Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

Background Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns. Methods Thirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up. Results During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level. Conclusions Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the “fast track” concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice. Level of evidence Prospective cohort study, 2.

Risk Factors for Musculoskeletal Complaints in Female Musicians: A Systematic Review and Exploration for Future Studies

BACKGROUND: Female musicians are prone to the development of musculoskeletal complaints (MSC). The etiology of this increased risk is poorly understood. As the number of professional female musicians increases, so does the importance of understanding female-specific risk factors for MSC in musicians. OBJECTIVE: To provide an overview of current literature of proven and possible risk factors/etiology of MSC in female musicians, and to identify topics for future studies. METHODS: Systematic review performed according to international guidelines. A database search was performed in MEDLINE (PubMed), Embase, CINAHL, Cochrane, PsycINFO, clinicaltrials.gov, and gray literature. Studies were independently selected and rated by two reviewers. QUIPS and STROBE guidelines were used for assessing quality and risk of bias. Risk factors were categorized by means of the theoretical framework of the International Classification of Functioning (ICF) and evaluated using the Bradford Hill criteria for causality. RESULTS: Out of 1,924 records, 10 eligible studies were included. A low to moderate level of methodological quality was present in the studies. Fifteen risk factors could be identified from the included studies, which were positioned in the ICF model. The two most frequently mentioned female-specific risk factors were hand size and joint laxity. None of the risk factors fulfilled Bradford Hill’s criteria for causality. Many other risk factors were suggested, while a number of expected causes were not encountered. CONCLUSION: At this moment, no evidence-based deductions can be made about female-specific risk factors for MSC in musicians. There is a lack of high-quality studies in this field and a need for studies with a different focus and a prospective study design.

Prevalence of Nonalcoholic Fatty Liver Diseases Among Obese Adults in Mosul City.

Objective: The present study's objective is to determine the prevalence of nonalcoholic fatty liver among obese adults in Mosul City, Iraq. Methodology: A prospective study design was applied to achieve the present study's objectives for November 1, 2019, to March 1, 2020. The total sample size was 225. All subjects were selected purposively from outpatient clinics at Al-Salam Teaching Hospital, Ibn Sina Teaching Hospital, and Mosul General Hospital. Results: Among obese adults, the prevalence of NAFLD is 68%; among the 225 patients examined herein,153 had NAFLD. Parameter comparisons between NAFLD and without NAFLD subjects and indicated the mean BMI was (38.8±4) Kg/m2 and (34.1±2.4) Kg/m2, respectively. WC was (106.6±3.9) cm in the NAFLD group and (102.7±3.3) cm in the subject without the NAFLD group. The mean triceps skinfold thickness was (3.8±1.4) cm in the NAFLD group and (2.9±0.9) cm in the subject without the NAFLD group. All parameters had high significance. Recommendations: Further studies on large populations are needed to facilitate the generalization of the current findings. Keywords: Fatty Liver, Nonalcoholic, Mosul

Prevalence of Nonalcoholic Fatty Liver Diseases Among Obese Adults in Mosul City.

Objective: The present study's objective is to determine the prevalence of nonalcoholic fatty liver among obese adults in Mosul City, Iraq. Methodology: A prospective study design was applied to achieve the present study's objectives for November 1, 2019, to March 1, 2020. The total sample size was 225. All subjects were selected purposively from outpatient clinics at Al-Salam Teaching Hospital, Ibn Sina Teaching Hospital, and Mosul General Hospital. Results: Among obese adults, the prevalence of NAFLD is 68%; among the 225 patients examined herein,153 had NAFLD. Parameter comparisons between NAFLD and without NAFLD subjects and indicated the mean BMI was (38.8±4) Kg/m2 and (34.1±2.4) Kg/m2, respectively. WC was (106.6±3.9) cm in the NAFLD group and (102.7±3.3) cm in the subject without the NAFLD group. The mean triceps skinfold thickness was (3.8±1.4) cm in the NAFLD group and (2.9±0.9) cm in the subject without the NAFLD group. All parameters had high significance. Recommendations: Further studies on large populations are needed to facilitate the generalization of the current findings. Keywords: Fatty Liver, Nonalcoholic, Mosul

Left Atrial Appendage Occlusion for Patients with Valvular Diseases: A Prospective Study Design

Background:As increasing evidence showed the efficacy of percutaneous left atrial appendage (LAA) occlusion in reducing the stroke risks in patients with non-valvular atrial fibrillation(AF), we design this study to quantify the effect of surgical LAA occlusion (SLAAO) for patients with valvular diseases and with or without AF.Methods:The current study will be implemented in two parts: Part 1 (AF study) is a prospective longitudinal study with a plan to consecutively register 2032 patients diagnosed with valvular diseases and AF and receiving cardiovascular surgeries. SLAAO will be performed at the individual surgeon’s preference. We centrally conducted a one-year follow-up on stroke, systemic arterial embolism, and all-cause mortality. Part 2 (non AF study) is a single-blinded, multicenter, randomized controlled trial with the purpose to evaluate the efficacy of SLAAO to reduce one-year embolism events in patients with valvular diseases, without AF, and receiving cardiovascular surgeries. 2118 patients will be randomized 1:1 to the intervention or control arm using a central randomization system.Results:The primary outcome is a composition of newly occurred ischemic stroke/transient ischemic attack (TIA) with positive neuroimaging or systemic arterial embolism, and cardiovascular mortality during one-year follow-up.Conclusion:The trial is designed to evaluate the efficacy of SLAAO to reduce embolism events one year after mitral or aortic surgeries, and this paper presents the prospective study protocol. It provides details of patient randomization, follow-up, methods of analysis of the material, and publication plan.

Evaluating associations of joint swelling, joint stiffness and joint pain with physical activity in first-degree relatives of patients with rheumatoid arthritis: Studies of the Aetiology of Rheumatoid Arthritis (SERA), a prospective cohort study

ObjectivePhysical activity (PA) in preclinical rheumatoid arthritis (RA) is associated with lower RA risk and disease severity. As joint signs and symptoms of inflammatory arthritis serve as a barrier to PA in RA, it is important to consider whether they affect PA in the time prior to RA. Therefore, we investigated whether joint swelling, stiffness or pain were associated with PA in first-degree relatives (FDRs) of patients with RA, a population at higher risk for future RA.DesignProspective study design.SettingWe recruited FDRs of patients with RA from academic centres, Veterans’ hospitals and rheumatology clinics or through responses to advertising from six sites across the USA.ParticipantsWe evaluated associations of joint stiffness, joint swelling and joint pain with PA time in 268 FDRs with ≥2 visits over an average 1.2 years. Clinicians confirmed joint swelling. Participants self-reported joint stiffness and/or pain.Primary outcome measuresPA during a typical 24-hour day was quantified via questionnaire, weighted to reflect metabolic expenditure, where 24 hours was the minimum PA time. Linear mixed models evaluated associations between symptoms and change in PA over time, adjusting for age, sex, race, body mass index, smoking and RA-related autoantibodies.ResultsAverage weighted PA time was 37±7 hours. In the cross-sectional analysis, PA time was 1.3±0.9 hours higher in FDRs reporting joint pain (p=0.15); and 0.8±1.6 and 0.4±1 hours lower in FDRs with joint swelling (p=0.60) and stiffness (p=0.69), respectively. Longitudinally, adjusting for baseline PA time, baseline symptoms were not significantly associated with changes in PA time. However, on average over time, joint stiffness and pain were associated with lower PA time (pinteraction=0.0002, pinteraction=0.002), and joint swelling was associated with higher PA time (pinteraction <0.0001).ConclusionBaseline symptoms did not predict future PA time, but on average over time, joint symptoms influenced PA time.

Årsaker til forsinkelser ved elektive operasjoner

Forsinkelser og strykninger under elektive operasjoner hindrer optimal drift og kan være en påkjenning for pasienter. Målet med studien var å identifisere og beskrive de faktiske årsaker til forsinkelser ved elektive operasjoner, samt omfang, varighet og andre kjennetegn ved slike forsinkelser. Studien har et flermetodisk prospektivt studiedesign. I en periode på to måneder ble alle elektronisk registrerte forsinkelser fulgt opp med strukturerte intervju. I løpet av studieperioden ble halvparten av elektive operasjoner registrert med en eller flere forsinkelser (N = 402). Informantene anga 60 ulike rotårsaker som en forklaring på forsinkelsene. I 72% av alle forsinkelser var årsaken knyttet til organisering/administrering av operasjonsplanleggingen. Forsinkelser ved elektive operasjoner skyldes i stor grad utilstrekkelig planlegging og organisering. Mer presis planlegging, informasjonsutveksling og forbedret dataverktøy kan redusere forsinkelser ved elektive operasjoner. Causes of delays in elective surgery: A prospective study Abstract Delays and cancellations in elective surgery prevent optimal services and can be stressful for patients. This study aimed to identify and describe the actual causes of delays in elective surgery, and the extent, duration and other characteristics of these delays. The study has a multi-method prospective study design. For two months, all electronically recorded delays in a Norwegian hospital were followed up with structured interviews to identify their true causes. Half of the elective surgeries recorded had one or more delays (N = 402). The delays had 60 different root causes; using qualitative content analysis, these were interpreted into 13 subcategories and four main categories, namely patient-related (17%), staff-related (10%), related to surgical ward/equipment (2%) or organizational (71%). Most delays were due to poor planning and organization of surgery. The study indicates that more precise planning, better information exchange and an improved electronic tool can reduce delays in elective surgery.

Effectiveness of a long-lasting insecticide treatment kit (ICON® Maxx) for polyester nets over three years of household use: a WHO phase III trial in Tanzania

Background ICON® Maxx (Syngenta) is an insecticide treatment kit of pyrethroid and binding agent for long-lasting treatment of mosquito nets. Interim recommendation for use on nets was granted by the World Health Organization (WHO) after successful evaluation in experimental huts following multiple washes. A full WHO recommendation is contingent upon demonstration of continued bio-efficacy after 3 years of use. Methods A household-randomized prospective study design was used to assess ICON Maxx-treated nets over 3 years in north-eastern Tanzania. Conventional treated nets (with lambda-cyhalothrin, but without binder) served as a positive control. At 6-monthly intervals, cross-sectional household surveys monitored net use and physical integrity, while cone and tunnel tests assessed insecticidal efficacy. Pyrethroid content was determined after 12 and 36 months. A parallel cohort of nets was monitored annually for evidence of net deterioration and attrition. Results After 12 months’ use, 97% of ICON Maxx-treated nets but only 67% of CTN passed the WHO efficacy threshold for insecticidal durability (> 80% mortality in cone or tunnel or 90% feeding inhibition in tunnel). After 24- and 36-months use, 67% and 26% of ICON Maxx treated nets met the cone criteria, respectively, and over 90% met the combined cone and tunnel criteria. Lambda-cyhalothrin content after 36 months was 17% (15.8 ± 4.3 mg/m2) of initial content. ICON Maxx nets were used year-round and washed approximately 4 times per year. In cross-sectional survey after 36 months the average number of holes was 20 and hole index was 740 cm2 per net. Cohort nets had fewer holes and smaller hole index than cross-sectional nets. However, only 15% (40/264) of cohort nets were not lost to follow-up or not worn out after 36 months. Conclusions Because more than 80% of nets met the WHO efficacy criteria after 36 months use, ICON Maxx was granted WHO full recommendation. Cross-sectional and cohort surveys were complementary and gave a fuller understanding of net durability. To improve net usage and retention, stronger incentives and health messaging should be introduced in WHO LLIN longitudinal trials. Untreated polyester nets may be made long-lastingly insecticidal in Africa through simple household treatment using ICON Maxx pyrethroid-binder kits.

Development of a Post-Acute Sequelae of COVID-19 (PASC) Symptom Lexicon Using Electronic Health Record Clinical Notes

Objective: To develop a comprehensive post-acute sequelae of COVID-19 (PASC) symptom lexicon from clinical notes to support PASC symptom identification and research. Methods: We identified 26,117 COVID-19 positive patients from the Mass General Brigham's electronic health records (EHR) and extracted 328,879 clinical notes from their post-acute infection period (day 51-110 from first positive COVID-19 test). The PASC symptom lexicon incorporated Unified Medical Language System (UMLS) Metathesaurus concepts and synonyms based on selected semantic types. The MTERMS natural language processing (NLP) tool was used to automatically extract symptoms from a development dataset. The lexicon was iteratively revised with manual chart review, keyword search, concept consolidation, and evaluation of NLP output. We assessed the comprehensiveness of the lexicon and the NLP performance using a validation dataset and reported the symptom prevalence across the entire corpus. Results: The PASC symptom lexicon included 355 symptoms consolidated from 1,520 UMLS concepts. NLP achieved an averaged precision of 0.94 and an estimated recall of 0.84. Symptoms with the highest frequency included pain (43.1%), anxiety (25.8%), depression (24.0%), fatigue (23.4%), joint pain (21.0%), shortness of breath (20.8%), headache (20.0%), nausea and/or vomiting (19.9%), myalgia (19.0%), and gastroesophageal reflux (18.6%). Discussion and Conclusion: PASC symptoms are diverse. A comprehensive PASC symptom lexicon can be derived using a data-driven, ontology-driven and NLP-assisted approach. By using unstructured data, this approach may improve identification and analysis of patient symptoms in the EHR, and inform prospective study design, preventative care strategies, and therapeutic interventions for patient care.

Diversity in Typhoid Diagnostic Protocols And Recommendation for Composite Reference Standard

Typhoid fever is a major public health burden which causes substantial global morbidity and mortality due to lack of decisive diagnostic protocols. The capacity of commonly use diagnostic test to validate the absence of typhoid fever is controversial. This study explores to evaluate new techniques for typhoid diagnosis and proposed a harmonised suitable standardized composite reference to be adopted. Published peer-reviewed articles indexed in PubMed, MEDLINE and Google scholar were reviewed for hospital-based studies. This study reveals new typhoid diagnostic techniques such as proteomics, serology, Rapid Diagnostic tests (RDTs), transcriptomics, genomics, and metabolomics. 34.4% of the studies use prospective study design. The study result establishes that, Widal test has a moderate diagnostic accuracy with average percentage sensitivity (52.9%), specificity (54%), positive predictive value (PPV) (56.8%) as well as negative predictive value (NPV) (55.6%) when compared with 29.4%, 28%, 29.5%, and 27.8% of Typhidot respectively. The findings showed a statistically significant difference on the sensitivity between Widal and Typhidot t (40) = 2.639, p = 0.012 at p&lt;0.05 using independent sample t-test. When there is no perfect reference standard that has an optimal diagnostic accuracy, the need for a harmonised suitable standardized composite reference is essential. Hence, this study recommends that, peripheral blood culture with established sensitivity of 60% and Widal test with average sensitivity of 52.9% be adopted as a consensus composite reference standard for typhoid fever diagnosis in other to improve confidence in prevalence estimates.