ABSTRACT
Lateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30-68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.
ABSTRACT
Cleaning products have long been a focus of efforts to improve sustainability and assure safety for the aquatic environment when disposed of after use. The latter is addressed at ingredient level through environmental risk assessment, including in formal frameworks such as REACH. Nevertheless, in the context of programs to improve overall sustainability, stakeholders demand both environmental safety assurance and progress at product level. Current product-level approaches for aquatic toxicity (e.g., USEtox™, Critical Dilution Volume) can be seen as predominantly hazard-based. The more logical approach would be risk-based, because ecotoxicity is generally threshold-dependent and hazard-based assessment produces conflicts with risk-based learnings. The development of a risk-based approach to assess formulated products is described: the International Association for Soaps, Detergents and Maintenance Products (A.I.S.E.) Charter Environmental Safety Check (ESC), which is consistent with the scientific principles underlying REACH. This is implemented through a simple spreadsheet tool and internal database of ingredient parameters including predicted no-effect concentration (PNEC) and removal rate. A novel feature is applying market volume information for both product types and ingredients to permit a risk-based calculation. To pass the ESC check, the projected environmental safety ratio (PESR) for each ingredient as formulated and dosed (unless cleared by a published risk assessment or exempted as inherently low risk) must be less than 1. The advantages of a risk-based approach are discussed. The strengths and limitations of various possible approaches to standard-setting, product-ranking and driving continuous improvement in respect of potential ecotoxic impacts on the aquatic environment are considered. It is proposed that as ecotoxicity is generally accepted to be threshold-dependent, with no effect below the threshold, the most constructive approach to continuous improvement of sustainability with regard to ecotoxicity is to focus efforts on instances where the safety margins for ingredients as used in specific products are narrow. This necessitates a risk-based approach. Integr Environ Assess Manag 2017;13:127-138. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of SETAC.
