Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have ...been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.
We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.
4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio RR 1.8, 95% confidence interval CI 0.6-5.2; NRS: RR 0.9, CI 0.3-2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).
The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Pollinating insects provide economically and ecologically valuable services, but are threatened by a variety of anthropogenic changes. The availability and quality of floral resources may be affected ...by anthropogenic land use. For example, flower-visiting insects in agroecosystems rely on weeds on field edges for foraging resources, but these weeds are often exposed to agrochemicals that may compromise the quality of their floral resources.
We conducted complementary field and greenhouse experiments to evaluate the: (1) effect of low concentrations of agrochemical exposure on nectar and pollen quality and (2) relationship between floral resource quality and insect visitation. We applied the same agrochemcial treatments (low concentrations of fertilizer, low concentrations of herbicide, a combination of both, and a control of just water) to seven plant species in the field and greenhouse. We collected data on floral visitation by insects in the field experiment for two field seasons and collected pollen and nectar from focal plants in the greenhouse to avoid interfering with insect visitation in the field.
We found pollen amino acid concentrations were lower in plants exposed to low concentrations of herbicide, and pollen fatty acid concentrations were lower in plants exposed to low concentrations of fertilizer, while nectar amino acids were higher in plants exposed to low concentrations of either fertilizer or herbicide. Exposure to low fertilizer concentrations also increased the quantity of pollen and nectar produced per flower. The responses of plants exposed to the experimental treatments in the greenhouse helped explain insect visitation in the field study. The insect visitation rate correlated with nectar amino acids, pollen amino acids, and pollen fatty acids. An interaction between pollen protein and floral display suggested pollen amino acid concentrations drove insect preference among plant species when floral display sizes were large. We show that floral resource quality is sensitive to agrochemical exposure and that flower-visiting insects are sensitive to variation in floral resource quality.
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•Bee colonies compensate in resource-poor landscapes by varying their foraging behaviour and have clear preferences for species of pollen.•Bees aim for a diverse, ...nutritionally-balanced pollen diet to ensure colony performance.•Diversity is key when considering pollen forage for social bees.•Introduced weeds and even wind-pollinated plants may provide critical nutrients for bees during periods of poor pollen availability.
Bees provide essential ecosystem services such as crop pollination, but perennial colonies of social species require year-round access to floral resources, especially in resource-poor agricultural landscapes. We investigated pollen resources used by a social bee (Tetragonula carbonaria, Meliponini) in forests and orchards of subtropical Australia. Pollen DNA metabarcoding with the markers rbcL and ITS2 was used to identify hive pollens from 57 colonies collected at seven sites each season over two years. We identified 341 botanical sources of hive pollens from 37 orders, 72 families, 218 genera and 302 species. Interestingly, introduced species (e.g. Ageratum spp. and Raphanus spp.) and wind-pollinated plants (Poaceae, Cyperaceae) were common pollen sources in both orchards and forests. Orchard colonies used a subset of pollen species used by colonies in forests, with many Myrtaceae (Corymbia, Eucalyptus and Melaleuca spp.), Poaceae, Asteraceae, Fabaceae and Proteaceae species found in both land uses. We found T. carbonaria foraged on “many small” rather than a “few large” pollen sources each season, regardless of land use. This suggests stingless bees aim for diversity in pollen diets. As such, land managers and beekeepers should ensure colonies have access to a variety of floral resources year-round. This may be achieved through targeted planting of key families identified in this study (e.g. Proteaceae, Asteraceae, Myrtaceae, Poaceae, Brassicaceae, Araliaceae, Cannabaceae, Arecaceae, Rubiaceae and Sapindaceae) and / or maintaining weeds while they are flowering in the orchard. Land managers may consider planting in unproductive areas such as riparian zones, edges or between crop rows if space is limited.
After an acute infection, older persons may benefit from geriatric rehabilitation (GR).
This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether ...frailty is associated with recovery.
Multicentre prospective cohort study.
59 GR facilities in 10 European countries.
Post-COVID-19 patients admitted to GR between October 2020 and October 2021.
Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL.
723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median interquartile range CFS 6.0 5.0-7.0) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients.
Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
The uncemented Symax hip stem is developed through optimization of the uncemented Omnifit hip stem. The Symax stem design combines an anatomical anteverted proximal geometry with a straight distal ...section. The proximal part is coated with a biomimetic hydroxyapatite (HA) coating for improved osseointegration to enhance load transfer and to minimize proximal bone loss. The distal part is treated with an anodization surface treatment in order to prevent distal bone apposition, which is expected to prevent distal loading and reduce proximal stress shielding. Aim of this study is to report mid-term clinical performance and evaluate whether the radiographic features are in line with the design principles of the Symax hip.
The biomimetic hydroxyapatite-coated uncemented Symax hip stem was evaluated in 80 patients during a 5-year prospective clinical international study. Harris Hip Score (HHS), Oxford Hip Score (OHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed preoperatively and postoperatively at 6 months and 1, 2, 3 and 5 years. Anteroposterior radiographs of the pelvis and axial radiographs of the operated hips were evaluated immediately postoperative and at follow-up 6 months and 1, 2, 3, and 5 years. Wilcoxon signed-rank test was used to analyse whether clinical outcome scores changed statistically significant over time. The overall percentage of agreement between two radiology assessment teams was used to evaluate observer agreement of radiology results. The Cohen's Kappa was evaluated as a measure of reliability to quantify the agreement between raters, corrected for chance agreement.
Clinical outcome scores were excellent at 5 years with mean HHS of 98.1, mean OHS of 16.2 and mean WOMAC of 6.9. Only 2.7% of the patients had pain at rest or on weight-bearing, and mid-thigh pain was reported by 1.4% of the patients after 5 years. The percentage of agreement between radiology assessment teams was 94 to 100%, except for distal line formation (48%). Radiographic evaluation showed stable stems and signs of excellent progressive proximal fixation and favourable bone remodeling.
The excellent mid-term clinical and radiographic performances are in line with the design principles and coating properties of this new implant and earlier published results.
http://ClinicalTrials.gov , NCT03469687 . Registered 19 March 2018 - Retrospectively registered.
Sub-Saharan African countries now face the double burden of Non Communicable and Communicable Diseases. This situation represents a major threat to fragile health systems and emphasises the need for ...innovative integrative approaches to health care delivery. Health services need to be reorganised to address populations' needs holistically and effectively leverage resources in already resource-limited settings. Access and delivery of quality health care should be reinforced and implemented at primary health care level within the framework of health system strengthening. Competencies need to be developed around services provided rather than specific diseases. New models of integration within the health sector and other sectors should be explored and further evidence generated to inform policy and practice to combat the double burden.
Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural ...analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect of giving postoperative LINFA after THA in patients already having LIA during surgery.
Patients and methods 60 consecutive patients undergoing non-cemented THA were randomized into two groups in a double-blind and controlled study. During surgery, all patients received standardized pain treatment with LIA. Postoperatively, they were treated either with a solution of Ropivacain, Ketorolac, and Adrenaline (LINFA group) or placebo (placebo group) administered through a catheter to the hip 10 and 22 h after surgery. Pain score, opioid consumption, and length of stay (LOS) were evaluated.
Results After adjustment for multiple testing, there was no statistically significant postoperative difference between the LINFA group and the placebo group regarding pain and tiredness. We found some evidence of a short-term effect on nausea and vomiting. Opioid consumption and length of stay were similar in the two groups.
Interpretation We found some evidence of a short-term effect of LINFA on nausea and vomiting, but no evidence of an effect on postoperative pain and tiredness. Thus, LINFA cannot be recommended as a standard pain treatment in patients with THA.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Genetic loss of the voltage-gated sodium channel Na
1.7 (Na
1.7
) results in lifelong insensitivity to pain in mice and humans. One underlying cause is an increase in the production of endogenous ...opioids in sensory neurons. We analyzed whether Na
1.7 deficiency altered nociceptive heterotrimeric guanine nucleotide-binding protein-coupled receptor (GPCR) signaling, such as initiated by GPCRs that respond to serotonin (pronociceptive) or opioids (antinociceptive), in sensory neurons. We found that the nociceptive neurons of Na
1.7 knockout (Na
1.7
) mice, but not those of Na
1.8 knockout (Na
1.8
) mice, exhibited decreased pronociceptive serotonergic signaling through the 5-HT
receptors, which are Gα
-coupled GPCRs that stimulate the production of cyclic adenosine monophosphate resulting in protein kinase A (PKA) activity, as well as reduced abundance of the RIIβ regulatory subunit of PKA. Simultaneously, the efficacy of antinociceptive opioid signaling mediated by the Gα
-coupled mu opioid receptors was increased. Consequently, opioids inhibited more efficiently tetrodotoxin-resistant sodium currents, which are important for pain-initiating neuronal activity in nociceptive neurons. Thus, Na
1.7 controls the efficacy and balance of GPCR-mediated pro- and antinociceptive intracellular signaling, such that without Na
1.7, the balance is shifted toward antinociception, resulting in lifelong endogenous analgesia.
Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural ...analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect of giving postoperative LINFA after THA in patients already having LIA during surgery.
Patients and methods 60 consecutive patients undergoing non-cemented THA were randomized into two groups in a double-blind and controlled study. During surgery, all patients received standardized pain treatment with LIA. Postoperatively, they were treated either with a solution of Ropivacain, Ketorolac, and Adrenaline (LINFA group) or placebo (placebo group) administered through a catheter to the hip 10 and 22 h after surgery. Pain score, opioid consumption, and length of stay (LOS) were evaluated.
Results After adjustment for multiple testing, there was no statistically significant postoperative difference between the LINFA group and the placebo group regarding pain and tiredness. We found some evidence of a short-term effect on nausea and vomiting. Opioid consumption and length of stay were similar in the two groups.
Interpretation We found some evidence of a short-term effect of LINFA on nausea and vomiting, but no evidence of an effect on postoperative pain and tiredness. Thus, LINFA cannot be recommended as a standard pain treatment in patients with THA.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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