Hallux valgus surgery in children with cerebral palsy: A systematic review.

BACKGROUND: Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity. OBJECTIVE: To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy. METHODS: A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included. RESULTS: 58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented. CONCLUSION: Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.

Experimental and theoretical studies of a coaxial free-electron maser based on two-dimensional distributed feedback.

The first operation of a coaxial free-electron maser (FEM) based on two-dimensional (2D) distributed feedback has been recently observed. Analytical and numerical modeling, as well as measurements, of microwave radiation generated by a FEM with a cavity defined by coaxial structures with a 2D periodic perturbation on the inner surfaces of the outer conductor were carried out. The two-mirror cavity was formed with two 2D periodic structures separated by a central smooth section of coaxial waveguide. The FEM was driven by a large diameter (7 cm), high-current (500 A), annular electron beam with electron energy of 475 keV. Studies of the FEM operation have been conducted. It has been demonstrated that by tuning the amplitude of the undulator or guide magnetic field, modes associated with the different band gaps of the 2D structures were excited. The Ka-band FEM generated 15 MW of radiation with a 6% conversion efficiency, in good agreement with theory.

Nursing attitudes to the care of elderly patients at risk of continuing hospital care.

This study assesses changes in nurses' attitudes to the process of decision-making regarding the care of elderly patients identified as being at risk of continuing (long-term) hospital care. It was undertaken during the course of an evaluation of an intervention programme which involved a new approach to decision-making concerning the long-term care of dependent elderly patients. Complementary components of the intervention programme were: (a) an early discharge planning service; and (b) an extended home care programme. The programme involved close liaison of specially trained community health nurses with staff members of the general medical wards of a large general hospital. At the onset of the evaluation, it was perceived by management that the staff of the general medical wards favoured continuing hospital care for very dependent elderly patients rather than community care. It was hypothesized that the intervention programme would result in a change in ward staffs' attitudes concerning the feasibility of home-based care and how decisions about care should be made. To test this, attitude changes of community health nurses and ward nurses were assessed over the period of implementation of the programme. Following the introduction of the programme, the study found that some of the ward nurses' attitudes became closer to those of community health nurses. There was a shift in ward nurses' attitudes away from a professional approach to decisions about the care and placement of very dependent elderly patients to a 'patient choice' approach. Nurses felt more strongly that they had an important role in patient care. Implications of the research are considered in relation to the process of discharge planning.