Physiological, perceptual, and biomechanical differences between treadmill and overground walking in healthy adults: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces. Five databases (CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science) were searched until September 2022. Included studies needed to be a crossover design comparing biomechanical, physiological, or perceptual measures between motorised-treadmill and overground walking in healthy adults (18-65 years) walking at the same speed (<5% difference). The quality of studies were assessed using a modified Downs and Black Quality Index. Meta-analyses were performed to determine standardised mean difference ± 95% confidence intervals for all main outcome measures. Fifty-five studies were included with 1,005 participants. Relative oxygen consumption (standardised mean difference [95% confidence interval] 0.38 [0.14,0.63]) and cadence (0.22 [0.06,0.38]) are higher during treadmill walking. Whereas stride length (-0.36 [-0.62,-0.11]) and step length (-0.52 [-0.98,-0.06]) are lower during treadmill walking. Most kinetic variables are different between surfaces. The oxygen consumption, spatiotemporal and kinetic differences on the treadmill may be an attempt to increase stability due to the lack of control, discomfort and familiarity on the treadmill. Treadmill construction including surface stiffness and motor power are likely additional constraints that need to be considered and require investigation. This research was supported by an Australian Government Research Training Program (RTP) scholarship. Protocol registration is CRD42020208002 (PROSPERO International Prospective Register of Systematic Reviews) in October 2020.

Relative oxygen consumption is greater on a treadmill when compared with overground when walking at similar speeds and needs to be considered when prescribing exercise.Walking on a treadmill results in several biomechanical changes compared to overground that may be related to changes in gait stability.It may be favourable for rehabilitation purposes for people to initially walk on a treadmill due to lower vertical ground reaction force at push-off and lower joint moments at the knee and ankle.

Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia.

BACKGROUND: Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS: A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS: All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION: Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Descriptive Analysis of a Telephone Based Community Monitoring Service for COVID-19.

The coronavirus disease (COVID-19) pandemic has required health services to rapidly respond to the needs of people diagnosed with the virus. Over 80% of people diagnosed with COVID-19 experience a mild illness and there is a need for community management to support these people in their home. In this paper we present, a telephone based COVID-19 community monitoring service developed in an Australian public health network, and we describe the rapid implementation of the service and the demographic and clinical characteristics of those enrolled. A retrospective mixed methods evaluation of the COVID-19 community monitoring service using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Eight hundred and fifty COVID-19 positive patients were enrolled, 54% female, 45% male, mean age 34 years SD 17. Four hundred and nine (48%) patients were born outside Australia. Among the 850 patients, 305 (36%) were classified as having a high risk of serious illness from COVID-19. The most prevalent risk factors were cardiovascular disease (37%), lung disease (30%) and age over 60 years (26%). The most common reported ongoing symptoms were fatigue (55%), breathing issues (26%) and mental health issues such as low mood (19%). There were no deaths in patients that participated in the service. The process of risk stratification undertaken with telephone triage was effective in determining risk of prolonged illness from COVID-19. Telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.

PO-31 - Circulating tumour cells and hypercoagulability: a lethal relationship in metastatic breast cancer.

INTRODUCTION: Circulating tumour cells (CTCs) are a marker of poor prognosis and are associated with increased risk of venous thromboembolism in metastatic breast cancer. AIM: We aimed to correlate presence of CTCs and markers of hyper-coagulability (D-dimer, fibrinogen and thrombin-antithrombin [TAT]) with survival in metastatic breast cancer. MATERIALS AND METHODS: In a prospective study, enumeration of CTCs (CellSearch) and D-dimer, fibrinogen and TAT (ELISA) were measured at a single timepoint in 50 MBC (median age 59, range 36-82) patients undergoing active treatment. Survival data was determined at a median follow-up of 366days (range 58-986). RESULTS: To date, 25 patients have died (median survival 566days, range 135-978). CTCs (>1/7.5ml) were identified in 13 patients (range 2-31) and were associated with increased markers of hypercoagulability [D-dimer: median 1814 (IQR 2700) vs 755 (IQR 735) ng/ml, p=0.004; fibrinogen: median 4.2 (IQR 1.9) vs 3.2 (1.3) g/l, p=0.05; TAT: median 6.2(IQR 6.3) vs 4.7 (5.2) ng/ml, p=0.1]. CTCs were associated with visceral compared to just bony metastases (p=0.03) and their presence was associated with a trend for reduced survival (295days (CI: 0-652) vs 737days (CI: 186-1288), p=0.1). There was no correlation between CTCs /markers of hypercoagulability and age, oestrogen receptor, progesterone receptor or Her2 status. D-dimer, fibrinogen and TAT all inversely correlated with survival and were all significantly higher in patients dying within 1year (D-dimer: 1098 (IQR 1122) vs 723 (IQR 735) ng/ml, p=0.03; fibrinogen: 4.4 (1.1) vs 3.2 (0.8) g/l, p=0.004; TAT: 8.1 (6.3) vs 4.7(3.1) ng/ml, p=0.03 [analysis excludes patients with <1year follow-up, n=13]). D-dimer >1,500ng/ml was associated with significantly reduced survival (295days [CI: 0-615] vs 836days [404-1267], p=0.05). On Cox regression, D-dimer, but not fibrinogen or TAT was associated with an increased risk of death (HR 1.3 per 1,000ng/ml D-dimer, p=0.07). CONCLUSIONS: The correlation between CTCs, hypercoagulability and reduced survival in metastatic breast cancer suggests a possible role for the coagulation system in supporting tumour cell metastasis and is therefore a potential therapeutic target.

Hepatosplenic T-cell lymphoma, immunosuppressive agents and biologicals: what are the risks?

We present three cases of the rare hepatosplenic T-cell lymphoma (HSTCL); two patients suffering from Crohn disease who developed HSTCL on azathioprine without exposure to biologicals, and a third patient who had psoriasis treated using etanercept, cyclosporine and methotrexate. The evidence for an association between HSTCL and immunosuppressive drugs and biologicals is reviewed. We argue for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents.

Effect of proton pump inhibitors on markers of risk for high-grade dysplasia and oesophageal cancer in Barrett's oesophagus.

BACKGROUND: It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high-risk group for Barrett's oesophagus. AIM: To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus influences markers for risk development of subsequent high-grade dysplasia/adenocarcinoma. METHODS: A review of all patients with Barrett's oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett's oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low-grade dysplasia. Subsequent development of high-grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low-grade dysplasia at entry was determined. RESULTS: Fourteen patients developed high-grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98-5.85) more likely to have a macroscopic marker or low-grade dysplasia than those patients already on a proton pump inhibitor. CONCLUSIONS: Use of proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett's oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.

Autoimmune hepatobiliary disease in trisomy 21.

Two patients with abnormal liver biochemistry are presented with hepatobiliary disorders rarely described in trisomy 21. The first was considered to have primary sclerosing cholangitis (PSC) and Crohn's disease. Liver biochemistry was normal after six months' treatment with ursodeoxycholic acid and diarrhea resolved after sulfasalazine. The second patient had autoimmune hepatitis that responded to immunosuppression. Autoimmune hepatobiliary disorders, highlighted by this report, occur in trisomy 21 but are rare. A high index of suspicion for these potentially treatable disorders is required.

Tuberous sclerosis complex and Wolff-Parkinson-White syndrome.

This report highlights the association between tuberous sclerosis and Wolff-Parkinson-White syndrome. Ten patients with concurrent diagnoses of Wolff-Parkinson-White syndrome and tuberous sclerosis were identified. Wolff-Parkinson-White syndrome presented early in life, nine cases being diagnosed in the first year. Eight of the 10 cases were male. In eight cases, the syndrome was associated with supraventricular tachycardias, and in nine with cardiac rhabdomyomata. One child died from cardiac failure secondary to obstruction of the left ventricular outflow tract by a rhabdomyoma. Five of nine survivors showed resolution of Wolff-Parkinson-White syndrome on follow up. The accessory pathway was localised in nine patients from surface electrocardiograms: six children had left sided pathways and three had right sided pathways.

A function for the integrin alpha6beta4 in the invasive properties of colorectal carcinoma cells.

Expression of the integrin alpha6beta4, a receptor for the laminin family of matrix proteins, has been correlated with the progression and metastatic potential of several different tumors, including colorectal carcinoma. For this reason, defining the mechanistic contribution of alpha6beta4 to the aggressive behavior of colorectal and other carcinoma cells is an issue of timely importance for cancer biology. In the present study, we sought to gain insight into the function of alpha6beta4 in colorectal carcinoma cells by studying the behavior of clone A cells, which express high surface levels of this integrin, and by restoring alpha6beta4 expression in RKO cells, a beta4-deficient rectal carcinoma cell line. The data obtained reveal that alpha6beta4 expression increases the adhesive strength of these cells on laminin-1 matrices, although it does not increase their ability to migrate on such matrices. The RKO/beta4 transfectants were considerably more spread on Matrigel, laminin-1, and collagen I than the mock transfectants and displayed numerous extensions suggestive of pseudopodia. More importantly, we discovered that expression of alpha6beta4 facilitates the ability of colorectal carcinoma cells to invade both Matrigel and collagen I matrices. The alpha6beta4-dependent increases in adhesion and invasion, as well as the observed morphological changes, required an intact beta4 cytoplasmic domain. These data argue for a ligand-independent role for alpha6beta4 in promoting cell invasion, and they have important implications for the involvement of this integrin in colorectal carcinoma progression.

Ulnar nerve palsy following fractures of the distal radius: clinical and anatomical studies.

We report three cases of progressive ulnar nerve palsy following fractures of the distal radius. One was an open injury and one involved dorsal displacement of the nerve through a dislocated distal radio-ulnar joint. All were associated with dense scar tissue formation around the nerve. Early surgical decompression was successful in all cases. An anatomical study indicated that the relative immunity of the nerve to injury in this region may be due to its greater excursion and mobility compared with the median nerve.

Nurses as role models and health educators.

This paper focuses on the role of the nurse as both a role model and as a health educator and examines some key areas where tension between these two appear to exist. The context is the changing British National Health Service and the expectations of both the providers of the care and the consumers. The concept of the nurse as a role model for health is explored: the use of the term 'role' and its implications for nurses; what being a role model might mean for nurses and some of the stresses which living up to these role models might impose; the extra burden of an implied healthy role model and the expectations which are placed on nurses from both within and outwith the profession. Communication theory and the view of the nurse as a 'credible source' may add to these pressures and this paper tries to offer to nurses an alternative standpoint from which they may begin to tackle their health promotion/education activities. The traditional role of the nurse as a health educator is examined and a variety of options are offered to encourage nurses to consider their approach to dealing with clients within the context of health education. Some different models of education which are more suitable for the flexible approach which is required for health education are outlined. The paper closes with some discussion points which suggest that self-awareness and personal developments may be among the most important qualities which nurses need to be effective health educators.

Operative fixation of fractures in children.

A total of 39 fractures of the diaphyses of long bones in 31 children were subjected to operative fixation. Indications for surgery included concomitant severe head injury, multiple injuries, patients nearing skeletal maturity, inability to obtain a satisfactory reduction by conservative means, severe soft-tissue injury with or without vascular trauma, long-standing neurological disorder with incapacity and contractures, malunion, and delayed union. Although long-bone diaphyseal fractures in children are generally managed non-operatively, the use of fixation may be indicated in certain cases.

Effects of cimetidine on the healing of benign gastric ulcers.

A prospective double-blind trial was undertaken to determine whether treatment with cimetidine influenced the healing of gastric ulcers in New Zealand patients. Ulcer size and healing was assessed by endoscopic examination. Of the 30 patients who completed the trial, 15 were given cimetidine and 15 placebo. At six weeks, 60% of the patients on cimetidine had healed their ulcers, whereas only 20% of those on the placebo had healed ulcers (P < 0.05). Fewer patients taking cimetidine required antacids for symptom control than those on placebo treatment (P < 0.05). The study confirmed that cimetidine treatment accelerates the healing of gastric ulcers.

Tissue distribution of orally administered bismuth in the rat.

1. A colloidal bismuth preparation, tripotassium dicitrato-bismuthate, was given (172 mg/kg body weight, 6/7 days) to 10 laboratory rats for 14 months. Bismuth was measured by atomic absorption spectrometry in various tissues and the pattern of distribution studied. 2. Bismuth was present in kidney lung, spleen, liver, brain, heart and skeletal muscles, in descending order of abundance. Haematological data, renal and liver function tests were normal in the bismuth-treated group. 3. The data suggested that chronic ingestion of bismuth in large doses in rats results in absorption and binding to tissues. Absorbed bismuth probably crosses the blood-brain barrier.

Fibresigmoidoscopy: technique of choice?

A study was undertaken to determine the practicality of replacing rigid sigmoidoscopy with flexible fibresigmoidoscopy. A total of 388 examinations were performed and complete examination was possible in 79% of patients in less than 10 minutes. Abnormalities were found in 18% of patients; colorectal polyps and tumours were identified in 11% of patients. No complications occurred and the investigation was well tolerated. Fibresigmoidoscopy is a practical, safe procedure for routine use in the outpatient setting and has several advantages over rigid sigmoidoscopy.