Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis.

BACKGROUND: Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. METHODS AND FINDINGS: Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). CONCLUSION(S): Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.

Effect of augmented feedback on classical ballet jump kinematics: A single-blind randomized controlled trial.

BACKGROUND: Augmented feedback strategies have been demonstrated to enhance jump-related biomechanics. Nevertheless, its effect on classical ballet is still unknown. The purpose of this study was to investigate whether a multimodal augmented feedback session is effective for improving lower limb and trunk kinematics during a classical ballet single-leg jump. METHODS: In a single-blind randomized controlled trial, 36 amateur classical ballet dancers were randomly assigned to either a control group (n = 18) to receive a brief warm-up session, or an augmented feedback group (n = 18) to receive, in addition to a brief warm-up session, a combined visual feedback session associated with verbal instruction. Hip kinematics in the frontal and transversal planes and knee and trunk kinematics in the frontal plane were analysed at baseline, immediate post-intervention, and one-week post-intervention. Intervention effects were analysed using a two-way, mixed model, repeated-measures analysis of variance. RESULTS: No interaction effects were observed, indicating that a single session of multimodal augmented feedback was insufficient to improve lower limb and trunk kinematics during a classical ballet single-leg jump in amateur classical ballet dancers. CONCLUSION: A single session of multimodal augmented feedback should not be used as the sole component in prevention programs intended to improve jump-related kinematics in amateur classical ballet dancers.

Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study.

BACKGROUND: Several fixation techniques have been described to treat acute olecranon fractures. Plate fixation is often used because of its superior mechanical properties. The reported rates of reoperation after olecranon plate fixation have been quite heterogeneous. The purpose of this study was to establish an updated reoperation rate based on modern precontoured plate constructs. METHODS: This retrospective cohort study used population-level administrative data to identify all surgically treated adult patients with olecranon fractures at 4 hospitals in Edmonton, AB, Canada, between 2010 and 2015. Radiographic review was conducted to identify patients who underwent precontoured olecranon plate fixation. Fracture characteristics including Mayo fracture classification and other concomitant upper-extremity injuries were identified. Chart reviews were performed to determine patient characteristics and patients who required reoperation. The primary reason for and type of reoperation were determined. RESULTS: Six hundred patients were surgically treated for olecranon fractures. Precontoured plate fixation was used in 321 patients. The average age of included patients was 56 years (standard deviation [SD], 19.4 years), and there were 173 female patients (53.9%). Reoperation was required in 90 patients (28%). For 50 patients, implant-related irritation was the primary reason for reoperation, representing 55.6% of the patients who underwent reoperation (50 of 90) and 15.6% of the total cohort (50 of 321). Other reasons for reoperation included hardware failure in 17 patients (5.3%), infection in 9 (2.8%), and contracture in 9 (2.8%). Patients who required reoperation were significantly younger (52.9 years [SD, 18.1 years] vs. 57.7 years [SD, 19.4 years]; P = .048) and had significantly higher rates of type III olecranon fractures (17.8% [16 of 90] vs. 8.2% [19 of 231]; P = .04) and Monteggia fractures (13.3% [12 of 90] vs. 4.8% [11 of 231]; P = .008). A multivariate logistic regression model also demonstrated increased odds ratios (ORs) for overall reoperation in patients with Monteggia fractures (OR, 2.99 [95% confidence interval, 1.25-7.17]; P = .014) and for reoperation due to implant-related irritation in younger patients (OR, 0.98 [95% confidence interval, 0.96-0.996]; P = .018). No discerning factors were identified for the 50 patients who underwent hardware removal for implant-related irritation compared with the whole reoperation group (n = 90). CONCLUSION: This study found that patients with olecranon fractures treated with precontoured plates experienced a hardware removal rate of 15.6% for implant-related irritation. Patients who sustained more complex fractures, such as Monteggia injuries, demonstrated higher rates of reoperation. Increasing age may be associated with lower rates of reoperation. In patients who required reoperation, there were no identifiable radiographic or clinical characteristics that were associated with implant-related irritation as their primary reason for reoperation.

Rehabilitation after arthroscopic Bankart repair: a systematic scoping review identifying important evidence gaps.

BACKGROUND: Evidence to develop best rehabilitation practices after Arthroscopic Bankart Repair (ABR) is lacking, leading to heterogeneity in rehabilitation approaches. OBJECTIVES: This systematic scoping review investigated current evidence for rehabilitation and associated outcomes following ABR, including rehabilitation parameters, evaluative approaches (outcomes/outcome measures, follow-up timing/duration). DATA SOURCES: A systematic search was performed of CINAHL, MEDLINE, and Embase databases in May 2019. STUDY SELECTION: Prospective studies detailing rehabilitation protocols following ABR reporting at least one postoperative assessment within 1 year of surgery (to measure impact of rehabilitation) were included. DATA EXTRACTION AND SYNTHESIS: Two blinded reviewers independently selected studies using standardized criteria and extracted study characteristics and outcomes of interest. Quality of evidence was assessed using Joanna Brigg's quality assessment tool. A narrative analysis was conducted and evidence gaps were identified. RESULTS: Nine studies evaluating 11 rehabilitation protocols with a total of 384 participants were included. Considerable variability was seen in rehabilitation protocols and evaluation parameters. Return to sports/activity was frequently measured, but not well-defined. Strengthening was an important component of rehabilitation protocols, but rarely reported as an outcome. Follow-up was variable, with 4 studies ending follow-up before 24-months postoperatively. Overall, patient outcomes improved postoperatively. CONCLUSIONS: There is a paucity of evidence investigating the impact of rehabilitation approaches following ABR. Although patient outcomes improve after ABR, selected outcomes/measures are highly variable with limited evidence on those important to measure rehabilitation success, particularly strength and return to activity. Identified evidence gaps should be addressed in future research.

Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?: A Randomized Controlled Trial.

BACKGROUND: Improvements in surgical fixation to repair distal biceps tendon ruptures have not fully translated to earlier postoperative mobilization; it is unknown whether earlier mobilization affords earlier functional return to work. This parallel-arm randomized controlled trial compared the impact of early mobilization versus 6 weeks of postoperative immobilization following distal biceps tendon repair. METHODS: One hundred and one male participants with a distal biceps tendon rupture that was amenable to a primary repair with use of a cortical button were randomized to early mobilization (self-weaning from sling and performance of active range of motion as tolerated during first 6 weeks) (n = 49) or 6 weeks of immobilization (splinting for 6 weeks with no active range of motion) (n = 52). Follow-up assessments were performed by a blinded assessor at 2 and 6 weeks and at 3, 6, and 12 months. At 12 months, distal biceps tendon integrity was verified with ultrasound. The primary outcome was return to work. Secondary outcomes were pain, range of motion, strength, shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) score, and tendon integrity. Intention-to-treat analysis was performed. A linear mixed model for repeated measures was used to compare pain, range of motion, strength, and QuickDASH between the groups over time; return to work was assessed with use of independent t tests. RESULTS: The groups were similar preoperatively (p ≥ 0.16). The average age (and standard deviation) was 44.7 ± 8.6 years. Eighty-three participants (82%) were followed to 12 months. There were no differences between the groups in terms of return to work (p ≥ 0.83). Participants in the early mobilization group had significantly more passive forearm supination (p = 0.04), with passive forearm pronation (p = 0.06) and active extension and supination (p = 0.09) trending toward significantly greater range of motion in the early mobilization group relative to the immobilization group. Participants in the early mobilization group had significantly better QuickDASH scores over time than those in the immobilization group (p = 0.02). There were no differences between the groups in terms of pain (p ≥ 0.45), active range of motion (p ≥ 0.09), or strength (p ≥ 0.70). Two participants (2.0%, 1 in each group) had full-thickness tears on ultrasound at 12 months (p = 0.61). Compliance was not significantly different between the groups (p = 0.16). CONCLUSIONS: Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. No clinically important group differences were seen. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Move It or Lose It? The Effect of Early Active Movement on Clinical Outcomes Following Rotator Cuff Repair: A Systematic Review With Meta-analysis.

OBJECTIVE: To assess the effect of early active shoulder movement after rotator cuff repair, compared to delayed active shoulder movement, on clinical outcomes, rotator cuff integrity, and return to work. STUDY DESIGN: Intervention systematic review. LITERATURE SEARCH: We searched 14 databases in November 2017 and updated the search in December 2018 and February 2020. STUDY SELECTION CRITERIA: We included comparative studies that assessed the effect of early active shoulder movement versus delayed active shoulder movement following rotator cuff repair. DATA SYNTHESIS: Means and SDs were used to calculate weighted mean differences and 95% confidence intervals for outcomes of interest. The sensitivity analysis included only randomized controlled trials and was performed when heterogeneity among studies was statistically significant. RESULTS: Eight studies with a total of 756 participants (early active shoulder movement, n = 379; delayed active shoulder movement, n = 377) were included. There was high-certainty evidence favoring early active movement for forward flexion (6 weeks), abduction (6 weeks), and external rotation (6 weeks and 3 and 6 months) postsurgery. There was moderate-certainty evidence of worse Western Ontario Rotator Cuff Index score (6 weeks) for the early active movement group, and no difference in rotator cuff integrity between the early and delayed active movement groups. There were no group differences for all other outcomes. CONCLUSION: Patients who commenced active shoulder movement early after rotator cuff repair had greater shoulder range of motion and worse shoulder-specific quality of life after surgery than patients who delayed active shoulder movement. However, the group differences did not appear to be clinically important, and rotator cuff integrity was similar. J Orthop Sports Phys Ther 2021;51(7):331-344. Epub 15 May 2021. doi:10.2519/jospt.2021.9634.

A prática da desinfecção dos oxímetros de dedo realizada pelos profissionais de Enfermagem / The practice of disinfection of finger oximeters performed by nursing professionals

RESUMO Objetivo analisar a prática da desinfecção dos oxímetros de dedo realizada pelos profissionais de Enfermagem. Métodos estudo quantitativo, descritivo e transversal com nove profissionais em unidade clínica hospitalar. Coletaram-se 18 amostras com swab, uma interna e uma externa de cada equipamento, isolando-se 51 colônias bacterianas para a testagem de suscetibilidade aos antimicrobianos. Resultados os profissionais não recebiam capacitação para a desinfecção do aparelho. Oito transportavam os oxímetros nos jalecos e um, na bandeja. Raramente desinfetavam o interior do aparelho por receio do álcool etílico 70% danificar o sensor. Em 17 amostras, cresceram diferentes gêneros bacterianos. Foram multirresistentes aos antimicrobianos 17,7%. Conclusão observou-se que os profissionais de Enfermagem não desinfetam corretamente os oxímetros de dedo. Recomendam-se o uso de álcool isopropílico 70% para desinfetar os sensores, por este não danificar o equipamento, e o uso de álcool etílico 70% na higienização dos dedos dos pacientes antes e após os testes.

ABSTRACT Objective to analyze the practice of disinfection of finger oximeters by nursing professionals. Methods a quantitative, descriptive, and cross-sectional study with nine professionals in a hospital clinical unit. Eighteen swab samples were collected, internally and externally from each equipment, isolating 51 bacterial colonies for antimicrobial susceptibility testing. Results the professionals were not trained to disinfect the equipment. Eight carried the oximeters in their lab coats, and one carried them on a tray. They rarely disinfected the inside of the device fearing the 70% ethyl alcohol would damage the sensor. In 17 samples, different bacterial genera grew. 17.7% were multidrug-resistant to antimicrobials. Conclusion it was observed that Nursing professionals don't disinfect finger oximeters correctly. The use of 70% isopropyl alcohol is recommended to disinfect the sensors, since it doesn't damage the equipment, and 70% ethyl alcohol to sanitize the patients' fingers before and after the tests.

Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study.

BACKGROUND: Loss of reduction (LoR) can occur after locking plate fixation of proximal humerus fractures (PHFs). This study determined biomechanical features of fracture fixation associated with preventing LoR postoperatively. One-year reoperation rates were also compared between those with/without LoR. METHODS: Population-based administrative data for 359 adults treated using a locking plate for PHF between 2010 and 2016 were examined. Two trained assessors reviewed standardized shoulder radiographs. LoR (Yes/No) was defined as any fracture displacement >0.5 cm, and/or >10° change in neck-shaft angle (NSA) alignment relative to intraoperative imaging. Multiple logistic regression assessed how the following affected maintaining reduction: (1) sex, (2) age, (3) Neer classification, (4) shaft impaction (SI), (5) shaft medialization (SM), (6) calcar reduction (CR), (7) NSA alignment, and (8) screw use. RESULTS: LoR was seen in 79 (22%) patients. LoR was significantly associated with increasing age (odds ratio [OR] = 1.06/yr, P < .001), fracture severity (4-part vs. 2-part fracture; OR = 4.63, P = .001), and varus NSA alignment (<125° vs. ≥145°: OR = 5.6, P = .02; <125° vs. 125-145°, OR = 2.2, P = .02]). Patients achieving simultaneous SI, SM, and CR were significantly less likely (OR = 0.009, P < .001) to lose reduction, after controlling for age, fracture severity, and NSA alignment. If only SI was achieved, patients were still significantly less likely to lose reduction relative to achieving none of these mechanical features (OR = 0.17, P = .006). Reoperations were higher when LoR occurred (n = 26/77 [33.4%]) compared with no LoR (n = 20/276 [7.2%]) (P < .001). CONCLUSIONS: SI was strongly associated with preventing LoR in patients treated using a locking plate for PHF. SI with concurrent SM, CR, and a neutral or valgus NSA had the lowest rates of LoR. LoR was associated with higher rates of reoperation.

Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach.

BACKGROUND: Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. OBJECTIVE: The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. DESIGN: A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. METHODS: Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. RESULTS: Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as "very useful" or "quite useful." Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. LIMITATIONS: The survey sample was relatively small and did not directly assess patient outcomes. CONCLUSIONS: An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.

The sub-supraspinatus recess and superior labral motion: an arthroscopic analysis.

BACKGROUND: Minimal information exists regarding the sub-supraspinatus recess superior to the labrum and inferior to the supraspinatus. Furthermore, movement of the superior labrum during glenohumeral range of motion has not previously been defined. The objectives of this arthroscopic study were to describe the (i) sub-supraspinatus recess dimensions and (ii) superior labral motion. METHODS: Forty-four patients were enrolled and underwent standardized arthroscopic assessment. Analysis consisted of static measurement of the sub-supraspinatus recess depth, as well as the amount of labral motion during passive shoulder motion. Labral movement was categorized relative to the glenoid rim (lateral to the rim, to the rim, or medial to the rim). RESULTS: All patients had a well-defined sub-supraspinatus recess varying from a depth of 0 mm to 5 mm (n = 10; 22.7%), 5 mm to 10 mm (n = 23; 52.3%) or >10 mm (n = 11; 25%). External rotation in abduction demonstrated the greatest labral movement (p < 0.001) with 28 (80%) shoulders moving medial to the rim. CONCLUSIONS: The sub-supraspinatus recess is consistently present with an average depth of 5 mm to 10 mm. Superior labral motion is present in most patients and is most pronounced in external rotation in abduction. This finding likely has clinical implications for superior labral repair surgery, especially for overhead athletes and laborers who require external rotation in an abducted position for a successful outcome.

Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

PURPOSE: To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair. METHODS: A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor. At 6, 12, and 24 months, strength was reassessed. At 12 months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. RESULTS: The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24 months. At 6 weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24 months, there were no group differences in ROM after 6 weeks (P > .08), and pain (P > .06), strength (P = .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). CONCLUSIONS: EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12 months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6 weeks following arthroscopic RC repair. LEVEL OF EVIDENCE: Level I, high-quality randomized controlled trial.

Functional, impulse-based quantification of plantar pressure patterns in typical adult gait.

BACKGROUND: Dynamic pedobarography is used to measure the change in plantar pressure distribution during gait. Clinical methods of pedobarographic analysis lack, however, a standardized, functional segmentation or require costly motion capture technology and expertise. Furthermore, while commonly used pedobarographic measures are mostly based on peak pressures, progressive foot deformities also depend on the duration the pressure is applied, which can be quantified via impulse measures. RESEARCH QUESTION: Our objectives were to: (1) develop a standardized method for functionally segmenting pedobarographic data during gait without the need for motion capture; (2) compute pedobarographic measures that are based on each segment's vertical impulse; and (3) obtain a normative set of such pedobarographic measures for non-disabled gait. METHODS: Pedobarographic data was collected during gait from sixty adults with normal feet. Using the maximum pressure map for each trial, an expert and novice rater independently identified the hallux, heel, medial forefoot, and lateral forefoot and computed nine normalized vertical impulse measures. RESULTS: From the computed impulse measures, the Heel-to-Forefoot Balance was 33.3 ± 5.5%, the Medial-Lateral Forefoot Balance (with hallux) 59.2 ± 8.0%, the Medial-Lateral Forefoot Balance (without hallux) 53.5 ± 7.7%, and the Hallux-to-Medial Forefoot Balance 21.0 ± 8.9% (mean ± standard deviation). The intra- and inter-rater reliability ranged between 0.93 and 1.00 and between 0.89 and 0.99, respectively (ICC(2,1)). SIGNIFICANCE: We developed a simple, stand-alone method for pedobarographic segmentation that is mechanistically linked to relevant anatomical regions of the foot. The normative impulse measures exhibited excellent reliability. This normative dataset is currently used in the clinical assessment of different foot deformities and gait impairments, and in the evaluation of treatment outcomes.

Does Topical Anesthetic Reduce Pain During Intraosseous Pin Removal in Children? A Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to determine the effectiveness of topical liposomal lidocaine in reducing the pain perceived by children undergoing percutaneous intraosseous pin (PP) removal in the outpatient orthopaedic clinic. METHODS: A triple-blinded, randomized, placebo-controlled clinical trial comparing topical liposomal lidocaine to a placebo was conducted at the Stollery Children's Hospital between September 2008 and February 2011. Subjects undergoing the removal of PP in the orthopaedic outpatient clinic between ages 3 and 16 years were recruited. A computer-generated variable-block randomization scheme was used to determine each subject's group assignment. Pain was recorded just before randomization and immediately after the procedure using the Oucher Scale (for subjects) and a 10-cm Visual Analog Scale (for parents and an observing orthopaedic technician). In a subset of individuals, follow-up telephone calls were made 24 hours postprocedure to inquire about any adverse event from the use of the topical liposomal lidocaine. Data were analyzed using the Student t test. RESULTS: Of a total of 296 recruited subjects, complete data were available on 281 subjects (140 intervention and 141 control). There were no significant differences between the 2 groups with regards to baseline characteristics, including preprocedure pain scores. Although postprocedure pain scores demonstrated an increase in pain in both groups (2.3 points in the treatment group and 2.0 points in the placebo group), no statistically significant difference was seen in postprocedure pain scores between groups (P=0.81). No adverse events were observed or reported. CONCLUSIONS: Topically applied liposomal lidocaine was not effective in reducing pain during this procedure, compared with a placebo. However, this study demonstrates that PP removal is a painful procedure in children. Given the large volume of patients who undergo this procedure and the long-term consequences of experiencing painful procedures in childhood, it is important to find safe and fast-acting methods to decrease procedural pain associated with PP removal.

Atividade integrativa das disciplinas de microbiologia com semiologia e semiotécnica: higienização das mãos / Integrative activity of the subjects of microbiology and semiology semiotechniques: hand hygiene

Este artigo relata a atividade realizada entre as disciplinas de Microbiologia, de Semiologia e de Semiotécnica do curso de enfermagem da Universidade do Estado de Santa Catarina-UDESC, como uma tentativa de interdisciplinaridade. A atividade da lavagem simples das mãos e cirúrgica foi realizada pelos acadêmicos matriculados nessas disciplinas. Em cada procedimento de lavagem, de dois acadêmicos voluntários, eram colhidas com suabes, amostras de partes das mãos. As amostras foram semeadas sobre placas de Petri contendo meio de cultivo para o crescimento bacteriano. Foi constatado elevado crescimento bacteriano no acadêmico com unhas compridas e que estava resfriado. Nenhum crescimento bacteriano foi constatado na extremidade dos dedos após a lavagem cirúrgica. O teste de suscetibilidade aos antimicrobianos foi realizado para alguns de prescrição de rotina, como amoxacilina + clavulanato, ácido nalidixico, ceftazidima, cefotaxima, ceftriaxona, emipenem, tetraciclina e sulfazotrim. Resistência ao antimicrobiano ácido nalidíxico e a tetraciclina foi constatado em bactérias de um dos voluntários. Foi confeccionada uma caixa contendo uma lâmpada que emite luz negra para simulação da lavagem das mãos. Os acadêmicos, ao utilizarem gel fosforescente, simularam os movimentos de lavagem simples das mãos e, posteriormente, as introduziram na caixa. Os locais atingidos pelo gel ficaram brancos, enquanto os locais que não o receberam ficaram pardos ou opacos. A atividade integrativa demonstrou aos acadêmicos a importância na lavagem correta das mãos para a redução de infecções e riscos aos pacientes. E, aos professores, a viabilidade na realização desse tipo de atividade para integrar as disciplinas e os conhecimentos entre as diversas áreas do curso de enfermagem.

This article reports on the activity carried out in the subjects of Microbiology and Semiology / Semiotechniques of the nursing program at the University of the State of Santa Catarina / UDESC, as an attempt to interdisciplinarity. The activity of simple hand washing and surgery was held by the students enrolled in these subjects. In each washing procedure, swabs of handpieces samples were collected from two academic volunteers. Samples were plated on Petri dishes containing culture medium for bacterial growth. It was found that there was high bacterial growth from the student with long fingernails and who had a cold. There was no bacterial growth at the end of the fingers after surgical lavage. The antimicrobial susceptibility testing was performed for some routine prescription, such as amoxicillin + clavulanate, nalidixic acid, ceftazidime, cefotaxime, ceftriaxone, emipinem, tetracycline and sulfazotrim. Resistance to the antibiotic nalidixic acid and tetracycline was observed in bacteria in one of the volunteers. A box was made containing a lamp emitting black light for simulation of hand washing. Students, by using gel phosphorescent, simulated the simple washing of hand movements and subsequently introduced their hands in the box. The sites affected by the gel were white, while the sites that did not receive were brown or opaque. The integrative activity showed the students the importance in proper hand washing to reduce infections and risks to patients. And it also showed the teachers, the feasibility in performing this type of activity to integrate the disciplines and knowledge among different areas of the nursing course.

Suprascapular nerve injury during arthroscopic superior labral repair: a prospective evaluation.

PURPOSE: This prospective study evaluated suprascapular nerve injury risk during arthroscopic superior labral repair in patients of average height or shorter. METHODS: From 2009 to 2011, 12 patients <179 cm tall undergoing arthroscopic superior labral repair were prospectively enrolled. Portal location, tear and anchor characteristics, and surgeon impression of medial glenoid wall perforation were collected. Suprascapular nerve conduction studies were obtained postoperatively. A musculoskeletal radiologist evaluated medial glenoid wall perforation and the distance from the anchor to the suprascapular neurovascular bundle on postoperative magnetic resonance images (MRI). DASH scores were recorded preoperatively and 6 months postoperatively. RESULTS: Medial wall perforation occurred in five (42 %) patients, with 3 patients having a single perforation and two patients having two perforations. Eight of 38 (21 %) anchors drilled into the superior half of the glenoid, and 6 of 20 (30 %) anchors inserted into the postero-superior quadrant of the glenoid, perforated the medial wall. Perforations occurred both through the portal of Wilmington and the antero-superior portal. The distance to the suprascapular neurovascular bundle from the perforating anchors ranged from 0 to 4 mm. Nerve conduction studies revealed subclinical signs of an incomplete nerve injury in one patient. DASH scores improved on average 29.3 points postoperatively (SD = 27.0, p = 0.007). CONCLUSION: Medial wall perforation is common in smaller patients during arthroscopic superior labral repairs; the suprascapular nerve can be injured if perforation occurs. The clinical significance of these findings is unclear. In spite of a high drill-out rate, the nerve is rarely injured; however, an anchor designed for implantation into bone that is instead lodged in the soft tissues has the potential to harm these tissues and surrounding structures. LEVEL OF EVIDENCE: Prospective cohort study, treatment study, Level III.

Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.

AIMS: To compare the masticatory and cervical muscle tenderness and pain sensitivity in the hand (remote region) between patients with temporomandibular disorders (TMD) and healthy controls. METHODS: Twenty female subjects were diagnosed with chronic TMD, and 20 were considered healthy. Subjects completed the Neck Disability Index and Limitations of Daily Functions in a TMD questionnaire. Tenderness of the masticatory and cervical muscles and pain sensitivity in the hand were measured using an algometer. Three-way mixed analysis of variance (ANOVA) evaluated differences in muscle tenderness between groups. One-way ANOVA compared pain sensitivity in the hand between groups. Effect sizes were assessed using Cohen guidelines. RESULTS: Significantly increased masticatory and cervical muscle tenderness and pain sensitivity in the hand were found in subjects with TMD when compared with healthy subjects. Moderate to high effect sizes showed the clinical relevance of the findings. CONCLUSION: The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD.

Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs.

OBJECTIVE: The purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters. METHODS: One photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters. RESULTS: Good to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37). CONCLUSION: The raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.

Avaliação da perda de função renal no paciente hipertenso e tratamento dessa patologia / Assessment of renal function loss in hypertensive patients and treatment of this pathology

Entre as várias causas primarias de doenças renal em estágio terminal identificadas em pacientes em diálise nos Estados Unidos, podemos identificar a nefropatia diabética como a mais comum, correspondendo a 40%, seguida pela doença vascular, incluindo a nefroesclerose hipertensiva (20%), doença glomerular primária (18%), doença tubulointerstical (7%) e doença cística (5%). A hipertensão está associada à progressão da doença renal de forma mais rápida, independente da causa da base; acrescido a regra de avanço da doença renal, a hipertensão pode ser o fator de risco mais comum aumentando mais vezes o risco de doença cardiovascular observado em pacientes com insuficiência renal. Clinicamente pode-se verificar um ciclo vicioso: “A hipertensão causando lesão renal, a qual aumento os níveis tensionais...”. Esse artigo discorrerá sobre a importância da um seguimento adequado do paciente hipertenso, como diagnosticar a perda de função renal, potencias lesões sobre o órgão, tratamento para cada subtipo de Nefroesclerose e formas de prevenir a perda de função renal no paciente hipertenso.

Técnicas cirúrgicas: uma atualização / Surgical techniques: an update

Com o passar dos anos, percebeu-se a necessidade de adaptar os métodos de de ensino de acordo com realidade do momento em que vive. Além disso, com o avanço de novas tecnologias como a videolaparoscopia, muito dos médicos em formação não os revisam mais e então se torna mister ter uma fonte de informação que permita que este , principalmente cirurgiões, possam ter noção, mais real possível, dos mesmos. Com esses objetivos, os autores pretendem aliar técnicas cirúrgicas já consagradas com a inovação da imagem digital (DVD), ensinando-as de forma clara , objetiva e didática a alunos de graduação, médicos residentes e a todos que possam vira ter interesse.