Samuel Johnson Community Hospital

INTRODUCTION: Frozen shoulder is a common condition, and current guidelines state that it is a diagnosis of exclusion. Along with a history and clinical examination, routine X-ray is mandated, to rule out any "masquerading" pathology such as fracture, dislocation, metastatic lesions or severe osteoarthritis. Despite the certainty of the guidelines there is a lack of evidence to support the use of routine X-rays in this situation. METHODS: A retrospective review was performed of all X-rays obtained in the diagnosis of frozen shoulder between February 2014 and August 2017 in an integrated musculoskeletal interface service. Results were screened and the prevalence of masquerading pathology was determined. RESULTS: A total of 350 shoulder X-rays that had been performed for patients with a provisional diagnosis of frozen shoulder were reviewed. Of these, 213 were from female patients (60.9%), the mean age was 57.7 (standard deviation 10.4) years and 342 (97.7%) did not have any concerning features. Six (1.7%) had severe osteoarthritis, one (0.3%) had a fracture and one (0.3%) had a lucency. All eight patients with masquerading pathology had findings from the history and clinical examination which would have warranted an X-ray, regardless of a differential diagnosis of frozen shoulder. CONCLUSIONS: The findings of this retrospective review of a large number of X-rays do not support the requirement of a routine X-ray to rule out masquerading pathology to confirm the diagnosis. The data suggest that it is unnecessary for patients without a relevant clinical history suggestive of serious or masquerading pathology to undergo routine imaging.

INTRODUCTION: Arthritis is a common diagnosis for people presenting to healthcare reporting joint pain and stiffness. It is estimated that around 10 million people in the United Kingdom are thought to have arthritis. National Guidance states that patients with osteoarthritis should be offered three core treatments: information, exercise and weight loss advice. The Osteoarthritis Self-management and Independent-living Support (OASIS) group is a programme of progressive exercise and educational advice. METHODS: This service evaluation was to determine if the OASIS group was improving functional and reported pain-level outcomes of patients with lower limb osteoarthritis between 2016 and 2018. Routinely collected data were analysed to determine its effects on a number of functional and self-reported outcomes. Ethical approval was not required following local National Health Service (NHS) Trust approval (Reference e2020-08). RESULTS: During the 3-year period of the review between 2016 and 2018, a total of 339 patients were invited to attend the OASIS group. A total of 196 (57.8%) patients improved their overall pain score. Of the patients who attended all six sessions, 96.7% (174) improved in at least one of the functional outcome measures, and 90% (162) improved in at least two functional outcomes. CONCLUSION: On evaluation of the OASIS group, it has shown to be effective at improving pain and functional performance of patients with lower limb osteoarthritis, whilst remaining cost-effective. In comparison with other similar initiatives, the results are comparable, and it is implemented over a shorter time period, enhancing the cost-effectiveness for the NHS.

Background: Drug-coated balloons (DCBs) have emerged as a potential option for treating in-stent restenosis (ISR). We aimed to assess the efficacy and safety of DCB compared to uncoated balloons (UCBs) for patients with ISR. Methods: We systematically searched Embase, MEDLINE, and Cochrane Library for randomized controlled trials comparing drug-coated balloons with uncoated balloons for coronary in-stent restenosis (ISR). Dichotomous and continuous outcomes were pooled using Revman 5.4 under a random-effects model. All the outcomes were assessed in a 6-month to 1-year follow-up period. Results: A total of seven RCTs involving 1407 patients were included in our review. DCBs significantly reduced the rate of target lesion revascularization (TLR) (RR 0.28; 95% CI: 0.16, 0.48), target vessel revascularization (TVR) (RR 0.36; 95% CI: 0.14, 0.90), major adverse cardiovascular events (MACE) (RR 0.39; 95% CI: 0.26, 0.58), and MI (RR 0.56; 95% CI: 0.35, 0.91). However, no significant difference was observed between the two groups regarding all-cause mortality, cardiovascular mortality, and stent thrombosis. DCB significantly improved angiographic outcomes such as binary restenosis (RR 0.23; 95% CI: 0.12, 0.43), late lumen loss (MD -0.44; 95% CI: - 0.55 to -0.33), and percent diameter stenosis (MD -13.91; 95% CI: - 24.15 to -3.67) compared to the UCB group. Conclusion: Our meta-analysis showed that drug-coated balloons have superior efficacy and safety compared to uncoated balloons in coronary in-stent restenosis patients.

Background It is uncertain whether a liberal red blood cell (RBC) transfusion strategy is superior to a restrictive approach in patients with acute coronary syndrome (ACS) and anemia. Methods We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 for randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in ACS patients with concurrent anemia. Results Five RCTs (4,510 patients) were included in this meta-analysis. There was no significant difference between the liberal and restrictive RBC transfusion strategy groups in the risk of major adverse cardiovascular events (MACE) (RR 0.91, 95% CI: 0.68–1.21; I 2 = 63%) and all-cause mortality (RR 0.85, 95% CI: 0.72, 1.00; I 2 = 0%). A liberal transfusion strategy reduced the risk of myocardial infarction (MI) (RR 0.80, 95% CI: 0.66, 0.98; I 2 = 0%). There were no significant differences between the two strategies in the risk of revascularization, heart failure, stroke, cardiac mortality, acute kidney injury or failure, and pneumonia, bacteremia, or infection. Liberal transfusion increased the risk of acute lung injury (RR 8.97, 95% CI: 1.65, 48.65; I 2 = 0%). Conclusions Our meta-analysis demonstrated that a liberal RBC transfusion strategy reduced the risk of MI and increased the risk of acute lung injury but did not affect other clinical outcomes compared to a restrictive approach in patients with mainly acute MI and anemia. New large-scale multicenter RCTs are required to confirm or refute our findings and provide more reliable results. Systematic Review Registration PROSPERO (CRD42024506844).

A principios de 1984 envi a Juan Jos Saer un largo cuestionario sobre cuyos puntos principales habamos conversado en Buenos Aires. Ambos estbamos de acuerdo en que preguntas y respuestas fueran por escrito, en parte para esquivar el gesto periodstico que tiende a crear la ilusin de un acceso privilegiado a cierta intimidad que el dilogo entre reporteador

Patients with Ehlers-Danlos syndrome (EDS) frequently report symptoms such as chronic pain and muscular fatigue that can heavily impact their quality of life. The treatment for many of the physical symptoms of EDS is focused on supportive care, which may include physical therapy and exercise programs. However, many patients will experience difficulty in deriving benefits from these activities due to significant pain and fatigue from physical activity. We report a case of a 39-year-old female with a history of EDS whose physical capabilities were severely impacted by their chronic pain and fatigue symptoms. After little progress was made with their current treatment plan of analgesics, manual therapy, exercise, and physical therapy, the patient was supplemented with creatine monohydrate due to its studied benefits in muscular strength and endurance for athletes. Following supplementation, the patient reported significant benefits in their muscular fatigue symptoms, allowing them to engage in daily activities and exercises more effectively. This case demonstrates a potential addition to the treatment of EDS that can improve a patient's quality of life.