The comprehensive cohort model in a pilot trial in orthopaedic trauma

Background: The primary aim of this study was to provide an estimate of effect size for the functional outcome of operative versus non-operative treatment for patients with an acute rupture of the Achilles tendon using accelerated rehabilitation for both groups of patients. The secondary aim was to assess the use of a comprehensive cohort research design (i.e. a parallel patient-preference group alongside a randomised group) in improving the accuracy of this estimate within an orthopaedic trauma setting. Methods: Pragmatic randomised controlled trial and comprehensive cohort study within a level 1 trauma centre. Twenty randomised participants (10 operative and 10 non-operative) and 29 preference participants (3 operative and 26 non-operative). The ge range was 22-72 years and 37 of the 52 patients were men. All participants had an acute rupture of their Achilles tendon and no other injuries. All of the patients in the operative group had a simple end-to-end repair of the tendon with no augmentation. Both groups then followed the same eight-week immediate weight-bearing rehabilitation programme using an off-the-shelf orthotic. The disability rating index (DRI; primary outcome), EQ-5D, Achilles Total Rupture Score and complications were assessed ed at two weeks, six weeks, three months, six months and nine months after initial injury. Results: At nine months, there was no significant difference in DRI between patients randomised to operative or non-operative management. There was no difference in DRI between the randomised group and the parallel patient preference group. The use of a comprehensive cohort of patients did not provide useful additional information as to the treatment effect size because the majority of patients chose non-operative management. Conclusions: Recruitment to clinical trials that compare operative and non-operative interventions is notoriously difficult; especially within the trauma setting. Including a parallel patient preference group to create a comprehensive cohort of patients has been suggested as a way of increasing the power of such trials. In our study, the comprehensive cohort model doubled the number of patients involved in the study. However, a strong preference for non-operative treatment meant that the increased number of patients did not significantly increase the ability of the trial to detect a difference between the two interventions

Medical interns' knowledge and training regarding urethral catheter insertion and insertion-related urethral injury in male patients

<p>Abstract</p> <p>Background</p> <p>Improper catheterization can lead to urethral injury. Yet research from four continents suggests training of junior doctors in catheterization is insufficient. European research suggests a majority of catheterization related morbidities occur when the procedure is performed by interns.</p> <p>Methods</p> <p>To assess the knowledge and practices of medical interns relating to urethral catheterization and iatrogenic urethral injury secondary to traumatic catheter insertion, a questionnaire survey was conducted of all first year medical interns at a tertiary national university hospital in the Philippines. The questionnaire contained 17 items covering 4 areas: methods of training in catheterization and level of experience; perceived adequacy of training; theoretical knowledge of catheterization; the mechanisms of catheter-related urethral injury.</p> <p>Results</p> <p>225/240 interns (94%) completed the survey (130 (57.8%) female). 125 (55.6%) responded that they had adequate theoretical training and 150 (66.7%) adequate practical training. All had performed more than 10 catheterizations and 204 (90%) were supervised when they first performed catheterization. Despite relatively high levels of experience and confidence, deficits were identified in detailed knowledge of correct catheterization procedures and of risks associated with urethral injury.</p> <p>Conclusions</p> <p>More thorough training of incoming medical interns in urinary catheterization may help to reduce the risk of complications and injury. Training should be universal and thought given to its timing within the curriculum. Training should include step by step instruction in the process, emphasis on history taking and awareness of factors associated with increased risk of urethral injury.</p

Impact of nutritional stress on the honeybee colony health

Honeybees Apis mellifera are important pollinators of wild plants and commercial crops. For more than a decade, high percentages of honeybee colony losses have been reported worldwide. Nutritional stress due to habitat depletion, infection by different pests and pathogens and pesticide exposure has been proposed as the major causes. In this study we analyzed how nutritional stress affects colony strength and health. Two groups of colonies were set in a Eucalyptus grandis plantation at the beginning of the flowering period (autumn), replicating a natural scenario with a nutritionally poor food source. While both groups of colonies had access to the pollen available in this plantation, one was supplemented with a polyfloral pollen patty during the entire flowering period. In the short-term, colonies under nutritional stress (which consumed mainly E. grandis pollen) showed higher infection level with Nosema spp. and lower brood and adult bee population, compared to supplemented colonies. On the other hand, these supplemented colonies showed higher infection level with RNA viruses although infection levels were low compared to countries were viral infections have negative impacts. Nutritional stress also had long-term colony effects, because bee population did not recover in spring, as in supplemented colonies did. In conclusion, nutritional stress and Nosema spp. infection had a severe impact on colony strength with consequences in both short and long-term

Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture.</p> <p>Methods/Design</p> <p>At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month.</p> <p>Discussion</p> <p>By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial.</p> <p>Trial registration</p> <p>ISRCTN50141196</p

The ruptured Achilles tendon: operative and non-operative treatment options

The Achilles tendon is the strongest and thickest tendon in the human body. Like any other tendon in the body, however, it is susceptible to rupture. Many surgeons advocate early operative repair of the ruptured Achilles tendon, citing decreased re-rupture rates and improved functional outcome. Waiting for surgical repair for longer than one month may lead to inferior functional results postoperatively. Non-operative treatment has higher re-rupture rates as compared to surgically repaired tendons, but may be the treatment of choice in some patients. While for many years, patients were rigidly immobilized in a non-weightbearing cast for 6–8 weeks postoperatively, newer studies have shown excellent results with early weightbearing, and this is quickly becoming the standard of care amongst many physicians

Severity and prognosis in stroke: scoping review

Introdução: O Acidente Vascular Encefálico (AVE) tem vindo a apresentar uma taxa de incidência estável e um considerável declínio na taxa de mortalidade, o que corresponde a um aumento na prevalência de sobreviventes. O conhecimento das alterações funcionais que podem surgir após o AVE, da sua severidade e das estratégias disponíveis para avaliar a disfunção, facilita a construção de um plano de reabilitação, com objetivos para os profissionais de saúde, para os indivíduos e para a família dentro do potencial de recuperação. A severidade surge, como um conceito abrangente associado à presença de défices neurológicos, motores ou funcionais e às alterações das atividades da vida diária. Alterações neurológicas, motoras ou funcionais mais severas fazem prever uma recuperação mais difícil e mais prolongada. A determinação do prognóstico em indivíduos com AVE engloba não só o risco de morte a curto prazo como também a probabilidade de recuperar a função a longo prazo. Objetivo: Avaliar o panorama acerca da informação existente sobre o nível de severidade e prognóstico em AVE’s. Métodos: A Revisão Scoping baseou-se na metodologia de Arksey & O’Malley (2005), sendo constituída por seis passos: 1) Identificação da questão; 2) Identificação da literatura relevante; 3) Seleção da literatura; 4) Mapeamento dos dados; 5) Recolha, sumário e transcrição dos resultados; 6) Consultoria (opcional). Resultados: Foram analisados 47 estudos observacionais. 95% dos autores referem-se à severidade como sendo a quantidade de défices neurológicos apresentados pelos indivíduos após o AVE e avaliam-na através de instrumentos de medida específicos para a avaliação de défices neurológicos (76% dos autores utilizaram a NIHSS na sua metodologia). O prognóstico no AVE surge associado à funcionalidade alcançada (89%); probabilidade/índice de mortalidade (54%); e encaminhamento após a alta (15%). O prognóstico pode ser influenciado por fatores sociodemográficos, fatores clínicos e por algumas comorbilidades, entre outros. Conclusão: Os estudos de severidade e prognóstico em AVE’s poderão não refletir a condição real do indivíduo e induzir em erro a aplicação destes conceitos na prática clínica, influenciando o prognóstico esperado.ABSTRACT: Background – Stroke has shown a stable incidence rate and an important decrease in mortality rate, which corresponds to an increase in the survival prevalence. Knowledge of functional changes, stroke severity, and strategies to evaluate dysfunction after stroke, ease the conception of a rehabilitation plan, with objectives for health professionals, stroke patients, and their families. Stroke severity is related to neurologic, motor, function and daily activities changes. More severe neurological, motor or functional abnormalities predict a more difficult and longer recovery. Prognosis determination in stroke patients encompasses not only the risk of death in the short term but also the probability of recovering function in the long term. Aim(s) – To evaluate the existing information about stroke severity and prognosis. Methods – The scoping review was based on six steps Arksey & O’Malley (2005) methodology: 1) identifying the research question; 2) systematic search; 3) selection of publications; 4) charting the data; 5) collating, summarizing and reporting the results; 6) consultation (optional). Results – A total of 47 observational studies were analyzed. For 95% of authors, severity is the number of neurological deficits presented by individuals after stroke and was assessed through specific measurement instruments for neurological deficits (76% of authors used NIHSS in their methodology). Stroke prognosis is related to the functionality affected (89%); the probability of dead/mortality rate (54%); and referral after discharge (15%). Prognosis may be influenced by socio-demographic factors, clinical factors and by some comorbidity, among others. Conclusion – Severity and prognostic studies in stroke may not reflect the individual’s actual condition and mislead the use of these concepts, in reality, influencing the expected prognosis.info:eu-repo/semantics/publishedVersio

Identification of thyroid tumor cell vulnerabilities through a siRNA-based functional screening

The incidence of thyroid carcinoma is rapidly increasing. Although generally associated with good prognosis, a fraction of thyroid tumors are not cured by standard therapy and progress to aggressive forms for which no effective treatments are currently available. In order to identify novel therapeutic targets for thyroid carcinoma, we focused on the discovery of genes essential for sustaining the oncogenic phenotype of thyroid tumor cells, but not required to the same degree for the viability of normal cells (non-oncogene addiction paradigm). We screened a siRNA oligonucleotide library targeting the human druggable genome in thyroid cancer BCPAP cell line in comparison with immortalized normal human thyrocytes (Nthy-ori 3-1). We identified a panel of hit genes whose silencing interferes with the growth of tumor cells, while sparing that of normal ones. Further analysis of three selected hit genes, namely Cyclin D1, MASTL and COPZ1, showed that they represent common vulnerabilities for thyroid tumor cells, as their inhibition reduced the viability of several thyroid tumor cell lines, regardless the histotype or oncogenic lesion. This work identified non-oncogenes essential for sustaining the phenotype of thyroid tumor cells, but not of normal cells, thus suggesting that they might represent promising targets for new therapeutic strategies