Isolated specialist or system integrated physician – different views on sickness certification among orthopaedic surgeons: an interview study

Background  

Sickness certification is a frequent and sometimes problematic task for orthopaedic surgeons.     

Triptans induce vasoconstriction of human arteries and veins from the thoracic wall

A common side effect of migraine treatment with triptans is chest symptoms. The origin of these symptoms is not known. The aim of the present study was to examine the vasocontractile effect of triptans in human arteries and veins from the thoracic wall and in coronary artery bypass grafts. In vitro pharmacology experiments showed that the 5-hydroxytryptamine (5-HT) type 1B and 1D receptor agonists, eletriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan, induced vasoconstriction in the thoracic blood vessels from 38% to 57% of the patients. 5-carboxamidotryptamine (5-CT) and sumatriptan elicited a vasoconstriction that was antagonized by the 5-HT1B receptor antagonist SB224289, whereas the 5-HT1D receptor antagonist BRL115572 had no effect. 5-HT induced a contraction that was inhibited by the 5-HT2A receptor antagonist ketanserin. 5-HT2A, 5-HT1B, and 5-HT1D receptor mRNA levels were detected by real-time PCR in all blood vessels studied. In conclusion, triptans induce vasoconstriction in arteries and veins from the thoracic wall, most likely by activation of 5-HT1B receptors. This response could be observed in only 38% to 57% of the patients, which may provide an explanation for why a similar number of patients experience chest symptoms as a side effect of migraine treatment with triptans.     

Physical function and quality of life after thoracoabdominal oesophageal resection. Results of a follow-up study

BACKGROUND: The long-term functional outcome after thoracoabdominal resection has to be better evaluated. A study was performed to evaluate patients after a similar operation both in terms of physical function and health-related quality of life (HRQL). METHODS: Eighteen patients were evaluated 2 years after a thoracoabdominal resection. Respiratory function, physical performance and range of motion in shoulder, thorax and spine were recorded. HQRL was assessed by EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) and EORTC QLQ-OES18 (Oeophageal module). RESULTS: Two years after surgery, respiratory function (forced vital capacity and forced expiratory volume in 1 s) was significantly impaired compared to preoperative values (p < 0.05). The physical performance was significantly reduced as measured by a functional stand-up test (p < 0.05) and the handgrip force (p < 0.001). Shoulder range of motion, thoracic lateral flexion and C7 to wall were within normal ranges, thoracic flexion significantly greater (p < 0.01) but chest expansion significantly decreased (p < 0.01) compared to controls. HQRL was comparable to age- and sex-matched population norms for most of the functions. A clinical significant difference was, however, found for diarrhoea, dyspnoea, appetite loss and fatigue. CONCLUSION: Within a 2-year period, each individual regains most of the respiratory and physical performances and HRQL after a thoracoabdominal resection.     

Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel

Based on two research projects in Sweden during the 1990s, the aim of this study was to identify former nursing personnel's main reasons for leaving nursing care, and to find out under what circumstances they would consider returning. Two open-ended questions in a questionnaire were analysed. The results showed that different aspects of working conditions, mainly working schedule, management and status of profession were the dominating reasons both for leaving and considering a return. The findings indicate that interventions required for retaining personnel in nursing care need to be addressed both at the political and at the local level.     

Lateral collateral ligament ankle injuries in young athletic individuals.

1. Eleven cases of surgical repair of acute tears of the capsule, anterior talo-fibular, and calcaneo-fibular ligaments of the ankle in young athletic individuals are reported. 2. Diagnosis was made by clinical examination and stress X-rays and confirmed by arthrography in selected cases. All of the ligament ruptures were visualized at surgery. 3. Post-surgery, all of the patients had a stable ankle and were able to return to vigorous athletic endeavors without disability. 4. This study lends support to the impression that surgical repair of severe lateral collateral ankle ligament injuries in young athletic individuals leads to a functionally and mechanically stable ankle able to withstand severe stress without disability.     

"Everybody's Different": a primary prevention program among fifth grade school children

The aim of the present study was to assess the efficacy and effectiveness of the primary prevention program “Everybody's Different” among fifth grade school children. Pre and post measurements were made in both the intervention and control groups regarding body image, weight concern, emotional well-being, attitudes and behaviors associated with disordered eating, self-esteem, anxiety, and depression. The study did not result in any significant improvements regarding self-esteem, eating attitudes, or body image. The prevention program does not seem to be effective for children in grade five in its present form. Further research on and development of primary prevention programs is needed.     

Hypoxic preconditioning confers long-term reduction of brain injury and improvement of neurological ability in immature rats

Exposure to preconditioning (PC) hypoxia 24 h before a severe hypoxic-ischemic (HI) insult reduces development of injury in the immature brain. Several protective regimens have proved effective in the short-term but not in the long-term perspective. The aim of the present study, therefore, was to evaluate the PC effect on long-term morphologic and neurologic outcome in the developing brain. Six-day-old rats were subjected to hypoxia (36 degrees C, 8.0% O2; PC/HI group) and sham controls to normoxia (36 degrees C; HI group) for 3 h. Twenty-four hours later, all rats were exposed to cerebral HI produced by unilateral carotid artery occlusion combined with 1 h, 15 min of hypoxia (36 degrees C, 7.7% O2). A cylinder test was used to evaluate forelimb asymmetry to determine sensorimotor function at 4, 6, and 8 wk of age. Spatial/cognitive ability was assessed by Morris water maze trials at 7 wk of recovery. Neuropathologic analysis was performed 8 wk after insult. Brain damage was reduced (p<0.0001) in PC/HI (45.0+/-11.1 mm3) in comparison with HI (159.3+/-12.2 mm3) rats. A bias for using the ipsilateral forelimb in wall movements was observed in the cylinder test in HI compared with PC/HI rats at 4 (p<0.001), 6 (p<0.01), and 8 (p<0.0001) wk of age. Results of the Morris water maze test revealed differences (p<0.0001) in average path length between groups on the third and fourth day of trials. Hypoxic PC before HI reduced brain injury by 72% at 8 wk after the insult and provided long-term improvement of sensorimotor and spatial/cognitive functions.