BackgroundWorldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). The high prevalence and serious consequences of PVDs have led to the development of several diagnostic tools and clinical guidelines to assist timely diagnosis and patient management. Given the increasing number of diagnostic methods available, a comprehensive review of available technologies is timely in order to understand their limitations and direct future development effort.Main bodyThis paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specificity, accuracy, ease of use, procedure time duration, and training requirements where applicable.ConclusionThis review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efficient diagnostic methods. Some newly emerging technologies are identified, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-effective, accurate and timely diagnosis of PVDs.Electronic supplementary materialThe online version of this article (10.1186/s12938-018-0494-4) contains supplementary material, which is available to authorized users.
Sensory-based intervention is a common approach used to address behavioral problems in children. Types of sensory-based intervention for children and details of the intervention effectiveness have not been systematically examined. This review examined the effectiveness and ideal types of sensory-based interventions for children with behavioral problems. Searching seven databases, a total of 132 studies were identified; 14 met the selection criteria and were reviewed. Seven of the studies were tactile-based interventions, four were proprioceptive-based intervention and three were vestibular-based interventions. Tactile-based interventions such as massage therapy were the most promising intervention in reducing behavioral problems. However, evidence concerning the effectiveness of sensory-based interventions remains unclear. More research is required for determining the appropriate intervention for children with behavioral problems.
Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure.
BackgroundWork-related musculoskeletal problems impact everyday function, working ability, and quality of life. Unaddressed musculoskeletal problems can lead to major injury and loss of function, contributing to participation restrictions, economic loss and the increasing burden of disease worldwide. Medical science laboratory technicians are not immune with reported work-related musculoskeletal problems between 40 and 80%. Similar data is not available for medical science students, who may be the most vulnerable at the beginning of their careers. This study investigated the prevalence, common sites, impact and potential solutions for work-related musculoskeletal problems in medical science students during their university laboratory training.MethodsA Standardised Nordic Musculoskeletal Questionnaire was administered to medical science students at a local university in Sydney, Australia, to evaluate the prevalence, site and impact of work-related musculoskeletal problems. Problems were defined as an ache, pain, discomfort or numbness in body regions within 12 months and last 7 days in this period. The questionnaire was administered between April and June 2017.ResultsThe response rate was 38.2% (n = 110/288). Over a third (n = 38/110) reported a laboratory related musculoskeletal problem in the last 12 months and just over a fifth (n = 24/110) within 7 days. The lower back (30% and 17%), neck (24% and 10%) and upper back (21% and 10%) were the most common sites of problems reported within a 12 month and 7 day period respectively. Problems reported in the lower back, neck and upper back prevented daily activities in the majority of cases (between 63 to 83%) with many seeking physician or health professional assistance (between 13 to 83%). Solutions suggested by respondents included better seating designs, rest periods and education about correct working posture.ConclusionsSome medical science students during their laboratory training are already experiencing high levels of musculoskeletal problems, even before they enter the workforce. While the response rate was low affecting generalizability, the extent of problems limiting activity and needs to seek assistance of those reporting problems is of concern. Strategies are suggested to address ergonomic and postural training, as part of university curriculums, including the identification of problems for early intervention to facilitate sustainable workforces.
The evidence about psychological therapies used to manage co-morbid depression after a spinal cord injury is presented here. A comprehensive search of five electronic databases identified nine studies (participants, n = 591) meeting inclusion criteria. Pooled statistical analyses were conducted in combination with narrative synthesis. Overall, multimodal cognitive behavioural therapy was found to be moderately effective (standardised mean difference = -0.52; 95% confidence interval = -0.85, -0.19). Activity scheduling, psychoeducation, problem solving and cognitive therapy may be particularly beneficial therapies within cognitive behavioural therapy. Further high-quality randomised controlled trials are needed to better substantiate these findings.
BackgroundTo determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Secondary aims were to report on clinical outcomes.MethodsA retrospective study was conducted at a major tertiary referral hospital in metropolitan Sydney over 12 months. An ICD-10 search of the electronic medical record system and paper medical charts identified patients with diabetes mellitus (type 1 or type 2) and a primary admission for diabetes foot infection (DFI). Patients were categorised as having contact or no contact with an MDT-HRFS.ResultsOne hundred ninety-six hospital admissions (156 patients) were identified with DFI over a 12-month period. Patients with no contact with a MDT-HRFS represented three quarters of admissions (no contact = 116, 74.7 % vs. contact = 40, 25.6 %, p = 0.0001) and presented with more severe infection (no contact = 39 vs. contact = 12). The odds of lower extremity amputation increased five-fold when both no contact and severe infection occurred in combination (no contact with severe infection and amputation = 34, 82.9 % vs. contact with severe infection and amputation = 7, 17.1 %, OR 4.9, 95 % CI 1.1–21.4, p = 0.037). Using estimates of both the contact and no contact population of people with diabetes and high-risk feet and assuming the risk of amputation was the same, than the number of expected amputations in the no contact group should have been 55, however the observed number was 77, 22 more than expected (p = 0.0001).ConclusionsPatients with no contact with a MDT-HRFS represented the majority of admissions for DFIs to a tertiary referral hospital. This group on population estimates appears to be at high risk of amputation of the lower extremity and therefore early referral of this high-risk group might lower this risk.
BackgroundWorkplace injury is an international costly burden. Health care workers are an essential component to managing musculoskeletal disorders, however in doing this, they may increase their own susceptibility. While there is substantial evidence about work-related musculoskeletal disorders across the health workforce, understanding risk factors in specific occupational groups, such as podiatry, is limited.The primary aim of this study was to determine the prevalence and intensity of work related low back pain in podiatrists.MethodsThis was an international cross-sectional survey targeting podiatrists in Australia, New Zealand and the United Kingdom. The survey had two components; general demographic variables and variables relating to general musculoskeletal pain in general or podiatry work-related musculoskeletal pain. Multivariable regression analyses were used to identify factors associated with musculoskeletal stiffness and pain and low back pain intensity. Thematic analysis was used to group comments podiatrists made about their musculoskeletal health.ResultsThere were 948 survey responses (5% of Australian, New Zealand and United Kingdom registered podiatrists). There were 719 (76%) podiatrists reporting musculoskeletal pain as a result of their work practices throughout their career. The majority of injuries reported were in the first five years of practice (n = 320, 45%). The body area reported as being the location of the most significant injury was the low back (203 of 705 responses, 29%). Being female (p < 0.001) and working in private practice (p = 0.003) was associated with musculoskeletal pain or stiffness in the past 12 months. There were no variables associated with pain or stiffness in the past four weeks. Being female was the only variable associated with higher pain (p = 0.018). There were four main themes to workplace musculoskeletal pain: 1. Organisational and procedural responses to injury, 2. Giving up work, taking time off, reducing hours, 3. Maintaining good musculoskeletal health and 4. Environmental change.ConclusionsThe postures that podiatrists hold while treating patients appear to impact on musculoskeletal pain and stiffness. Recently graduated and female podiatrists are at higher risk of injury. There is a need for the profession to consider how they move and take care of their own musculoskeletal health.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0185-y) contains supplementary material, which is available to authorized users.
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