A web-based library consult service for evidence-based medicine: Technical development

BACKGROUND: Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. RESULTS: To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. CONCLUSION: A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement

The Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult Acquired Flatfoot Deformity

Category: Midfoot/Forefoot Introduction/Purpose: Residual forefoot supination present after correcting the hindfoot in Stage IIb adult acquired flatfoot deformity (AAFD) can be addressed with a dorsal opening wedge medial cuneiform (Cotton) osteotomy. The amount of correction is generally judged clinically and there currently are no preoperative guides that can predict the size of graft needed. The aim of this study was to evaluate the relationship between the Cotton osteotomy graft size and other accessory flatfoot reconstructive procedures, and the amount of correction of longitudinal arch collapse. We hypothesized that correction of longitudinal arch collapse, as measured by the cuneiform articular angle (CAA), would primarily be influenced by the Cotton osteotomy performed. More specifically, we hypothesized that the size of the graft would have the largest effect on the CAA. Methods: Seventy-nine feet in 74 patients undergoing Cotton osteotomy as part of flatfoot reconstruction were reviewed retrospectively. Preoperative and minimum 40-week postoperative lateral weightbearing foot radiographs were compared to assess correction of longitudinal arch collapse as measured by 13 radiographic parameters, with particular emphasis on the CAA. Additional demographic and intraoperative variables analyzed for association with radiographic change included age, gender, body mass index (BMI), amounts and graft types of Cotton osteotomy and lateral column lengthening (LCL), and amount of medializing calcaneal osteotomy (MCO). Other concomitant procedures at the time of surgery, namely Achilles lengthening, flexor digitorum longus (FDL) transfer, spring ligament reconstruction, gastrocnemius recession, and excision of accessory navicular were also recorded. Ultimately, a multivariable linear regression model was developed to estimate the effect of Cotton osteotomy on change in the CAA, adjusting for patient and clinical variables. Results: Cotton osteotomy graft size was significantly associated with changes in the CAA (P < .001), calcaneal pitch (P = .03), lateral talo-navicular Cobb angle (P = .03), and lateral naviculo-medial cuneiform Cobb angle (P = .03). Multivariable linear regression models included age at surgery, gender, BMI, and the use of all concomitant procedures (LCL, Achilles lengthening, FDL transfer, gastrocnemius recession, and excision of accessory navicular) except for spring ligament reconstruction, since this was not associated with any of the four radiographic measurements. Cotton graft size was the only factor found to significantly predict a change in the CAA in the final linear regression model (P < .001, R2 = .27), with each millimeter of Cotton corresponding to a 2.1-degree decrease of the CAA (figure 1). Conclusion: Correction of longitudinal arch collapse, as measured by the CAA, was primarily influenced by graft size of the Cotton osteotomy in a linear fashion. The results also demonstrate that the procedure has a more distal effect in correction of longitudinal arch collapse and is of particular importance when the apex of deformity is at the medial cuneiform. Because the relationship between the Cotton osteotomy graft size and the CAA can be modeled linearly, we believe that preoperative measurement of the CAA can be a useful guide in helping surgeons to titrate the proper amount of longitudinal arch collapse correction intraoperatively

Progress in the development of kynurenine and quinoline-3-carboxamide-derived drugs

The diverse neuro- and immunomodulatory effects of kynurenine pathway (KP) enzymes and metabolites exert offer possibilities for intervention in diseases such as autoimmunity, neurodegeneration and neoplastic processes.This review focuses on data obtained from to the preclinical and clinical use of a KP metabolite analogue and structurally related compounds. 4-Cl-KYN has completed clinical trials in depression without success. However, the good safety data give hope for further trials in suicide prevention, neuropathic pain and dyskinesia. Quinoline-3-carboxiamide derivatives laquinimod, paquinimod and tasquinimod show structural similarities to kynurenines. Laquinimod and paquinimod show promising results in the treatment of autoimmune diseases, tasquinimod is considered primarily as an anti-cancer drug. Data available until 31th of May, 2020 at Clinicaltrials.gov and PubMed have been reviewed.The failure of 4-Cl-KYN for use as an anti-depressant may be related to inadequate concentration, or that the ketamine-like rapid anti-depressant effect is not produced via NMDAR modulation. Further clarification may emerge from studies involving higher drug concentration, and/or from identification of ketamine targets. Clinical application trials in very diverse indications of structurally related quinoline-3-carboxamides and the wide range of their mode of action warrant further studies permitting direct comparison of effects and better target identification

Adult-acquired flatfoot deformity

Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD