Health conditions among retired professional footballers: a scoping review

Objective

To conduct a scoping review providing an overview of the health conditions occuring in retired male and female professional footballers, with an emphasis on musculoskeletal, mental, neurocognitive, cardiovascular and reproductive health conditions.

Methods

In January 2022, a comprehensive systematic literature search in three databases (MEDLINE via PubMed, SPORTDiscus via EBSCOhost and EMBASE) was conducted for common health conditions among retired male and female professional footballers. Primary research studies (full text available online) which described the incidence or prevalence of a health condition (musculoskeletal, mental, neurocognitive, cardiovascular, reproductive) among retired male and female professional footballers were included for review. Case reports, qualitative research and grey literature were omitted.

Results

In total, 917 eligible articles were identified from the databases, with 41 meeting the eligibility criteria. Osteoarthritis of the hip, knee and ankle were found to be common among retired professional footballers. Mental health symptoms (eg, anxiety, depression) are experienced by retired male and female professional footballers. The incidence of neurocognitive disease appears to be higher among retired male professional footballers than among matched controls. There is very limited evidence examining the presence of health conditions in retired female professional footballers.

Conclusion

Osteoarthritis of the lower limb, musculoskeletal pain and mental health symptoms are common among retired professional footballers. Knowledge about the occurrence and timing of musculoskeletal, mental health and neurocognitive conditions among retired professional footballers can be used by a wide range of stakeholders to proactively intervene during and after a player's career to mitigate risk.

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.

Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study

Background

Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA.

Objectives

This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs.

Methods

Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain.

Results

Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ<-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP.

Conclusion

Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.

Abstract PO-044: Mechanobiological analysis of human patient pancreatic cancer tissues and the effect of cellular transmembrane mucins on glycocalyx-actomyosin mechanics

Pancreatic cancer is one of the most lethal malignancies with a 5-year survival rate currently below 10%. Unfortunately, current diagnostic methods are unable to readily recognize early disease progression, and symptoms are commonly misdiagnosed. Therefore, determining novel biomarkers related to disease progression remains an important area of research. Transmembrane mucins, a major component of the cellular glycocalyx, normally play a protective role in epithelial tissues; they are also known to be overexpressed in various cancers, including pancreatic. In addition, mucins are known to increase aggressiveness, enhance drug resistance, and reduce survivability in cancers where they are upregulated. Although the biochemical effects of mucins are well understood, there is minimal research into how they affect cancer cells at a biophysical level. Recently, there has been great interest in examining the biophysical properties of cancer cells. The current consensus is that cancerous cells are softer than their normal counterparts, and that more metastatic cells become softer compared to more benign tumor cells. Measuring these physical properties could potentially give clinicians a more rapid way to diagnose tumors, determine the course of disease progression, physically determine the effect of a biomolecule when its expression is altered, or determine the efficacy of various chemotherapeutics. In this study, we will first use atomic force microscopy-based nanomechanical mapping to measure the biophysical differences between normal cells, cancerous cells, and the extracellular matrix extracted from human patient tumor tissues and track the measured changes, both before and after chemo treatments. Our preliminary in vitro results suggest that 2D-adherent human cancerous pancreatic cells are indeed softer than their normal counterparts, in agreement with the literature. In addition, modulation of the glycocalyx architecture via hyaluronidase treatment leads to considerable changes in cellular stiffness in both normal and cancerous cells, implying a link between the glycocalyx and the underlying actomyosin skeleton. Future studies will examine the in vitro effects of specific transmembrane mucins. Using overexpression and knockdown transfection models, the impact on cellular mechanics, as well as structural changes in the glycocalyx and actomyosin cortex, will be analyzed in pancreatic cancer cells to determine how these mucins effect cellular mechanics and by extension regulate tumorigenesis and metastasis.

Citation Format: Andrew Massey. Mechanobiological analysis of human patient pancreatic cancer tissues and the effect of cellular transmembrane mucins on glycocalyx-actomyosin mechanics [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-044.

Bubble concept for sporting tournaments during the COVID-19 pandemic: Football Club World Cup

Objectives

To report the person-to-staff transmission of COVID-19 with the implementation of a bubble concept that included testing, hygiene, distancing and monitoring strategies to mitigate risks.

Methods

A prospective case series included all staff on-site involved in the Football Club World Cup. The tournament was conducted within ‘bubbles’. All personnel travelling to the tournament were required to be in possession of a negative RT-PCR test within 72 hours of arrival and subjected to a testing schedule during the tournament. Each location was assigned a COVID-19 protocol enforcement officer to ensure adherence to regular testing, hygiene measures, physical distancing and daily symptom reporting (via ScribePro app).

Results

The study involved 70 recruited staff with a combined 1321 test days on the symptom checker app. The mean number of days completed on the symptom checker app was 18.87 days (range: 7–28). Of the five questions asked as part of the daily symptom checker, only one was answered positively (0.015%). This individual was isolated, assessed within 20 min and tested. The initial diagnosis was likely a non-COVID-19-related viral illness. Further testing returned three negative tests during the remainder of the tournament.

Conclusions

There was no person-to-staff transmission of COVID-19 during the tournament within our sample. The organisation of a sporting tournament during the COVID-19 pandemic is possible with risk mitigation strategies. These strategies include setting up a bubble with regular testing, hygiene measures, physical distancing and daily symptom reporting.

Match High-Speed Running Distances Are Often Suppressed After Return From Hamstring Strain Injury in Professional Footballers

BACKGROUND

High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury.

HYPOTHESIS

Match high-speed running distance will change after returning from hamstring injury.

STUDY DESIGN

Non-randomized cohort.

LEVEL OF EVIDENCE

Level 3.

METHODS

Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis.

RESULTS

Preinjury cumulative high-speed running distances were strongly correlated for each individual (r2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less (P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury.

CONCLUSION

Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury.

CLINICAL RELEVANCE

Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis

BACKGROUND

Hamstring injuries are common and account for considerable time lost to play in athletes. Platelet-rich plasma has potential as a means to accelerate healing of these injuries.

PURPOSE

(1) To present the evidence of platelet-rich plasma injection in the treatment of hamstring injuries, (2) evaluate the "best-case scenario" in dichotomous outcomes, and (3) evaluate the "worst-case scenario" in dichotomous outcomes.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Two authors systematically reviewed the PubMed, Embase, and Cochrane Library databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with any discrepancies resolved by mutual consensus. The level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine and the quality of evidence by the Coleman Methodology Score. Meta-analysis by fixed effects models was used if heterogeneity was low (I² < 25%) and random effects models if heterogeneity was moderate to high (I²≥ 25%). P values <.05 were considered statistically significant.

RESULTS

A total of 10 studies were included with 207 hamstring injuries in the platelet-rich plasma group and 149 in the control group. Random-effects model for mean time to return to play that compared platelet-rich plasma + physical therapy to physical therapy alone non-significantly favored platelet-rich plasma + physical therapy (mean difference, -5.67 days). The fixed effects model for reinjury rates, which also compared platelet-rich plasma + physical therapy with physical therapy alone nonsignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.88). The best-case scenario fixed effects model for reinjury rates nonsignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.82). The worst-case scenario fixed effects model for reinjury rates nonsignificantly favored physical therapy alone (risk ratio, 1.13). The mean ± SD complication rate for either postinjection discomfort, pain, or sciatic nerve irritation was 5.2% ± 2.9% (range, 2.7% to 9.1%).

CONCLUSION

There has been statistically nonsignificant evidence to suggest that PRP injection ± PT reduced mean time to RTP or reinjury rates compared to no treatment or PT alone for hamstring injuries in a short-term follow-up. The complication profiles were favorable. Further studies of high quality and large cohorts are needed to better support or disprove the consensus of the systematic review and meta-analysis.

Superparamagnetic iron oxide nanoparticles of curcumin enhance gemcitabine therapeutic response in pancreatic cancer

Pancreatic cancer is a complex disease accounting for fibrotic tumors and an aggressive phenotype. Gemcitabine (GEM) is used as a standard therapy, which develops chemoresistance leading to poor patient outcome. We have recently developed a superparamagnetic iron oxide nanoparticle (SPION) formulation of curcumin (SP-CUR), which is a nontoxic, bioactive anti-inflammatory/anti-cancer agent for its enhanced delivery in tumors. In this study, we demonstrate that SP-CUR effectively delivers bioactive curcumin to pancreatic tumors, simultaneously enhances GEM uptake and its efficacy. Mechanistic revelations suggest that SP-CUR targets tumor microenvironment via suppression of sonic hedgehog (SHH) pathway and an oncogenic CXCR4/CXCL12 signaling axis that inhibits bidirectional tumor-stromal cells interaction. Increased GEM uptake was observed due to upregulation of the human nucleoside transporter genes (DCK, hCNT) and blocking ribonucleotide reductase subunits (RRM1/RRM2). Additionally, co-treatment of SP-CUR and GEM targets cancer stem cells by regulating pluripotency maintaining stemness factors (Nanog, Sox2, c-Myc and Oct-4), and restricting tumor sphere formation. In an orthotopic mouse model, an enhanced accumulation of SP-CUR was found in pancreas, which potentiated GEM to reduce tumor growth and metastasis. Analysis of tumor tissues suggest that the treatment inhibits tumor stroma (α-SMA, Desmin and Hyluronic Acid) and induces changes in cell stiffness, as measured via Atomic Force Microscopy. This was accompanied by alteration of key cellular proteins of SHH signaling such as SHH, Gli-1, Gli-2, Sufu, and NFĸB-65 as indicated by Immunoblotting and Immunohistochemistry. These results suggest that SP-CUR has a great potential for future clinical use in the management of pancreatic cancer.

Environmental enrichment normalizes hippocampal timing coding in a malformed hippocampus

Neurodevelopmental insults leading to malformations of cortical development (MCD) are a common cause of psychiatric disorders, learning impairments and epilepsy. In the methylazoxymethanol (MAM) model of MCDs, animals have impairments in spatial cognition that, remarkably, are improved by post-weaning environmental enrichment (EE). To establish how EE impacts network-level mechanisms of spatial cognition, hippocampal in vivo single unit recordings were performed in freely moving animals in an open arena. We took a generalized linear modeling approach to extract fine spike timing (FST) characteristics and related these to place cell fidelity used as a surrogate of spatial cognition. We find that MAM disrupts FST and place-modulated rate coding in hippocampal CA1 and that EE improves many FST parameters towards normal. Moreover, FST parameters predict spatial coherence of neurons, suggesting that mechanisms determining altered FST are responsible for impaired cognition in MCDs. This suggests that FST parameters could represent a therapeutic target to improve cognition even in the context of a brain that develops with a structural abnormality.

Abstract B163: Identification and preclinical characterisation of VER-250840, a potent, selective Chk1 inhibitor with in vivo oral single-agent antitumor activity

On sustaining damage to their DNA, cells employ a sophisticated mechanism of detection and repair, termed the DNA damage response (DDR). As a critical component of the DDR and G2/M checkpoint, Chk1 kinase represents an attractive target for cancer therapy. We have utilized a structure-based drug design approach to identify and develop VER-250840, a novel, orally active inhibitor of the checkpoint kinase, Chk1. VER-250840 exhibited sub-nM potency against Chk1 kinase with exquisite selectivity over an extensive and diverse panel of kinases. In vitro, VER-250840 inhibited Chk1 autophosphorylation with an IC50 of 1.0 nM and increased the number of S-phase tumor cells staining positive for pan-nuclear γH2AX with an EC50 of 7 - 27 nM. Accumulated genomic DNA damage by Chk1 inhibition led to irreversible cell cycle arrest, inhibition of tumor cell proliferation, increased replication stress, and cell death in both 2D culture and multicellular tumor spheroids. In an in vivo A2058 tumor xenograft PD study, VER-250840 demonstrated rapid and sustained inhibition of Chk1 auto-phosphorylation within 30 minutes of oral administration. Doses of 10 mg/kg and higher PO resulted in greater than 90% inhibition of tumor pChk1 (S296) over 24 hours. In SKOV3 in vivo models, VER-250840 inhibited Chk1 auto-phosphorylation, modulated other biomarkers of replication stress and DNA damage, and exhibited moderate antitumor activity with minimal toxicity when administered orally on a 21-day once-daily schedule. Work is ongoing to further optimize in vivo efficacy. In conclusion, VER-250840 demonstrates potent and selective activity as a monotherapy both in vitro and in vivo. From these findings, further evaluation and optimization of this novel kinase inhibitor is justly merited.

Citation Format: Joanne Wayne, Stephen Stokes, Nicolas Foloppe, Helen Browne, Teresa Brooks, Karen Benwell, Lisa Baker, Zoe Daniels, Andrea Fiumana, Christopher Graham, Alba Macias, Daniel Maddox, Sean McKenna, Christopher Northfield, Stuart Ray, Heather Simmonite, Emma Stefaniak, Paul Webb, Mike Wood, Andrew Massey. Identification and preclinical characterisation of VER-250840, a potent, selective Chk1 inhibitor with in vivo oral single-agent antitumor activity [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B163.

Abstract 3216: Attenuation of pancreatic tumor growth by a small molecule tubulin inhibitor

Introduction: Pancreatic cancer (PanCa) is one of the most fatal cancers and is ranked as the fourth common cause of cancer-related deaths among both men and women in the US. The management of PanCa is exceptionally difficult due to the extremely poor response to available chemotherapeutic drugs. Microtubules are dynamic structures composed of α-β-tubulin heterodimers that are essential in cell division and are important targets for several clinical drugs (paclitaxel, docetaxel and vinblastine). However, clinical use of these tubulin-targeting drugs have toxicity and drug resistance issues in cancer patients. Thus, identification of more potent non-toxic inhibitors of β-tubulin is urgently required for cancer therapy purposes. In this study, we have identified a synthetic compound (ABI-231) which is a potent inhibitor of β-tubulin and evaluated its therapeutic efficacy against PanCa in vitro, and in vivo model systems.

Methods: ABI-231 ((2-(1H-indol-3-yl)-1H-imidazol-4-yl) (3, 4, 5-trimethoxyphenyl)) - methanone was synthesized and characterized in our department. Effect of ABI-231 on proliferation, migration and invasion of human PanCa cells (ASPC1, HPAFII, and PANC1) was performed by in vitro functional assays (MTS, wound healing, and Boyden chamber migrations). Effect of ABI-231 on the expression of β-tubulin isoforms was determined and compared with other clinical inhibitors of β-tubulin by Western blot, and qRT-PCR. Moreover, the effect of ABI-231 on the expression of β-tubulin III in PanCa cells was determined by confocal microscopy. Therapeutic efficacy of ABI-231 against PanCa was evaluated in an ectopic xenograft mouse model.

Results: ABI-231 treatment inhibited cell proliferation, invasion, migration and colony formation abilities of PanCa cells in a dose-dependent manner (1-100 nM) compared to vehicle treated group. Aberrant expression of β-tubulin III is involved in aggressiveness and drug resistance of various type of cancers including PanCa. ABI-231 effectively inhibited the protein levels and mRNA expression of total β-tubulin (TBB), TBB1, TBB2c, TBB3 and TBB4 in PanCa cells via destabilization. Our confocal microscopy results further showed inhibition of β-tubulin in ABI-231 treated PanCa cells. Upregulation of micro RNA 200c (miR-200c) has been shown to inhibit the expression of β-tubulin III in cancer cells. ABI-231 treatment of PanCa cells showed significant (p&lt;0.01) induction of miR-200c as determined by qRT-PCR. ABI-231 administration (intra-tumoral; 50μg/mouse), three times/week significantly (p&lt;0.01) inhibited the growth of ASPC1 cells derived xenograft tumors in athymic nude mice.

Conclusion: Taken together, our results suggest that ABI-231 is a potent β-tubulin inhibitor and chemotherapeutic agent which could be used for the treatment of pancreatic cancer.

Citation Format: Vivek K. Kashyap, Bilal B. Hafeez, Qinghui Wang, Saini Setua, Andrew Massey, Aditya Ganju, Murali M. Yallapu, Duane D. Miller, Wei Li, Meena Jaggi, Subhash C. Chauhan. Attenuation of pancreatic tumor growth by a small molecule tubulin inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3216. doi:10.1158/1538-7445.AM2017-3216

International Evidence-Based Medicine Survey of the Veterinary Profession: Information Sources Used by Veterinarians

Veterinarians are encouraged to use evidence to inform their practice, but it is unknown what resources (e.g. journals, electronic sources) are accessed by them globally. Understanding the key places veterinarians seek information can inform where new clinically relevant evidence should most effectively be placed. An international survey was conducted to gain understanding of how veterinary information is accessed by veterinarians worldwide. There were 2137 useable responses to the questionnaire from veterinarians in 78 countries. The majority of respondents (n = 1835/2137, 85.9%) undertook clinical work and worked in a high income country (n = 1576/1762, 89.4%). Respondents heard about the survey via national veterinary organisations or regulatory bodies (31.5%), online veterinary forums and websites (22.7%), regional, discipline-based or international veterinary organisations (22.7%) or by direct invitation from the researchers or via friends, colleagues or social media (7.6%). Clinicians and non-clinicians reportedly used journals most commonly (65.8%, n = 1207/1835; 75.6%, n = 216/286) followed by electronic resources (58.7%, n = 1077/1835; 55.9%, n = 160/286), respectively. Respondents listed a total of 518 journals and 567 electronic sources that they read. Differences in veterinarian preference for resources in developed, and developing countries, were found. The nominated journals most read were the Journal of the American Veterinary Medical Association (12.7% of nominations) for clinicians and the Veterinary Record (5.7%) for non-clinicians. The most accessed electronic resource reported was the Veterinary Information Network (25.6%) for clinicians and PubMed (7.4%) for non-clinicians. In conclusion, a wide array of journals and electronic resources appear to be accessed by veterinarians worldwide. Veterinary organisations appear to play an important role in global communication and outreach to veterinarians and consideration should be given to how these channels could be best utilised for effective dissemination of key research findings.

Pattern Formation by Staphylococcus epidermidis via Droplet Evaporation on Micropillars Arrays at a Surface

We evaluate the effect of epoxy surface structuring on the evaporation of water droplets containing Staphylococcus epidermidis (S. epidermidis). During evaporation, droplets with S. epidermidis cells yield to complex wetting patterns such as the zipping-wetting1-3 and the coffee-stain effects. Depending on the height of the microstructure, the wetting fronts propagate circularly or in a stepwise manner, leading to the formation of octagonal or square-shaped deposition patterns.4,5 We observed that the shape of the dried droplets has considerable influence on the local spatial distribution of S. epidermidis deposited between micropillars. These changes are attributed to an unexplored interplay between the zipping-wetting1 and the coffee-stain6 effects in polygonally shaped droplets containing S. epidermidis. Induced capillary flows during evaporation of S. epidermidis are modeled with polystyrene particles. Bacterial viability measurements for S. epidermidis show high viability of planktonic cells, but low biomass deposition on the microstructured surfaces. Our findings provide insights into design criteria for the development of microstructured surfaces on which bacterial propagation could be controlled, limiting the use of biocides.

Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis

OBJECTIVE

To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses.

DESIGN AND MAIN OUTCOME MEASURES

Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised.

RESULTS

The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up.

CONCLUSION

Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.

Survey of the UK veterinary profession 2: sources of information used by veterinarians

Access to the most up-to-date evidence is an important cornerstone for veterinarians attempting to practice in an evidence-based manner; therefore, an understanding of what and how information is accessed is vital. The aim of this study was to identify what resources the UK veterinary profession access and regard as most useful. Based on questionnaires received from veterinarians, the Veterinary Times was nominated as most often read journal or magazine by respondents (n=3572, 79 per cent). In Practice (n=3224, 82 per cent) and the Veterinary Record (n=165, 34 per cent) were seen as most useful by clinicians, and non-clinicians, respectively. Google was the most often nominated electronic resource by all respondents (n=3076, 71 per cent), with Google (n=459, 23 per cent) and PubMed (n=60, 17 per cent) seen as most useful by clinicians and non-clinicians, respectively. The abstract and conclusion sections were the most read parts of scientific manuscripts nominated by all respondents. When looking for assistance with difficult cases, colleagues were the common information choice for clinicians. Different sections of the veterinary profession access information, and deem resources useful, in different ways. Access to good quality evidence is important for the practice of evidence-based veterinary medicine, and therefore, researchers should think about disseminating their findings in a targeted way for optimal use by the profession.

Long-term treatment with responsive brain stimulation in adults with refractory partial seizures

OBJECTIVE

The long-term efficacy and safety of responsive direct neurostimulation was assessed in adults with medically refractory partial onset seizures.

METHODS

All participants were treated with a cranially implanted responsive neurostimulator that delivers stimulation to 1 or 2 seizure foci via chronically implanted electrodes when specific electrocorticographic patterns are detected (RNS System). Participants had completed a 2-year primarily open-label safety study (n = 65) or a 2-year randomized blinded controlled safety and efficacy study (n = 191); 230 participants transitioned into an ongoing 7-year study to assess safety and efficacy.

RESULTS

The average participant was 34 (±11.4) years old with epilepsy for 19.6 (±11.4) years. The median preimplant frequency of disabling partial or generalized tonic-clonic seizures was 10.2 seizures a month. The median percent seizure reduction in the randomized blinded controlled trial was 44% at 1 year and 53% at 2 years (p < 0.0001, generalized estimating equation) and ranged from 48% to 66% over postimplant years 3 through 6 in the long-term study. Improvements in quality of life were maintained (p < 0.05). The most common serious device-related adverse events over the mean 5.4 years of follow-up were implant site infection (9.0%) involving soft tissue and neurostimulator explantation (4.7%).

CONCLUSIONS

The RNS System is the first direct brain responsive neurostimulator. Acute and sustained efficacy and safety were demonstrated in adults with medically refractory partial onset seizures arising from 1 or 2 foci over a mean follow-up of 5.4 years. This experience supports the RNS System as a treatment option for refractory partial seizures.

CLASSIFICATION OF EVIDENCE

This study provides Class IV evidence that for adults with medically refractory partial onset seizures, responsive direct cortical stimulation reduces seizures and improves quality of life over a mean follow-up of 5.4 years.