App-Based Rehabilitation in Back Pain, a Systematic Review.

Smartphones and their associated applications are used frequently by patients and clinicians alike. Despite the technology being widely accessible, their use to aid in rehabilitation is yet to be adopted. The SARS CoV-2 pandemic has presented an opportunity to expedite their integration given the difficulty patients currently have in accessing healthcare. The aim of this study was to perform a systematic literature review on the use of smartphone rehabilitation applications compared to standard physiotherapy for back pain. We conducted a search of Medline/Pubmed and google databases using the search terms [APP] AND [[Orthopaedic] OR [Neurosurgery]], following the PRISMA guidelines. All prospective studies investigating rehabilitation applications for back pain or following spine surgery were included. A total of nine studies met the inclusion criteria which investigated 7636 patients, of which 92.4% were allocated to the interventional group (n = 7055/7636) with a follow up of 4 weeks to 6 months. All except one study reported on patients experiencing back pain on average for 19.6 ± 11.6 months. The VAS-pain score was presented in all studies without significance between the interventional and control group (p = 0.399 before and p = 0.277 after intervention). Only one research group found significantly higher improvement in PROMs for the application group, whereas the remaining showed similar results compared to the control group. Using application-based rehabilitation programs provides an easily accessible alternative or substitute to traditional physiotherapy for patients with back pain. Given that smartphones are so prevalent in activities in our daily lives, this will enhance and improve rehabilitation if patients are self-dedicated and compliant.

Review article: Utility of troponin after syncope: A systematic review and meta-analysis.

The role of serum troponin testing in patients presenting to the ED after syncope is unclear. The aim of this systematic review was to examine the practice and utility of troponin testing among patients presenting to the ED after syncope. We conducted a search of MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases from 1990 to February 2017 using keyword and subject headings for syncope and troponin testing. Design and results of the included studies are extracted. Studies were assessed for heterogeneity and the pooled proportion of measured troponin and positive troponin result described. There were nine studies included for analysis. Significant statistical heterogeneity among studies was observed (P < 0.001). Using the random effects model, the pooled proportion of patients presenting to the ED after syncope who had troponin measured was 0.64 (95% CI 0.46-0.82). Among patients who had been troponin tested, the pooled proportion who had a positive result was 0.19 (95% CI 0.13-0.26). Variability among reported outcomes prevented further meta-analysis. Troponin testing was commonly performed for the assessment of patients with syncope with a substantial proportion returning positive results. The correlation between raised troponin and patient outcomes was not adequately reported. It is possible that an elevated troponin may indicate serious illness, rather than myocardial damage alone.

Catalytic CO2 Reduction with Boron- and Aluminum Hydrides.

The previously reported dimeric NHI aluminum dihydrides 1 a,b, as well as the bis(NHI) aluminum dihydride salt 9 +[OTs]-, the bis(NHI) boron dihydride salt 10 +[OTs]-, and the "free" bis(NHI) ligand 12 were investigated with regard to their activity as a homogenous (pre)catalyst in the hydroboration (i. e. catalytic reduction) of carbon dioxide (CO2) in chloroform under mild conditions (i. e. room temperature, 1 atm; NHI=N-heterocyclic imine, Ts=tosyl). Borane dimethylsulfide complex and catecholborane were used as a hydride source. Surprisingly, the less sterically hindered 1 a exhibited lower catalytic activity than the bulkier 1 b. A similarly unexpected discrepancy was found with the lower catalytic activity of 10 + in comparison to the one of the bis(NHI) 12. The latter is incorporated as the ligand to the boron center in 10 +. To elucidate possible mechanisms for CO2 reduction the compounds were subjected to stoichiometric reactivity studies with the borane or CO2. Aluminum carboxylates 4, 6, and 7 + with two, four, and one formate group per two aluminum centers were isolated. Also, the boron formate salt 11 +[OTs]- was characterized. Selected metal formates were subjected to stoichiometric reactions with boranes and/or tested as a catalyst. We conclude that each type of catalyst (1 a,b, 9 +, 10 +, 12) follows an individual mechanistic pathway for CO2 reduction.

Acceptability of opt-out consent in a hospital patient population.

Research has been slow to leverage digitalised medical records as a data resource. Our study assessed patient acceptability of opt-out consent for secondary use of digital patient data. A questionnaire was distributed to patients in multiple languages and with an interpreter. Of 919 completed surveys, 33% were of non-English speaking background, 15% self-reported cognitive impairment and 3% were refugees. Opt-out consent was accepted in this diverse population; 87% of participants approved, or were indifferent to opt-out consent. Gender, employment and cognition status were not significant determinants of acceptability.

Breaking good: breaking ties with social groups may be good for recovery from substance misuse.

According to the Social Identity Model of Identity Change, maintaining social identities and support over time is good for health and well-being, particularly during stressful transitions. However, in this study we explore the circumstances under which maintaining social identities - such as 'substance user' - may be harmful to health, and when a successful transition constitutes identity change, rather than maintenance. This prospective study examined social identities of 132 adults entering a drug and alcohol therapeutic community (TC) at admission, three fortnightly intervals and exit, as well as a representative subsample of 60 participants at follow-up. Repeated measures ANOVA results showed that user identity decreased significantly over time, such that 76% of the sample decreased in user identity strength over the first month in the TC. At the same time, recovery identity ratings increased significantly over time, with 64% of the sample staying the same or increasing their recovery identity ratings over the first month. Identity change, indexed by the change in the difference score between user identity and recovery identity over the treatment period, accounted for 34% of the variance in drinking quantity, 41% of the variance in drinking frequency, 5% of the variance in other drug use frequency, and 49% of the variance in life satisfaction at follow-up, after accounting for initial substance abuse severity and social identity ratings at entry to the TC. The findings indicate that moving from a substance using identity towards a recovery identity constitutes an important step in substance abuse treatment.