stimulation for improving outcomes in patients with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Chronic or refractory breathlessness adversely affects quality of life. Current treatment strategies for managing breathlessness are often inadequate in providing complete relief. Kinesiology taping is generally used in musculoskeletal practice for preventive and rehabilitative purposes. Recently, our attention was drawn to the plausible mechanism(s) and indication for use of kinesiology taping for managing chronic breathlessness. We present a brief review of the scientific rationale and efficacy of kinesiology taping for respiratory function-related outcomes. Through this publication, we hope to catalyse discussions amongst palliative care professionals and researchers on the potential use of kinesiology taping in the management of chronic breathlessness. [ABSTRACT FROM AUTHOR]

Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described. [ABSTRACT FROM AUTHOR]

The Equine Veterinary Education article highlights recent studies on various equine health topics. One study from the UK and Finland examined immune-mediated keratitis in horses, finding that blepharospasm and uveitis increased the odds of enucleation. Another study assessed the use of smartphone ECGs in foals, showing good agreement with traditional ECGs. Additional studies looked at fentanyl administration, steamed hay for severe asthma, and pectin-honey hydrogels for preventing surgical site infections in horses. Overall, these studies provide valuable insights into equine health and treatment options. [Extracted from the article]

In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. ACTRN12619000344190 [ABSTRACT FROM AUTHOR]

Treating chronic diffuse sclerosing osteomyelitis (DSO) is challenging and many treatments have been reported. However, we know of no standard protocol or guidelines. In this systematic review of relevant publications we provide an overview of the different treatments used. We made an electronic search of PubMed, Medline, Embase, Web of Science, and the Cochrane Library databases, for papers that described the treatment of DSO of the mandible. The search yielded 48 papers that applied to all inclusion criteria, resulting in 16 case reports, 13 case series, 18 retrospective clinical cohort studies, and one randomised controlled trial. Reported treatment options included different operations; the use of antibiotics, anti-inflammatories, and antiresorptive medication; conservative treatment; and hyperbaric oxygen. Surgical treatment resulted in a low success rate and was associated with higher morbidity than other treatments. Conservative treatment, and that of bisphosphonates, yielded more promising results, so conservative treatment and bisphosphonates seem to be the most promising therapeutic options. However, because of the high risk of bias, no firm conclusions can be drawn, and larger studies with clear inclusion criteria and specified endpoints are needed. [ABSTRACT FROM AUTHOR]

The article examines the impact of long-term pulmonary rehabilitation on adults diagnosed with idiopathic pulmonary fibrosis, revealing no significant enhancement in 6-minute walk distance compared to standard care but demonstrating notable improvements in endurance time. It addresses outcomes related to exercise capacity, the effectiveness of rehabilitation programs in enhancing functional abilities, and the specific benefits observed in endurance levels among patients with this condition.

Optimising stoma appliances to manage stoma output to prevent leakage, associated peri-stomal skin damage and the subsequent negative impacts on quality of life is a key role for stomal therapy nursing. Use of deep convex stoma appliances to achieve optimal management of stoma output is often required when stomas are retracted, in deep skin folds or with uneven skin surface. Choosing convexity has often been described as subjective using observation combined with clinical experience and a period of trial and error to achieve appropriate appliance selection. This paper describes the methodology to replicate assessment of the depth and slope of convexity, individualised to the person's stoma in a skin fold using a camera and common measurement tools. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Background: There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs. Method: Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs. Conclusion: This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview. Plain English summary: There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention. [ABSTRACT FROM AUTHOR]

The management of postoperative bleeding, after gastric endoscopic submucosal dissection (ESD), has become particularly important because of the recent increase in antithrombotic use. Endoscopic shielding with polyglycolic acid (PGA) sheets has been shown to be effective. However, shrinkage and early displacement of the sheet remain challenges. This study aimed to determine the efficacy and safety of our developed method, named wafer paper and ring-mounted PGA sheet (WaRP). Twenty-four patients with antithrombotic uptake who underwent the WaRP method following gastric ESD were retrospectively examined. This involved the delivery of a PGA sheet wrapped in wafer paper with ring-thread, and its fixation on the gastric floor using hemoclips. The primary outcome was the technical success rate of the WaRP, and several secondary outcomes were evaluated. The technical success rate of WaRP was 100%. The procedure lasted a mean of 10.5 min (SD 6.7 min). The prevalence of complete retention at follow-up endoscopy was 83.3% (20/24). There were no WaRP-associated complications, but post-ESD hemorrhage occurred in two patients undergoing hemodialysis (8.3%). The WaRP method is a simple and reliable means of PGA sheet delivery and placement that reduces the incidence of post-ESD hemorrhage. [ABSTRACT FROM AUTHOR]

The article focuses on a commentary that critically appraises the potential of eccentric resistance training to enhance strength and power, yet not improve gait in patients with neurological conditions. Topics discussed include the study's findings on the effects of eccentric resistance training, its implications for rehabilitation strategies, and the need for further research to address gait-related outcomes in this patient population.

There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator. Semi-structured exit interviews were conducted with volunteer participants from the online and comparator arms of the trial, and focus groups were held with study physiotherapists. Transcripts were analyzed using reflexive thematic analysis. Perspectives from participants with MS yielded three themes: usability of their program, utility of their program, and motivation to participate. Visual and dexterity impairments limited the usability of the online program. Having an opportunity "to be pushed" was valued by participants in both trial arms. Motivation to exercise was variable, and participants desired periodic face-to-face contact with their physiotherapists. Perspectives from trial physiotherapists yielded similar and complementary findings concerning usability and utility. Participants with MS and physiotherapists found the online physiotherapy platform useful for supporting exercise, yet they identified some limitations. As the appeal of online platforms has increased since the pandemic, it will be important to consider the needs of people with moderate to severe MS. NCT03039400. People with moderate-to-severe MS and physiotherapists involved in a clinical trial found online physiotherapy useful for supporting exercise. Physiotherapists and participants using the online program desired improved platform accommodations for people living with MS with visual and dexterity impairments. Physiotherapists and people living with MS from both the online exercise program and comparator groups perceived a need for more face-to-face contact and opportunities to build therapeutic alliance. Perspectives from prescribing physiotherapists and people living with MS about supporting exercise online may have practice implications during and post-pandemic. [ABSTRACT FROM AUTHOR]

Purpose Overactive bladder syndrome is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence in the absence of urinary tract infection or another obvious pathological condition. Electronic questionnaires have been used in a few specialties with the hope of improving treatment outcomes and patient satisfaction. However, they have not been widely used in the urological field. When treating overactive bladder, the main outcome is to improve patient quality of life. The primary objective of this study was to evaluate whether electronic questionnaires would be equally accepted as or preferred to paper questionnaires. The secondary objective was to look at the preference in relation to patient age, education and iPad® tablet familiarity. Materials and Methods We prospectively evaluated the iList® electronic questionnaire application using a friendly iPad tablet in patients with overactive bladder who presented to the urology clinic at our institution. Each of the 80 patients who were recruited randomly completed the validated OABSS (Overactive Bladder Symptom Score) and the PPBC (Patient Perception of Bladder Condition) questionnaires in paper and electronic format on the tablet. Variables potentially associated with the outcomes of interest included demographic data, questionnaire method preference, patient response rate and iPad familiarity. We used the 2-sided Z-test to determine whether the proportion of patients who considered the tablet to be the same, better or much better than paper was significantly greater than 50%. The 2-sided chi-square test was applied to assess whether the intervention effect significantly differed among the demographic subgroups. Results A total of 80 patients 21 to 87 years old were enrolled in the study from November 2015 to August 2016. Of the patients 53% were female and 49% were 65 years or younger. The incidence of those who considered the tablet to be the same or better than paper was 82.5% (95% CI 74.2–90.8, p <0.001). The incidence of patients who considered the tablet to be the same or better than paper ranged from 76% to 97% regardless of age, gender and education subgroup as well as in those with any familiarity with the tablet (each p <0.001). Of the 20 patients who were not familiar with the tablet 45% preferred the electronic questionnaire (p = 0.654). Conclusions We found that the proportion of patients who considered electronic questionnaires to be equivalent to or better than paper versions was higher than those who preferred paper questionnaires regardless of age, gender or education level. [ABSTRACT FROM AUTHOR]

Background: Narrative therapy has been proposed to have practice-based evidence however little is known about its research evidence-base in the treatment of eating disorders. The aim of this study was to conduct a systematic review of the outcome literature of narrative therapy for eating disorders. Method: Treatment outcome data were extracted from 33 eligible included studies following systematic search of five data bases. The study is reported according to Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. Results: Of the identified 33 studies, 3 reported positive outcomes using psychometric instruments, albeit some were outdated. Otherwise, reported outcomes were based on therapy transcript material and therapist reports. The most commonly reported treatment outcome was in relation to shifts in identity narratives and improved personal agency with a trend towards under-reporting shifts in ED symptoms. Some improvements were reported in interpersonal and occupational engagement, reduced ED symptoms, and improved quality of life, however, there was an absence of standardized measures to support these reports. Conclusions: This systematic review found limited support for narrative therapy in the treatment of eating disorders through practice-based evidence in clinician reports and transcripts of therapy sessions. Less is known about systematic treatment outcomes of narrative therapy. There is a need to fill this gap to understand the effectiveness of narrative therapy in the treatment of EDs through systematic (1) Deliveries of this intervention; and (2) Reporting of outcomes. In doing so, the research arm of narrative therapy evidence base will become more comprehensively known. Plain English summary: Narrative therapy has been proposed as a promising intervention for the treatment of eating disorders. However, the treatment outcomes of narrative therapy for eating disorders are under-researched. This systematic review of the literature has demonstrated limited support for narrative therapy through practice-based evidence in clinician reports and transcripts of therapy sessions. These reports demonstrated how narrative therapy was associated with identity shifts, some symptom reduction, reduced hospitalisations, improved agency over the problem and improvements in quality of life. There is a need for future research to systematically report treatment outcomes. This will fill a gap in research evidence-base for narrative therapy in the treatment of eating disorders. [ABSTRACT FROM AUTHOR]

Purpose The AUA (American Urological Association) QIPS (Quality Improvement and Patient Safety) committee created a white paper on the diagnosis and management of nonneurogenic chronic urinary retention. Materials and Methods Recommendations for the white paper were based on a review of the literature and consensus expert opinion from the workgroup. Results The workgroup defined nonneurogenic chronic urinary retention as an elevated post-void residual of greater than 300 mL that persisted for at least 6 months and documented on 2 or more separate occasions. It is proposed that chronic urinary retention should be categorized by risk (high vs low) and symptomatology (symptomatic versus asymptomatic). High risk chronic urinary retention was defined as hydronephrosis on imaging, stage 3 chronic kidney disease or recurrent culture proven urinary tract infection or urosepsis. Symptomatic chronic urinary retention was defined as subjectively moderate to severe urinary symptoms impacting quality of life and/or a recent history of catheterization. A treatment algorithm was developed predicated on stratifying patients with chronic urinary retention first by risk and then by symptoms. The proposed 4 primary outcomes that should be assessed to determine effectiveness of retention treatment are 1) symptom improvement, 2) risk reduction, 3) successful trial of voiding without catheterization, and 4) stability of symptoms and risk over time. Conclusions Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition. [ABSTRACT FROM AUTHOR]

Effluent discharged from paper industries has an unfavourable impact on all the biotic and abiotic components of the environment due to the presence of various bio-recalcitrant toxic compounds. Multiple physico-chemical treatment systems have been adopted over the last two decades for the elimination of refractory organics from paper industry effluent but with limited success. Augmentation of biological treatment through metabolic and cometabolic strategies seems to be a promising and sustainable option. This article aims at presenting a comprehensive account of treating the paper industry effluent with existing treatment strategy using potent green agents through bioaugmentation and mineralization of chlorophenols via ortho- and meta- pathways. Sequential treatment based on consortia of specialized microorganisms remove > 90% of different toxic and recalcitrant compounds present in paper industry effluent. The rapid technological development in microbial fuel cells holds the potential for simultaneous paper industry effluent treatment and energy production. [Display omitted] • Defined bacterial and fungal consortium in aid of bioaugmentation. • Bioaugmentation strategies for efficient removal of recalcitrant organics. • Cometabolism and metabolism as a tool against organic compounds in paper industry effluent. • Sequential treatment as a novel approach in treatment of paper industry industrial effluent. [ABSTRACT FROM AUTHOR]

The article discusses a study which found that a short course of opioids did not provide pain relief in patients with acute low back or neck pain compared to a placebo.

The article explores the effectiveness of high-intensity vs. low-intensity resistance training for knee osteoarthritis patients.

The article explores the effectiveness of a personalized care pathway for chronic knee pain after knee replacement surgery.

The article evaluates the effectiveness of high-intensity vs. low-intensity resistance training for knee osteoarthritis patients.

• The use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. • Improvements on severity of symptoms in both groups suggest that the self-care program using a mobile app or a paper book may be beneficial in individuals with fibromyalgia. • The Sleep Strategies was the most used function of the ProFibro app, followed by the Exercise Program, and the diary for the practice of gratitude. The ProFibro application (app) was developed as a Mobile Health resource to promote self-care in fibromyalgia management. This study aimed to assess the effects of the use of the ProFibro app for six weeks compared to the use of a traditional paper book of similar content to improve health-related quality of life, symptoms, and self-care agency in individuals with fibromyalgia. Forty individuals with fibromyalgia were included in this randomized, single-blind, parallel trial. One group received intervention content using the ProFibro app on a smartphone while the other received similar information using a paper book. Participants were assessed at baseline and after six weeks. The primary outcome was the Revised Fibromyalgia Impact Questionnaire. Secondary outcomes were Widespread Pain Index, Pain Visual Analog Scale, Symptom Severity Scale, and Appraisal of Self-Care Agency Scale – Revised. No differences in changes were found between groups at the end of the treatment for any outcome. Both groups showed improvements in symptom severity. The use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. Both groups showed improvements from baseline on severity of symptoms, suggesting that the self-care program using a mobile app or a paper book may be beneficial for individuals with fibromyalgia. [ABSTRACT FROM AUTHOR]

Objectives: The deltoid ligament can tear in association with ankle fractures, syndesmotic injuries, or independently. In previous biomechanical research. the optimal surgical treatment for an anterior deltoid tear has been shown to be a repair with a tibiocalcaneal augmentation, with no additional benefit of a tibiotalar augmentation. However, tibiocalcaneal augmentation is technically challenging to perform as there is a risk of damage to neurovascular structures in the medial ankle. Therefore, by testing tibiotalar augmentation first, the purpose of this study is to determine if this simpler surgery is sufficient to stabilize the ankle in the setting of an anterior and complete deltoid tear. Additionally, concerns over loss of range of motion due to overconstraint in plantarflexion and dorsiflexion have been raised with ligament augmentation surgery. The secondary purpose of this study is to determine if these concerns are warranted. We hypothesize that sectioning the deltoid ligaments will substantially heighten ankle laxity in eversion and external rotation, anterior deltoid repair will mitigate laxity but not restore native stability, and incorporation of tibiotalar and tibiocalcaneal augmentations will further improve stability. We hypothesize that none of the surgical treatments will introduce loss of range of motion due to overconstraint. Methods: Ten cadaveric ankles were mounted on a 6° of freedom robotic arm. Each specimen underwent biomechanical testing in 9 successive states: 1) Intact, 2) Anterior deltoid cut, 3) Anterior deltoid repair, 4) Repair + tibiotalar augmentation, 5) Repair + tibiotalar + tibiocalcaneal augmentation, 6) Posterior deltoid cut, leaving anterior repair and augmentations intact, 7) Removal of the tibiocalcaneal augmentation, 8) Removal of the tibiotalar augmentation, and 9) Removal of the anterior repair (complete cut state). This study design allowed the comparison of the 3 treatment options separately in the setting of an anterior tear and a complete tear. Testing consisted of 6 range of motion tests, measuring how much rotation occurred under a 5-Nm load: 1) Eversion at neutral, 2) Eversion at 25° plantarflexion, 3) External rotation at neutral, 4) External rotation at 25° plantarflexion, 5) Plantarflexion, and 6) Dorsiflexion. One-factor random intercepts linear mixed effects statistical models were created to run an analysis of variance followed by post-hoc pairwise comparisons between testing states in the setting of an anterior tear and a complete tear. Results: The results from the anterior cut analysis are shown in Figures 1 and 2, and the results from the complete cut analysis are shown in Figures 3 and 4. The anterior tear significantly increased ankle laxity compared to native in all tests: external rotation at neutral (+2.8°, p<0.0001), at 25° (+2.4°, p=0.0002), eversion at neutral (+2.1°, p=0.0019), at 25° (+5.6°, p<0.0001). The complete tear significantly increased ankle laxity compared to native in all tests (all p<0.0001): external rotation at neutral (+6.9°), at 25° (+7.2°), eversion at neutral (11.6°), at 25° (+12.0°). In the setting of the anterior tear, an anterior repair restored native ER at neutral and 25° and eversion at neutral but remained significantly more lax at 25° plantarflexion (+2.9°, p=0.0007). In the setting of a complete tear, the anterior repair failed to restore native stability in any test. The tibiotalar augmentation showed no significant differences from the anterior repair in any test either in the setting of an anterior or complete deltoid tear. The addition of the tibiocalcaneal augmentation restored native external rotation and eversion stability at neutral and 25° plantarflexion, both in the setting of an anterior tear and a complete tear, showing significant improvements over the tibiotalar augmentation. No significant reductions in range of motion were found for any surgical state in any test compared to native. Conclusions: The tibiotalar augmentation showed no significant improvement over a suture repair in the setting of an anterior or complete deltoid tear. The addition of a tibiocalcaneal augmentation showed significant improvement over the tibiotalar augmentation, restoring native stability in eversion and external rotation in the anterior tear and complete tear models. When these augmentations were tested in the reverse order, previous research showed that the tibiocalcaneal augmentation demonstrated significant improvement over the anterior repair, and the addition of tibiotalar augmentation demonstrated no significant change. Therefore, the optimal treatment in the setting of an anterior or complete deltoid tear was a suture repair plus a tibiocalcaneal augmentation. While this surgery may be technically challenging, it has a strong stabilizing effect on the ankle joint, and future research is necessary to further improve the safety and simplicity of this technique. Nonoperative management of deltoid ligament tears may lead to persistent changes in ankle biomechanics and poor patient outcomes. Deltoid ligament repair with augmentation might hasten rehabilitation, reduce stiffness, and facilitate earlier resumption of preinjury activity. [ABSTRACT FROM AUTHOR]

Objectives: Tibial spine fractures (TSFs) are common in the pediatric population. While screw and suture fixation are used for surgical repair, most studies in porcine or adult human bone suggest suture fixation is superior. However, a recently published report by this study group demonstrated that two-screw and two-suture repair, where sutures were tied over a metaphyseal bone bridge, were biomechanically comparable in human pediatric cadaveric knees. The key failure mechanism of the suture group involved 'cheese wiring' through the metaphyseal bone bridge. Therefore, this study hypothesized that TSF fixation with sutures attached to anchors placed in stronger cortical bone would produce biomechanically superior repair. It evaluated the properties of these constructs in human pediatric knees and compared them to prior results obtained from two-screw and two-suture constructs. Methods: In the previous study, pediatric knee specimens were randomly assigned to two-screw or two-suture fixations. Circumferential marks were made around the ACL insertion (Figure 1A). An osteotome induced a standardized Meyers-Mckeever Type III TSF (Figure 2A). For knees assigned to screw fixation, each fracture was reduced and held in place with two 4.0 mm cannulated screws and washers (Figure 1B). For knees assigned to suture fixation, two No. 2 high-tensile-strength sutures were passed through the fracture fragment and the base of the ACL, one through the anterior 1/3, the other through the posterior 1/3 (Figure 2B). The sutures were passed through medial and lateral bony tunnels, each 1cm away from the midline and two physis lengths distal to the tibial plateau. The fracture was reduced by pulling tension on the sutures, which were then secured over a 1cm tibia bony bridge (Figure 2C). Each specimen was potted in fiberglass resin and then mounted for biomechanical testing on a servohydraulic load frame (Figure 1D, 2D) at approximately 30° of flexion to simulate typical ACL loading conditions. Each specimen was then subjected to cyclic preconditioning, which consisted of 20 cycles of loading between 5 and 25N at a rate of 60 cycles per minute. Next, a cyclic loading protocol was applied to each specimen. This included 500 cycles between 5 and 75N at a crosshead speed of 100mm per minute, sampled at 20Hz. Upon the completion of cyclic loading, samples were allowed to recover for thirty minutes. Finally, a load-to-failure protocol was conducted at a rate of 0.5 mm per second. The primary outcome was the ultimate failure load in newtons (N). The mode of failure was macroscopically documented. In the current study, six new pediatric knees were selected to best match the age and laterality of the previous screw and suture groups. These specimens were placed through the same dissection, fracture, biomechanical testing, and data collection protocols used in the prior study. However, the present study assessed a different fixation: suture plus suture anchors. Suture plus suture anchor specimens were repaired in the same way as suture specimens, with the following exception: instead of tying sutures across a metaphyseal bony bridge following their exit of the medial and lateral bony tunnels, the sutures were secured with knots to two 2.8 mm suture anchors, also placed 1 cm away from the midline medially and laterally, at a distance of three physis lengths from the tibial plateau (Figure 3A, 3B, and 3C). Independent samples t-tests compared ultimate failure loads between pairs of repair methods, while a one-way analysis of variance test was used to compare ultimate failure loads across all repair methods. Results: A total of eighteen (Range: 5 years – 11 years) pediatric cadaveric knees were tested: twelve from the prior published study, and six in the suture plus suture anchor group. The screw and suture repair groups had identical mean (8.30 years) and median (8.50 years) ages, while the suture plus suture anchor group had a mean and median age of 9.33 and 9.00 years, respectively. All groups had an identical number of samples of each laterality. The ultimate failure load significantly differed across fixation methods (p = 0.008). This relationship was primarily driven by higher ultimate failure loads in the suture plus suture anchor group (Mean: 224.00N, SD: 48.37N) when compared to the screw (Mean: 143.52N, SD: 41.97N) (p=0.01) and suture (Mean: 135.35N, SD: 47.94N) (p=0.009) groups. Ultimate failure load did not significantly differ between screw and suture fixations (p = 0.7597). One screw and one suture construct did not survive the cyclic loading protocol. All suture plus suture anchor constructs survived. Every screw construct failed at the level of the intact tibial spongy bone; no failure occurred through the ACL-fracture fragment complex. Four suture constructs failed by cheese wire through the cortical bony bridge, while two failed by cheese wiring, thus creating a new fracture, in the ACL-tibial spine avulsion fracture complex. Each suture plus suture anchor construct failed because of a fracture of the ACL-tibial spine avulsion fragment complex (Figure 3D). Conclusions: Screw and suture fixation of type III Meyers-Mckeever TSFs have statistically comparable ultimate failure loads in human pediatric cadaveric bone. These loads of failure are relatively low compared to those obtained in adult cadaveric and porcine bone. This study demonstrates that sutures plus suture anchors placed in the meta-diaphyseal cortex provide a significantly stronger fixation. Although this study is limited by its inability to assess rotational biomechanics and slight age differences between fixation groups, these results suggest that suture plus suture anchors provide the strongest repair for these injuries in human pediatric specimens. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of ulnar collateral ligament (UCL) injuries and their surgical treatment has risen significantly since the first treated by Dr. Jobe in 1974. The recent surgery, primarily amongst 15- to 25-year-olds involved in overhead sports, is concerning and necessitates refinement of and/or development of the most effective treatment options. The traditional surgical treatment has been UCL reconstruction, but more recently, the development of UCL repair techniques, particularly with the use of internal bracing, are an exciting potential alternative. Whereas previous work has examined early complications and early outcomes following UCL repair with internal brace, to our knowledge, few if any previous studies have compared mid-term outcomes between UCL repair and UCL reconstruction. Our study aimed to examine differences in mid-term outcomes between competitive athletes following UCL repair with internal brace or following UCL reconstruction from a single institution. Specifically, we compared patient-reported elbow and upper extremity function measures and return to preinjury sport between treatment groups. Methods: Using CPT codes from an ongoing prospective data repository, we performed a retrospective search to identify patients that underwent either UCL repair with internal brace or UCL reconstruction between 2013 and 2021. We included those 15 to 45 years old that were at least 2-years post-operative and were competitive athletes at time of surgery. We excluded those with prior index elbow surgery, those with UCL repair without internal bracing. We performed detailed chart reviews using the electronic medical record and collected demographic information, injury data, and surgical details. We assessed patient-reported outcomes at follow-up using the following measures of elbow/upper extremity function: 1) American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E; function subscale); 2) Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOC); 3) Andrews-Carson score. We further collected information on return-to-sport timing and success. We calculated summary statistics for demographic, injury, surgical, and outcomes data within both the UCL repair and reconstruction groups. We compared key demographic, injury, and surgical data between UCL repair and reconstruction groups using independent t-tests for continuous variables and chi-square tests for categorical data. For outcomes data, we used linear regression modeling (controlling for relevant demographic covariates) to compare patient-reported function measures (ASES-E; KJOC; Andrews-Carson) between groups. Lastly, we summarized return to preinjury sport (and reasons for the inability to return) and compared the proportions of successful return to preinjury sport between groups using a chi-square test. Results: Clinical and outcomes data were successfully collected for 411 athletes with UCL injuries and surgical treatment (mean age at surgery=18.9±2.9 years; 93% male; mean follow-up time=4.9±2.2 years). Of the 411 UCL procedures, 265 (64%) were UCL repair with internal brace, and 146 (36%) were UCL reconstructions. The UCL repair group was younger (p=0.04), had shorter follow-up time (p<0.01), and had a higher proportion of females (p=0.02) when compared with the UCL reconstruction group (Table 1). Table 1 also shows primary sport at time of UCL injury and level of competition within both groups. Within the UCL repair group, there was a higher proportion of partial UCL tears and a lower proportion of complete UCL tears when compared with the UCL reconstruction group (p<0.01; Table 1). Additionally, within the UCL repair group, there was a lower proportion of concomitant ulnar nerve transpositions when compared with the UCL reconstruction group (p<0.01; Table 1). There were no differences between groups in the proportions of concomitant osteophyte excisions (Table 1). Outcomes-related data are shown in Table 2. Because of differences between groups in age and follow-up time, we controlled for these in comparisons of patient-reported outcomes between groups. After controlling for age and follow-up time, the groups did not differ in ASES-E, KJOC, nor Andrews-Carson scores at follow-up (Table 2). Of the 265 athletes in the repair group, 244 attempted to return to their preinjury sport (Table 2). Among the 244 that attempted to return, 237 (97%) were able to return to their preinjury sport, and 7 were unable to return due to limitations from their UCL repair (Table 2). Of the 146 athletes in the reconstruction group, 140 attempted to return to their preinjury sport (Table 2). Among the 140 that attempted to return, 137 (98%) were able to return to their preinjury sport, and 3 were unable to return due to limitations from their UCL reconstruction (Table 2). Other reasons for not attempting to return to preinjury sport within the 2 groups are shown in Table 2. The two groups did not statistically differ in the proportions that returned to preinjury sport (Table 2). Conclusions: In the current study, we found excellent elbow function and return-to-sport mid-term outcomes in a large cohort of both UCL repairs with internal brace and UCL reconstructions. Whereas the groups did differ in some demographic, injury, and concomitant surgical procedure variables, they did not differ in patient-reported outcomes nor in the ability to return to preinjury sport. These findings suggest that UCL repair with internal brace may be a viable option for the treatment of UCL injuries when clinically-indicated. Given the observational and retrospective nature of the current study, future research should evaluate randomized surgical intervention of UCL injuries. [ABSTRACT FROM AUTHOR]

Objectives: Meniscal allograft transplantation (MAT) is an accepted and effective treatment option in the context of unsalvageable menisci, particularly in young and active patients. It has been shown to reduce pain and improve knee function in previously symptomatic patients. However, there is still limited knowledge about the long-term survival rates of allografts, the durability of clinical results, and the influence of patient-specific parameters, such as leg alignment, tibial slope, and preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade. The purpose of this study was to determine (1) the long-term clinical success rate after MAT with bony fixation in a large, single-center cohort of consecutive patients, and (2) if patient-specific and procedural variables influence the clinical, anatomic, and subjective outcomes and risk of failure. Methods: Data on 185 consecutive knees undergoing MAT in a single institution were prospectively collected and screened for inclusion in this study. The minimum follow-up time was 2 years. Radiographic variables (International Cartilage Regeneration & Joint Preservation Society [ICRS] grade and Kellgren and Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (PROMs), Lysholm score, Knee Disability and Osteoarthritis Outcome Score (KOOS) including subscores, International Knee Documentation Committee (IKDC) score, and visual analog score (VAS) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery due to graft failure or conversion to total knee arthroplasty (TKA). Anatomic failure was considered a tear covering >20% of the allograft, any peripheral tear, and unstable peripheral fixation leading to dislocation of the graft. Subjective failure was defined as Lysholm score ≤65. Preoperative tibial slope and leg alignment were assessed. Survival analyses were performed utilizing the Kaplan-Meier estimate. Univariate and multivariate analyses were performed to determine risk factors for clinical and anatomic failure. Results: A total of 157 knees met inclusion criteria (Table 1). After a mean follow-up time of 7 ± 3.5 years, 127 (80.9%) knees were free of clinical, anatomic, and subjective failure. Fourteen (8.9%) knees experienced clinical failure, 26 (16.6%) knees were identified as anatomic failure, and 13 patients (8.3%) suffered from subjective failure with a reported Lysholm score of ≤65 at a mean follow-up of 7 years. Concurrent osteochondral allograft transplantation was identified as a predictor of both clinical (HR 4.55; 95% CI 1.46-14.17; p=0.009) and anatomic failure (HR 3.05; 95% CI 1.34-6.92; p=0.008). Cartilage damage of ICRS grade 3 or 4 of the index compartment conveyed an increased risk for clinical (HR 3.41; 95% CI 1.05-11.01; p=0.04) and anatomic failure (HR 3.04; 95% CI 1.31-7.11; p=0.01) (Table 2). There were no differences in outcomes between medial and lateral MAT. High-grade cartilage damage (defined as ICRS grades 3 and 4) preoperatively (HR 10.67; 95% CI 1.037-109.768; p=0.046), patients age over 25 (HR 5.44; 95% CI 0.120-246.070; p=0.384), and a body mass index >30 (HR 2.24; 95% CI 0.748-6.705; p=0.149) were associated with subjective failure. Considering the entire study population, PROMs including KOOS and IKDC were significantly improved at final follow-up compared to preoperative scores across all measurements (p<0.005). Conclusions: MAT showed good-to-excellent clinical results at a mean follow-up of 7 years. Low ICRS lesion grade was associated with a higher clinical and anatomic survival rate. Patients with concurrent osteochondral allograft transplantation are at higher risk of clinical and anatomic failure, but still report significantly improved PROMs. These results suggest MAT has a lasting beneficial effect both as in isolation and in complex cases with one or more concurrent procedures. [ABSTRACT FROM AUTHOR]

Objectives: Revision anterior cruciate ligament (ACL) reconstruction has been demonstrated to have outcomes inferior to those noted in primary ACL reconstructions in terms of patient-reported outcomes, return to activity and sports, and graft rupture rates. However, the long-term assessment of patients undergoing revision ACL reconstruction remains unknown, primarily due to the large number of patients needed to do an adequate analysis. A group was assembled to prospectively enroll and follow a revision ACL cohort to determine the risk factors for poor outcomes in a revision cohort, of which over 1,200 patients were enrolled from 83 surgeons and 52 sites and prospectively followed for 10 years. The overarching goal was to assess the long-term progression of outcomes following revision ACL reconstruction, and to determine how the initial factors at the time of revision surgery may influence and predict disease progression. The focus of this study is to characterize the 10-year natural history of this unique dataset, quantified by 3 complementary methodologies: patient-reported outcomes, radiologic measures, and physical examination measures. The purpose was to assess for clinical long-term outcomes, including incidence of graft failure, as well as signs and symptoms of knee osteoarthritis (OA) in this revision cohort at 10 years postoperatively. Methods: Patients were brought back to 6 sites for physical examination by an independent blinded sports medicine physician who was not involved with the revision ACL reconstruction. The physical exam included knee range of motion (ROM), ligamentous testing and bilateral KT-1000 assessment. A series of radiographs (standardized bilateral standing AP, synaflexer bent knee [similar to tunnel/Rosenberg], sunrise, and full extension lateral views) were obtained to assess for incidence of structural OA. Validated patient-reported outcome measures (PROMs) including International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Marx activity rating scale were also obtained. Two physicians independently graded the radiographs for severity of structural OA using the modified Kellgren-Lawrence (KL) grading system (grades 0 to 4). Structural OA was defined as a Kellgren-Lawrence grade of 3 or 4. Symptomatic OA was defined by the KOOS Pain subscale of < 70 points. Multivariate regression models were used to determine the predictors (risk factors) for both structural OA (KL grades 3 to 4) and symptomatic OA (KOOS pain < 70 points) at 10 years follow-up, controlling for the patient's age, sex, body mass index (BMI), baseline PROMs, ACL graft choice, prior and current meniscal pathology and treatment at the time of revision surgery, chondral pathology at the time of revision surgery, and incidence of any subsequent surgeries. Results: 205 patients (107 [52.4%] women) representing 40 surgeons returned at an average 12-year follow-up (range, 10-16 years). The mean (SD) age of this cohort at the time of their onsite evaluation was 40.2 (10.4) years with a BMI of 25.7 (range, 17.0-42.0). Physical Exam: Physical examination demonstrated loss of extension compared to the opposite knee in 118 (58%) and extension less than full (0 degrees) in 84 (41%). With regards to failure, a soft Lachman endpoint was noted in 41 patients (20%). A Lachman >5 mm was noted in 20 patients (10%), and 26 patients (13%) had a grade 2 pivot shift and 4 (2%) had a grade 3 pivot shift. KT-1000 measurements demonstrated 23 (11%) patients with 5 mm or greater involved versus uninvolved side-to-side difference. The blinded surgeons in their opinion detected 37 (18%) with a nonfunctional ACL. If all nonfunctional parameters were applied (Lachman ≥2, Pivot shift ≥2, KT-1000 side-to-side difference of ≥5mm, and surgeon determining failure) only 8 patients (4%) met all failure parameters. Radiographs: Radiographs demonstrated that 115 (56%) exhibited joint space narrowing of the tibiofemoral joint (K-L grades 3 to 4) in their involved knee compared to 28 (14%) in their uninvolved knee (Table 1). The significant drivers of a higher KL grade (structural OA) at 10 years were found to be higher age, higher baseline BMI, having a medial meniscus excision performed either prior to or at the time of revision surgery, having a prior lateral meniscal excision, or having a subsequent surgery (p<0.05; Table 2). Sex, baseline activity level, graft choice, and chondral pathology at the time of revision were not significant. PROMs: PROMs of the onsite group reflected the PROMs of the overall cohort at 10 years (Figure 2). There were 40 onsite subjects (20%) that reported KOOS pain scores of < 70 points (defined as symptomatic OA), while 91 subjects (44%) reported KOOS pain scores over 90 points (defined as no pain). The predictors of increased pain (lower KOOS pain score) at 10 years were subjects who had higher pain scores at the time of revision surgery, grades 3 to 4 chondral pathology in the lateral compartment at the time of revision surgery, medial meniscus excision performed prior to the time of revision surgery or having a subsequent surgery (p<0.05; Table 3). Conversely, having a hamstring autograft or an allograft (compared to a bone-tendon-bone autograft) at the time of revision surgery predicted less symptomatic pain at 10 years. Age, sex, baseline BMI, activity level, and lateral meniscal pathology at the time of revision were not significant predictors of increased knee pain at 10 years. Conclusions: Outcomes in this first ever report of a revision ACL cohort at minimum 10 years follow-up demonstrates worrisome outcomes at a still young age. This study demonstrated a loss of ROM in 41-58% of the cohort, an 18% graft failure rate, 56% who exhibited KL grades of 3 to 4, and 20% who reported KOOS pain scores of less than 70 points, which collectively, all emphasize the challenge of managing the revision ACL reconstruction patient. [ABSTRACT FROM AUTHOR]

Objectives: Despite recent efforts, the reinjury rate following anterior cruciate ligament (ACL) reconstruction remains high, with documented reports of up to 30%. According to retrospective evidence, high posterior tibial slope (≥12°) has been identified as an anatomic risk factor contributing increased graft reinjury rates. Surgeons are therefore exploring the effectiveness of slope reducing high tibial osteotomy (SRO) as a means of modifying this potential risk factor. While cadaveric models suggest that this surgical procedure decreases the forces across the ACL graft, there are few clinical trials examining its' safety and clinical effectiveness in patient samples. Therefore, the purpose of this study is to compare functional performance and graft reinjury rates between patients undergoing ACL reconstruction surgery with SRO versus matched controls undergoing isolated ACL reconstruction. We hypothesized that patients undergoing ACL reconstruction with SRO would exhibit similar performance outcomes with a low failure rate when compared to their matched counterparts. Methods: A retrospective matched-case control study was conducted in accordance with the 'Strengthening the Reporting of Observational Studies in Epidemiology' guidelines for patients undergoing ACL reconstruction (Figure 1), utilizing a single surgeon database (n=1978). The experimental group (ACL+SRO) consisted of patients ages 18-50 years old that were at least 24-months out of ACL reconstruction with a concomitant SRO. Patients were age, sex, and revision-matched to a cohort of individuals undergoing isolated ACL reconstruction. Exclusion criteria consisted of contralateral knee injury (<24 months prior to surgery), isolated coronal-plane high tibial osteotomy, and multiligamentous knee injury. Patient demographics and surgical data were obtained, including pre/postoperative posterior tibial slope (o) for the ACL+SRO group and presurgery activity levels. Data were gathered at return to sports and included knee range of motion, single-leg balance, single-leg hop testing, and self-reported International Knee Documentation Committee and ACL-Return to Sports After Injury (ACL-RSI) scores. Complications and injury surveillance was conducted throughout the postoperative follow-up period. Primary outcome measures included the Single Assessment Numeric Scale (SANE), and graft failure rates at two-years. Secondary outcomes included return to sport rate and level of participation, and postoperative complications (infection, loss of motion, deep vein thrombosis, etc). Generalized Linear Models and chi-square analyses were conducted using SPSS (IBM, Chicago IL) to compare groups with an a-priori alpha level of.05. Results: Of the 1978 patients in the ACL registry, 48 met the study criteria and were included in the analyses (ACL+SRO group, n=24; Isolated ACL group, n=24). Baseline comparisons revealed that the ACL+SRO group had a higher bodyweight (200.9 ±35.1 vs 179.7 ±33.9, P <.001) and subsequent higher body mass index (29.7 ±4.6 vs 26.7 ±5.0, P =.044), Table 1. Additional baseline differences included ACL graft type, and staged procedures (P <.05, Table 2). The mean preoperative posterior tibial slope was 17.0° ±2.7° and 7.0° ±2.2° following SRO (mean diff: -10.0°, P <.001). Table 3 depicts the comparisons at return to sport, with the ACL+SRO group demonstrating longer time to return (P <.001) and lower ACL-RSI scores (P =.027). At 2 years, there were no statistical differences in SANE score (85.3 ±7.3 vs 88.2 ±9.7, P =.349), graft reinjury rate (0.0% vs 0.0%, P = 1.000), rate of return to sports (85.7% vs 91.7%, P =.844), or level of return to sports between groups with 45.8% (n=11) of the ACL+SRO group returning to a level I or II cutting and pivoting sport versus 54.2% (n=13) in the Isolated ACL group (P =.656). There were no reported postoperative infections or deep vein thromboses in either group (P >.05). Conclusions: The current study suggests that SRO in the setting of ACL reconstruction for large posterior tibial slope deformities is effective at correcting malalignment, restoring objective and self-reported function, and avoiding graft failure out to 2 years. This procedure also holds promise to allow a majority of patients to return to various levels of sporting activities. To our knowledge, this is the first comparative study examining the return to sports and 2-year outcomes of this population to a matched isolated ACL cohort. While these data do provide evidence for ongoing investigation, we recommend the performance of larger clinical trials to confirm these results. [ABSTRACT FROM AUTHOR]

Background: The most impactful research on pediatric type 1 diabetes (T1D) remains unknown. Objective: We aimed to evaluate the characteristics and impact of the 100 most-cited articles on pediatric T1D. Materials and Methods: Using a predefined bibliometric strategy, the Scopus database was searched for high-cited papers (HCPs) published from 2001 to 2020. Articles were evaluated for data on the publication year, countries, authors, journals, topics, and types. Social network analysis was performed to visualize the interaction among countries, organizations, and authors using VOSviewer software. Results: The top 100 HCPs received 390 to 4634 citations, averaging 773.5 citations per paper (CPP). The funded HCPs (n = 50) had a higher impact (CPP 791.5). The majority of HCPs (n = 83) were collaborative. Classifying by research type, 65 studies were clinical (n = 65), risk factors (n = 27), epidemiology (n = 26), pathophysiology (n = 16), treatment outcome (n = 13), genetics (n = 12), complications (n = 3), quality of life (n = 2), and prognosis (n = 1). The number of authors involved was 1,101, affiliated with 545 organizations in 27 countries; the USA (n = 64) and the UK (n = 24) were the most productive countries, whereas Australia and the UK were the most impactful. D.M. Nathan and J.M. Lawrence were the most prolific authors, while P. Raskin and J.M. Lachin were the most impactful. Conclusions: High-income countries such as the USA, UK, and Australia contribute significantly to high-impact pediatric T1D research. Funding and collaboration improve the impact of citations in publications. Less researched areas such as treatment outcomes, genetics, complications, quality of life, and prognosis should be the focus of future research on pediatric T1D. [ABSTRACT FROM AUTHOR]

Genetic cardiomyopathies are disorders of the cardiac muscle, most often explained by pathogenic mutations in genes encoding sarcomere, cytoskeleton, or ion channel proteins. Clinical phenotypes such as heart failure and arrhythmia are classically treated with generic drugs, but aetiology-specific and targeted treatments are lacking. As a result, cardiomyopathies still present a major burden to society, and affect many young and older patients. The Translational Committee of the Heart Failure Association (HFA) and the Working Group of Myocardial Function of the European Society of Cardiology (ESC) organized a workshop to discuss recent advances in molecular and physiological studies of various forms of cardiomyopathies. The study of cardiomyopathies has intensified after several new study setups became available, such as induced pluripotent stem cells, three-dimensional printing of cells, use of scaffolds and engineered heart tissue, with convincing human validation studies. Furthermore, our knowledge on the consequences of mutated proteins has deepened, with relevance for cellular homeostasis, protein quality control and toxicity, often specific to particular cardiomyopathies, with precise effects explaining the aberrations. This has opened up new avenues to treat cardiomyopathies, using contemporary techniques from the molecular toolbox, such as gene editing and repair using CRISPR-Cas9 techniques, antisense therapies, novel designer drugs, and RNA therapies. In this article, we discuss the connection between biology and diverse clinical presentation, as well as promising new medications and therapeutic avenues, which may be instrumental to come to precision medicine of genetic cardiomyopathies. [ABSTRACT FROM AUTHOR]

Every year, hundreds of thousands of children worldwide are born with sickle cell disease, a genetic disorder that impacts the hemoglobin molecules in blood. If left undiagnosed and untreated, most affected children will die before reaching the age of five. However, highly accurate diagnostic methods and effective treatment regimens for sickle cell disease have been known for many years, and children who receive early diagnosis and subsequent comprehensive care survive well into adulthood-as evidenced by the tremendous success of universal newborn screening programs in North America and Europe. [ABSTRACT FROM PUBLISHER]

The article discusses the combination of corticosteroid injections and exercise for tendinopathy treatment. It mentions that while corticosteroid injections provide short-term pain relief, they may hinder the long-term effectiveness of exercise. The study suggests that a judicious approach to exercise, including education and pain monitoring, should be the primary treatment, with corticosteroid injections reserved for cases where they are necessary due to their limited short-term benefit.

The article discusses the challenges faced in managing chronic, disabling low back pain in primary care and highlights the findings of the RESTORE trial, which demonstrated clinically important and durable effects of cognitive functional therapy (CFT) on health outcomes. The article emphasizes the need for scalable training methods for clinicians to deliver CFT, the lack of funding mechanisms for CFT in national health services.