Background
Adhesive capsulitis is a common cause of stiff shoulder and may result in pain and restriction of movement. The study aimed to investigate the role of hydrodilatation of the glenohumeral ...joint in the management of adhesive capsulitis.
Methods
Patients referred from the shoulder clinic underwent hydrodilatation under ultrasound guidance. Of 209 referred for hydrodilatation, 163 underwent the procedure and attended follow-up physiotherapy. Outcome measures were available for 118 patients (58 men and 60 women). Mean age of the study group was 52.6 years.
Results
There was a statistically significant improvement in both Oxford Shoulder Score (OSS) and Disability Arm Shoulder Hand Scores (Quick DASH) in the first 4 weeks after the procedure, which was maintained but not improved to the end of the study period. Patients presenting with pain, those who had a history of steroid injections and older patients all had worse functional scores at presentation. Diabetes (both Type I and II), previous physiotherapy, length of history and whether pain or stiffness, or both, were the predominant symptom did not have any statistical significance at presentation. These factors were not predictors of any statistically significant improvement in functional scores.
Conclusions
Hydrodilatation results in a significant improvement of symptoms in patients with adhesive capsulitis.
To collect data on current management and outcome of acute severe acromioclavicular joint (ACJ) injuries to inform the knowledge base, design and conduct of future research and explore the patient ...and injury features predicting surgical management. A prospective cohort study was conducted by two trainee collaboratives of acute Grade III to VI ACJ injuries presenting to 12 hospital trusts. 54 Patients were recruited within four weeks of injury regardless of treatment type over a one-year period. Patient reported outcomes and healthcare resource use were collected at six and 12 months post injury. Accounting for Rockwood grade, age, gender and dominant arm injury, the operative group had a statistically lower Oxford Shoulder Score (OSS) at baseline (10.8 vs 25.3, <0.0001) and at six months (37 vs 43.8, p = 0.024) than the non-operative group. There was no statistical difference at 12 months (40 vs 44, p = 0.205). The odds of operative management were inversely correlated with baseline OSS (OR 0.89, p = 0.014). There was no clear preferential method of fixation in the ten patients that received surgery. Future research needs to take into consideration the transitory population of working age, on response to follow up. A future randomised clinical trial (RCT) should be multicentred, pragmatic and stratified for baseline function and injury grade at randomisation.
Patients with hip fracture have complex medical issues, both at the time of admission and after discharge from hospital. We have observed a surge in patient-initiated and carer-initiated contacts ...with general physicians (GPs) for periods longer than those usually reported, in a series of patients sustaining fractures from July 2008 to September 2013.
To establish (1) the frequency of contact with GPs (primary outcome) and (2) the factors influencing the frequency of different modes of contact.
Ten GP practices in West Northumberland were asked to retrospectively identify patients sustaining hip fractures, and to provide data on the number of GP contacts (patient visits to GP, telephone consultations, GP visits to patient's home) up to 1 year before and 1 year after fracture. Generalised linear models (GLM) were constructed using number of postfracture GP contacts as response variable; age, gender, residential status, number of prefracture contacts and days to contact postfracture were covariates.
Each patient recorded cumulative 8.4 GP contacts before and 10.79 contacts after fracture. There were significantly more telephone contacts with GPs and GP home visits, but significantly fewer patient visits to GP clinics. In the GLM analysis, patient age and number of prefracture GP contacts predicted all types of postfracture contacts, while gender was not. Patients discharged home visited their GPs five times more frequently than those discharged to institutional care.
After hip fractures, telephone contacts and GP visits to patients' homes increase, but patient visits to GP clinics decrease, influenced by age and residential status.
Humans are not good at acting on what they already know. As early as 1601, Captain Admiral James Lancaster of the East India Company stumbled on the fact that lemon juice provided an effective ...prevention against scurvy. By the middle of the 18th century, James Lind, a naval physician, was putting that information to the test in the first recorded randomised control trial (RCT).
Lind took 12 men suffering from the symptoms of scurvy and divided them into six pairs, treating each with one of a selection of recommended but untested remedies borrowed from other physicians. These included daily doses of a quart of cider; 25 drops of 'elixir of vitriol'; half a pint of sea-water; a nutmeg-sized paste of garlic, mustard seed, horseradish, balsam of Peru and myrrh gum; two spoonfuls of vinegar; and (rather more effectively) two oranges and one lemon. By the end of the week's treatment, the men who had been fed on citrus fruits were the only ones to show signs of improvement in their symptoms.
In spite of this unequivocal evidence, it still took another half century for the Royal Navy to make a portion of citrus fruits a standard addition to sailors' rations - and, even then, only with the campaigning and support of Lind's advocates. In the Seven Years' War (1756-63), Britain raised 185,899 sailors: 1,512 died in action, while 133,708 died of scurvy. However, the Royal Navy was faster at curing scurvy than its main naval opponents - one reason why it was able to win the Battle of Trafalgar against a larger force of scurvy-ridden French and Spanish ships (Leigh, 2018).
Data and evidence Stephen Aldridge
Using Evidence to End Homelessness,
04/2020
Book Chapter
Odprti dostop
Humans are not good at acting on what they already know. As early as 1601, Captain Admiral James Lancaster of the East India Company stumbled on the fact that lemon juice provided an effective ...prevention against scurvy.¹ By the middle of the 18th century, James Lind, a naval physician, was putting that information to the test in the first recorded randomised control trial (RCT).
Lind took 12 men suffering from the symptoms of scurvy and divided them into six pairs, treating each with one of a selection of recommended but untested remedies borrowed from other physicians. These included daily doses
Three new series of molecular assemblies have been designed and synthesized for the study of photoinduced electron and energy transfer. Chapter I introduces theoretical aspects of photoinduced ...electron transfer involving ruthenium(II) polypyridyl complexes and explains the relationship of these fundamental processes within the framework of attempts to create chemical systems capable of artificial photosynthesis. Chapter 2 describes the synthesis of the amino acid, trans-4-hydroxy-L-proline, and explains its use as a starting material for further substitution with redox active substituents. Once substituted, this amino acid is useful in constructing molecular assemblies based on oligoproline peptides and has the potential for use in a wide range of other peptide-based molecular assemblies. The design, synthesis, and characterization of four new oligoproline molecular assemblies is presented in Chapter 3. These peptides each have a ruthenium(II) polypyridyl complex that functions as a chromophore/electron transfer acceptor and a phenothiazine electron transfer donor. These peptides are of the general form Pro6-Pra(PTZ)-Prox-Pra(Rud 2m)-Pro6, where x = 2–5. Electron transfer in these peptides shows a unique distance dependence. Chapter 4 describes the synthesis of five new chromophore-quencher type molecular assemblies based on energy transfer quenching of a ruthenium(II) polypyridyl complex by covalently bound anthracene. These complexes are of the general form Ru(bpy′) 2(bpy-An)2+ where bpy′ varies in its electronic structure. Synthesis, characterization, and preliminary photophysical data is presented. Chapter 5 describes the synthesis of five chromophore-quencher complexes based on electron transfer quenching of a ruthenium(II) polypyridyl complex by covalently bound methyl viologen. These complexes are also of the general form Ru(bpy′)2(bpy-MV)4+ where bpy′ varies in its electronic structure. The synthesis and characterization of these complexes is presented.
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