Functional Rehabilitation With a Foot Plate Modification for Circular External Fixation.
Functional Rehabilitation With a Foot Plate Modification for Circular External Fixation.
Foot Ankle Int. 2013 Apr 5;
Blair JA, Owens JG, Saucedo J, Hsu JR,
BACKGROUND: Customized foot plates attached to the foot ring of an ankle-spanning circular external fixator present a unique opportunity for patients undergoing complex lower-extremity limb salvage to participate in highly advanced weight-bearing physical therapy. The purpose of this study was to identify the rehabilitation capabilities afforded by this external fixator modification. METHODS: Surgical logs and radiographs were reviewed to identify all lower-extremity limb salvage patients from February 2008 to December 2010 treated with an ankle-spanning circular external fixator and a customized foot plate treated by the same orthopedic surgeon and enrolled in our institution’s Return To Run clinical pathway. Medical records were reviewed to identify a series of exercises that each patient was able to perform. RESULTS: Eleven patients were identified. All patients were treated by the same physical therapist. All 11 patients were able to bear full weight on their foot plates and perform regular and split squats. Six of 11 patients were able to ambulate unassisted, and 5 patients required a cane. All 11 patients could navigate stairs and use an elliptical and stair-stepping machine. Six of 11 patients could perform single-leg hack squats. Eight of 11 patients were able to perform double-leg shuttle jumps, although only 5 of 11 patients could perform single-leg shuttle jumps. Five of 11 patients were able to perform a single-leg balance. Only 1 patient was able to run on the foot plate. CONCLUSIONS: Patients undergoing lower-extremity limb salvage with an ankle-spanning circular external fixator and a customized foot plate were able to participate in highly advanced weight-bearing physical therapy exercises during the osseous and soft-tissue healing process. LEVEL OF EVIDENCE: Level IV, retrospective case series. HubMed – rehab
Autoantibodies against complement C1q in patients with Behcet’s disease: association with vascular involvement.
Mod Rheumatol. 2013 Apr 7;
Bassyouni IH, Gamal S, Talaat RM, Siam I
AIM: The aim of our study was to determine the prevalence of anti-C1q antibodies and their possible association with clinical presentation in Behcet’s disease (BD) patients with special emphasis for patients with vascular involvement. METHODS: Plasma anti-C1q Abs levels were measured using an enzyme-linked immunosorbent assay in 51 BD patients and 25 age- and gender-matched healthy controls. RESULTS: We found elevated concentrations of anti-C1q more frequently in patients with BD (18 %) than in healthy controls (8 %). The highest prevalence was found in patients with vascular BD (42 %) which was significantly higher than patients without vascular BD and healthy controls (p = 0.025). Furthermore, patients with vascular BD had the highest mean anti-C1q levels when compared to BD patients without vascular involvement or healthy control subjects (p = 0.015). We did not find significant differences in the prevalence of any other organ involvement between BD patients with elevated vs. normal anti-C1q ab levels. Anti-C1q ab levels positively correlated with ESR (r = 0.383, p = 0.006) and negatively with C4 (r = -0.304, p = 0.030). CONCLUSION: In conclusion, we found an increased prevalence of anti-C1q autoantibodies in BD patients with vascular involvement. Further large scale longitudinal studies are required to assess and clarify the significance and the pathogenic role of anti-C1q antibodies in BD and other autoimmune diseases in which vasculitis is a component. HubMed – rehab
Patient-physician communication about code status preferences: A randomized controlled trial.
Cancer. 2013 Apr 5;
Rhondali W, Perez-Cruz P, Hui D, Chisholm GB, Dalal S, Baile W, Chittenden E, Bruera E
BACKGROUND: Code status discussions are important in cancer care, but the best modality for such discussions has not been established. The objective of this study was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients’ do-not-resuscitate (DNR) preference. METHODS: Patients in a supportive care clinic watched 2 videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient’s code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient. RESULTS: A total of 78 patients completed the study, and 74% chose DNR after the question video, whereas 73% chose DNR after the recommendation video. Median physician compassion score was very high and not different for both videos. All 30 of 30 patients who had chosen DNR for themselves and 30 of 48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% versus 62%). Age (odds ratio?=?1.1/year) and white ethnicity (odds ratio?=?9.43) predicted DNR choice for the video patient. CONCLUSIONS: Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice. Cancer 2013. © 2013 American Cancer Society. HubMed – rehab