Musculoskeletal injury epidemiology in law enforcement and firefighter recruits during physical training: a systematic review.

Objectives: Report the injury epidemiology of law enforcement and firefighter recruits. Design: A systematic epidemiological review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was completed. Data sources: Five online databases were searched from database inception to 5 May 2021. Eligibility criteria for selecting studies: Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by law enforcement or firefighter recruits were included. We reported on all components of injury where data were available. All injury incidence rates were calculated as per 1000 training days (Poisson 95% CI) to allow comparisons between studies. Study quality was assessed using the Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies. Results: No studies reporting firefighter recruits were identified. Eight published studies that reported on injuries to law enforcement recruits were identified. The studies were all low quality, and the credibility of the evidence was assessed as very low. Seven studies reported medical attention injuries, and one study reported the number of medical withdrawals from a recruit training programme. The prevalence of law enforcement recruits with medical attention injuries ranged from 13.7% to 24.5%. The overall medical attention injury incidence rate for law enforcement recruits ranged from 1.67 injuries per 1000 training days (Poisson 95% CI 1.00 to 2.34 injuries per 1000 training days) to 4.24 injuries per 1000 training days (Poisson 95% CI 2.97 to 5.51 injuries per 1000 training days). Conclusion: This review reported the prevalence and incidence rates for musculoskeletal injuries in law enforcement officers. However, the credibility of the evidence is very low. PROSPERO registration number: CRD42021251084.

Coombs-negative haemolytic anaemia in pregnancy: A case report.

We present a rare case of Coombs-negative autoimmune haemolytic anaemia in a multiparous woman in secondary care. There were no known underlying medical or obstetric risk factors for haemolytic anaemia. Following extensive investigation and a therapeutic trial of oral corticosteroids, a diagnosis was made. Autoimmune haemolytic anaemia is potentially fatal, and prompt diagnosis with haematology input is essential to ensure maternal and fetal safety in pregnancy and the puerperium. With only a small number of cases of Coombs-negative autoimmune haemolytic anaemia reported in the literature, we present this rare case for discussion. We highlight the importance of thorough investigation of refractory anaemia in pregnancy and consider the associated challenges.

Use of Neurofeedback to Enhance Response to Hypnotic Analgesia in Individuals With Multiple Sclerosis.

This proof of principle study examined the potential benefits of EEG neurofeedback for increasing responsiveness to self-hypnosis training for chronic pain management. The study comprised 20 individuals with multiple sclerosis (MS) who received 5 sessions of self-hypnosis training--1 face-to-face session and 4 prerecorded sessions. Participants were randomly assigned to have the prerecorded sessions preceded by either (a) EEG biofeedback (neurofeedback) training to increase left anterior theta power (NF-HYP) or (b) a relaxation control condition (RLX-HYP). Eighteen participants completed all treatment sessions and assessments. NF-HYP participants reported greater reductions in pain than RLX-HYP participants. The findings provide support for the potential treatment-enhancing effects of neurofeedback on hypnotic analgesia and also suggest that effective hypnosis treatment can be provided very efficiently.

The Associations Between Pain-related Beliefs, Pain Intensity, and Patient Functioning: Hypnotizability as a Moderator.

OBJECTIVES: On the basis of the idea that thoughts held about pain may represent "self-suggestions" and evidence indicating that people with higher levels of trait hypnotizability are more responsive to suggestions, the current study evaluated hypothesized moderating effects of hypnotizability on the associations between pain-related thoughts and both pain intensity and pain interference. METHODS: Eighty-five individuals with chronic pain were given measures of hypnotizability, pain intensity, pain interference, and pain-related thoughts (control beliefs, catastrophizing). RESULTS: Analyses supported a moderating role of hypnotizability on the association between control beliefs and pain interference. Specifically, the negative association between pain control beliefs and pain interference were stronger among those with higher trait hypnotizability than between those with lower trait hypnotizability. DISCUSSION: The study findings, if replicated in additional samples of individuals with chronic pain, have important clinical and theoretical implications. For example, if trait hypnotizability is found to predict an individual's response to a particular technique of cognitive therapy-such as focusing on and repeating pain control belief self-statements-measures of hypnotizability could be used to identify individuals who might be most responsive to this technique. The current findings indicate that research to further examine this possibility is warranted.

Abstraction of core measure data: creating a process for interrater reliability.

Health care facilities are challenged with an ever-increasing demand for producing accurate quality data to be used for guiding internal improvement initiatives as well as for reimbursement. It is essential that data abstraction be reliable and valid. In this article, we describe an interrater reliability process of data abstraction using the Centers for Medicare and Medicaid Services core measures that successfully reduced variability between abstractors and produced higher quality data.