Hasil untuk "Miscellaneous systems and treatments"

Mirela Oliveira Figueiredo, Lais Riviera Baratela, Roberta Giampá Roiz

Introdução: Literatura internacional relata efeitos benéficos de sessões de terapia ocupacional assistida por cães para crianças no Transtorno do Espectro Autista (TEA). Objetivo: Apresentar atividades realizadas em sessões de terapia ocupacional assistida por cães que propiciaram o engajamento, desempenho e comportamentos sociais e emocionais positivos. Método: Estudo de design quase-experimental com nove crianças entre 3 a 5 anos no TEA. Cada criança foi avaliada pré e durante intervenção por checklist que mensurou frequência de demonstração de componentes de desempenho e engajamento e de comportamentos sociais e emocionais. As sessões foram videogravadas, dois investigadores preencheram separadamente o checklist com posterior análise qualitativa descritiva de cada criança. Resultados: Vinte atividades em que as crianças demonstraram engajamento, com foco nos componentes de desempenho sensório-motor (coordenação motora fina e global, equilíbrio, resposta visual e tátil) e cognitivo (atenção, resolução de problemas) e nos comportamentos sociais e emocionais (olhar para o cão, sorrir para o cão, tocar voluntariamente no cão, comunicar-se com o cão, frequência de aproximação e tempo perto do cão). Conclusão: As atividades demonstraram potencial para fomento do engajamento das crianças e estimulação de componentes de desempenho e comportamentos sociais e emocionais. Pesquisas futuras são necessárias para validação de um protocolo.

Junru Mao, Anni Zhao, Yiqing Cai et al.

Objective: To evaluate the efficacy and safety of traditional Chinese exercises (TCE) in patients with diabetic peripheral neuropathy (DPN) and to recommend best practices for using TCE to improve neurological function, glycemic control, and psychological well-being. Methods: Nine databases were searched from the inception to October 2024. Effect relationships were assessed using meta-analysis with Stata 17, and the methodological quality and certainty of the evidence were evaluated using standard tools. Results: Twelve studies comprising three study designs (nine randomized controlled, one quasi-experimental controlled, and two single-arm clinical trials), were identified. Compared with usual care, TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor (mean difference [MD] = 3.86 m/s, 95% confidence interval [CI]: 0.38 to 7.34, P = .03), sural sensory (MD = 4.15 m/s, 95% CI: 0.68 to 7.63, P = .02), median motor (MD = 3.84 m/s, 95% CI: 2.14 to 5.54, P < .001), and median sensory nerves (MD = 6.14 m/s, 95% CI: 4.54 to 7.74, P < .001). TCE practices also reduced glycosylated hemoglobin level (MD = −0.59%, 95% CI: −0.91 to −0.27, P < .001) and fasting blood glucose (standardized mean difference [SMD] = −1.08, 95% CI: −1.79 to −0.37, P < .001). The overall quality of evidence was very low. Conclusion: The results indicate that TCE therapy improves certain outcomes in patients with DPN. Although the optimal type, intensity, frequency, and duration of TCE interventions are uncertain, these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.

Abhay Mudey, Juhi Raut

About 65.5 % of the Indians live in rural areas while availability of healthcare is biased towards urban setups. Medicine in undergraduates is taught in ivory towers of medical colleges, a paradigm shift in teaching bedside medicine from these ivory towers to community level is required. Hence a new competency-based medical education for undergraduate course was adopted with family adoption program as a vital component, which provides an opportunity for undergraduates to get sensitised to problems and social dynamics at grass root level. We propose an integrated holistic health team model to implement family adoption program so as to address needs of community and build consensus amongst graduate students from various health disciplines to work in integrated team approach and result in enhanced learning. A five pronged strategy is implemented by forming an integrated team comprising of students from medical, aental, ayurveda, and physiotherapy &amp; nursing streams. The institutions that have undergraduate program for any two to five of these disciplines can adopt proposed approach. Expected outcomes of utilising this model is to create holistic health team thereby inculcating in budding graduates team spirit, mutual cooperation &amp; respect for other disciplines of health sciences and thereby holistic healthcare to community.

Zahra Khan Afridi, Areeba Khan, Fatima Masood et al.

Abstract Background This study conducted to determine the prevalence and severity of musculoskeletal discomfort among two-wheeler riders; however, musculoskeletal discomfort refers to pain, discomfort, or impairment in the muscles, bones, joints, tendons, ligaments, or other structures that support the body’s movement. It is a common problem experienced by individuals involved in various physical activities, including motorcycle riding. Methods This investigation was longitudinal research in which the Nordic muscular questionnaire (NMQ) was used to rule out the possibility of musculoskeletal disorders in motorcyclists. In Karachi, Pakistan, data were collected beginning in September of 2021 and continuing through February of 2022 using the convenience sampling method. Sixty-four individuals made up the sample. Participants were males ranging between the ages of 19 and 50 who rode standard motorcycles for their commute for about 6 to 8 h daily. Participants who had a tumor, an infection, or other comorbid are excluded. Results Sixty-four participants were included in this study, out of which 40 (62.5%) reported difficulty and discomfort in their neck, followed by their lower back (48.5%), shoulders (34.4%), and hips (26.6%). Sixteen motorcyclists (25%) complained wrist pain. When asked out their level of discomfort. However, 51.6% of individuals experienced lower back pain at the 12th month, while 46.9% had neck pain. 28.1%, 17.2%, and 14.1% reported shoulder, hip, and upper back discomfort. 51.6% of individuals had not seen a specialist for lower back symptoms. Lower back, neck, shoulders, and hip have been affected the longest, according to participants. Conclusion In conclusion, motorcyclists had a substantially greater rate of musculoskeletal problems than other drivers. Regulating musculoskeletal disorders in motorcyclists helps reduce symptoms and clinical indications of disease.

Denys Tietbol Wolkmann Eilert, Angela Peña Ghisleni, Graciele Sbruzzi

A pandemia de COVID-19 catalisou o desenvolvimento de práticas colaborativas e interprofissionais nos hospitais, promovendo a reorganização de fluxos e investimentos na assistência. Tais práticas, reconhecidas pela Organização Mundial da Saúde, conduziu os profissionais a desenvolver processos de trabalho, que necessitam de uma atuação integrada, visando um cuidado centrado nos usuários. Este estudo teve o objetivo de analisar as ações de enfrentamento da COVID-19 sob a perspectiva da interprofissionalidade e da percepção dos profissionais do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brasil, identificando os processos de trabalho colaborativos que foram construídos e o legado deixado pelas ações realizadas. O estudo é qualitativo do tipo estudo de caso. Foram realizadas entrevistas com profissionais das equipes assistenciais COVID-19 do HCPA (n=18), fisioterapeutas, médicos, enfermeiros, fonoaudiólogos, nutricionistas e psicólogos. A análise de conteúdo foi utilizada para compreensão do corpus dos dados coletados. Um roteiro semiestruturado guiou as entrevistas e a avaliação do material foi realizada a partir da organização em duas categorias: construção de processos de trabalho colaborativos e interprofissionais; o legado para o hospital, profissionais e usuários. Observou-se que os profissionais desenvolveram processos de trabalho colaborativos, incluindo treinamentos, utilização de ventilação não-invasiva (VNI), huddles para discussões, mediações interprofissionais de apoio psicológico e cuidados à beira-leito compartilhados. O trabalho integrado, a troca de conhecimentos e as novas rotinas deram visibilidade ao trabalho interprofissional e correspondem ao legado deixado para o hospital, resultando em um aprendizado para enfrentar pandemias futuras.

M. Sherwani

Background and Objectives: To evaluate the success rate of the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy to treat obstruction of the lacrimal pathway. Methods: The study involved prospective randomized case series. Operative and postoperative data were prospectively collected on 114 patients (120 eyes) who presented to Rizgary Teaching Hospital (Erbil city – Iraq) with epiphora and obstruction of the nasolacrimal system, from February 2013 until October 2017. All patients consecutively underwent endoscopic dacryocystorhinostomy. The follow-up evaluation included system evaluation and endoscopic assessment of the newly created ostium; the follow-up was done at 1 week, 1 month, and 3 months postoperatively, and results were compared between the different groups. Results: A total of 120 cases of endoscopic dacryocystorhinostomy were performed on 114 patients. Procedure success rate was around 95.8%using powered drill and endoscopic system with minimum complication. Age group of 25-44 years (45.8%) is the higher percentage and the female gender accounts for 83.3%. No complications were recorded in78.3% of the patients, while 10% had developed granulation tissue at fistula site. Only 5%of the cases suffered from synechia and 5.7%were miscellaneous complications. No statistical significant differences were found between the surgery and age, gender, or side of operation. Conclusion: Powered endoscopic dacryocystorhinostomy is the most suitable treatment for patients at the level of the sac or in the nasolacrimal duct obstruction.

J. Serup

Sridevi R Pitta, Alexandra Reischman, Robert Zalenski

Undergraduate medical education (UGME) is the time when doctors' attitudes toward patients and their profession are formed. It is also a period of tremendous stress for future physicians, including high levels of negative stress. Such stress can be maladaptive and may sow the seeds of burnout and long-term dissatisfaction. We believe that the introduction of yoga practice in the 1st year of medical school could ameliorate the negative stressors to which undergraduate medical students are exposed. Although there are some studies in the U.S. and internationally that support the use of Yoga in UGME, they do not provide sufficient data to make a compelling case for widespread implementation of yoga programs in undergraduate curricula. We, therefore, wish to advocate for conducting a trial of the integration of yoga in the undergraduate medical curriculum to combine yoga's ancient health wisdom into the context of modern scientific medicine. Large, prospective, multicenter, and multi-method pilot projects are needed to identify how a program of yoga practice and theory could counter the UGME environment that ultimately produces depression, anxiety, and non-effective coping strategies among medical students. A curriculum for yoga for undergraduate medical students deserves serious consideration and a prominent place among efforts to improve UGME.

Marc-Olivier Dubé, Jasmine Arel, Philippe Paquette et al.

Abstract Background Scapular stabilization exercises (SSE) are often included in the treatment of individuals with rotator cuff-related shoulder pain (RCRSP) to decrease pain and improve function. These SSE typically aim to strengthen the scapular muscles and optimize dynamic neuromuscular control of the scapula, which may improve overall shoulder stability and movement quality. No consensus of the recommended SSE for the management of RCRSP is available. Hence, this study aimed to consult physiotherapists to co-create an inventory of recommended SSE based on the exercise’s relevance and frequency of prescriptions for the rehabilitation of individuals with RCRSP. Methods A group of 16 physiotherapists with experience in treating shoulder pain participated in a sequential consultation incorporating two distinct rounds of consultation focusing on SSE (modified Delphi design). In round 1, physiotherapists identified and demonstrated up to 10 SSE that they commonly recommend or use among individuals with RCRSP. The description and performance of all SSE were audio and video recorded. All SSE suggested by more than one participant in round 1 advanced to round 2. In round 2, physiotherapists rated these SSE on a 4-point Likert scale according to their perceived relevance and frequency of prescription for this population. Results In round 1, out of the 25 SSE recommended by participants, 19 SSE (76.0%) were recommended by more than one physiotherapist and advanced to round 2. In round 2, 13 SSE were consensually classified (agreement ≥75%) as being relevant for the rehabilitation of individuals with RCRSP. SSE targeting the recruitment of the serratus anterior and lower trapezius muscles were considered the most relevant for the management of RCRSP, whereas SSE targeting neuromuscular scapular control were the most prescribed SSE for the management of RCRSP. Conclusions An inventory composed of 13 SSE was co-created by physiotherapists based on their relevance and frequency of prescription for the rehabilitation of individuals with RCRSP. When designing an exercise program, physiotherapists can use this SSE inventory to inform their exercise selection, in combination with their current knowledge on shoulder rehabilitation, as well as patients’ preferences.

N. Hosogaya, T. Miyazaki, Yuri Fukushige et al.

Objectives The aim of this trial is to evaluate the antiviral efficacy, clinical efficacy, and safety of nelfinavir in patients with asymptomatic and mild COVID-19. Trial design The study is designed as a multicenter, open-label, blinded outcome assessment, parallel group, investigator-initiated, exploratory, randomized (1:1 ratio) controlled clinical trial. Participants Asymptomatic and mild COVID-19 patients will be enrolled in 10 university and teaching hospitals in Japan. The inclusion and exclusion criteria are as follows: Inclusion criteria: (1) Japanese male or female patients aged ≥ 20 years (2) SARS-CoV-2 detected from a respiratory tract specimen (e.g., nasopharyngeal swab or saliva) using PCR, LAMP, or an antigen test within 3 days before obtaining the informed consent (3) Provide informed consent Exclusion criteria: (1) Symptoms developed ≥ 8 days prior to enrolment (2) SpO 2 < 96 % (room air) (3) Any of the following screening criteria: a) ALT or AST ≥ 5 × upper limit of the reference range b) Child-Pugh class B or C c) Serum creatinine ≥ 2 × upper limit of the reference range and creatinine clearance < 30 mL/min (4) Poorly controlled diabetes (random blood glucose ≥ 200 mg/dL or HbA1c ≥ 7.0%, despite treatment) (5) Unsuitable serious complications based on the assessment of either the principal investigator or the sub-investigator (6) Hemophiliac or patients with a marked hemorrhagic tendency (7) Severe diarrhea (8) Hypersensitivity to the investigational drug (9) Breastfeeding or pregnancy (10) With childbearing potential and rejecting contraceptive methods during the study period from the initial administration of the investigational drug (11) Receiving rifampicin within the previous 2 weeks (12) Participated in other clinical trials and received drugs within the previous 12 weeks (13) Undergoing treatment for HIV infection (14) History of SARS-CoV-2 vaccination or wishes to be vaccinated against SARS-CoV-2 (15) Deemed inappropriate (for miscellaneous reasons) based on the assessment of either the principal investigator or the sub-investigator Intervention and comparator Patients who meet the inclusion criteria and do not meet any of the exclusion criteria will be randomized to either the nelfinavir group or the symptomatic treatment group. The nelfinavir group will be administered 750 mg of nelfinavir orally, three times daily for 14 days (treatment period). However, if a participant tests negative on two consecutive PCR tests of saliva samples, administration of the investigational drug for that participant can be discontinued at the discretion of the investigators. The symptomatic treatment group will not be administered the investigational drug, but all other study procedures and conditions will be the same for both groups for the duration of the treatment period. After the treatment period of 14 days, each group will be followed up for 14 days (observational period). Main outcomes The primary endpoint is the time to negative conversion of SARS-CoV-2. During the study period from Day 1 to Day 28, two consecutive negative PCR results of saliva samples will be considered as the negative conversion of the virus. The secondary efficacy endpoints are as follows: For patients with both asymptomatic and mild disease: area under the curve of viral load, half decay period of viral load, body temperature at each time point, all-cause mortality, incidence rate of pneumonia, percentage of patients with newly developed pneumonia, rate of oxygen administration, and the percentage of patients who require oxygen administration. For asymptomatic patients: incidence of symptomatic COVID-19, incidence of fever (≥ 37.0 °C for two consecutive days), incidence of cough For patients with mild disease: incidence of defervescence (< 37.0 °C), incidence of recovery from clinical symptoms, incidence of improvement of each symptom The secondary safety endpoints are adverse events and clinical examinations. Randomization Patients will be randomized to either the nelfinavir group or the symptomatic treatment group using the electric data capture system (1:1 ratio, dynamic allocation based on severity [asymptomatic], and age [< 60 years]). Blinding (masking) Only the assessors of the primary outcome will be blinded (blinded outcome assessment). Numbers to be randomized (sample size) The sample size was determined based on our power analysis to reject the null hypothesis, S (t | z =1) = S (t | z = 0) where S is a survival function, t is time to negative conversion, and z denotes randomization group, by the log-rank test with a two-sided p value of 0.05. We estimated viral dynamic parameters by fitting a nonlinear mixed-effects model to reported viral load data, and simulated our primary endpoint from viral-load time-courses that were realized from sets of viral dynamics parameters sampled from the estimated probability distribution of the parameters (sample size: 2000; 1000 each for randomization group). From this estimation of the hazard ratio between the randomization groups for the event of negative conversion using this simulation dataset, the required number of events for rejecting our null hypothesis with a power of 0.80 felled 97.345 by plugging the estimated hazard ratio, 1.79, in Freedman’s equation. Therefore, we decided the required number of randomizations to be 120 after consideration of the frequency of censoring and the anticipated rate of withdrawal caused by factors such as withdrawal of consent. Trial Status Protocol version 6.0 of February 12, 2021. Recruitment started on July 22, 2020 and is anticipated to be completed by March 31, 2022. Trial registration This trial was registered in Japan Registry of Clinical Trials (jRCT) ( jRCT2071200023 ) on 21 July 21, 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1 ). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2 ).

R.K. Mutatkar

Dinusha Balasooriya, Chamil Karunarathna, Inoka Uluwaduge

Chronic wound is one of a leading cause of amputation worldwide. Successful management of chronic wound has become a challenge to all existing medical systems across the world. Sri Lankan Traditional and Ayurvedic medicine reveals many promising herbal and alternative remedies for chronic wounds. We hereby report a successfully managed case of an 80-year-old female patient suffering from a chronic wound for two years, when presenting has advised for amputation of the leg. The treatment protocol included the application of hirudotherapy along with the bark paste of Pongamia pinnata followed by Flueggea leucopyrus with recommended other external and internal remedies. At the end of the treatment protocol, pain, exudates, odor, burning sensation, and itching were reduced completely while swelling and wound size was reduced remarkably and showed a significant healing in the wounded area.

Luciane Magalhães Corte Real, Luciane Marilei Pereira Stepanski, Jaqueline dos Santos Picetti et al.

O mundo já viveu muitas pandemias e pode-se dizer que cada uma delas modificou as relações interpessoais, como por exemplo a gripe espanhola, em que as pessoas tiveram que fazer isolamento e tomar cuidados para não infectar parentes e amigos. Com a pandemia de COVID-19, a necessidade de distanciamento e isolamento social também transformam a convivência entre as pessoas. Nesta perspectiva, a presente pesquisa investiga as aprendizagens relatadas por seus participantes durante este período, a partir de uma pesquisa qualitativa e exploratória tendo como instrumento um questionário com perguntas abertas e fechadas disponibilizado no Google Formulários. Os participantes referem impactos positivos e negativos em suas vidas e, quanto aos impactos positivos, as aprendizagens. Foram encontradas três categorias que se relacionam, a saber, aprendizagens dentro nas relações humanas, organização do tempo e consumismo. Há preocupação em como empregar o tempo disponível e sobre o consumo de mercadorias sem a devida necessidade. Nas relações interpessoais, as aprendizagens se voltam para a vida e sua qualidade, para a saúde e o aproveitamento do tempo para família, amigos e lazer.  Palavras-chave: Aprendizado. COVID-19. Pandemia.

A. Motavalli, A. Majdi, L. Hosseini et al.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) commonly complicated by cognitive impairment. Unfortunately, no medical therapy has been proved to improve cognitive problems in these patients. This meta-analysis investigated the effectiveness of different categories of drugs on the minimal assessment of cognitive function in MS (MACFIMS)-related tasks outcome in MS patients. To this end, a systematic evaluation was conducted using PubMed, Google Scholar, and Scopus databases. Among a total of 128 publications, 31 studies met our inclusion criteria, and 22 included in the meta-analysis. We found that symbol digit modalities test (SDMT), paced auditory serial addition test (PASAT), controlled oral word association test (COWAT), and California verbal learning test (CVLT) were the most frequently reported tasks in included studies. The frequently reported drugs were classified into five main groups of acetylcholine esterase inhibitors, CNS stimulants, fampridine, herbal remedies, and miscellaneous. Overall heterogeneity of the studies was modest. The treatments did not affect cognitive function in any of the tasks (p>0.05). However, in subgroup analysis, we found significant improvement in SDMT task outecomes after treatment by fampridine (0.283 SMD, 95%CI, 0.015 to 0.550, p = 0.039, I2=11.7%). Our meta-analysis highlighted that the currently proposed therapeutic agents had no beneficial effects on the alleviation of MS-induced cognitive impairment.

Cham-Kyul Lee, Ha-Ra Kang, Yeon-Sun Lee et al.

Background Due to the aging population in Korea, knee osteoarthritis (KOA) has become an increasingly common condition. Many patients with KOA prefer analgesics, herbal medicines, acupuncture, or exercise, rather than arthroscopic surgery or a knee replacement. Gyebutang (GB) granules are a herbal extract widely used to treat KOA in traditional Korean medicine, but there is insufficient evidence of its efficacy and safety. Methods A multicenter, randomized, assessor-blinded, 2-armed parallel, controlled clinical trial has been designed to investigate the efficacy and safety of GB combined with acupuncture for the treatment of KOA. There will be 100 patients with KOA enrolled in the study from 3 traditional Korean medicine hospitals. The participants will be randomly allocated to an experimental group (GB and acupuncture) or a control group (celecoxib and acupuncture) in a 1:1 ratio. Both groups will receive acupuncture treatment once a week for 6 weeks; one group will receive GB and the other will receive celecoxib for the same duration. Results The primary outcome will be the change of knee osteoarthritic pain, based on scores on a 100 mm visual analog scale. The secondary outcomes will be scores on a numeric rating scale, the Western Ontario and McMaster Universities osteoarthritis index, patient global assessment, European quality of life 5-dimension 5-level scale, and adverse events. Conclusion The results of this study will provide evidence of efficacy and safety of GB as a treatment for patients with KOA.

Youme Ko, Bo-Hyoung Jang, Min-Seok Oh et al.

Background: Low back pain (LBP) is a major burden in Korea. Despite its high prevalence, the government and the public health sector do not address the specific evidences of symptom control and prevention of LBP to reduce long-term healthcare costs and increase the quality of life. Thus, the Korean medicine sector encourages to collection and analysis of the medical utilization pattern of patients with LBP in Korea to provide evidences of LBP control strategy as well as political decisions. Methods: KLOS, a prospective, multi-center, patient registry pilot study will collaborate with 7 traditional Korean medicine hospitals and recruit patients with LBP into the registry. A total of 150 eligible patients with new episodes of LBP, who visit a Korean hospital without any other treatment history, will be enrolled in the registry. After enrollment, we will collect the individual characteristics of each patient, such as pain intensity, LBP-related daily disability, anthropometrics, and Health-Related Quality of Life (HRQoL) at baseline and FU1 and FU2. We will also access the patients’ clinical and administrative electronic records to analyze the pattern of patients’ resource utilization. Overall, the aims of KLOS are to (1) explore the general characteristics of patients with new episodes of LBP and (2) evaluate the efficacy and safety of various Korean medicine treatments for LBP, based on nationwide registry outcome collecting process. Discussion: The first pilot study of prospective, multi-center registry of newly diagnosed LBP patients in traditional Korean medicine hospitals. The result of this study may show the current status of LBP patients who receive Korean medicine treatments and provide evidences for reasonable decision-making on Korean medicine healthcare policy in the future. Trial registration number: ClinicalTrials.gov Identifier: NCT02418286.

A. Håkansson, Madison Ford

Background More remains to be understood about attitudes towards treatment for gambling disorder and where to seek treatment. Given the low degree of treatment seeking behaviour in this condition, it may be of interest to study people’s perception about where to seek help in case of problem gambling. From a study originally aiming to address health correlates of problem gambling, the present sub-study aimed to examine the general population’s attitudes towards where to advise a person with problem gambling to seek treatment, and correlates of recommending a formal professional treatment modality. Methods A cross-sectional general population web survey in Sweden (N=2,038, 55% women, 6% lifetime problem gamblers) was conducted. Preferred advice for gambling-related treatment seeking was defined with a question asking about where one would hypothetically advise a friend to seek help for gambling addiction. Advice for professional vs peer support help was compared with respect to individual characteristics, in problem gamblers and non-problem gamblers. Results Fifty percent preferred to recommend peer support help for gambling, whereas among professional treatment options, the largest share preferred primary care (22%) or psychiatry/addiction psychiatry (18%), while few suggested occupational health-care (6%) or social services (3%). Opting for a professional treatment modality for problem gambling was unrelated to one’s own problem gambling, whereas those recommending professional treatment were younger and more likely to report psychological distress. In problem gamblers specifically, history of indebtedness was associated with recommending professional treatment. Conclusion Many people may not perceive gambling disorder to require professional treatment, and may recommend peer support outside of formal treatment systems. Younger individuals, as well as those with a personal history of psychological treatment needs, may be more prone to recommending formal treatment. The findings may have implications for treatment trajectories and may facilitate overcoming perceived treatment barriers.

R. Douglas, A. Psaltis, J. Rimmer et al.

Chronic rhinosinusitis (CRS) patients who fail medical management have few treatment options other than endoscopic sinus surgery (ESS). A novel biodegradable mometasone furoate drug delivery system (LYR‐210) providing continuous topical steroid therapy to sinonasal mucosa over 24 weeks was developed to treat unoperated CRS patients who have failed medical management prior to ESS. LYR‐210 was designed to slowly expand in the middle meatus, ensuring efficient drug delivery as mucosal swelling reduces.

A. M. Nyholm, H. Palm, Håkon Sandholdt et al.

Background: The purpose of this study was to estimate the incidence of reoperation and the effect of implant position on the risk of reoperation within 12 months following osteosynthesis with use of parallel implants for femoral neck fractures. Methods: From cases registered in the Danish Fracture Database, 1,206 consecutive surgeries for a primary femoral neck fracture treated with use of parallel implants during the period of December 2011 to November 2015, and having available radiographs and follow-up data, were reviewed. Data included age, sex, time to surgery, fracture classification, and American Society of Anesthesiologists (ASA) score. Fracture displacement, posterior tilt, the number of implants, posterior distance, calcar distance, tip-cartilage distance, and angulation of implants were measured on pre- and postoperative radiographs. Data on secondary surgeries were collected from the Danish Civil Registration System. The effects of the included variables on the risk of reoperation were evaluated using Cox regression analysis. Results: The median age was 73 years (range, 21 to 102 years); in 69% of the cases, the patient was female. Two implants were used in 997 cases and 3 implants were used in 209. In 157 cases, the patient underwent reoperation within 1 year; in 228 cases, the patient died within 1 year. The median time to reoperation was 116 days. Patients <70 years of age were more likely to undergo reoperation (18.0% compared with 9.8%) but less likely to die (7.4% compared with 26.3%) than were patients ≥70 years of age. Female sex, higher ASA score, and displaced fractures were associated with increased risk of reoperation. Time to surgery was associated with increased risk of reoperation for displaced fractures only. Of the variables pertaining to the osteosynthesis, only insufficient fracture reduction, placement of the implants with an angle to the shaft of ⩽125°, and femoral head perforation significantly increased the risk of reoperation. We found no effect of the posterior distance, the calcar distance, the tip-caput distance, or whether or not the implants were parallel. Conclusions: Insufficient reduction, varus position of the implants, and perforation of the femoral head cartilage were the only surgical factors influencing the risk of reoperation. Sufficient fracture reduction is perhaps more important than focusing on an optimal position of the implants. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

P. Szymanski, M. Badri, B. Mayosi

BACKGROUND There is limited information on acute heart failure (AHF) and its treatment in sub-Saharan Africa. OBJECTIVE To describe the clinical characteristics and causes of heart failure (HF), adherence to HF treatment guidelines, and mortality of patients with AHF presenting to Groote Schuur Hospital (GSH), Cape Town, South Africa. METHODS This sub-study of The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF) was a prospective and observational survey that focused on the enrolment and follow-up of additional patients with AHF presenting to GSH and entered into the existing registry after publication of the primary THESUS-HF article in 2012. The patients were classified into prevalent (existing) or incident (new) cases of HF. RESULTS Of the 119 patients included, 69 (58.0%) were female and the mean (standard deviation) age was 49.9 (16.3) years. The majority of prevalent cases were patients of mixed ancestry (63.3%), and prevalent cases had more hypertension (70.0%), diabetes mellitus (36.7%), hyperlipidaemia (33.3%) and ischaemic heart disease (IHD) (36.7%) than incident cases. The top five causes of HF were cardiomyopathy (20.2%), IHD (19.3%), rheumatic valvular heart disease (RHD) (18.5%), cor pulmonale (11.8%) and hypertension (10.1%), with the remaining 20.1% consisting of miscellaneous causes including pericarditis, toxins and congenital heart disease. Most patients received renin-angiotensin system blockers and loop diuretics on discharge. There was a low rate of beta-blocker, aldosterone antagonist and digoxin use. Rehospitalisation within 180 days occurred in 25.2% of cases. In-hospital mortality was 8.4% and the case fatality rate at 6 months was 26.1%. CONCLUSION In Cape Town, the main causes of AHF are cardiomyopathy, IHD and RHD. AHF affects a young population and is associated with a high rate of rehospitalisation and mortality. There is serious under-use of beta-blockers, aldosterone antagonists and digoxin. Emphasis on the rigorous application of treatment guidelines is needed to reduce readmission and mortality.