Rehab Centers: Fish Oil Supplementation Reduces Cortisol Basal Levels and Perceived Stress: A Randomized, Placebo-Controlled Trial in Abstinent Alcoholics.

Fish oil supplementation reduces cortisol basal levels and perceived stress: A randomized, placebo-controlled trial in abstinent alcoholics.

Filed under: Rehab Centers

Mol Nutr Food Res. 2013 Feb 6;
Barbadoro P, Annino I, Ponzio E, Romanelli RM, D’Errico MM, Prospero E, Minelli A

Behavioral distress and dysfunctions of hypothalamic-pituitary-adrenocortical (HPA) axis play a central role in alcohol abuse. Omega-3 fatty acids are proposed as having antistress, regulatory effects on HPA responsiveness, but a possible protective role in ethanol addiction is unexplored.A randomized, doubleblind, placebo-controlled trial was performed in male alcoholics undergoing residential rehabilitation program, to evaluate the effects of 3-week supplementation with fish-oil providing eicosapentaenoic (60 mg/day) and docosahexaenoic acid (252 mg/day) on perceived stress/anxiety and HPA activity, assessed by measuring saliva basal cortisol levels at various daytimes (0730 h, 1130 h, 1600 h, 2000 h, and 2400 h) and the acute cortisol response to Trier Social Stress Test.Results showed that in supplemented subjects, before versus after decrease of stress/anxiety ratings was accompanied by reduction of cortisol basal levels throughout the day; no changes were observed in placebo group. At the end of intervention, amplitude, and duration of stress-evoked cortisol response did not differ between groups; however, the peak of cortisol response was temporally anticipated in supplemented subjects. In conclusion, an elevated omega-3 intake may reduce distress symptoms and basal cortisol secretion in abstinent alcoholics, thus providing a valid subsidiary measure to increase the efficacy of rehabilitation programs in ethanol addicts.
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Do the skills acquired by novice surgeons using anatomic dry models transfer effectively to the task of diagnostic knee arthroscopy performed on cadaveric specimens?

Filed under: Rehab Centers

J Bone Joint Surg Am. 2013 Feb 6; 95(3): e151-8
Butler A, Olson T, Koehler R, Nicandri G

The use of surgical simulation in orthopaedic education is increasing; however, its ideal place within the training curriculum remains unknown. The purpose of this study was to determine the effectiveness of training novice surgeons on an anatomic dry model of the knee prior to training them to perform diagnostic arthroscopy on cadaveric specimens.Fourteen medical students were randomly assigned to two groups. The experimental group was trained to perform diagnostic arthroscopy of the knee on anatomic dry models prior to training on cadaveric specimens. The control group was trained only on cadaveric specimens. Proficiency was assessed with use of a modified version of a previously validated objective assessment of arthroscopic skill, the Basic Arthroscopic Knee Skill Scoring System (BAKSSS). The mean number of trials required to attain minimal proficiency when performing diagnostic knee arthroscopy was compared between the groups. The cumulative transfer effectiveness ratio (CTER) was calculated to measure the transfer of skills acquired by the experimental group.The mean number of trials to demonstrate minimum proficiency was significantly lower in the experimental group (2.57) than in the control group (4.57) (p < 0.01). The mean time to demonstrate proficiency was also significantly less in the experimental group (37.51 minutes) than in the control group (60.48 minutes) (p < 0.01). The CTER of dry-model training for the task of performing diagnostic knee arthroscopy on cadaveric specimens was 0.2.Previous training utilizing an anatomic dry knee model resulted in improved proficiency for novice surgeons learning to perform diagnostic knee arthroscopy on cadaveric specimens. A CTER of 0.2 suggests that dry models can serve as a useful adjunct to cadaveric training for diagnostic knee arthroscopy but cannot entirely replace it within the orthopaedic curriculum. Further work is necessary to determine the optimal amount of training on anatomic dry models that will maximize transfer effectiveness and to determine how well skills obtained in the simulated environment transfer to the operating room.
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Effect of plane of arm elevation on glenohumeral kinematics: a normative biplane fluoroscopy study.

Filed under: Rehab Centers

J Bone Joint Surg Am. 2013 Feb 6; 95(3): 238-45
Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ

Understanding glenohumeral motion in normal and pathologic states requires the precise measurement of shoulder kinematics. The effect of the plane of arm elevation on glenohumeral translations and rotations remains largely unknown. The purpose of this study was to measure the three-dimensional glenohumeral translations and rotations during arm elevation in healthy subjects.Eight male subjects performed scaption and forward flexion, and five subjects (three men and two women) performed abduction, inside a dynamic biplane fluoroscopy system. Bone geometries were extracted from computed tomography images and used to determine the three-dimensional position and orientation of the humerus and scapula in individual frames. Descriptive statistics were determined for glenohumeral joint rotations and translations, and linear regressions were performed to calculate the scapulohumeral rhythm ratio.The scapulohumeral rhythm ratio was 2.0 ± 0.4:1 for abduction, 1.6 ± 0.5:1 for scaption, and 1.1 ± 0.3:1 for forward flexion, with the ratio for forward flexion being significantly lower than that for abduction (p = 0.002). Humeral head excursion was largest in abduction (5.1 ± 1.1 mm) and smallest in scaption (2.4 ± 0.6 mm) (p < 0.001). The direction of translation, as determined by the linear regression slope, was more inferior during abduction (-2.1 ± 1.8 mm/90°) compared with forward flexion (0.1 ± 10.9 mm/90°) (p = 0.024).Scapulohumeral rhythm significantly decreased as the plane of arm elevation moved in an anterior arc from abduction to forward flexion. The amount of physiologic glenohumeral excursion varied significantly with the plane of elevation, was smallest for scaption, and showed inconsistent patterns across subjects with the exception of consistent inferior translation during abduction.When evaluating scapulohumeral kinematics during clinical assessment or for rehabilitation protocols, it is important to take into account and control the plane of arm elevation. Abnormalities in scapular motion may be better evaluated during forward flexion of the arm because greater scapular motion is required for this arm motion.
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