Objective: The objective was to compare intra-articular lidocaine (IAL) versus intravenous sedation (IVS) for the reduction of acute, anterior shoulder dislocations in the emergency department (ED) in terms of ED length of stay, rate of successful reductions, patient satisfaction, and complications. Methods: This was a prospective, randomized trial. Patients in the IAL group received 4 mg/kg (up to 200 mg) of 1% lidocaine injected into the glenohumeral joint using a lateral approach. Patients in the IVS group received medications for sedation as per the discretion of the treating physician. Follow-up was arranged within 2 weeks of the ED visit to assess for complications. Results: Forty-four patients (25 IAL, 19 IVS) were included. This trial was stopped early owing to a combination of unexpected findings in success, resource limitations, and difficulty in patient enrolment. Median time from first physician assessment to patient discharge was not different between the IAL (170 minutes) group and the IVS (145 minutes) group (D 225 minutes; 95% CI 232, 70; p 5 0.46). There was a significantly lower rate (p , 0.001) of successful closed reduction in the IAL group (48%) compared to the IVS group (100%). Patient satisfaction and physician ease of reduction were higher in the IVS group compared to the IAL group (p , 0.05). There were no reported complications in either group at time of reduction or follow-up. Conclusions: There was no difference in ED length of stay between groups. There was a lower rate of successful reductions and lower satisfaction scores in the IAL group. RÉ SUMÉObjectif : L'objectif consistait à comparer l'injection de lidocaïne intra-articulaire (LIA) avec la sé dation intraveineuse (SIV) dans la ré duction d'une dislocation anté rieure aiguë de l'é paule au service des urgences (SU) quant à la duré e du sé jour, au taux de ré ussite de la ré duction, à la satisfaction des patients et aux complications. Mé thodes : Il s'agissait d'un essai randomisé prospectif. Les patients du groupe de la LIA ont reç u 4 mg/kg (jusqu'à 200 mg) de lidocaïne à 1 % par injection dans l'articulation de l'é paule abordé e par voie laté rale. Les patients du groupe de la SIV ont reç u des mé dicaments sé datifs choisis par le mé decin traitant. Le suivi é tait pré vu deux semaines aprè s la visite au SU afin d'é valuer les complications. Ré sultats : L'essai comptait 44 sujets (25 pour la LIA et 19 pour la SIV). Il a é té interrompu de maniè re pré coce en raison d'une combinaison de facteurs, soit des ré sultats impré vus quant à la ré ussite, des ressources limité es et le recrutement difficile des sujets. Le temps mé dian é coulé entre la premiè re é valuation par le mé decin et le congé du patient n'é tait pas diffé rent dans les deux groupes : 170 minutes pour le groupe de la LIA et 145 minutes pour la SIV (D : 225 minutes; IC à 95 % : 232, 70; p 5 0,46). Le taux de ré ussite de la ré duction par manipulation é tait significativement plus faible (p , 0,001) dans le groupe de la LIA (48 %) que dans le gro...

Crohn's disease (CD) is a chronic inflammatory bowel disease that affects nearly one million people in the United States and Canada. While current pharmaceutical treatments are effective in controlling symptoms, patients continue to experience a reduced quality of life (QOL). Based on preliminary studies, QOL in CD patients may be improved by engaging in physical activity. Exercise may decrease CD activity and reduce psychological stress. Current research also suggests that low-intensity exercise does not exacerbate gastrointestinal symptoms and does not lead to flare-ups. Furthermore, exercise appears to reduce CD symptoms and improve QOL. In summary, physical activity may be beneficial to certain patient groups, but more studies are needed before broad recommendations can be made.

Background Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. Methods A prospective longitudinal cohort (n = 241) was formed from patients identified within four weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM repeated measures ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. Results For pain interference, the three trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the two trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The “Minimal or No Recovery” trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the “Minimal or No Recovery” trajectory. Conclusions These results suggest that three meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and two recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories. Trial registration National Institutes of Health - clinicaltrials.gov (NCT02711085; Retrospectively registered Mar 17, 2016).

Background Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. Methods A prospective longitudinal cohort of n= 241 was formed from patients identified within 4 weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. Results For pain interference, the 3 trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the 2 trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The “Minimal or No Recovery” trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the “Minimal or No Recovery” trajectory. Conclusions These results suggest that 3 meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and 2 recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories.

Background. Chronic or persistent pain and disability following noncatastrophic “musculoskeletal” (MSK) trauma is a pervasive public health problem. Recent intervention trials have provided little evidence of benefit from several specific treatments for preventing chronic problems. Such findings may appear to argue against formal targeted intervention for MSK traumas. However, these negative findings may reflect a lack of understanding of the causal mechanisms underlying the transition from acute to chronic pain, rendering informed and objective treatment decisions difficult. The Canadian Institutes of Health Research (CIHR) Institute of Musculoskeletal Health and Arthritis (IMHA) has recently identified better understanding of causal mechanisms as one of three priority foci of their most recent strategic plan. Objectives. A 2-day invitation-only active participation workshop was held in March 2015 that included 30 academics, clinicians, and consumers with the purpose of identifying consensus research priorities in the field of trauma-related MSK pain and disability, prediction, and prevention. Methods. Conversations were recorded, explored thematically, and member-checked for accuracy. Results. From the discussions, 13 themes were generated that ranged from a focus on identifying causal mechanisms and models to challenges with funding and patient engagement. Discussion. Novel priorities included the inclusion of consumer groups in research from the early conceptualization and design stages and interdisciplinary longitudinal studies that include evaluation of integrated phenotypes and mechanisms.

Background Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. Methods A prospective longitudinal cohort of n= 241 was formed from patients identified within 4 weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. Results For pain interference, the 3 trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the 2 trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The “Minimal or No Recovery” trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the “Minimal or No Recovery” trajectory. Conclusions These results suggest that 3 meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and 2 recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories.

Objectives: To determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period. Methods: A retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013. Results: A total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤ 21 years after introduction of the 2010 amendment for young and novice drivers. Conclusions: There was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour. En tout, 29 (7,7 %) conducteurs en état d'ébriété ont succombé à leurs blessures après leur arrivée à l'hôpital. La proportion de conducteurs en état d'ébriété n'a pas changé après les modifications apportées au CR en 2009, mais une diminution importante du TAD moyen a été notée chez les conducteurs en état d'ébriété. Enfin, aucune différence, par rapport aux années antérieures, n'a été relevée en ce qui concerne la proportion de conducteurs en état d'ébriété, âgés de 21 ans ou moins après l'entrée en vigueur des modifications apportées en 2010 visant les jeunes conducteurs et les apprentis conducteurs. Conclusions: Une diminution importante du taux moyen d'alcoolémie a été enregistrée chez tous conducteurs en état d'ébriété après l'entrée en vigueur des modifications apportées au CR de l'Ontario en 2009, ce qui donne à penser que les modifications à la loi peuvent inciter les personnes restreindre leur consommation d'alcool avant de se mettre au volant.

Crohn's disease is a chronic inflammatory bowel disorder that has genetic and environmental risk factors. Although moderate physical activity seems to reduce the risk of developing Crohn's disease, some high-performance athletes live with the disease. Uncontrolled Crohn's disease predisposes patients to numerous nutrient deficiencies and associated health issues such as anemia and osteoporosis. Low-intensity exercise has been shown to decrease flare-ups in sedentary patients; however, high-intensity exercise may lead to increased symptoms. Physicians play a crucial role in coordinating a team approach among the athlete, parents, coach, and athletic trainers to provide the best possible management of diet, training schedule, and treatment.