Systematic review of treatment for pyogenic flexor tenosynovitis of the hand.

AIMS: Pyogenic flexor tenosynovitis (PFT) comprises 2.5-9.4% of all primary hand infections. Management is variable, including surgical intervention, systemic antibiotics, or both. However, there are no evidence-based treatment guidelines. We conducted a systematic review to determine the best evidence for existing interventions and a meta-analysis to summarise published data quantitatively. METHODS: MEDLINE and Embase (OVID) databases were searched in January 2023 and March 2024. Screening and data extraction were performed in duplicate. The risk of bias was assessed using National Institute of Health study assessment tools. A protocol is available on PROSPERO (CRD42023411142), and the review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data analysis was performed in RStudio. RESULTS: 24 studies (n = 1108 patients) were included following screening of 2386 abstracts. All were retrospective (18 case series and six cohort studies). Surgical interventions were assessed in 22 studies, combined with specific antibiotic regimes in four studies. Two studies described non-operative management alone. The pooled mean hospital stay for those undergoing operative intervention was 8.3 days (SD 7.5, n = 552), compared to 4.76 days (SD 0.12, n = 58) for non-operative intervention. Two studies reported PROMs (DASH), reporting no difference when comparing operative and non-operative interventions. Most studies were of poor quality (20), with four being fair. CONCLUSIONS: There is insufficient evidence in favour of one intervention regarding hospital stay or PROMs, including the superiority of operative management or non-operative approaches. Given the prevalence of PFT, management should be guided by robust data. Future experimental studies of surgical techniques and comparisons with non-operative management are warranted.

What kind of a problem is loneliness? Representations of connectedness and participation from a study of telepresence technologies in the UK.

Loneliness is represented in UK policy as a public health problem with consequences in terms of individual suffering, population burden and service use. However, loneliness is historically and culturally produced; manifestations of loneliness and social isolation also require social and cultural analysis. We explored meanings of loneliness and social isolation in the UK 2020-2022 and considered what the solutions of telepresence technologies reveal about the problems they are used to address. Through qualitative methods we traced the introduction and use of two telepresence technologies and representations of these, and other technologies, in policy and UK media. Our dataset comprises interviews, fieldnotes, policy documents, grey literature and newspaper articles. We found loneliness was represented as a problem of individual human connection and of collective participation in social life, with technology understood as having the potential to enhance and inhibit connections and participation. Technologically-mediated connections were frequently perceived as inferior to in-person contact, particularly in light of the enforced social isolation of the COVID-19 pandemic. We argue that addressing loneliness requires attending to other, related, health and social problems and introducing technological solutions requires integration into the complex social and organisational dynamics that shape technology adoption. We conclude that loneliness is primarily understood as a painful lack of co-presence, no longer regarded as simply a subjective experience, but as a social and policy problem demanding resolution.