Early mobilisation following mini-open rotator cuff repair: a randomised control trial.

This study compared the clinical outcomes following mini-open rotator cuff repair (MORCR) between early mobilisation and usual care, involving initial immobilisation. In total, 189 patients with radiologically-confirmed full-thickness rotator cuff tears underwent MORCR and were randomised to either early mobilisation (n = 97) or standard rehabilitation (n = 92) groups. Patients were assessed at six weeks and three, six, 12 and 24 months post-operatively. Six-week range of movement comparisons demonstrated significantly increased abduction (p = 0.002) and scapular plane elevation (p = 0.006) in the early mobilisation group, an effect which was not detectable at three months (p > 0.51) or afterwards. At 24 months post-operatively, patients who performed pain-free, early active mobilisation for activities of daily living showed no difference in clinical outcomes from patients immobilised for six weeks following MORCR. We suggest that the choice of rehabilitation regime following MORCR may be left to the discretion of the patient and the treating surgeon.

Systematic review of rotator cuff tears in workers' compensation patients.

BACKGROUND: The burden imposed by workplace rotator cuff (RC) injuries has been reasonably defined. However, literature associated with the demographic characteristics and 'best practices' to manage such injuries among workers' compensation (WC) patients is scant. AIMS: To consolidate the existing literature on full-thickness RC tears among WC patients. Subject, shoulder and injury characteristics were examined to determine if and how WC recipients may differ from their non-compensable counterparts. METHODS: A systematic search (databases, clinical practice guideline web resources, conference proceedings and reference lists) revealed 450 abstracts. Two blinded reviewers independently assessed abstracts for inclusion. Sixty abstracts were subsequently included in a blinded full manuscript review. Seventeen of these manuscripts (3.8% of sample; 11 intervention and 6 determinant) were included in the present review. RESULTS: Previous studies demonstrate that operative interventions are appropriate for full-thickness RC tears as substantial gains in range of motion, strength and quality of life were witnessed within the first post-operative year. Non-operative interventions, including workplace-based work hardening, physical therapy and the use of an early referral system, were shown to improve outcomes. Conflicting results exist with respect to determinants such as age and sex. Importantly, WC patients had consistently poorer outcomes than non-WC patients. CONCLUSIONS: Our results show that although WC patients experience substantial benefits from various treatments for full-thickness RC tears, disparities exist between them and their non-WC counterparts. The lack of WC-specific literature limited our results. Larger studies, particularly ones comparing WC patients with their non-compensable counterparts, are crucial to allow for future evidence-based recommendations.

The use of dietary supplements in the elderly: current issues and recommendations.

Research on dietary intake in the elderly shows evidence of both adequate and inadequate nutrient consumption from food. More recent studies have documented inadequate mineral intake from food and confirmed the overall decline in nutrient intake from food as people age. Food is incontrovertibly the best vehicle for nutrient consumption. However, some authorities have found reason to recommend a daily multivitamin-mineral for the elderly as a reasonable way to assure adequate micronutrient intake. There appears to be no reason to recommend complete liquid supplements or modular macronutrient supplements to the active free-living elderly population.

[Treatment of acute lymphoblastic leukemia in low risk adults]. / Tratamiento de la leucemia aguda linfoblástica del adulto de riesgo bajo.

Forty five adult patients with low risk acute lymphoblastic leukemia were treated with prednisone, vincristine and adriamycin. 91 per cent (41 patients) obtained complete remission with a mean survival was of 39 months. The side effects of treatment were minimal and less patient had to delay his chemotherapy. This regimen of treatment is a good option for adults patients with low risk acute lymphoblastic leukemia, in consequence of: a) high value of complete remission and its duration. b) the mean survival obtained and the probability of cure. c) the absence of severe side effects and without necessity of support therapy or hospitalization.