Application of MAPO (Movement and Assistance of Hospitalized Patients) method in hospitals and nursing homes: frequency of manual patient handling-part 2.

This study examines the evolution of MAPO method for estimating the frequency of overloading tasks in healthcare workers during different shifts. The data presented were collected from 51 in-patient wards (25 hospitals and 26 nursing homes), and 917 workers: the frequency of MPH tasks is a complementary value to the MAPO exposure level, which is useful to implement a prevention plan targeted towards the reduction of overloading tasks. Based on the frequency of manual patient handling, it appears that the afternoon shift is at greatest risk, with tasks liable to cause overloading occurring within a frequency range of 70-85 per worker. The study analyzes different pieces of equipment and their relative percentages of use, concluding that, overall, they are underutilised (especially minor aids and height-adjustable beds). Practitioner summary: The organisational data collected in hospitals and nursing homes confirms the availability of patient handling aids and equipment, but also indicates that they are underutilised with respect to the frequency of overloading tasks.

Rituximab for remission induction in elderly patients with ANCA-associated vasculitis.

OBJECTIVES: Advancing age is a risk factor for treatment-related side effects and mortality in AAV patients treated with cyclophosphamide (CYC) and glucocorticoids (GC) for remission induction. The efficacy and safety of rituximab (RTX) in elderly AAV patients has not been well described. METHODS: We performed a single center retrospective review of 31 consecutive AAV patients aged 60 or more at the time of RTX use for remission induction. All patients received RTX with GC for remission induction. Four patients received concomitant CYC for a mean duration of 52 days. We evaluated clinical and laboratory variables at diagnosis, rates of complete remission defined as Birmingham Vasculitis Activity Score/Wegener's Granulomatosis (BVAS/WG) = 0 and patient survival, renal survival, infections requiring hospitalization, and vasculitis relapse 24 months following RTX use. RESULTS: Of the 31 patients, 77% were Caucasian, 68% female, mean age was 71 ± 6 years, 58% were MPO ANCA positive, and 42% had relapsing disease. The mean BVAS/WG score entry was 4.4 ± 1.5, 71% had glomerulonephritis (GN) and 10% had alveolar hemorrhage. The mean baseline e-GFR was 40 ± 28ml/min/1.73m(2). Thirty patients achieved remission with a mean time to remission of 57 ± 27 days. The single patient with refractory vasculitis responded to CYC. The mean prednisone dose at 6 months was 5.6 ± 4mg. Remission maintenance therapy was started within 12 months of RTX induction in 6 patients (4 with RTX, 1 with azathioprine, and 1 with mycophenolate mofetil). One patient suffered a limited relapse 10 months post RTX use. Among the 22 patients with GN at baseline, 1 developed ESRD. One-year patient survival among 25 patients with at least 1 year of follow-up was 100%. There were no episodes of infusion reaction or leukopenia. There were 3 episodes of bacterial pneumonia, 1 episode of candida pneumonia, and 1 episode of disseminated cutaneous zoster. CONCLUSIONS: This study demonstrates that rituximab is effective for remission induction in elderly patients with AAV. Furthermore, we observed a high incidence of infectious complications. Our experience was limited by its retrospective design, and further studies are needed to evaluate the efficacy and safety of RTX in elderly AAV patients.

BK virus replication in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis.

BACKGROUND: BK virus (BKV) is an important cause of renal dysfunction in kidney transplant (KTX) recipients. Immunosuppression intensity is a major risk factor for BKV replication in these patients. The prevalence of BKV replication in immunosuppressed patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) without transplant is not known. METHODS: Consecutive patients (n = 37) with a diagnosis of GPA (n = 25) or MPA (n = 12) without history of KTX were evaluated for plasma BKV replication by quantitative PCR (group A). Descriptive data were collected. BKV replication in this nontransplant immunosuppressed vasculitis cohort was compared with a historical cohort of vasculitis KTX recipients (group B). RESULTS: Group A patients had mean disease duration of 75 months. Mean age was 57 years and 54% were female. Mean time from vasculitis onset to BKV testing was 36 months, and 19/37 patients were tested within 24 months of induction therapy. At the time of BKV testing, 73% were on prednisone (P) with azathioprine, mycophenolate mofetil (MMF), methotrexate or leflunomide. None of the nontransplanted vasculitis patients had detectable plasma BKV. Among 35 patients in group B, 16 were tested for BKV; 5/16 (31%) had detectable virus in plasma at a mean of 6 months after TX (p = 0.002). Most (94%) were on maintenance therapy with MMF, P and tacrolimus. CONCLUSION: Immunosuppressed patients with GPA/MPA without KTX had no evidence of plasma BKV. However, BKV was common in GPA/MPA patients after KTX, suggesting that replication may be related to differences in immunosuppression, alloimmune activation or differences in host defense mechanisms.

OARSI-OMERACT initiative: defining thresholds for symptomatic severity and structural changes in disease modifying osteoarthritis drug (DMOAD) clinical trials.

OBJECTIVE: Total joint replacement has been proposed as an endpoint in disease modifying osteoarthritis drug (DMOAD) randomized clinical trials (RCTs); however, disparities have generated concerns regarding this outcome. A combined Osteoarthritis Research Society International (OARSI)/Outcome Measures in Rheumatology (OMERACT) initiative was launched in 2004 to develop a composite index ['virtual total joint replacement' (VJR)] as a surrogate outcome for osteoarthritis (OA) progression in DMOAD RCTs. Our objective was to evaluate the prevalence of patients fulfilling different thresholds of sustained pain, reduced function, and X-ray change in existing DMOAD RCTs. DESIGN: Post hoc analysis of summary data from the placebo arm of eight DMOAD RCTs. RESULTS: Eight OA RCTs representing 1379 patients were included. Pain was assessed by WOMAC and/or VAS and function by WOMAC and/or Lequesne. Among six knee and two hip studies, 248 (22%) and 132 (51%) patients respectively had X-ray progression [decrease joint space width (JSW) ≥0.5 mm]. The prevalence of patients fulfilling clinical and radiographic criteria was highest (n = 163, 12%) in the least stringent scenario (pain + function ≥80 at ≥2 visits); with few patients (n = 129, 2%) in the most stringent scenario (pain + function ≥80 at ≥4 visits). Using these prevalence data, a sample size of 352-2144 per group would be needed to demonstrate a 50% difference between groups. CONCLUSIONS: The prevalence of patients with sustained symptomatic OA of at least a moderate degree with X-ray progression is low. Even using lenient criteria to define VJR, large patient numbers would be required to detect differences between groups in DMOAD RCTs. Investigation of the optimal cutoff threshold and combination of symptoms and radiographic change should be pursued.

Effects of individualized whole-body vibration on muscle flexibility and mechanical power.

AIM: The first purpose of the present study was to assess acute, residual and chronic effects of whole-body vibration on hamstring and lower back flexibility through the application of an individual frequency of vibration. The second purpose was to determine whether the applied vibration intervention over time influences flexibility and reactive strength differently. METHODS: Thirty-four young physically active subjects (19 female and 15 male) were randomly assigned to either a Control or a Vibration Group. Lower back and hamstring flexibility was measured using the Stand and Reach Test. The reactive strength was estimated calculating the power in Drop Jump. RESULTS: During whole-body vibration the relative change in acute flexibility for the Vibration Group (5.30+/-1.67 cm, 284%) reached a level of significance (P=0.038) compared to that of the Control Group (3.14+/-2.11 cm, 84%). Statistically significant differences in residual flexibility between the two groups were found at 6-min after the conclusion of vibration (P=0.034), at which point the Vibration Group showed the maximal relative change to pre-test (6.31+/-3.36 cm, 138%) versus the Control Group (3.06+/-1.87 cm, 20%). Chronic exposure of whole-body vibration did not produce significant changes in flexibility over time (P>0.05), whereas power in the Drop Jump performance of the Vibration Group increased significantly resulting in a benefit of 16% (P=0.019). CONCLUSION: The current study shows that individualized whole-body vibration without superimposing other exercises is an effective method of acutely increasing lower back and hamstring flexibility. Furthermore, the applied individualized whole-body vibration over time influences the reactive strength rather than flexibility.

A dynamometer for evaluation of dynamic muscle work.

The validation of a new dynamometer for evaluation of dynamic muscle work is presented. The device was based on a precise measurement of load displacements of any machine using gravitational loads as external resistance. It allowed, through a sensor consisting of an infrared photo interrupter, the calculation of velocity, force and power during concentric, eccentric and stretch-shortening cycle activity. To validate the dynamometer 33 male and female track and field athletes (12 throwers and 21 jumpers) participated in the study. The throwers (4 women and 8 men) were asked to perform half-squat exercises on a slide machine with a load of 100% of the subject's body mass. The day-to-day reproducibility of half-squat exercises gave a correlation coefficient of r = 0.88, 0.97 and 0.95 for average push-off force (AF), average push-off velocity (AV), and average push-off power (AP) respectively. Comparison of half-squat measurements was performed against jumping and running test evaluation by the jumpers (7 women and 14 men). The interrelationships among the different variables studied demonstrated a strong correlation between AF, AV and AP and sprinting and jumping parameters (r = 0.53-0.97; P < 0.05-0.001). Using values of AF, AV and AP developed in half-squat exercises executed with different loads, ranging from 35% to 210% of the subject's body mass, it was also possible to establish the force-velocity and power-velocity relationships for both male and female jumpers. In any individual case, the maximal error due to the measurement system was calculated to be less than 0.3%, 0.9% and 1.2% for AF, AV, and AP respectively.(ABSTRACT TRUNCATED AT 250 WORDS)