Exercise and Fall Prevention: Narrowing the Research‐to‐Practice Gap and Enhancing Integration of Clinical and Community Practice

Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence‐based, exercise‐focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence‐based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence‐to‐practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs.     

Physical therapists’ self-perceived adequacy of entry-level education and their current confidence levels with respect to temporomandibular disorders: A pilot study

ABSTRACT

Objective

Physical therapy (PT) has been shown to be one of the most effective conservative treatments for temporomandibular disorders (TMD). The objectives of this pilot study are to determine the self-perceived knowledge, adequacy of entry-level education, and the current confidence levels of PTs in Florida regarding TMD treatment.     

国产雷帕霉素洗脱支架治疗急性冠状动脉综合征：安全性和临床有效性

目的:分析国产雷帕霉素洗脱支架治疗急性冠状动脉综合征的安全性和有效性。方法:选择2004-11/2006-02在河北大学附属医院接受冠状动脉介入治疗的急性冠状动脉综合征患者102例,其中ST段抬高型心肌梗死54例,非ST段抬高型心肌梗死28例,不稳定型心绞痛20例。根据血管情况置入国产雷帕霉素药物洗脱支架(Firebird支架),支架选择原则为:支架长度应覆盖病变两端;血管直径:支架直径=1∶1.1。所有患者术前3d均口服阿司匹林100mg,氯吡格雷75mg,术中推注肝素8000￣10000U,手术每延迟1h,补充肝素1000u,术后皮下注射低分子肝素5￣7d;服用氯吡格雷75mg,1次/d,共服用9￣12个月,并长期服用阿司匹林100mg,1次/d。随访情况:术后6个月时随访64例;7个月时随访26例;8个月时随访12例;平均随访6.8个月,患者出院后定期进行门诊随访,记录一般情况及严重心脏不良事件(包括急性、亚急性、迟发支架内血栓形成;再发心肌梗死;急诊冠状动脉旁路移植术;死亡),术后6￣8个月行冠状动脉造影评价支架内再狭窄情况。并观察材料及宿主反应。结果:102例患者经皮冠状动脉介入治疗治疗均获得成功,共治疗靶血管102支,置入Firebird支架116枚,术中3例ST段抬高型心肌梗死患者出现无复流现象,2例发生室颤,电转复恢复窦性心律,3例因分支受压,出现心绞痛症状。术后4例出现穿刺部位血肿,经重新加压压迫后好转。随访6￣8个月所有患者未发生严重心血管事件;42例(41.2%)患者术后6￣8个月行冠状动脉造影复查,无一例发生支架内再狭窄。随访期间所有患者无全身毒性及超敏反应发生,生物相容性好。结论:国产药物洗脱支架治疗急性冠状动脉综合征安全,有效。     

The predictive value of intraoperative KT-1000 arthrometer measurements in single incision anterior cruciate ligament reconstruction

We reviewed 28 patients who underwent anterior cruciate ligament reconstruction with immediate, 1-, 2-, and 3-year postreconstruction KT-1000 manual maximum testing. Arthrometer measurements were correlated with functional knee criteria to evaluate the ability of the KT-1000 to predict postreconstruction functional results. Despite a range of immediate postreconstruction arthrometer injured-minus-normal (I - N) differences, there was no association with I - N difference at last follow-up. Patients followed-up for 1 year were not different from those who were followed-up for longer with respect to intraoperative or 1-year I - N difference or functional performance scores. Furthermore, excellent functional knee scores were the norm at all stages of follow-up despite a wide range of arthrometric laxity changes. The results suggest that functional knee criteria, although partially subjective, are more useful indicators of outcome than intrareconstruction and postreconstruction arthrometric measures.     

Lower limb ischaemia and reperfusion alters gut permeability.

The gut may be important in the aetiology of multiple organ failure (MOF) by amplifying of the inflammatory response to trauma. We investigated the effects of the reperfusion of ischaemic lower limbs on gut permeability. Male Wistar rats (n = 30) were randomised to (group 1) controls; (group 2) 3 h bilateral hind-limb ischaemia alone; or 3 h ischaemia followed by (group 3) 15 min reperfusion or (group 4) 2 h reperfusion. Gut permeability and plasma endotoxin were measured prior to tourniquet application, immediately before tourniquet release, and following reperfusion. To evaluate the effect of the hypotension that follows tourniquet release, (group 5) sodium nitroprusside was infused in further controls to maintain mean arterial pressure (MAP) at 75 mmHg for 2 h. Horseradish peroxidase was instilled into the isolated ileo-caecal loop 15 min before the animals were killed to measure permeability of horseradish peroxidase through mucosal intercellular tight junctions by electron microscopy. Mean arterial pressure increased from 105 +/- 5 mmHg to 136 +/- 4 mmHg on tourniquet application and fell to 79 +/- 7 mmHg following reperfusion (p less than 0.05). In group 1 (controls), group 2 (ischaemia alone animals) and group 5 (ischaemia and nitroprusside) one animal out of six demonstrated permeability to horseradish peroxidase. Following reperfusion, horseradish peroxidase permeability had not developed by 15 min (group 3) but was present in all animals by 2h (group 4) (p = 0.015 Fisher's exact test). Plasma endotoxin increased from 21.8 +/- 2.0 pg ml-1 to 30.7 +/- 2.6 pg ml-1 following 2 h reperfusion (p less than 0.05 Scheffe F-test).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

ObjectiveTo investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression.MethodsThe study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO₂) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO₂ and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching.FindingsOf 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO₂: 90–93%) in 13.1% (108/826) and severe (SpO₂: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5–4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality.ConclusionPresumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.