Tendinopathy—from basic science to treatment

Chronic tendon pathology (tendinopathy), although common, is difficult to treat. Tendons possess a highly organized fibrillar matrix, consisting of type I collagen and various 'minor' collagens, proteoglycans and glycoproteins. The tendon matrix is maintained by the resident tenocytes, and there is evidence of a continuous process of matrix remodeling, although the rate of turnover varies at different sites. A change in remodeling activity is associated with the onset of tendinopathy. Major molecular changes include increased expression of type III collagen, fibronectin, tenascin C, aggrecan and biglycan. These changes are consistent with repair, but they might also be an adaptive response to changes in mechanical loading. Repeated minor strain is thought to be the major precipitating factor in tendinopathy, although further work is required to determine whether it is mechanical overstimulation or understimulation that leads to the change in tenocyte activity. Metalloproteinase enzymes have an important role in the tendon matrix, being responsible for the degradation of collagen and proteoglycan in both healthy patients and those with disease. Metalloproteinases that show increased expression in painful tendinopathy include ADAM (a disintegrin and metalloproteinase)-12 and MMP (matrix metalloproteinase)-23. The role of these enzymes in tendon pathology is unknown, and further work is required to identify novel and specific molecular targets for therapy

Protocol: developing a conceptual framework of patient mediated knowledge translation, systematic review using a realist approach

<p>Abstract</p> <p>Background</p> <p>Patient involvement in healthcare represents the means by which to achieve a healthcare system that is responsive to patient needs and values. Characterization and evaluation of strategies for involving patients in their healthcare may benefit from a knowledge translation (KT) approach. The purpose of this knowledge synthesis is to develop a conceptual framework for patient-mediated KT interventions.</p> <p>Methods</p> <p>A preliminary conceptual framework for patient-mediated KT interventions was compiled to describe intended purpose, recipients, delivery context, intervention, and outcomes. A realist review will be conducted in consultation with stakeholders from the arthritis and cancer fields to explore how these interventions work, for whom, and in what contexts. To identify patient-mediated KT interventions in these fields, we will search MEDLINE, the Cochrane Library, and EMBASE from 1995 to 2010; scan references of all eligible studies; and examine five years of tables of contents for journals likely to publish quantitative or qualitative studies that focus on developing, implementing, or evaluating patient-mediated KT interventions. Screening and data collection will be performed independently by two individuals.</p> <p>Conclusions</p> <p>The conceptual framework of patient-mediated KT options and outcomes could be used by healthcare providers, managers, educationalists, patient advocates, and policy makers to guide program planning, service delivery, and quality improvement and by us and other researchers to evaluate existing interventions or develop new interventions. By raising awareness of options for involving patients in improving their own care, outcomes based on using a KT approach may lead to greater patient-centred care delivery and improved healthcare outcomes.</p

Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study.

Objectives: This randomised feasibility study aimed to examine the clinical and biomechanical effects of functional foot orthoses (FFO) in the treatment of midfoot osteoarthritis (OA) and the feasibility of conducting a full randomised-controlled trial. Methods: Participants with painful, radiographically confirmed midfoot OA were recruited and randomised to receive either FFO or a sham control orthosis. Feasibility measures included recruitment and attrition rates, practicality of blinding and adherence rates. Clinical outcome measures were change from baseline to 12 weeks for severity of pain (numerical rating scale), foot function (Manchester Foot Pain and Disability Index) and patient global impression of change scale. To investigate the biomechanical effect of foot orthoses, in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks. Results: Of the 119 participants screened, 37 were randomised and 33 completed the study (FFO=18, sham=15). Compliance with foot orthoses and blinding of the intervention was achieved in three-quarters of the group. Both groups reported improvements in pain, function and global impression of change; the FFO group reporting greater improvements compared to the sham group. The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group. Conclusions: The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses. This feasibility study provides useful clinical, biomechanical and statistical information for the design and implementation of a definitive randomised-controlled trial to evaluate the effectiveness of FFO in treating painful midfoot OA

Leer una revista académica es como hacer etnografía

Eine Sicht des ethnographischen Arbeitsvorganges ist es, dass dieser Prozess dem Lesen wissenschaftlicher Manuskripte ähnelt. In diesem Beitrag drehe ich diesen Vergleich um: Ich schlage vor, das Lesen von wissenschaftlichen Artikeln zum Betreiben von Ethnographie zu verwenden. Ich verdeutliche dies mittels einer Ethnographie zu Artikeln, die in einem Heft der Studies in Higher Education erschienen sind. Mein Ziel ist, einer von RORTY inspirierten, pragmatischen Perspektive folgend zu zeigen und zu bewerten, ob es sich bei diesen Artikeln um für uns sinnvolle "Geschichten" handelt oder nicht. URN: urn:nbn:de:0114-fqs0401408One view of doing ethnography is that it is like trying to construct a reading of a manu­script. What follows is a text which turns that definition around. Thus the proposition here is that "constructing a reading of a series of manuscripts—a journal—is like doing ethnography". The article itself is an ethnographic explication of the numer­ous texts contained in one edition of Studies in Higher Education. The aim is to provide an ac­count of the texts therein in order to judge, from a Rortyan, pragmatist perspective, whether or not these stories are good for us. URN: urn:nbn:de:0114-fqs0401408Una opinión sobre hacer etnografía es que ésta se parece al intento de construir una lectura de un manuscrito. Lo que sigue es un texto que coloca esa definición en el tapete. Es decir, la proposición es que "la construcción de la lectura de una serie de manuscritos, por ejemplo una revista, es similar a hace etnografía". El artículo mismo es una explicación etnográfica de los numerosos textos contenidos en una edición de Estudios de Educación Superior. El propósito es proporcionar una versión de los textos a fin de juzgar desde una perspectiva Rortiana, pragmática, si tales relatos son o no buenos para nosotros. URN: urn:nbn:de:0114-fqs040140

Reading an Academic Journal is Like Doing Ethnography

Eine Sicht des ethnographischen Arbeitsvorganges ist es, dass dieser Prozess dem Lesen wissenschaftlicher Manuskripte ähnelt. In diesem Beitrag drehe ich diesen Vergleich um: Ich schlage vor, das Lesen von wissenschaftlichen Artikeln zum Betreiben von Ethnographie zu verwenden. Ich verdeutliche dies mittels einer Ethnographie zu Artikeln, die in einem Heft der Studies in Higher Education erschienen sind. Mein Ziel ist, einer von RORTY inspirierten, pragmatischen Perspektive folgend zu zeigen und zu bewerten, ob es sich bei diesen Artikeln um für uns sinnvolle "Geschichten" handelt oder nicht.One view of doing ethnography is that it is like trying to construct a reading of a manu­script. What follows is a text which turns that definition around. Thus the proposition here is that "constructing a reading of a series of manuscripts—a journal—is like doing ethnography". The article itself is an ethnographic explication of the numer­ous texts contained in one edition of Studies in Higher Education. The aim is to provide an ac­count of the texts therein in order to judge, from a Rortyan, pragmatist perspective, whether or not these stories are good for us.Una opinión sobre hacer etnografía es que ésta se parece al intento de construir una lectura de un manuscrito. Lo que sigue es un texto que coloca esa definición en el tapete. Es decir, la proposición es que "la construcción de la lectura de una serie de manuscritos, por ejemplo una revista, es similar a hace etnografía". El artículo mismo es una explicación etnográfica de los numerosos textos contenidos en una edición de Estudios de Educación Superior. El propósito es proporcionar una versión de los textos a fin de juzgar desde una perspectiva Rortiana, pragmática, si tales relatos son o no buenos para nosotros

Reading an Academic Journal is Like Doing Ethnography

One view of doing ethnography is that it is like trying to construct a reading of a manu­script. What follows is a text which turns that definition around. Thus the proposition here is that "constructing a reading of a series of manuscripts—a journal—is like doing ethnography". The article itself is an ethnographic explication of the numer­ous texts contained in one edition of Studies in Higher Education. The aim is to provide an ac­count of the texts therein in order to judge, from a Rortyan, pragmatist perspective, whether or not these stories are good for us. URN: urn:nbn:de:0114-fqs040140

Perhaps I am Still Waiting for Godot?

In this narrative, I use notions from Beckett’s Waiting for Godot to help me reflect on concerns about uncertainty, identity, the advantages and disadvantages of waiting, as well as the strange invention of Godot himself (or her-self)