How do people with chronic low back pain perceive specific and general exercise? A mixed methods survey

PURPOSE

Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk-focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk-focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP.

METHODS

An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six-point Likert scales categorized people's beliefs about individual exercises. Open-ended questions were used to gather further beliefs which were then coded into themes.

RESULTS

People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not.

CONCLUSION

This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise.

2 Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study

INTRODUCTION

Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection.UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported.Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2-18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection - 17 days versus 4 days for uncomplicated presentation).The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes.

Monitoring of in-vitro ultrasonic stimulation of cells by numerical modeling

Ultrasound stimulation of living tissues is a promising technique that can be safely applied for regenerative treatments. However, the ultrasound-induced mechanotransduction is still not well understood because of the large number of parameters involved at different scales and their difficult experimental accessibility. In this context, in-vitro studies may help to gain insight into the interaction between ultrasound and cells. Nevertheless, to conduct a reliable analysis of ultrasound effects on cell culture, the monitoring of the acoustic intensity delivered to the cells is of prime interest. Thanks to the development of an innovative custom experimental set-up inspired from ultrasound stimulation of bone regeneration conditions, major disturbing phenomena such as multiple reflections and standing wave formation inside the Petri dish are eliminated. Thus, the level of ultrasound stimulation, especially, in terms of spatial average temporal average intensity (I_SATA), delivered to the cells can be monitored. Then, to properly estimate the level of ultrasound stimulation, a finite element model representing the experimental in-vitro configuration is developed. The numerical model manages on capturing the characteristics of the experimentally measured acoustic intensity distribution as illustrated by the experimental and numerical I_SATA values of 42.3 and 45.8 mW/cm² respectively, i.e. a relative difference of 8%. The numerical model would therefore allow exploring data inaccessible to experimental measurement and parametric studies to be carried out and facilitates the investigation of different virtual experimental configurations.

Integrated fundal assessment pathway for patients with suspected shunt malfunction via digital retinal images

Introduction: Papilloedema is an important clinical sign in the assessment of neurosurgical patients presenting with suspected shunt malfunction.Methods: We describe our 18-month experience using a newly acquired nonmydriatic digital retinal camera to acquire fundal photographs for this purpose.Results: It was used to take digital photographs in 67 patients presenting with suspected shunt malfunction and 54% of these images were discussed with the on-call ophthalmology team for advice. Of these 81% had instant input provided by ophthalmology and the remainder were sent to the ophthalmology department for formal assessment. Of all shunt related regional referrals in the same time period, we found that only 13% of the referred patients were discussed with the on-call ophthalmology team. The rest had decisions made by the on-call neurosurgical team.Conclusions: We believe this new integrated pathway is clinically and cost-effective and recommend it as a useful tool in other neurosurgical units.

Structural and functional 3D mapping of skin tumours with non-invasive multispectral optoacoustic tomography

BACKGROUND

Recent advances in technology have enabled the development of various non-invasive skin imaging tools to aid real-time diagnosis of both benign and malignant skin tumours, minimizing the need for invasive skin biopsy. Multispectral optoacoustic tomography (MSOT) is a recently developed non-invasive imaging tool, which offers the unique capacity for high resolution three dimensional (3D) optical mapping of tissue by further delivering highly specific optical contrast from a depth of several millimetres to centimetres in living tissues. MSOT enables volumetric, spectroscopic differentiation of tissue, both in vivo and in real time, with and without the application of biomarker-specific probes, and is further able of providing spatial maps of skin chromophores, as well as underlying blood vasculature.

METHODS

Three patients with suspicious skin tumours consented to have their lesions imaged with MSOT prior to excision. The histological findings and measurements were compared.

RESULTS

We demonstrated the first in vivo clinical use of MSOT for 3D reconstruction of skin tumours in three patients with good histological correlation.

CONCLUSION

Our findings confirm the potential benefit of the new imaging method in guiding surgical intervention to achieve a more precise excision with better clearance and lower relapse rates. It can also potentially help to shorten the duration of Mohs' micrographic surgery. Further large-scale studies are necessary to ensure correlation between MSOT and histology.

Surgical interventions for bilateral congenital cataract

BACKGROUND

Congenital cataracts are opacities of the lens in one or both eyes of children that cause a reduction in vision severe enough to require surgery. Cataract is the largest treatable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration.

OBJECTIVES

The objective of this review was to assess the effects of surgical treatments for bilateral symmetrical congenital cataracts. Success was measured according to the vision attained and occurrence of adverse events.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, which contains the Cochrane Eyes and Vision Group Trials Register (2005, Issue 2), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005, week 27), LILACS (6 July 2005), the Science Citation Index and the reference list of the included studies. We also contacted trial investigators and experts in the field for details of further studies.

SELECTION CRITERIA

We included all prospective, randomised controlled trials that compared one type of cataract surgery to another, or to no surgery, in children with bilateral congenital cataracts aged 15 years or younger.

DATA COLLECTION AND ANALYSIS

Two authors extracted data. No meta-analysis was performed.

MAIN RESULTS

Four trials met the inclusion criteria. All trials were concerned with reducing the development of visual axis opacification (VAO). This was achieved with techniques that included an anterior vitrectomy or optic capture. Posterior capsulotomy alone was inadequate except in older children.

AUTHORS' CONCLUSIONS

Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.

Surgical interventions for bilateral congenital cataract

BACKGROUND

Congenital cataracts are opacities of the lens in one or both eyes of children, causing a reduction in vision bad enough to require surgery. Cataract is the largest preventable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration.

OBJECTIVES

The objective of this review is to assess the effects of surgical treatments for bilateral symmetrical congenital cataracts. Success is measured according to the vision attained and occurrence of adverse events.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register - CENTRAL (which includes the Cochrane Eyes and Vision Group specialised register), MEDLINE, EMBASE, the Science Citation Index and the reference list of the included study. We also contacted trial investigators and experts in the field for details of further studies.

SELECTION CRITERIA

We included all prospective, randomised controlled trials that compared one type of cataract surgery to another or to no surgery, in children aged 15 years or younger with bilateral congenital cataracts.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data. No meta-analysis was performed.

MAIN RESULTS

One trial met the inclusion criteria. This trial randomised 130 eyes of 65 children. Follow up of 56 children at three years found no difference in visual acuity between lensectomy and lens aspiration with primary capsulotomy. Secondary opacification developed at a higher rate in the lens aspiration group (66%) compared to the lensectomy group (2%).

REVIEWER'S CONCLUSIONS

The two methods of surgery for bilateral congenital cataracts in this review have good visual results but the incidences of side effects differ. Further randomised trials are required to inform modern practice.

Natural history of diabetic macular streak exudates: evidence from a screening programme

BACKGROUND/AIMS

Diabetic retinopathy screening guidelines recommend referral to an ophthalmologist if there is exudate within one disc diameter of the fovea. Many of these patients, however, have resolution of small amounts of exudate without treatment. This study aimed to assess whether patients with minimal streak or dot exudates within one disc diameter of the fovea can be monitored in a screening programme without compromising visual acuity.

METHODS

A retrospective review of records and Polaroid photographs obtained by one screening centre over a 10 year period was performed. Outcomes measured were referral rates, alteration of Snellen visual acuity, and the need for macular photocoagulation treatment.

RESULTS

55 patients (74 eyes) fulfilled entry criteria (37 streak and 37 dot exudates). Mean follow up was 56.1 months (range 12-127 months). Twenty five patients (30 eyes) were referred to an ophthalmologist. 13 eyes (17.6%) required macular photocoagulation treatment. Four eyes (5.4%) lost two or more lines of Snellen acuity over the follow up period (three from macular oedema and one from macular ischaemia). There was no relation between the presence or resolution of minimal exudate and visual loss (p>0.2).

CONCLUSION

It is appropriate to monitor eyes with streak or dot macular exudates at 6-9 monthly intervals in a screening programme.

Lipophilic versus hydrophilic beta(1) blockers and the cardiac sympatho-vagal balance during stress and daily activity in patients after acute myocardial infarction

OBJECTIVE

To compare the effects of a lipophilic and a hydrophilic beta(1) blocker on cardiac sympatho-vagal balance during daytime activity and stress in patients four to six weeks after myocardial infarction.

DESIGN

Randomised, double blind, crossover study comparing the effect of atenolol (50 mg once daily) with metoprolol CR (100 mg once daily) with treatment periods of four weeks.

SETTING

Large teaching hospital.

PATIENTS

50 patients (45 male, 5 female, age range 40 to 75 years), four to six weeks after an acute myocardial infarction.

METHODS

At the end of each treatment period the 24 hour heart rate variability, heart rate variability power spectra during head up tilt and mental stress, baroreflex sensitivity, and exercise performance were evaluated.

RESULTS

During daytime activity and during orthostatic and mental stress, both heart rate and the ratio between the low and high frequency spectral components of the heart rate variability were significantly lower with atenolol. Conversely, there was no difference between treatments in baroreflex sensitivity and resting plasma catecholamines. Exercise duration and peak oxygen consumption did not differ between treatments, but the heart rate during submaximal and peak exercise was significantly lower with atenolol.

CONCLUSIONS

At the doses used in this study, atenolol achieved greater beta(1) adrenergic blockade than metoprolol CR and this was associated with significant inhibition of vagal withdrawal during stress. This suggests that peripheral blockade of beta(1) adrenergic receptors may be more important than central blockade in preventing stress induced vagal withdrawal in patients after myocardial infarction.

Time-related hemodynamic changes after aortic replacement with the freestyle stentless xenograft

BACKGROUND

The Freestyle valve is a porcine aortic root fixed with net zero pressure across the cusps and treated with the anticalcification agent alpha-aminooleic acid. We evaluated the hemodynamic function of this stentless valve.

METHODS

We implanted the valve into 80 consecutive patients scheduled to receive a bioprosthesis. Sixty-nine patients were more than 70 years old and 14 had calcified aortic sinuses. The "cylinder within a cylinder" implantation technique was used. Twenty-seven patients received coronary grafts, and 3 had mitral repair. All patients were studied echocardiographically during week 1 and 41 were studied at 6 months.

RESULTS

Median ischemic time for isolated aortic valve replacement was 44 minutes. There were four hospital deaths, none valve related. No patient had more than trivial aortic regurgitation. Mean systolic gradients for valve sizes 21 to 25 mm fell significantly with time (p < or = 0.05) due to remodeling of the porcine root and early regression of left ventricular hypertrophy. Late hemodynamic function was equivalent to an aortic homograft.

CONCLUSIONS

The Freestyle valve is easily implanted and has excellent hemodynamics. Transvalvular gradients decrease progressively.