Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture.

OBJECTIVE: The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture. DESIGN: Assessor-blinded randomized controlled trial. PARTICIPANTS: Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture. Inclusion criteria were: they were able to weight-bear as tolerated or partial weight-bear, were referred for physiotherapy, and experienced pain. Ninety-one participants completed the study. METHODS: Participants were randomly allocated to receive manual therapy (anterior-posterior joint mobilization over the talus) plus a standard physiotherapy programme (experimental), or the standard physiotherapy programme only (control). They were assessed by a blinded assessor at baseline, and at 4, 12 and 24 weeks. The main outcomes were activity limitation and quality of life. Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks. RESULTS: There were no clinically worthwhile differences in activity limitation or quality of life between groups at any time-point. There was also no between-group difference in quality-adjusted life-years, but the experimental group incurred higher out-of-pocket costs (mean between-group difference = AU$200, 95% confidence interval 26-432). CONCLUSION: When provided in addition to a physiotherapy programme, manual therapy did not enhance outcome in adults after ankle fracture.     

Comparison of mechanical and electrical activity and interstitial cells of Cajal in urinary bladders from wild-type and W/Wv mice

Background and purpose:

W/W^v and wild-type murine bladders were studied to determine whether the W/W^v phenotype, which causes a reduction in, but not abolition of, tyrosine kinase activity, is a useful tool to study the function of bladder interstitial cells of Cajal (ICC).

Experimental approach:

Immunohistochemistry, tension recordings and microelectrode recordings of membrane potential were performed on wild-type and mutant bladders.

Key results:

Wild-type and W/W^v detrusors contained c-Kit- and vimentin-immunopositive cells in comparable quantities, distribution and morphology. Electrical field stimulation evoked tetrodotoxin-sensitive contractions in wild-type and W/W^v detrusor strips. Atropine reduced wild-type responses by 50% whereas a 25% reduction occurred in W/W^v strips. The atropine-insensitive component was blocked by pyridoxal-5-phosphate-6-azophenyl-2′,4′-disulphonic acid in both tissue types. Wild-type and W/W^v detrusors had similar resting membrane potentials of −48 mV. Spontaneous electrical activity in both tissue types comprised action potentials and unitary potentials. Action potentials were nifedipine-sensitive whereas unitary potentials were not. Excitatory junction potentials were evoked by single pulses in both tissues. These were reduced by atropine in wild-type tissues but not in W/W^v preparations. The atropine-insensitive component was abolished by pyridoxal-5-phosphate-6-azophenyl-2′,4′-disulphonic acid in both preparations.

Conclusions and implications:

Bladders from W/W^v mice contain c-Kit- and vimentin-immunopositive ICC. There are similarities in the electrical and contractile properties of W/W^v and wild-type detrusors. However, significant differences were found in the pharmacology of the responses to neurogenic stimulation with an apparent up-regulation of the purinergic component. These findings indicate that the W/W^v strain may not be the best model to study ICC function in the bladder.     

A profile of the online dissemination of national influenza surveillance data

Background  

Influenza surveillance systems provide important and timely information to health service providers on trends in the circulation of influenza virus and other upper respiratory tract infections. Online dissemination of surveillance data is useful for risk communication to health care professionals, the media and the general public. We reviewed national influenza surveillance websites from around the world to describe the main features of surveillance data dissemination.     

Cost and utilisation of healthcare resources during rehabilitation after ankle fracture are not linked to health insurance, income, gender, or pain: an observational study

Question: What are the costs and utilisation of healthcare resources, their determinants, and quality of life for people attending outpatient physiotherapy after ankle fracture? Design: Longitudinal observational study. Participants: Ninety-four adults (2 dropouts) following cast removal after isolated ankle fracture attending outpatient physiotherapy at three hospitals in Sydney, Australia. Outcome measures: Costs incurred (direct healthcare costs and out-of-pocket costs) and utilisation of healthcare system resources were measured at 4, 8, 12, 16, 20, and 24 weeks. Quality of life was measured shortly after cast removal and at 4, 12, and 24 weeks. Factors known to influence costs and utilisation in other conditions (private health insurance, income level, gender, and pain) were also measured. Results: The total cost per person was AUD 735 (SD 876) over 24 weeks. Outpatient physiotherapy accounted for the highest costs in both direct healthcare (39%) and out-of-pocket (42%) costs. Less than 20% of participants sought private non-medical care in addition to receiving outpatient physiotherapy. None of the factors investigated had a significant influence on costs and utilisation. Quality of life score improved over the 24 weeks by a mean of 6.1 points out of 45 (95% CI 5.2 to 6.9), with most of the improvement occurring in the domain of independent living. Conclusion: Information on costs and utilisation of healthcare resources can be used to plan health services, eg, the number of physiotherapy sessions required after ankle fracture. Private health insurance, income level, gender, or pain did not influence the costs or the decision behind seeking care over and above publicly-provided physiotherapy.     

Association of seborrhoeic warts with skin cancer in renal transplant recipients**

Background Renal transplant recipients (RTR) have a well recognized increased risk of cutaneous malignancy. A clinical observation that RTR with skin cancer often had multiple seborrhoeic warts prompted an investigation in RTR into the relationship between seborrhoeic warts and skin cancer and an exploration into potential risk factors for seborrhoeic warts in this population, including infection with human papillomavirus (HPV). Methods This was a case control study involving 308 RTR. Clinical examinations identified seborrhoeic warts. Histological records reviewed to look for evidence of prior cutaneous malignancy. Seroprevalence of antibodies to 34 different HPV types tested using multiplex serology. Odds ratios (OR) calculated using unconditional logistic regression analysis to look for associations between skin cancer, HPV infection and seborrhoeic warts, controlling for potential confounding factors of gender, age and time since transplantation. Results Seborrhoeic warts were associated with non‐melanoma skin cancer [OR = 3.7; 95% confidence intervals (CI) ranging from 1.6–8.9; P = 0.002] when confounding factors of gender, age and time since transplantation were controlled for. There was also an association between seborrhoeic warts and viral warts (OR = 3.0, CI: 1.6–5.4; P < 0.0001), but no association between seborrhoeic warts and infection with single or multiple HPV types. Conclusions Seborrhoeic warts are associated with cutaneous malignancy, but not with any of the HPV types tested. The reasons for this association are unclear. RTR with multiple seborrhoeic warts may require more regular cutaneous examination to monitor for early signs of skin cancer.