Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri-operative care: a narrative review.

The protection of healthcare workers from the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a paramount concern. SARS-CoV-2 is likely to remain endemic and measures to protect healthcare workers against nosocomial infection will need to be maintained. This review aims to inform the assessment and management of the risk of SARS-CoV-2 transmission to healthcare workers involved in elective peri-operative care. In the absence of data specifically related to the risk of SARS-CoV-2 transmission in the peri-operative setting, we explore the evidence-base that exists regarding modes of viral transmission, historical evidence for the risk associated with aerosol-generating procedures and contemporaneous data from the COVID-19 pandemic. We identify a significant lack of data regarding the risk of transmission in the management of elective surgical patients, highlighting the urgent need for further research.

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence.

BACKGROUND: Emerging data highlights the potential role of cyclooxygenase (COX) inhibitors in the primary prevention of malignancy, reducing metastatic spread and improving overall mortality. Despite nonsteroidal anti-inflammatory drugs (NSAIDs) forming a key component of the WHO analgesic ladder, their use in cancer pain management remains relatively low. This review re-appraises the current evidence regarding the efficacy of COX inhibitors as analgesics in cancer pain, providing a succinct resource to aid clinicians' decision making when determining treatment strategies. METHODS: Medline® and Embase® databases were searched for publications up to November 2018. Randomised controlled trials (RCTs) and double-blind controlled studies considering the use of NSAIDs for management of cancer-related pain in adults were included. Animal studies, case reports, and retrospective observational data were excluded. RESULTS: Thirty studies investigating the use of NSAIDs in cancer pain management were identified. There is a lack of high-quality evidence regarding the analgesic efficacy of NSAIDs in cancer pain, with short study durations and heterogeneity in outcome measures limiting the ability to draw meaningful conclusions. CONCLUSIONS: Despite the renewed interest in these cost-effective, well-established medications in cancer treatment outcomes, there is a paucity of data from the past 15 yr regarding their efficacy in cancer pain management. However, when analgesic strategies in the cancer population are being formulated, it is important that the potential benefits of this class of drug are considered. Further work investigating the role of NSAIDs in cancer pain management is undoubtedly warranted.

High grade splenic rupture in an elite Rugby Union player.

The authors present the case of an amateur under-18 international squad Rugby Union player who sustained a Grade III splenic rupture while scoring a try. He was admitted to hospital and treated with strict bedrest following initial computed tomography (CT) evaluation. He maintained hemodynamic stability throughout and registered no drop in hemoglobin. A repeat CT scan five days later showed no radiological progression and he was discharged with instructions to avoid exercise for three months. A follow-up CT scan performed at 10 weeks after the injury showed radiological resolution but the decision was made to avoid physical contact for a further three months. The player made a full recovery and is now back playing representative rugby. This report reviews the management and raises the question as to when players should be allowed back to play contact sports following a splenic rupture.

The association between neck disability and jaw disability.

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

Erythritol and Lufenuron Detrimentally Alter Age Structure of Wild Drosophila suzukii (Diptera: Drosophilidae) Populations in Blueberry and Blackberry.

We report on the efficacy of 0.5 M (61,000 ppm) erythritol (E) in Truvia Baking Blend, 10 ppm lufenuron (L), and their combination (LE) to reduce egg and larval densities of wild populations of Drosophila suzukii (Matsumura) infesting fields of rabbiteye blueberries (Vaccinium virgatum) and blackberries (Rubus sp.). Formulations included the active ingredients (lufenuron, erythritol, or both), sugar (in control and erythritol treatments), and Dawn hand-soap applied to plants with pressurized 3-gallon garden spray tanks. The three chemical treatments (E, L, and LE) had no effect on D. suzukii ovipositing in blackberry and blueberry fruit, but they did reduce larval infestation by 75%, particularly densities of first and second instars. Erythritol and lufenuron were equally efficacious compounds as a D. suzukii ovicide and larvicide, but they did not display additive or synergistic activity. Extremely high larval mortality in control fruits show an age structure heavily skewed toward egg output.

The cross-sectional area of supraspinatus as measured by diagnostic ultrasound.

We have established a reference standard for the cross-sectional area (CSA) of supraspinatus as measured by diagnostic ultrasound. The influence of hand dominance and of ageing on the CSA was also assessed. We examined 72 subjects aged from 20 to 79 years. Standard values of the CSA were determined with a high measure of interobserver reliability. Although the CSA on the dominant side was significantly larger (p < 0.001) by 0.16 cm2 (95% CI 0.072 to 0.249) than that on the non-dominant side, this difference had no clinical significance. The CSA of supraspinatus decreased significantly with ageing.

A systematic review of physiotherapy for spondylolysis and spondylolisthesis.

The purpose of this systematic review was to assess the evidence concerning the effectiveness of physiotherapy intervention in the treatment of low back pain related to spondylolysis and spondylolisthesis. A literature search of published and unpublished articles resulted in the retrieval of 71 potential studies on the subject area. Fifty-two of the 71 articles were studies, and these studies were reviewed using preset relevance criteria. Given the inclusion and exclusion criteria chosen for this systematic review, there were very few acceptable studies and only two studies met the relevance criteria for the critical appraisal. Both studies provide evidence to suggest that specific exercise interventions, alone or in combination with other treatments, have a positive effect on low-back pain due to spondylolysis and spondylolisthesis; however, the type of exercise used was different in the two studies. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area; therefore, few conclusions can be made, and further research is warranted.

Electromyographic activity of the masticatory and cervical muscles during resisted jaw opening movement.

One of the relaxation techniques that have been used by physical therapists when treating patients with temporomandibular disorders, is the agonist contract-antagonist relax technique (AC). When the AC technique is applied, a submaximal resistance to the jaw opening movement is necessary to cause relaxation of the masticatory muscles. No information about the effect of this technique on masticatory or cervical muscles has been found in the literature. Thus, the aim of this study was to evaluate the electromyographic activity of the masseter and anterior temporalis and the upper trapezius and splenius capitis during resisted jaw opening movement. A convenience sample of 30 students was used. Electromyography activity of the superficial masseter, anterior temporalis, upper trapezius and splenius capitis was registered before, during and after the application of this resistive movement to jaw opening. A two-way anova with repeated measures analysis was used to analyse data. The level of significance was at alpha = 0.05. The EMG activity of both the masticatory muscles and the cervical muscles increased during and after the application of resisted jaw opening (P < 0.05). Based on the results obtained from this study, the behaviour of all muscles analysed (masseter, anterior temporalis, splenius capitis and upper trapezius) was similar. All muscles increased their activity when the resistance to the jaw opening movement was applied. Complex muscular interactions of the supra- and infrahyoid muscles (jaw openers), masticatory muscles, and cervical muscles may exist to stabilize the craniomandibular system during resisted jaw opening.

Does physical therapy have a role in fitness?

The author discusses the role of the physical therapist in fitness along with the interplay and communication necessary between the physician and therapist to ensure optimum care. The increased scientific knowledge of the physical therapist is also discussed.

Physiotherapy specialization in Canada: an update.

Because of a perceived need for specialization within the profession, the Canadian Physiotherapy Association (CPA) accepted the concept of specialization for physiotherapists, during its Annual General Meeting (AGM) in June 1985. A proposal concerning the implementation of specialization (termed the "Specialization Document"), will be presented to the 1986 AGM for approval by the Association's voting delegates. This paper provides a brief outline of the document's contents, including: the structure of the proposed Canadian College of Physiotherapy, which will oversee the certification process; the role of the CPA Divisions in establishing specialty councils; and the mechanism whereby certification will be granted, touching on such factors as eligibility for certification, evaluation of competence, recertification, and cost. The specialization document makes provision, in the initial stages of specialization, for an Implementation Committee, whose task will be to define the criteria necessary for the establishment of the College's standards for specialization and certification. Specialization does not mean that all therapists must become certified specialists; certification will neither prohibit nonspecialists from practising in a specified area nor relegate certified specialists to practising only in special areas in which they are certified. The CPA Board of Directors supports certification because it is designed to promote the highest quality of health care by physiotherapists, while promoting the growth of physiotherapy theory and practice through a critical evaluation of current and potential treatment methodology. Because of the many steps necessary for a careful and logical development of the specialization methodology, it is expected that final approval of the certification process will require many years to achieve.

Comparison of glenohumeral joint laxity in elite and recreational swimmers.

OBJECTIVE: To investigate whether glenohumeral joint (GHJ) hyperlaxity is related to swimming training volume, we evaluated elite and recreational swimmers for differences in GHJ laxity and general joint hypermobility (GJH). PARTICIPANTS: Thirty male and female elite swimmers, aged 15-25 years, were compared with 30 recreational swimmers on five clinical GHJ laxity tests. GJH was assessed based on evaluation of hypermobility in four other joints or joint combinations. OUTCOME MEASURES: Group differences in both GHJ laxity and GJH were analyzed using chi 2 analysis. RESULTS: Compared with the recreational swimmers, the elite swimmers demonstrated significantly greater GJH, as well as significantly greater GHJ laxity on three of five laxity tests. The specific patterns of greater GHJ laxity demonstrated by the elite swimmers versus the recreational swimmers favour an acquired origin for these laxity differences, while the results of the GJH assessment suggest that these laxity differences are inherent. CONCLUSIONS: It was concluded that a combination of acquired and inherent factors contributes to the greater GHJ laxity demonstrated in elite swimmers. We discuss the implications of this study for the prevention of shoulder overuse dysfunction (SOD) in elite swimmers.

Type IV hiatal hernia post laparoscopic Nissen fundoplication: report of a case.

A postoperative hiatal hernia is a rare but serious complication of fundoplication. We report herein a 62-year-old female who presented with abdominal pain and vomiting 2 years following laparoscopic Nissen fundoplication. At laparotomy, the stomach and the transverse colon were intrathoracic (type IV hiatal hernia); the esophageal hiatus was markedly dilated with no evidence that they had been approximated. At 18 months follow-up, she is doing very well apart from occasional heartburn. A high index of suspicion is needed to diagnose postoperative hiatal hernias. A routine closure of the crura with nonabsorbable suture material and an avoidance of iatrogenic pneumothorax may help to reduce the occurrence of this problem.

Importance and clarification of measurement properties in rehabilitation

OBJETIVO: O objetivo do presente artigo foi revisar criticamente os conceitos e tipos de confiabilidade, validade e responsividade de medidas, e discutir suas implicações para a pesquisa em reabilitação e para a prática clínica de qualidade.MÉTODO: Uma revisão crítica da literatura foi realizada considerando as vantagens, as limitações e o uso adequado das propriedades de medida em reabilitação.RESULTADOS E DISCUSSÃO: A qualidade das medidas é avaliada por critérios tais como confiabilidade, validade e responsividade. Muitos estudos publicados não apresentam estas propriedades de medida as quais estão relacionadas e algumas vezes sobrepõe-se sendo freqüentemente confundidas. Este artigo de revisão esclareceu os conceitos e tipos de confiabilidade, validade e responsividade. Exemplos relevantes para a área de reabilitação foram apresentados. Discutiu-se como as propriedades de medida interagem entre si e influenciam o tamanho do efeito e o poder dos estudos. CONCLUSÕES: Medidas são essenciais na pesquisa em reabilitação e na avaliação clínica. As propriedades de medida devem ser apresentadas para permitir que o leitor possa avaliar a qualidade dos resultados apresentados. Os esclarecimentos das propriedades de medida apresentados neste artigo podem contribuir para a padronização das definições e para a melhoria da qualidade da pesquisa em reabilitação e da prática clínica.

Fatores de risco no futebol: desproporçäo flexores/ extensores de torque no joelho e encurtamento muscular / Risk factors in football: flexor/extensor disproportion of knee torque and muscular shortening

Este trabalho tem dois objetivos: (a) determinar a relação entre extensiblidade muscular e distensões músculo-tendinosas e (b) identificar a relação entre a proporção de torque entre flexores/extensores (F/E) do joelho versus estiramento ligamentar do joelho e distensões nos membros inferiores (MIs). A extensibilidade muscular e o torque F/E do joelho de 62 jogadores amadores canadenses foram avaliados antes de um campeonato de futebol com duração de 6 meses. Vinte e duas lesões foram observadas prospectivamente durante o campeonato. Jogadores com encurtamento nos ísquio-tibiais sofreram mais distensões neste grupo muscular do que seus colegas. Jogadores com uma alta proporção F/E de torque no joelho, obtido com o dinamômetro isocinético Cybex II na velocidade de 30§ por segundo (§/s), sofreram um maior número de distensões nos Mis do que seus colegas. Os resultados desta pesquisa devem ser interpretados cuidadosamente devido ao pequeno número de lesões observadas. Entretanto, estes resultados serviram para alertar fisioterapeutas sobre fatores de risco que podem estar associados a uma alta incidência de lesões no futebol.