Infections in Anterior Cruciate Ligament Reconstruction

Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity potentially resulting in poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is generally more effective than graft removal, but with persistent infection consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusions: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis

To what Extent can Flipped Learning Improve EFL Learners’ Speaking and Writing Skills in Online Education?

This paper reports on a qualitative study targeting the benefits of Flipped Learning in an online EFL education class composed of ten intermediate learners. The researcher made use of multiple sources of data including artifacts, semi-structured interviews, and observation. Students had to produce two major assignments in this class. The first one was a writing task in which they were asked to write a short opinion essay. The second one was a speaking task in which they were required to talk for three minutes about a topic of their choice. Both tasks were based on material covered in our online meetings. The findings showed that flipped learning had an overall significant effect on learners’ performance. The researcher also provided pedagogical insights for applying Flipped Learning and recommendations for further research

Exposition professionnelle au formaldéhyde en France en 2013

35e congrès national de médecine et santé au travail, PARIS, FRANCE, 05-/06/2018 - 08/06/2018Formaldéhyde is used in many countries. Il a été classé «cancérogène avéré pour l'homme» par le Centre international de recherche sur le cancer en 2004 et «cancérogène supposé pour l'être humain» par l'Union européenne en 2014. l'exposition professionnelle au formaldéhyde en France en 2013 et les secteurs et professions les plus exposés.Le formaldéhyde est utilisé dans de nombreux secteurs pour ses différentes propriétés depuis de nombreuses années. Il a été classé « cancérogène avéré pour l'homme » par le Centre international de recherche sur le cancer en 2004 et « cancérogène supposé pour l'être humain » par l'Union européenne en 2014. L'objectif de ce travail est de décrire l'exposition professionnelle au formaldéhyde en France en 2013 et d'identifier les secteurs et professions les plus exposants. Méthodes Dans le cadre du programme Matgéné, une matrice emplois-expositions (MEE) au formaldéhyde a été conçue par expertise. Cette MEE attribue pour chacun des emplois exposés (profession dans un secteur d'activité) entre 1950 et 2017 des indices d'exposition (probabilité, intensité, fréquence). Le croisement de cette MEE avec les données du recensement de la population de 2013 a permis d'estimer la prévalence d'exposition professionnelle au formaldéhyde en France selon la profession et le secteur d'activité. Résultats En 2013, 290000 travailleurs étaient exposés professionnellement au formaldéhyde en France, soit 1,3 % de la population au travail. Les secteurs d'activité dont la prévalence est la plus élevée sont les secteurs de l'habillement (18,4 % d'exposés), la fabrication de textile (18,2 %) et l'industrie du cuir et de la chaussure (12,8 %). Par ailleurs, les secteurs présentant le plus grand nombre d'exposés sont les activités pour la santé humaine (environ 81 000 exposés), la fabrication de produits métalliques (29 000) et les autres services personnels comprenant les services funéraires et les manucures (28 700). Les ouvriers qualifiés de type artisanal et les artisans du textile, de l'habillement, et du cuir et les ouvriers qualifiés de type industriel du travail des métaux ont les prévalences d'exposition les plus élevées (respectivement 35 %, 35 % et 30 %). Les professions avec le plus grand nombre de travailleurs exposés sont les ouvriers qualifiés de type industriel du travail des métaux (40 200), les aides-soignants et professions assimilées (32 900) et les techniciens médicaux (24 000). Conclusions Ces résultats sont les seuls à ce jour qui documentent l'exposition au formaldéhyde en France pour l'ensemble des travailleurs quel que soit leur statut (salariés ou indépendants). Ils permettent d'identifier les professions et les secteurs d'activité contribuant le plus à l'exposition au formaldéhyde (prévalences les plus élevées) mais également les professions et secteur dans lesquels le nombre de personnes exposées est le plus important. Ces informations sont utiles pour la surveillance de ce risque professionnel et la priorisation des actions de prévention à mettre en place

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women

Radiographic Results of Intramedullary Nails for Lateral Malleolus Fractures

Category: Ankle, Trauma Introduction/Purpose: Plating the lateral malleolus yields predictable patient outcomes and anatomic reductions with an efficient surgical procedure. However, large incisions and prominence result in wound complications in 5% to 16% of patients. Although rudimentary intramedullary fixation has been applied for these fractures for decades, new intramedullary devices have become available with broader indications. These nails have the promise of holding accurate reductions and faster patient rehabilitation with virtually non-existent wound issues due to the minimal incisions required for implantation. The aim of this study was to determine if a new intramedullary nail could provide radiographically sound reductions while reducing wound complications and providing faster rehabilitation in a variety of ankle fracture classifications. Methods: We retrospectively reviewed the x-rays of 40 ankle fracture patients repaired by two surgeons at different institutions from March 2015 through October 2016. Patients were followed for a minimum of six weeks. Radiographs were reviewed for fracture healing, mortise alignment and fibular length (figure 1). The group was comprised of usual fracture patterns SER 2, 3,4, PER, uni bimalleolar and trimalleolar. Most reductions were performed percutaneously, however a small-incision was used to reduce older fractures or those that could not be reduced without direct visualization. Results: All fractures appeared to have complete union and radiographically anatomic reductions. No wound infections presented, and patients experienced reduced pain with early weight-bearing. Conclusion: Modern intramedullary nails can deliver excellent results and provide an important part of a surgeon’s treatment armamentarium for lateral malleolus fractures. The nails are especially valuable for non-compliant patients or those with comorbidities that negatively affect skin healing

Adherence and Competence in Manual Based Therapy

Background: Many children with chronic disorders have healthy siblings. These siblings are at risk of developing behavioral and emotional problems, but few sibling interventions have been established to help prevent such problems. The SIBS (short for siblings)-intervention is designed to aid the healthcare system in their support of siblings of children with chronic disorders. Effective implementation of manuals assume that program strategies and methods are conducted with integrity, which means to which extent the intervention is being delivered as planned. This study aimed to examine group leaders’ adherence and competence when implementing the SIBS-manual, differences in treatment integrity levels between group leaders (experts i.e., research staff and non-experts i.e., health care professionals), and the degree of overlap between adherence and competence. Method: This study is part of the SIBS-project. Two coders coded 194 sessions from 37 different groups with 21 group leaders (experts and non-experts). They used the SIBS-adherence form to measure adherence and a modified version of Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) to measure competence. Different statistical analyses were conducted: descriptives, reliability, independent sample t-test, correlations and effect size. Results: The results showed adequate levels of treatment integrity. However, the results indicated a significant difference in treatment integrity between experts and non-experts, where experts showed a higher level of adherence and competence in both sibling and parent groups. Further, the results indicated a large correlation between levels of adherence and competence, but only for group leaders in the parent groups. When eliminating the non-experts, the correlation between adherence and competence was significant for both the sibling- and parent groups. Conclusion: The results indicated adequate levels of treatment integrity for both experts and non-experts. High treatment integrity helps researchers understand whether or not it is the SIBS-manual that gives positive treatment outcomes. Moreover, this will help the researchers decide whether the manual should be used in clinical practice to help reduce the behavioral and emotional problems siblings of children with chronic disorders can suffer from