bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the implementation of ‘sick day guidance’ to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation
Authors: Martindale Anne-Marie , Elvey Rebecca , Howard Susan J , McCorkindale Sheila , Sinha Smeeta , Blakeman Tom
Published: November 2017

Objectives

The study sought to examine the implementation of sick day guidance cards designed to prevent acute kidney injury (AKI), in primary care settings.

Design

Qualitative semistructured interviews were conducted and comparative analysis informed by normalisation process theory was undertaken to understand sense-making, implementation and appraisal of the cards and associated guidance.

Setting

A single primary care health setting in the North of England.

Participants

29 participants took part in the qualitative evaluation: seven general practitioners, five practice nurses, five community pharmacists, four practice pharmacists, two administrators, one healthcare assistant and five patients.

Intervention

The sick day guidance intervention was rolled out (2015–2016) in general practices (n=48) and community pharmacies (n=60). The materials consisted of a ‘medicine sick day guidance’ card, provided to patients who were taking the listed drugs. The card provided advice about medicines management during episodes of acute illness. An information leaflet was provided to healthcare practitioners and administrators suggesting how to use and give the cards.

Results

Implementation of sick day guidance cards to prevent AKI entailed a new set of working practises across primary care. A tension existed between ensuring reach in administration of the cards to at risk populations while being confident to ensure patient understanding of their purpose and use. Communicating the concept of temporary cessation of medicines was a particular challenge and limited their administration to patient populations at higher risk of AKI, particularly those with less capacity to self-manage.

Conclusions

Sick day guidance cards that focus solely on medicines management may be of limited patient benefit without adequate resourcing or if delivered as a standalone intervention. Development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI.
Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria
Authors: Holton Alice E , Gallagher Paul J , Ryan Cristín , Fahey Tom , Cousins Gráinne
Published: November 2017

Objectives

Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol–medication interactions for use in older adults.

Design

Following a systematic review, review of drug compendia and clinical guidance documents, a two-round Delphi consensus method was conducted.

Setting

Ireland and the United Kingdom (UK), primary care and hospital setting.

Participants

The Project Steering Group developed a list of potentially serious alcohol–medication interactions. The Delphi panel consisted of 19 healthcare professionals (general practitioners, geriatricians, hospital and community pharmacists, clinical pharmacologists and pharmacists, and physicians specialising in substance misuse).

Results

An inventory of 52 potentially serious alcohol–medication interactions was developed by the Project Steering Group. British National Formulary black dot warnings (n=8) were included in the final criteria as they represent ‘potentially serious’ interactions. The remaining 44 criteria underwent a two-round Delphi process. In the first round, 13 criteria were accepted into the POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) criteria. Consensus was not reached on the remaining 31 criteria; 9 were removed and 8 additional criteria were included following a review of panellist comments. The remaining 30 criteria went to round 2, with 17 criteria reaching consensus, providing a final list of 38 potentially serious alcohol–medication interactions: central nervous system (n=15), cardiovascular system (n=9), endocrine system (n=5), musculoskeletal system (n=3), infections (n=3), malignant disease and immunosuppression (n=2), and respiratory system (n=1).

Conclusions

POSAMINO is the first set of explicit potentially serious alcohol–medication interactions for use in older adults. Following future validation studies, these criteria may allow for the risk stratification of older adults at the point of prescribing.
Association between organisational and workplace cultures, and patient outcomes: systematic review
Authors: Braithwaite Jeffrey , Herkes Jessica , Ludlow Kristiana , Testa Luke , Lamprell Gina
Published: November 2017

Design and objectives

Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.

Setting

A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.

Participants

The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.

Primary and secondary outcome measures

Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.

Results

The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.

Conclusions

Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.
Association between respiratory syncytial viral disease and the subsequent risk of the first episode of severe asthma in different subgroups of high-risk Australian children: a whole-of-population-based cohort study
Authors: Homaira Nusrat , Briggs Nancy , Pardy Christopher , Hanly Mark , Oei Ju-Lee , Hilder Lisa , Bajuk Barbara , Lui Kei , Rawlinson William , Snelling Tom , Jaffe Adam
Published: November 2017

Objective

To determine the contribution of respiratory syncytial virus (RSV) to the subsequent development of severe asthma in different subgroups of children at risk of severe RSV disease.

Settings

The study was conducted in New South Wales (NSW), Australia.

Participants

The study comprised all children born in NSW between 2000 and 2010 with complete follow-up till 31 December 2011. The cohort was divided into three subgroups: (1) non-Indigenous high-risk children: non-Indigenous children born preterm or born with a low birth weight; (2) Indigenous children: children of mothers whose Indigenous status was recorded as Aboriginal and/or Torres Strait Islander and (3) non-Indigenous standard risk children: all other non-Indigenous term children.

Primary outcome measure

Risk of development of severe asthma in different subgroups of children who had RSV hospitalisation in the first 2 years of life compared with those who did not.

Design

We performed a retrospective cohort analysis using population-based linked administrative data. Extended Cox model was used to determine HR and 95% CI around the HR for first asthma hospitalisation in different subgroups of children.

Results

The cohort comprised 847 516 children born between 2000 and 2010. In the adjusted Cox model, the HR of first asthma hospitalisation was higher and comparable across all subgroups of children who had RSV hospitalisation compared with those who did not. The HR (95% CI) was highest in children aged 2–3 years; 4.3 (95% CI 3.8 to 4.9) for high-risk, 4.0 (95% CI 3.3 to 4.8) for Indigenous and 3.9 (95% CI 3.7 to 4.1) for non-Indigenous standard risk children. This risk persisted beyond 7 years of age.

Conclusion

This large study confirms a comparable increased risk of first asthma hospitalisation following RSV disease in the first 2 years of life across different subgroups children at risk.
How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis
Authors: Moran Valerie , Allen Pauline , McDermott Imelda , Checkland Kath , Warwick-Giles Lynsey , Gore Oz , Bramwell Donna , Coleman Anna
Published: November 2017

Objectives

From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services.

Design

We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs).

Setting/participants

We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning.

Results

Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein.

Conclusions

Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs.
Study design and protocol for a mixed methods evaluation of an intervention to reduce and break up sitting time in primary school classrooms in the UK: The CLASS PAL (Physically Active Learning) Programme
Authors: Routen Ash C , Biddle Stuart J H , Bodicoat Danielle H , Cale Lorraine , Clemes Stacy , Edwardson Charlotte L , Glazebrook Cris , Harrington Deirdre M , Khunti Kamlesh , Pearson Natalie , Salmon Jo , Sherar Lauren B
Published: November 2017

Introduction

Children engage in a high volume of sitting in school, particularly in the classroom. A number of strategies, such as physically active lessons (termed movement integration (MI)), have been developed to integrate physical activity into this learning environment; however, no single approach is likely to meet the needs of all pupils and teachers. This protocol outlines an implementation study of a primary school-based MI intervention: CLASS PAL (Physically Active Learning) programme. This study aims to (A) determine the degree of implementation of CLASS PAL, (B) identify processes by which teachers and schools implement CLASS PAL and (C) investigate individual (pupil and teacher) level and school-level characteristics associated with implementation of CLASS PAL.

Methods and analysis

The intervention will provide teachers with a professional development workshop and a bespoke teaching resources website. The study will use a single group before-and-after design, strengthened by multiple interim measurements. Six state-funded primary schools will be recruited within Leicestershire, UK.

Evaluation data will be collected prior to implementation and at four discrete time points during implementation: At measurement 0 (October 2016), school, teacher and pupil characteristics will be collected. At measurements 0 and 3 (June–July 2017), accelerometry, cognitive functioning, self-reported sitting and classroom engagement data will be collected. At measurements 1(December 2016–March 2017) and 3 , teacher interviews (also at measurement 4; September–October 2017) and pupil focus groups will be conducted, and at measurements 1 and 2 (April–May 2017), classroom observations. Implementation will be captured through website analytics and ongoing teacher completed logs.

Ethics and dissemination

Ethical approval was obtained through the Loughborough University Human Participants Ethics Sub-Committee (Reference number: R16-P115). Findings will be disseminated via practitioner and/or research journals and to relevant regional and national stakeholders through print and online media and dissemination event(s).
Reducing bed occupancy and length of stay on a functional older adults’ psychiatric ward
Authors: Cadinouche Azad , Chitewe Auzewell , Khan Kehkashan , Lamin Sylvester , Ratneswaran Kajanesh , Shah Amar , Aurelio Marco
Published: November 2017

A quality improvement project was initiated on Ivory ward, a functional older adult psychiatric inpatient ward at Newham Centre for Mental Health, part of the East London NHS Foundation Trust. The project was started by staff on the ward after it had come to their attention that their ward had the highest bed occupancy and length of stay across similar wards in the trust. The mean bed occupancy in the 9 months before the project started was 87.7%. The mean length of stay on the ward in the 9 months before the project started was 70 days. The team used the model for improvement, which is the trust’s methodology of choice for quality improvement projects, to reduce bed occupancy and length of stay. The focus was on running small-scale tests of change to see whether these could lead to improvement. These change ideas were refined, scaled up or discontinued as appropriate to help achieve the aim. The project’s aim was to promote quality of care by reducing patient length of stay on Ivory ward to 45 days and bed occupancy to ≤70% or by 1 January 2016. The project team managed to reduce bed occupancy to 58% and length of stay to an average of 35 days.
Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey
Authors: Shinjo Takuya , Morita Tatsuya , Kiuchi Daisuke , Ikenaga Masayuki , Abo Hirofumi , Maeda Sayaka , Tsuneto Satoru , Kizawa Yoshiyuki
Published: November 2017

Objectives

Voluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.

Methods

219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.

Results

A total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).

Conclusions

In Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.
Differential preventive activity of sulindac and atorvastatin in Apc+/Min-FCCCmice with or without colorectal adenomas
Authors: Chang Wen-Chi L , Jackson Christina , Riel Stacy , Cooper Harry S , Devarajan Karthik , Hensley Harvey H , Zhou Yan , Vanderveer Lisa A , Nguyen Minhhuyen T , Clapper Margie L
Published: November 2017

Objective

The response of subjects to preventive intervention is heterogeneous. The goal of this study was to determine if the efficacy of a chemopreventive agent differs in non-tumour-bearing animals versus those with colorectal tumours. Sulindac and/or atorvastatin was administered to Apc+/Min-FCCC mice with known tumour-bearing status at treatment initiation.

Design

Male mice (6–8 weeks old) underwent colonoscopy and received control chow or chow with sulindac (300 ppm), atorvastatin (100 ppm) or sulindac/atorvastatin. Tissues were collected from mice treated for 14 weeks (histopathology) or 7 days (gene expression). Cell cycle analyses were performed on SW480 colon carcinoma cells treated with sulindac, atorvastatin or both.

Results

The multiplicity of colorectal adenomas in untreated mice bearing tumours at baseline was 3.6-fold higher than that of mice that were tumour free at baseline (P=0.002). Atorvastatin completely inhibited the formation of microadenomas in mice that were tumour free at baseline (P=0.018) and altered the expression of genes associated with stem/progenitor cells. Treatment of tumour-bearing mice with sulindac/atorvastatin led to a 43% reduction in the multiplicity of colorectal adenomas versus untreated tumour-bearing mice (P=0.049). Sulindac/atorvastatin increased the expression of Hoxb13 and Rprm significantly, suggesting the importance of cell cycle regulation in tumour inhibition. Treatment of SW480 cells with sulindac/atorvastatin led to cell cycle arrest (G0/G1).

Conclusions

The tumour status of animals at treatment initiation dictates response to therapeutic intervention. Atorvastatin eliminated microadenomas in tumour-free mice. The tumour inhibition observed with Sul/Atorva in tumour-bearing mice was greater than that achieved with each agent.
Advances in computational modelling for personalised medicine after myocardial infarction
Authors: Mangion Kenneth , Gao Hao , Husmeier Dirk , Luo Xiaoyu , Berry Colin
Published: November 2017

Myocardial infarction (MI) is a leading cause of premature morbidity and mortality worldwide. Determining which patients will experience heart failure and sudden cardiac death after an acute MI is notoriously difficult for clinicians. The extent of heart damage after an acute MI is informed by cardiac imaging, typically using echocardiography or sometimes, cardiac magnetic resonance (CMR). These scans provide complex data sets that are only partially exploited by clinicians in daily practice, implying potential for improved risk assessment. Computational modelling of left ventricular (LV) function can bridge the gap towards personalised medicine using cardiac imaging in patients with post-MI. Several novel biomechanical parameters have theoretical prognostic value and may be useful to reflect the biomechanical effects of novel preventive therapy for adverse remodelling post-MI. These parameters include myocardial contractility (regional and global), stiffness and stress. Further, the parameters can be delineated spatially to correspond with infarct pathology and the remote zone. While these parameters hold promise, there are challenges for translating MI modelling into clinical practice, including model uncertainty, validation and verification, as well as time-efficient processing. More research is needed to (1) simplify imaging with CMR in patients with post-MI, while preserving diagnostic accuracy and patient tolerance (2) to assess and validate novel biomechanical parameters against established prognostic biomarkers, such as LV ejection fraction and infarct size. Accessible software packages with minimal user interaction are also needed. Translating benefits to patients will be achieved through a multidisciplinary approach including clinicians, mathematicians, statisticians and industry partners.
How to do equine anaesthesia in the field
Authors: McFadzean William , Love Emma
Published: November 2017

Anaesthesia in the field is commonly performed in equine practice for short, minor surgical procedures and is a vital skill for equine clinicians. This article focuses on the practicalities of performing general anaesthesia of horses in the field in a safe manner.
Reducing antimicrobial use: a practitioner experience
Authors: Allen Julian , Bellini Jenny
Published: November 2017

In late 2015, the farm team at Friars Moor Livestock Health made a decision to improve responsible antimicrobial use on their dairy farms. In this article, Julian Allen and Jenny Bellini discuss their experiences of trying to reduce antimicrobial use.
Advice requested via social media
Authors: Knight Andrew
Published: November 2017

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Advice requested via social media’, was submitted and is discussed by Andrew Knight. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.

The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. It aims to provide a framework that will help practitioners find solutions when facing similar dilemmas.
The Convention on the Rights of Persons with Disabilities as a tobacco control tool in the mental health setting
Authors: van der Eijk Yvette
Published: November 2017

Background

Smoking rates remain high among people with mental health conditions, even though smoking contributes to negative mental health outcomes and is a leading cause of mortality. Many mental health facilities are not covered by smoke-free laws or do not encourage smoking cessation, and people with mental health conditions are often targeted in tobacco industry promotions.

Objective

To analyse how the Convention on the Rights of Persons with Disabilities (CRPD), to which most countries are a Party, obliges State Parties to review policies and practices for tobacco control in the mental health setting.

Method

Analysis of CRPD Articles relevant to smoking and mental health.

Results

The CRPD contains several provisions that oblige State Parties to address the issue of smoking and mental health, particularly in relation to quit services, smoke-free policies in mental health facilities, health education focused on correcting misperceptions about smoking and mental health, and protecting people with mental health conditions from tobacco industry targeting.

Conclusions

The CRPD is a potentially powerful tool to promote tobacco control in the mental health context.
Herb-chronology as a tool for determining the age of perennial forbs in tropical climates
Authors: Hiebert-Giesbrecht Mickel Randolph , Novelo-Rodríguez Candelaria Yuseth , Dzib Gabriel Rolando , Calvo-Irabién Luz María , von Arx Georg , Peña-Rodríguez Luis Manuel
Published: November 2017

Age in wild plant populations is one of the most elusive developmental parameters in plant biology. Several approaches take advantage of a plant’s morphological traits to determine developmental stages or plant age. Annual growth rings forming in woody tissues of perennial plants are one of the traits that have been widely used to determine the age of trees (dendrochronology) and, more recently, herbaceous perennials (herb-chronology). In temperate, alpine, and arctic climates, it has been reported that seasonal variations in climate lead to the formation of annual growth rings in herbaceous perennial forbs; however, to date, no similar studies have been carried out on plants from tropical regions. We have investigated the applicability of herb-chronology on the tropical plant Pentalinon andrieuxii (Müll. Arg.) B.F. Hansen & Wunderlin, a native vine of the Yucatan peninsula. Our results show that herb-chronology is a potentially useful tool in determining the age of plants growing in tropical climates.
Fluorescence quenching of a biologically active boronic acid derivative by aniline in different solvents
Authors: Melavanki Raveendra M.
Published: November 2017

Boronic acid derivatives are novel biologically active fluorescent molecules with numerous applications in various fields. A study of their fluorescent properties reveals some information that can be utilized in sensor design. One such study is fluorescence quenching. Here fluorescence quenching of 2-methoxypyridin-3-yl-3-boronic acid (2MPBA) in different solvents of a wide range of polarities has been carried out at room temperature by steady state fluorescence measurements. Aniline is used as the quencher. The positive deviation observed in Stern–Volmer (S-V) plots is analyzed using different quenching models. Various quenching parameters like S-V constant (KSV), quenching rate parameter (kq), volume constant (V), and kinetic distance (r) have been estimated using extended S-V equations. KSV is found to vary from 12.94 to 62.49 (mol/L)−1 with respect to solvents. From the calculated values of these parameters it is concluded that the static quenching mechanism is active in the studied system. However the reactions are diffusion-limited, which is confirmed by invoking the finite sink approximation model.
Numerical simulation of MHD flow of micropolar fluid inside a porous inclined cavity with uniform and non-uniform heated bottom wall
Authors: Nazeer Mubbashar , Ali N. , Javed Tariq
Published: November 2017

Buoyancy-driven, incompressible, two-dimensional flow of a micropolar fluid inside an inclined porous cavity in the presence of magnetic field is investigated. The nonlinear partial differential equations are solved by employing a robust Galerkin finite element scheme. The pressure term in this scheme is eliminated by using the penalty method. The results are exhibited in the form of streamlines, isotherms, and local and average Nusselt numbers for two cases, namely, the constant and the sinusoidal heated lower wall of the conduit. In both cases, the side walls of the cavity are cold and the upper side is insulated. The main difference between the two cases is observed from temperature contours. For constant heated bottom wall a finite discontinuity appears in the temperature distribution at the corners of the bottom wall. In contrast, no such discontinuity appears in the temperature distribution for non-uniform heated bottom wall. The quantitative changes in temperature contours in different portions of the cavity are identified by comparing the results for both cases. The code is also validated and benchmarked with the previous numerical data available in the literature. It is found that the magnetic field inclined at a certain angle either suppresses or enhances the intensity of primary circulations depending on the inclination of the cavity. Further, the average Nusselt number at the bottom wall is higher when magnetic field is applied vertically irrespective of the inclination of cavity. The analysis presented here has potential application in solar collectors and porous heat exchangers.
Effectiveness of Acupuncture and Electroacupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis
Authors: Seo See Yoon , Lee Ki-Beom , Shin Joon-Shik , Lee Jinho , Kim Me-Riong , Ha In-Hyuk , Ko Youme , Lee Yoon Jae
Published: November 2017

The aim of this systematic review was to assess evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture and electroacupuncture in patients with chronic neck pain. We searched nine databases including Chinese, Japanese and Korean databases through 30 July 2016. The participants were adults with chronic neck pain and were treated with acupuncture or electroacupuncture. Eligible trials were those with intervention groups receiving acupuncture and electroacupuncture with or without active control, and control groups receiving other conventional treatments such as physical therapy or medication. Outcomes included pain intensity, disability, quality of life (QoL) and adverse effects. For statistical pooling, the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a fixed-effects model. Sixteen RCTs were selected. The comparison of the sole acupuncture group and the active control group did not come out with a significant difference in pain (SMD 0.24, 95% CI [Formula: see text]0.27–0.75), disability (SMD 0.51, 95% CI [Formula: see text]0.01–1.02), or QoL (SMD [Formula: see text]0.37, 95% CI [Formula: see text]1.09–0.35), showing a similar effectiveness of acupuncture with active control. When acupuncture was added into the control group, the acupuncture add-on group showed significantly higher relief of pain in studies with unclear allocation concealment (SMD [Formula: see text]1.78, 95% CI [Formula: see text]2.08–[Formula: see text]1.48), but did not show significant relief of pain in studies with good allocation concealment (SMD [Formula: see text]0.07, 95% CI [Formula: see text]0.26–0.12). Significant relief of pain was observed when the sole electroacupuncture group was compared to the control group or electroacupuncture was added onto the active control group, but a lot of the results were evaluated to have low level of evidence, making it difficult to draw clear conclusions. In the result reporting adverse effects, no serious outcome of adverse event was confirmed. Acupuncture and conventional medicine for chronic neck pain have similar effectiveness on pain and disability when compared solely between the two of them. When acupuncture was added onto conventional treatment it relieved pain better, and electroacupuncture relieved pain even more. It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision. Therefore better designed large-scale studies are needed in the future.
Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates
Authors: Abe Yoshihiro , Suzuki Masahiro , Wakita Hiromasa
Published: November 2017

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.

Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.

Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.

Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.
Assessment of Usefulness of Anthropometric Data for Predicting the Scaphoid and the Screw Length: A New Technique
Authors: Jain Darshan Kumar A. , Shetty Naresh , Naveen Kumar L , Sundaresh D. C
Published: November 2017

Background: Headless screw is frequently used for scaphoid fracture fixation. Aim of the study was to assess the correlation between the axial length of the scaphoid and the axial length of the middle phalanx of index, middle, ring and little finger so as to provide an indirect method to assess the length of the scaphoid and thereby the length of the screw.

Methods: Thirty five fresh frozen cadavers with seventy wrists and hands were dissected. The age, sex and side were recorded. The axial length of the scaphoid, axial length of the middle phalanx of index, middle, ring and little finger were recorded and a correlation was assessed. Five cadavers were randomly selected and radiographs of the hand were done. Pearson coefficient correlation was assessed between the axial length of the middle phalanx of ring finger on a radiograph and actual length of middle phalanx.

Results: A significant positive correlation was noted between the axial length of the scaphoid and the axial length of the middle phalanx of ring finger (r = 0.646), also a positive correlation between the axial length of middle phalanx of ring finger on a radiograph and the axial length of the scaphoid measured by vernier caliper (r = 0.91).

Conclusions: A preoperative radiograph of the wrist with hand will help us indirectly assess the axial length of the scaphoid by measuring the axial length of the middle phalanx of ring finger.
Fight Bite Injuries: Aggressive Tendencies Associated with Smaller Second to Fourth Digit Ratio
Authors: Joyce Cormac W. , O’ Regan Andrew , Kelly Jack L. , O’ Shaughnessy Michael
Published: November 2017

Background: Fight bite injuries are typically sustained by young, combative males and are the direct consequence of an aggressive act. Second to fourth digit ratios (2D:4D) are dependent on prenatal androgen exposure and lower ratios have been shown to be linked to various psychological and physical traits, including aggression. The aim of this study was to examine the 2D:4D ratios in a cohort of patients with fight bite injuries and compare these to an age and gender-matched control group.

Methods: The 2D:4D ratios were calculated using plain films of the hand from 133 patients (122 males, 11 females) with fight bite injuries. A further 133 radiographs were obtained from patients that did not have fight bite injuries and digit ratios were calculated in the same fashion. Statistical analysis was then carried out to compare the 2D:4D ratios between the different groups.

Results: The 2D:4D ratios for male fight bite patients was significantly smaller than the male control group (p < 0.05). No significant difference was observed between the female fight bite patients and the female control group (p > 0.05).

Conclusions: Fight bite injuries are usually sustained as a result of aggression. 2D:4D ratios are reflect intrauterine androgen exposure and low ratios have been linked to aggressive tendencies. We have demonstrated that male patients who sustained fight bite injuries have a lower 2D:4D ratio then the general population, thereby suggesting that exposure to prenatal androgens can lead to aggressive tendencies in adulthood. This suggests that lower ratios may predict a predisposition to acts of aggression, and as such result in an increased likelihood of sustaining an injury such as a fight bite.
Early Results of the ARPE Arthroplasty Versus Trapeziectomy for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis
Authors: Craik Johnathan D. , Glasgow Simon , Andren James , Sims Mark , Mansouri Reza , Sharma Ritesh , Ellahee Najab
Published: November 2017

Background: Thumb carpometacarpal joint arthroplasty for osteoarthritis may hold advantages over trapeziectomy by preserving range of motion, whilst providing stability and preventing thumb shortening.

Methods: We compare functional and satisfaction outcomes scores, radiological shortening and complication rates between patients treated with trapeziectomy and those receiving the ARPE thumb CMCJ arthroplasty.

Results: Seventy-five trapeziectomies and one hundred and ten ARPE arthroplasties were performed over the study period. Both treatments resulted in significant improvements in functional scores. When matching patients according to pre-operative function, patients receiving the ARPE arthroplasty had better post-operative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). More patients receiving the ARPE arthroplasty were satisfied with their treatment (trapeziectomy = 7.8/10, ARPE = 8.7/10) and would have the same treatment again (trapeziectomy = 76%, ARPE = 89%). The ARPE also resulted in less thumb shortening. However the ARPE arthroplasty is associated with a higher complication rate, with 14% of patients requiring further surgery at a mean of 2 years follow up (95% implant survival).

Conclusions: Both trapeziectomy and the ARPE CMCJ arthroplasty are effective treatment options for thumb CMCJ osteoarthritis. Arthroplasty may offer potential advantages in terms of post-operative function and patient satisfaction. However the risk of complications and requirement for further surgery is greater and must be carefully considered during patient selection and pre-operative counselling.
Very Distal Radius Wedge Osteotomy for Kienböck’s Disease: Case Series
Authors: Okubo Hirotaka , Futenma Chojo , Sunagawa Hideyuki , Kinjo Masaki , Kanaya Fuminori
Published: November 2017

Background: Radius osteotomy is one of the standard surgical procedures for the treatment of Kienböck’s disease. Unfortunately, radius osteotomy can result in an incongruous distal radio-ulnar joint (DRUj) postoperatively, because the procedure is performed proximal to the DRUj.

Methods: A very distal radius wedge osteotomy was performed as a 15-degree lateral closing wedge osteotomy with the apex of the wedge distal to that of conventional lateral closing wedge osteotomy; this procedure was developed to avoid postoperative incongruous DRUj. We performed this procedure on 6 patients (stage III-A: 1, stage III-B: 5) with a mean age of 49 years. Clinical and radiographic evaluations were performed at a mean follow-up of 32 months.

Results: Wrist pain disappeared in all patients. Mean grip strength improved from 35% to 87% of the contralateral side (p = 0.0255). Mean range of motion, measured as flexion-extension arc, improved from 93 to 128 degrees. Nakamura’s score was good in all patient. Mean lunate covering ratio increased from 61% to 90% (p = 0.0151) and mean sigmoid notch inclination angle, a radiographic parameter of DRUj congruency, was not significantly different between pre-operative and final follow-up evaluation. No clinical or radiographic DRUj osteoarthritis findings were observed.

Conclusions: Our procedure of very distal radius wedge osteotomy provided satisfactory clinical results without an incongruous DRUj. This technique might prevent the occurrence of postoperative DRUj osteoarthritis.
Feasibility and Advantages of Full Thickness Skin Graft from the Anterolateral Thigh
Authors: Shin Seung-Han , Kim Chulkyu , Lee Yong-Suk , Kang Jin-Woo , Chung Yang-Guk
Published: November 2017

Background: Full thickness skin graft (FTSG) gives better outcomes than split thickness skin graft (STSG), but it has the drawback of limited donor sites. Anterolateral thigh (ALT), a popular donor site of STSG, is also a popular donor site of perforator flaps. This area has the advantage of large flap size available with primary closure. Based on this we harvested FTSG instead of STSG from the ALT.

Methods: We retrospectively reviewed 10 cases of FTSG from the ALT, with the recipient site of foot in 3, ankle in 2, lower leg in 2, forearm in 2, and wrist in 1 patient. In all cases elliptical full thickness skin was harvested from the ALT, and the donor site was closed primarily. The skin was defatted and placed onto the defect with vacuum-assisted closure (VAC). The skin size ranged 7-30 cm in length and 3–12 cm in width. Mean follow up period was 7 months (range, 3–13).

Results: FTSG from the ALT provided durable wound coverage, with excellent color and texture matching. Partial (< 20%) graft failure was observed in 1 case, but no additional surgery was necessary. No patient reported donor site pain at postoperative 2 weeks. No donor site complications were encountered. No patient complained a feeling of tension in the thigh at final follow-up.

Conclusions: FTSG from the ALT is feasible with the aid of VAC. Considering the skin quality, large skin size available, early pain relief, and little donor site morbidity, the ALT should be revisited as a donor site of FTSG.
Extensor Digitorum Communis (EDC) Anchor and Interposition Arthroplasty for the Metacarpo-Phalangeal Joint (MCPJ)
Authors: Mennen Ulrich
Published: November 2017

Replacing a destroyed MCPJ has always been a challenge. Few operations have resulted in consistent satisfactory results. Also, anchoring a subluxed EDC tendon from the metacarpal head has produced numerous corrective procedures, again indicating the difficulty to keep the extensor tendon aligned. The EDC anchor and interposition arthroplasty procedure addresses both these challenging problems.
An Anatomic Variant of Persistent Median Artery in Association with Carpal Tunnel Syndrome: Case Report and Review of the Literature
Authors: Feintisch Adam M. , Ayyala Haripriya S. , Datiashvili Ramazi
Published: November 2017

The persistent median artery can be a rare cause of carpal tunnel syndrome. We present an anatomic variant of this artery. A 47-year-old female patient with bilateral carpal tunnel syndrome was found to have bilateral patent, functional persistent median arteries (PMA) upon operative exploration. Unlike previous reports, the PMAs were not located dorsal to the flexor retinaculum (FR). Rather, the PMAs were interposed between the palmar aponeurosis and the FR. Accompanied by two venae comitantes, the aberrant arteries were positioned directly in line with our carpal tunnel incisions on both hands. Although rare, it is important for the surgeon to be aware of this anatomic variant to prevent inadvertent injury to what may be an important vascular supply to the distal median nerve.
A Multi-Scale Wavelet Finite Element Model for Damage Detection of Beams Under a Moving Load
Authors: He Wen-Yu , Zhu Songye , Chen Zhi-Wei
Published: November 2017

The resolution of structural finite element model (FEM) determines the computation cost and accuracy in dynamic analysis. This study proposes a novel wavelet finite element model (WFEM), which facilitates adaptive mesh refinement, for the dynamic analysis and damage detection of beam structures subjected to a moving load (ML). The multi-scale equations of motion for the beam under the ML are derived using the second-generation cubic Hermite multi-wavelets as the shape functions. Then an adaptive-scale analysis strategy is established, in which the scales of the wavelet beam elements are dynamically changed according to the ML position. The performance of the multi-scale WFEM is examined in both dynamic analysis and damage detection problems. It is demonstrated that the multi-scale WFEM with a similar number of degrees of freedom can achieve much higher accuracy than the traditional FEM. In particular, the multi-scale WFEM enables the detection of sub-element damage with a progressive model updating process. The advantage in computation efficiency and accuracy makes the proposed method a promising tool for multi-scale dynamic analysis or damage detection of structures.
Enhanced muscle blood flow with intermittent pneumatic compression of the lower leg during plantar flexion exercise and recovery
Authors: Zuj K. A. , Prince C. N. , Hughson R. L. , Peterson S. D.
Published: November 2017

This study tested the hypothesis that intermittent compression of the lower limb would increase blood flow during exercise and postexercise recovery. Data were collected from 12 healthy individuals (8 men) who performed 3 min of standing plantar flexion exercise. The following three conditions were tested: no applied compression (NoComp), compression during the exercise period only (ExComp), and compression during 2 min of standing postexercise recovery. Doppler ultrasound was used to determine superficial femoral artery (SFA) blood flow responses. Mean arterial pressure (MAP) and cardiac stroke volume (SV) were assessed using finger photoplethysmography, with vascular conductance (VC) calculated as VC = SFA flow/MAP. Compared with the NoComp condition, compression resulted in increased MAP during exercise [+3.5 ± 4.1 mmHg (mean ± SD)] but not during postexercise recovery (+1.6 ± 5.9 mmHg). SV increased with compression during both exercise (+4.8 ± 5.1 ml) and recovery (+8.0 ± 6.6 ml) compared with NoComp. There was a greater increase in SFA flow with compression during exercise (+52.1 ± 57.2 ml/min) and during recovery (+58.6 ± 56.7 ml/min). VC immediately following exercise was also significantly greater in the ExComp condition compared with the NoComp condition (+0.57 ± 0.42 ml·min−1·mmHg−1), suggesting the observed increase in blood flow during exercise was in part because of changes in VC. Results from this study support the hypothesis that intermittent compression applied during exercise and recovery from exercise results in increased limb blood flow, potentially contributing to changes in exercise performance and recovery.

NEW & NOTEWORTHY Blood flow to working skeletal muscle is achieved in part through the rhythmic actions of the skeletal muscle pump. This study demonstrated that the application of intermittent pneumatic compression during the diastolic phase of the cardiac cycle, to mimic the mechanical actions of the muscle pump, accentuates muscle blood flow during exercise and elevates blood flow during the postexercise recovery period. Intermittent compression during and after exercise might have implications for exercise performance and recovery.