Effects of early functional mobilization after acute Achilles tendon rupture repair

Background: Patient outcome after Achilles tendon rupture (ATR) varies greatly, and complications such as deep venous thrombosis (DVT) and tendon elongation are common. Although accelerated rehabilitation is considered safe, the optimal content of the rehabilitation protocol is still unknown. Immediate early functional mobilization (EFM) could possibly be a way to reduce the risk of complications and improve outcome. Aim: The overall aim of this thesis was to investigate whether EFM could reduce the risk of complications and improve outcome in individuals after surgical treatment of acute ATR. Methods: A total of 149 ATR patients treated with a standardized surgical protocol were postoperatively randomized to either EFM (immediate full weightbearing and ankle motion in an orthosis) or standard treatment (ST, non-weightbearing plaster cast for 2 weeks). The incidence of DVT was examined by means of compression duplex ultrasound at 2 and 6 weeks postoperatively. Self-reported loading, steps and pain were recorded as well as evaluations of plantar pressure measurement, ultrasound imaging of the muscle-tendon morphology, clinical assessments, questionnaires, gait analysis, and functional outcome at different time points over the first postoperative year. Results: EFM did not increase the risk of re-ruptures and infections compared to ST. EFM versus ST showed no difference in the incidence of DVT at 2 or 6 weeks. Risk factors for exhibiting a DVT postoperatively were older age and BMI >26, as well as low loading (≤50%) the first week after surgery in the EFM group. More experience of pain during activity was associated with lower degree of loading. Suffering from a DVT postoperatively resulted in inferior patient-reported outcome up to a year after ATR repair. Patients in the EFM group reported higher general health and vitality compared to ST at 6 months postoperatively. The two groups exhibited no differences in functional outcome, neither at 6 months nor at one year. EFM resulted in more pronounced tendon elongation at 2 weeks compared to ST. At later time points, no significant differences in elongation were found. However, tendon elongation of more than 3 cm resulted in inferior outcome in the heel-rise test at one year. No significant differences in muscle atrophy between groups were observed, although a trend for increased atrophy was seen in the ST group. The soleus atrophy seemed to be persistent at one year postoperatively. No significant differences in gait patterns between groups were observed at 8 weeks or at 6 months. Conclusions: EFM after ATR repair does not increase or reduce the risk of DVT, re-rupture and infection in the short term or tendon elongation and muscle atrophy in the long term, but EFM resulted in enhanced general health and vitality in the medium term outcome. Higher loading in the EFM group was associated with a lower risk of DVT. Suffering a DVT results in inferior patient-reported outcome and exhibiting excessive tendon elongation leads to impaired functional outcome at one year

Lily Pordes Collection 1929-1999

Certificates of Austrian citizenship (Heimatschein) and of US naturalization (photocopies).Also included in the paper collection is a Questionnaire of the Austrian Heritage Collection at the Leo Baeck Institute.Lily Elisabeth Pordes, née Aufwerber was born in Vienna in 1911.Austrian Heritage CollectionSee also AHC interview with Lily Elisabeth Pordes (AHC 834)digitize

Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: A European randomized, double-blind, placebo-controlled trial

The efficacy and safety of high-dose intravenous polyspecific immunoglobulin G (IVIG) as adjunctive therapy in streptococcal toxic shock syndrome (STSS) were evaluated in a multicenter, randomized, double-blind, placebo-controlled trial. The trial was prematurely terminated because of slow patient recruitment, and results were obtained from 21 enrolled patients (10 IVIG recipients and 11 placebo recipients). The primary end point was mortality at 28 days, and a 3.6-fold higher mortality rate was found in the placebo group. A significant decrease in the sepsis-related organ failure assessment score at days 2 (P = .02) and 3 (P = .04) was noted in the IVIG group. Furthermore, a significant increase in plasma neutralizing activity against superantigens expressed by autologous isolates was noted in the IVIG group after treatment (P = .03). Although statistical significance was not reached in the primary end point, the trial provides further support for IVIG as an efficacious adjunctive therapy in STSS

Validation of automated sepsis surveillance based on the Sepsis-3 clinical criteria against physician record review in a general hospital population : observational study using electronic health records data

Background: Surveillance of sepsis incidence is important for directing resources and evaluating quality-of-care interventions. The aim was to develop and validate a fully-automated Sepsis-3 based surveillance system in non-intensive care wards using electronic health record (EHR) data, and demonstrate utility by determining the burden of hospital-onset sepsis and variations between wards. Methods: A rule-based algorithm was developed using EHR data from a cohort of all adult patients admitted at an academic centre between July 2012 and December 2013. Time in intensive care units was censored. To validate algorithm performance, a stratified random sample of 1000 hospital admissions (674 with and 326 without suspected infection) was classified according to the Sepsis-3 clinical criteria (suspected infection defined as having any culture taken and at least two doses of antimicrobials administered, and an increase in Sequential Organ Failure Assessment (SOFA) score by >2 points) and the likelihood of infection by physician medical record review. Results: In total 82 653 hospital admissions were included. The Sepsis-3 clinical criteria determined by physician review were met in 343 of 1000 episodes. Among them, 313 (91%) had possible, probable or definite infection. Based on this reference, the algorithm achieved sensitivity 0.887 (95% CI: 0.799 to 0.964), specificity 0.985 (95% CI: 0.978 to 0.991), positive predictive value 0.881 (95% CI: 0.833 to 0.926) and negative predictive value 0.986 (95% CI: 0.973 to 0.996). When applied to the total cohort taking into account the sampling proportions of those with and without suspected infection, the algorithm identified 8599 (10.4%) sepsis episodes. The burden of hospital-onset sepsis (>48 hour after admission) and related in-hospital mortality varied between wards. Conclusions: A fully-automated Sepsis-3 based surveillance algorithm using EHR data performed well compared with physician medical record review in non-intensive care wards, and exposed variations in hospital-onset sepsis incidence between wards