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A comparison of trunk control in people with no history, standing-induced, and recurrent low back pain during trunk extension
No full textObjectives: This study compares people with recurrent low back pain (rLBP) and people with pre-clinical low back pain (standing-induced low back pain developers; PDs) to each other and back-healthy controls (non-pain developers; NPDs). Movement variability and muscular co-activity related to coordination are important for both rLBP and PDs, and these two groups also have altered static spine extension. Methods: Eleven participants with recurrent low back pain, and twenty-one asymptomatic participants, categorized as PDs (11) and NPDs (10) through an established standing protocol, volunteered for this study. Three phases of standing extension motion (lean, hold, and return to neutral) were analyzed. Root mean square angular jerk was calculated from trunk and pelvis kinematics, co-activation of the trunk and hip musculature were assessed in four-muscle sets. Results: Root-mean-square jerk was greater when returning to neutral than when leaning back during standing extension in all three groups. People with rLBP had reduced co-activity in their trunk extensors, people classified as PD had more co-activity in their hip extensors compared with the other groups, and anterior trunk co-activity was phase-dependent, and similar between groups. Discussion: Movement control alterations with low back pain may start as an over-protective co-activation strategy in those with standing-induced LBP and progress to an under-protective strategy in those with recurrent low back pain. Level of Evidence: 3
Joint work and ground reaction forces during running with daily-use and running-specific prostheses
No full textSome individuals with a transtibial amputation (TTA) may not have access to running-specific prostheses and therefore choose to run using their daily-use prosthesis. Unlike running-specific prostheses, daily-use prostheses are not designed for running and may result in biomechanical differences that influence injury risk. To investigate these potential differences, we assessed the effect of amputation, prosthesis type, and running speed on joint work and ground reaction forces. 13 people with and without a unilateral TTA ran at speeds ranging from 2.5 m/s to 5.0 m/s. People with TTA ran using their own daily-use and running-specific prostheses. Body kinematics and ground reaction forces were collected and used to compute joint work. People with TTA had smaller peak braking, propulsive and medial/lateral ground reaction forces from the amputated leg compared to people without TTA. People wearing running-specific prostheses had smaller peak amputated leg vertical ground reaction forces compared to daily-use prostheses at speeds above 3.5 m/s. Medial/lateral forces were also smaller in running-specific prostheses, which may present balance challenges when running on varied terrain. Running-specific prostheses stored and returned more energy and provided greater propulsion, resulting in more similar positive hip work between legs compared to daily-use prostheses. Increases in positive hip work, but not device work, highlight the importance of the hip in increasing running speed. Running-specific devices may be beneficial for joint health at running-speeds above 3.5 m/s and provide advantages in propulsion and energy return at all speeds compared to daily-use prostheses, helping people with TTA achieve faster running speeds
Cannabidiol use in older adults
No full textCannabidiol (CBD) is a nonpsychoactive component of the Cannabis sativa plant. CBD products, which have become popular in the United States, are frequently used to treat pain, anxiety, and sleep disorders—conditions that affect older adults. Evidence is insufficient to recommend the use of CBD for these disease states. OTC CBD products are widely available, and there are significant concerns regarding their safety, including mislabeling, standardization issues, and drug interactions. The informed pharmacist will be a valuable resource for discussing the use and safety of CBD with older adults
Lefamulin: The First Systemic Pleuromutilin Antibiotic
No full textObjective: To review the pharmacology, microbiology, efficacy, and safety of lefamulin. Data Sources: A literature search was performed using PubMed and Google Scholar (2010 to end-April 2020) with the search terms BC-3781 and lefamulin. Other resources included abstracts presented at recent conferences, prescribing information, and the manufacturer’s and Food and Drug Administration websites. Study Selection and Data Extraction: All relevant English-language articles of studies assessing the efficacy and safety of lefamulin were included. Data Synthesis: Lefamulin is a pleuromutilin antibiotic with activity against Staphylococcus aureus, Streptococcus pneumoniae, and atypical bacteria. Lefamulin, given at the dose of 150 mg intravenously or 600 mg orally on an empty stomach every 12 hours for 5 to 7 days, was proven noninferior to moxifloxacin for the treatment of community-acquired bacterial pneumonia (CABP). Common adverse reactions include injection site reactions, hepatic enzyme elevation, gastrointestinal upset, hypokalemia, insomnia, and headache. Lefamulin is associated with QT prolongation, and concomitant use with CYP3A substrates that prolong the QT interval is contraindicated. Lefamulin may cause fetal harm. Relevance to Patient Care and Clinical Practice: Lefamulin is a novel antibiotic with a unique mechanism of action. It represents an alternative option to β-lactams and macrolides in the treatment of adults with CABP and an alternative option to amoxicillin and doxycycline in the outpatient setting given the rise in resistance to macrolides and safety concerns with fluoroquinolones. Nausea, vomiting, and diarrhea may limit the tolerability of the oral formulation. Conclusions: Lefamulin is the first systemic pleuromutilin antibiotic that has proven safe and effective for adults with CABP
Chart Review to Compare Peripheral Nerve Blocks for Analgesia Following a Total Knee Replacement
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A Retrospective Chart Review to Compare Two Peripheral Nerve Blocks for Analgesia Following a Total Knee Replacement
Problem: Pain after a total knee replacement (TKR) can be severe. The most commonly used pain management 24 hours after surgery is administration of intravenous opioids, which by itself does not always provide adequate post op pain relief ( Otten, C. & Dunn, K. 2011; Kerr, D. 2008; Jenstrup, M.T et al 2011). With the current opioid crisis, controlling pain without opioids whenever possible is essential.
Purpose: To analyze whether a combination block of an adductor canal block with intra-articular infiltration (AII) or an adductor canal block (ACB) alone can provide enough pain relief that there will be minimal or no need to use opioids for pain relief 24 hours TKR post-surgery.
Goal: To decrease opioid requirement to relieve pain 24 hours post TKR surgery.
Objective: To compare efficacy to reduce opioid requirement 24 hours post TKR surgery between an AII or an ACB alone.
Plan: A quality improvement convenience sample retrospective chart review.
Outcomes and Results: Sixty charts were reviewed, 30 for men and 30 for women and further divided by men and women that received AII or an ACB prior to undergoing TKR surgery block (N=15 men and 15 women for AII and for ACB). There was a significant decrease (p=0.015) in reported pain with the AII block (N=30) than with the ACB block (N= 30). All participants in the AII group had a recording of pain score of 0 compared to six participants in the ACB group with an initial pain score of two and 15 participants in ACB group with an initial pain score of three
Making Breastfeeding Work for Medical Offices: A Six-Point Plan Proposal
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Making Breastfeeding Work for Medical Offices: A Six-Point Plan Proposal
Problem
The health benefits of breastfeeding, for both mother and child, has been researched, documented and acknowledged by experts and leaders of health. Identification of limited evidence-based lactation support for breastfeeding women and their children (the breastfeeding dyad) in primary care clinics/offices, has been noted as a major barrier to breastfeeding exclusivity and duration.
Purpose
Making Breastfeeding Work for Medical Offices: A Six-Point Plan has been devised to meet the needs of a busy office. The purpose of this project is to provide a streamlined, evidence-based breastfeeding support toolkit for medical providers of all levels caring for the breastfeeding dyad.
Goals
The goal of the project was to identify perceived barriers to providing evidence-based breastfeeding and lactation support in primary care offices and to provide a toolkit of evidenced-based education, resources, and guidance for busy medical offices.
Objectives
The first objective was to identify the perceived and actual barriers providers and clinics face with breastfeeding support. The next objective was the development of a streamlined, evidenced-based, breastfeeding support toolkit for medical providers of all levels caring for the breastfeeding dyad. Finally, the implementation of the toolkit in offices and certification as breastfeeding friendly medical office.
Plan
The Making Breastfeeding Work for Medical Offices: A Six-Point Plan, was piloted in four medical clinics in Boulder County Colorado. Each office performed the self-assessment then implemented the toolkit over four months, and did the self-test again for post implementation assessment. Two site visits, pre and post intervention, and a Lunch-and-Learn with basic breastfeeding education was done during the intervention. A quasi-experimental quantitative design using a convenience sample with a coded before and after survey. Each survey was compiled and evaluated for statistical comparison using t-test.
Outcomes and Results
Other countries, states, and professional boards have established a Baby-Friendly Office Initiative or Breastfeeding Friendly Community Clinic guidelines. These vary from 8-19 steps yet, research states that providers do not follow all the steps, and on average, only five to six steps after implementation. The most difficult step identified was the approval of a lactation/breastfeeding policy in each clinic- even with a generic policy included in the toolkit.
The clinics all verbally reported that the toolkit was easy to use and helpful to their offices. Over all, the intervention was successful with improvement in post-assessment scores compare to the pre-assessment
The Mesopotamian Mīs Pȋ Ceremony & Clifford Geertz’s Thick Description: Principles for Studying the Cultural Webs of the Deceased
No full textNavigating Familial Opioid Use Addictions and Socially Complex Situations in the Treatment of Acute and Chronic Inpatient Pain
No full textUse and Partitioning of Riparian Corridors by Mammalian Carnivores in Rio Mora National Wildlife Refuge
Get PDFLand conversion across the Southwestern U.S. for agricultural and livestock use and prolonged drought conditions cascade to reduce ecosystem function, including habitat provision for wildlife. Arroyo restoration efforts aim to improve wildlife habitat by decreasing soil erosion and enhancing water retention. These hydrologic and geomorphic changes increase the likelihood that wildlife use restored corridors by increasing riparian vegetation cover. Rio Mora National Wildlife Refuge (RMNWR) has restored several arroyos by installing a system of one-rock dams throughout the refuge, but the extent to which mammals prefer restored over unrestored riparian corridors and how habitat structure influences mammalian use and density in those corridors is unknown. To test whether arroyo restoration improves habitat for large mammals, we collected data on corridor morphology and vegetation structure in the vicinity of 30 camera traps along 10 corridors within the RMNWR. Habitat variability across camera traps was driven by corridor level differences in water availability, vegetation composition, and morphology, rather than restoration status. A total of fifteen species were recorded using two of the ten canyons. Mean species abundance differed only for three species that were found in one canyon versus another, while mean species occurrence showed a greater difference for nine of the fifteen species. Habitat structure effects tended to relate modestly to visitation rates