Search

To examine the association between rehabilitation utilization within 12 months of breast cancer diagnosis and out-of-pocket costs in the second year (12-24mo after diagnosis). Secondary analysis of the 2009-2019 Surveillance, Epidemiology and End Results-Medicare linked database. Individuals who received rehabilitation services were propensity-score matched to individuals who did not receive services. Overall and health care service-specific models were examined using generalized linear models with a gamma distribution. Inpatient and outpatient medical facilities. A total of 35,212 individuals diagnosed with nonmetastatic breast cancer and were continuously enrolled in Medicare Fee-For Service (parts A, B, and D) in the 12 months before and 24 months postdiagnosis. Not applicable. Individual cost responsibility, a proxy for out-of-pocket costs, which was defined as deductibles, coinsurance, and copayments during the second year after diagnosis (12-24mo postdiagnosis). The mean individual cost responsibility was higher in individuals who used rehabilitation than those who did not ($4013 vs $3783), although it was not a clinically meaningful difference (d =0.06). Individuals who received rehabilitative services had significantly higher costs attributed to individual provider care ($1634 vs $1476), institutional outpatient costs ($886 vs $812), and prescription drugs ($959 vs $906), and significantly lower costs attributed to institutional inpatient costs ($455 vs $504), and durable medical equipment ($81 vs $86). Older adults with breast cancer who received rehabilitation services had higher cost responsibility during the second year after diagnosis than those who did not. Future work is needed to examine the relationship between rehabilitation and out-of-pocket costs across longer periods of time and in conjunction with perceived benefit. [ABSTRACT FROM AUTHOR]

Older breast cancer survivors have difficulty accessing rehabilitation interventions addressing activity limitations. Stakeholder input may improve accessibility of interventions. We sought expert consensus on intervention content and delivery features (e.g., where, mode, duration) to inform development of more accessible interventions for this population. We conducted a modified Delphi process with patient, clinical, administrative, and research experts. In Round 1, experts evaluated content and delivery features according to domains of feasibility and prioritization. In Round 2, panelists were asked to re-rank or confer agreement of content and delivery features that met Round 1 consensus. Ranking was based on median score. Consensus was defined as a percentage of panelists that ranked an option within one unit of the median. For nominal data, consensus was defined as percent agreement. Panelists (n = 20) prioritized physical activity strategies (Median Rank: 2; Consensus: 85%) and adaptive skills training (3; 65%). Panelists also prioritized delivery through outpatient services (1; 100%), post-treatment (1; 100%), combination mode of delivery (100%), duration of three months or less (100%) and occurring one to two days per week (100%). Cancer rehabilitation interventions should be designed with input from stakeholders. The stakeholder intervention priorities identified in this study (e.g., content, setting, and mode) may improve relevance and accessibility of future cancer rehabilitation interventions. Interventions delivered in outpatient clinics and post-treatment using virtual and in-person visits may improve accessibility. Future research should examine the effectiveness and implementation of these intervention characteristics. [ABSTRACT FROM AUTHOR]

Cancer-related disability is a complex problem for older breast cancer survivors. One aspect of cancer-related disability is a survivor's inability to complete meaningful daily activities and engage in life roles, referred to as activity limitations and participation restrictions respectively. There is a limited understanding of how interventions influence activity limitations and participation restrictions in this population. A scoping review was undertaken to identify and characterize nonpharmacological interventions developed to address activity limitations and participation restrictions. A systematic search of electronic databases (Ovid Medline, Embase, EBSCO CINAHL, and Ovid PsycINFO) was conducted in April 2020 and updated October 2020. Eleven studies met inclusion criteria. Most frequently observed delivery features were in-person and one-on-one format. Six interventions incorporated telehealth delivery components. Interventions were often complex and varied in content. Exercise and behavioral strategies were among the most frequently used active ingredients. Activity limitations and participation restrictions were often secondary outcomes, and measures of these outcomes were varied in content and assessment method. Study samples were not representative of the current population of older adult breast cancer survivors. Future intervention research should clarify intervention delivery, content, and dose, prioritize comprehensive measurement of activity limitations and participation restrictions, as well as recruit and involve representative study samples to enhance generalizability of findings. [ABSTRACT FROM AUTHOR]

To examine patient-level predictors of referral to cancer rehabilitation medicine services following a physical activity screening assessment among cancer survivors. Secondary analysis of individuals that completed My Wellness Check Program (MWC), an electronic health record-integrated symptom screening and referral system for cancer survivors, between April 2021 and January 2022. Multivariable logistic regression models were fit to calculate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Ambulatory oncology clinics in an urban academic medical center. 1,174 cancer survivors who completed the Moving Through Cancer physical activity assessment and at least one MWC assessment battery. Not applicable. Positive screening for physical inactivity (yes/no). Completed referral to cancer rehabilitation medicine services following a positive screen (yes/no). Forty-six percent of survivors screened positive as being physically inactive. Individuals with moderate-severe physical dysfunction compared to none-to-mild (aOR: 1.750; 95%CI: 1.137 - 2.693; p=0.0109) had higher odds and self-reporting Hispanic/Latino ethnicity compared to non-Hispanic/Latino ethnicity (0.720; 0.556, 0.932; p=0.0126) had lower odds of positive screening for physical inactivity. Only 31% of survivors with physical inactivity received a completed referral to cancer rehabilitation medicine services. There were no significant predictors associated with referral completion. Self-reported physical function and ethnicity may help clinicians identify cancer survivors at risk for physical inactivity. Additional research on provider- and organizational-level variables are needed to determine the relationship between referral completion to cancer rehabilitation medicine services following physical activity assessments. This study was funded in part by grant P30CA240139 (Nimer, S: PI; Penedo, F: Cancer Control Co-Leader). P.I.M. was supported by a National Cancer Institute career development award (K01CA258955). We acknowledge the Miami Clinical & Translational Science Institute for their help with data collection on the primary study (UL1TR002736). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

We aimed to describe experiences of sexual harassment of female-identifying academic OT practitioners. We used Interpretive Phenomenological Analysis to examine participants' experiences collected through semi-structured interviews and full-text descriptions of experiences. All participants worked or had worked in academia. Ten participants entered text via a survey, uploaded text via a survey, and/or completed Zoom interviews, some participating in multiple ways, resulting in 13 transcripts for analysis. Not applicable. Themes from semi-structured interviews. Participants reported a range of experiences with sexual harassment and its effects on their personal and professional lives. Experiences ranged from inappropriate comments and micro aggressions to coercion, sexual assault, and stalking. Participants reported not attending conferences to avoid specific perpetrators, having work intentionally delayed or stolen by the perpetrator, and leaving their jobs altogether. Four themes were generated to describe these experiences: (1) Blurred lines, (2) Unbalanced consequences, (3) How did I get here?, and (4) We don't talk about it. Across the themes, power dynamics inherent in the harassment experiences were a constant, underlying thread running. Sexual harassment of female OT academics is an ongoing problem and is damaging to short- and long-term personal and professional growth. We suggest that the focus of eliminating sexual harassment must include improving organizational culture, awareness, expectations, re-establishing norms, and supporting victims' safety in all realms, physical, mental, and professional. Nothing to disclose. [ABSTRACT FROM AUTHOR]

To describe trends in National Institutes of Health (NIH) funded grants focused on cancer rehabilitation research and identify scientific gaps. Research and training project grants funded during Fiscal Year (FY) 2015 to 2022 focused on cancer survivorship and rehabilitation were identified using the NIH Research, Condition, and Disease Classification categorization for rehabilitation and an algorithm of cancer survivorship terms. The title, abstract and specific aims page of each grant were reviewed for eligibility. Eligible grants were double coded to extract grant characteristics. The research utilized data from NIH Information for Management, Planning, Analysis and Coordination - II database. This analysis included new research grants funded from FY 2015 through 2022. The year 2015 was considered baseline as Archives of Physical Medicine and Rehabilitation published findings from the 2014 NIH Subject Matter Expert Group on opportunities and gaps in cancer rehabilitation in 2016. Not applicable. The primary outcome measures were funding mechanism, year of funding, study population of interest, and classification of primary and secondary study outcomes based on the International Classification of Functioning, Disability and Health. In addition to the main outcome measures, number of grants, funding dollars, scientific influence metrics, and study type according to the 2021 NIH Research Plan on Rehabilitation themes will be analyzed. Data extraction and analysis are ongoing and will be completed by July 2023. The findings reveal that cancer rehabilitation is an emerging funding area, but gap areas persist. Future research should examine both the implementation and impact of cancer rehabilitation at the patient-, provider-, and system-level to advance cancer rehabilitation science, and improve outcomes among cancer survivors. Rachelle Brick is funded by the Cancer Prevention Fellowship Program within the Division of Cancer Prevention at the National Cancer Institute. The presentation was prepared as part of the authors' official duties as employees of the US Federal Government. The findings and conclusions are those of the authors and do not necessarily represent the official position of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

The objective of this short report was to describe types of education provided to older, hospitalized patients with cancer and their caregivers using electronic health record data. A total of 437 patients, representing 512 inpatient stays (admissions), met the inclusion criteria. The sample were predominately male (58%) and White (95%). The average patient age at first admission was 74 years (SD 6.21 years) and the average length of admission was 5 days (SD 3.41 days). Out of all admissions, 89% included at least one documented education session with a provider. Three important results emerged from this study 1) education on medications is commonly conveyed to cancer patients (77%), 2) nurses are primarily responsible for providing education (65%), and 3) caregivers are infrequently involved (41%) in patient education. Additional educational topics tailored to the long-term needs of older adults with cancer are warranted. These topics should be delivered by an array of interprofessional care providers with demonstrated competency. Lastly, patient education should ensure inclusion of caregivers as part of the interprofessional cancer care team to promote successful management of cancer-related concerns. [ABSTRACT FROM AUTHOR]

There are limited medium- and long-term studies investigating clinical outcomes following revision rotator cuff surgery. The aim of the current study was to analyze the medium-term pain and functional outcomes of a cohort of revision rotator cuff repairs. This was a multicenter, prospective cohort study of revision rotator cuff repairs undertaken between March 2009 and December 2010. Pain, function (Flex-SF), and postoperative data were collected at baseline; 6, 12, and 24 months; and 5 years. A total of 125 revision rotator cuff repairs were included in this study. Average improvement in Flex-SF and pain from baseline to 5 years was 8.5 (P <.001) and 2.1 points, respectively (P <.001). The improvement was not as pronounced as those who underwent primary repair. Significantly lower pain scores were seen in nonsmokers (P <.001) and in those who underwent tenotomy rather than tenodesis (2 vs. 3.5, P <.05) for a damaged long head of biceps. Significantly higher function scores were seen in those with only 1 tendon involved (P <.05). The patient-reported retear rate was 32.6%, and the reoperation rate was 34.7%. Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation, though not as good as primary repair. Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon. [ABSTRACT FROM AUTHOR]

The purpose of this project was to determine if evidence-based practice change related to antibiotic administration criteria for outpatients receiving percutaneous nephrostomy tube exchanges implemented by a medical center's Vascular and Interventional Radiology department impacted hospital admission rates for infection in these patients. The 2017 practice change was based on 2010 guidelines from the Society of Interventional Radiology (SIR), stating that outpatients with a low risk of acquiring infection did not need to receive a perioperative antibiotic, as evidence has shown prophylactic therapy has no significant effect on infection rates for this population. Using a retrospective review design, 1 year of data before and after the practice change were collected and analyzed using the repeated measures generalized estimating equation (GEE) model with a binomial output by Liang & Zeger. Fisher's exact test was used to evaluate demographic variables by level of risk of infection. Data included 493 procedural events for 126 outpatients. The mean number of events per patient was 3.91 (SD: 4.15; median: 2; interquartile range: 3). Admission and infection criteria within thirty days of the event and infection risk factors were collected for each patient. Age, sex, and race were the variables that had a significant relationship with risk level of infection. Due to sample size, the GEE model could not be run using risk level (high/low) to predict admissions before or after the practice change. The relationship between the number of risk factors (0-5) and the odds of admission for infection was the same regardless of the practice change (before: odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.19-3.95; after: OR = 1.9, 95% CI = 1.12-3.22, p interaction =.67). For every increase in a patient's number of risk factors, the odds of developing an infection would be expected to increase by almost 90% (OR = 1.9, 95% CI = 1.27-2.84). Although it was not possible to determine efficacy of the practice change, the predictive analysis indicated that risk level is a significant predictor of admission for infection regardless of antibiotic therapy. The results suggest that demographic indicators should be considered when determining appropriate therapies for this procedure; however, research studies should evaluate this relationship with larger samples to design specific recommendations. Our project results support the 2010 SIR antibiotic prophylaxis guidelines and their more recently updated antibiotic parameter guidelines from 2018. • Variables of age, sex, ethnicity, and history of type II diabetes had significant relationships with risk level of infection. • For every incremental increase to patient's number of infection risk factors, odds of having an infection increased by almost 90%. • Relationship between number of risk factors and odds having an infection was the same regardless of whether the procedure took place before or after practice change. • Limited conclusions given sample size, but analysis, indicate that following policy change, risk level is likely to affect antibiotic administration. [ABSTRACT FROM AUTHOR]

Determine service delivery preferences for individuals with different disabilities, as well as from rural and urban areas. This study employs concurrent mixed methods utilizing quantitative t-tests and regression with qualitative thematic analysis. Data was collected from an online survey sent to patients following telehealth sessions at Shepherd Center, a disability rehabilitation center, April-July 2020 (N=300). Of the 309 respondents, most were female (64.7%) and White (69.2%) with an average age of 51.57 (range=12-83, SD=13.63). None. Preferences related to telehealth. Respondents lived an average of 65.04 miles (SD=89.06) from Shepherd Center with 9.7% in rural counties. Respondents experienced various disabilities: 21.0% ABI, 10.7% SCI, 61.3% MS, and 8.7% with other disabilities. Patients who lived farther from Shepherd Center preferred telehealth (β=0.07, p< 0.05), as did patients who live in rural versus urban counties (β=0.39, p< 0.05). Patients in rural areas travel more than twice as many miles as non-urban patients (rural: M=112.53, SD=54.91; non-rural: M=39.28, SD=42.07) (t=8.32, p< 0.001, d=1.69), with a higher estimated cost of $82.04 round trip ($0.56/mile). No statistical differences for preference in service delivery methods were identified between disability type. Preferences for delivery of healthcare services according to qualitative methods were as follows: Telehealth. Patients who preferred telehealth services indicated it was primarily for convenience, with most comments from patients in rural areas indicating that time/cost savings associated with less travel were key. In-person. Overall, patients who preferred in-person services indicated it was due to benefits of personal interactions with the care team. Hybrid. Several patients preferred receiving a hybrid model because it combined benefits of telehealth and in-person services. The results suggest: 1) individuals from rural areas and who live farther away prefer telehealth services; 2) telehealth was similarly preferred by and is appropriate for individuals of all disability types; and 3) hybrid models of care should be considered for future service delivery, with telehealth offered for basic services and in-person services offered for intensive/detailed services. None. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability.Methods: An expert panel was convened to build an international consensus on the operating room diagnosis/confirmation of hip instability. Seventeen surgeons who have published or lectured nationally or internationally on the topic of hip instability were invited to participate. Fifteen panel members completed a pre-meeting questionnaire and agreed to participate in a 1-day consensus meeting on May 15, 2021. A review of the literature was performed to identify published intraoperative reference criteria used in the diagnosis of hip instability. Studies were included for discussion if they reported and intraoperative findings associated with hip instability. The evidence for and against each criteria was discussed, followed by an anonymous voting process. For consensus, defined a priori, items were included in the final criteria set if at least 80% of experts agreed.Results: A review of the published literature identified 11 operating room criteria that have been used to facilitate the diagnosis of hip instability. Six additional criteria were proposed by panel members as part of the pre-meeting questionnaire. Consensus agreement was achieved for 8 criteria, namely ease of hip distraction under anesthesia (100.0% agreement), inside-out pattern of chondral damage (100.0% agreement), location of chondral damage on the acetabulum (93.3% agreement), pattern of labral damage (93.3% agreement), anteroinferior labrum chondral damage (86.7% agreement), perifoveal cartilage damage (97.6% agreement), a capsular defect (86.7% agreement), and capsular status (80.0% agreement). Consensus was not achieved for 9 items, namely ligamentum teres tear (66.7% agreement), arthroscopic stability tests (46.7% agreement), persistent distraction after removal of traction (46.7% agreement), findings of examination under anesthesia (46.7% agreement), the femoral head divot sign (40.0% agreement), inferomedial synovitis (26.7% agreement), drive-through sign (26.7% agreement), iliopsoas irritation (26.7% agreement) and ligamentum teres-labral kissing lesion (13.3% agreement). All experts agreed on the final list of 8 criteria items reaching consensus.Conclusion: This expert panel identified 8 criteria that can be used in the operating room to help confirm the diagnosis of hip instability.Level Of Evidence: Level V expert opinion. [ABSTRACT FROM AUTHOR]

Background Bullous pemphigoid (BP) has been associated with neurologic disorders. Objective We sought to analyze the association between BP and neurologic disorders. Methods We retrospectively identified residents of Olmsted County, Minnesota, with a first lifetime diagnosis of BP between January 1, 1960, and December 31, 2009. Three age- and sex-matched Olmsted County, Minnesota, residents without BP were selected as control subjects for each patient. We compared history of or development of neurologic disorders (dementia, Alzheimer disease, Parkinson disease, multiple sclerosis, cerebrovascular disease, and seizures) between groups using case-control and cohort designs. Results In all, 87 patients with BP were identified and matched to 261 control subjects. The odds of a previous diagnosis of any neurologic disorder or a history of dementia were significantly increased among cases compared with controls (odds ratio 6.85; 95% confidence interval [CI] 3.00-15.64; P < .001; and odds ratio 6.75; 95% CI 2.08-21.92; P = .002, respectively). Both Parkinson disease (hazard ratio 8.56; 95% CI 1.55-47.25; P = .01) and any type of neurologic disorder (hazard ratio 2.02; 95% CI 1.17-3.49; P = .01) were significantly more likely to develop during follow-up in patients with than without BP. Limitations Small geographic area and retrospective study design are limitations. Conclusion Findings confirmed an association of BP with neurologic disorders, especially dementia and Parkinson disease. [ABSTRACT FROM AUTHOR]

Background: Bullous pemphigoid (BP) is an autoimmune blistering disease that is associated with increased mortality. Objective: We sought to determine the incidence and mortality of patients with BP. Methods: A total of 87 residents of Olmsted County, Minnesota, were identified who had their first lifetime diagnosis of BP from January 1960 through December 2009. Incidence and mortality were compared with age- and sex-matched control patients from the same geographic area. Results: The adjusted incidence of BP was 2.4 per 100,000 person-years (95% confidence interval, 1.9-2.9). Incidence of BP increased significantly with age (P < .001) and over time (P = .034). Trend tests indicate increased diagnosis of localized disease (P = .006) may be a contributing factor. Survival observed in the incident BP cohort was significantly poorer than expected (P < .001). Survival was not different among patients with multisite versus localized disease (P = .90). Limitations: Retrospective study design and study population from a small geographic area are limitations. Conclusion: Incidence of BP in the United States is comparable with that found in Europe and Asia. The mortality of BP is lower in the United States than Europe, but higher than previous estimates. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to investigate whether, in patients with bilateral symptomatic femoroacetabular impingement, bilateral surgery under 1 anesthetic is safe and efficacious and allows a rapid return of function compared with staged procedures. Methods: Three groups were evaluated: in group 1 both hips were treated simultaneously, in group 2 both hips were treated in a staged fashion, and in group 3 a single hip was addressed. The outcome measures were anesthesia and surgical times; time in the hospital; visual analog scale score for pain on postoperative days 1, 3, 7, and 30; analgesic use; and time until the patient could bike, drive, perform office work, perform gym activities, run, and return to play. Midterm evaluation was performed with the Non-Arthritic Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at 6 and 12 months postoperatively. Results: We enrolled 76 patients (122 hips) in this study. There were 42 male and 34 female patients. The mean age was 33 years (range, 14 to 50 years), and the mean body mass index was 24 (range, 18 to 35). Group 1 comprised 26 patients (52 hips, 16 male and 10 female patients). Group 2 comprised 20 patients (40 hips, 13 male and 7 female patients), with a mean time between surgeries of 14.56 weeks. Group 3 comprised 33 patients (30 hips, 13 male and 17 female patients). No preoperative differences were found between the groups. The surgical and anesthesia times in group 1 were significantly longer than those in groups 2 and 3. We found no significant differences in postoperative visual analog scale scores, analgesic use, or length of hospital stay. Group 1 required more time before patients were able to ride a stationary bicycle (14.7 days in group 1, 7.8 days in group 2, and 8.5 days in group 3; P < .05). We found no differences between the groups regarding when patients returned to driving, performing office work, or reporting a normal gait. Each group had significant improvements in the Western Ontario and McMaster Universities Osteoarthritis Index and Non-Arthritic Hip Score at 6 and 12 months compared with preoperatively (P < .05). No significant differences in outcome scores were found in the 3 groups before surgery and at 6 or 12 months after surgery. Conclusions: Simultaneous femoroacetabular impingement surgery does not lead to higher rates of complications, postoperative pain, analgesic use, or side effects. The return to daily activities is similar to a single-hip procedure with the advantage of a single rehabilitation. Level of Evidence: Level III, retrospective comparative study. [Copyright &y& Elsevier]

Abstract: The objective was to evaluate the presence and distribution of the lubricating and anti-adhesion glycoprotein lubricin and cells containing the contractile isoform smooth muscle α-actin (SMA) in pseudomembranes around loose hip prostheses. Periprosthetic tissue was obtained at revision arthroplasty of eight aseptic, loose hip implants, and for comparison three loose knee prostheses. Immunohistochemical analysis was performed in 3 zones: zone 1, within 300μm of the edge of the implant–tissue interface; zone 2, between zones 1 and 3; zone 3, within 300μm of the resected/trimmed edge. The presence of lubricin was extensive in all samples: (1) as a discrete layer at the implant–tissue interface; (2) within the extracellular matrix (ECM); (3) intracellularly. There was significantly more high grade (>50%) lubricin surface staining at the implant–tissue interface compared with the resected edge. While there was also a significant effect of location of high grade ECM lubricin staining, there was no significant effect of implant type (i.e. hip versus knee). All but two hip pseudomembrane samples showed the presence of many SMA-containing cells. There was a significant effect of location on the number of SMA-expressing cells, but not of implant type. These findings might explain why the management of loose prosthesis is so challenging. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To determine the biomechanical strength of Achilles tendon allografts with 2 different bone plug configurations as prepared for arthroscopic posterior cruciate ligament reconstruction when fixed as tibial inlay constructs. Methods: Nine matched pairs of cadaveric tibias were reconstructed by a standardized tibial inlay technique by use of either a cylindrical bone plug (12 mm in diameter) or a figure-of-8 bone plug (12 × 18 mm). Constructs were subjected to cyclic tensile loading followed by load to failure. The statistical analysis consisted of paired t tests with significance set at P < .05. Results: No significant differences were found in yield load, ultimate load, stiffness, load at 5 mm, and total cyclic displacement between the groups. Although both constructs showed equivalent biomechanical properties, the tendons of the cylindrical bone plugs failed predominantly by shear off the bone compared with the figure-of-8 plugs, which failed by the sutures tearing through the tibial plateau. Conclusions: Tibial constructs with cylindrical and figure-of-8 bone plugs as prepared for use in arthroscopic posterior cruciate ligament reconstruction have comparable immediate biomechanical stability when fixed by a tibial inlay technique in a cadaveric model. Clinical Relevance: Cylindrical and figure-of-8 bone plugs have comparable immediate biomechanical stability when fixed by a tibial inlay method, with the cylindrical technique being potentially technically easier to perform. [Copyright &y& Elsevier]

Abstract: The specific recognition by proteins of the 5′ and 3′ ends of RNA molecules is an important facet of many cellular processes, including RNA maturation, regulation of translation initiation and control of gene expression by degradation and RNA interference. The aim of this review is to survey recent structural analyses of protein binding domains that specifically bind to the extreme 5′ or 3′ termini of RNA. For reasons of space and because their interactions are also governed by catalytic considerations, we have excluded enzymes that modify the 5′ and 3′ extremities of RNA. It is clear that there is enormous structural diversity among the proteins that have evolved to bind to the ends of RNA molecules. Moreover, they commonly exhibit conformational flexibility that appears to be important for binding and regulation of the interaction. This flexibility has sometimes complicated the interpretation of structural results and presents significant challenges for future investigations. [Copyright &y& Elsevier]

Summary: Objective: To describe the features of invasive Panton-Valentine Leucocidin positive Staphylococcus aureus (PVL-SA) in children at a London teaching hospital, from 2004 to 2008. Methods: Retrospective case note review. Results: Eleven previously healthy children, 7 male, median age 9 years (range 7 months–13 years), had invasive infections due to unrelated community-acquired meticillin-sensitive PVL-SA. Possible risk factors were identified in 10 cases. Eight patients had complicated musculoskeletal infections, 2 had pneumonia, and 1 had a massive retropharyngeal abscess. At admission neutropenia was present in 2 patients, deep vein thrombosis in 3, and initial blood cultures were positive in 8. Patients with musculoskeletal involvement had a median of 3 (range 1–6) sites of infection, and required median 5 (range 1–11) operative procedures. Eight patients were admitted to PICU, 7 had septic shock. Median duration of hospital stay was 51 (range 14–255) days. One child died and 5 have long-term morbidity. Conclusions: The clinical features of invasive PVL-SA in this series were similar to those reported from USA and Europe. Musculoskeletal infection was the most common manifestation, frequently progressing to multiple sites and severe sepsis. Most cases had risk factors and clinical features which might have allowed earlier diagnosis, and possibly improved outcome. [Copyright &y& Elsevier]

Purpose: The ideal surgical management of isolated and combined posterior cruciate ligament (PCL) injuries is controversial. One active debate concerns the advantages of an open tibial inlay technique versus an arthroscopic transtibial tunnel technique. Therefore, the goal of this study is to biomechanically compare arthroscopic and open double-bundle PCL tibial inlay procedure with and without posterolateral corner (PLC) deficiency. Methods: Ten matched pairs of cadaveric knees were randomly assigned to undergo PCL sectioning and reconstruction using either the open inlay or arthroscopic inlay approach. Clinical testing consisted of posterior drawer, TELOS stress testing, and dial testing at both 30° and 90°. The knee conditions tested were intact, after PCL sectioning, after PLC release, and following PCL reconstruction, with and without the PLC repair. Both 1-way repeated measures and 2-way mixed design analyses of variance were used to determine differences between the knee conditions, with significance set at P < .05. Results: After PCL and PLC reconstruction, 10 of 10 open specimens and 9 of 10 arthroscopic specimens were a grade 0 posterior drawer. The remaining arthroscopic specimen was grade I. The average radiographic posterior displacement for arthroscopic and open reconstructions (PCL+/PLC+) was 3.9 and 2.7 mm, respectively, with no significant difference. However, if the PLC was deficient (PCL+/PLC-), the translation for arthroscopic and open specimens increased to 8.5 and 6.5 mm, respectively, and was statistically different from the intact state but not from each other. At 30° of knee flexion, both the open and arthroscopic specimen averaged 8.4° of external rotation. At 90° of knee flexion, the external rotation measurements increased to 9.6° and 9.3° in the arthroscopic and open groups, respectively. Additionally, there was no significant difference in external rotation between intact and reconstructed knees with either group. Conclusions: The arthroscopic method of double-bundle inlay PCL reconstruction provides comparable stability to the open inlay using clinically relevant measurement tools both in the PLC intact or deficient state. Clinical Relevance: This novel arthroscopic double-bundle PCL inlay reconstruction provides comparable stability to the open approach with a potential for lower operative morbidity. [Copyright &y& Elsevier]

Revision surgery for lumbar stenosis is associated with longer surgical times, greater technical challenges, and a higher rate for potential complication rates than primary surgery. However, in well-selected patients, clinical success can be achieved. Identification of symptomatic residual or recurrent areas of stenosis or instability is paramount. Adhering to basic principles of revision surgery is crucial to its safe and effective execution. However, the surgeries are often far from “basic,” requiring the surgeon to be adept at a wide range of conventional and novel surgical techniques. [ABSTRACT FROM AUTHOR]

This article discusses the effects of cancer on broader domains of health; the evidence and application of activity-focused rehabilitation approaches in rehabilitation populations; and the role of nurses in the promotion of activity-focused rehabilitation. Narrative review of rehabilitation literature. Cancer impacts activity engagement, community participation, and quality of life. Optimal cancer rehabilitation may lie in adoption and implementation of activity-focused rehabilitation approaches. Recent research suggests that this approach may improve impairments and activity engagement outcomes. Nurses are critical for screening for activity limitations and participation restrictions and early referral to rehabilitation treatment. Nurses can also educate survivors on the importance of meta-cognitive and self-management strategies to promote engagement in meaningful activities to reduce long-term disability. [ABSTRACT FROM AUTHOR]

The prevalence of atopy is associated with a Western lifestyle, as shown by studies comparing neighboring regions with different socioeconomic backgrounds. Atopy might reflect various conditions differing in their susceptibility to environmental factors. We sought to define phenotypes of atopic sensitization in early childhood and examine their association with allergic diseases and hereditary background in Finland and Estonia. The analysis included 1603 Finnish and 1657 Estonian children from the DIABIMMUNE multicenter young children cohort. Specific IgE levels were measured at age 3, 4, and 5 years, respectively, and categorized into 3 CAP classes. Latent class analysis was performed with the statistical software package poLCA in R software. Both populations differed in terms of socioeconomic status and environmental determinants, such as pet ownership, farm-related exposure, time spent playing outdoors, and prevalence of allergic diseases (all P <.001). Nevertheless, we found similar latent classes in both populations: an unsensitized class, a food class, 2 inhalant classes differentiating between seasonal and perennial aeroallergens, and a severe atopy class. The latter was characterized by high total and specific IgE levels and strongly associated with wheeze (odds ratio [OR], 5.64 [95% CI, 3.07-10.52] and 4.56 [95% CI, 2.35-8.52]), allergic rhinitis (OR, 22.4 [95% CI, 11.67-44.54] and 13.97 [95% CI, 7.33-26.4]), and atopic eczema (OR, 9.39 [95% CI, 4.9-19.3] and 9.5 [95% CI, 5.2-17.5] for Finland and Estonia, respectively). Environmental differences were reflected in the larger seasonal inhalant atopy class in Finland, although composition of classes was comparable between countries. Despite profound differences in environmental exposures, there might exist genuine patterns of atopic sensitization. The distribution of these patterns might determine the contribution of atopic sensitization to disease onset. [ABSTRACT FROM AUTHOR]

Background Living on a farm has repeatedly been shown to protect children from asthma and allergies. A major factor involved in this effect is consumption of unprocessed cow's milk obtained directly from a farm. However, this phenomenon has never been shown in a longitudinal design, and the responsible milk components are still unknown. Objectives We sought to assess the asthma-protective effect of unprocessed cow's milk consumption in a birth cohort and to determine whether the differences in the fatty acid (FA) composition of unprocessed farm milk and industrially processed milk contributed to this effect. Methods The Protection Against Allergy—Study in Rural Environments (PASTURE) study followed 1133 children living in rural areas in 5 European countries from birth to age 6 years. In 934 children milk consumption was assessed by using yearly questionnaires, and samples of the “usually” consumed milk and serum samples of the children were collected at age 4 years. Doctor-diagnosed asthma was parent reported at age 6 years. In a nested case-control study of 35 asthmatic and 49 nonasthmatic children, 42 FAs were quantified in milk samples. Results The risk of asthma at 6 years of age was reduced by previous consumption of unprocessed farm milk compared with shop milk (adjusted odds ratio for consumption at 4 years, 0.26; 95% CI, 0.10-0.67). Part of the effect was explained by the higher fat content of farm milk, particularly the higher levels of ω-3 polyunsaturated FAs (adjusted odds ratio, 0.29; 95% CI, 0.11-0.81). Conclusion Continuous farm milk consumption in childhood protects against asthma at school age partially by means of higher intake of ω-3 polyunsaturated FAs, which are precursors of anti-inflammatory mediators. [ABSTRACT FROM AUTHOR]

Despite remaining a controversial diagnosis, piriformis syndrome continues to affect patients' quality of life with pain, sitting discomfort, and exercise intolerance. Open sciatic neurolysis has been noted by the senior author to often only bring temporary relief of the symptoms, with the recurrence presumably due to postoperative scar tissue. Minimally invasive techniques used to decompress the nerve have met with mixed results. This article describes a step-by-step surgical technique designed to maximize patient safety, as well as surgeon orientation, and achieve a thorough neurolysis. Preoperative findings suggestive of piriformis syndrome are described and include retro-trochanteric pain, sciatica-like leg pain, and paresthesias, as well as a positive response to computed tomography–guided injection of dilute ropivacaine hydrochloride and 40 mg of triamcinolone. The operation is performed with the patient in the lateral decubitus position through 2 portals 6 to 8 cm apart, allowing for good triangulation. Dissection is undertaken with a combination of radiofrequency and a laparoscopic peanut, with the assistance of a vascular sling to control the sciatic nerve. Encouraging results have been achieved, and with increasing interest in this procedure, a step-by-step technical description with an accompanying video may prove useful for other experienced hip arthroscopists. Pearls and pitfalls are discussed. [ABSTRACT FROM AUTHOR]

Abstract: The treatment of posterior cruciate ligament injuries remains controversial. There is no consensus on the ideal technique for reconstruction or the optimal graft design. Specifically, there is intense debate about which technique is superior: the open tibial inlay technique or the transtibial arthroscopic technique. We present a novel all-arthroscopic tibial inlay technique using a bifid bone–patellar tendon–bone allograft. This technique offers the advantages of the open tibial inlay technique, including avoidance of the killer turn and restoration of biomechanical stability. Furthermore, this technique is completely arthroscopic and therefore avoids the morbidity of the open tibial inlay technique from the posterior incision and capsulotomy. Our technique also avoids the need for repositioning of the patient intraoperatively. Our technique recreates the double-bundle anatomy of the posterior cruciate ligament and provides bony fixation on both tibial and femoral sides. Our cadaveric studies have shown that our technique restores stability as effectively as the traditional open tibial inlay technique. Early results in our first 11 cases are promising. [Copyright &y& Elsevier]