Immediate and short-term effects of mulligan concept positional sustained natural apophyseal glides on an athletic young-adult population classified with mechanical neck pain: an exploratory investigation.

Objectives: Mechanical neck pain (MNP) is common in the athletic population. While symptoms may present at the cervical spine for patients complaining of MNP, thoracic spinal alignment or dysfunction may influence cervical positioning and overall cervical function. Clinicians often employ cervical high-velocity low-amplitude (HVLA) thrust manipulations to treat MNP, albeit with a small level of inherent risk. Mulligan Concept positional sustained natural apophyseal glides (SNAGs) directed at the cervicothoracic region are emerging to treat patients with cervical pain and dysfunction, as evidence supporting an interdependent relationship between the thoracic and cervical spine grows. The purpose of this a priori study was to evaluate outcome measures of patients classified with MNP treated with the Mulligan Concept Positional SNAGs. Methods: Ten consecutive young-adult patients, ages ranging from 15 to 18 years (mean = 16.5 ± 1.78), classified with MNP were treated utilizing Mulligan Concept Positional SNAGs. The Numeric Rating Scale (NRS), Patient-Specific Functional Scale (PSFS), Neck Disability Index (NDI), Disablement in the Physically Active (DPAS), and Fear-Avoidance Based Questionnaire-Physical Activity (FABQPA) were collected for inclusion criteria and to identify patient-reported pain and dysfunction. Results: Patients reported decreases in pain on the NRS [5.4 to .16, p = .001], increases in function on the PSFS [5.2 to 10, p = .001], and increases in cervical range of motion (CROM) [ext p = .003, flex p = .009, left rot p = .001, right rot p = .002] immediately post-treatment and between treatments. Discussion: Positional SNAGs directed at the cervicothoracic region may address a variety of patient reported symptoms for MNP, and the number of treatment sessions needed for symptom resolution may be closer to a single session rather than multiple treatments. Level of Evidence: 4.

THE UTILIZATION OF MULLIGAN CONCEPT THORACIC SUSTAINED NATURAL APOPHYSEAL GLIDES ON PATIENTS CLASSIFIED WITH SECONDARY IMPINGEMENT SYNDROME: A MULTI-SITE CASE SERIES.

BACKGROUND AND PURPOSE: Secondary impingement syndrome (SIS) is a common complaint in the sporting population particularly among athletes engaging in overhead activities. While symptoms may be present at the shoulder with patients complaining of SIS, spinal alignment or dysfunction can influence scapular positioning and overall shoulder girdle function. As an adjunct therapy to traditional interventions for SIS, thoracic high-velocity low-amplitude (HVLA) thrusts have been utilized and correlated with patient reported decreases in pain. Mulligan Concept (MC) thoracic sustained natural apophyseal glides (SNAGs) are an emerging treatment intervention utilized to treat patients with shoulder pain and dysfunction as the evidence supporting an interdependent relationship between the thoracic spine and the shoulder is growing. The purpose of this case series was to investigate the effects of one MC thoracic SNAG treatment session on subjects classified with SIS, while utilizing a classification-based treatment protocol. CASE DESCRIPTIONS: Seven subjects classified with SIS were treated utilizing a MC thoracic SNAG. The Numeric Rating Scale (NRS) was administered at initial evaluation, immediately following intervention, and at the 48-h follow-up to identify patient-reported pain during range of motion, manual strength testing, and special tests of the shoulder. Investigators collected the Shoulder Pain and Disability Index (SPADI) at initial evaluation and the 48-h follow-up to identify patient-reported dysfunction. OUTCOMES: Following one MC thoracic SNAG treatment (3 sets of 10 repetitions), minimal clinically important differences (MCIDs) were reported utilizing the NRS. A decrease in pain during active shoulder abduction (ABD) was detected immediately post-treatment, and the NRS change scores for resisted external rotation (RER) and active ABD were statistically different and clinically important at the 48-h follow-up. DISCUSSION: Based on the results of this case series, thoracic SNAGs may influence short-term pain levels and shoulder mobility in the included subjects with SIS and support the concept of regional interdependence (RI) between the thoracic spine and glenohumeral joint. Continued exploration into the proposed benefits of the MC thoracic SNAG treatment as an adjunct therapy when treating patients complaining of SIS is warranted. LEVEL OF EVIDENCE: 4 (Case Series).

Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service.

Outpatient parenteral antimicrobial therapy (OPAT) has evolved relatively slowly in the UK. This study describes the OPAT service based in a large UK teaching hospital in Sheffield, and examines the clinical efficacy, patient acceptability and costs saved over a 10-year period. Data on 3812 episodes of OPAT administered between January 2006 and January 2016 were retrieved from a prospectively maintained electronic database. This study compared the real costs of the OPAT service with estimated costs of conventional inpatient care for these patient episodes, and analysed patient feedback questionnaires that were administered randomly between January 2014 and January 2015. A wide range of infections were managed during the 10-year period. Skin and soft tissue infections accounted for 57% of OPAT episodes. The total number of bed-days saved was 49,854. A successful outcome (cure or improvement) was found in 3357 (88%) episodes. Re-admission occurred in 265 (7%) episodes. The rates of healthcare-associated infections were low: 15 intravenous-line-related infections were recorded (0.3 per 1000 OPAT patient-days). Patient acceptance and satisfaction with OPAT were high. OPAT cost 15%, 39%, 40% and 44% of inpatient costs for an infectious diseases unit, national average costs, other departments (non-infectious diseases unit), and the minimum national average costs for each diagnostic category, respectively. This study shows that OPAT is safe, clinically efficacious and acceptable for treating a wide range of infections with high levels of patient satisfaction and substantial cost savings.

Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective.

OBJECTIVES: Outpatient parenteral antibiotic therapy (OPAT) is an effective treatment strategy for a wide variety of infections as long as clinical risk is minimized by conforming to practice guidelines. However, its cost-effectiveness has not been established in the setting of the UK National Health Service. We examined the clinical efficacy and cost-effectiveness of an OPAT service based in a large UK teaching hospital, predominantly using the outpatient 'infusion centre' and patient/carer administration models of service delivery. PATIENTS AND METHODS: Data on clinical activity and outcomes were collected prospectively on 334 episodes of treatment administered by the Sheffield OPAT service between January 2006 and January 2008. Cost-effectiveness was calculated by comparing real costs of OPAT with estimated inpatient costs for these patient episodes incorporating two additional sensitivity analyses. RESULTS: Of the OPAT episodes, 87% resulted in cure or improvement on completion of intravenous therapy. The readmission rate was 6.3%, and patient satisfaction was high. OPAT cost 41% of equivalent inpatient costs for an Infectious Diseases Unit, 47% of equivalent inpatient costs using national average costs and 61% of inpatient costs using minimum inpatient costs for each diagnosis. CONCLUSIONS: Using this service model, OPAT is safe and clinically effective, with low rates of complications/readmissions and high levels of patient satisfaction. OPAT is cost-effective when compared with equivalent inpatient care in the UK healthcare setting.

A novel mutation in CD83 results in the development of a unique population of CD4+ T cells.

Using a mouse mutagenesis screen, we have identified CD83 as being critical for the development of CD4(+) T cells and for their function postactivation. CD11c(+) dendritic cells develop and function normally in mice with a mutated CD83 gene but CD4(+) T cell development is substantially reduced. Additionally, we now show that those CD4(+) cells that develop in a CD83 mutant animal fail to respond normally following allogeneic stimulation. This is at least in part due to an altered cytokine expression pattern characterized by an increased production of IL-4 and IL-10 and diminished IL-2 production. Thus, in addition to its role in selection of CD4(+) T cells, absence of CD83 results in the generation of cells with an altered activation and cytokine profile.