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What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? - insights from the RECODE-DCM peri-operative rehabilitation incubator
No full textIntroduction: Evidence on degenerative cervical myelopathy (DCM) has frequently focussed on surgical management, overlooking the role of non-surgical clinicians. Their contributions in the patient journey remain largely underexplored in the literature.Research question: What is the role of non-surgical clinicians in the assessment and management of people with DCM?Material and methods: This narrative review synthesizes knowledge from a comprehensive MEDLINE search and the collective expertise of the RECODE-DCM Peri-Operative Rehabilitation Incubator, an expert working group hosted by Myelopathy.org. Key domains of non-surgical clinician involvement include: 1) early recognition and referral, 2) patient education, 3) pain management, 4) preoperative management, and 5) postoperative rehabilitation.Results: Timely DCM diagnosis depends on first-contact clinicians recognizing hallmark symptoms. In the absence of standardized screening criteria, tools like the modified Japanese Orthopaedic Association score can support early identification. Non-surgical clinicians educate patients with mild or non-myelopathic spinal cord compression to recognize signs of DCM progression, ensuring timely surgical consultation. These clinicians also play a multidisciplinary role in the biopsychosocial management of pain, incorporating pharmacological and non-pharmacological strategies to address nociceptive and neuropathic pain. While predictors of postoperative outcomes, such as disease severity, gait dysfunction and smoking, are known, evidence on preoperative optimization and prehabilitation remains limited. Emerging research highlights the benefits of early postoperative rehabilitation, including cervical range of motion and stabilization exercises, in improving 12-month postoperative outcomes.Discussion and conclusion: Non-surgical clinicians play an integral role in DCM management across the care continuum. A multidisciplinary, patient-centred approach is essential. Postoperative rehabilitation holds promise, but prospective trials are necessary to establish standardization and optimal strategies for clinical delivery.</p
Mechano-immunomodulation of macrophages influences the regenerative environment of fracture healing through the regulation of angiogenesis and osteogenesis
No full textSuccessful completion of the initial inflammatory phase is critical for the establishment of a regenerative environment conducive to long-term fracture healing. Mechanical signals are among the most potent regulators of bone repair, yet whether local mechanics can modulate inflammation and associated immune response remains poorly understood. In this study, we develop a 3D in vitro model comprising of a purpose-built bioreactor that can replicate distinct loading conditions experienced during ambulation of fixated or unfixed large bone defects, and a haematoma mimetic fibrin hydrogel mirroring the local tissue composition, mechanical properties, and immune environment. Harnessing this system, we demonstrated that macrophages, key regulators of the early immune response, are mechanoresponsive and sensitive to the loading magnitude of local compressive forces. Specifically, moderate loading (5 % strain) as experienced within semi-rigid fixation, was capable of driving a hybrid phenotype with a higher regenerative secretome in M0 macrophages, while inhibiting inflammation in pro-inflammatory M1-like macrophages which supported capillary-size vascular formation. Conversely, higher loading (35 % strain), representative of mechanically unstable defects, was shown to elicit a poor regenerative immune response detrimental to vascular growth and long-term mineralisation. Collectively, our findings highlight mechanical cues as potent stimuli to modulate early immune responses, thus informing the development of novel materials and mechanotherapies to enhance bone repair.Statement of significanceMechano-immunology is an emerging field that aims at interrogating how mechanical cues shape immune cell phenotype and function. This study presents for the first time, the design and validation of a purpose-built 3D in vitro platform of a dynamically loaded bone fracture haematoma. Utilising this model, we demonstrate that macrophages are mechanoresponsive and sensitive to compressive loading magnitude, with moderate loading (5 % strain) producing a hybrid regenerative macrophage phenotype and secretome, while excessive loading (35 % strain) produced a secretome detrimental to angiogenesis and osteogenesis. Moreover, moderate strain can also dampen inflammation in a model of an inflamed compromised fracture. This knowledge may inform the development of novel mechano-immunomodulatory materials and therapeutics that target the early inflammation phase for bone repair.</p
Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant children with spastic cerebral palsy (SPELL trial): a parallel group randomized controlled trial
No full textAims: Dynamic muscle stretching exercises are one of the interventions frequently prescribed by physiotherapists for children with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The SPELL trial will assess the clinical effectiveness of an individually tailored dynamic stretching programme, compared to usual care for ambulant children with spastic CP.Methods: We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit children aged four to 11 years with a diagnosis of spastic CP (bilateral or unilateral) and Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated one:one allocation ratio) to either: 1) a dynamic stretching exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment, and advice regarding self-management and exercise.Conclusion: The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: joint range of motion (Cerebral Palsy Integrated Pathway protocol) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A); balance (GOAL subdomain A, B, D); pain and discomfort (GOAL subdomain C); health-related quality of life (youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)); educational attendance; exercise adherence; and additional physiotherapy treatment at six and 12 months. The primary analysis will be intention to treat.</p
Substantial heterogeneity in trauma triage tool characteristic operationalization for identification of major trauma: a hybrid systematic review
No full textPurpose: Trauma Triage Tools (TTTs) support pre-hospital staff to identify major trauma patients based on prehospital characteristics and bring them to appropriate trauma centres. However, while triaging trauma has been examined extensively, there appears to be little consensus on how variables within TTTs are applied. We therefore aimed to examine the prehospital characteristics and their operationalization applied in the international literature in TTTs.Methods: We applied a hybrid systematic review approach. Searches were conducted in multiple databases. We initially searched for systematic reviews that analyse prehospital characteristics applied in TTTs, then supplemented this with an updated search of original TTT papers from November 2019.Results: We identified 92 papers which identified 52 adult general population TTTs. Results indicate considerable heterogeneity in prehospital characteristics included in TTTs internationally. There was similarity in the higher-level categories included in the tools: tools often included measurements of a patient's physiological characteristics, injury characteristics, mechanism of injury and any modifiers for high-risk groups. However, the prehospital characteristics that made up those groups, how they were applied and interpreted were found to vary considerably.Conclusion: While there is agreement in the higher-level categories used in TTTs, the thresholds adopted in specific variables vary widely, which may reflect statistical rather than clinical considerations. This may contribute to considerable variation in standards of major trauma triaging internationally. An agreed taxonomy of operationalization of prehospital characteristics used in TTTs is required to prevent sub-optimal clinical decision-making in major trauma triaging.Registration: PROSPERO CRD42023393094.</p
Rehabilitation needs of people with brain tumours in Ireland ("BRAIN-RESTORE"): a survey of healthcare professionals' views
No full textPurpose: Access to rehabilitation after brain tumour can be limited, resulting in unmet needs. We examined healthcare professionals' perceptions of rehabilitation need and current rehabilitation services for people with brain tumours in Ireland.Methods: A cross-sectional survey of community and hospital-based healthcare professionals caring for people with brain tumours was conducted in August 2023. Quantitative and qualitative data were collected. Frequency, percentages, 95% confidence intervals (CIs) and chi-square tests are presented.Results: 123 participants completed surveys, health and social care professions (HSCPs) (72, 58.5%), medical (30, 24%) and nursing (21, 17%), and most had >10 years clinical experience (74, 60%). A range of complex rehabilitation challenges, which can persist across care settings, were identified. These included cognitive impairments (≥75% across acute, community, specialist rehabilitation and palliative settings); balance issues (≥65% across acute, community, specialist rehabilitation and palliative settings); inability to return to work (≥75% across acute, community, specialist rehabilitation and palliative settings). Many barriers for patients and healthcare professionals were linked to system-level factors such as limited access to specialist rehabilitation, community therapists lacking capacity and lack of defined care pathway.Conclusions: These findings will help healthcare professionals and health-service providers identify priorities to inform a more comprehensive treatment pathway and improve rehabilitation for those with brain tumours.</p
Exploring health related quality of life for women with breast cancer in Ireland and Québec, Canada throughout the COVID-19 pandemic
No full textThe long-term consequences from the COVID-19 pandemic on breast cancer (BC) is highly unknown, however persisting unmet needs and psychosocial difficulties are likely. The objectives of this study were to evaluate the change in health-related quality of life (HR-QoL) from the pandemic to post-pandemic for women living with a diagnosis of BC and to assess the association between COVID-19 stressor impact and HR-QoL in Ireland and Québec, Canada. Women with a diagnosis of BC were initially enrolled in the cohort study. HR-QoL was assessed during the pandemic (2020-2021) and post-pandemic periods (2022). COVID-19 stressor impact was computed post-pandemic, and change in HR-QoL during and post-pandemic was compared between Ireland and Québec using independent t-tests. Multivariable analysis of covariance (ANCOVA) was used to evaluate the association between COVID-19 stressor impact and changes in HR-QoL, and compare it between Ireland and Québec. 405 participants were included from both settings (Ireland n = 267; Québec n = 138). The average HR-QoL improved from the COVID-19 pandemic to post-pandemic, and there were no differences between Ireland and Québec. Women with high COVID-19 stressor impact (18.9% of participants) had a significantly smaller improvement in their overall HR-QoL compared to those with low COVID-19 stressor impact, and this was evident in Ireland (p p 0.05). Overall, HR-QoL for women with BC improved from pandemic to post-pandemic period. However, similarly in both settings, women who experienced higher levels of COVID-19-related stress had a slower recovery in HR-QoL. These results can guide decisions about health services and policies to adequately address the on-going effect of the pandemic and also prepare for future health crises.</p
“It was completely transformational”: experiences of a prison staff coaching programme
No full textPurpose: Although existing research demonstrates that the health and wellbeing of prison staff is affected by many factors, the current academic evidence base for effective support is limited. The aim of this study was to explore the experiences of prison staff who had been involved in the Spark Inside Prison Staff Coaching Programme to understand the perceived benefits of this intervention.Design/methodology/approach: An exploratory approach using in-depth semi-structured interviews with 17 staff who had experienced coaching was used.Findings: Perceived benefits included personal and professional growth, a positive sense of self and improved relationships. A positive influence on health and wellbeing and staff retention was noted.Originality/value: The research details the perceived benefits of coaching for prison staff and adds to the evidence base about what interventions can usefully support the health and wellbeing of correctional staff. The findings have implications for prisons as well as broader occupations who experience challenges with staff retention.</p
Characterizing the hard and soft nanoparticle-protein corona with multilayer adsorption
No full textNanoparticles (NPs) in contact with biological fluid adsorb biomolecules into a corona. This corona comprises proteins that strongly bind to the NP (hard corona) and loosely bound proteins (soft corona) that dynamically exchange with the surrounding solution. While the kinetics of hard corona formation is relatively well understood, thanks to experiments and robust simulation models, the experimental characterization and simulation of the soft corona present a more significant challenge. Here, we review the current state of the art in soft corona characterization and introduce a novel open-source computational model to simulate its dynamic behavior, for which we provide the documentation. We focus on the case of transferrin (Tf) interacting with polystyrene NPs as an illustrative example, demonstrating how this model captures the complexities of the soft corona and offers deeper insights into its structure and behavior. We show that the soft corona is dominated by a glassy evolution that we relate to crowding effects. This work advances our understanding of the soft corona, bridging experimental limitations with improved simulation techniques.</p
Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis
No full textBackground: Widespread use of conjugate vaccines (PCVs) has reduced vaccine-type invasive pneumococcal disease (IPD). We describe the serotype distribution of IPD after extensive use of ten-valent PCV (PCV10; Synflorix, GSK) and 13-valent PCV (PCV13; Prevenar 13, Pfizer) globally.Methods: IPD data were obtained from surveillance sites participating in the WHO-commissioned Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project that exclusively used PCV10 or PCV13 (hereafter PCV10 and PCV13 sites, respectively) in their national immunisation programmes and had primary series uptake of at least 70%. Serotype distribution was estimated for IPD cases occurring 5 years or more after PCV10 or PCV13 introduction (ie, the mature period when the serotype distribution had stabilised) using multinomial Dirichlet regression, stratified by PCV product and age group (Findings: The analysis included cases occurring primarily between 2015 and 2018 from 42 PCV13 sites (63 362 cases) and 12 PCV10 sites (6806 cases) in 41 countries. Sites were mostly high income (36 [67%] of 54) and used three-dose or four-dose booster schedules (44 [81%]). At PCV10 sites, PCV10 serotypes caused 10·0% (95% CI 6·3-12·9) of IPD cases in children younger than 5 years and 15·5% (13·4-19·3) of cases in adults aged 50 years or older, while PCV13 serotypes caused 52·1% (49·2-65·4) and 45·6% (40·0-50·0), respectively. At PCV13 sites, PCV13 serotypes caused 26·4% (21·3-30·0) of IPD cases in children younger than 5 years and 29·5% (27·5-33·0) of cases in adults aged 50 years or older. The leading serotype at PCV10 sites was 19A in children younger than 5 years (30·6% [95% CI 18·2-43·1]) and adults aged 50 years or older (14·8% [11·9-17·8]). Serotype 3 was a top-ranked serotype, causing about 9% of cases in children younger than 5 years and 14% in adults aged 50 years or older at both PCV10 and PCV13 sites. Across all age and PCV10 or PCV13 strata, the proportion of IPD targeted by higher-valency PCVs beyond PCV13 was 4·1-9·7% for PCV15, 13·5-36·0% for PCV20, 29·9-53·8% for PCV21, 15·6-42·0% for PCV24, and 31·5-50·1% for PCV25. All top-ten ranked non-PCV13 serotypes are included in at least one higher-valency PCV.Interpretation: The proportion of IPD due to serotypes included in PCVs in use was low in mature PCV10 and PCV13 settings. Serotype distribution differed between PCV10 and PCV13 sites and age groups. Higher-valency PCVs target most remaining IPD and are expected to extend impact.Funding: Bill & Melinda Gates Foundation as part of the WHO Pneumococcal Vaccines Technical Coordination Project.</p
The history and development of Irish orthopaedics: a descriptive review
No full textFrom 'grave diggers' to a 'Trauma System for Ireland', the history of Irish orthopaedics is a unique and fascinating story. This story has developed over decades and centuries, with many late and great surgeons and trainers playing major roles in developing our orthopaedic services nationally, as we know them today. The authors acknowledge that it would be wrong to think that a 1500-word review could provide an in-depth, yet comprehensive, discussion of all topics past and present of celebration, deliberation and further debate, related to orthopaedic surgery in Ireland. However, this article sought to provide a brief account of some of the key, landmark moments of orthopaedics over the last 3 centuries in Ireland, many of which are responsible for shaping the landscape of the outpatient rooms, orthopaedic wards and theatre suites, in which we provide high standard orthopaedic care to the people of our island today.</p