Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

Functional activities in daily life can require squatting and shifting body weight during transverse plane rotations. Stability of the knee can be challenging for people with a total knee replacement (TKR) due to reduced proprioception, nonconforming articular geometry, muscle strength, and soft tissue weakness. The objective of this study was to identify strategies utilized by individuals with TKR in double-stance transferring load during rotation and flexion. Twenty-three subjects were recruited for this study: 11 TKR subjects (age: 65 6 6 years; BMI 27.4 6 4.1) and 12 healthy subjects (age: 63 6 7; BMI 24.6 6 3.8). Each subject completed a novel crossover button push task where rotation, flexion, and extension of the knee were utilized. Each subject performed two crossover reaching tasks where the subject used the opposite hand to cross over their body and press a button next to either their shoulder (high) or knee (low), then switched hands and rotated to press the opposite button, either low or high. The two tasks related to the order they pressed the buttons while crossing over, either low-to-high (L2H) or high-to-low (H2L). Force platforms measured ground reaction forces under each foot, which were then converted to lead force ratios (LFRs) based on the total force. Knee flexion angles were also measured. No statistical differences were found in the LFRs during the H2L and L2H tasks for the different groups, although differences in the variation of the loading within subjects were noted. A significant difference was found between healthy and unaffected knee angles and a strong trend between healthy and affected subject's knee angles in both H2L and L2H tasks. Large variations in the LFR at mid-task in the TKR subjects suggested possible difficulties in maintaining positional stability during these tasks. The TKR subjects maintained more of an extended knee, which is a consistent quadriceps avoidance strategy seen by other researchers in different tasks. These outcomes suggest that individuals with a TKR utilize strategies, such as keeping an extended knee, to achieve rotary tasks during knee flexion and extension. Repeated compensatory movements could result in forces that may cause difficulty over time in the hip joints or low back. Early identification of these strategies could improve TKR success and the return to activities of daily living that involve flexion and rotation

Guidelines for the management of postmenopausal osteoporosis for GPs

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Background: Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis. Objective: This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.O'Neill S; MacLennan A; Bass S; Diamond T; Ebeling P; Findlay D; Flicker L; Markwell A; Nowson C; Pocock N; Sambrook P; Singh M

Guidelines for the management of postmenopausal osteoporosis for GPs

BACKGROUND : Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis.OBJECTIVE : This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies.DISCUSSION : Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonatesr raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.<br /

The integration of a Podiatrist into an orthopaedic department: a cost-consequences analysis

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background The aim of this study was to evaluate the cost-consequences of a podiatry-led triage clinic provided in an orthopaedic department relative to usual care for non-urgent foot and ankle complaints in an Australian tertiary care hospital. Methods All new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014 and 2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015 and 2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on new and review patient appointments; the number of new patients / session; the number of appointments / patient; the number of patients discharged; the surgical conversion rate; staff time; and imaging use were collected. A cost-consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12-month period. Results The Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The Podiatrist consulted with more new patients / session, mean (SD) of 3.6 (1.0) versus 0.7 (0.8), p < 0.001 and utilised less appointments / patient than the Orthopaedic Surgeons, mean (SD) of 1.3 (0.6) versus 1.9 (1.1), p < 0.001. The percentage of patients discharged without surgery was similar in the Podiatry Triage Clinic and usual care, 80.3% and 87.5% p = 0.135, respectively, but the surgical conversion rate was higher in the Podiatry Triage Clinic, 76.1% versus 12.5% p < 0.001. The total integrated appointment cost for the 12-month usual care period was $32,744, which represented a cost of$454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing$94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441. Conclusions The integration of a Podiatrist into an orthopaedic department significantly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons

Making Mas: TruDynasty Carnival Takes Josephine Baker to the Caribbean Carnival

Jacqueline Taucar, in conversation with Thea and Dario Jackson, investigates the sculptural qualities of the Josephine Baker Mas for the Scotiabank Caribbean Carnival Festival in 2011. This article traces the conception, construction, and complexities of choreography for this carnivalesque reimagining of Baker in Paris of the twenties for a contemporary Canadian ambulant expression. This Queen Mas talks back to the objectification by Parisians and embodying Queen Mas as an instance of female empowerment

Decisions at the end of life: have we come of age?

Decision making is a complex process and it is particularly challenging to make decisions with, or for, patients who are near the end of their life. Some of those challenges will not be resolved - due to our human inability to foresee the future precisely and the human proclivity to change stated preferences when faced with reality. Other challenges of the decision-making process are manageable. This commentary offers a set of approaches which may lead to progress in this field

The \u3cem\u3eChlamydomonas\u3c/em\u3e Genome Reveals the Evolution of Key Animal and Plant Functions

Chlamydomonas reinhardtii is a unicellular green alga whose lineage diverged from land plants over 1 billion years ago. It is a model system for studying chloroplast-based photosynthesis, as well as the structure, assembly, and function of eukaryotic flagella (cilia), which were inherited from the common ancestor of plants and animals, but lost in land plants. We sequenced the ∼120-megabase nuclear genome of Chlamydomonas and performed comparative phylogenomic analyses, identifying genes encoding uncharacterized proteins that are likely associated with the function and biogenesis of chloroplasts or eukaryotic flagella. Analyses of the Chlamydomonas genome advance our understanding of the ancestral eukaryotic cell, reveal previously unknown genes associated with photosynthetic and flagellar functions, and establish links between ciliopathy and the composition and function of flagella

Quality improvement of community pharmacy services:a prioritisation exercise

Funded by NHS Education for ScotlandPeer reviewedPublisher PD