Ultrasound-Guided Infiltrative Treatment Associated With Early Rehabilitation Program in Adhesive Capsulitis in "Post-Covid syndrome"...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

The aim of the study is to evaluate the efficacy of ultrasound-guided infiltrative treatment associated with early rehabilitation program in patients with adhesive capsulitis devoleped in Post-Covid syndrome. This is an observational study. The setting for patient assessment is ambulatory. Six consecutive patients regarded to outclinic for adhesive capsulitis in the post-covid syndrome are clinically and ultrasonographically evaluated and undergo an interventional ultrasound procedure associated with early rehabilitation treatment. Patients are treated with infiltrative hydrodistension therapy under ultrasound guidance. This technique consists in injecting a saline solution combined with corticosteroids and anesthetic that relax the capsule thanks to the increase in hydrostatic pressure (called hydrodistension) increasing the volume capacity of the shoulder. The rehabilitation treatment is undertaken immediately after the infiltrative treatment in order to improve the joint ROM. Attive shoulder range of motion (ROM), Visual Analogic Scale for Pain (VAS), Shoulder Pain and Disability Index (SPADI) and Disability of the Arm, Shoulder and Hand (DASH) are used for clinical assessment. In patients with adhesive capsulitis, before the treatment, a fairly reduced shoulder range of motion is seen with mean elevation values allowed for 55°;abduction 40 °, internal rotation allowed for 30 ° with arm abducted to 90 °, external rotation allowed for 40 ° with arm abducted to 90 °. After 2 months from the treatment we obtain an almost complete recovery of the range of motion (elevation 150 °;abduction 130 °, internal rotation allowed in for 70 ° with arm abducted to 90 °, external rotation allowed for 80 ° with arm abducted at 90 °). The VAS mean score before the treatment is 6,9, after 2 months of treatment the VAS score is 1. In patients with adhesive capsulitis developed in post-Covid Syndrome, infiltrative hydrodistension therapy associated with early rehabilitation treatment provides more successful results in terms of active ROM of the joint and reduction of pain. The author declares no conflict of interest.

Clinical advances: pregnancy in gastroenterologic and hepatic conditions.

The fields of gastroenterology and hepatology, along with endoscopic practice, have seen significant changes and innovations to practice in just the past few years. These practice changes are not limited to gastroenterology, but maternal fetal medicine and the care of the pregnant person have become increasingly more sophisticated as well. Gastroenterologists are frequently called on to provide consultative input and/or perform endoscopy during pregnancy. To be able to provide the best possible care to these patients, gastroenterologists need to be aware of (and familiar with) the various nuances and caveats related to the care of pregnant patients who either have underlying gastrointestinal (GI) conditions or present with GI and liver disorders. Here, we offer a clinical update with references more recent than 2018, along with a few words about SARS-CoV-2 infection and its relevance to pregnancy.

BPM Support for Patient-Centred Clinical Pathways in Chronic Diseases.

Epidemiological trends over the past decade show a significant worldwide increase in the burden of chronic diseases. At the same time, the human resources of health care are becoming increasingly scarce and expensive. One of the management concepts that can help in solving this problem is business process management (BPM). The results of research conducted in the healthcare sector thus far prove that BPM is an effective tool for optimizing clinical processes, as it allows for the ongoing automatic tracking of key health parameters of an individual patient without the need to involve medical personnel. The aim of this article is to present and evaluate the redesign of diagnostic and therapeutic processes enabling the patient-centric organization of therapy thanks to the use of new telemedicine techniques and elements of hyperautomation. By using an illustrative case study of one of the most common chronic diseases, Chronic Obstructive Pulmonary Disease (COPD), we discuss the use of clinical pathways (CPs) prepared on the basis of the current version of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a communication tool between healthcare professionals, the patient and his or her caregivers, as well as the method of identifying and verifying new knowledge generated on an ongoing basis in diagnostic and therapeutic processes. We also show how conducting comprehensive, patient-focused primary health care relieves the health care system, and at the same time, thanks to the use of patient engagement and elements of artificial intelligence (predictive analyses), reduces the significant clinical risk of therapy.

Endoscopy training in the UK pre-COVID-19 environment: a multidisciplinary survey of endoscopy training and the experience of reciprocal feedback.

OBJECTIVE: Training in gastrointestinal endoscopy in the UK occurs predominantly in a real world one-to-one trainer to trainee interaction. Previous surveys have shown surgical and gastroenterology trainees have had mixed experiences of supervision and training, and no surveys have explored specifically the role of trainee to trainer feedback. This study aimed to explore the experience of training and of providing trainer feedback for all disciplines of endoscopy trainees. DESIGN/METHOD: An online survey designed in collaboration with Joint Advisory Committee training committee and trainee representatives was distributed from January 2020 but was interrupted by the COVID-19 pandemic and hence terminated early. RESULTS: There were 129 responses, including trainees from all disciplines and regions, of which 86/129 (66.7%) rated the culture in their endoscopy units favourably-either good or excellent. 65/129 (50.4%) trainees reported having one or more training lists allocated per week, with 41/129 (31.8%) reporting only ad hoc lists. 100/129 (77.5%) respondents were given feedback and 97/129 (75.2%) were provided with learning points from the list. 65/129 (50.4%) respondents reported their trainer completed a direct observation of procedure or direct observation of polypectomies. 73/129 (56.6%) respondents reported that they felt able to give feedback to their trainer, with 88/129 (68.2%) feeling they could do this accurately. Barriers to trainer feedback cited included time constraints, lack of anonymity and concerns about affecting the trainer-trainee relationship. CONCLUSION: Overall, the training environment has improved since previous surveys. There are still issues around interdisciplinary differences with some surgical trainees finding the training environment less welcoming, and trainee perceptions of hierarchical barriers and trainer responsiveness to feedback limiting the accuracy of their feedback.

Endoscopes used in positive and critically ill patients are SARS-CoV-2 negative at virological assessment.

The risk of SARS-CoV-2 transmission in endoscopy is not only between patients and endoscopy staff but is also through inadequately reprocessed endoscopes. There are no studies that could confirm the efficacy of current ways of endoscope reprocessing on the elimination of SARS-CoV-2. The aim of this pilot study was to evaluate the efficacy of high disinfection of endoscopes with peracetic acid on eliminating SARS-CoV-2, but surprisingly we found that the virus cannot be detected on any part of endoscopes used in critically ill patients due to SARS-CoV-2 and this was the same for all types of endoscopies and procedures. If confirmed in larger studies, these findings will probably open a new scenario in the overall understanding of the real impact of the virus.

[Diagnostic and therapeutic strategies of lung cancer patients during the outbreak of 2019 novel coronavirus disease (COVID-19)].

With the increasing number of cases and widening geographical spread, the 2019 novel coronavirus disease (COVID-19) has been classified as one of the class B infectious diseases but prevented and controlled as class A infectious disease by the National Health Commission of China. The diagnosis and treatment of lung cancer patients have been challenged greatly because of extraordinary public health measures since the lung cancer patients are a high-risk population during the COVID-19 outbreak period. Strict protection for lung cancer patients is needed to avoid infection. Lung cancer patients are difficult to differentiate from patients with COVID-19 in terms of clinical symptoms, which will bring great trouble to the clinical work and physical and mental health of lung cancer patients. This review will demonstrate how to applicate appropriate and individual management for lung cancer patients to protect them from COVID-19.