Musculoskeletal physiotherapists' discharge practices for people treated with low back pain: A United Kingdom survey.

BACKGROUND: Persistent low back pain (LBP) is the leading cause of disability, and a major burden on the healthcare system globally. Many people with LBP experience recurrent pain flares and receive repeated appointments and re-referrals to services such as physiotherapy. However, it is not clear what the criteria are for discharging people with LBP from physiotherapy services. This study aims to describe the current practices for discharging people from physiotherapy for LBP in the United Kingdom (UK). METHODS: A cross-sectional study using an anonymous online national (UK) survey was conducted among qualified physiotherapists who treat people with LBP in UK musculoskeletal out-patient services. RESULTS: A total of 104 surveys were completed. The majority of respondents reported using (i) a shared decision-making (77%) and (ii) person-physiotherapist goal attainment (74%) approach to discharging people with LBP. Sixty-three percent of respondents reported using a patient-initiated follow-up (PIFU) approach. Only 8% of respondents reported using a graded discharge approach with 'booster' appointments. A PIFU or graded discharge approach was considered most pertinent for people at higher risk of a pain flare (97%; 86%) and with low self-efficacy to self-manage their LBP. CONCLUSIONS: This UK survey established that discharge practices for people with LBP after physiotherapy vary. Whilst the majority of people are currently discharged with a PIFU appointment, a graded discharge approach may be more beneficial for people who are less likely to initiate a PIFU appointment. Further consideration on the development of such a pathway is now required.

The Emulsified PFC Oxycyte® Improved Oxygen Content and Lung Injury Score in a Swine Model of Oleic Acid Lung Injury (OALI).

PURPOSE: Perfluorocarbons (PFCs) can transport 50 times more oxygen than human plasma. Their properties may be advantageous in preservation of tissue viability in oxygen-deprived states, such as in acute lung injury. We hypothesized that an intravenous dose of the PFC emulsion Oxycyte® would improve tissue oxygenation and thereby mitigate the effects of acute lung injury. METHODS: Intravenous oleic acid (OA) was used to induce lung injury in anesthetized and instrumented Yorkshire swine assigned to three experimental groups: (1) PFC post-OA received Oxycyte® (5 ml/kg) 45 min after oleic acid-induced lung injury (OALI); (2) PFC pre-OA received Oxycyte® 45 min before OALI; and (3) Controls which received equivalent dose of normal saline. Animals were observed for 3 h after OALI began, and then euthanized. RESULTS: The median survival times for PFC post-OA, PFC pre-OA, and control were 240, 87.5, and 240 min, respectively (p = 0.001). Mean arterial pressure and mean pulmonary arterial pressure were both higher in the PFC post-OA (p < 0.001 for both parameters). Oxygen content was significantly different between PFC post-OA and the control (p = 0.001). Histopathological grading of lung injury indicated that edema and congestion was significantly less severe in the PFC post-OA compared to control (p = 0.001). CONCLUSION: The intravenous PFC Oxycyte® improves blood oxygen content and lung histology when used as a treatment after OALI, while Oxycyte® used prior to OALI was associated with increased mortality. Further exploration in other injury models is indicated.

Evaluation of silver coated hemostatic dressing to control hemorrhage in a porcine model of lethal vascular injury.

THE AIM OF THE STUDY: An ideal hemostatic dressing that would control bleeding and protect the wound from further contamination is still being sought for combat casualty care. The new SilverLeaf™ (SL) bandage was made of material containing active hemostatic property and possible antimicrobial property from silver coating. This study was conducted to compare and ascertain the hemostatic properties of SL and compare it with known hemostatic dressings: Combat Gauze® (CG) and WoundStat™ (WS) in a swine model with punch, vascular injury. MATERIAL AND METHODS: Three hemostatic dressings were evaluated in anesthetized Yorkshire swine hemorrhaged for 45 sec in a femoral arterial puncture model. The hemostatic dressings SL, CG, or WS were applied on an actively bleeding wound, followed by 5 minutes of compression at 200 mm Hg. The pressure was then released to baseline and skin closed with towel clamps. After 15 minutes, 500 ml of (Hextend) resuscitation fluid infused over a period of 30 minutes. The animal's vital signs were monitored for the 3-hour experiment period. Primary outcomes documented were incidence of bleeding after application of the dressing, restoration of MAP and rate of survival.Results. The pre-treatment blood loss for WS was 375.66 ml (16.49%), SL 282.08 ml (12.15%) and CG 307.24 ml (12.68%) and was comparable between groups (p>0.56). The post-treatment blood loss for WS was 286.05 ml (10.65%), SL 386.81 ml (16.92%), and CG 525.76 ml (21.52%). There was no significant difference in post-treatment blood loss (p>0.37) between groups. The Mean Arterial Pressure (MAP) did not significantly differ between the groups at all time points compared. The SL and CG had comparable MAPS during the first hour. The SL had a slight advantage, but didn't reach statistical significance. This suggests that all the bandages were comparable. The two time points at which the post-treatment bleeding occurred in the three groups after the release of manual compression and after restoration of blood pressure. The post-treatment re-bleeding rates were 22.22% (2/9) for WS and SL, 44.44% (4/9) for CG. The survival rates were 100% for WS, 88.89% for SL, and 77.78% for CG. CONCLUSION: The findings indicate that SilverLeaf, WoundStat and Combat Gauze were comparable in controlling bleeding, preventing re-bleeding, maintenance of mean arterial pressure and improving survival following treatment.

Comparison of Combat Gauze and TraumaStat in two severe groin injury models.

BACKGROUND: Fabric-like hemostatic dressings offer promise for hemorrhage control in noncompressible areas, especially given their similarity in form to standard gauze currently in use. Recently, two such products, Combat Gauze (CBG) and TraumaStat (TMS), were introduced. Their performance is evaluated in two vascular injury models. MATERIALS AND METHODS: The dressings were evaluated in anesthetized Yorkshire pigs, hemorrhaged by full transection of the femoral vasculature with 2 min free bleeding period (CBG = 6, TMS = 6) or by 4 mm femoral arterial puncture with 45 s free bleeding period (CBG = 8, TMS = 8). After injury, dressings were applied, followed by 5 min of manual compression and then 500 mL resuscitation fluid infused over 30 min. Vital signs, blood pressure, and blood loss were recorded throughout the 3-h experiment. Bleeding control was the primary outcome. RESULTS: All animals had similar pretreatment mean arterial pressure (MAP) (∼ 36.5 mmHg); pretreatment blood loss following injury was similar for both dressing groups in the two models [24% ± 8% estimated blood volume (EBV) 2 min after transection and 17% ± 4% EBV 45 s after puncture. Incidence of post-treatment bleeding, primarily occurring after release of manual compression or restoration of blood pressure, was more frequent in the puncture model (17% with both CBG and TMS) than the transection model (57% with CBG versus 75% with TMS). Post-treatment blood loss not controlled by the dressing was 19% ± 22% and 31% ± 17% EBV, for CBG and TMS, respectively. Survival rate was 100% for both dressings in the transection model, and was 88% for CBG and 50% for TMS in the puncture model. CONCLUSIONS: These findings indicated that CBG and TMS were similarly effective in improving hemostasis. These two fabric-like dressings showed easy application and removal, leaving a clean wound for surgical repair.

Comparison of 10 hemostatic dressings in a groin transection model in swine.

BACKGROUND: Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. To test the relative efficacy of different formulations in bleeding control, recently manufactured products need to be compared using a severe injury model. METHODS: Ten hemostatic dressings and the standard gauze bandage were tested in anesthetized Yorkshire pigs hemorrhaged by full transection of the femoral vasculature at the level of the groin. Application of these dressings with a 5-minute compression period (at approximately 200 mm Hg) was followed with a subsequent infusion of colloid for a period of 30 minutes. Primary outcomes were survival and amount and incidence of bleeding after dressing application. Vital signs and wound temperature were continuously recorded throughout the 3-hour experimental observation. RESULTS: These findings indicated that four dressings were effective in improving bleeding control and superior to the standard gauze bandage. This also correlated with increased survival rates. Absorbent property, flexibility, and the hemostatic agent itself were identified as the critical factors in controlling bleeding on a noncompressible transected vascular and tissue injury. CONCLUSIONS: Celox, QuikClot ACS, WoundStat, and X-Sponge ranked superior in terms of low incidence of rebleeding, volume of blood loss, maintenance of mean arterial pressure >40 mm Hg, and survival.