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The burden of peripheral artery disease is significant for public health but the readily available on-line information on the disease is poorly studied. This study seeks to evaluate the quality and readability of patient resources and identify gaps that appear in the top search results for peripheral artery disease.Internet searches were performed for "PAD" and "Peripheral Artery Disease" and "PVD" on three search engines and two metasearch engines. The top 30 websites from each search engine were compiled, screened, and evaluated across four categories of information to assess overall quality: accountability, interactivity, structure, and content. Four indices were used to evaluate readability of the text for the viewer. Statistical analyses was performed using Rstudio with ANOVA.Sixty-three websites met inclusion criteria, of which 25 were open access (34.9%), 30 were from hospital/healthcare organization (48%), 5 were from a governmental agency (8%), 4 were industry sponsored (6%), and 2 were from professional medical societies (3%). Median total quality score was 19 out of 47 (IQR, 15 -30): of the components of this score, accountability was 5 out of 17 (2 -10), interactivity was 2 out of 5 (2.0 -2.0), site structure was 3 out of 4 (2.5 -3.0), and site content was 11 out of 21 (7 -14). Total score varied significantly by organization type (P = 0.007). Open access (30, 17 -34, median, IQR) and governmental agency (30, 29 -31) websites scored the highest while hospital/healthcare organization (16, 14v21) websites scored the lowest. Overall readability was low with a median Flesch-Kincaid Grade Level Score of 10.7 (IQR, 10 -12). Using this index, only one website (1.6%) was written below the recommended 6th grade reading level.Freely available online patient education materials for peripheral artery disease are poor, have varying quality, and are largely written at a level higher than that of an average US adult thus depriving the patient from understanding the existing information. We recommend that the vascular surgery community re-examine the current offering and provide improved readable websites to patients to facilitate patient education and shared decision making.

Bilateral deficits in sensorimotor function have been observed in unilateral musculoskeletal pain conditions. Altered interhemispheric inhibition (IHI) between primary sensory cortices (S1s) is one mechanism that could explain this phenomenon. However, IHI between S1s in response to acute muscle pain, and the relationship between IHI and pressure pain sensitivity in the unaffected limb have not been examined. In 21 healthy individuals, IHI was assessed using somatosensory evoked potentials in response to paired median nerve electrical stimulation at: 1) baseline; 2) immediately following pain resolution; and 3) at 30-minutes follow-up. Acute muscle pain was induced by injection of hypertonic saline into the right abductor pollicis brevis (APB) muscle. Pressure pain thresholds were assessed at the right and left APB muscles before and 30-minutes after pain resolution. Compared to baseline, IHI from the affected to unaffected S1 was unaltered in response to acute muscle pain immediately following pain resolution, or at 30-minutes follow-up. Pressure pain thresholds were reduced over the right (P = .001) and left (P = .001) APB muscles at 30-minutes follow-up. These findings suggest IHI between S1s is unaffected by acute, short-lasting muscle pain, despite the development of increased sensitivity to pressure in the unaffected APB muscle. PERSPECTIVE: IHI from the affected S1 (contralateral to the side of pain) to unaffected S1 is unaltered following the resolution of acute muscle pain. This finding suggests that IHI between S1s may not be relevant in the development of bilateral sensorimotor symptoms in unilateral pain conditions.

Background Emergency nurses are at higher risk than the average worker of experiencing lumbar pain. This is the first study to undertake real time monitoring to quantify lumbar movements of nurses working in the emergency department (ED). Methods Emergency nurses at a single Australian ED were recruited for a prospective observational case study. Participants worked in four discrete clinical areas of the ED; In-charge, triage, resuscitation, and cubicles. Data collected included participant demographics, lumbar pain pre- and post-shift, and real-time recording of lumbar movements. Results Sixty-two nurses participated. There were statistically significant differences in time spent standing (p = 0.005), sitting (p ≤ 0.001) and in locomotion (moving) (p ≤ 0.001) when compared by clinical role. Triage nurses spent over half their shift sitting, had the most sustained (> 30 s) flexions (60+ degrees) and had a median of 4 periods of uninterrupted sitting (10−30 mins) per shift. Conclusions Differences in movement demands were identified based on various clinical roles in the ED. Triage was associated with greater periods of uninterrupted sitting and with greater degrees of sustained flexion, both of which are predictors for back pain. This study provides foundation evidence that triage may not be the most appropriate location for staff returning from back injury.

Emerging evidence suggest a possible association between immune thrombocytopenia (ITP) and some formulations of COVID-19 vaccine. We conducted a retrospective case series of ITP following vaccination with Vaxzevria ChadOx1-S (AstraZeneca) and mRNA Comirnaty BNT162b2 COVID-19 (Pfizer-BioNTech) vaccines and compare the incidence to expected background rates for Victoria during the first six months of the Australian COVID-19 vaccination roll-out in 2021. Cases were identified by reports to the Victorian state vaccine safety service, SAEFVIC, of individuals aged 18 years or older presenting with thrombocytopenia following COVID-19 vaccination without evidence of thrombosis. Twenty-one confirmed or probable cases of ITP were identified following receipt of AstraZeneca (n = 17) or Pfizer-BioNTech (n = 4) vaccines. This translates to an observed incidence of 8 per million doses for AstraZeneca vaccine, twice the expected background rate of 4.1 per million. The observed rate for Pfizer-BioNTech was consistent with the expected background rate. The median time to onset for the cases post AstraZeneca vaccination was 10 days (range 1–78) and median platelet nadir 5 × 109/L (range 0–67 × 109/L). Hospital presentations or admissions for management of symptoms such as bleeding occurred in 18 (86%) of the cases. The majority of cases (n = 11) required intervention with at least 2 therapy modalities. In conclusion, we observed a substantially higher than expected rate of ITP following AstraZeneca vaccination. ITP is the second haematological adverse event, distinct from that of thrombosis with thrombocytopenia syndrome (TTS), observed following AstraZeneca vaccination.

Objective This study aimed to develop and internally validate risk prediction models for predicting groin wound surgical site infections (SSIs) following arterial intervention and to evaluate the utility of existing risk prediction models for this outcome. Methods Data from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study were used. The GIVE study prospectively enrolled 1 039 consecutive patients undergoing an arterial procedure through 1 339 groin incisions. An overall SSI rate of 8.6% per groin incision, and a deep/organ space SSI rate of 3.8%, were reported. Eight independent predictors of all SSIs, and four independent predictors of deep/organ space SSIs were included in the development and internal validation of two risk prediction models. A systematic search of the literature was conducted to identify relevant risk prediction models for their evaluation. Results The “GIVE SSI risk prediction model” (“GIVE SSI model”) and the “GIVE deep/organ space SSI risk prediction model” (“deep SSI model”) had adequate discrimination (C statistic 0.735 and 0.720, respectively). Three other groin incision SSI risk prediction models were identified; both GIVE risk prediction models significantly outperformed these other risk models in this cohort (C statistic 0.618 – 0.629; p Conclusion Two models were created and internally validated that performed acceptably in predicting “all” and “deep” groin SSIs, outperforming current existing risk prediction models in this cohort. Future studies should aim to externally validate the GIVE models.

Background There has been increasing concerns regarding the declining number of medical students entering surgical residencies. The aim of this study is to analyze strategies and outcomes to enhance recruitment to the surgical specialties. Methods A systematic literature PRISMA-based search was performed. Study quality and bias were assessed. Meta-analysis was performed using DerSimonian Laird method. Results Of 3288 unique titles identified, 73 studies met inclusion criteria. Median study unique sample size was 84 participants (range 15–910). Subjective interest was reported in 59 studies, while objective match rate was reported by only 21 studies. The cumulative odds of students interested in the studied specialty was 1.98 (95% CI 1.47–2.67, I2 = 0%) and in any surgical specialty was 1.40 (95% 1.01–1.95, I2 = 37%) after an intervention compared to baseline. Conclusion While studies show increased odds of “interested in” a surgical specialty, the results may be subject to high selective and confounding biases.