The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial.

BACKGROUND: Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term. METHODS: We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post-intervention. RESULTS: Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056). CONCLUSION: Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.

Improvement of thiol groups and total antioxidant capacity in patients with non-alcoholic fatty liver after treatment with pioglitazone.

OBJECTIVE: The aim of the present study was to evaluate oxidative stress state in non-alcoholic fatty liver (NAFLD) patients at the time of diagnosis and by passing three months from the treatment. METHODS: 37 patients with NAFLD in summer 2019 were enrolled in this study. Also, 37 healthy controls that were matched for sex and age were included as a control group. Oxidative stress parameters such as lipid peroxidation (MDA), total antioxidant capacity (TAC), and Thiols were measured by standard methods and were then compared with before treatment. RESULTS: At the time of diagnosis, MDA levels were significantly increased and FRAP and Thiol levels were significantly decreased. After 3 months of treatment with pioglitazone, MDA levels decreased and FRAP and Thiol group increased. CONCLUSIONS: Non-alcoholic fatty liver disease is associated with the higher levels of MDA and lower serum levels of total antioxidant capacity and Thiol group levels.

Factors affecting strategic plan implementation using interpretive structural modeling (ISM).

Purpose Strategic planning is the best tool for managers seeking an informed presence and participation in the market without surrendering to changes. Strategic planning enables managers to achieve their organizational goals and objectives. Hospital goals, such as improving service quality and increasing patient satisfaction cannot be achieved if agreed strategies are not implemented. The purpose of this paper is to investigate the factors affecting strategic plan implementation in one teaching hospital using interpretive structural modeling (ISM). Design/methodology/approach The authors used a descriptive study involving experts and senior managers; 16 were selected as the study sample using a purposive sampling method. Data were collected using a questionnaire designed and prepared based on previous studies. Data were analyzed using ISM. Findings Five main factors affected strategic plan implementation. Although all five variables and factors are top level, "senior manager awareness and participation in the strategic planning process" and "creating and maintaining team participation in the strategic planning process" had maximum drive power. "Organizational structure effects on the strategic planning process" and "Organizational culture effects on the strategic planning process" had maximum dependence power. Practical implications Identifying factors affecting strategic plan implementation is a basis for healthcare quality improvement by analyzing the relationship among factors and overcoming the barriers. Originality/value The authors used ISM to analyze the relationship between factors affecting strategic plan implementation.

Effect of a modified dynamic accordion hinge Denis Browne brace on the success rate of the Ponseti method in idiopathic clubfoot: a preliminary study.

After the success of Dr Ponseti's method for the treatment of idiopathic clubfoot deformity, the number of patients who need soft tissue release has decreased, but the use of foot abduction orthosis is crucial for maintaining correction after this method. The lack of adherence to the orthosis regimen is reported to be a major factor for recurrence. Noncompliance with brace may be because of skin ulceration and blistering or irritability of children because of restrictiveness of the leg motion in the brace. The aim of this article is to introduce a new design of Denis Browne brace (accordion Hinge DB brace) and evaluate the results. We treated a total of 90 patients with idiopathic clubfoot (145 clubfeet) by Dr Ponseti's method and then prescribed a new design accordion to a hinge DB brace after correction of the deformity. We retrospectively reviewed the rate of complications, noncompliance, results, and effectiveness of this newly designed brace. The mean follow-up duration was 36 months (range 14-50 months). All 145 (100%) clubfeet showed complete correction after applying Dr Ponseti's method before brace prescription. Then, the accordion hinge DB brace was applied after removal of the last cast, 23 h a day for 3 months, followed by nightly use subsequently for up to 4 years. Noncompliance was encountered for 15 (10.3%) clubfeet and in 11 (7.5%) clubfeet, relapse was observed. The mean time to relapse was 14 months. Among 15 noncompliant patients, 13 were older than 2 years of age and only one relapse occurred in a patient younger than 2 years old. We did not encounter any case with skin ulceration. On the basis of the results, and compared with our previous study with a classic DB brace, a considerable reduction in noncompliance and relapse was observed. We did not encounter any case with skin ulceration. This accordion hinge DB brace reduces the rate of the complications of classic DB brace, and we strongly recommend the accordion hinge DB brace after the Ponseti method and serial casting. LEVEL OF EVIDENCE: 4.