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Designing a strategy to implement optimal conservative treatments in patients with knee or hip osteoarthritis in orthopedic practice: a study protocol of the BART-OP study

Designing a strategy to implement optimal conservative treatments in patients with knee or hip osteoarthritis in orthopedic practice: a study protocol of the BART-OP study

Australia, rheumatologists play a leading role, while in the Netherlands, the orthopedic surgeon is responsible for OA treatment in hospital care. In the Netherlands, a stepped-care strategy (SCS) based on (inter)national guidelines [20,21] is developed to facilitate the use of conservative treatments in three steps in primary care [22,23]. The first step consists of education, life style advice, and acetaminophen. If the treatment options in the first step are not sufficient, treatment options in the second step can be considered (exercise therapy, dietary therapy, and non-steroidal anti-inflammatory drugs). Multidisciplinary care, intra-articular injections, and transcutaneous electrical nerve stimulation are treat- ment options in the third step and could be considered if treatment options in step one or two are ineffective. After implementation of the SCS, most recommended conservative treatments seem to be well used, except dietary therapy [23]. Both studies provide evidence to promote the use of conservative treatments in primary care or in a setting where the rheumatologists play a leading role, but strategies for the optimization of conser- vative treatments in orthopedic care are still lacking. Infor- mation about the current use of conservative treatments, and barriers and facilitators influencing the adoption of conservative treatments in orthopedic practice, is needed to develop a tailored implementation strategy focused on orthopedic care.
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Arthrocentesis versus conservative treatments for TMJ dysfunctions: A preliminary prospective study

Arthrocentesis versus conservative treatments for TMJ dysfunctions: A preliminary prospective study

joint (TMJ) arthrocentesis consists of lavage of the upper joint space of the TMJ, aiming primarily to remove necrotic tissue, blood and pain mediators from the joint. 4 Nitzan et al. (1991) first described TMJ arthrocentesis as the simplest form of Background and objective: The temporomandibular disorders present with a variety of signs and symptoms which include pain in the joint and its surrounding, jaw sounds, limited jaw opening, jaw deviation and headache. The aim of this study was to compare the results and efficacy of arthrocentesis with those of conservative treatments for temporomandibular joint disorders.
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Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments

Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments

Pulmonary infection is a common complication during flail chest treatment. Studies have reported that pulmon- ary infection is one of the main factors associated with longer time of mechanical ventilation and ICU stay, as well as with poor prognosis [18]. In the present study, the rate of pulmonary infection was significantly lower in the surgical group compared with the conservative group. This could be explained, at least in part, by the following reasons: 1) early ventilator weaning could effectively de- crease the incidence of ventilator-associated pneumonia; 2) early ventilator weaning allows early ambulation, phys- ical exercise therapy, and autonomous cough and expec- toration, which could reduce the accumulation of airway secretions, and prevent hypostatic pneumonia and even lobar atelectasis. As previously shown, the requirement for tracheostomy and endotracheal re-intubation could increase in patients needing long-term mechanical venti- lation or for patients with weaning difficulties [19, 20]. Therefore, since surgical treatment of flail chest is associ- ated with a shorter requirement for mechanical ventila- tion, surgery should decrease the need for tracheostomy and endotracheal re-intubation.
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The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: a systematic review

The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: a systematic review

The findings of our study can be of use to clinical trial planners by providing a general benchmark of minimum group mean change scores on pain measures for chronic mechanical neck pain patients. These findings may also be of use in the development of clinical guidelines, in that they provide a benchmark against which the results of studies of various treatments can be compared. This does not, however, replace using control groups in future trials, especially in the early stages of research into a specific modality of treatment. Where a body of studies does exist, and where there are no or few well-controlled trials, these findings may provide a proxy measure for guideline devel- opers in evaluating the benefit of various treatments.
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A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study)

A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study)

Statistical analyses were conducted using SAS 9.4 (SAS Institute, Inc., Cary, NC, USA). In previous report, min- imally clinically important difference was ≥ 0.5 for both ZCQ Physical Function and ZCQ Symptom Severity [16]. The follow-up assessment was done for 1 month from the first visit. We applied a strict set of criteria (≥ 0.8 points) for the purpose of adjustment of multiple comparisons of 3 groups. The sample size has been cal- culated to detect a difference between groups of 0.8 points in changes of symptom severity on ZCQ for the pairwise comparisons of each of the three treatments, using Bonferroni correction. This assumption corre- sponds to our preliminary study. We calculated that with a sample size of 42 patients per group, a total of 126 patients would provide 80% power to detect this dif- ference with P set at 0.0167 (= 0.05/ 3).
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An 8-week multimodal treatment program improves symptoms of knee osteoarthritis: a real-world multicenter experience

An 8-week multimodal treatment program improves symptoms of knee osteoarthritis: a real-world multicenter experience

Methods: Patients with symptomatic, radiographically confirmed knee OA resistant to tradi- tional conservative treatments underwent a supervised 8-week multimodal treatment program consisting of low-impact aerobic exercise, muscle flexibility exercises, joint mobilization, physi- cal therapy modalities, muscle strengthening and functional training, patient education, and a series of 3 or 5 weekly hyaluronic acid injections. Patients were evaluated at admission, 4 weeks, and 8 weeks. Patient-reported outcomes included knee pain severity using an 11-point (0–10) numerical scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Results: A total of 3,569 patients completed an 8-week treatment course between January 2008 and April 2013 at 66 dedicated treatment centers in the United States. Knee pain severity assessed on a numeric scale decreased 59% on average, from 5.4±2.9 to 2.2±2.2 (P0.001). Western Ontario and McMaster Universities Osteoarthritis Index subscores decreased by 44% to 51% (all P0.001) during the 8-week program. The percentage of patients achieving the threshold for Western Ontario and McMaster Universities Osteoarthritis Index minimally perceptible clinical improvement was 79% for the Pain subscale, 75% for Function, and 76% for Stiffness. Favorable patient outcomes were reported in all subgroups, regardless of age, sex, body mass index, disease severity, or number of treatment cycles.
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<p>Outcomes of Extraocular Muscle Surgery for Diplopia or Abnormal Head Posture After Treatment of Brain Disease</p>

<p>Outcomes of Extraocular Muscle Surgery for Diplopia or Abnormal Head Posture After Treatment of Brain Disease</p>

It is well known that most patients with isolated ocular motor nerve palsy (palsy of the oculomotor, trochlear or abducens cranial nerves) due to microvascular causes recover sponta- neously within 6 months. 11 – 13 In this study, as we focused on patients after treatment of severe brain disease with ocular complications such as diplopia or AHP, microvascular causes were excluded. Recently, advances in medical treatment have increased the survival rates for patients with severe brain disease, and a prospective, multicenter, observational case – cohort study, conducted by Rowe et al 14 reported that 16.5% of post-stroke patients had ocular misalignment with diplopia. Therefore, treatment for diplopia and AHP, as well as general complications such as hemiparesis, should be demanded, to improve QOL. However, although surgical and conservative treatments were effective in eliminating diplopia and AHP in approximately 80% of patients, long periods (more than 4 years on average in this study) elapsed before EOM surgery in both groups (45.8 months for the SCVD group and 50.9 months for the BT group); therefore, we strongly believe that these patients should visit an ophthalmologist much sooner after their treatment for brain disease. Furthermore, eye- movement training for saccades and pursuit eye movements, and convergence insuf fi ciency 15,16 may be more effective after treatment for diplopia and AHP, because diplopia remained in 10 cases including oculomotor palsy and central ocular motility disorders; of those, 5 showed successful ocular alignment of less than 10 PD by APCT. In such cases, prism therapy was also unable to eliminate diplopia. We think that the remaining diplopia was closely related to the deterioration of fusion and/or accommodation, and perhaps to impaired visual-integration processing due to the brain damage. 17
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Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes

Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes

Vernon et al. [10] conducted a systematic review of the outcome of control groups used in clinical trials of conservative treatments for chronic neck pain. These trials included primarily laser and acupuncture studies; no study of manual therapy was included. In this review, the mean [95% CI] effect size of change in pain ratings in the no-treatment control studies at outcome points up to 10 weeks was 0.18 [-0.05, 0.41] and for outcomes from 12-52 weeks it was 0.4 [0.12, 0.68]. In the placebo control groups it was 0.50 [0.10, 0.90] at up to 10 weeks and 0.33. [-1.97, 2.66] at 12-24 weeks. None of the com- parisons between the no-treatment and placebo groups were statistically significant. It was concluded that changes in pain scores in subjects with chronic neck pain not due to whiplash who are enrolled in no-treat- ment and placebo control groups were similarly small and not significantly different. As well, they do not appear to increase over longer-term follow-up. The pla- cebo and no-treatment control procedures in these trials appeared to be successful in inducing relatively little therapeutic benefit.
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Book Reviews

Book Reviews

conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipula- tions or mobilizations, pelvic blocking, McKenzie/end- range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal anti- inflammatory drugs. 2,3,7-24 The purpose of this case report

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Oncoplasty’s Contribution in Breast Cancers: About 48 Cases

Oncoplasty’s Contribution in Breast Cancers: About 48 Cases

OALibJ | DOI:10.4236/oalib.1101330 4 February 2015 | Volume 2 | e1330 coplastic surgery, while the rate of unhealthy sites varies between 15% and 20% for the standard conservative surgery. Our rate of positive margins after oncoplastic treatment (14.5%) seems comparable to the published se- ries on oncoplastic surgery and those on conventional conservative treatments as well (Table 3).

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The Conservative Party Leadership Election of 2016: An Analysis of the Voting Motivations of Conservative Parliamentarians

The Conservative Party Leadership Election of 2016: An Analysis of the Voting Motivations of Conservative Parliamentarians

That means for our ideological determinants we will not include the economic wet/dry divide, but we will retain the morality liberal/conservative divide. As Cameron set about reforming the Conservatives in opposition post 2005 the liberalism-conservatism cleavage around morality was central to identifying his modernising supporters and traditionalist critics (Hayton, 2010, pp. 492- 3). Gaining acceptance for modernised social liberalism would be a slow and painful process in the period between 1992 and 2015. Academic research identified that 30.5 percent of the 1992-1997 PCP was identifiable with socially liberal thinking (Heppell, 2002, p. 312), which had increased to only 31.9 percent of the 2010-2015 PCP (Heppell, 2013, p. 348). Cameron increasingly alienated himself from the traditionalist wing of his own party by his positive rhetoric vis-à-vis endorsing civil partnerships and adoption rights for same sex couples. His championing of equal marriage rights for same sex couples succeeded in pitting secular, modernising free market liberals against religious social conservatives (Ashcroft and Oakeshott, 2015, pp. 404-12). On this touchstone issue, Gove and May voted for and Leadsom abstained. On the basis of this our morality hypothesis is as follows:
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Global conservative and multipeakon conservative solutions for the two-component Camassa-Holm system

Global conservative and multipeakon conservative solutions for the two-component Camassa-Holm system

Some related earlier works [, ] studied the global existence of solutions to the CH equation. However, the system considered in this work is a heavily coupled one, in which the mutual effect between the two components makes the analysis quite complicated and involved as compared with the system with a single component as studied in [, ]. The key and novel effort made in this work to circumvent the difficulty is the utilization of the skillfully defined characteristic and the new set of variables, as well as careful estimates for each iterative approximate component of the solutions, which allows us to establish the global conservative solutions of system (.). It is shown that the multipeakon structure is preserved by the semigroup of a global conservative solution and the multipeakon solu- tion is obtained by carefully computing the convolution equations P i and P xi (i = , . . . , n),
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Protest as Conservative Phenomenon

Protest as Conservative Phenomenon

In order to increase the complexity of protest in modern society one needs to create critique positions, i.e. positions from which the society may criticize itself. These positions can only be created in its functional systems. However, one must distinguish functional systems that operate with a conservative logic from other functional systems characterized by a progressive logic. Thus, conservative logic is to be found in politics (political innovation is very dangerous electorally), in economy (for as long as there are markets and liquidity everything goes well), in the mass media (let’s give the public what the public asks for), in law (decision-making on the basis of established principles, concepts and rules). On the other hand, one can find progressive logic and pressure for emancipation in other systems such as art (the imaginary makes it possible for us to observe the real, to put it into perspective and criticize it), religion (the immanence of society becomes an object of observation from a transcendental perspective, although it is constrained by the holy scriptures), science (the criteria of truth are not based on social consensus or the so-called “common sense”) and intimacy (the inner experience that is actualized in intimate relations becomes a point of reference for articulating the need for changing social conditions). But when a society has not developed enough its art, religion, science and intimacy, then it finds it almost impossible to criticize itself. Their development means that in the social processes one refers often to these systems, and uses them to reach decisions and to describe himself/herself and others. But, as a matter of fact, how often have we witnessed a preference for artistic logic over that of the mass media, or scientific logic over the economic one, or the religious logic over political logic?
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An FPGA Implementation of Barrel Shifter Using Reversible Logic Gates

An FPGA Implementation of Barrel Shifter Using Reversible Logic Gates

ABSTRACT: The conservative reversible gates are used to designed reversible sequential circuits. The sequential circuits are flip flops and latches. The conservative logic gates are Feynman, Toffoli, and Fredkin.the design of two vectorstestable sequential circuits based on conservative logic gates.All sequential circuit based onconservative logic gates can be tested for classical unidirectionalstuck-at faults using only two test vectors.The two test vectorsare all 1s, and all 0s. The designs of two vectors testable latches,master-slave flip-flops and double edge triggered (DET) flip- flopsare presented.We also showedthe application of the proposed approach toward 100% faultcoverage for single missing/additional cell defect in the quantum-dot cellular automata (QCA) layout of the Fredkin gate. The conservative logic gates are in terms of complexity, speed and area.
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Analytical Solutions for Spatially Variable Transport-Dispersion of Non-Conservative Pollutants

Analytical Solutions for Spatially Variable Transport-Dispersion of Non-Conservative Pollutants

downstream boundary conditions. Some efforts have been made in order to acquire analytical solutions for time- dependent and variable diffusion coefficients (Basha and El-Habel [8]; Philip [9]; Zoppou and Knight [10-11]; Pérez and Skaggs [12]). Such solutions have been introduced by Shukla [13] for transport-dispersion of non- conservative pollutants in rivers under time-dependent periodic waste disposal at the upstream end. The solutions of transport and transport-dispersion problems of conservative pollutants for spatially variable dispersion coefficient have been presented by Zoppou and Knight [11] and Pérez and Skaggs [12]. The former derived the solution when the flow velocity is a linear function of distance and the dispersion coefficient is proportional to the square of the velocity as applicable for a channel flow being augmented by steady unpolluted lateral inflow of groundwater and the solution may be applied for flows in circular tubes and between parallel plates due to an existence of similar relationship between flow velocity and dispersion coefficient as well. Pérez and Skaggs [12] developed a solution in a finite spatial domain for linearly increasing dispersion coefficient in groundwater transport- dispersion.
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Anti bacterial Effectiveness of Electro- Chemically Activated (ECA) Water as a Root Canal Irrigant- An In-vitro Comparative Study

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Since 2001, as well as in earlier studies many researchers had concluded that antimicrobial property of ECA water is questionable, and they concluded that ECA water has only limited activity as compared to other routine treatments e.g., EDTA or sodium hypochlorite [18-20]. Many researchers have again reinvented the exact mechanism of action of ECA water as an antimicrobial root canal irrigant yet retaining its mildness and being less toxic. The present study was chosen only to re-evaluate the antimicrobial efficacy of ECA water.

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Analytical and Numerical Treatments of Conservative Diffusions and the Burgers Equation

Analytical and Numerical Treatments of Conservative Diffusions and the Burgers Equation

In the 1930s certain similarities were discovered between the equations of classical statistical mechanics and the Schrödinger equation. From such discoveries arose the stochastic interpretation of quantum mechanics. The formal equations for the diffusions of stochastic mechanics were first formulated by Fényes in 1952 [11] and [12] and later taken up by Nelson [2]. Following this interpretation the trajectories of the configuration, described as a Markov stochastic process, are regarded as physically real. Nelson’s derivation demands time reversibility of the process and vanishing of the stochastic acceleration. The Langevin equation can describe equivalent quantum-mechanical systems in a path-wise manner. These are the so-called conservative diffusions of Carlen [13]. The existence of so-conceived QM particle paths was proven under certain reasonable conditions [13]. Nelson’s original formulation employed a stochastic Newton’s law, where the form of the stochastic acceleration had to be postulated. A Lagrangian formulation of stochastic mechanics was achieved by Pavon in complex form [14]. However, the achieved presentation is far from intuitive. In her treatment the stochastic Lagrangian is the classical Lagrangian evaluated on a complex-valued velocity field in place of the real-valued classical velocity, while the dynamics is given by a complex-valued stochastic differential equation, corresponding to the treatment of Nottale. The Lagrangian problem was formulated as a constrained optimization problem, where the dynamics acted as the constraint.
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Conservative treatment of fibroids

Conservative treatment of fibroids

Myoma coagulation or myolysis with the laparoscope or hysteroscope is a valuable addition to the armamentarium of treatments for a problem that remains pervasive among women. Likewise, surgical techniques include the use of the Nd:YAG laser as well as the bipolar needle. The addi- tion of myolysis to earlier uterine-sparing endometrial ablation or resection markedly improves the success rate of these minimally invasive alternatives to hysterectomy [11]. Myoma coagulation, when combined with endometrial ablation among women with symptomatic fibroids and bleeding, also reduces all subsequent surgery rates compared with endometrial ablation alone [11].
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Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review

Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review

To date, there have been five systematic reviews [5-9] investigating conservative interventions for hand OA. The focus of the two earliest reviews was on pharmaco- logical interventions, with little emphasis given to reha- bilitative treatments [6,9]. Although Towheed’s systematic review [8] and its update [5] reviewed studies of rehabilitative approaches, the main emphasis of these reviews was on methodological quality rather than treat- ment effects. The effectiveness of different rehabilitation interventions on specific treatment goals has not yet been fully explored. The most recently published sys- tematic review [7] summarized the evidence based on systematic reviews rather than relevant primary studies. Its most striking finding was the paucity of available sys- tematic reviews in this area and limited quality evidence that can be used to guide best practice.
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“I need somebody who knows about feet” a qualitative study investigating the lived experiences of conservative treatment for patients with posterior tibial tendon dysfunction

“I need somebody who knows about feet” a qualitative study investigating the lived experiences of conservative treatment for patients with posterior tibial tendon dysfunction

investigated a brace cohort, reported 60% of patients were satisfied with the brace and treatment, however 35% were partially satisfied or unsatisfied with brace treatment [28]. The most recent randomised controlled trial in 2015 (n = 39) investigated the use of orthoses (off the shelf Airlift brace) augmented with either strengthening or stretching in patients with PTTD. All participants reported signifi- cant improvements in pain and disability but no improve- ments in self-reported outcome measures [19]. The greatest limitation in this body of literature is the lack of qualitative research which could unpack the reasons be- hind the nuances reported during treatments [12]. The lived experience is concerned with experiences and phe- nomena that are particular to a person and that hold sig- nificance to the person within their life [29, 30]. Studying this phenomena therefore provides the understanding of experience from those who have lived it [29]. Understand- ing the lived experiences for patients with PTTD may help to improve clinical outcomes for this group of patients in future. The aim of this study is to understand the lived ex- periences of patients undergoing treatment for PTTD.
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