Bristol Regional Medical Center

Early cervical spine immobilisation (CSI) has long been a critical component of the pre-hospital management of traumatic injuries with possible spinal cord injury. CSI aims to stabilise the spine to prevent worsening an unstable injury. There is conflicting evidence regarding its effectiveness, and concerns exist about the potential risks, including neurological damage, respiratory compromise, and difficulty performing intubation. This article will review the relevant literature to assess whether CSI should continue to be used routinely in pre-hospital trauma care. A literature review was conducted using the Web of Science, Cinahl, Embase, Medline and Cochrane databases, and manual searches of reference lists. Articles published after 2010 were included. Selection was based on the title and abstract, followed by a full-text review. No studies directly compare outcomes between immobilisation and non-immobilisation, hence, it is difficult to determine whether the benefits outweigh the risks. The potential adverse effects of CSI have been more robustly evidenced than the benefits of CSI. Therefore, CSI may not be appropriate for routine use and should be limited to patients at higher risk of an unstable spinal injury. Further research is necessary to assess whether CSI reduces morbidity and mortality of spinal injuries.

In multi-site studies, it is common for some sites not to have recorded key variables. Although it is theoretically pos- sible to use data from sites with recorded observations to impute the missing values, this process becomes challenging when data pooling is not feasible due to logistic or legal constraints. We therefore propose a multiple imputation approach, cross-site imputation, to recover any variables across sites without the need to pool individual-level data. The solution involves transporting predicted regression coefficients and variances from studies with observed data to impute missing variables at sites without data. The approach is illustrated in an applied example of recovering confounders across Swedish hospitals, and theoretical considerations are outlined. Given the increasing importance of multi-site studies in observational research, cross-site imputation could offer a practical approach for imputing variables that have not been recorded in some study sites.

ObjectiveTo provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy.DesignLiving systematic review and network meta-analysis.Data sourcesMultiple databases including grey literature sources were searched up to February 2019.Study eligibility criteriaRandomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures.Data extraction and synthesisReviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence.Primary outcome measureThe validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire.Results29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy.Summary/conclusionIn our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme.PROSPERO registration numberCRD42018086467.

ObjectiveFamilial hypercholesterolaemia (FH) elevates low-density lipoprotein cholesterol (LDL-C) and increases cardiovascular disease (CVD) risk. This study aimed to provide evidence for the feasibility of conducting a randomised controlled trial to evaluate the efficacy of an intervention designed to improve diet and physical activity in families with FH.DesignA parallel, randomised, waitlist-controlled, feasibility pilot trial.SettingThree outpatient lipid clinics in the UK.ParticipantsFamilies that comprised children (aged 10–18 years) and their parent with genetically diagnosed FH.InterventionFamilies were randomised to either 12-week usual care or intervention. The behavioural change intervention aimed to improve dietary, physical activity and sedentary behaviours. It was delivered to families by dietitians initially via a single face-to-face session and then by four telephone or email follow-up sessions.Outcome measuresFeasibility was assessed via measures related to recruitment, retention and intervention fidelity. Postintervention qualitative interviews were conducted to explore intervention acceptability. Behavioural (dietary intake, physical activity and sedentary time) and clinical (blood pressure, body composition and blood lipids) outcomes were collected at baseline and endpoint assessments to evaluate the intervention’s potential benefit.ResultsTwenty-one families (38% of those approached) were recruited which comprised 22 children and 17 adults with FH, and 97% of families completed the study. The intervention was implemented with high fidelity and the qualitative data revealed it was well accepted. Between-group differences at the endpoint assessment were indicative of the intervention’s potential for improving diet in children and adults. Evidence for potential benefits on physical activity and sedentary behaviours was less apparent. However, the intervention was associated with improvements in several CVD risk factors including LDL-C, with a within-group mean decrease of 8% (children) and 10% (adults).ConclusionsThe study’s recruitment, retention, acceptability and potential efficacy support the development of a definitive trial, subject to identified refinements.Trial registration numberISRCTN24880714.

Background: Subxiphoid incisional hernias are one of the complications following a median sternotomy, a surgical procedure to provide access to the mediastinum. Incidence has been reported between 1-4%, although the true incidence is not well known due to its asymptomatic nature. Method: A comprehensive search was performed on multiple sites. Keywords included “incisional hernia OR Subxiphoid hernia” AND “Median sternotomy OR Cardiac Surgery OR Coronary artery bypass graft OR Transplant OR Valve replacement”. Articles up to 1st of August 2020 were included in this study. Results: 8 articles were included in the study, with a total number of 132 patient identified. The incidence ranged from 0.81% to 3.44%. There was a mixture of repair method and follow up period reported. Recurrence post-repair ranged from 10% to 43%. Conclusion: Subxiphoid incisional hernias remains challenging to manage. We have discussed the incidence, risk factors, preventions, and management of subxiphoid incisional hernias including both the open and laparoscopic technique.

This study examined the stability of concentrated sodium nitroprusside infusions during administration by a motorized syringe-pump system. Sodium nitroprusside and the free-cyanide degradation product were determined in infusion samples collected over periods of up to 24 h. Measures which were taken to protect the delivery system from light, ensured satisfactory stability of the infusion for at least 12 h from the time of preparation.

Abstract The reinforcing and/or informational effects of immediacy of feedback on test performance have been a topic of some debate for several years. In the present research, it was hypothesized that subjects receiving knowledge of the correct answer to each item, immediately after answering, would exhibit superior test performance when compared with control groups. Subjects were matchpaired on the basis of their first examination scores. Subsequently, one group was tested on a Modular EDEX Student Response System which provided immediate item-by-item feedback. Control groups took the examination in the traditional and modular manner with no immediate feedback. Scores of. the immediate feedback group were significantly higher than those of the traditional groups.