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Objective: To review the prospective studies of ankle-ligament-injury risk factors.Data Sources: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology.Data Synthesis: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma.Conclusions/Recommendations: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive screening measures are an established part of a dementia assessment and often include measures of subjective difficulties, e.g., Everyday Memory Questionnaire (EMQ), informant-rated difficulty, Cambridge Behavioural Inventory - Revised (CBI-R), and objective cognitive assessments like Addenbrooke's Cognitive Examination (ACE-III). While these measures have validity for the purpose of diagnosing dementia, in clinical practice they are often used outside of their evidence base for the purpose of cognitive re-assessment. The current study sought to evaluate the psychometric properties for the repeated use of these assessments., Methods: This study used a longitudinal design, which included 49 healthy controls, 33 people with subjective memory difficulties, and 10 people with Alzheimer's disease (AD) being assessed twice, with approximately a 1-year interval between assessments., Results: The EMQ has adequate re-test reliability (r = 0.78), but people with an AD diagnosis rated their memory as better than those with SMD, making it unsuitable as a measure. The CBI-R had moderate re-test reliability (r = 0.62). However, deterioration on the CBI-R was not useful for diagnosing AD. The ACE-III has high re-test reliability (r = 0.89). A change of five was associated with reasonable classification accuracy for identifying AD and achieved statistical significance., Conclusion: Using a 1-year interval, of the three measures used in this study, only the ACE-III total score may be a useful measure of change over time, although it should be applied cautiously due to the lack of representativeness of the sample, and change scores should always be triangulated with other forms of evidence of deterioration., (© 2024 S. Karger AG, Basel.)

Post stroke anxiety is associated with reduced quality of life, worse rehabilitation outcomes and poor social functioning in stroke survivors. Despite its clinical relevance, there are a lack of screening tools to identify post-stroke anxiety. The Hospital Anxiety and Depression Scale (HADS-A) and Geriatric Anxiety Inventory (GAI) are the only self-report screening test for anxiety validated in stroke patients. However, both of these measures have limitations associated with their clinical utility, length of time to administer and cost to purchase. This study aimed to assess the classiciation accuracy of a freely available and shorter alternative, the Generalized Anxiety Disorder 2-item (GAD-2) for use in the acute stroke setting. This study used retrospective analysis of a sequential sample in a clinical database of mood and cognitive scores. Patients' scores on the GAD-2 and HADS-A were compared. The GAD-2 demonstrated strong convergent validity with the HADS-A and good specificity and sensitivity for clinical anxiety. In conclusion, the GAD-2 may be a useful screening assessment of post-stroke anxiety in the acute setting; however, it should be used with due consideration of the methodological limitations of this study.

Introduction: Visual and spatial perception (VSP) are cognitive domains frequently assessed in the screening and neuropsychological assessment of dementia. Evidence suggests that VSP impairment is common in the early stages of Alzheimer's disease (AD). Despite this evidence, the ability of VSP tests to discriminate between healthy older adults and people with AD remains mixed. The purpose of this literature review was to employ a systematic search strategy to identify empirical evidence supporting the diagnostic utility of VSP tests which may be used in the screening and diagnosis of AD., Methods: Specified criteria were used to perform a systematic literature search of the PsycINFO and PubMed databases with no date restrictions. Relevant data from the selected studies were extracted, and a published appraisal tool (the Quality Assessment of Diagnostic Accuracy Studies-2) was used to evaluate methodological quality., Results: Of the 144 articles returned, six studies and 11 VSP tests met review inclusion criteria. Four tests demonstrated both sensitivity and specificity values above 80%. A computerised 3D Visual Task demonstrated the highest sensitivity and specificity values (90% and 95%, respectively). The quality of the identified studies was considered to be satisfactory. Identified limitations and the implications of issues relating to study methodology are discussed, and recommendations for future research are suggested., Conclusion: The evidence from this review suggests that certain tests of VSP may be a useful addition to the routine screening of AD., (© 2023 S. Karger AG, Basel.)

Fiber Bragg gratings are written across all 120 single-mode cores of a multi-core optical Fiber. The Fiber is interfaced to multimode ports by tapering it within a depressed-index glass jacket. The result is a compact multimode "photonic lantern" filter with astrophotonic applications. The tapered structure is also an effective mode scrambler.

Background: The purpose of this study was to determine plantar pressure and contact areas of the foot inside the athletic shoe during activity. The objectives were to determine if plantar pressure and contact area measurements collected on multiple trials from the same subject were reliable, to determine the variability of measurements between subjects as compared to that found between steps within a single subject, to determine the relationship between contact area and plantar pressure, and to ascertain whether there were any systematic gender differences in these measurements., Methods: Sixteen healthy adults volunteered for participation in the first part of the study that was designed to determine reliability and variability of the testing methodology. A separate group of fifty healthy high school and collegiate athletes participating in soccer, field hockey, basketball, and lacrosse comprised the second part of the study that was designed to investigate gender differences in terms of normalized midfoot plantar pressure and contact area, and the interrelationship between the two measurements. Data were collected during the midstance phase of gait, using the Pedar in-shoe measurement system (Novel GMBH, St. Paul, MN). Athletes wore their own athletic shoes and performed walking trials on a surface similar to that used in their sport. The foot was divided into four regions based on radiographic measurements., Results: The midfoot region demonstrated excellent reliability across multiple trials of the same subject in contact area and plantar pressure, and the variability between steps within a single subject was small when compared to that between subjects. Normalized midfoot contact area and plantar pressure values were highly correlated with r values of 0.862 on the left foot and .912 on the right foot. No significant differences were found in normalized midfoot contact area or plantar pressure values between males and females., Conclusions: The Pedar in-shoe pressure measurement system can be used reliably to quantify contact area and plantar pressure beneath the midfoot region during the midstance phase of gait. This measurement technique can now be used in risk factor studies designed to identify individuals at risk for injury to the foot, ankle, and other lower extremity structures.

Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine additional risk factors for lower extremity injury.

We describe a low-coherence interferometric technique for simultaneous measurement of geometric thickness and group refractive index of highly dispersive samples. The technique is immune to the dispersion-induced asymmetry of the interferograms, thus overcoming limitations associated with some other low-coherence approaches to this simultaneous measurement. We use the experimental configuration of a tandem interferometer, with the samples to be characterized placed in an air gap in one arm of the measurement interferometer. Unambiguous, dispersion-insensitive measurements of critical group-delay imbalances in the measurement interferometer are determined from the optical frequency dependence of interferogram phases, by means of dispersive Fourier transform spectrometry. Sample thickness and group refractive index are calculated from these group delays. A thickness measurement precision of 0.2 microm and group index measurement accuracy of 5 parts in 10(5) across a wavelength range of 150 nm have been achieved for BK7 and fused-silica glass samples in the thickness range 2000 to 6000 microm.

Patient-controlled analgesia (PCA) with intravenous pethidine was compared with nurse-controlled pethidine infusions for pain relief in 200 patients after major abdominal or thoracic surgery. Pain, level of sedation, nausea and presence of other adverse effects, in addition to cumulative pethidine requirement, were measured for the first 24 hours after surgery. Both groups were similar for age, weight and type of surgery. There was no significant difference between the quality of analgesia achieved in both groups. The frequency and severity of adverse effects was also similar. The cumulative pethidine dose administered to both groups was identical. It is concluded that nurse-controlled opioid infusions are as effective as PCA and may be used as an alternative to PCA where this is either unavailable or unsuitable.

Indomethacin commenced before operation was compared with postoperative indomethacin administration for pain relief in patients after elective thoracic surgery. In addition to indomethacin, all patients received i.v. opioids titrated to their individual requirements. There was no significant difference between the two groups in quality of pain relief, in cumulative opioid requirement or in the incidence of adverse effects. The quality of pain relief compared well with previous similar studies using this technique.

A study was conducted in patients receiving intravenous opioid analgesia to determine the incidence and degree of retrograde flow along the parallel gravity-driven infusion line. From 1187 hours of observations retrograde flow was found in 2.5% of the total time. In 70% of these cases this was equivalent to less than 1 mg of pethidine and in 96% this was equivalent to less than 5 mg of pethidine. The need for routine use of antireflux valves during intravenous opioid analgesia is therefore questioned.

Nurse-controlled continuous intravenous opioid analgesia was evaluated prospectively in 60 patients after thoracotomy. The rate of opioid infusion was adjusted, and bolus does were administered, as required to maintain patient comfort. The patients evaluated their pain using a visual analogue scale on 10 occasions during the first 48 hours after surgery. Pain scores remained consistently low throughout the period of measurement. Over the study period there was a 30-fold difference between the least and greatest requirement for opioid to achieve adequate analgesia. No major side effects were encountered. The study indicates that nurse-controlled intravenous analgesia can be successfully used for pain relief after thoracotomy.

Clinical observations of nurses working with spinal cord patients describe positional changes affecting diuresis. Research has not documented this phenomenon in detail. Knowledge of the timing of diuresis may allow more control over bladder management. The purpose of this descriptive pilot study was to determine the relationship among body position, timing of diuresis, urine volume, and fluid intake in spinal cord injured subjects. A convenience sample of six subjects with varying levels of spinal cord injury were studied. For five consecutive days, positional changes were determined during bed, wheelchair, and tilt activities. Fluid intake and urine volume, specific gravity, and colony count were measured. Data analysis using correlation and regression statistics revealed head and foot elevation and fluid intake may account for some variance but do not predict total variance in urine output. Future research to validate findings in a controlled setting may provide a scientific basis for bladder management.

Laser therapy has been used extensively for surgery to the respiratory tract since its first application in 1971. At this hospital, the surgeon's preferred technique for laser surgery to the tracheobronchial tree is to use the Nd-YAG laser through a fibreoptic bronchoscope passed through a rigid bronchoscope. General anaesthesia is employed and ventilation is controlled using jet-ventilation by the Sanders technique. Review of the literature failed to locate adequate information on the effect of manoeuvres such as insertion of instruments and the presence of a tracheal obstruction distal to the bronchoscope on the quality of ventilation using this technique. A bench study was undertaken, therefore, in an attempt to mimic such clinical situations and to assess the effect of such manoeuvres on the adequacy and pattern of ventilation. Under all conditions tested 'end-tidal' CO2 concentrations accurately reflected distal 'tracheal' concentrations. The lowest inspired O2 concentration was 50% while entraining air through the bronchoscope. The highest was 86% while entraining oxygen.

The effect of indomethacin on postoperative pain was studied in 60 adult patients undergoing thoracotomy in a prospective, randomized, double-blind manner. Patients receiving indomethacin required significantly less opioid after operation and had significantly lower pain scores compared with the control group. Pain on movement and on coughing were reduced also. No major adverse effects were encountered.

A patient with an ulnopalmar fifth carpometacarpal joint dislocation was successfully treated by nonoperative means. Dissection of five fresh cadaveric specimens revealed that the intermetacarpal ligament is the primary restraint to this unusual type of dislocation.

Intravenous lignocaine (1.5 mg kg-1) was evaluated in patients undergoing intraocular surgery as a means of preventing the rise in intraocular pressure which accompanies tracheal intubation. In patients given either suxamethonium or pancuronium to facilitate tracheal intubation, lignocaine pretreatment conferred no benefit over placebo in preventing the intraocular hypertensive response.

In a prospective randomized trial, epidural buprenorphine was compared with intramuscular morphine for pain relief after spinal corrective surgery. Both forms of analgesia were given on demand and both produced excellent reduction of pain as assessed with visual linear analogue. The quality and duration of analgesia were similar for both groups of patients. Since the correct placement of epidural catheters could be done intraoperatively in difficult cases and since many patients for spinal corrective surgery have limited respiratory reserve, the authors feel that epidural buprenorphine provides an excellent alternative to conventional opiate analgesia after this type of surgery.

In a randomised controlled trial, epidural buprenorphine was compared with intramuscular morphine for postoperative analgesia in patients after hip surgery. Analgesia was given on demand and consisted of epidural boluses of 60 micrograms of buprenorphine in 10 ml of normal saline or intramuscular morphine 0.15 mg/kg. Both forms of analgesia produced excellent pain relief as assessed by the linear analogue scoring system. In both quality and duration of pain relief, no significant difference was found between the two forms of analgesia, but the total dose of epidural buprenorphine required was five times less than the equivalent dose of intramuscular morphine. No side effects attributable to epidural buprenorphine administration were found. The authors conclude that low dose epidural buprenorphine provides an excellent alternative to intramuscular opiates for pain relief after hip surgery.

Continuous intercostal nerve blockade was used to provide analgesia after cholecystectomy. The blockade was maintained by the insertion of a single extradural catheter into an appropriate intercostal space and by "topping-up" with local anaesthetic on demand. Of the patients studied, 92%, and 76%, required no additional analgesia in the first 24 h and first 48 h following operation, respectively. Measurements of peak flow were obtained on the 1st day after operation. A mean improvement of 37% on pre- "top-up" peak flows, was found. It is suggested that continuous intercostal analgesia is a a safe, reliable and powerful form of analgesia which may improve respiratory function after cholecystectomy.

Dorsal column stimulation was undertaken in 10 patients referred to the Pain Relief Clinic for management of otherwise intractable angina pectoris. All patients were on maximal medical therapy and were determined to be unsuitable for coronary artery revascularization by the referring cardiologists. Dorsal column stimulation was beneficial in all patients by decreasing the frequency and severity of anginal attacks. The mechanism of action of dorsal column stimulation in this condition is uncertain.

A synthetic dressing has been developed that isolates the burn wound to protect patients from microbial contamination. This dressing is unique as it is formed from a 2-component system directly on the wound, leaving no voids for microbial proliferation. The synthetic cover, HYDRON Burn Dressing, adheres to the entire wound surface so that additional dressings are not required. It is sufficiently flexible to permit patient mobility. The components used to form the dressing are an ultra-pure, high molecular weight form of HYDRON, a hydrophilic polymer, poly (2-hydroxyethyl methacrylate) and Polethylene Glycol-400. The dressing is intended to be applied directly to the wound immediately post-burn, prior to sloughing or removal of the eschar, a period in the burn therapy regimen for which satisfactory alternative dressings are not readily available. Decreased frequency of dressing changes compared to conventional procedure provides an additional benefit with a corresponding reduction in pain to the patient. Gross examination of the wounds under the dressing has shown that the healing process proceeds similarly to that of wounds under conventional treatment. There is no evidence of fluid accumulation or maceration or desiccation of the eschar. In our series of 32 patients the barrier dressing formed on the wound has offered a new, effective procedure for treatment of the burn wound.

The quality of blood salvaged at operation and prepared with the Dideco Autotrans BT 795 autotransfusion device was compared with that of donor blood in 41 patients having cardiac surgery involving cardiopulmonary bypass. Saved blood had a higher haemoglobin concentration (17.3 v. 13.1 g dl-1; P less than 0.001), a higher 2,3-diphosphoglycerate concentration (5.3 v. 1.1 mmol litre-1; P less than 0.00001), higher white cell count (17.1 X 10(9) litre-1 v. 4.1; P less than 0.00001), higher pH (7.5 v. 6.6; P less than 0.00001) and a more physiological potassium concentration (5.4 v. 8.8 mmol litre-1; P less than 0.00001) than donor blood. Saved blood platelet count was 34.5 X 10(9) litre-1 compared with 146.24 X 10(9) litre-1 (P less than 0.00001) and its heparin concentration was 0.64 u. ml-1. We conclude that this autotransfusor is a useful aid to blood conservation, producing good quality red cells with relatively normal pH and potassium values. However, modification of the centrifugation and washing is required to lessen the high white cell count and heparin concentrations found in the saved blood.

Displaced fractures of the olecranon in adults were analyzed for pain, function, range of motion, and roentgenographic appearance. With one exception, the 38 transverse or oblique fractures were treated by reduction and internal fixation. Results were best in the group treated by screw plus wire in combination (average rating, 17.7 points). Other ratings averaged 17.2 for the intramedullary screw, 16.8 for figure-of-eight wire, and 16.7 for Arbeitsgemeinschaft fur osteosynthesefragen (AO) tension-band wire. Factors associated with poorer results included postoperative displacement or malreduction greater than or equal to 2 mm and articular involvement greater than or equal to 60%. Symptomatic metal prominence was particularly common after AO tension-band wiring, occurring in 80%. All seven comminuted fractures were treated by primary excision. The one comminuted fracture with greater than or equal to 60% articular involvement that was treated by excision had a poor result because of instability.

The effect on gastric emptying of metoclopramide i.v. was studied in three groups of parturient women (n = 120). The groups included those undergoing elective Caesarean section, those who had been in established labour, and those who had received narcotics while in established labour, with their respective controls. Significant delay in gastric emptying occurred when labour was established. This delay was further prolonged by the administration of a narcotic. Metoclopramide i.v. produced a significant improvement in gastric emptying in all groups.

Four commonly used methods of internal fixation for displaced olecranon fractures were analyzed in a biomechanical model to determine strength of fixation. A transverse osteotomy in fresh cadaver specimens was internally fixed and was tested to failure by rapid loading. Screw plus wire in combination provided the greatest strength of fixation. Energy to failure averaged 31.0 Nm for cancellous screw, 32.0 Nm for figure-of-eight wire, 35.3 Nm for Arbeitsgemeinschaft fur Osteosynthesefragen (AO) tension band, and 39.4 Nm for screw-plus-wire combination. Comparison of screw and wire in combination to screw alone or to figure-of-eight wire demonstrated a significant difference (p less than 0.05). The difference between screw plus wire and AO tension-band fixation did not achieve statistical significance (0.2 greater than p greater than 0.1).

India ink was injected through extradural catheters placed in the posterior intercostal space in 12 cadavers undergoing autopsy and the subsequent spread of the India ink was assessed under direct vision. The ink spread subpleurally to reach a number of intercostal spaces and medially to reach the paravertebral space. It is concluded that analgesia extending over a number of dermatomes is achieved by subpleural tracking of local anaesthetic to reach intercostal nerves above and below the one injected.

Patients with cervical intra-epithelial neoplasia had significantly increased neutralising antibody activity to type 2 herpes simplex virus in the cervical mucus. While patients differed from control subjects with respect to their number of sexual partners and socio-economic class, there were significant differences in neutralising antibody activity for case control comparisons within the same number of sexual partners or socio-economic groupings. The results lend support to the putative association between type 2 herpes simplex virus infection and pre-invasive and invasive carcinoma of the uterine cervix.

This case report gives the first published description of the use of dorsal column stimulation in the management of a patient with intractable angina pectoris that was unresponsive to maximal medical therapy, who was unsuitable for coronary artery revascularization surgery.