Tag: pubmed

PLoS One. 2021 May 28;16(5):e0252137. doi: 10.1371/journal.pone.0252137. eCollection 2021.

ABSTRACT

OBJECTIVE: To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity.

DESIGN: Systematic review and meta-analyses.

METHODS: We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool.

RESULTS: Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24-10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66-12.06), three (MD: 8.45; 95%CI: 3.43-13.47) and six months (MD: 3.57; 95%CI: 0.81-6.32) and one year (MD: 1.42; 95%CI: 0.21-2.64) and similar differences for other planes of movement. In terms of repair integrity, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64-1.75).

DISCUSSION: Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

PMID:34048450 | DOI:10.1371/journal.pone.0252137

Int J Nurs Knowl. 2021 May 28. doi: 10.1111/2047-3095.12331. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the Nursing Diagnosis Ineffective Health Management in people with type 2 diabetes.

METHODS: Cross-sectional correlational study conducted with 112 patients from August 2018 to April 2019 in a primary healthcare facility, Ceará, Brazil. Used a structured interview and a form created by the authors specifically for the study. Descriptive and inferential statistics were used in the data analysis.

FINDINGS: The Nursing Diagnosis Ineffective Health Management was present in 63.4% of the patients. The defining characteristics with the highest prevalence were difficulty with prescribed regimen (61.6%) and failure to include a treatment regimen in daily living (60.7%). The following significant associations were found: gender and failure to take action to reduce risk factors (P = 0.003), medication and difficulty with prescribed regimen (P = 0.003), and high blood pressure and ineffective choices in daily living for meeting health goals (P = 0.005). The following defining characteristics were associated with the presence of Ineffective Health Management: difficulty with prescribed regimen (P = 0.001), failure to take action to reduce risk factors (P = 0.008), ineffective choices in daily living for meeting health goals (P = 0.001), and failure to include the treatment regimen in daily living (P = 0.001).

CONCLUSIONS: The Nursing Diagnosis Ineffective Health Management had a high prevalence in the sample. Its defining characteristics are associated with the nursing diagnosis itself and with sociodemographic and clinical variables.

IMPLICATIONS FOR NURSING PRACTICE: Ineffective Health Management should be considered a priority for developing and implementing nursing care for people with type 2 diabetes, especially in primary health care settings.

PMID:34048151 | DOI:10.1111/2047-3095.12331

Photochem Photobiol. 2021 May 28. doi: 10.1111/php.13457. Online ahead of print.

ABSTRACT

The current study aimed to evaluate the effectiveness of Photobiomodulation therapy for the prevention of incidence of Alveolar Osteitis (AO) and post-operative pain following third molar surgery. In this double-blind clinical trial, the impacted teeth of patients having bilateral impacted mandibular third molars were surgically extracted; for each participant, one socket was randomly assigned to receive photobiomodulation treatment, the other received sham treatment. 660 nm 200 mW, CW applied at a distance of ~1cm to 4 points on the occlusal area of extraction socket (beam area at the tissue ~0.64 cm² , 312.5 mW/cm² , 1J, 1.6 J/cm² ). Also, 810 nm 200 mW CW was applied at tissue surface at three points on the buccal and three points on the lingual gingiva, for 15 seconds (400 mW/cm² , 3 J, 6 J/cm² ). There was a statistically meaningful difference in AO frequency between the two groups, and the photobiomodulation group showed lower AO frequency compared with the sham PBM treatment (P-value = 0.035). According to the findings of this study, photobiomodulation therapy reduced the incidence of AO following surgical removal of impacted mandibular third molars. The incidence of AO typically occurs 3-7 days post extraction (1), and our results suggest that PBM treatment within the 7 days could help reduce the risk of AO development.

PMID:34048061 | DOI:10.1111/php.13457

J Periodontol. 2021 May 28. doi: 10.1002/JPER.21-0034. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis.

METHODS: A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were utilized to evaluate oral hygiene at baseline and were repeated after 1, 3 and 6 months. Knowledge about periodontal disease was measured and the participants’ motivation was determined using the Oral Hygiene Motivation Scale.

RESULTS: Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared to the control group. The subjects’ RMNPI and PBI scores at the 1-, 3- and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared to baseline.

CONCLUSIONS: The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of gingivitis patients, especially regarding interproximal surfaces. This article is protected by copyright. All rights reserved.

PMID:34048073 | DOI:10.1002/JPER.21-0034

Eur J Pain. 2021 May 28. doi: 10.1002/ejp.1810. Online ahead of print.

ABSTRACT

BACKGROUND: Pain catastrophizing underpins several psychosocial theories of pain, but there is limited evidence to support the proposal that changes in pain catastrophizing cause changes in pain. Results from mediation analyses have conflicting results, and one reason for these might be the timing of the assessment of pain catastrophizing. This study aimed to test the effect of the timing of pain catastrophizing on pain intensity.

METHODS: Causal mediation analysis using data from a randomized controlled trial which included 100 participants with chronic low back pain. The trial found that clinical hypnosis, compared to pain education, reduced worst pain intensity and pain catastrophizing. In model 1, we used data from 2-week follow-up for pain catastrophizing and 3-month follow-up for pain. In model 2, we used data from 3-month follow-up for both pain catastrophizing and pain.

RESULTS: The intervention had a significant average total effect on pain (-1.34 points, 95% CI -2.50 to -0.13). The average causal mediation effect was significant when pain catastrophizing and pain were measured at the same time (-0.62 points, 95% CI -1.30 to -0.11), but not significant when pain catastrophizing and pain intensity were measured at different times (-0.10 points, 95% CI -0.42 to 0.09).

CONCLUSIONS: The timing of the assessment influenced the mediating role of pain catastrophizing on pain intensity. These results raise questions on the casual role that pain catastrophizing has on pain intensity. Psychosocial interventions such as clinical hypnosis can reduce pain intensity even when there has been no change in pain catastrophizing.

PMID:34048108 | DOI:10.1002/ejp.1810

Diabetes Ther. 2021 May 28. doi: 10.1007/s13300-021-01071-5. Online ahead of print.

ABSTRACT

INTRODUCTION: This study investigates the use of do-it-yourself artificial pancreas systems (DIYAPS) in the UK, and whether self-reported outcomes associated with them are affected by the demographics of the user.

METHODS: An online survey was conducted to assess user demographic data and self-reported time-in-range (TIR) outcomes. Statistical analysis was undertaken to review the results and check whether there were major differences in change in TIR across age, gender and duration of diabetes.

RESULTS: Of 253 valid responses to the survey across a wide age range of users, 74.4% related to adult users and 25.6% related to under-16s. The majority (65.6%) used AndroidAPS, but there was greater use of Loop (43.1%) amongst under-16s than amongst adults (25.9%). Correspondingly, more under-16s (40.0%) than adults (24.3%) used Omnipod Eros. A 17.3% (± 13.7%) increase in time in range was reported across all participants, with no significant differences observed between age groups, genders or diabetes duration groups (p > 0.05).

CONCLUSIONS: The results show that these systems are being used by both genders, and that users cover a wide range of ages and diabetes durations. They also show that improvements in self-reported DIYAPS healthcare outcomes may not be specific to any particular age, gender or duration of diabetes, and the results may provide additional insights into the applicability of the algorithms by demographic. This study may also inform healthcare professionals about the use and effectiveness of DIYAPS solutions.

PMID:34047963 | DOI:10.1007/s13300-021-01071-5

Clin Pharmacol Ther. 2021 May 28. doi: 10.1002/cpt.2311. Online ahead of print.

ABSTRACT

Aromatase inhibitors (AI) are the treatment of choice for hormone receptor-positive early breast cancer in postmenopausal women. None of the third-generation AIs are superior to the others in terms of efficacy. We attempted to identify genetic factors that could differentiate between the effectiveness of adjuvant anastrozole and exemestane by examining single-nucleotide polymorphism (SNP)-treatment interaction in 4465 patients. A group of SNPs were found to be differentially associated between anastrozole and exemestane regarding outcomes. However, they showed no association with outcome in the combined analysis. We followed up common SNPs near LY75 and GPR160 that could differentiate anastrozole from exemestane efficacy. LY75 and GPR160 participate in epithelial-to-mesenchymal transition and growth pathways, in both cases with SNP-dependent variation in regulation. Collectively, these studies identified SNPs that differentiate the efficacy of anastrozole and exemestane and they suggest additional genetic biomarkers for possible use in selecting an AI for a given patient.

PMID:34048027 | DOI:10.1002/cpt.2311

Eur Radiol. 2021 May 28. doi: 10.1007/s00330-021-08062-x. Online ahead of print.

ABSTRACT

OBJECTIVES: To test the diagnostic accuracy of a 3D dual-echo steady-state (DESS) sequence at 7-T MRI regarding the detection of chondral calcific deposits of the knee in comparison to 3-T MRI, using CT as cross-sectional imaging reference standard.

METHODS: CT and 7-T MRI (DESS) of knee joints in 42 patients with radiographically known chondrocalcinosis (13 of 42 bilateral) were prospectively acquired for all included patients (n = 55 knee joints). Additionally, 3-T MRI (DESS) was performed for 20 of these 55 knee joints. Two fellowship-trained musculoskeletal radiologists scored eight cartilage regions of each knee joint separately regarding presence of cartilage calcification, diagnostic confidence level, and sharpness of calcific deposits. In an explorative subanalysis, micro-CT of the menisci was evaluated after knee arthroplasty in one patient. Diagnostic performance metrics and nonparametric tests were used to compare between modalities. p values < 0.05 were considered to represent statistical significance.

RESULTS: Sensitivity for chondrocalcinosis detection was significantly higher for 7-T MRI (100%) compared to 3-T MRI (reader 1: 95.9%, p = 0.03; reader 2: 93.2%, p = 0.002). The diagnostic confidence was significantly higher for both readers at 7 T compared to both 3-T MRI (p < 0.001) and to CT (p = 0.03). The delineation of chondral calcifications was significantly sharper for 7-T compared to both 3-T MRI and CT (p < 0.001, both readers). Micro-CT in one patient suggested that 7-T MRI may potentially outperform standard CT in diagnosing chondral calcifications.

CONCLUSION: 3D-DESS imaging at 7-T MRI offers a significantly higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI.

KEY POINTS: • 3D dual-echo steady-state (DESS) MRI at 7 T has a higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI (p ≤ 0.03). • 3D DESS MRI at 7 T yields no false-negative cases regarding presence of chondral calcific deposits. • 3D DESS MRI at 7 T offers better delineation and higher diagnostic confidence in detection of chondral calcific deposits compared to 3-T MRI (p < 0.001).

PMID:34047850 | DOI:10.1007/s00330-021-08062-x

Eur J Orthop Surg Traumatol. 2021 May 28. doi: 10.1007/s00590-021-03015-y. Online ahead of print.

ABSTRACT

PURPOSE: Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG).

METHODS: Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups.

RESULTS: The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups.

CONCLUSION: The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.

PMID:34047855 | DOI:10.1007/s00590-021-03015-y

Sleep Breath. 2021 May 28. doi: 10.1007/s11325-021-02395-z. Online ahead of print.

ABSTRACT

BACKGROUND: The connection between obstructive sleep apnea and secondary erythrocytosis is controversial. We hypothesised that there may be a higher prevalence of erythrocytosis in patients with obesity hypoventilation syndrome (OHS) due to persistent hypoxemia.

METHODS: The study was a retrospective, cross-sectional review of patients with OHS derived from an established cohort of “non-invasive ventilation” patients at the Department of Sleep Medicine at the Royal Infirmary Medical Centre, Edinburgh (2004-2017). Relevant clinical data were obtained from patient records.

RESULTS: The cohort comprised 74 patients with OHS, 44 men (60%), mean age at diagnosis 54 ± 10 years. The mean haematocrit level for the group overall was 0.44, in men 0.45, and in women 0.41. Of 11 patients with erythrocytosis (15%), 7 were men. Thirteen patients (18%) died during follow-up (2004-2017). There was a statistically significant increase in risk of death in patients with higher and lower haematocrit levels compared to that in patients with OHS who had normal haematocrits.

CONCLUSIONS: This is the first study showing increased prevalence of erythrocytosis in OHS patients. There was a “U”-shaped correlation with mortality according to haematocrit levels.

PMID:34047903 | DOI:10.1007/s11325-021-02395-z