Exploring the infectious contribution to intussusception causality using the effects of COVID-19 lockdowns in Australia: An ecological study.

INTRODUCTION: Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases under 2 years of age are classed as idiopathic with viral infection implicated as one of the causes. COVID-19 public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were reported - reductions greater than would be expected with our previous understanding of its infectious aetiology. METHODS: We conducted a retrospective, multi-state, ecological study over a twelve-year period. Monthly case numbers of ICD-10-AM K56.1 'Intussusception' coded admissions were acquired from state-wide admissions datasets from New South Wales (NSW), Victoria and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared to non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods. RESULTS: We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the under 2 year age groups with Victoria experiencing a 62.7% reduction (Rate ratio (RR) = 0.37, p < 0.0001) and NSW a 40.1% reduction (RR = 0.599, p = 0.006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases. CONCLUSION: Our ecological study demonstrates significant decreases in the frequency of paediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated.

Fertility-Related Conversations in the Context of COVID-19 and Vaccinations.

We used text analysis to examine trends and self-reporting in Twitter regarding COVID-19 disease and COVID-19 vaccines' effects on fertility. Trends and self-reporting related to COVID19 vaccines indicates that further research is needed to enable women to feel they have sufficient information to make decisions regarding vaccination, together with social listening and engagement with women's concerns regarding vaccination effects.

Interdisciplinary Learning Health System Response to Public Vaccine Concerns.

In Victoria, Australia, jurisdictional vaccine safety service is conducted by SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community). SAEFVIC developed a public Vaccine Safety Report (saefvic.online/vaccinesafety) to present key surveillance information. This study applies an interdisciplinary learning health system approach to evaluate the report, taking into consideration public expressions of concern on social media.

WALANT Technique versus Local Anesthesia with a Tourniquet in Carpal Tunnel Syndrome.

Objectives: Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding and improve visualization. However, it may be associated with discomfort and intolerance when sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries have become very popular and enable the patient to be involved in the procedure; in addition, the adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and WALANT technique. The objective of this paper is to report the results of CTD, comparing those performed with local anesthesia and those performed with the WALANT. Methods: In this prospective study, 60 CTS were operated in two different institutions. Patients in group 1 (30 patients) were operated under LA-T, while patients in group 2 (30patients) were operated on using lidocaine with epinephrine (WALANT). Statistical analysis was performed. Results: Postoperative pain immediately after surgery, at 4 and 24 hours, and 15, and 30 days after surgery; and degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was slightly shorter in the LA-T group, but the difference was not significant. Conclusion: In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the intraoperative comfort of the patient.

Vaccine safety in Australia during the COVID-19 pandemic: Lessons learned on the frontline.

Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Victoria's vaccine safety service for reporting adverse events following immunisation (AEFI), has provided integrated spontaneous surveillance and clinical services for individuals affected by AEFI since 2007. We describe SAEFVIC's response to the COVID-19 vaccine program, and reflect on lessons learned for vaccine safety. The massive scale of the Australian COVID-19 vaccine program required rapid adaptations across all aspects of SAEFVIC's vaccine safety services. Collection of AEFI reports was streamlined and expanded, incorporating both spontaneous and active surveillance data. Dramatically increased report volumes were managed with additional staffing, and innovations to automate, filter, and triage reports for priority follow up. There were two major adverse events of special interest (AESI): thrombosis with thrombocytopaenia syndrome and myocarditis, with multiple other AESI also investigated. Rapid escalation mechanisms to respond to AESI were established, along with AESI-specific databases for enhanced monitoring. Vaccine education and training resources were developed and public-facing vaccine safety reports updated weekly. Frequent communication with local and national government and regulatory bodies, and consultation with specialist groups was essential. The COVID-19 vaccine program has highlighted the importance of vaccine safety in supporting public confidence in vaccines and informing evidence-based immunisation policy. Supporting the COVID-19 vaccine program has required flexibility in adapting to policy changes and evolving vaccine safety signals, careful triage and prioritisation, informatics innovation, and enhanced engagement with the public regarding vaccine safety. Long-term investment to continue strengthening vaccine safety systems, building on lessons learned, will be essential for the ongoing success of Australian vaccination programs.

Total Elbow Arthroplasty in the Context of an Olecranon Nonunion: A Surgical Technique and Report of Three Cases.

The deficiency of the triceps tendon has been considered a relative contraindication to performing a total elbow arthroplasty. One of the conditions that may compromise triceps integrity is the presence of an olecranon non-union (ON). In this scenario, the placement of a total elbow arthroplasty in a patient with end-stage elbow arthritis is a complex problem to be solved. The aim of this study is to describe the surgical technique for the placement of a TEA in the context of a previous ON and to report the results of three cases. Surgical technique: the focus of the nonunion is identified, and the olecranon fragment is proximally reflected with the triceps tendon to allow accurate exposure of the medullary canal of the ulna and easy access to the joint. With the elbow in a fully flexed position, the previously assembled test prosthesis is placed and the proximal ulna fragment should then be reduced to match the distal ulna. Osteosynthesis with a tension band technique was performed at 45° of elbow extension. A non-absorbable Krackow suture (Ti-Cron 2-0) from the triceps's tendon to the hole of the wire in the distal ulna is applied to decrease the triceps tension traction. Bone grafting is performed when a persistent gap is present at the fracture site following reduction. This technique enables us to achieve a stable elbow with little pain and maintains the extensor apparatus's continuity.

Description of unusual osteochondral laminar fragment patterns in Distal Radius fractures.

BACKGROUND: Distal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. PATIENTS AND METHODS: We reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. RESULTS: Two main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: Significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI 1.4 to 2.9). DISCUSSION: Global prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. LEVEL OF EVIDENCE: IV (Observational/Descriptive); Cross sectional study.

Artificial Intelligence Education for the Health Workforce: Expert Survey of Approaches and Needs.

BACKGROUND: The preparation of the current and future health workforce for the possibility of using artificial intelligence (AI) in health care is a growing concern as AI applications emerge in various care settings and specializations. At present, there is no obvious consensus among educators about what needs to be learned or how this learning may be supported or assessed. OBJECTIVE: Our study aims to explore health care education experts' ideas and plans for preparing the health workforce to work with AI and identify critical gaps in curriculum and educational resources across a national health care system. METHODS: A survey canvassed expert views on AI education for the health workforce in terms of educational strategies, subject matter priorities, meaningful learning activities, desired attitudes, and skills. A total of 39 senior people from different health workforce subgroups across Australia provided ratings and free-text responses in late 2020. RESULTS: The responses highlighted the importance of education on ethical implications, suitability of large data sets for use in AI clinical applications, principles of machine learning, and specific diagnosis and treatment applications of AI as well as alterations to cognitive load during clinical work and the interaction between humans and machines in clinical settings. Respondents also outlined barriers to implementation, such as lack of governance structures and processes, resource constraints, and cultural adjustment. CONCLUSIONS: Further work around the world of the kind reported in this survey can assist educators and education authorities who are responsible for preparing the health workforce to minimize the risks and realize the benefits of implementing AI in health care.

Time until union in absolute vs. relative stability MIPO plating in simple humeral shaft fractures.

PURPOSE: The objective of this study is to evaluate the effect of absolute stability (AS) versus relative stability (RS) performed through a minimally invasive plate osteosynthesis (MIPO) in AO/OTA 12A1 and 12A2 fractures on healing and the time to radiographic union. METHODS: This was a retrospective cohort study of all patients treated with plate fixation for AO/OTA type 12A1-A2 fractures at a single institution. Patients were grouped according to the type of stability used in their surgery. Time until radiographic union was estimated using the Kaplan-Meier method, which was compared by long-rank test between both types of surgical techniques. RESULTS: A total of 70 patients were included in this study with 35 patients in each group. The median follow-up was 9 (IQR 6-14) months. The median time to radiographic union was significantly lower in the AS group than in the RS group: 12 (interquartile range (IQR) 10-14) weeks versus 18 (IQR 16-19) weeks, respectively (p < 0.001). Non-union was seen in two cases (7%) in the relative stability group. Three patients in the RS group developed a post-operative radial nerve palsy. CONCLUSION: The main finding of this study is that the median time to radiographic union was significantly shorter in the patients treated with AS compared to those with a RS technique. These findings support the recommendations of the AO foundation in that simple metaphyseal fractures (type A) that require surgical treatment should be treated with an AS construct. RS techniques should be reserved to multifragmentary fractures where fragment preservation of blood supply is paramount.

Osteosíntesis en fracturas femorales periprotésicas de cadera Vancouver tipos B1 y C. Análisis multicéntrico / Osteosynthesis in Vancouver type B1 and C periprosthetic hip fractures of the femur. A multicenter analysis

Introducción: Nuestro objetivo fue analizar los resultados del tratamiento con osteosíntesis en pacientes con fracturas Vancouver tipos B1 y C, evaluar las complicaciones, las reintervenciones y la tasa de mortalidad en este grupo. Materiales y métodos: Estudio multicéntrico, retrospectivo. Se estableció una base de datos que incluía a 53 pacientes con fracturas periprotésicas de fémur Vancouver tipos B1 y C tratadas con osteosíntesis, desde 2008 hasta 2021, en dos centros hospitalarios de alta complejidad. Resultados: La fijación proximal más utilizada fue con tornillos bicorticales más lazadas de alambre. El tipo de fractura según la clasificación de Vancouver se correlacionó con un valor significativo en el uso de tornillos de compresión interfragmentaria (p 0,001), con un total de 13 pacientes (24,52%), 9 en fracturas Vancouver tipo C. El tiempo de consolidación promedio fue de 4 meses, con un puntaje promedio del Harris Hip Score de 68. Doce pacientes (22,64%) tuvieron complicaciones: retraso de la consolidación (7 casos; 13,2%), falla de la osteosíntesis con trazo de fractura a nivel distal del tallo (un caso; 1,88%), una nueva osteosíntesis por falla a nivel del material de osteosíntesis (un caso; 1,88%) y tres fallecieron (5,66%). Conclusiones: El manejo de las fracturas femorales periprotésicas es un tema complejo y desafiante. El tratamiento con osteosíntesis constituye un método exitoso que requiere de la aplicación de principios actuales de técnicas mínimamente invasivas que, junto con una fijación proxi-mal estable, mejoran las posibilidades de éxito. Nivel de Evidencia: IV

Introduction: Our objective was to analyze the results of osteosynthesis treatment in patients with Vancouver type B1 and C fractures, evaluate complications, reinterventions and the mortality rate in this group. Materials and methods: Multicenter, retrospective study. A database was established that included 53 patients with Vancouver type B1 and C periprosthetic femoral fractures treated with osteosynthesis, from 2008 to 2021, who were evaluated in two high-complexity hospital centers. Results: The most used proximal fixation was bicortical screws and wire loops. The type of fracture according to the Vancouver classification correlated with a significant value in the use of interfragmentary compression screws (p 0.001), with a total of 13 patients (24.52%), 9 in Vancouver type C fractures. Mean consolidation was 4 months, with a mean Harris Hip Score of 68. Twelve patients (22.64%) had complications: delayed union (7 cases; 13.2%), failed osteosynthesis with fracture at the distal level of the stem (one case; 1.88%), one new osteosynthesis due to failure at the level of the osteosynthesis material (one case; 1.88%) and three patients died (5.66%). Conclusions: The management of periprosthetic femoral fractures is a complex and challenging issue. Osteosynthesis treatment is a successful method that requires the application of current principles of minimally invasive techniques that, together with stable proximal fixation, improve the chances of success. Level of Evidence: IV

Trapeziometacarpal osteoarthritis: Arthroscopic hemitrapeziectomy using the Thenar Portal.

BACKGROUND: Although the standard 1Radial and 1Ulnar portals allow for visualisation of most of the trapezium articular surface, the proximity of these two portals can often make arthroscopic triangulation and visualisation of the most lateral capsule and joint surface challenging. Despite its already reported advantages in improving visualisation, there is little literature reporting the clinical experience with the Thenar Portal. The purpose of this study is to describe potential complications and the short-term clinical-radiographic outcomes of arthroscopic hemitrapeziectomy using the Thenar Portal in order to determine its safety and efficacy as a standard working portal. PATIENTS AND METHODS: A retrospective chart review was conducted for all patients diagnosed with first carpometacarpal (CMC) osteoarthritis who were treated surgically with an arthroscopic hemitrapeziectomy. Only patients with stage II or III osteoarthritis and a minimum of 1-year follow-up were included. Twenty-two patients (24 thumbs) with an average age of 62 years met the inclusion criteria. The average follow-up was 52 months. Intra-operative and post-surgical complications were recorded. Objective evaluation consisted of an assessment of range of motion (ROM), grip and pinch strength. Subjective evaluation consisted of a DASH questionnaire and the visual analog scale to score pain at rest, during activities, and function. RESULTS: There were no intra- or post-surgical complications. In one case, pain persisted with a poor functional result, requiring a revision surgery. Average range of motion (compared with the contralateral) showed a statistically significant improvement in palmar abduction and radial abduction of the CMC joint: 50° vs. 55° (p=0.01235), and 50° vs. 55° (p=0.06009), respectively. There was no statistically significant improvement in thumb adduction, grip strength, or lateral and tip-pinch. All patients achieved retropulsion with their affected thumb. According to the VAS, average rest pain improved from 7.5 to 0 (p<0.001) and from 9 to 0 (p<0.001) during activity. The average final function and QuickDASH were 9 (VAS) and 8, respectively (p<0.001). The average radiographic proximal migration of the first metacarpal was 2.9mm (range: 0.7-5.8mm). DISCUSSION: Arthroscopic hemitrapeziectomy using the Thenar portal: 1) improved visualisation of the trapeziometacarpal joint, 2) facilitated arthroscopic triangulation, and 3) represents a safe and effective alternative for the treatment of thumb osteoarthritis, with pain relief and function improvement in most patients without a higher risk of complications. LEVEL OF EVIDENCE: IV.

'We are very individual': anticipated effects on stroke survivors of using their person-generated health data.

BACKGROUND: Person-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may experience changes in their health and care process, such as engagement with their own healthcare, and their sense of social support and connectedness. Research into evaluating those reported effects has not kept up; thus, a method for measuring PGHD outcomes was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems. A key step of the method ensures that the patient's voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform healthcare providers on decisions about stroke care, and thereby improve health outcomes. OBJECTIVE: This paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors' use of PGHD from a poststroke simulated rehabilitation technology. METHODS: This study gathered the perspectives of stroke survivors and clinicians through three focus groups and three interviews, recruited for convenience. Participants were also asked questions intended to encourage them to comment on the initial items of the patient-reported outcome measure-PGHD. Deductive thematic analysis was performed. RESULTS: This paper has further demonstrated that outcomes of using PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative and nil effects on their health behaviours. Survivors and clinicians had varying perspectives in three of the six themes presented, and emphasise the importance of allowing stroke survivors to participate in the evaluation of digital health services.

Enabling Better Use of Person-Generated Health Data in Stroke Rehabilitation Systems: Systematic Development of Design Heuristics.

BACKGROUND: An established and well-known method for usability assessment of various human-computer interaction technologies is called heuristic evaluation (HE). HE has been adopted for evaluations in a wide variety of specialized contexts and with objectives that go beyond usability. A set of heuristics to evaluate how health information technologies (HITs) incorporate features that enable effective patient use of person-generated health data (PGHD) is needed in an era where there is a growing demand and variety of PGHD-enabled technologies in health care and where a number of remote patient-monitoring technologies do not yet enable patient use of PGHD. Such a set of heuristics would improve the likelihood of positive effects from patients' use of PGHD and lower the risk of negative effects. OBJECTIVE: This study aims to describe the development of a set of heuristics for the design and evaluation of how well remote patient therapeutic technologies enable patients to use PGHD (PGHD enablement). We used the case of Kinect-based stroke rehabilitation systems (K-SRS) in this study. METHODS: The development of a set of heuristics to enable better use of PGHD was primarily guided by the R3C methodology. Closer inspection of the methodology reveals that neither its development nor its application to a case study were described in detail. Thus, where relevant, each step was grounded through best practice activities in the literature and by using Nielsen's heuristics as a basis for determining the new set of heuristics. As such, this study builds on the R3C methodology, and the implementation of a mixed process is intended to result in a robust and credible set of heuristics. RESULTS: A total of 8 new heuristics for PGHD enablement in K-SRS were created. A systematic and detailed process was applied in each step of heuristic development, which bridged the gaps described earlier. It is hoped that this would aid future developers of specialized heuristics, who could apply the detailed process of heuristic development for other domains of technology, and additionally for the case of PGHD enablement for other health conditions. The R3C methodology was also augmented through the use of qualitative studies with target users and domain experts, and it is intended to result in a robust and credible set of heuristics, before validation and refinement. CONCLUSIONS: This study is the first to develop a new set of specialized heuristics to evaluate how HITs incorporate features that enable effective patient use of PGHD, with K-SRS as a key case study. In addition, it is the first to describe how the identification of initial HIT features and concepts to enable PGHD could lead to the development of a specialized set of heuristics.

Patient-Reported Outcome Measures of Utilizing Person-Generated Health Data in the Case of Simulated Stroke Rehabilitation: Development Method.

BACKGROUND: Person-generated health data (PGHD) are health data that people generate, record, and analyze for themselves. Although the health benefits of PGHD use have been reported, there is no systematic way for patients to measure and report the health effects they experience from using their PGHD. Patient-reported outcome measures (PROMs) allow patients to systematically self-report their outcomes of a health care service. They generate first-hand evidence of the impact of health care services and are able to reflect the real-world diversity of actual patients and management approaches. Therefore, this paper argues that a PROM of utilizing PGHD, or PROM-PGHD, is necessary to help build evidence-based practice in clinical work with PGHD. OBJECTIVE: This paper aims to describe a method for developing PROMs for people who are using PGHD in conjunction with their clinical care-PROM-PGHD, and the method is illustrated through a case study. METHODS: The five-step qualitative item review (QIR) method was augmented to guide the development of a PROM-PGHD. However, using QIR as a guide to develop a PROM-PGHD requires additional socio-technical consideration of the PGHD and the health technologies from which they are produced. Therefore, the QIR method is augmented for developing a PROM-PGHD, resulting in the PROM-PGHD development method. RESULTS: A worked example was used to illustrate how the PROM-PGHD development method may be used systematically to develop PROMs applicable across a range of PGHD technology types used in relation to various health conditions. CONCLUSIONS: This paper describes and illustrates a method for developing a PROM-PGHD, which may be applied to many different cases of health conditions and technology categories. When applied to other cases of health conditions and technology categories, the method could have broad relevance for evidence-based practice in clinical work with PGHD.

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis.

Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

Patient-Reported Outcomes of Utilising Person-Generated Health Data in Simulated Rehabilitation Technology: Perceptions of Stroke Survivors.

Patient-reported outcome measures (PROMs) contribute to improving the evidence base in many areas of clinical care. An area where PROMs can help build the evidence base is in person-generated health data (PGHD) that is available to people who engage with many health technologies. An important use case for PGHD outcomes is in simulated poststroke rehabilitation that use body-tracking technologies. This study gathered stroke survivor perceptions-through 2 focus groups and 5 interviews-on PGHD effects from a leading poststroke simulated rehabilitation technology. Deductive thematic analysis was performed. The findings show that PGHD outcomes of utilising PGHD can be measured. Moreover, the findings provided a deeper understanding of PGHD effects and broadened the scope through the perceptions of stroke survivors themselves. This work will further refine and validate the development of a PROM for utilising PGHD for poststroke simulated rehabilitation systems, and has wider relevance and application.

Measuring the outcomes of using person-generated health data: a case study of developing a PROM item bank.

INTRODUCTION: Patient-reported outcome measures (PROMs) allow patients to self-report the status of their health condition or experience independently. A key area for PROMs to contribute in building the evidence base is in understanding the effects of using person-generated health data (PGHD), and using PROMs to measure outcomes of using PGHD has been suggested in the literature. Key considerations inherent in the stroke rehabilitation context makes the measurement of PGHD outcomes in home-based poststroke rehabilitation, which uses body-tracking technologies, an important use case. OBJECTIVE: This paper describes the development of a preliminary item bank of a PROM-PGHD for Kinect-based stroke rehabilitation systems (K-SRS), or PROM-PGHD for K-SRS. METHODS: The authors designed a method to develop PROMs of using PGHD, or PROM-PGHD. The PROM-PGHD Development Method was designed by augmenting a key PROM development process, the Qualitative Item Review, and follows PROM development best practice. It has five steps, namely, literature review; binning and winnowing; initial item revision; eliciting patient input and final item Revision. RESULTS: A preliminary item bank of the PROM-PGHD for K-SRS is presented. This is the result of implementing the first three steps of the PROM-PGHD Development Method within the domains of interest, that is, stroke and Kinect-based simulated rehabilitation. CONCLUSIONS: This paper has set out a case study of our method, showing what needs to be done to ensure that the PROM-PGHD items are suited to the health condition and technology category. We described it as a case study because we argue that it is possible for the PROM-PGHD method to be used by others to measure effects of PGHD utilisation in other cases of health conditions and technology categories. Hence, it offers generalisability and has broader clinical relevance for evidence-based practice with PGHD. This paper is the first to offer a case study of developing a PROM-PGHD.

Utilidad del empleo de mepivacaína-fentanilo en el bloqueo del plexo braquial vía axilar para la analgesia postoperatoria / Utility of mepivacaine-fentanyl in the blockade of brachial plexus axillary via for postoperative analgesia

Introducción: actualmente se usan más técnicas regionales para la anestesia en las cirugías y para analgesia de los dolores posoperatrios de miembros superiores. El empleo de adyuvantes junto con anestésicos locales para el bloqueo del plexo braquial vía axilar, proporciona anestesia-analgesia adecuada de la extremidad superior para cirugías de mano y antebrazo. Objetivo: evaluar la utilidad de mepivacaína-fentanilo en el bloqueo del plexo braquial vía axilar para la analgesia postoperatoria. Materiales y métodos: se realizó un estudio observacional, analítico, longitudinal y prospectivos en el Hospital Militar Docente "Dr. Mario Muñoz Monroy", en el período comprendido entre enero de 2014 a noviembre de 2016. La muestra fueron 40 pacientes consecutivos divididos en dos grupos homogéneos de 20 pacientes cada uno. Se evaluó la calidad y duración de la analgesia postoperatoria mediante escala análoga visual del dolor (EVA) en 2da, 4ta y 6ta h postoperatoria, se consideró analgesia satisfactoria cuando (EVA) ≤ 3, analgesia moderada de 4 a 6 y analgesia no satisfactoria ≥ 7. Para el análisis estadístico descriptivo se determinó la media y la desviación estándar, se utilizó el test de la T de Student. Resultados: en la 2da hora grupo I EVA ≤ 3: 20 pacientes (100 %) y Grupo II: 19 pacientes (95 %) p=0.5; 4ta hora GI EVA ≤ 3: 20 pacientes (10 %) y GII: 17 pacientes (85 %) p=1; 6ta hora GI EVA ≤ 3: 19 pacientes (95 %) y GII: 10 pacientes (50 %) p=1. Las complicaciones ocuparon 10 % en ambos grupos. Conclusiones: la aplicación de mepivacaína-fentanilo para la analgesia postoperatoria resultó ser útil, con calidad y duración de la analgesia postoperatoria y con escasas complicaciones (AU).

Introduction: currently, more regional techniques are used for anesthesia in surgeries and for analgesia in postoperative pains of upper limbs. The use of adjuvants together with local anesthetics for the brachial plexus blockade by axillary way provides the adequate anesthesia-analgesia of the high limb for hand and forearm surgery. Objective: to assess the utility of mepivacaine-fentanyl in the brachial plexus blockade by axillary way for postoperative anesthesia. Materials and methods: an observational, analytic, longitudinal and prospective study was carried out in the Teaching Military Hospital ¨Dr. Mario Munoz Monroy¨ in the period from January 2014 to November 2016. The sample were 40 consecutive patients divided into two homogenous groups of 20 patients each. The quality and duration of postoperative analgesia were assessed through the pain visual analogue scale (EVA in Spanish) in the 2nd, 4th and 6th postoperative hour; analgesia was considered satisfactory when EVA ≤3; moderated when from 4 to 6, and nonsatisfactory ≥7. The media and standard deviation were determined for the descriptive statistical analysis; the T Student test was used. Results: In the 2nd hour, Group I, EVA ≤ 3: 20 patients (100 %), and Group II: 19 patients (95 %) p=0.5; in the 4th hour, Group I, EVA ≤3: 20 patients (10 %) and Group II: 17 patients (85 %) p=1. Complications were 10 % in both groups. Conclusions: the application of mepivacaine-fentanyl for postoperative analgesia was useful, with quality and duration of postoperative analgesia and scarce complications (AU).

Utilidad del empleo de mepivacaína-fentanilo en el bloqueo del plexo braquial vía axilar para la analgesia postoperatoria / Utility of mepivacaine-fentanyl in the blockade of brachial plexus axillary via for postoperative analgesia

Introducción: actualmente se usan más técnicas regionales para la anestesia en las cirugías y para analgesia de los dolores posoperatrios de miembros superiores. El empleo de adyuvantes junto con anestésicos locales para el bloqueo del plexo braquial vía axilar, proporciona anestesia-analgesia adecuada de la extremidad superior para cirugías de mano y antebrazo. Objetivo: evaluar la utilidad de mepivacaína-fentanilo en el bloqueo del plexo braquial vía axilar para la analgesia postoperatoria. Materiales y métodos: se realizó un estudio observacional, analítico, longitudinal y prospectivos en el Hospital Militar Docente "Dr. Mario Muñoz Monroy", en el período comprendido entre enero de 2014 a noviembre de 2016. La muestra fueron 40 pacientes consecutivos divididos en dos grupos homogéneos de 20 pacientes cada uno. Se evaluó la calidad y duración de la analgesia postoperatoria mediante escala análoga visual del dolor (EVA) en 2da, 4ta y 6ta h postoperatoria, se consideró analgesia satisfactoria cuando (EVA) ≤ 3, analgesia moderada de 4 a 6 y analgesia no satisfactoria ≥ 7. Para el análisis estadístico descriptivo se determinó la media y la desviación estándar, se utilizó el test de la T de Student. Resultados: en la 2da hora grupo I EVA ≤ 3: 20 pacientes (100 %) y Grupo II: 19 pacientes (95 %) p=0.5; 4ta hora GI EVA ≤ 3: 20 pacientes (10 %) y GII: 17 pacientes (85 %) p=1; 6ta hora GI EVA ≤ 3: 19 pacientes (95 %) y GII: 10 pacientes (50 %) p=1. Las complicaciones ocuparon 10 % en ambos grupos. Conclusiones: la aplicación de mepivacaína-fentanilo para la analgesia postoperatoria resultó ser útil, con calidad y duración de la analgesia postoperatoria y con escasas complicaciones (AU).

Introduction: currently, more regional techniques are used for anesthesia in surgeries and for analgesia in postoperative pains of upper limbs. The use of adjuvants together with local anesthetics for the brachial plexus blockade by axillary way provides the adequate anesthesia-analgesia of the high limb for hand and forearm surgery. Objective: to assess the utility of mepivacaine-fentanyl in the brachial plexus blockade by axillary way for postoperative anesthesia. Materials and methods: an observational, analytic, longitudinal and prospective study was carried out in the Teaching Military Hospital ¨Dr. Mario Munoz Monroy¨ in the period from January 2014 to November 2016. The sample were 40 consecutive patients divided into two homogenous groups of 20 patients each. The quality and duration of postoperative analgesia were assessed through the pain visual analogue scale (EVA in Spanish) in the 2nd, 4th and 6th postoperative hour; analgesia was considered satisfactory when EVA ≤3; moderated when from 4 to 6, and nonsatisfactory ≥7. The media and standard deviation were determined for the descriptive statistical analysis; the T Student test was used. Results: In the 2nd hour, Group I, EVA ≤ 3: 20 patients (100 %), and Group II: 19 patients (95 %) p=0.5; in the 4th hour, Group I, EVA ≤3: 20 patients (10 %) and Group II: 17 patients (85 %) p=1. Complications were 10 % in both groups. Conclusions: the application of mepivacaine-fentanyl for postoperative analgesia was useful, with quality and duration of postoperative analgesia and scarce complications (AU).

Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review.

BACKGROUND: Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft's Kinect, a video-based technology that uses infrared to track a user's body movements. OBJECTIVE: This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit. METHODS: The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS. RESULTS: In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems. CONCLUSIONS: This paper calls specifically for further studies of K-SRS-and for studies of technologies that allow patients to generate their own health data in general-to pay more attention to how patients' own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs.