Shoulder dystocia, or shoulder entrapment at birth, is an obstetrician’s nightmare, which not infrequently leads to court litigation with complaints of serious foetal and/or maternal damage. Increasingly, retrospective management scrutiny is extending well beyond second stage birth mechanics and involving all case file entries, history taking, ultrasound scan measurements and haematology profile results, etc. The article highlights some medico-legal issues including the influence of the Montgomery ruling on patient disclosure and subsequent management.
Background Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies. Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology. Results Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded. Conclusions A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness.
Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the ‘Hamburg Declaration’. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the ‘Global Alliance for the Promotion of Physical Activity’ to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The ‘Hamburg Declaration’ calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.
Background: Athletes present a different category of the population. Trivial complaints may mask more serious illness, especially when the athlete is undergoing intensive training, and the function of his immune system may be sub-optimal.
No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.
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