Grip and muscle strength dynamometry in acute burn injury: Evaluation of an updated assessment protocol

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5 – 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient \u3e0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the sub-acute phase of injury were also associated with muscle strength assessment results. Hand held dynamometry is a reliable assessment tool for evaluating within session muscle strength in the acute and sub-acute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength

The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury. Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. Data analysis was an available cases analysis with no data imputed. Regression analyses were used for all longitudinal outcome data and between-group comparisons were used for descriptive analyses. Forty-eight patients were randomised resistance training (RTG) (n=23) or control group (CG) (n=25). The RTG demonstrated improved outcomes for the functional domain of the Burn Specific Health Scale-Brief (p=0.017) and the Quick Disability of Arm Shoulder and Hand (pp=0.001). Total quality of life scores, lower limb disability, muscle strength and volume were not seen to be different between groups (p\u3e0.05). Resistance training in addition to usual rehabilitation therapy showed evidence of improving functional outcomes, particularly in upper limb burn injuries. Additionally, resistance training commenced acutely after a burn injury was not seen to be harmful to patients. Crown Copyright © 2020 Published by Elsevier Ltd. All rights reserved

Added value of second biopsy target in screen-detected widespread suspicious breast calcifications

Introduction: There is controversy on the optimal work‐up of screen‐detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen‐detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Methods: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen\u27s Kappa were calculated. Results: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post‐hoc second target biopsy cases. Conclusion: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post‐hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological‐pathological concordant; discordance still requires repeat sampling

Genetic variants within NOGGIN, COL1A1, COL5A1, and IGF2 are associated with musculoskeletal injuries in elite male Australian football league players: A preliminary study

Introduction: Australian Football is a dynamic team sport that requires many athletic traits to succeed. Due to this combination of traits, as well as technical skill and physicality, there are many types of injuries that could occur. Injuries are not only a hindrance to the individual player, but to the team as a whole. Many strength and conditioning personnel strive to minimise injuries to players to accomplish team success. Purpose: To investigate whether selected polymorphisms have an association with injury occurrence in elite male Australian Football players. Methods: Using DNA obtained from 46 elite male players, we investigated the associations of injury-related polymorphisms across multiple genes (ACTN3, CCL2, COL1A1, COL5A1, COL12A1, EMILIN1, IGF2, NOGGIN, SMAD6) with injury incidence, severity, type (contact and non-contact), and tissue (muscle, bone, tendon, ligament) over 7 years in one Australian Football League team. Results: A significant association was observed between the rs1372857 variant in NOGGIN (p = 0.023) and the number of total muscle injuries, with carriers of the GG genotype having a higher estimated number of injuries, and moderate, or combined moderate and high severity rated total muscle injuries. The COL5A1 rs12722TT genotype also had a significant association (p = 0.028) with the number of total muscle injuries. The COL5A1 variant also had a significant association with contact bone injuries (p = 0.030), with a significant association being found with moderate rated injuries. The IGF2 rs3213221-CC variant was significantly associated with a higher estimated number of contact tendon injuries per game (p = 0.028), while a higher estimated number of total ligament (p = 0.019) and non-contact ligament (p = 0.002) injuries per game were significantly associated with carriage of the COL1A1 rs1800012-TT genotype. Conclusions: Our preliminary study is the first to examine associations between genetic variants and injury in Australian Football. NOGGIN rs1372857-GG, COL5A1 rs12722-TT, IGF2 rs3213221-CC, and COL1A1 rs1800012-TT genotypes held various associations with muscle-, bone-, tendon- and ligament-related injuries of differing severities. To further increase our understanding of these, and other, genetic variant associations with injury, competition-wide AFL studies that use more players and a larger array of gene candidates is essential

Progress in the Fremantle Primary Prevention Study- A Pilot Study of Risk Factor Modification for Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in 40-80year olds in Australia. Many of the risk factors though modifiable are often undiagnosed and hence untreated. Increasingly, general practice is recognised as being well positioned but under-utilised in attempts to improve primary prevention. The study aims to monitor the changes in CVD risk following delivery of high and low intervention strategies at the GP level. Methods: 1200 participants in total were recruited during routine surgery attendances from 3 WA general practices since November 2006. Baseline data was collected on all. One group then received standard care as per best practice guidelines with 3 monthly follow-up to 12 months. The second group received standard care as per best practice guidelines delivered by their GP with no scheduled interim follow-up but with follow-up at 12 months after study commencement. Data on risk factor indicators was measured at each contact and a composite score on global cardiovascular risk calculated using the New Zealand Risk Calculator. Principal Findings: In January 2008, data was recorded on 1178 participants at baseline (22 withdrew), 3 month data on 537, 6 month data on 458 and 9 month on 272 and 12 month data on 96. Interim data will be presented. While a significant proportion of the community are already known to have cardiovacular risk factors, GPs and their practice staff are ideally positioned to assess the extent of this potential morbibity and institute treatment modalities and programs to reverse and modify them

Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: An international survey

Objective: To investigate knowledge, attitudes and practices of oncologists towards physical 2 activity (PA) in cancer survivors, and the association between oncologists’ own PA behavior 3 and PA promotion. Methods: Oncologists (n=123) completed a survey based on the Theory of 4 Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, 5 attitudes, intentions, social norm, Perceived Behavioral Control (PBC), confidence and 6 knowledge of exercise prescription. Structural equation modelling (SEM) evaluated these 7 associations. Results: Less than half of oncologists reported regularly promoting PA to 8 patients (46%), with 20% providing written information and 23% referrals. Only 26% were 9 physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion 10 (CFI=0.905, SRMR=0.040). Social norm was the only significant pathway to intention, but 11 also a significant indirect pathway to PA promotion (p=.007). Confidence to promote PA, 12 PBC and intentions were direct significant pathways to PA promotion (p\u3c.05). Exploratory 13 SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 14 13.1% Social Norm, 10.7% Attitude, 10.0% Confidence to Recommend and 17.8% PA 15 promotion behavior (CFI=0.921, SRMR=0.076). Instrumental-attitude was a direct significant 16 pathway to PA behavior (p=.001). PA behavior was a direct significant pathway to social 17 norms, attitude, confidence to recommend, and PA promotion (p \u3c 0.05). Conclusions: 18 Oncologists reported a modest ability to promote PA, low PA promotion rates and limited 19 knowledge of exercise prescription. Patient physical activity promotion may be improved 20 through strategies that increase oncologists’ PBC, confidence and their own personal PA 21 participation

Alternate electrode positions for the measurement of hand volumes using bioimpedance spectroscopy

Background: Bioimpedance spectroscopy (BIS) is a tool that can be used to measure body composition in a variety of populations. Previous studies have investigated novel applications to utilize BIS to measure localized body composition, including in the hand. According to BIS guidelines, there should be no skin wounds at the site of electrodes, and that electrode positions may be modified in specific circumstances, as our group has validated previously in burn wound populations. Methods and Results: To determine in noninjured participants, whether BIS measurements recorded using alternate electrode positions on the palm of the hand and forearm, or a combination of electrodes on the dorsum and volar surface of the hand and forearm, were comparable with electrode positions on the dorsum of the hand and forearm. The study demonstrated that drive and sense electrodes on the palm of the hand and volar forearm, and a combination of electrodes on the palm of the hand and dorsum of the forearm, resulted in comparable measures of impedance of extracellular water (difference from reference position: 1.26%–4.75%, p = 0.411–0.558) and total water (difference from reference: 2.15%–2.40%, p = 0.258–0.781). Electrodes on the dorsum of the hand and volar forearm resulted in significantly different measures for the same BIS variables (percentage difference range 4.66%–6.15%, p \u3c 0.001–0.003). Conclusion: Electrode positions on the palm of the hand and volar forearm, or on the palm of the hand and dorsum of the forearm, are interchangeable as clinical measures of hand lymphedema and total water impedance

Does electrical stimulation improve healing in acute minor burn injury, as measured by bioimpedance spectroscopy? A single center, randomized, controlled trial

Background: Electrical stimulation (ES) has been shown to improve wound healing in chronic wounds. Recent studies in burn injured populations have demonstrated that ES improved edema and healing using short duration stimulation. This study utilized a low energy long duration ES using a portable device. The aim was to determine how this mode of stimulation influences the acute burn wound, as measured using bioimpedance spectroscopy (BIS). Our group has previously validated the use of BIS for measuring edema changes with wound healing in burn injured patients. Methods: This study is a within patient control, randomized study of 30 patients (24 male) presenting with burns to multiple limbs. One affected limb was randomized to receive ES and routine dressings. The other wound received routine care only. Minor burn wounds were stimulated for 10–14 days for more than 20 h/day. Serial localized BIS resistance and phase angle raw data measures were used to monitor edema and wound responses with treatment. Results: Multi-level mixed effects regression analyses demonstrated phase angle at 50 kHz increased at a faster rate in the stimulated wound. Stimulated wounds exhibited an increased rate of edema reduction as measured by extracellular tissue impedance. Conclusion: ES was confirmed to be an easily applied adjunct therapy to improve the rate of edema reduction in acute minor burn injury, and positively influences phase angle measures in the acute burn wound