Current management of isolated sternal fractures in the UK: Time for evidence based practice? A cross-sectional survey and review of literature

Routine admission of patients with isolated sternal fractures for observation is still widespread in the UK. However, the evidence appears to suggest that this is unnecessary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK. We contacted 85 acute admitting units over a three-month period and were able to get a response from 67 units. Most of the hospitals were district general hospitals (52) and situated in England (49). The orthopaedic department was the most common admitting department. 51 units indicated that they regularly admit isolated sternal fractures for observation. Other indications for admission included pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals performed ECG and cardiac enzyme tests prior to admission and 6 hospitals carried out echocardiogram following admission on a regular basis. Patients were not followed up on discharge. 2 hospitals with on-site cardiothoracic unit followed-up patients on discharge, and 1 hospital advised GP follow-up. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. The current practice of management of isolated sternal fractures in the UK does not appear to conform to available evidence. In order to decide on management plans based on more rigorous evidence, there is a need for a prospective double blind randomised study of patients with isolated sternal fractures, comparing those discharged to those admitted over a longer follow-up period.     

Knowledge,Attitudes and Practices Related to African Swine Fever Within Smallholder Pig Production in Northern Uganda

Uganda is a low‐income country with the largest pig population in East Africa. Pig keeping has a large potential, commercially and as a tool for poverty reduction, but African swine fever (ASF) is a major hurdle for development of the sector. The objective of this study was to evaluate knowledge, attitudes and practices related to ASF in the smallholder pig production value chain in northern Uganda. The study included three separate series of participatory rural appraisals (PRA), comprising purposively selected farmers and other actors in the pig production value chain. In the PRAs, various participatory epidemiology tools were used. A total of 49 PRAs and 574 participants, representing 64 different villages, were included. The results indicate that participants were well aware of the clinical signs of ASF, routes for disease spread and measures for disease control. However, awareness of the control measures did not guarantee their implementation. A majority of middlemen and butchers acknowledged having sold live pigs, carcasses or pork they believed infected with ASF. Outbreaks of ASF had a strong negative impact on participants’ socio‐economic status with loss of revenue and reversal into more severe poverty. In conclusion, lack of knowledge is not what is driving the continuous circulation of ASF virus in this setting. To control ASF and reduce its impact, initiatives that stimulate changes in management are needed. Because the behaviour of all actors in the value chain is largely influenced by the deep rural poverty in the region, this needs to be combined with efforts to reduce rural poverty.     

Reference data for bone speed of sound measurement by quantitative ultrasound in healthy children

Introduction The aim of the study was to establish reference data for tibia and radius bone ultrasonic speed of sound (SOS) measurement in our pediatric population, and to compare the results with original (built-in) reference data. We also investigated the relationship between SOS Z-scores and anthropometric parameters and bone markers. Method SOS was measured in 463 healthy children (1–16 years) for the tibia and radius using Omnisense 7000 device (Sunlight Medical Inc., Israel). Height, weight, calcium intake, serum alkaline phosphatase and osteocalcin concentrations were obtained. Results Age- and gender-specific mean speed of sound (SOS) values that describe SOS changes at the tibia and radius were demonstrated. Reference data obtained in our population was very similar to the built-in reference data obtained in Israeli children except for the slightly lower radial SOS values in our population after 8 years of age. A triphasic pattern was observed with a steep increase in SOS values at 0–6 year and at puberty, with a steady period during childhood for both genders at both sites. SOS Z-scores obtained in both measurement sites showed good agreement (girls r=0.40, p<0.0001; boys r=0.33, p<0.0001). No correlation was detected between SOS Z-score and height SDS, calcium intake or osteocalcin levels. SOS Z-score correlated negatively with weight SDS in girls and serum alkaline phosphatase in boys. Conclusion We report the reference data for SOS in healthy Turkish children, which are very similar to that obtained in Israeli children, suggesting a consistency of SOS across ethnicities.     

C-reactive protein as an available biomarker determining mental component of health-related quality of life among individuals with spinal cord injury

Objectives: C-reactive protein (CRP) has been shown to correlate with health-related quality of life (HRQL) in some chronic medical conditions. However, these associations have not yet described in spinal cord injury (SCI). In this study, we tried to identify biomarkers associated with HRQL in SCI.

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: Referred patients to Brain and Spinal Cord Injury Research Center between November 2010 and April 2013.

Outcome Measure: Blood samples were taken to measure circulatory CRP, leptin, adiponectin, ferritin, parathyroid hormone, calcitonin, thyroid hormones, fasting plasma glucose and lipid profile. All the analyses were performed with adjustment for injury-related confounders (level of injury, injury completeness and time since injury) and demographic characteristics. HRQL was measured with Short Form health survey (SF-36).

Results: The initial inverse association between CRP and total score of SF-36 (P: 0.006, r?=??0.28) was lost after adjustment for confounders. However, the negative correlation between CRP and Mental Component Summary (MCS) remained significant (P: 0.0005, r?=??0.38). Leptin level was inversely correlated with Physical Component Summary (PCS) (P: 0.02, r?=??0.30).

Conclusion: Although CRP and leptin levels were not related with total scores of SF-36 questionnaire, CRP can be more useful in determining mental component of HRQL whereas leptin can be a determinant of physical component. The combined consideration of these two biomarkers may help to predict HRQL in individuals with SCI.     

肝移植受者生存质量现状及影响因素分析

目的调查肝移植受者生存质量现状,并探讨其影响因素。 方法选取2017年12月在中山大学附属第一医院器官移植科复查的115例肝移植受者,使用一般资料问卷和简明健康调查(SF-36)量表进行调查。采用独立样本t检验比较肝移植组与常模对照组SF-36量表各维度得分,采用单因素方差分析比较不同学历等人口社会学及临床相关资料对生存质量的影响,组间两两比较采用LSD法。计数资料采用频数和构成比表示。P<0.05为差异有统计学差异。 结果共发放问卷115份,回收有效问卷108份,有效回收率93.9%。108例肝移植受者生存质量总分平均为(592±138)分,其中PCS得分平均为(286±71)分,MCS得分平均为(306±75)分;生理机能维度得分最高[(86±14)分],生理职能维度得分最低[(55±42)分]。肝移植受者生理机能、生理职能、躯体疼痛、社会功能和情感职能5个维度得分均低于常模,差异均有统计学意义(t＝3.78、6.05、5.54、1.61和0.36,P均<0.01)。以SF-36量表中PCS和MCS作为因变量,分析肝移植受者人口社会学及临床相关资料对生存质量的影响。结果显示,性别、文化程度、月收入、术后生存时间以及术后有无再就业是肝移植受者生存质量的影响因素(P均<0.05)。 结论肝移植受者生存质量还有待提高。医护人员应多关注女性、文化程度较低、月收入较低、术后生存时间<1年、术后未再就业的肝移植受者,提高其生存质量。     

Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India

BackgroundWe evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India.MethodsAn online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019.Results173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12 months, and 49.1% had assessed children with DDH aged > 2 years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays.ConclusionsIn India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners.Electronic supplementary materialThe online version of this article (10.1007/s43465-020-00233-0) contains supplementary material, which is available to authorized users.     

The role of osteopathy in clinical care: Broadening the evidence-base

Osteopathy is a system of health care practiced in various countries throughout the world that focuses on osteopathic manual techniques as a cornerstone of patient care. However, we still know little about the practice, role and use of osteopathy within the broader health system in most countries. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with core stakeholders including health consumers, osteopaths, other health professionals, and policymakers and funding bodies. The development of a rigorous health services research agenda around this topic has much to offer and the framework outlined here is offered with the hope of inspiring a broader field of inquiry into osteopathy in the clinical care setting.     

Predictors of bariatric surgery among an interested population

BackgroundSeverely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process.MethodsA 64-item survey was developed to assess factors in the decision-making process for bariatric surgery. The survey included the decisional conflict scale, decision self-efficacy scale, EuroQol 5D, and the standard gamble. Patients were recruited from a regularly scheduled bariatric surgery interest group meeting associated with a large, university-based bariatric practice and administered a survey at the conclusion of the interest group. Logistic regression models were used to predict who pursued or still planned to pursue surgery at 12 months.Results200 patients were recruited over an 8-month period. Mean age was 45 years; mean BMI was 48 kg/m², and 77% were female. The 12-month follow-up rate was 95%. At 12 months, 33 patients (17.6%) had surgery and 30 (16.0%) still planned to have surgery. There was no association between age, gender, or obesity-associated conditions and surgery or plan to have surgery. Patients having surgery or still planning to have surgery had significantly worse scores for quality of life and better scores for decisional conflict (indicating readiness to make a decision).ConclusionThe decision to have bariatric surgery is strongly associated with patientsʼ perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. Interestingly, factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patientsʼ decisions.     

番禺区大石街农村妇女乳腺癌患病率及乳腺癌预防知信行调查分析

目的：通过对番禺区大石街农村妇女的乳腺癌患病率及乳腺癌预防知信行的调查结果,分析番禺区农村妇女乳腺癌预防的现状及存在问题,为有关机构及部门如何制定对策,预防农村妇女乳腺癌的发生发展提供参考依据。方法采用随机整群抽样法,通过乳腺检查及乳腺癌预防知信行问卷调查的方式,调查番禺区大石街1428名农村妇女乳腺癌患病率及乳腺癌预防的知信行现状,回收有效问卷1420份。结果受调查者对乳腺癌的12项危险因素平均知晓率为42.25%,乳腺癌的5项征兆的平均知晓率为41.06%;对乳腺癌预防的3项态度调查,同意及非常同意的平均占89.74%,不一定及不同意的平均占10.26%;乳腺彩超或X线检查中从未检查的13.73%,定期检查的18.31%,乳腺自检中从未自检的37.75%、定期自检的仅0.99%;乳腺癌患病率为0.14%,其他乳腺疾病以乳腺增生和乳腺囊肿为主,患病率依次为29.44%、6.55%。结论番禺区大石街农村妇女对乳腺癌预防基本知识的知晓率低,约10%对乳腺癌预防持消极态度,乳腺定期检查率低,乳腺癌及其他乳腺疾病患病率较高。社区卫生服务机构及其主管部门应针对存在问题制定对策,有效防控农村妇女乳腺癌的发生发展。     

知信行理论模式用于急诊科护士的患者自杀风险培训

目的探讨知信行理论模式用于急诊科护士患者自杀风险培训的效果。方法组建自杀风险教育多学科团队,采用知信行理论模式对143名急诊科护士进行为期3个月的患者自杀风险培训,比较培训前后护士的自杀态度和自杀护理行为。结果培训后,急诊科护士自杀态度总分及3个维度得分显著低于培训前,自杀护理行为得分显著高于培训前(P0.05,P0.01)。结论知信行理论模式用于急诊科护士患者自杀风险培训可有效改善护士对自杀的态度,规范其患者自杀护理行为。     

洛阳市维持性血液透析患者生活质量调查及影响因素分析

目的 通过对洛阳市维持性血液透析(maintenance hemodialysis,MHD)患者的生活质量进行调查,分析影响MHD患者生活质量的因素,为改善MHD患者生活质量提出依据.方法 采用质量调查问卷(Short-Form 36 Health Survey Questionnaire,SF-36)生活质量量表对洛阳市第一人民医院、洛阳市中心医院、河南科技大学第一附属医院、河南科技大学第三附属医院、解放军150医院、洛阳市第一中医院、洛阳市第二中医院352例MHD患者进行问卷调查,计算血液透析患者生活质量得分,与健康常模进行比较,分析影响MHD患者生活质量的因素.结果 研究组患者SF-36量表8个维度的得分显著低于健康常模(P＜0.05).MHD患者生活质量与性别、年龄、透析龄、血红蛋白、透析充分性(Kt/V)等因素有关.结论 MHD患者生活质量明显低于健康人群,年龄、性别、透析龄、血红蛋白、Kt/V是影响MHD患者生活质量的重要因素,改善这些因素有望提高MHD患者的生活质量.     

Fertility concerns among breast cancer patients in Mexico

ObjectiveYoung women represent a high proportion of the total number of breast cancer (BC) patients in Mexico; however, no previous studies addressing their attitudes regarding the risk of chemotherapy-induced infertility and its contributing factors are available. The aim of this study was to evaluate the concerns of young women with BC towards the risk of infertility in two referral centers in Mexico with access to public health services.MethodsA cross-sectional study including women with newly or previously detected BC aged 40 years or younger at diagnosis was conducted. Variables regarding concerns about fertility were collected from an adapted version of the Fertility Issues Survey.Results134 consecutive eligible women responded to the in-person paper survey. 55% were partnered, 35.1% had no children, and 48% reported willingness to have children prior to BC diagnosis. Only 3% of patients considered to be able to afford extra expenses. At diagnosis, 44% of women expressed some level of concern about infertility risk. The only factor significantly associated with fertility concern was the desire of having children prior to diagnosis (OR 11.83, p = 0.006). Only 30.6% patients recalled having received information regarding infertility risk from their physicians.ConclusionA minority of young women with breast cancer in Mexico is informed about the risk of BC treatment-induced infertility, despite substantial interest. Informing all patients about infertility risk and available options for fertility preservation should be an essential aspect of the supportive care of young women with BC, even in low-middle income countries such as Mexico.     

Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India

BackgroundYoung (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying.MethodsThe YBC treated with a curative intent between 2015 and 2016 at our institute were analysed.ResultsThere were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients.ConclusionMore than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.     

A status report on management of cleft lip and palate in India

Introduction:

This national survey on the management of cleft lip and palate (CLP) in India is the first of its kind.

Objective:

To collect basic data on the management of patients with CLP in India for further evaluation.

Materials and Methods:

A proforma was designed and sent to all the surgeons treating CLP in India. It was publicized through internet, emails, post and through personal communication.

Subjects:

293 cleft surgeons representing 112 centers responded to the questionnaire. Most of the forms were filled up by personal interview.

Results:

The cleft workload of the participating centers is between 10 and 2000 surgeries annually. These centers collectively perform 32,500–34,700 primary and secondary cleft surgeries every year. The responses were analyzed using Microsoft excel and 112 as the sample size. Most surgeons are repairing cleft lip between 3-6 months and cleft palate between 6 months to 1 year. Millard and Tennison repairs form the mainstay of lip repair. Multiple techniques are used for palate repair. Presurgical orthopedics, lip adhesion, nasendoscopy, speech therapy, video-fluoroscopy and orthognathic surgery were not always available and in some cases not availed of even when available.

Conclusion:

Management of CLP differs in India. Primary surgical practices are almost similar to other studies. There is a lack of interdisciplinary approach in majority of the centers, and hence, there is a need for better interaction amongst the specialists. A more comprehensive study with an improved questionnaire would be desirable.     

The assessment of clinical practice in osteopathic education: Is there a need to define a gold standard?

In the United Kingdom, assessment of clinical practice in medical education has proved to be a consistently difficult process. Central to these difficulties are issues surrounding the validity, reliability and feasibility of assessment of clinical practice that accurately reflect student abilities, whilst also representing ‘real life’ examples of patient care. Currently there is no consensus as to what might be regarded as best practice in clinical assessment within UK general medicine.Osteopathic institutions within the UK have an educational, professional and ethical obligation to ensure that their assessment satisfies all these criteria. However, it is arguable that there is also a need to ensure that standards exist between schools so that all students graduating from different programmes are comparably assessed to a standard that may be valid and reliable. Although the framework exists for the development of consensus for clinical assessment for osteopaths in the UK, there has been no formal discussion within the profession to date. A constructive and pragmatic approach in identifying a suitable standard in clinical education in the UK may be to identify best practice between schools as to how the assessment of students may be delivered, and then to identify how best to ensure that this assessment is consistently and appropriately delivered across schools.