•Tips and tricks for fabrication of the relative motion (RM) orthoses•Fabrication simplification•Ideas for immediate clinical use
Relative Motion (RM) orthoses are an extremely important and ...beneficial intervention in hand rehabilitation. They can be used for a variety of hand conditions including for positioning, protection, alignment and exercise. In order to achieve the intended goals of this orthotic intervention, the clinician must pay attention to detail during its fabrication. The purpose of this manuscript is to offer some simple and practical fabrication tips for hand therapists who want to include the use of RM orthoses to manage these different clinical conditions. Photos are provided to reinforce some of the key concepts.
●A systematic review was performed on studies utilizing 3D printed orthoses for musculoskeletal conditions of the elbow, wrist, hand and digits in clinical settings.●The 10 studies included in this ...systematic review report on actual patient use of 3D printed orthoses.●The 3D printing process of orthoses for the upper extremity remains complex and under-utilized.●There is a need for more clinical trials to study the benefits of 3D printed orthoses compared with custom made low temperature thermoplastic orthoses for patients in the hand therapy setting.
Systematic Review
3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists.
The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity.
Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis.
Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice.
3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required.
While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.
The COVID-19 pandemic caused disruption to continuing educational opportunities for hand therapists. In response, some courses were offered via online platforms, including virtual orthotic ...fabrication courses. It is important to determine the effectiveness and benefits of these courses for educating certified hand therapists and examine if remote learning of orthotic fabrication skills has continued merit and relevance.
To investigate the value and effectiveness of orthotic fabrication courses taught in a virtual format.
Cross-sectional, mixed methods survey study.
A 31-item survey consisting of Likert-type, direct response, and open-ended questions about experiences and opinions of virtual orthotics courses was electronically delivered to certified hand therapists. Data analysis included descriptive and correlational statistics to highlight frequencies, ranges, and relationships between the participant demographics and opinions/experiences. Thematic analysis guided the coding of the qualitative data.
A total of 459 responded, with a response rate of 9.7%. Most respondents had not participated in online courses on orthotic fabrication. Those that did reported high satisfaction but noted that clinical experience and knowledge from previous courses influenced this experience. Most participants felt that novice clinicians and students would not gain enough skills and confidence from online courses. However, participants with all levels of experience found the courses to be of value.
Results suggest that while online learning of this skill set is valuable and effective, it is most beneficial for experienced clinicians. Disadvantages included the lack of instructor feedback necessary for hands-on skill development and the lack of peer interaction. Advantages included convenience of time, cost, accessibility, and the ability to revisit the topic as needed. Online learning of orthotic fabrication skills is a sustainable option for clinicians seeking to advance their skills. Nevertheless, it is not a substitute for initial training for novice hand therapists due to the lack of feedback and skill development.
•Orthotic fabrication skills can be taught in a virtual format.•Advantages include time, cost, and the ability to access course material on demand.•Disadvantages include limited instructor feedback, peer interaction, and material access.
Background
Although increasing evidence has suggested that an efficacy‐effectiveness gap exists between clinical trial (CT) and real‐world evidence (RWE), to the authors' knowledge, the magnitude of ...this difference remains undercharacterized. The objective of the current study was to quantify the magnitude of survival and toxicity differences between CT and RWE for contemporary cancer systemic therapies.
Methods
Patients receiving cancer therapies funded under Cancer Care Ontario's New Drug Funding Program (NDFP) were identified. Landmark CTs with data regarding survival and adverse events (AEs) for each drug indication were identified. RWE for survival and hospitalization rates during treatment were ascertained through Canadian population‐based databases. The efficacy‐effectiveness gap for each drug indication was calculated as the difference between RWE and CT data for median overall survival (OS), 1‐year OS, and generated hazard ratios (HRs) with 95% CIs from Kaplan‐Meier OS curves. Toxicity differences were calculated as the difference between RWE of hospitalization rates and CT serious AE rates.
Results
Twenty‐nine indications from 20 systemic therapies were included. Twenty‐eight of 29 indications (97%) demonstrated worse survival in RWE, with a median OS difference of 5.2 months (interquartile range, 3.0‐12.1 months). Lower effectiveness in RWE also was demonstrated through a meta‐analysis of an OS hazard ratio of 1.58 (95% CI, 1.39‐1.80). The median difference between RWE for hospitalization rates and CT serious AEs was 14% (95% CI, 9%‐22%).
Conclusions
An efficacy‐effectiveness gap exists for contemporary cancer systemic therapies, with a 5.2‐month lower median OS observed in RWE compared with CT data. These data supports the use of RWE to better inform real‐world decision making regarding the use of cancer systemic therapies.
Through a review of clinical trial and real‐world evidence for contemporary cancer systemic therapies, an efficacy‐effectiveness gap has been demonstrated. Thus, supportive evidence is provided in the current study for the further investigation of real‐world outcomes of patients to inform real‐world decision making.
•Exercise relative motion orthoses are frequently used by clinicians.•The relative motion (RM) pencil test is used prior to fabricating an exercise RM orthosis.•Measurement of the metacarpophalangeal ...differential is described.•Various clinical conditions are linked with the best suited exercise relative motion orthosis.•An algorithm is provided for decisions related to evaluation, exercise and RM orthosis design.
Early adversity is an important risk factor that relates to internalizing symptoms and altered brain structure.
To assess the direct effects of early adversity and child internalizing symptoms (ie, ...depression, anxiety) on cortical gray matter (GM) volume, as well as the extent to which early adversity associates with variation in cortical GM volume indirectly via increased levels of internalizing symptoms.
A prospective investigation of associations between adversity within the first 6 years of life, internalizing symptoms during childhood and early adolescence, and altered brain structure in late adolescence (age, 18-21 years) was conducted in a community-based birth cohort in England (Avon Longitudinal Study of Parents and Children). Participants from the cohort included 494 mother-son pairs monitored since the mothers were pregnant (estimated date of delivery between April 1, 1991, and December 31, 1992). Data collection for the present study was conducted between April 1, 1991, and November 30, 2010; the neuroimaging data were collected between September 1, 2010, and November 30, 2012, and data analyses for the present study occurred between January 25, 2013, and February 15, 2015. Risk factors were adversity within the first 6 years of the child's life (including prenatal exposure) and the child's internalizing symptoms between age 7 and 13 years.
Early childhood adversity.
The main outcome was GM volume of cortical regions previously associated with major depression measured through T1-weighted magnetic resonance images collected in late adolescence.
Among 494 young men included in this analysis, early adversity was directly associated with lower GM volumes in the anterior cingulate cortex (β = -.18; P = .01) and higher GM volume in the precuneus (β = .18; P = .009). Childhood internalizing symptoms were associated with lower GM volume in the right superior frontal gyrus (β = -.20; P = .002). Early adversity was also associated with higher levels of internalizing symptoms (β = .37; P < .001), which, in turn, were associated with lower superior frontal gyrus volume (ie, an indirect effect) (β = -.08; 95% CI, -0.14 to -0.01; P = .02).
Adversity early in life was associated with higher levels of internalizing symptoms as well as with altered brain structure. Early adversity was related to variation in brain structure both directly and via increased levels of internalizing symptoms. These findings may suggest that some of the structural variation often attributed to depression might be associated with early adversity in addition to the effect of depression.
Oophorectomy prior to menopause is associated with late-life dementia. Memory decline may start within 6 months after oophorectomy in middle-aged women, suggested by lower verbal and working memory ...performance. Unknown is whether such changes persist beyond 6 months, and whether they are reversed by estradiol. Short-term benefits of estradiol on verbal memory following oophorectomy were observed in one study, but longer term effects remain unknown. In the present study, middle-aged BRCA1/2 mutation carriers with early oophorectomy at least 1 year prior to study onset were tested on verbal and working memory with results stratified by (1) current estradiol use (n = 22) or (2) no history of estradiol use (n = 24), and compared to age-matched premenopausal controls (n = 25). Both memory abilities were adversely affected by oophorectomy, but only working memory was maintained by estradiol. Estrogen metabolite levels correlated with working memory, suggesting a role for estradiol in preserving this ability. Memory decline appears to persist after early oophorectomy, particularly for women who do not take estradiol.
•Examined effects of bilateral salpingo-oophorectomy on memory in women with BRCA1/2.•Bilateral salpingo-oophorectomy reduced verbal and working memory.•Estradiol therapy had no effect on verbal memory following salpingo-oophorectomy.•Estradiol therapy maintained working memory following salpingo-oophorectomy.•Estradiol levels correlated with working memory performance.
Distinct differences in the human voice emerge during adolescence, with males producing deeper and more resonant voices than females by the end of sexual maturation. Using magnetic resonance images ...of heads and voice recordings obtained in 532 typically developing adolescents, we investigate what might be the drivers of this change in voice, and the subjective judgment of the voice “maleness” and “femaleness”.
We show clear sex differences in the morphology of voice-related structures during adolescence, with males displaying strong associations between age (and puberty) and both vocal-fold and vocal-tract length; this was not the case in female adolescents. At the same time, males (compared with females) display stronger associations between age (and puberty) with both fundamental frequency and formant position. In males, vocal morphology was a mediator in the relationship between bioavailable testosterone and acoustic indices.
Subjective judgment of the voice sex could be predicted by the morphological and acoustic parameters in males only: the length of vocal folds and its acoustic counterpart, fundamental frequency, is a larger predictor of subjective “maleness” of a voice than vocal-tract length and formant position.
•We used magnetic resonance imaging to measure length of vocal cords and vocal tract.•These measures and voice acoustics were obtained in 532 adolescents.•We describe sex and age effects for both sets of measurements.•Length of vocal folds mediates testosterone influence on fundamental frequency.•Fundamental frequency mediates testosterone influence on voice “maleness”.
The practice of surgical critical care (SCC) has traditionally necessitated additional in-house, extended night and weekend clinical commitments, which can be viewed as less desirable for many ...surgeons. Therefore, the authors have observed that some SCC surgeons elect to transition their practice to focus solely on general surgery (GS) rather than continuing practicing both SCC and GS. We hypothesized that surgeons with a practice focused on SCC are more likely to make the transition to a GS practice than those who have certification in other subspecialties that are certified through the American Board of Surgery.
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