Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm

The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries

What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice

Background: Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren’s disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren’s disease. Methods: A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren’s disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. Results: Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, ‘lack of joint extension’ and accounted for the most frequently used. Conclusions: Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren’s disease requires consistency to address issues that fall into 3 main categories:- Definition of terms Protocol statement Outcome reportin

Optimal functional outcome measures for assessing treatment for Dupuytren's disease: A systematic review and recommendations for future practice

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Ball et al.; licensee BioMed Central Ltd.Background: Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods: A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results: Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions: There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes

An information security reference framework for e-learning management systems

M.Sc. (Computer Science)Knowledge sharing technique has been revolutionized over the past years, and the use of Information and Communication Technologies (ICTs) is one of the main contributors to this revolution. One of the knowledge sharing means that emerged from the use of ICTs is the electronic Learning (e-Learning) system. An e-Learning Management System (e-LMS) is a software application that utilises ICTs to manage and deliver e-Learning to users. One of the main advantages of the e-LMS is unlimited access to information, including shared knowledge regardless of geographic location and time, which is the basis for its widespread popularity of e-LMSs in the academic and corporate environment. The main motivation behind this study is the realisation of the unique nature of e-LMSs, and its dependency on ICTs that makes it more vulnerable to information security risks; if these information security risks are not mitigated or put to an acceptable level, the overall integrity of the entire e-Learning process will be compromised. Moreover, in spite of the abundance of literature in e-Learning systems, the security aspect of e-LMS has been given very little consideration. This dissertation will investigate the possible information security risks facing e-LMSs from each user’s (i.e. Lecturers, Learners and Administrator) perspective. For the identified risks, as a possible information security counter measure, the author has created an information security reference framework, called ‘An Information Security Reference Framework for e-Learning Management Systems’ (ISRFe-LMS), which is based on the International Organization for Standardization’s (ISO) 27002. The ISO 27002 Standard is internationally accepted best practice for Information Security Management. Thus, the purpose of this dissertation is strictly focused on creating and enhancing the security of e-LMSs through the creation of the ISRFe-LMS. The Moodle e-LMS has been studied from its information security capabilities and mapped to the ISRFe-LMS, to validate how well it conforms to the security standards and criteria set by the ISRFe-LMS