Effectiveness of Scapular Stabilization Versus Non-Stabilization Stretching on Shoulder Range of Motion, a Randomized Clinical Trial.

Background: Previous research has demonstrated the benefits of both stabilization and non-stabilization of the scapula during stretching in individuals with posterior shoulder tightness, but limited evidence exists in patients with shoulder pain. Hypothesis/Purpose: The aim of this study was to determine the effect of stabilized scapular stretching on patients with shoulder pain. The primary hypothesis of this study is that stabilized scapular stretching will improve glenohumeral motion and pain compared to non-stabilized stretch program. A secondary hypothesis of this study is that stabilized scapular stretching will produce greater improvement in function compared to the non-stabilized stretching program. Study Design: Randomized Clinical Trial. Methods: Sixteen patients with sub-acromial pain associated with tendinopathy and associated pathologies presenting to physical therapy were randomized into two groups (stabilized or non-stabilized scapular stretching). Baseline pain and range of motion were measured prior to and following each treatment session for three visits that occurred over the course five to seventeen days depending on the patients availability. The dependent measurements were stabilized horizontal adduction, stabilized internal rotation, stabilized shoulder flexion, non-stabilized shoulder flexion, and current pain level. Results: Patients in the scapular stabilization stretching group increased horizontal adduction 40° (CI95 31, 48°) compared to the non-stabilization stretching group increase of 8° (CI95 0, 17°) over the course of the three treatments (p<0.001). Similarly, the stabilized stretching group increased internal rotation 48° (CI95 26, 69°) compared to the non-stabilized stretching group increase of 26° (CI95 4, 48°) (p=0.001). Pain decreased in the stabilized stretching group by 1.4 points (CI95 -0.4, 3.2) but increased slightly in non-stabilized group by -0.5 points (CI95 -2.3, 1.3) which was not a clinically meaningful change. (p=0.03). Conclusion: Stabilized scapular stretching was more effective than non-stabilized stretching at gaining shoulder mobility in patients with shoulder pain. Benefits were immediate and sustained between treatment sessions. Stretching interventions improved range of motion but had limited effect on shoulder pain. Level of Evidence: 2.

Healthcare in the Age of COVID-19: A Midwestern Catholic Health System's Innovative and Technology-Forward Approach to Life-Saving Care.

After the novel coronavirus SARS-CoV-2 was declared a pandemic in mid-March, it challenged healthcare systems to provide care while mitigating the risk to both patients and staff. The high transmissibility of the virus combined with PPE shortages made this an even more difficult task. A Catholic health system in Sioux Falls, South Dakota, embraced healthcare technology in order to bridge the gap between providing patient care, exposure to the virus, and lack of PPE. To treat COVID-19 patients, they developed a COVID clinic that provides triage, testing, and a hospital-at-home service. The service uses Health Recovery Solution devices to monitor more symptomatic or high-risk patients and provide real-time health data to physicians at a remote site, keeping stable COVID patients out of the hospital while still providing quality care. They also embraced telemedicine across all primary care and subspecialties, increasing the use of the AveraNow platform from less than 50 virtual visits per day to more than 1,000 per day. In long term care, the organization implemented multiple forms of healthcare technology, including TYTO Care devices, the Polycom RealPresence device, and doxy.me services to continue to provide care to these extremely high-risk patients. In the arguably most at-risk environment, the emergency department, the health system was able to use their eCARE emergency video call system to reduce the amount of staff exposed to COVID patients and allow physicians to minimize their exposure while still being able to communicate with patients and perform necessary procedures. Hopefully health systems that have yet to embrace telemedicine or other forms of healthcare technology can use this organization's model to implement changes, especially in the face of uncertainty regarding whether coronavirus will peak again, and whether that peak will be even higher than the surge already seen throughout the U.S.

Pneumomediastinum and ST-Segment Elevation.

Although acute myocardial infarction is the most clinically significant cause of ST-segment elevation, other serious clinical conditions have been reported with this electrocardiographic abnormality. We report a patient with pneumomediastinum who presented with dyspnea and electrocardiographic changes mimicking ST-segment elevation myocardial infarction. Coronary angiography demonstrated no evidence of myocardial injury and the electrocardiographic abnormality promptly resolved with the resolution of the pneumomediastinum.

Natural disasters and myocardial infarction: the six years after Hurricane Katrina.

OBJECTIVE: To determine the prolonged effect of Hurricane Katrina on the incidence and timing of acute myocardial infarction (AMI) in the city of New Orleans. PATIENTS AND METHODS: Our study population consisted of 1476 patients with AMI before (August 29, 1999, to August 28, 2005) and after (February 14, 2006, to February 13, 2012) Hurricane Katrina at Tulane University Health Sciences Center to determine post-Katrina alterations in the occurrence and timing of AMI. RESULTS: Compared with pre-Katrina values, there was a more than 3-fold increase in the percentage of admissions for AMI during the 6 years after Hurricane Katrina (P<.001). The percentage of admissions for AMI after Hurricane Katrina increased significantly on nights (P<.001) and weekends (P<.001) and decreased significantly on mornings (P<.001), Mondays (P<.001), and weekdays (P<.001). Patients with AMI after Hurricane Katrina also had significantly higher rates of psychiatric comorbidities (P=.01), smoking (P<.001), lack of health insurance (P<.05), and unemployment (P<.001). CONCLUSION: These results indicate that the effect of natural disasters on the occurrence of AMI may persist for at least a 6-year period and may be related to various factors including population shifts, alterations in the health care system, and the effects of chronic stress and associated behaviors.

Coronary angiographic significance of hyperacute ST-T changes associated with regadenoson stress.

An abnormal electrocardiographic stress test is typically characterized by ST segment depression. In rare cases, ST segment elevation is observed, which, in the absence of diagnostic Q waves, has anatomic specificity for localized myocardial ischemia. Most instances of ST elevation occurring during cardiac stress testing have been observed with exercise, with only six cases reported with pharmacologic stress. Despite different physiologic mechanisms for inducing myocardial ischemia, development of ST segment elevation during pharmacologic stress, as illustrated by the present case, may also be indicative of critical coronary stenoses, warranting urgent coronary arteriography.

Leclercia adecarboxylata in an immunocompetent patient.

Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompromised individuals. In reported cases of immunocompetent patients infected with this organism, it is seen exclusively in the context of polymicrobial infections. We report here the case of an abscess in an immunocompetent patient that grew out L. adecarboxylata as a pure culture. The limited literature available on this organism is reviewed, and the potential implication of this finding is discussed.