A scoping review of educational programmes on artificial intelligence (AI) available to medical imaging staff

INTRODUCTION

Medical imaging is arguably the most technologically advanced field in healthcare, encompassing a range of technologies which continually evolve as computing power and human knowledge expand. Artificial Intelligence (AI) is the next frontier which medical imaging is pioneering. The rapid development and implementation of AI has the potential to revolutionise healthcare, however, to do so, staff must be competent and confident in its application, hence AI readiness is an important precursor to AI adoption. Research to ascertain the best way to deliver this AI-enabled healthcare training is in its infancy. The aim of this scoping review is to compare existing studies which investigate and evaluate the efficacy of AI educational interventions for medical imaging staff.

METHODS

Following the creation of a search strategy and keyword searches, screening was conducted to determine study eligibility. This consisted of a title and abstract scan, then subsequently a full-text review. Articles were included if they were empirical studies wherein an educational intervention on AI for medical imaging staff was created, delivered, and evaluated.

RESULTS

Of the initial 1309 records returned, n = 5 (∼0.4 %) of studies met the eligibility criteria of the review. The curricula and delivery in each of the five studies shared similar aims and a 'flipped classroom' delivery was the most utilised method. However, the depth of content covered in the curricula of each varied and measured outcomes differed greatly.

CONCLUSION

The findings of this review will provide insights into the evaluation of existing AI educational interventions, which will be valuable when planning AI education for healthcare staff.

IMPLICATIONS FOR PRACTICE

This review highlights the need for standardised and comprehensive AI training programs for imaging staff.

Safety of macitentan for the treatment of pulmonary hypertension: Real‐world experience from the OPsumit® USers Registry (OPUS) and OPsumit® Historical USers cohort (OrPHeUS)

Macitentan is an oral endothelin receptor antagonist for the management of pulmonary arterial hypertension (PAH). The OPsumit® USers Registry (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) medical chart review provide real‐world data for patients newly initiating macitentan. This study aims to describe the characteristics, safety profile, and clinical outcomes of PAH patients newly treated with macitentan in the combined OPUS/OrPHeUS data set. OPUS was a prospective, multicenter, long‐term, observational drug registry from April 2014 to June 2020. OrPHeUS was a retrospective, US, multicenter chart review: observation period October 2013 to March 2017. All analyses were descriptive. At registry closure in June 2020, the combined population consisted of 5654 patients, of whom 81.9% were diagnosed with PAH. For these 4626 patients, median duration of macitentan exposure observed was 14.5 (Q1 = 5.2, Q3 = 29.0) months; idiopathic PAH (54.8%) was the most common form of PAH; macitentan was initiated as monotherapy (37.9%), or as part of double (48.0%) or triple therapy (14.1%); discontinuation due to nonhepatic/hepatic adverse events occurred in 17.1%/0.3% of patients; 9.9% of patients experienced ≥1 hepatic adverse events; Kaplan–Meier estimates showed that at 1 year 59.9% (95% confidence interval: 58.3, 61.5) of patients were free from hospitalization and survival was 90.4% (89.3, 91.3). This analysis of real‐world data from the combined OPUS and OrPHeUS populations demonstrated that macitentan is well tolerated in a large, diverse population of PAH patients, with overall and hepatic safety profiles consistent with previous macitentan clinical trials.

The impact of COVID-19 on the clinical experience and training of undergraduate Student radiographers internationally: The clinical tutors' perspective

Introduction

The impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual ‘rules of engagement’ devised by their various health departments.

Aim

The purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic.

Methods

The UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates’ skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic.

Results

Data were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients.

Conclusion

The current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic.

Implications for practice

Clinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance

INTRODUCTION

The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE.

AIM

This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles.

METHODS

Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol.

RESULTS

A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development.

CONCLUSION

Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training.

IMPLICATIONS FOR PRACTICE

Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE

INTRODUCTION

The radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers' perspectives, perceptions and hopes for role advancement in the UAE.

METHODS

A qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysis RESULTS: 29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change.

CONCLUSION

The study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement.

IMPLICATIONS FOR PRACTICE

To sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.

UK reporting radiographers' perceptions of AI in radiographic image interpretation - Current perspectives and future developments

INTRODUCTION

Radiographer reporting is accepted practice in the UK. With a national shortage of radiographers and radiologists, artificial intelligence (AI) support in reporting may help minimise the backlog of unreported images. Modern AI is not well understood by human end-users. This may have ethical implications and impact human trust in these systems, due to over- and under-reliance. This study investigates the perceptions of reporting radiographers about AI, gathers information to explain how they may interact with AI in future and identifies features perceived as necessary for appropriate trust in these systems.

METHODS

A Qualtrics® survey was designed and piloted by a team of UK AI expert radiographers. This paper reports the third part of the survey, open to reporting radiographers only.

RESULTS

86 responses were received. Respondents were confident in how an AI reached its decision (n = 53, 62%). Less than a third of respondents would be confident communicating the AI decision to stakeholders. Affirmation from AI would improve confidence (n = 49, 57%) and disagreement would make respondents seek a second opinion (n = 60, 70%). There is a moderate trust level in AI for image interpretation. System performance data and AI visual explanations would increase trust.

CONCLUSIONS

Responses indicate that AI will have a strong impact on reporting radiographers' decision making in the future. Respondents are confident in how an AI makes decisions but less confident explaining this to others. Trust levels could be improved with explainable AI solutions.

IMPLICATIONS FOR PRACTICE

This survey clarifies UK reporting radiographers' perceptions of AI, used for image interpretation, highlighting key issues with AI integration.

L-Dopa release from mesoporous silica nanoparticles engineered through the concept of drug-structure-directing agents for Parkinson's disease

Parkinson's disease (PD) is a progressive neurodegenerative disease, the 2nd most common after Alzheimer's disease, the main effect of which is the loss of dopaminergic neurons. Levodopa or l-Dopa is an amino acid used in the treatment of PD that acts as the immediate precursor to dopamine. However, over time the efficacy of the medication gradually decreases requiring modified delivery methods. One of the major challenges for the medication to work is to achieve a gradual continuous supply of l-Dopa to the brain to minimise symptoms. Herein, mesoporous silica nanoparticles (MSNs) were engineered through the concept of drug-structure-directing agents (DSDAs) with inherent therapeutic activity. The DSDA used was l-Dopa drug modified by amidation with fatty acids to build anionic surfactants that were able to form micelles as templates for the assembly of inorganic precursors to form the silica framework. This templating route produced MSNs with tunable sizes ranging from 100 nm to 1 μm and with different shapes: spherical, with either solid structures with radial mesopores and porous shells, or hollow-shells with inside large void cavities; and elongated, characterized by long hollows covered by mesoporous shells. The concept of using DSDAs to synthesize drug nanocarriers can be used to avoid the surfactant removal and subsequent drug loading steps involved in the synthesis of conventional MSNs. We hypothesized that the l-Dopa released from MSN materials is mediated by the size and solubility of the DSDAs, and the surface chemical interactions between the DSDAs and MSN hosts. Different pHs (acidic and neutral) simulating gastrointestinal tract conditions were tested, and the results showed hardly any release for gastric conditions at pH 1.2, avoiding the premature release in the stomach typical of conventional MSNs, while for intestinal conditions of pH 7.4, the release of l-Dopa occurred in a continuous and sustained manner, which is well suited to the drug's application and delivery route, and matches well with achieving a sustained l-Dopa delivery to relief symptoms. This could open up new uses for MSNs synthesized by this approach to treat PD.

The effect of a digital training tool to aid chest image interpretation: Hybridising eye tracking technology and a decision support tool

INTRODUCTION

Eye tracking technology, checklists and search strategies have been demonstrated as useful aids in image interpretation. A training tool was developed, by the research team, which included these features. This study aimed to evaluate the effect of the training tool on participant image interpretation performance.

METHODS

The study was carried out with reporting radiographers who had either commenced training in chest image interpretation (n = 12) or were trained in musculoskeletal image interpretation (n = 23) (total n = 35). Participants were allocated to a control or intervention group. Participants completed an initial assessment at recruitment and re-attended nine months later for a follow-up assessment. The intervention group were given unlimited access to a digital training tool. During assessments participants interpreted 20 chest images whilst using eye tracking technology (total of 1400 images were interpreted). A confidence level was obtained from participants on their diagnosis and a questionnaire, to obtain demographic data, was completed following the assessment.

RESULTS

Improvements were seen in the confidence of intervention group participants (p < 0.05). False Positive (FP) scores decreased for both the control and intervention group (p < 0.05), this decrease was from 4.20 to 3.20 for the control group and from 5.87 to 3.27 for the intervention group. True Negative (TN) scores increased, from 5.13 to 6.73 for the intervention group (p < 0.05). Mean decision time decreased for both the control and intervention group.

CONCLUSION

The tool led to positive effects on participant performance and could be a useful aid in chest image interpretation learning.

IMPLICATIONS FOR PRACTICE

Improvements in performance were observed with a digital tool. The tool could improve image interpretation methods and training.

P4673Macitentan in chronic thromboembolic pulmonary hypertension (CTEPH): combined data from OPUS and OrPHeUS real-world data sets

Introduction

The OPsumit® USers Registry (OPUS) provides real-world data in patients (pts) with pulmonary hypertension newly started on macitentan. The OPsumit® Historical USers cohort (OrPHeUS) study was conducted to supplement OPUS to fulfil the FDA request to characterise the safety of macitentan in clinical practice. Both studies included pts with CTEPH.

Purpose

To describe the characteristics and safety outcomes of CTEPH pts newly treated with macitentan.

Methods

OPUS is a prospective, US, multicentre, long-term, observational drug registry (NCT02126943) ongoing since Apr 2014. OrPHeUS was a retrospective, US, multicentre medical chart review (NCT03197688); data collected Oct 2013-Mar 2017. This subgroup analysis describes CTEPH patient characteristics at macitentan initiation, hospitalisations, survival and liver function tests (LFTs) in the combined OPUS/OrPHeUS data set. LFTs are also provided for the OPUS/OrPHeUS pulmonary arterial hypertension (PAH) population.

Results

As of Oct 2018, OPUS/OrPHeUS included 144 CTEPH pts with follow-up data. At macitentan initiation, median (Q1, Q3) age was 66 (56, 73) years; of the 53 pts with a WHO functional class (FC) assessment, 35.8%, 49.1% and 15.1% were in FC II, III and IV, respectively. Median (Q1, Q3) time from CTEPH diagnosis was 18.6 (7.4, 56.4) months (n=141). At macitentan initiation, 32.6% of pts had no PAH therapy, 63.9% were receiving one and 3.5% were receiving two PAH therapies. Median (Q1, Q3) exposure to macitentan was 15.9 (4.3, 30.4) months. There were 43 (29.9%) CTEPH pts who discontinued treatment; 23 due to an adverse event (AE), 0 due to a hepatic AE (HAE) and 20 not due to an AE/HAE. There were 58 (40.3%) CTEPH pts who experienced ≥1 hospitalisation and 9 (6.3%) pts died. LFTs are presented in the table.

LFTs CTEPH follow-up pts PAH follow-up pts (N=144) (N=4072) ALT or AST ≥3x ULN   Pts with ≥1 event, n (%) 1 (0.7) 132 (3.2)   Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.024 (0.020, 0.029) ALT or AST ≥3x ULN and total bilirubin ≥2x ULN   Pts with ≥1 event, n (%) 1 (0.7) 27 (0.7)   Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.005 (0.003, 0.007) ALT: alanine aminotransferase; AST: aspartate aminotransferase; CI: confidence interval; ULN: upper limit of normal.

Conclusions

Analysis of OPUS/OrPHeUS data provides further insight into real-world use of macitentan in CTEPH pts. The observed hepatic safety profile in CTEPH pts is in line with that of PAH pts.

Acknowledgement/Funding

Actelion Pharmaceuticals Ltd

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Greenland records of aerosol source and atmospheric lifetime changes from the Eemian to the Holocene

The Northern Hemisphere experienced dramatic changes during the last glacial, featuring vast ice sheets and abrupt climate events, while high northern latitudes during the last interglacial (Eemian) were warmer than today. Here we use high-resolution aerosol records from the Greenland NEEM ice core to reconstruct the environmental alterations in aerosol source regions accompanying these changes. Separating source and transport effects, we find strongly reduced terrestrial biogenic emissions during glacial times reflecting net loss of vegetated area in North America. Rapid climate changes during the glacial have little effect on terrestrial biogenic aerosol emissions. A strong increase in terrestrial dust emissions during the coldest intervals indicates higher aridity and dust storm activity in East Asian deserts. Glacial sea salt aerosol emissions in the North Atlantic region increase only moderately (50%), likely due to sea ice expansion. Lower aerosol concentrations in Eemian ice compared to the Holocene are mainly due to shortened atmospheric residence time, while emissions changed little.

Past climate changes in Greenland ice were accompanied by large aerosol concentration changes. Here, the authors show that by correcting for transport effects, reliable source changes for biogenic aerosol from North America, sea salt aerosol from the North Atlantic, and dust from East Asian deserts can be derived.

Advanced and extended scope practice of diagnostic radiographers in Scotland: Exploring strategic imaging service imperatives

INTRODUCTION

The development of diagnostic imaging services manifests features specific to the Scottish environment, in particular development of the radiographic workforce through implementing skills mix and role developments to enhance outcomes for patients. A component of a College of Radiographers Industry Partnership Scheme (CoRIPS) supported study, this research investigates perspectives of strategic service managers with Health Board responsibility for service delivery.

METHOD

A questionnaire survey was administered to strategic service managers across Scotland (N = 14), followed up with telephone interviews. There was a return rate of 57% (n = 8) for the questionnaires and n = 4 agreed to be interviewed. Data collected related to radiographer roles across their Board area; awareness and understanding of service development issues and features as well as perspective on opportunities and barriers in the context of Scottish Government policy, workforce logistics, attitudes and inter-professional relationships.

RESULTS

The results indicate evidence of financial, logistical and political barriers to service evolution, offset by a sense of optimism that scope for beneficial change may be approaching. There are a range of significant initiatives in place and an appetite exists to pursue the development of radiographer roles and skill mix for the benefit of service users more generally.

CONCLUSION

The difficulties in achieving change are well understood and there are basic issues related to finance and industrial relations. There are also however, cultural elements to contend with in the form of attitudes demonstrated by some radiographers and significantly, the radiological community whose influence on the practice of independently regulated radiographers seems incongruent.

Determination of Cl Impurities and 36Cl Instant Release from Used Candu Fuels

Chlorine-36 has been identified as a potential source of radiological risk in the disposal of nuclear fuel waste. The radioisotope 36Cl (t1/2 = 3 × 1O5 a) is produced by neutron activation of Cl impurities in UO2 fuel. The total average Cl impurity level in four unirradiated CANDU UO2 fuel samples was 2.3 ± 1.1 ppm. ORIGEN-S calculations using a 5 ppm Cl impurity in a CANDU fuel resulted in a 36Cl activity comparable to the activity of 129I and 14C produced in the fuel thus requiring 36Cl to be considered in disposal risk assessments. The “instant release” of 36Cl from the gap and grain boundary regions of the fuel to solution was measured by leaching both clad fuel and fuel samples crushed to grain-sized particles. The 36Cl concentration was measured by Accelerator Mass Spectrometry. The 36Cl releases from fuel samples taken from 8 different fuel bundles ranged from 0.5% to 20.4% of the total 3 Cl inventory over a leaching period of 32 days. The 36Cl released was found to correlate with the stable Xe gas release, the fuel burnup and the linear power rating (LPR). For a typical CANDU fuel with an LPR of -42 kW/m, the “instant release” of 36Cl would be about 5% of the total inventory.

Haploinsufficiency of SOX5 at 12p12.1 is associated with developmental delays with prominent language delay, behavior problems, and mild dysmorphic features

SOX5 encodes a transcription factor involved in the regulation of chondrogenesis and the development of the nervous system. Despite its important developmental roles, SOX5 disruption has yet to be associated with human disease. We report one individual with a reciprocal translocation breakpoint within SOX5, eight individuals with intragenic SOX5 deletions (four are apparently de novo and one inherited from an affected parent), and seven individuals with larger 12p12 deletions encompassing SOX5. Common features in these subjects include prominent speech delay, intellectual disability, behavior abnormalities, and dysmorphic features. The phenotypic impact of the deletions may depend on the location of the deletion and, consequently, which of the three major SOX5 protein isoforms are affected. One intragenic deletion, involving only untranslated exons, was present in a more mildly affected subject, was inherited from a healthy parent and grandparent, and is similar to a deletion found in a control cohort. Therefore, some intragenic SOX5 deletions may have minimal phenotypic effect. Based on the location of the deletions in the subjects compared to the controls, the de novo nature of most of these deletions, and the phenotypic similarities among cases, SOX5 appears to be a dosage-sensitive, developmentally important gene.

Left ventricular non-compaction on MRI in a patient with 22q11.2 distal deletion

We report on a 22-year-old male carrying a presumptive clinical diagnosis of Dubowitz-like phenotype who has been followed-up by cardiology for bicuspid aortic valve with ascending aorta and aortic root dilatation. Cardiac magnetic resonance imaging (CMRI) confirmed these findings, along with an incidental finding of left ventricular non-compaction (LVNC). Genetic workup revealed the diagnosis of 22q11.2 distal deletion encompassing the BCR gene. This is the first time LVNC has been reported in a patient with 22q11.2 distal deletion.

Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial

OBJECTIVE

To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management.

METHODS

Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test.

RESULTS

Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: -2.2 cm (95% CI, -2.6 to -1.7) and -2.0 cm (-2.5 to -1.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: -2.1 (-2.6 to -1.6) and -1.6 (-2.2 to -1.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p>0.05).

CONCLUSIONS

The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.

Does the application of tape influence quadriceps sensorimotor function in knee osteoarthritis?

OBJECTIVES

Using additional data from two previously reported studies, the aim was to determine the effects of immediate and short-term continuous (3 weeks) application of knee tape on quadriceps sensorimotor function in individuals with symptomatic knee osteoarthritis (OA).

METHODS

A within-subjects study (n = 18) and a randomized controlled trial (n = 87) were performed using community volunteers. Therapeutic tape (patellar realignment and soft-tissue unloading) was compared with control (placebo) tape and no tape. Outcome measures included knee joint position sense, isometric quadriceps strength and electromyographic quadriceps onset during stair descent.

RESULTS

Application of therapeutic tape worsened joint position sense (variable error) at a knee angle of 40 degrees (P < 0.01), but did not immediately alter any other sensorimotor parameter. Even after 3 weeks of wearing tape continuously, sensorimotor function was not altered. Furthermore, no differential effect of tape was noted when participants were dichotomized into those with poor and good sensorimotor scores at baseline.

CONCLUSIONS

Neither immediate application nor continuous use of tape (for 3 weeks) appears to influence sensorimotor function in people with knee OA. Alterations in sensorimotor function cannot explain the pain-relieving effects of therapeutic tape observed in this population.

Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis

OBJECTIVES

To evaluate the effects of two knee taping techniques, therapeutic tape and neutral tape, on pain and observed disability in symptomatic generalized knee osteoarthritis (OA).

METHODS

Using a within-subjects study design, 18 participants were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing neutral knee tape. Outcome measures included assessment of pain during each of four activities (using a visual analogue scale) and assessment of observed disability (walking speed, timed up and go test, and the step test).

RESULTS

Therapeutic tape significantly reduced pain on three of the four activities assessed, when compared with the neutral and untaped conditions (P<0.017). The only statistically significant change in observed disability was detected in the step test (P<0.001), in favour of the therapeutic tape.

CONCLUSIONS

Therapeutic knee tape is a simple, inexpensive strategy that increases the treatment options for therapists and patients in the conservative management of knee OA. Whilst effective in immediately reducing pain, it does not appear to have a significant immediate impact on observed disability associated with the disease. Therapeutic tape may be used as an adjunct to drug and exercise therapies, potentially augmenting the individual benefits of each.

Long-term (7 to 8-year) experience with finasteride in men with benign prostatic hyperplasia

OBJECTIVES

To evaluate the effects of finasteride, a specific type II 5-alpha-reductase inhibitor, on symptoms of benign prostatic hyperplasia, prostate volume, and urinary flow during a 7 to 8-year period.

METHODS

A total of 190 men with symptomatic benign prostatic hyperplasia and enlarged prostates entered one of two Phase II double-blind 3 to 6-month studies. Of these, 156 patients continued taking open-label finasteride, and more than 70 patients completed 7 to 8 years of treatment. The symptoms were scored using a patient self-administered modified Boyarsky symptom questionnaire. Prostate volume was measured by magnetic resonance imaging or ultrasonography, and the maximal urinary flow rate was assessed noninvasively.

RESULTS

Treatment with finasteride for 7 to 8 years led to sustained improvement in symptoms, reduction in prostate volume (28% from baseline), and increased urinary flow (median 2.5 mL/s from baseline). Decreases in dihydrotestosterone (86%) and prostate-specific antigen (54%) levels were also maintained. Long-term finasteride treatment was safe and generally well tolerated.

CONCLUSIONS

Long-term treatment with finasteride was well tolerated and resulted in durable symptom relief and improvement in prostate volume and urinary flow.

Recalcitrant chronic low back and leg pain--a new theory and different approach to management

The management of chronic low back and leg pain has always provided a challenge for therapists. This paper examines the influence of a repetitive movement such as walking as a possible causative factor of chronic low back pain. Diminished shock absorption and limited hip extension and external rotation are hypothesized to affect the mobility of the lumbar spine. These compensatory changes can result in lumbar spine dysfunction. Treatment must therefore be directed not only at increasing the mobility of the hips and thoracic spine, but also the stability of the lumbar spine. Sometimes however, the symptoms can be exacerbated by treatment, so the neural tissue needs to unloaded to optimize the treatment outcome. This can be achieved by taping the buttock and down the leg following the dermatome to shorten the inflamed tissue.

Development of a sensitive whole blood chemiluminescence method for assessing the bioactivity of calcium phosphate powders

The development of simple, but highly sensitive and accurate in vitro methods for assessing the bioactivity of biomaterials is a key requirement for assuring their successful clinical application. Moreover, screening techniques that will allow various materials to be recommended, or otherwise, for further testing, have the potential to make appreciable savings in the time and expense associated with product development. This paper gives details of a novel whole blood chemiluminescence method, based on the photoprotein Pholasin, which emits light in the presence of the free radical superoxide. other reactive oxygen species and the enzyme myeloperoxidase. This whole blood assay may have the potential as a screening method for assessing calcium phosphate (Ca-P) bioceramic powders according to their relative bioactivity. The method employed involves exposure of samples of anti-coagulated (heparinised) blood to the various Ca-P materials and stimulating the contacted leukocytes in the blood with phorbol-12-myristate-13-acetate (PMA). PMA stimulates protein kinase C directly and sets in motion a cascade of events in the leukocytes leading to the activation of the superoxide generating NADPH oxidase system. PMA also promotes degranulation, which is the fusion of the granule membrane with the plasma membrane and the extracellular release of granule enzymes. Changes in the free radical and degranulation activity of the cells, as measured by the luminescent response of Pholasin to cells stimulated with PMA, after exposure to the Ca-P powders, are presented as percentage differences from the response to (control) blood samples not exposed to the powders. The resultant data clearly indicate significant differences in the light detected via Pholasin from the blood exposed to the bioceramic materials compared to that from the relevant controls. These differences correlate well with the ascribed bioactivity of the Ca-P powders. as assigned from the measured chemical and structural properties. Furthermore, the method can also be applied to samples of blood, which have been diluted in the ratio 1:100 in standard blood dilution buffer. The light output response in the diluted blood experiments is exactly the same as that observed with undiluted whole blood but occurs immediately as compared to the many minutes required to give response in the latter case. Thermally processed (800 degrees C) Ca-P materials have also been studied. A relationship between the heat-induced properties of the powders and the chemiluminescence responses recorded from blood cells stimulated with PMA has been established.

A systematic review of physical interventions for patellofemoral pain syndrome

OBJECTIVE

Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS.

DATA SOURCES

Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords "patellofemoral," "patella," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000.

STUDY SELECTION

The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention.

RESULTS

Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others.

CONCLUSIONS

The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.

Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome

OBJECTIVE

To determine whether electromyographic (EMG) onsets of vastus medialis obliquus (VMO) and vastus lateralis (VL) are altered in the presence of patellofemoral pain syndrome (PFPS) during the functional task of stair stepping.

DESIGN

Cross-sectional.

SETTING

University laboratory.

PATIENTS

Thirty-three subjects with PFPS and 33 asymptomatic controls.

INTERVENTIONS

Subjects ascended and descended a set of stairs-2 steps, each 20-cm high-at usual stair-stepping pace. EMG readings of VMO and VL taken on middle stair during step up (concentric contraction) and step down (eccentric contraction).

MAIN OUTCOME MEASURES

Relative difference in onset of surface EMG activity of VMO compared with VL during a stair-stepping task. EMG onsets were determined by using a computer algorithm and were verified visually.

RESULTS

In the PFPS population, the EMG onset of VL occurred before that of VMO in both the step up and step down phases of the stair-stepping task (p <.05). In contrast, no such differences occurred in the onsets of EMG activity of VMO and VL in either phase of the task for the control subjects.

CONCLUSION

This finding supports the hypothesized relationship between changes in the timing of activity of the vastimuscles and PFPS. This finding provides theoretical rationale to support physiotherapy treatment commonly used in the management of PFPS.

A novel approach to pain relief pre-therapeutic exercise

Musculoskeletal problems are often multifactorial and consequently can be challenging to treat. This paper examines management of chronic musculoskeletal conditions in the light of Panjabi's stabilisation subsystems and Dye's concept of homeostasis and critical symptom threshold. In many circumstances treatment can aggravate symptoms. Tape may be used to unload painful structures to minimise the aggravation of the symptoms so treatment can be directed at improving the patient's 'envelope of function'. This involves specific muscle training of the dynamically unstable segment/s and increasing the mobility of the less flexible surrounding soft tissues. Three case studies of chronic low back and leg pain, patellofemoral pain and shoulder impingement secondary to multidirectional instability, are presented as examples of multifactorial musculoskeletal problems requiring unloading, stabilisation and control.

Patellar taping: is clinical success supported by scientific evidence?

Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapy and sports medicine practices. Despite its prevalence, the aetiology, pathogenesis, and recommended treatment remain unclear. One component of treatment for PFPS that has been subjected to scrutiny is patellar taping. This taping was designed to realign the patella within the femoral trochlea, thus reducing pain from PFPS and improving both quadriceps and patellofemoral joint function. Clinical and research findings confirm that the pain associated with PFPS is significantly reduced with patellar taping. Therefore, research has aimed at determining the mechanisms of this pain relief. The means by which patellar tape can relieve pain may provide insight into the aetiology and risk factors for PFPS, thus allowing more appropriately designed treatment regimes and preventative strategies. There is evidence to suggest that patellar tape improves patella alignment (measured radiographically) and quadriceps function (torque production and extensor moments). Evidence that patellar tape enhances the activation of individual vastii (magnitude or timing) is limited in quality and quantity, which probably reflects the difficulties inherent in measuring this complex question. There is preliminary evidence for improved knee control during gait in association with patellar tape. This paper critically reviews the studies that have examined the effects of patellar taping and makes informed recommendations for further research and clinical practice.