The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study

Background: It is generally acknowledged that the posterior ethmoidal cells drain under the superior nasal turbinate (SorNT) or, rarely, under the supreme nasal turbinate (SmeNT), and the sphenoid ostium (SO) opens to the sphenoethmoidal recess. However, detailed relations between these structures are variable, complex and still not clear. There is no reliable data on the prevalence of SmeNT and drainage of the posterior ethmoidal cells under this structure. The aim of this study was to re-evaluate the anatomy of the aforementioned region. Materials and methods: Multiplanar and three-dimensional reconstruction analysis of 100 thin slice paranasal sinus computed tomography scans. Results: SmeNT was identified in 77 subjects (136 sides). It formed the ostium to the posterior ethmoidal cell adjacent to the skull base or orbit in 58 subjects (91 sides). This cell drained independently from the remaining posterior ethmoidal cells. The sphenoethmoidal (Onodi) cell drained to supreme meatus in 41 subjects (54 sides), and to superior meatus in 37 subjects (49 sides). SO was always located medial to the posteroinferior attachment of SmeNT, or SorNT (in absence of SmeNT). Conclusions: Patients with divergent drainage of the posterior ethmoids (with posterior ethmoidal cell draining to the supreme meatus) may require more extensive surgery to avoid persistence or recurrence of inflammatory disease. SmeNT is more common than thought, but due to its posterior and superior location to SorNT, it is rarely seen intraoperatively. If SmeNT is present, SO is always located medial to its posteroinferior attachment. (Folia Morphol 2018; 77, 1: 110–115

Development of a behaviour change intervention: a case study on the practical application of theory

BACKGROUND: Use of theory in implementation of complex interventions is widely recommended. A complex trial intervention, to enhance self-management support for people with osteoarthritis (OA) in primary care, needed to be implemented in the Managing Osteoarthritis in Consultations (MOSAICS) trial. One component of the trial intervention was delivery by general practitioners (GPs) of an enhanced consultation for patients with OA. The aim of our case study is to describe the systematic selection and use of theory to develop a behaviour change intervention to implement GP delivery of the enhanced consultation. METHODS: The development of the behaviour change intervention was guided by four theoretical models/frameworks: i) an implementation of change model to guide overall approach, ii) the Theoretical Domains Framework (TDF) to identify relevant determinants of change, iii) a model for the selection of behaviour change techniques to address identified determinants of behaviour change, and iv) the principles of adult learning. Methods and measures to evaluate impact of the behaviour change intervention were identified. RESULTS: The behaviour change intervention presented the GPs with a well-defined proposal for change; addressed seven of the TDF domains (e.g., knowledge, skills, motivation and goals); incorporated ten behaviour change techniques (e.g., information provision, skills rehearsal, persuasive communication); and was delivered in workshops that valued the expertise and professional values of GPs. The workshops used a mixture of interactive and didactic sessions, were facilitated by opinion leaders, and utilised 'context-bound communication skills training.' Methods and measures selected to evaluate the behaviour change intervention included: appraisal of satisfaction with workshops, GP report of intention to practise and an assessment of video-recorded consultations of GPs with patients with OA. CONCLUSIONS: A stepped approach to the development of a behaviour change intervention, with the utilisation of theoretical frameworks to identify determinants of change matched with behaviour change techniques, has enabled a systematic and theory-driven development of an intervention designed to enhance consultations by GPs for patients with OA. The success of the behaviour change intervention in practice will be evaluated in the context of the MOSAICS trial as a whole, and will inform understanding of practice level and patient outcomes in the trial

SAT0583-HPR - Differences between service providers and users when defining feasible optimal NHS occupational therapy treatment for patients with thumb base OA : results from a Delphi study

Background: The OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year developmental study for a full randomised controlled trial (RCT) into the clinical and cost effectiveness of an occupational therapy and splint intervention for thumb base OA. To develop an optimal package of care for evaluation within a multi-centre RCT, the views of both clinicians and patients are crucial. Objectives: To conduct a Delphi study to obtain agreement between both patients with thumb base OA and AHPs concerning the most appropriate optimal NHS OT programme, splint and placebo splint intervention to use in the RCT. Methods: The Delphi panel consisted of 63 AHPs experienced in treating adults with thumb base OA, and 7 patients with thumb base OA. The panel were asked to rate how much they agreed or disagreed about what optimal NHS OT care for thumb base OA should include, and what method(s) of delivery (individual one-to-one, group, patient leaflets, or telephone advice) they deemed were more appropriate. The Delphi study comprised 3 rounds. A seven-point Likert-type scale was used. Pre-defined inclusion and exclusion criteria were applied in order to reach a final number of statements which, in turn, created the desired tool. Group differences were analysed using Mann-Whitney U tests. Results: Between-groups analyses showed significant differences in the ratings of overall importance of items to be included in an optimal NHS OT consultation (Table 1). Conclusions: AHPs and patients differed in their views about the importance of including ‘Education for Family/Significant Others/Carers’, ‘NHS Clinic Procedures’, ‘Prognosis Advice’, ‘Referral to other Health Care Professional’, ‘Sleep Assessment and Management’ and ‘Treatment Options’ in an optimal NHS OT consultation, and in the methods of delivery used in the consultation. AHPs placed significantly less importance than patients on ‘One-to-One Contact’, ‘Leaflets’ and ‘Telephone Advice’. These findings demonstrate the importance of consulting with patients at an early stage in developing an intervention

Self-reported quality care for knee osteoarthritis: comparisons across Denmark, Norway, Portugal and the UK

Objectives: To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK. Methods: Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete a cross-sectional survey including quality indicators (QI) for OA care. A QI was considered as eligible if the participant had checked 'Yes' or 'No', and as achieved if the participant had checked 'Yes' to the indicator. The median percentage (with IQR and range) of eligible QIs achieved by country was determined and compared in negative binominal regression analysis. Achievement of individual QIs by country was determined and compared using logistic regression analyses. Results: A total of 354 participants self-reported QI achievement. The median percentage of eligible QIs achieved (checked 'Yes') was 48% (IQR 28%, 64%; range 0-100%) for the total sample with relatively similar medians across three of four countries. Achievement rates on individual QIs showed a large variation ranging from 11% (referral to services for losing weight) to 67% (information about the importance of exercise) with significant differences in achievement rates between the countries. Conclusions: The results indicated a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing healthcare services, ideas may be generated on how the quality might be improved across nations. Larger studies are needed to confirm and further explore the findings.EULAR Health Professional Grant; Norwegian Fund through the FYSIOPRIM project; National Institute for Health Research (NIHR) [RP-PG-0407-10 386]; Arthritis Research UK Centre in Primary Care grant [18139]; National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands by a Knowledge Mobilisation Research Fellowship from the National Institute for Health Research; National Institute for Health Research (NIHR); Fundacao para a Ciencia e Tecnologia [PEst-OE/MAT/UI0006/2014]info:eu-repo/semantics/publishedVersio

Surface topography of hydroxyapatite affects ROS17/2.8 cells response

Hydroxyapatite (HA) has been used in orthopedic, dental, and maxillofacial surgery as a bone substitute. The aim of this investigation was to study the effect of surface topography produced by the presence of microporosity on cell response, evaluating: cell attachment, cell morphology, cell proliferation, total protein content, and alkaline phosphatase (ALP) activity. HA discs with different percentages of microporosity (< 5%, 15%, and 30%) were confected by means of the combination of uniaxial powder pressing and different sintering conditions. ROS17/2.8 cells were cultured on HA discs. For the evaluation of attachment, cells were cultured for two hours. Cell morphology was evaluated after seven days. After seven and fourteen days, cell proliferation, total protein content, and ALP activity were measured. Data were compared by means of ANOVA and Duncan’s multiple range test, when appropriate. Cell attachment (p = 0.11) and total protein content (p = 0.31) were not affected by surface topography. Proliferation after 7 and 14 days (p = 0.0007 and p = 0.003, respectively), and ALP activity (p = 0.0007) were both significantly decreased by the most irregular surface (HA30). These results suggest that initial cell events were not affected by surface topography, while surfaces with more regular topography, as those present in HA with 15% or less of microporosity, favored intermediary and final events such as cell proliferation and ALP activity

DIGITAL KITAMBO: DECOLONISING NARRATIVES AND BRINGING THE PAST INTO THE FUTURE AT THE NATIONAL MUSEUMS OF KENYA

The Swahili word ‘kitambo’, which refers to occurrences in the past that are understood to be at least indirectly connected to the speaker, can be used to describe experimental museology through digital cultural heritage. There is a need to improve access and enhance conservation goals within African cultural heritage institutions, and the National Museums of Kenya (NMK) has been developing innovative technologies and communication tools with the Kenya Heritage Resource Information System (KEHRIS). This paper will discuss Digital Kitambo—a pilot project completed at NMK from 2013 – 2019 to create the spatially integrated database KEHRIS, digitise 10,000 artefacts and specimens from the archaeology and palaeontology collections, and develop digital learning programmes to engage a wider audience. &nbsp;Qualitative research methodology included participant observation, qualitative interviews and focus groups with museum staff as well as focus groups with primary and secondary teachers to develop curricula for local schools. This paper traces the evolution of Digital Kitambo from its inception and reflects on both the successes and shortcomings of the initiative with particular attention to its goals of decolonising the museum’s collections and contributing to new national narratives by engaging the public through digital initiatives. &nbsp;A palavra swahili “Kitambo” refere-se a ocorrências passadas, ligadas ao orador, nem que seja de forma indireta; neste sentido, pode ser usada para descrever a museologia experimental através do património cultural digital. Verifica-se a necessidade de melhorar a acessibilidade e os objetivos de conservação nas instituições que conservam o património cultural africano. Nesta perspetiva, os Museus Nacionais do Quénia (NMK) têm vindo a desenvolver tecnologias inovadoras e ferramentas de comunicação com o Kenya Heritage Resource Information System (KEHRIS). O presente texto discute o Kitambo Digital - um projeto piloto, desenvolvido pelos NMK, entre 2013 e 2019, e que visava criar a base de dados espacialmente integrada no KEHRIS, tendo-se procedido à digitalização de 10.000 artefactos e espécimes das coleções de arqueologia e paleontologia, a par do desenvolvimento de programas de aprendizagem digital almejando envolver um público tão vasto quanto possível. A metodologia de investigação qualitativa incluiu a observação dos participantes, entrevistas qualitativas e grupos focais com os funcionários do museu, bem como com docentes do ensino básico e secundário, tendo como objetivo desenvolver currículos para as escolas locais. O texto traça a evolução do Kitambo Digital, desde o seu início, refletindo os seus pontos positivos e as suas vulnerabilidades, tendo particular atenção ao objetivo que diz respeito à descolonização das coleções do museu, contribuindo para o surgimento de novas narrativas nacionais e convocando a participação do público através da promoção e divulgação de iniciativas digitais