Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC)

Characteristics of patients reporting high (HAD) or low (LAD) (aesthetic discomfort). (DOC 55 kb

Comparison of the effect of Platelet Rich Plasma (PRP) with Hyaluronic Acid (HA) injections to treat chronic Jumper's knee

Introduction: Patellar Tendinopathies (PT) represent a very frequent disorder which incidence can reach 30-50% among jumping sports. This trouble is often rebel to classical treatment. Objective: To compare the efficacy of a single injection of RPR to a double infiltration of HA at one week interval. Patients/Methods: Thirty-three patients suffering from PT were enrolled into the study and split into two randomized groups . Eighteen patients (Group 1) have received one PRP injection and the other fifteen subjects (Group 2) received two HA infiltrations. Pain and functionality of the knee were evaluated before injection (T0), 6 weeks (T2) and 3 months (T3) after injections: pain with VAS and pressure algometer, algofunctional scores with IKDC and VISA-P questionnaires, ultrasound, isokinetic evaluation (quadriceps contractions : concentric 60°/sec (C60), concentric 240°/sec (C240), excentric 30°/sec (E30) and VAS during testing). Results: At baseline, difference existed only between groups for algometer, tendon thickness and axial hypoechoic area. In both groups, VAS, algometer, IKCD, VISA-P, VAS for isokinetic testing C60, C240 and E30 were significantly improved at T2 and T3 compared to T0. Comparison between the 2 groups showed no difference excepted for algometer, tendon thickness (T2, T3) and axial hypoechoic area (T2). Discussion and conclusions: There existed a similar improvement of the symptoms in both groups. PRP has already shown its efficacy in PT. HA should probably be a new therapeutic opportunity in this indication. Nevertheless, it should better, for further studies, to include a more homogeneous population and a longer follow-up period of time

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills

Determinants of COVID-19 vaccine intention in a University population: a serial mediation approach

editorial reviewe

Pratique actuelle pour le retour au sport après une entorse de cheville: Sondage de médecins francophones

peer reviewedBackground: Recommendations are available for assessment criteria for safe return-to-play (RTP) after a lateral ankle sprain. However, their current use among physicians is unknown. Methods: French-speaking physicians in Belgium, France and Switzerland were asked to complete an online survey and report their clinical assessment of selected RTP criteria. Results:The respondent sample (n = 109) included physicians with and without Sports Medicine education, varied level of experience and proportion of athletes in their practice population. Pain was the most selected criterion for safe RTP (90% of physicians), followed by ability to engage in functional tasks (82%), functional instability (73%), range of motion (61%), proprioception (47%), mechanical instability (39%), strength (38%) and swelling (31%). A low proportion of physicians use quantitative measures to assess these criteria (between 4% and 53%). Conclusions: A large proportion of physicians consider the recommended criteria for RTP decisions. However, physicians do not frequently use quantitative measures.Introduction: Il existe des recommandations concernant les critères d'évaluation pour un retour au sport (RTS) réussi à la suite d'une entorse latérale de la cheville. Cependant, leur utilisation actuelle par les médecins est inconnue. Méthodes: Des médecins francophones de Belgique, de France et de Suisse ont été invités à répondre à une enquête en ligne et à faire part de leur évaluation clinique de certains critères de RTS. Résultats: L'échantillon de répondants (n = 109) comprenait des médecins avec et sans formation en médecine du sport, un niveau d'expérience varié et une proportion d'athlètes différente dans leur patient. La douleur était le critère le plus sélectionné pour une RTS réussi (90 % des médecins), suivi de la capacité à s'engager dans des tâches fonctionnelles (82 %), de l'instabilité fonctionnelle (73 %), de l'amplitude des mouvements (61 %), de la proprioception (47 %), de l'instabilité mécanique (39 %), de la force (38 %) et du gonflement (31 %). Une faible proportion de médecins utilise des mesures quantitatives pour évaluer ces critères (entre 4% et 53%). Conclusions: Une grande proportion de médecins prend en compte les critères recommandés pour autoriser le RTS. Cependant, les médecins n'utilisent pas fréquemment des mesures quantitatives

Current perception and practice of athletics coaches about the modification of footstrike pattern in endurance runners: A survey

peer reviewedPurpose To date, the relationship between footstrike pattern and performance, as well as with injury incidence in endurance running remains unclear. For these reasons, it is currently not recommended to modify footstrike pattern in an uninjured long-distance runner. The purpose of this study was to analyse whether athletic coaches apply these current scientific recommendations with their endurance runners on the field. Methods A Delphi method study was used to develop an online survey that was administered to French-speaking athletic coaches in Belgium. The survey comprised three sections: 1) coaches’ profile, 2) coaches’ perception of footstrike patterns, 3) practices pertaining to footstrike patterns. Results One hundred and fourteen respondents completed the entire questionnaire. Ninety-six (84%) athletic coaches reported modifying the footstrike pattern of their endurance runners. They reported that they modify their runners’ rearfoot and forefoot strike more often than a midfoot strike (P < 0.0001) to prevent injury (83%) and to improve performance (66%). According to them, midfoot strike is considered as the best landing pattern for endurance performance (47%) and injury prevention (36%) whereas rearfoot strike is considered as the worst (respectively, 50% and 52%). Summary and conclusion This study highlights the disparities between scientific recommendations and athletic coaches’ field practices for modifying footstrike patterns in endurance runners. Contrary to current scientific literature recommendations, a large proportion of coaches modify the natural footstrike pattern of their endurance runners towards a midfoot strike pattern to improve performance and prevent injury

Clinical prediction models for diagnosis of COVID-19 among adult patients: a validation and agreement study.

peer reviewed[en] BACKGROUND: Since the beginning of the pandemic, hospitals have been constantly overcrowded, with several observed waves of infected cases and hospitalisations. To avoid as much as possible this situation, efficient tools to facilitate the diagnosis of COVID-19 are needed. OBJECTIVE: To evaluate and compare prediction models to diagnose COVID-19 identified in a systematic review published recently using performance indicators such as discrimination and calibration measures. METHODS: A total of 1618 adult patients present at two Emergency Department triage centers and for whom qRT-PCR tests had been performed were included in this study. Six previously published models were reconstructed and assessed using diagnostic tests as sensitivity (Se) and negative predictive value (NPV), discrimination (Area Under the Roc Curve (AUROC)) and calibration measures. Agreement was also measured between them using Kappa's coefficient and IntraClass Correlation Coefficient (ICC). A sensitivity analysis has been conducted by waves of patients. RESULTS: Among the 6 selected models, those based only on symptoms and/or risk exposure were found to be less efficient than those based on biological parameters and/or radiological examination with smallest AUROC values ( 0.75 for Se and NPV but poor agreement (Kappa and ICC < 0.5) between them. The results of the first wave were similar to those of the second wave. CONCLUSION: Although quite acceptable and similar results were found between all models, the importance of radiological examination was also emphasized, making it difficult to find an appropriate triage system to classify patients at risk for COVID-19

Bone Marrow-Derived Mesenchymal Stromal Cell Therapy in Severe COVID-19: Preliminary Results of a Phase I/II Clinical Trial

peer reviewedBackground: Treatment of acute respiratory distress syndrome (ARDS) associated with COronaVIrus Disease-2019 (COVID-19) currently relies on dexamethasone and supportive mechanical ventilation, and remains associated with high mortality. Given their ability to limit inflammation, induce immune cells into a regulatory phenotype and stimulate tissue repair, mesenchymal stromal cells (MSCs) represent a promising therapy for severe and critical COVID-19 disease, which is associated with an uncontrolled immune-mediated inflammatory response. Methods: In this phase I-II trial, we aimed to evaluate the safety and efficacy of 3 intravenous infusions of bone marrow (BM)-derived MSCs at 3-day intervals in patients with severe COVID-19. All patients also received dexamethasone and standard supportive therapy. Between June 2020 and September 2021, 8 intensive care unit patients requiring supplemental oxygen (high-flow nasal oxygen in 7 patients, invasive mechanical ventilation in 1 patient) were treated with BM-MSCs. We retrospectively compared the outcomes of these MSC-treated patients with those of 24 matched control patients. Groups were compared by paired statistical tests. Results: MSC infusions were well tolerated, and no adverse effect related to MSC infusions were reported (one patient had an ischemic stroke related to aortic endocarditis). Overall, 3 patients required invasive mechanical ventilation, including one who required extracorporeal membrane oxygenation, but all patients ultimately had a favorable outcome. Survival was significantly higher in the MSC group, both at 28 and 60 days (100% vs 79.2%, p = 0.025 and 100% vs 70.8%, p = 0.0082, respectively), while no significant difference was observed in the need for mechanical ventilation nor in the number of invasive ventilation-free days, high flow nasal oxygenation-free days, oxygen support-free days and ICU-free days. MSC-treated patients also had a significantly lower day-7 D-dimer value compared to control patients (median 821.0 µg/L [IQR 362.0-1305.0] vs 3553 µg/L [IQR 1155.0-6433.5], p = 0.0085). Conclusions: BM-MSC therapy is safe and shows very promising efficacy in severe COVID-19, with a higher survival in our MSC cohort compared to matched control patients. These observations need to be confirmed in a randomized controlled trial designed to demonstrate the efficacy of BM-MSCs in COVID-19 ARDS. Clinical Trial Registration (www.ClinicalTrials.gov), identifier NCT0444545

Characteristics of primary care practices associated with patient education during COVID-19: Results of the PRICOV-19 cross-sectional study in 38 countries

editorial reviewedAbstract: - Background During the COVID-19 pandemic, prevention was at the heart of the management of the health crisis with an important component related to citizen health education and therapeutic education for both the covid infected patient and the patient at risk. Primary care practices (PCPs) played a crucial role in these educational activities. - Questions / Objectives This paper aims to explore which PCP configurations enabled responsiveness to the patient education component during the COVID-19 pandemic. - Methods A "Patient Education - PE" score was created based on responses to six self-reported questionnaire items, such as staff involvement in providing information to patients by telephone. These were compiled by PRICOV, a multi-country cross-sectional study in Europe and Israel. A linear mixed model (LMM) analysis was performed with continuous PE score and PCP characteristics with 3638 respondents. - Results The mean PE score was 2.55 (SD. 0.68) with a maximum of 4 and varies suite widely between countries. Among all PCP characteristics, the following factors significantly (p < 0.05) increasing the PE score are main payment system (with a capitation payment system or another system compared to the fee for service), perception of the same or above average PCP with patients with chronic conditions and perception of adequate government support. - Conclusion The results highlight some levers that will overcome some barriers and enable the development of the educational approach appropriate to primary care; the model presented is still incomplete and requires further investigation to identify additional configuration elements favorable to educational activities.PRICO

Factors influencing the adoption and participation rate of nursing homes staff in a saliva testing screening programme for COVID-19.

peer reviewedTesting strategies are crucial to prevent and control the spread of covid-19 but suffer from a lack of investment in understanding the human factors that influence their implementation. The aim of this study was to understand the factors that encourage participation and the level of engagement of nursing homes staff in a routine saliva testing programme for COVID-19 In December 2020, nursing homes (n = 571) in Wallonia (Belgium) were invited to participate in a saliva testing programme for their staff. The directors were questioned by telephone at the end of a 3-week pilot phase. 445 nursing homes took part in the evaluation questionnaire, of which 36(8%) answered that they chose not to participate in the testing programme. The average participation rate of nursing staff was 49(±25)%. Perception of the justification of the efforts required for testing and perception of practicability of the procedure were significantly associated with the adoption of the system by the nursing homes directors (OR(95%CI): 5.96(1.97-18.0), p = 0.0016); OR(95%CI): 5.64(1.94-16.4), p = 0.0015 respectively). Staff support, incentives and meetings increased the level of engagement in testing (p<0.05). While the adoption of the programme confirmed the acceptability of salivary testing as a means of screening, the participation rate confirmed the need for studies to understand the factors that encourage health care staff to take part. The results suggested rethinking strategies to consider staff engagement from a health promotion perspective