ABSTRACT
BACKGROUND: We conducted a study of recommendations from the American Academy of Orthopaedic Surgeons (AAOS) guideline, "Optimizing the Management of Rotator Cuff Problems." Using these recommendations, we conducted searches of clinical trial registries and bibliographic databases to note the extent to which new research has been undertaken to address areas of deficiency. HYPOTHESIS: Newly conducted research regarding rotator cuff repair and injury is available that will fill knowledge gaps identified by the AAOS guideline. STUDY DESIGN: Cross-sectional study. METHODS: For each recommendation in the AAOS guideline, we created PICO (participants, intervention, comparator, outcome) questions and search strings. Searches were conducted of ClinicalTrials.gov, the World Health Organization's International Clinical Trials Registry Platform, MEDLINE via PubMed, and EMBASE to locate studies undertaken after the final literature search performed by the AAOS work group. RESULTS: We located 210 newly registered trials and 448 published studies that are relevant to the recommendations made in the rotator cuff guideline. The majority of the recommendations have been addressed by relevant registered trials or published studies. Of the 448 published studies, 185 directly addressed the guideline recommendations. Additionally, 71% of the 185 published studies directly addressing the recommendations were randomized trials or systematic reviews/meta-analyses. The most important finding of our study was that the recommendations in the AAOS rotator cuff guideline have been adequately addressed. CONCLUSION: Orthopaedic researchers have adequately addressed knowledge gaps regarding rotator cuff repair treatment and management options. As such, the AAOS may consider a guideline update to ensure that recommendations reflect current findings in orthopaedic literature.
ABSTRACT
BACKGROUND: Phosphatidylserine (PS) is a phospholipid found in cell membranes of most animals and plants. PS has been shown to reduce stress and increase performance in runners, cyclists and golfers. The purpose of this study was to investigate the effects of a PS containing formulation on cognitive function, mood and endocrine response before and after intense resistance exercise. METHODS: 18 lower body, resistance trained, college aged males ingested 14 days of supplement (IQPLUS Focus, providing 400 mg of soy-derived PS) and a Placebo (PL), in a randomized, double-blind, placebo controlled, cross-over manner. Following 14 days of supplementation, participants performed an acute bout of lower body resistance training. Mood (Profile of Mood States, POMS) and cognitive function (Serial Subtraction Test, SST) were measured prior to, 5 minutes after, and 60 minutes after exercise. Venous blood samples were collected prior to, and 5, 15, 25, 40 and 60 minutes after exercise. Blood samples were analyzed for plasma cortisol and testosterone. Data were analyzed using repeated measures ANOVA. RESULTS: PS supplementation significantly reduced the time needed for a correct calculation on the SST by 20% (reduced by 1.27 s per calculation; PL: 6.4 s, PS: 5.13 s; p = 0.001), and reduced the total amount of errors by 39% (PL: 1.28 + .69, PS: .78 + .27, p = 0.53), and increased the amount of correct calculations by 13% (PL: 22.1 + 2.24, PS: 24.9 + 1.52, p = 0.07) prior to or in response to exercise compared to PL. Following exercise, there was no difference in SST scores between PS and PL. There were no significant changes in regards to mood or endocrine response to exercise as a result of PS supplementation. CONCLUSION: PS supplementation significantly increased cognitive function prior to exercise. Improved cognitive function could benefit athletes and non-athletes alike. PS did not appear to affect mood or endocrine response prior to or following resistance exercise.
ABSTRACT
BACKGROUND: An epidemiological link between respiratory infection and acute myocardial infarction (AMI) has been suggested, and recent data indicate that there is an association between AMI and pneumococcal community-acquired pneumonia (CAP) in hospitalized patients. The objective of this study was to investigate the association of AMI with the severity of pneumonia at hospitalization and clinical failure during hospitalization among patients with CAP. METHODS: An observational, retrospective study involving consecutive patients hospitalized with CAP was performed at the Veterans Hospital of Louisville, Kentucky. Patients admitted to the intensive care unit were defined as having severe CAP. Clinical failure was defined as the development of respiratory failure or shock. AMI was diagnosed on the basis of abnormal troponin levels and electrocardiogram findings. Propensity-adjusted models that controlled for clinical and nonclinical factors were used to investigate the association between AMI and pneumonia severity index and between AMI and clinical failure. RESULTS: Data for a total of 500 patients were studied. At hospital admission, AMI was present in 13 (15%) of 86 patients with severe CAP. During hospitalization, AMI was present in 13 (20%) of 65 patients who experienced clinical failure. Following risk adjustment, significant associations were discovered between AMI and the pneumonia severity index score (modeled with a restricted cubic spline) (P = .05) and between AMI and clinical failure (P = .04). CONCLUSIONS: A combined diagnosis of CAP and AMI is common among hospitalized patients with severe CAP. In cases in which the clinical course of a hospitalized patient with CAP is complicated by clinical failure, AMI should be considered as a possible etiology.
