Prognostic Information on Progression to Dementia: Quantification of the Impact on Quality of Life.

Background: The increasing interest in early identification of people at risk of developing dementia, has led to the development of numerous models aimed at estimating the likelihood of progression from mild cognitive impairment (MCI) to dementia. It is important to study both the need for and possible outcomes related with such prediction models, including the impact of risk predictions on perceived quality of life (QoL). Objective: This study aimed to quantify the impact that receiving a risk prediction on progression from MCI to dementia has on QoL. Methods: A Discrete Choice Experiment (DCE) and Time Trade Off (TTO) study were performed. Participants completed choice tasks related to dementia prognosis while imagining having MCI. We collected DCE data by an online survey, and TTO data via videoconferencing interviews. DCE data were analyzed using a mixed multinomial logit model and were anchored to a health state utility scale using mean observed TTO valuations. Results: 296 people participated in the DCE and 42 in the TTO. Moderate and high predicted dementia risks were associated with decrements in utility (-0.05 and -0.18 respectively), compared to no prognostic information. Low predicted risk was associated with an increase in utility (0.06), as well as the availability of medication or lifestyle interventions (0.05 and 0.13 respectively). Conclusions: This study shows a significant impact of dementia risk predictions on QoL and highlights the importance of caution when sharing information about expected MCI disease courses.

The dose-response of pain throughout a Nordic hamstring exercise intervention.

The Nordic hamstring exercise (NHE) reduces hamstring injury incidence. Compliance to large exercise volumes of the NHE is poor, with exercise related soreness often seen as a contributing factor. We investigated the dose-response of NHE exposure with delayed onset muscle soreness (DOMS) and non-DOMS pain. Forty males were randomized to a 6-week intervention of four different NHE dosages: Group 1: very low volume; Group 2: low volume; Group 3: initial high to low volume; Group 4: low to high volume. Group 4 experienced more DOMS (p < 0.05) and non-DOMS pain (p = 0.030) than other groups. High volumes of NHE increase DOMS and non-DOMS pain while lower volume protocols have lesser DOMS and non-DOMS pain responses.

Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands.

OBJECTIVE: To develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost. DESIGN: We developed decision analytical models to estimate the consequences of delayed elective surgical procedures (eg, total hip replacement, bariatric surgery or septoplasty). SETTING: The framework was applied to a large hospital in the Netherlands. OUTCOME MEASURES: Quality measures impacts on quality of life and costs were taken into account and combined to calculate net monetary losses per week delay, which quantifies the total loss for society expressed in monetary terms. Net monetary losses were weighted by operating times. RESULTS: We studied 13 common elective procedures from four specialties. Highest loss in quality of life due to delayed surgery was found for total hip replacement (utility loss of 0.27, ie, 99 days lost in perfect health); the lowest for arthroscopic partial meniscectomy (utility loss of 0.05, ie, 18 days lost in perfect health). Costs of surgical delay per patient were highest for bariatric surgery (€31/pp per week) and lowest for arthroscopic partial meniscectomy (-€2/pp per week). Weighted by operating room (OR) time bariatric surgery provides most value (€1.19/pp per OR minute) and arthroscopic partial meniscectomy provides the least value (€0.34/pp per OR minute). In a large hospital the net monetary loss due to prolonged waiting times was €700 840 after the first COVID-19 wave, an increase of 506% compared with the year before. CONCLUSIONS: This surgical prioritisation framework can be tailored to specific centres and countries to support priority setting for delayed elective operations during and after the COVID-19 pandemic, both in and between surgical disciplines. In the long-term, the framework can contribute to the efficient distribution of OR time and will therefore add to the discussion on appropriate use of healthcare budgets. The online framework can be accessed via: https://stanwijn.shinyapps.io/priORitize/.

Early versus delayed lengthening exercises for acute hamstring injury in male athletes: a randomised controlled clinical trial.

BACKGROUND: To evaluate the efficacy of early versus delayed introduction of lengthening (ie, eccentric strengthening) exercises in addition to an established rehabilitation programme on return to sport duration for acute hamstring injuries in a randomised controlled superiority trial. METHODS: 90 male participants (age: 18-36 years, median 26 years) with an MRI-confirmed acute hamstring injury were randomised into an early lengthening (at day 1 of rehabilitation) group or a delayed lengthening (after being able to run at 70% of maximal speed) group. Both groups received an established rehabilitation programme. The primary outcome was time to return to sport (ie, time from injury to full unrestricted training and/or match play). The secondary outcome was reinjury rate within 12 months after return to sport. Other outcomes at return to sport included the Askling H-test, hamstring strength, clinical examination and readiness questions. RESULTS: The return to sport in the early lengthening group was 23 (IQR 16-35) days and 33 (IQR 23-40) days in the delayed lengthening group. For return to sport (in days), the adjusted HR for the early lengthening group compared with the delayed lengthening group was 0.95 (95% CI 0.56 to 1.60, p=0.84). There was no significant difference between groups for reinjury rates within 2 months (OR=0.94, 95% CI 0.18 to 5.0, p=0.94), from 2 to 6 months (OR=2.00, 95% CI 0.17 to 23.3, p=0.58), and 6 to 12 months (OR=0.57, 95% CI 0.05 to 6.6, p=0.66). CONCLUSION: Accelerating the introduction of lengthening exercises in the rehabilitation of hamstring injury in male athletes did not improve the time to return to sport nor the risk of reinjury.

The Dose-Response of the Nordic Hamstring Exercise on Biceps Femoris Architecture and Eccentric Knee Flexor Strength: A Randomized Interventional Trial.

PURPOSE: To examine the dose-response of the Nordic hamstring exercise (NHE) on biceps femoris long head (BFlh) architecture and eccentric knee flexor strength. DESIGN: Randomized interventional trial. METHODS: Forty recreationally active males completed a 6-week NHE training program consisting of either intermittent low volumes (group 1; n = 10), low volumes (group 2; n = 10), initial high volumes followed by low volumes (group 3; n = 10), or progressively increasing volumes (group 4; n = 10). A 4-week detraining period followed each program. Muscle architecture was assessed weekly during training and after 2 and 4 weeks of detraining. Eccentric knee flexor strength was assessed preintervention and postintervention and after 2 and 4 weeks of detraining. RESULTS: Following 6 weeks of training, BFlh fascicle length (FL) increased in group 3 (mean difference = 0.83 cm, d = 0.45, P = .027, +7%) and group 4 (mean difference = 1.48 cm, d = 0.94, P = .004, +14%). FL returned to baseline following detraining in groups 3 and 4. Strength increased in group 2 (mean difference = 53.6 N, d = 0.55, P = .002, +14%), group 3 (mean difference = 63.4 N, d = 0.72, P = .027, +17%), and group 4 (mean difference = 74.7, d = 0.83, P = .006, +19%) following training. Strength returned to baseline following detraining in groups 2 and 3 but not in group 4. CONCLUSIONS: Initial high volumes of the NHE followed by lower volumes, as well as progressively increasing volumes, can elicit increases in BFlh FL and eccentric knee flexor strength. Low volumes of the NHE were insufficient to increase FL, although as few as 48 repetitions in 6 weeks did increase strength.

Biceps Femoris Fascicle Lengths Increase after Hamstring Injury Rehabilitation to a Greater Extent in the Injured Leg.

Objectives: Document changes in fascicle length during rehabilitation from hamstring injury of the injured and uninjured legs and secondarily to describe any association between these changes and reinjury rate. Design: Multicentre case series. Methods: Fifty-two prospectively included hamstring injured athletes had their biceps femoris long head fascicle lengths measured at the start and end of rehabilitation using two-dimensional ultrasound. Absolute and relative changes in fascicle length were compared for each leg using linear mixed models. Participants were followed for six months after being cleared to return to sport for any reinjury. Fascicle lengths and rehabilitation duration were compared for those who reinjured and those who did not. Results: Injured leg fascicle length was shorter at the start of rehabilitation (9.1 cm compared to 9.8 cm, p < 0.01 ) but underwent greater absolute and relative lengthening during rehabilitation to 11.1 cm (18% increase) compared to 10.2 cm (8% increase, p < 0.01 ) for the uninjured leg. There were no significant differences in any fascicle length parameter for the 5 participants who reinjured in the 6 months following their return to sport compared to those that did not reinjure. Conclusions: While both injured and uninjured legs displayed increases in fascicle length during rehabilitation, the larger fascicle length increases in the injured leg suggest that either a different training stimulus was applied during rehabilitation to each leg or there was a different response to training and/or recovery from injury in the injured leg. Reinjury risk appears to be independent of fascicle length changes in this cohort, but the small number of reinjuries makes any conclusions speculative.

A cost-effectiveness analysis of three approaches for lymph node assessment in patients with low- and intermediate-risk endometrial cancer.

OBJECTIVE: To assess the cost-effectiveness of sentinel lymph node mapping compared to risk factor assessment and routine full lymph node dissection for the assessment of lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer. METHODS: A decision-analytic model was designed to compare three lymph node assessment strategies in terms of costs and effects: 1) sentinel lymph node mapping; 2) post-operative risk factor assessment (adjuvant therapy based on clinical and histological risk factors); 3) full lymph node dissection. Input data were derived from systematic literature searches and expert opinion. QALYs were used as measure of effectiveness. The model was built from a healthcare perspective and the impact of uncertainty was assessed with sensitivity analyses. RESULTS: Base-case analysis showed that sentinel lymph node mapping was the most effective strategy for lymph node assessment in patients with low- and intermediate-risk endometrial cancer. Compared to risk factor assessment it was more costly, but the incremental cost effectiveness ratio stayed below a willingness-to-pay threshold of €20,000 with a maximum of €9637/QALY. Sentinel lymph node mapping was dominant compared to lymph node dissection since it was more effective and less costly. Sensitivity analyses showed that the outcome of the model was robust to changes in input values. With a willingness-to-pay threshold of €20,000 sentinel lymph node mapping remained cost-effective in at least 74.3% of the iterations. CONCLUSION: Sentinel lymph node mapping is the most cost-effective strategy to guide the need for adjuvant therapy in patients with low and intermediate risk endometrioid endometrial cancer.

Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play.

BACKGROUND: Clinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this. OBJECTIVE: Our objectives were to describe MRI characteristics at RTP, to evaluate healing and to examine the association of MRI characteristics at RTP with reinjury for clinically recovered hamstring intramuscular tendon injuries. METHODS: We included 41 athletes with hamstring intramuscular tendon injuries and an MRI at baseline and RTP. For both MRIs, we used a standardised scoring form that included intramuscular tendon injury characteristics. We recorded reinjuries during 1-year follow-up. RESULTS: At RTP, 56% of the intramuscular tendons showed a partial or complete thickness tendon discontinuity. Regarding healing from injury to RTP, 18 of 34 (44% overall) partial-thickness tendon discontinuities became continuous and 6 out of 7 (15% overall) complete thickness tendon discontinuities became partial-thickness tendon discontinuities. Waviness decreased from 61% to 12%, and 88% of tendons became thickened. We recorded eight (20%) reinjuries within 1 year. Intramuscular tendon characteristics at RTP between participants with or without a reinjury were similar. CONCLUSION: Complete resolution of an intramuscular tendon injury on MRI is not necessary for clinically successful RTP. From injury to RTP, the intramuscular tendon displayed signs of healing. Intramuscular tendon characteristics of those with or without a reinjury were similar.

Similar Isokinetic Strength Preinjury and at Return to Sport after Hamstring Injury.

INTRODUCTION: Side-to-side strength differences are often used in return to sport (RTS) decision making after hamstring injury. In football (soccer), there is little consensus, and a side-to-side difference of <10% is often suggested as a criterion. To date, no study has determined whether differences exist when comparing the strength of the injured limb at RTS with the preinjury level. PURPOSE: The aims of this study were to compare the isokinetic strength at RTS with preinjury strength in the injured limb and to investigate the side-to-side differences at RTS. METHODS: This study was based on a pooled group of patients participating in two single-site randomized controlled trials. All eligible professional male soccer players who suffered a hamstring injury confirmed by magnetic resonance imaging were included. The isokinetic strength of the injured limb at RTS was compared with preinjury screening tests, and the side-to-side difference was determined at both time points. RESULTS: In total, 41 hamstring injuries were included in the analyses. Side-to-side differences in isokinetic strength at RTS were similar to preinjury levels. At RTS, the average strength of the injured limb was >95% compared with preinjury strength. Overall, 63.4% of the players had a >10% negative strength difference (i.e., the injured limb being weaker), and 57.9% of the players had a >10% positive strength difference (i.e., the injured limb being stronger) in at least one of the five isokinetic variables. CONCLUSION: The distribution of isokinetic strength differences when comparing strength at RTS with preinjury measures was similar, urging clinical caution when interpreting these results. Small changes in the isokinetic strength of the injured limb at RTS compared with preinjury strength suggest that isokinetic cutoff values are not useful to guide the restoration of strength as a criterion for RTS after hamstring injury.

Accuracy of exhaust emission factor measurements on chassis dynamometer.

To improve the accuracy, reliability, and representativeness of emission factors, 10 European laboratories worked together to study the influence of 20 parameters on the measurement of light-vehicle emission factors on chassis dynamometer of 4 main categories: driving patterns, vehicle-related parameters, vehicle sampling, and laboratory-related parameters. The results are based on (1) literature synthesis, (2) approximately 2700 specific tests with 183 vehicles, and (3) the reprocessing of more than 900 tests. These tests concern the regulated atmospheric pollutants and pre-Euro to Euro 4 vehicles. Of the 20 parameters analyzed, 7 seemed to have no effect, 7 were qualitatively influential, and 6 were highly influential (gearshift strategy, vehicle mileage, ambient temperature, humidity, dilution ratio, and driving cycle). The first four of the six were able to have correction factors developed for them. The results allow for the design of recommendations or guidelines for the emission factor measurement method.