What influences parental decisions about antibiotic use with their children: A qualitative study in rural Australia.

BACKGROUND: Inappropriate use of antibiotics can promote bacterial resistance, which is a growing public health concern. As children are amongst the highest recipients of antibiotics, understanding the drivers of parental decisions towards their children's antibiotic use is imperative for the development of strategies to assist parents in making more informed decisions. This is particularly relevant to the decisions of parents living in resource-limited settings. This study explored the perspectives and practices of parents living in a rural setting about the use of antibiotics in their children. METHODS: Three focus group interviews were conducted with 10 parents of children under 12yrs, living in rural and remote areas of the Northern Territory, Australia. A focus group guide was developed to facilitate discussions, which was informed by the Theory of Planned Behaviour. Transcripts were analysed abductively using thematic analysis. FINDINGS: Four themes emerged explaining factors that contributed to parent decisions about their children's antibiotic use: 1) Parental knowledge, attitudes and decision making; 2) Perceptions of antimicrobial resistance; 3) Healthcare challenges; 4) Behaviours with antibiotics. While parents demonstrated accurate knowledge of the indications for antibiotic use, their decisions about the need for antibiotics were often driven by fear of serious illness. This fear was exacerbated by resource limitations associated with living in a resource-limited setting. Additional drivers of parental decision making included what parents have read or heard from both medical and non-medical networks, underscoring the importance of Social Norms in predicting behavioural intentions. CONCLUSION: Mothers living in remote areas experiencing reduced access to health services may make decisions about antibiotic use out of fear and based on the advice of their personal network when they perceive their child is vulnerable to a health threat. Findings from this study provide guidance for future research in the prediction of antibiotic use behaviours and for context-specific interventions.

The relationship between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review.

OBJECTIVE: To systematically review literature investigating the relationship between hip muscle strength and dynamic lower extremity valgus during movement tasks in asymptomatic females. METHODS: Four databases (CINAHL, SPORTDiscus, Embase and Ovid MEDLINE) were searched in February 2017. Studies investigating the relationship between hip muscle strength and dynamic knee or lower extremity valgus during movement tasks among asymptomatic females over 18 years old were included. Meta-analyses were performed where two or more studies used similar tasks. RESULTS: Five studies reported no relationship between hip strength and dynamic lower extremity valgus. Greater peak lower extremity valgus was associated with reduced hip strength in eight studies, and greater hip strength in three studies. In the meta-analysis, a relationship between weaker hip strength and greater dynamic lower extremity valgus was found for ballistic single leg landing, but not double leg landing or single leg squat tasks. CONCLUSIONS: Although the relationship between hip strength and dynamic lower extremity valgus is conflicting, meta-analysis revealed lower extremity dynamic valgus was consistently associated with hip strength in single leg ballistic tasks, but not double leg ballistic or single leg squat tasks. The relationship between hip strength and dynamic lower extremity valgus may be conditional to task demand.

Load to Failure and Stiffness: Anchor Placement and Suture Pattern Effects on Load to Failure in Rotator Cuff Repairs.

BACKGROUND: Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. PURPOSE: To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen-crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. RESULTS: There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P < .05). CONCLUSION: According to study results, when choosing a repair technique, other factors such as number of sutures in the repair should be considered to judge the strength of the repair. CLINICAL RELEVANCE: Previous in vitro studies have shown the double-row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties.

Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain.

INTRODUCTION: The pain of patellar tendinopathy (PT) may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch) in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. METHODS: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0-10 scale) enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2-4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA]) scores from baseline to day 14 were assessed. No statistical inference testing was performed. RESULTS: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation) at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30%) was demonstrated by 54% of patients. CONCLUSION: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT.

Outlet biceps tenodesis: a new technique for treatment of biceps long head tendon injury.

Degeneration and tearing of the long head of the biceps brachii tendon (LHBT) are common intra-articular findings, and surgical intervention including tenodesis or tenotomy is beneficial. A new arthroscopic shoulder technique may be performed through an anterior portal while one is viewing from a posterior portal: (1) Visualize the intra-articular biceps tendon. (2) Identify the segment of the LHBT to be enlarged. (3) Use a tissue modulation wand to enlarge the tendon. (4) Evaluate the diameter of the enlarged segment. It should be twice the original diameter. (5) Cut the biceps tendon at the proximal end of the enlarged segment. (6) View the tendon within the tunnel. (7) Identify and cut the remaining stump of the biceps tendon. Seventeen cadaveric shoulders were used to compare the pullout force, stiffness, and displacement of outlet tenodesis versus tenotomy. There was a significant increase in pullout force for the outlet tenodesis group when compared with tenotomy. This technique is used to operatively treat LHBT intra-articular pathology in patients who would benefit from tenotomy and traditional biceps tenodesis and may minimize the retraction of the biceps tendon distally.

Anatomical evaluation of a cortical button for distal biceps tendon repairs.

BACKGROUND: The posterior interosseous nerve (PIN) is at risk for injury during one-incision distal biceps tendon repair using a cortical button. The purpose of this study was to evaluate the proximity of a cortical button to the PIN during one-incision repairs of the distal biceps tendon using human cadaveric models. METHODS: In ten cadaveric elbows the biceps tendon was identified, traced to its insertion, and transected. With the forearm supinated, a guide pin was drilled through the radial tuberosity at a 0°, perpendicular to the table. A dorsal incision was used to identify the PIN. The tendon was repaired with a cortical button, ensuring the device lay in line with the radial shaft. The distance from the device to the PIN was measured using digital calipers. This process was repeated with the guide pin aimed at 20° proximal toward the radiocapitellar joint (RCJ) and 30° distal toward the wrist. The data were compared using a Student's paired t-test. RESULTS: The average distance from the device to the PIN with the straight posterior insertion was 8.94 mm, 11.86 mm with 20° proximal, and 0.55 mm with 30° distal angles. The distance between the button and the PIN was significantly greater when aiming the device 20° toward the RCJ compared to the straight insertion technique (p = 0.0061). CONCLUSIONS: The distance between the PIN and cortical button can be significantly increased by aiming the guide pin between 0° and 20° proximal toward the RCJ and placing the device in line with the radial shaft.

Concussion Management, Education, and Return-to-Play Policies in High Schools: A Survey of Athletic Directors, Athletic Trainers, and Coaches.

BACKGROUND: Concussions represent 8.9% to 13.2% of all high school athletic injuries. How these injuries are managed is currently unknown. HYPOTHESIS: There are differences in concussion management and awareness among boys football, boys ice hockey, and boys and girls soccer. STUDY DESIGN: Descriptive epidemiologic study. METHODS: High school athletic directors were contacted via e-mail and asked to complete, and request that their staff complete, an online survey with 4 sections aimed at athletic directors, head coaches, team physicians, and certified athletic trainers. RESULTS: According to coaches, concussion awareness education was provided for football (97%), hockey (65%), and boys and girls soccer (57% and 47%, respectively) (P < 0.01). Use of sideline screening tools was significantly greater for football (P = 0.03). All participants agreed that a player who has suffered a concussion cannot return to play the same day. CONCLUSION: There is a difference in concussion management and awareness among the 4 sports. Concussion education is well promoted in football but should be expanded in soccer and hockey. Players are not allowed to return to play the same day, and the majority are referred to a physician. CLINICAL RELEVANCE: Study results highlight the differences in concussion education among sports. Health care providers should address these gaps.