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Clinical Implant Dentistry and Related... Jul 2024To assess navigation accuracy for complete-arch implant placement with immediate loading of digitally prefabricated provisional.
OBJECTIVES
To assess navigation accuracy for complete-arch implant placement with immediate loading of digitally prefabricated provisional.
MATERIALS AND METHODS
Consecutive edentulous and terminal dentition patients requiring at least one complete-arch FDP were treated between December 2020 and January 2022. Accuracy was evaluated by superimposing pre-operative and post-operative cone beam computed tomography (CBCT), recording linear (mm) and angular (degrees) deviations. T-tests were performed to investigate the potential effect of the registration algorithm (fiducial-based vs. fiducial-free), type of references for the fiducial-free algorithm (teeth vs. bone screws), site characteristic (healed vs. post-extractive), implant angulation (axial vs. tilted), type of arch (maxilla vs. mandible) on the accuracy with p-value <0.05.
RESULTS
Twenty-five patients, 36 complete-arches, and 161 implants were placed. The overall mean angular deviation was 2.19° (SD 1.26°). The global platform and apex mean deviations were 1.17 mm (SD 0.57 mm), and 1.30 mm (SD 0.62 mm). Meaningful global platform (p = 0.0009) and apical (p = 0.0109) deviations were experienced only between healed and post-extraction sites. None of the analyzed variables significantly influenced angular deviation. Minor single-axis deviations were reported for the type of jaw (y-axis at implant platform and apex), registration algorithm (y-axis platform and z-axis deviations), and type of references for the fiducial-free algorithm. No statistically significant differences were found in relation to implant angulation.
CONCLUSIONS
Within the study limitations navigation was reliable for complete-arch implant placement with immediate loading digitally pre-fabricated FDP. AI-driven surface anatomy identification and calibration protocol made fiducial-free registration as accurate as fiducial-based, teeth and bone screws equal as references. Implant site characteristics were the only statistically significant variable with healed sites reporting higher accuracy compared to post-extractive. Live-tracked navigation surgery enhanced operator performance and accuracy regardless of implant angulation and type of jaw. A mean safety room of about 1 mm and 2° should be considered.
PubMed: 38967100
DOI: 10.1111/cid.13360 -
International Journal of Sports... 2024In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines...
BACKGROUND
In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA).
PURPOSE
The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines.
METHODS
This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed.
RESULTS
Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05).
CONCLUSION
Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA.
LEVEL OF EVIDENCE
3b.
PubMed: 38966826
DOI: 10.26603/001c.118926 -
BMC Neurology Jul 2024Body weight unloaded treadmill training has shown limited efficacy in further improving functional capacity after subacute rehabilitation of ischemic stroke patients.... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of robot-assisted versus standard training on motor function following subacute rehabilitation after ischemic stroke - protocol for a randomised controlled trial nested in a prospective cohort (RoboRehab).
BACKGROUND
Body weight unloaded treadmill training has shown limited efficacy in further improving functional capacity after subacute rehabilitation of ischemic stroke patients. Dynamic robot assisted bodyweight unloading is a novel technology that may provide superior training stimuli and continued functional improvements in individuals with residual impairments in the chronic phase after the ischemic insult. The aim of the present study is to investigate the effect of dynamic robot-assisted versus standard training, initiated 6 months post-stroke, on motor function, physical function, fatigue, and quality of life in stroke-affected individuals still suffering from moderate-to-severe disabilities after subacute rehabilitation.
METHODS
Stroke-affected individuals with moderate to severe disabilities will be recruited into a prospective cohort with measurements at 3-, 6-, 12- and 18-months post-stroke. A randomised controlled trial (RCT) will be nested in the prospective cohort with measurements pre-intervention (Pre), post-intervention (Post) and at follow-up 6 months following post-intervention testing. The present RCT will be conducted as a multicentre parallel-group superiority of intervention study with assessor-blinding and a stratified block randomisation design. Following pre-intervention testing, participants in the RCT study will be randomised into robot-assisted training (intervention) or standard training (active control). Participants in both groups will train 1:1 with a physiotherapist two times a week for 6 months (groups are matched for time allocated to training). The primary outcome is the between-group difference in change score of Fugl-Meyer Lower Extremity Assessment from pre-post intervention on the intention-to-treat population. A per-protocol analysis will be conducted analysing the differences in change scores of the participants demonstrating acceptable adherence. A priori sample size calculation allowing the detection of the minimally clinically important between-group difference of 6 points in the primary outcome (standard deviation 6 point, α = 5% and β = 80%) resulted in 34 study participants. Allowing for dropout the study will include 40 participants in total.
DISCUSSION
For stroke-affected individuals still suffering from moderate to severe disabilities following subacute standard rehabilitation, training interventions based on dynamic robot-assisted body weight unloading may facilitate an appropriate intensity, volume and task-specificity in training leading to superior functional recovery compared to training without the use of body weight unloading.
TRIAL REGISTRATION
ClinicalTrials.gov. NCT06273475.
TRIAL STATUS
Recruiting. Trial identifier: NCT06273475. Registry name: ClinicalTrials.gov. Date of registration on ClinicalTrials.gov: 22/02/2024.
Topics: Humans; Robotics; Stroke Rehabilitation; Ischemic Stroke; Prospective Studies; Exercise Therapy; Recovery of Function; Male; Female; Middle Aged; Treatment Outcome; Cohort Studies; Adult; Motor Activity
PubMed: 38965499
DOI: 10.1186/s12883-024-03734-9 -
BMJ Open Jul 2024Reviews of commercial and publicly available smartphone (mobile) health applications (mHealth app reviews) are being undertaken and published. However, there is...
INTRODUCTION
Reviews of commercial and publicly available smartphone (mobile) health applications (mHealth app reviews) are being undertaken and published. However, there is variation in the conduct and reporting of mHealth app reviews, with no existing reporting guidelines. Building on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we aim to develop the Consensus for APP Review Reporting Items (CAPPRRI) guidance, to support the conduct and reporting of mHealth app reviews. This scoping review of published mHealth app reviews will explore their alignment, deviation, and modification to the PRISMA 2020 items for systematic reviews and identify a list of possible items to include in CAPPRRI.
METHOD AND ANALYSIS
We are following the Joanna Briggs Institute approach and Arksey and O'Malley's five-step process. Patient and public contributors, mHealth app review, digital health research and evidence synthesis experts, healthcare professionals and a specialist librarian gave feedback on the methods. We will search SCOPUS, CINAHL Plus, AMED, EMBASE, Medline, APA PsycINFO and the ACM Digital Library for articles reporting mHealth app reviews and use a two-step screening process to identify eligible articles. Information on whether the authors have reported, or how they have modified the PRISMA 2020 items in their reporting, will be extracted. Data extraction will also include the article characteristics, protocol and registration information, review question frameworks used, information about the search and screening process, how apps have been evaluated and evidence of stakeholder engagement. This will be analysed using a content synthesis approach and presented using descriptive statistics and summaries. This protocol is registered on OSF (https://osf.io/5ahjx).
ETHICS AND DISSEMINATION
Ethical approval is not required. The findings will be disseminated through peer-reviewed journal publications (shared on our project website and on the EQUATOR Network website where the CAPPRRI guidance has been registered as under development), conference presentations and blog and social media posts in lay language.
Topics: Mobile Applications; Humans; Telemedicine; Systematic Reviews as Topic; Research Design; Review Literature as Topic
PubMed: 38964792
DOI: 10.1136/bmjopen-2023-083364 -
Trials Jul 2024Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain...
BACKGROUND
Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP.
METHODS
A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%.
DISCUSSION
This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis.
TRIAL REGISTRATION
Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.
Topics: Humans; Neck Pain; Low-Level Light Therapy; Chronic Pain; Randomized Controlled Trials as Topic; Combined Modality Therapy; Treatment Outcome; Pain Measurement; Disability Evaluation; Adult; Female; Male; Middle Aged; Exercise Therapy; Time Factors; Quality of Life
PubMed: 38961460
DOI: 10.1186/s13063-024-08289-1 -
Journal of Robotic Surgery Jul 2024Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper...
Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2-L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers' spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial-lateral and superior-inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.
Topics: Humans; Pedicle Screws; Robotic Surgical Procedures; Algorithms; Tomography, X-Ray Computed; Cadaver; Lumbar Vertebrae; Spinal Fusion; Surgery, Computer-Assisted
PubMed: 38960985
DOI: 10.1007/s11701-024-02001-w -
Journal of Shoulder and Elbow Surgery Jul 2024To investigate the usefulness of the routinely planned six-week outpatient visit and x-ray in patients treated surgically for the most common upper extremity fractures...
OBJECTIVES
To investigate the usefulness of the routinely planned six-week outpatient visit and x-ray in patients treated surgically for the most common upper extremity fractures including clavicle, proximal humerus, humeral shaft, olecranon, radial shaft and distal radius.
METHOD
This was a retrospective cohort study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the x-ray made at the 6-week outpatient visit. Abnormalities were defined as all differences between the intra-operative (or direct postoperative) and 6-week x-ray. In case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard post operative treatment and follow-up protocol based on the 6-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion.
RESULTS
A total of 267 patients were included. Abnormalities on x-ray at 6 weeks postoperatively were found in only 10 (3.7%) patients of which only 4 (1.5%) had clinical implications (in three patients extra imaging was required and in one patient it was necessary to deviate from standard weightbearing/ROM limitation regime). The clinical/radiological findings during the 6-week outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive for complications.
CONCLUSION
The routine 6-week outpatient visit and x-ray, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered.
LEVEL OF EVIDENCE
Level IV; Case Series; Prognosis Study.
PubMed: 38960137
DOI: 10.1016/j.jse.2024.04.025 -
Enhanced rotation sensing with high-order exceptional points in a multi-mode coupled-ring gyroscope.Optics Letters Jul 2024Exceptional points (EPs) of non-Hermitian systems are sensitive to perturbations and facilitate the development of highly sensitive gyroscopes. We propose a compact...
Exceptional points (EPs) of non-Hermitian systems are sensitive to perturbations and facilitate the development of highly sensitive gyroscopes. We propose a compact multi-mode optical gyroscope protocol that incorporates two coupled rings and exhibits a fourth-order EP, achieving higher sensitivity compared to gyroscopes based on second-order EPs. We show that the gyroscope sensitivity can be further improved by deviating from the fourth-order EP due to the gain dependence on the cavity intensity. Furthermore, our protocol exhibits resilience against backscattering from counter-propagating modes, which leads to a reduced angular random walk (ARW) factor and increased sensitivity. These features make our protocol highly promising for advancing high-performance optical gyroscopes and enhancing angular velocity sensing technologies.
PubMed: 38950273
DOI: 10.1364/OL.529990 -
Cureus May 2024Background and aims This research investigates COVID-19 awareness among primary school teachers and staff in Bisha City. It aims to enhance safety protocols by examining...
Background and aims This research investigates COVID-19 awareness among primary school teachers and staff in Bisha City. It aims to enhance safety protocols by examining knowledge, awareness levels, and demographic associations. Despite school reopening, concerns linger. The study promotes informed decision-making, fostering a safer school environment and contributing to the well-being of the educational community. Methods In an institutional-based cross-sectional study among primary school teachers and administrative staff in Bisha City, our research aimed to comprehensively evaluate awareness regarding specific measures for minimizing COVID-19 risks. With a sample size of 348 participants, we employed a robust methodology, including online questionnaires addressing sociodemographic characteristics and knowledge about COVID-19 risks. The data collection period spanned from March 2022 to December 2023, providing a temporal context for responses. A pilot test ensured questionnaire clarity, and efforts were made to enhance reliability and validity, incorporating validated scales and iterative adjustments based on feedback. Non-response or incomplete responses were handled transparently, with sensitivity analyses to assess potential impact. The awareness level was measured using 17 Likert scale questions, and predefined categories (poor, moderate, and good) facilitated result interpretation. Researcher influence was minimized through training and inter-rater reliability checks. Confidentiality and anonymity were rigorously maintained, adhering to ethical considerations. Statistical analyses employed frequency tables, percentages, mean, standard deviations, and the chi-square test. Dissemination included academic publications, reports to the educational directorate, and presentations at conferences. This holistic approach contributes to the robustness and societal impact of our study, offering insights into COVID-19 awareness among educators in Bisha City. Results In this study assessing awareness among teachers and administrative staff in Bisha City regarding COVID-19 risk minimization, data from 348 respondents revealed key bio-demographic characteristics. The majority demonstrated good knowledge of environmental (83%) and personal hygiene risks (84%). The chi-square test indicated no significant associations between bio-demographic factors and awareness levels. Specifically, for age groups, χ²(4, N = 348) = 5.46, p = 0.707; for gender, χ²(1, N = 348) = 1.95, p = 0.744; for educational levels, χ²(4, N = 348) = 2.13, p = 0.995; for residency, χ²(1, N = 348) = 1.11, p = 0.892; and for job types, χ²(3, N = 348) = 8.30, p = 0.404. The absence of significant associations underscores the potential universality of successful awareness campaigns, suggesting that future efforts can maintain an inclusive approach without tailoring messages. These results emphasize the importance of sustained awareness efforts across the diverse demographic spectrum of the educational community. Conclusion This study reveals robust COVID-19 awareness among primary school teachers and staff in Bisha City, with no significant demographic associations. Successful, inclusive awareness campaigns can further enhance safety measures and promote well-being in the educational community.
PubMed: 38947569
DOI: 10.7759/cureus.61337 -
Frontiers in Immunology 2024Despite advances in surgical and therapeutic approaches, high-grade serous ovarian carcinoma (HGSOC) prognosis remains poor. Surgery is an indispensable component of...
Despite advances in surgical and therapeutic approaches, high-grade serous ovarian carcinoma (HGSOC) prognosis remains poor. Surgery is an indispensable component of therapeutic protocols, as removal of all visible tumor lesions (cytoreduction) profoundly improves the overall survival. Enhanced predictive tools for assessing cytoreduction are essential to optimize therapeutic precision. Patients' immune status broadly reflects the tumor cell biological behavior and the patient responses to disease and treatment. Serum cytokine profiling is a sensitive measure of immune adaption and deviation, yet its integration into treatment paradigms is underexplored. This study is part of the IMPACT trial (NCT03378297) and aimed to characterize immune responses before and during primary treatment for HGSOC to identify biomarkers for treatment selection and prognosis. Longitudinal serum samples from 22 patients were collected from diagnosis until response evaluation. Patients underwent primary cytoreductive surgery or neoadjuvant chemotherapy (NACT) based on laparoscopy scoring. Twenty-seven serum cytokines analyzed by Bio-Plex 200, revealed two immune phenotypes at diagnosis: Immune High with marked higher serum cytokine levels than Immune Low. The immune phenotypes reflected the laparoscopy scoring and allocation to surgical treatment. The five Immune High patients undergoing primary cytoreductive surgery exhibited immune mobilization and extended progression-free survival, compared to the Immune Low patients undergoing the same treatment. Both laparoscopy and cytoreductive surgery induced substantial and transient changes in serum cytokines, with upregulation of the inflammatory cytokine IL-6 and downregulation of the multifunctional cytokines IP-10, Eotaxin, IL-4, and IL-7. Over the study period, cytokine levels uniformly decreased in all patients, leading to the elimination of the initial immune phenotypes regardless of treatment choice. This study reveals distinct pre-treatment immune phenotypes in HGSOC patients that might be informative for treatment stratification and prognosis. This potential novel biomarker holds promise as a foundation for improved assessment of treatment responses in patients with HGSOC. ClinicalTrials.gov Identifier: NCT03378297.
Topics: Humans; Female; Ovarian Neoplasms; Cystadenocarcinoma, Serous; Cytokines; Middle Aged; Aged; Neoadjuvant Therapy; Phenotype; Cytoreduction Surgical Procedures; Biomarkers, Tumor; Neoplasm Grading; Prognosis; Treatment Outcome; Adult
PubMed: 38947323
DOI: 10.3389/fimmu.2024.1394497