Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review

Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients.  Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research.  Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental.  Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants.&nbsp

Cardiac troponins and physical exercise. It’s time to make a point

The timely diagnosis of acute coronary syndrome (ACS), in particular myocardial infarction (MI), is still one of the most challenging issues in medicine. The introduction into routine laboratory practice of assays for measuring the cardiospecific troponins has dramatically revolutionized the diagnostic ap-proach and the recent development of methods with improved analytical sensibility (i.e., highly sensitivity [HS] assays), has further contributed to improve the negative predictive value of troponin testing but, contextually, has substantially lowered the clinical specificity of these markers. In particu-lar, clinical studies have demonstrated the existence of an exercise-related increase of HS-troponins, with measurable values detectable in up to 94% of athletes undergoing endurance sports. This mea-surable amount of troponin in blood would mirror an increased membrane permeability and early tro-ponin release rather than reflecting a clinically threatening myocardial injury. As such, the measurable amount of cardiac troponins as assessed with the novel HS assays requires major clinical focus (i.e., serial measurement of cardiac biomarkers, detailed clinical history-taking, integration with ECG and imaging findings) to prevent misdiagnosis of ACS and/or MI in otherwise healthy persons

Effects of winter swimming on haematological parameters

Introduction: Winter swimming represents an intensive short-term exposure to cold, and thus it is considered a strong physical stress. Cold-based treatments, i.e. immersions in cold water, are spreading in sport medicine for improving recovery following muscle traumas, although a universal acceptance of that method is not still achieved. Materials and methods: Fifteen healthy subjects (13 males and 2 females) were recruited among the participants to a 150 meters long swimming race in cold water (6 °C). Blood samples were collec-ted the day before and immediately after the race and a panel of haematological parameters was eva-luated. Results: Swimming in cold water induced a significant variation in the blood cell fraction composition compared to the rest condition, as measured the day before the competition. Red blood cells, white blood cells and platelets count increased significantly (4.7%, P = 0.005; 40.6%, P < 0.001 and 25.0%, P < 0.001, respectively). While the relative number of leukocytes did not change significantly, apart from a strong decrease of the eosinophils population (-48.6%; P < 0.001), a strong increase in the total number of neutrophil granulocytes, lymphocytes and monocytes was recorded (42.6%, P = 0.002, 58.2%, P = 0.001 and 27.5%, P = 0.021, respectively). Following normalization on plasma vo-lume change (-2.54%) the results were unchanged, demonstrating that the variations were not due to a mere haemoconcentration. Conclusions: When represented by brief exposure to cold water, winter swimming induces strong non-pathological modifications of haematological homeostasis

Liquiritigenin reduces osteoclast activity in zebrafish model of glucocorticoid-induced osteoporosis

Drug and therapies currently used to treat human bone diseases have a lot of severe side effects. Liquiritigenin is a flavonoid extracted from Glycyrrhiza glabra roots which has been reported to have positive effects in vitro on osteoblasts activity and bone mineralization as well as inhibitory effect on osteoclasts differentiation and activity in vitro. The present study was aimed to evaluate the in vivo effects of liquiritigenin on bone structure and metabolism in physiological and pathological conditions using Danio rerio as experimental animal model. Treatments with liquiritigenin were performed on embryos to evaluate the osteogenesis during skeletal development. Other treatments were performed on adult fish affected by glucocorticoid-induced osteoporosis to assay the therapeutic potential of liquiritigenin in the reversion of bone-loss phenotype in scale model. Liquiritigenin treatment of zebrafish embryo significantly enhances the osteogenesis during development in a dose-dependent manner. In addition, liquiritigenin inhibits the formation of the osteoporotic phenotype in adult zebrafish model of glucocorticoid-induced osteoporosis preventing osteoclast activation in scales. Interestingly, liquiritigenin does not counteract the loss of osteoblastic activity in scales. The liquiritigenin exhibits in vivo anti-osteoporotic activity on adult fish scale model. It can be considered a good candidate to develop new drugs against osteoporosis

Physical Activity and Bone Health: What Is the Role of Immune System? A Narrative Review of the Third Way

Bone tissue can be seen as a physiological hub of several stimuli of different origin (e.g., dietary, endocrine, nervous, immune, skeletal muscle traction, biomechanical load). Their integration, at the bone level, results in: (i) changes in mineral and protein composition and microarchitecture and, consequently, in shape and strength; (ii) modulation of calcium and phosphorous release into the bloodstream, (iii) expression and release of hormones and mediators able to communicate the current bone status to the rest of the body. Different stimuli are able to act on either one or, as usual, more levels. Physical activity is the key stimulus for bone metabolism acting in two ways: through the biomechanical load which resolves into a direct stimulation of the segment(s) involved and through an indirect load mediated by muscle traction onto the bone, which is the main physiological stimulus for bone formation, and the endocrine stimulation which causes homeostatic adaptation. The third way, in which physical activity is able to modify bone functions, passes through the immune system. It is known that immune function is modulated by physical activity; however, two recent insights have shed new light on this modulation. The first relies on the discovery of inflammasomes, receptors/sensors of the innate immunity that regulate caspase-1 activation and are, hence, the tissue triggers of inflammation in response to infections and/or stressors. The second relies on the ability of certain tissues, and particularly skeletal muscle and adipose tissue, to synthesize and secrete mediators (namely, myokines and adipokines) able to affect, profoundly, the immune function. Physical activity is known to act on both these mechanisms and, hence, its effects on bone are also mediated by the immune system activation. Indeed, that immune system and bone are tightly connected and inflammation is pivotal in determining the bone metabolic status is well-known. The aim of this narrative review is to give a complete view of the exercise-dependent immune system-mediated effects on bone metabolism and function

Evaluation of the Coulter Counter S-Plus VI

This article reports an evaluation of the Coulter Counter model S-Plus VI automatic analyser for haematology, and data are presented on linearity, carry-over, precision, accuracy and stability of the instrument, when compared with a model S-Plus IV/D

Raised pedestrian crossings: Analysis of their characteristics on a road network and geometric sizing proposal

In urban areas traffic-calming strategies and pedestrian friendly measures are often adopted to reduce the adverse impacts of motor vehicles on vulnerable users. This study surveyed 24 raised pedestrian crossings (RPCs) to examine their geometrical and functional characteristics. Geometric characteristics, location, administrative and effective vehicle speed, and the whole-body vibration acceleration induced to vehicle occupants while they are passing over, were considered. In addition to the analysis of the field data, geometrical and functional criteria to design RPCs were carried out. Particularly, two design approaches have been considered. In the first one, RPC provides a designated route across a carriageway raised to the same level, or close to the same level, as the sidewalks that provide access to the pedestrian crossing. In such condition, an RPC is not a traffic-calming device and its design should satisfy geometrical and comfort criteria for designing roads. The results from the surveys demonstrated that less than 10% of RPCs guarantee ride comfort. According to the second design approach, an RPC acts both as a marked pedestrian feature and as a traffic-calming device (i.e., it is trapezoidal in shape with sharp edges). The analysis of the vertical accelerations on vehicle occupants reveal that more than 90% of the surveyed RPCs comply with geometrical and dynamic criteria for speed tables. Extreme variations concerning the observed geometrical characteristics of RPCs and the modelled dynamic performances have been observed: It results in noneffective treatments. Therefore, the results of this study would contribute to providing geometric best practices for overcoming the regulation gap in this subject, and designing RPCs according to international standards