Manual Techniques Research Articles

Immediate Effect Of Lumbar Manipulation On Lumbar Range Of Motion And Lower Limb Functional Test In Recreational Football Players: An Experimental Study

Context: Football is a commonly played sport. Functional impediments in footballers may arise due to decreased spinal mobility, which affects quality of life and performance. Manipulative treatment is a manual therapy techniques which uses a high velocity “thrust” applied to a synovial joint over very short amplitude. Aims:To evaluate the immediate effect of lumbar manipulation on lumbar range of motion (ROM) and lower limb function in footballers. Methods and Material:22 male footballers of 18 to 30 years underwent a single session of lumbar manipulation. Modified-modified Schober‟s test was used to evaluate changes in lumbar ROM, while Anterior, Postero-lateral and Postero- medial components of Star excursion balance test (SEBT) were used to measure dynamic balance and single leg triple hop distance test for lower limb strength. Results: Statistical analysis revealed significant differences in outcome measures obtained. Post intervention t-value and p-value for SEBT Anterior (t= 5.583, p= 0.001), SEBT Postero-medial (t=10.376, P=0.001), SEBT Postero-lateral (t=8.495, P=0.001), Lumbar ROM (t=2.569, p=0.018), Triple hop (t=6.492, p=0.001). Conclusions: Lumbar manipulation has shown to increase lumbar ROM and enhance performance of lower limb functional tests in footballers. Thus this study recommends lumbar manipulation can be applied to enhance the performance of the players.

Image Analysis Using the Fluorescence Imaging of Nuclear Staining (FINS) Algorithm.

Finding appropriate image analysis techniques for a particular purpose can be difficult. In the context of the analysis of immunocytochemistry images, where the key information lies in the number of nuclei containing co-localised fluorescent signals from a marker of interest, researchers often opt to use manual counting techniques because of the paucity of available tools. Here, we present the development and validation of the Fluorescence Imaging of Nuclear Staining (FINS) algorithm for the quantification of fluorescent signals from immunocytochemically stained cells. The FINS algorithm is based on a variational segmentation of the nuclear stain channel and an iterative thresholding procedure to count co-localised fluorescent signals from nuclear proteins in other channels. We present experimental results comparing the FINS algorithm to the manual counts of seven researchers across a dataset of three human primary cell types which are immunocytochemically stained for a nuclear marker (DAPI), a biomarker of cellular proliferation (Ki67), and a biomarker of DNA damage (γH2AX). The quantitative performance of the algorithm is analysed in terms of consistency with the manual count data and acquisition time. The FINS algorithm produces data consistent with that achieved by manual counting but improves the process by reducing subjectivity and time. The algorithm is simple to use, based on software that is omnipresent in academia, and allows data review with its simple, intuitive user interface. We hope that, as the FINS tool is open-source and is custom-built for this specific application, it will streamline the analysis of immunocytochemical images.

Características de la contractura muscular cervical de pacientes atendidos en un centro de salud de Chiclayo, Perú

Objective. To determine the Sociodemographic and therapeutic characteristics of patients with cervical muscle contracture treated at the Reque Health Center, Chiclayo, 2022. Material and methods. Descriptive and prospective observational study in a population of 98 patients attended. The Sociodemographic data was collected through an interview, the therapeutic data through a collection sheet and the level of pain through the EVA scale. Results. The population was characterized by a mean age of 46.1 years, predominance of females (60.2%), and occupation as housewife (28.6%) and worker/farmer (23.5%). Likewise, 33.7% presented comorbidities, being arterial hypertension (48.5%) and type 2 diabetes mellitus (30.3%), the most frequent. Manual and kinesic techniques (75.0%), twice a week (59.2%) and one month (67.3%); they were the most frequent types, frequency and time of therapy; respectively. The level of very strong pain was the most frequent (66.3%), and was associated with the longest therapy time (p<0.001). Conclusions. Cervical muscle contracture in the study population occurred mainly between 30 and 59 years of age, females, and housewives. Likewise, the manual and kinesic techniques, with a frequency of twice a week for a month; were the most frequent therapeutic characteristics.

Underway measurement of cyanobacterial microcystins using a surface plasmon resonance sensor on an autonomous underwater vehicle

AbstractFreshwater cyanobacterial harmful algal blooms (CHABs) are a well‐known global public health threat. Monitoring and early detection of CHAB toxins are currently accomplished using labor‐intensive sampling techniques and subsequent shore‐based analyses, with results typically reported 24–48 h after sample collection. We have developed and implemented an uncrewed, autonomous mobile sampler‐analytical system capable of conducting targeted in situ toxin measurements in < 2 h. A surface plasmon resonance (SPR) instrument was combined with the environmental sample processor (ESP) to fully automate detection and quantification of particle‐associated cyanobacterial microcystins (pMC). This sensor‐sampler system was integrated with a long‐range autonomous underwater vehicle (LRAUV) and deployed in western Lake Erie for field trials in the summer of 2021. The LRAUV was remotely piloted to acquire samples at selected locations within and adjacent to a CHAB. Sixteen pMC measurements ranging from 0.09 to 0.55 μg/L lake water were obtained over a 14‐day period without recovery of the LRAUV. The SPR/ESP/LRAUV system complements existing satellite, aerial, and manual sampling CHAB survey techniques, and could be used to enhance predictive models that underpin bloom and toxicity forecasts. This system is also extensible to detection of other algal toxins in freshwater and marine environments, with its near real‐time assessment of bloom toxin levels potentially offering additional socioeconomic benefits and public health protection in a variety of settings.

Safety and efficacy of Symani robotic-assisted microsurgery: Assessment of vascular anastomosis patency, thrombus, and stenosis in a randomized preclinical study

IntroductionThe Symani Surgical System undergoes scrutiny in this study as part of a series of preclinical investigations. Previous studies compared the precision of robotic-assisted anastomoses with manual techniques. This study aims to evaluate critical, histological and gross parameters at site of anastomosis and at distance in a rat model to provide insights into the safety and efficacy of robotic-assisted microsurgery, enhancing its potential for clinical adoption. Materials and MethodsExperienced microsurgeons performed arterial and venous anastomoses in sixteen Wistar rats, randomized in four treatment groups: robotic artery, robotic vein, manual artery, and manual vein. Various parameters were evaluated at two time-points (T0 and T30) on the day of the procedure and at Day 28(T28d). In the second phase of the study animals underwent necropsy, histopathologic analysis and micro-CT scans angiography imaging of anastomosis sites, major organs and distant target organs by a blinded assessor. ResultsPatency rates were 100% at T0 and T30 for all anastomoses, remaining so at T28d for the robotic subgroups, while decreasing to 87.5% for manual arterial anastomoses due to an obstructive thrombus. No evidence of clot migration. Blood flow parameters and procedure times did not significantly differ. The blinded semi-quantitative histological analysis revealed no significant disparities between robotic and manual anastomoses across various pathological indicators. No gross abnormalities were detected in musculoskeletal examinations. ConclusionThis preclinical study demonstrates the safety of the Symani Surgical System. Results suggest equivalence between robotic and manual techniques regarding thrombus formation at the anastomotic site and distal organs.

Evaluating Plasmodium falciparum automatic detection and parasitemia estimation: A comparative study on thin blood smear images.

Malaria is a deadly disease that is transmitted through mosquito bites. Microscopists use a microscope to examine thin blood smears at high magnification (1000x) to identify parasites in red blood cells (RBCs). Estimating parasitemia is essential in determining the severity of the Plasmodium falciparum infection and guiding treatment. However, this process is time-consuming, labor-intensive, and subject to variation, which can directly affect patient outcomes. In this retrospective study, we compared three methods for measuring parasitemia from a collection of anonymized thin blood smears of patients with Plasmodium falciparum obtained from the Clinical Department of Parasitology-Mycology, National Reference Center (NRC) for Malaria in Paris, France. We first analyzed the impact of the number of field images on parasitemia count using our framework, MALARIS, which features a top-classifier convolutional neural network (CNN). Additionally, we studied the variation between different microscopists using two manual techniques to demonstrate the need for a reliable and reproducible automated system. Finally, we included thin blood smear images from an additional 102 patients to compare the performance and correlation of our system with manual microscopy and flow cytometry. Our results showed strong correlations between the three methods, with a coefficient of determination between 0.87 and 0.92.

Treatments using elements of Kobido massage for anti-ageing prevention and relaxation

The growing emphasis on maintaining a youthful appearance is driven by increased public awareness of the importance of good health and an attractive appearance, which going hand in hand with social development. Kobido massage is a suggested technique for enhancing the look and state of facial skin, serving as a non-surgical alternative to a facelift. The procedure employs specific manual techniques executed by a skilled specialist. This study aimed to evaluate the effectiveness of selected elements of kobido massage on improving the appearance of the skin, relaxing facial muscles, reducing their tension and improving blood and lymph circulation in the head area. The study included a group of 27 women who received 10 of the same treatments. The most frequently observed effects of the sequence of procedures were a reduction in tension and smoothing of facial skin folds, as well as a change in facial contour. The obtained results were consistent with the expectations of the majority of the participants. Kobido massage can be an effective method of improving the appearance of facial skin and may be a safe alternative to surgical lifting.

Effect of manual manipulation on mechanical gait parameters.

A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics. This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait. A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded. We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms. Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.

ANALYSIS OF HEALTHCARE QUALITY: PUBLIC CLINICS AND PRIVATE REHABILITATION CENTERS FROM PATIENTS' PERSPECTIVE

Introduction: Continuous analysis of healthcare quality is crucial to ensure optimal health experiences for patients. In this study, we focus on comparing the quality of care provided between public clinics and private rehabilitation centers, considering the perspective of patients. Objective: To examine the attitudes of the general population towards satisfaction with care provided in private rehabilitation centers compared to public institutions of physical medicine. Materials and methods: In this cross-sectional study conducted in February 2023, 125 participants were surveyed via an online Google Form to gather sociodemographic data and explore perceptions of physical therapy. The subsequent statistical analysis, using Microsoft Excel 2007 and IBM SPSS 23.0, encompassed descriptive and inferential statistics, revealing significant insights into respondents' perspectives and forming the foundation for a comprehensive discussion. Results: Research results indicate higher satisfaction with care provided in private centers compared to public institutions, while simultaneously highlighting issues with the organization of the public sector system. The findings suggest that both types of institutions excel in specific areas, with other areas identified as potential areas for improvement. Conclusion: Based on the analysis of patient perspectives, we conclude that both public clinics and private rehabilitation centers play a pivotal role in providing quality healthcare. While public clinics emphasized their role inaccessibility and comprehensive care, private rehabilitation centers stood out for their personalized approach, prompt patient reception, and utilization of manual techniques. Keywords:healthcare quality analysis, public clinics, private rehabilitation centers, patients' perspective

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report.

Recognizing testicular torsion is extremely important in patients presenting to the emergency department (ED) with acute scrotal pain. Traditional manual detorsion techniques are frequently employed by emergency physicians but are not always successful. Delays in detorsion increase the risk of testicular infarction and infertility, and the need for orchiectomy. Novel techniques such as the testicular traction technique have been described as a potential solution for difficult-to-detorse testicles. Our case report describes a 20-year-old male with no significant past medical history who presented to a rural ED with acute, atraumatic testicular pain secondary to testicular torsion with an intact cremasteric reflex. After confirming the diagnosis using Doppler ultrasound, manual detorsion using the traditional "open book" technique was attempted and unsuccessful. The patient was subsequently successfully detorsed using the novel testicular traction technique. The testicular traction technique is a safe, rapid, and effective primary or adjunctive technique in manual testicular detorsion. Given the time-sensitive nature of testicular torsions, adjunctive techniques play a crucial role in managing challenging detorsions, particularly in resource-limited rural settings with limited access to urologic services. Although it is commonly thought that the cremasteric reflex is absent in testicular torsions, it may be present in rare circumstances, and its presence should not be an absolute in ruling out torsion.

Цервикалгия у пациентов с мигренью – коморбидная нозология или клинический аспект центральной сенситизации?

Relevance. The phenomenon of central sensitization occurs when physiological activity in nociceptive pathways increases and leads to abnormal sensitivity; it is defined as “increased sensitivity of nociceptive neurons of the central nervous system to their normal or subthreshold afferent input,” according to the definition provided by the International Association for the Study of Pain (IASP). The excitability of spinal cord neurons significantly modifies the gain of the somatosensory system. Chronic pain syndromes, anxiety-depressive disorder, sleep disorders are currently very common in the population, significantly reducing the quality of life of the population; the pathogenesis of these nosologies lies in central sensitization. Objective. To study the clinical manifestations of central sensitization in patients with episodic migraine associated with neck pain or cervicogenic headache. Materials and methods. The longitudinal prospective study included 180 patients, divided into 3 groups: 1) patients with a combination of migraine and cervicogenic headache – 60 people (study group); 2) patients with a combination of migraine and cervicalgia diagnoses – 60 people (control group); 3) patients diagnosed with migraine without complaints of pain and limitation of movements in the cervical spine – 60 people (additional group). Results. In patients with migraine and comorbid cervical headache, more pronounced central sensitization was revealed when compared with comorbid cervicalgia. Myofascial pain syndrome involving the trapezius and temporal muscles can resolve on its own with specific migraine therapy with monoclonal antibodies, however, to relieve tension and soreness in the masseter and inferior oblique muscles, the addition of therapeutic exercises and gentle manual techniques is more effective. Taking into account the identified direct relationships of moderate strength between the number of painful points of exit of the trigeminal nerve, the muscles of the pericranial region involved, as well as the effect of treatment of migraine attacks with monoclonal antibodies, it can be concluded that central sensitization is more pronounced when the masseter and inferior oblique muscles are involved. Conclusions. During examination of patients with migraine with comorbid active cervicalgic factor or even if it is absence, it is necessary to make a thorough examination of the facial and cranioverebral region muscles, even in the absence of patient complaints of pain in the face or neck, and also prescribe specific therapeutic exercises to increase the effectiveness of treatment. In all patients with migraine, regardless of chronicity, it is necessary to assess the intensity of central sensitization for timely and more complete provision of medical care.

Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study.

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.

Blood Harmonisation of Endoscopic Transsphenoidal Surgical Video Frames on Phantom Models.

Physical phantom models have been integral to surgical training, yet they lack realism and are unable to replicate the presence of blood resulting from surgical actions. Existing domain transfer methods aim to enhance realism, but none facilitate blood simulation. This study investigates the overlay of blood on images acquired during endoscopic transsphenoidal pituitary surgery on phantom models. The process involves employing manual techniques using the GIMP image manipulation application and automated methods using pythons Blend Modes module. We then approach this as an image harmonisation task to assess its practicality and feasibility. Our evaluation uses Structural Similarity Index Measure and Laplacian metrics. The results we obtained emphasize the significance of image harmonisation, offering substantial insights within the surgical field. Our work is a step towards investigating data-driven models that can simulate blood for increased realism during surgical training on phantom models.

Enhanced reliability and time efficiency of deep learning-based posterior tibial slope measurement over manual techniques.

Multifaceted factors contribute to inferior outcomes following anterior cruciate ligament (ACL) reconstruction surgery. A particular focus is placed on the posterior tibial slope (PTS). This study introduces the integration of machine learning and artificial intelligence (AI) for efficient measurements of tibial slopes on magnetic resonance imaging images as a promising solution. This advancement aims to enhance risk stratification, diagnostic insights, intervention prognosisand surgical planning for ACL injuries. Images and demographic information from 120 patients who underwent ACL reconstruction surgery were used for this study. An AI-driven model was developed to measure the posterior lateral tibial slope using the YOLOv8 algorithm. The accuracy of the lateral tibial slope, medial tibial slopeand tibial longitudinal axis measurements was assessed, and the results reached high levels of reliability. This study employed machine learning and AI techniques to provide objective, consistentand efficient measurements of tibial slopes on MR images. Three distinct models were developed to derive AI-based measurements. The study results revealed a substantial correlation between the measurements obtained from the AI models and those obtained by the orthopaedic surgeon across three parameters: lateral tibial slope, medial tibial slopeand tibial longitudinal axis. Specifically, the Pearson correlation coefficients were 0.673, 0.850and 0.839, respectively. The Spearman rank correlation coefficients were 0.736, 0.861and 0.738, respectively. Additionally, the interclass correlation coefficients were 0.63, 0.84and 0.84, respectively. This study establishes that the deep learning-based method for measuring posterior tibial slopes strongly correlates with the evaluations of expert orthopaedic surgeons. The time efficiency and consistency of this technique suggest its utility in clinical practice, promising to enhance workflow, risk assessmentand the customization of patient treatment plans. Level III, cross-sectional diagnostic study.

Teaching of manual cataract extraction in ophthalmic surgical training programmes

BackgroundManual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.AimsThis study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.MethodsAn electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.ResultsNineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1–3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.ConclusionsThere is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.

A structured investigation on the site supervisory traits in applying science and technology related fundamental concepts in construction operations

Purpose Productivity increase is correlated with profitability, sustainability and competitiveness of the construction firms. Recent studies reveal that the primary causes of productivity decline are poor usage of scientific and technological advances, ineffective supervision strategies and poor apprenticeship facilities/opportunities. Accordingly, the purpose of this study was to evaluate how well construction supervisors can utilise fundamental science and technological concepts/ideas to increase the efficiency and productivity of construction activities. Design/methodology/approach A new strategic layout was designed with the use of potential training guide tools. Based on the designed layout, a new supervisory training programme was developed, and 62 construction supervisors were selected, trained and evaluated in line with six parts of competencies and the relevant learning domains. An assessment guide with different levels of descriptions and criteria was developed through literature analysis and expert interviews. The research tools were verified using comprehensive approaches. Findings The overall mean values of supervisors’ performance scores indicate proficient-level grades in the competency characteristics related to taking measurements, generating drawings/designs using manual techniques and computer-aided tools, involving Bill of Quantities (BOQ) preparations and preparing training plans/materials for improving the competencies of labourers on estimation, measurements and understanding drawings. Their proficiency was notably lower in the use of information and communication technology application tools in construction tasks compared to others. The findings point to a modern generalised guideline that establishes the ranges of supervisory attributes associated with science and technology-related applications. Research limitations/implications The study outcomes produce conceptualised projections to restructure and revalue the job functions of various working categories by adding new definitions within the specified scope. This may result in constructive benefits to upgrading the current functions associated with urbanisation, sustainability and society. The implementation of the study’s findings/conclusions will have a significant impact on present and future practices in other developing nations and developing industries, even if they are directly applicable to the Sri Lankan construction industry. Originality/value Up to certain limits/stages, the study fills not only the knowledge gap in the field of creating protocols and application techniques connected to lifelong learning and skill enhancement/upgrading but also the existing gaps in work attributes and roles of construction supervisors associated with the utilisation of fundamental science and technological concepts/ideas towards reinforcing sustainable and productive site operations.

Fuzzy cognitive mapping in participatory research and decision making: a practice review

BackgroundFuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023.ResultsThe methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases.ConclusionsA strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.

Current Aspects of Medical Rehabilitation of Patients with Cancer Related Lymphedema of Extremities: a Narrative Review

INTRODUCTION. Over the past decades, in developed countries and in the Russian Federation, there has been an increase in the number of patients with secondary lymphedema who have undergone surgical treatment with dissection of regional lymph nodes and radiation therapy for various forms of gynecological cancer in women and prostate cancer in men, as well as breast cancer. AIM. Search and analysis of the results of previously published randomized controlled trials (RCTs) of the effectiveness of various non-drug rehabilitation methods in patients with lymphedema of the extremities who underwent radical treatment for cancer of various locations. MATERIALS AND METHODS. A search was conducted and studied publications in international scientific peer-reviewed publications (PEDro Database) on medical rehabilitation for cancer treatment-related lymphedema (LSPR) for the period from 1996 to December 2023 using the keywords “lymphedema”, “rehabilitation”. 145 RCTs focused on medical rehabilitation and conservative treatment of LSPR. DISCUSSION. Lifestyle correction and psychosocial interventions are recommended to improve the quality of life of patients. Studies have found that early activation, various physical exercises with a slow increase in loads under the supervision of a physical therapist are safe and help increase endurance, strength and range of motion in a limb with lymphatic edema. The clinical effectiveness of therapeutic exercises in the pool has been proven, manifested in the reduction of edema in patients with LSPR. The effectiveness of compression products with Velcro technology as an alternative to rigid low-stretch bandages in patients with LSPR has been confirmed. The anti-edematous and anti-inflammatory effects of low-intensity laser therapy and magnetic therapy in the rehabilitation of patients with LSLR have been proven. Alternating pneumatic compression (APC) is recommended as an adjuvant treatment in addition to comprehensive decongestant therapy. Preference should be given to the use of technologies of advanced hardware lymphatic drainage methods that imitate manual techniques. CONCLUSION. To improve the physical and socio-psychological functioning of patients with LSPR, an integrated approach is required, including lifestyle changes, psychological correction, compression therapy, modern exercise therapy techniques, and safe physiotherapeutic technologies. Conducted scientific research indicates the high effectiveness of the use of manual and hardware lymphatic drainage techniques, while the use of PPC is more economical and accessible, and does not require the involvement of specialists who know the expensive method of manual lymphatic drainage.

Visualization of Effectiveness: The Use of a Set of Colored Cleaning Wipes for Visible Disinfection of Ultrasound Probes

The German health authorities’ guidelines for medical devices in 2012 highlighted the importance of cleaning ultrasound probes, emphasizing their validation and reliability. In addition to automated and validated options, alternative manual methods such as wipe disinfection have gained traction due to their independence from additional hardware. The study examines the effectiveness of a manual cleaning process using wipes, addressing concerns raised by the Robert Koch Institute regarding the lack of validation for wipe disinfection of semi-critical devices. The EQUINOS colored wipe disinfection kit identified wetting gaps in all cleanings across four probes tested. The results indicate significant challenges in ensuring complete surface wetting, particularly in complex device parts such as clip-on areas and fixtures for additional biopsy attachments, suggesting that manual methods alone may not adequately mitigate the risk of infection transmission (p value &lt; 0.0001). The study concludes that while manual disinfection methods are a commonly used alternative to automated reprocessing, there is a critical need for enhanced training and potentially the development of more effective manual disinfection techniques or colored wipes to ensure patient safety and compliance with healthcare hygiene standards.

Robotic-assisted total knee arthroplasty is associated with the use of thinner polyethylene liners compared to navigation-guided and manual techniques.

The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA). There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January2018, and 30 June2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs. Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAsand 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8%and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater. Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatchand ultimately allow for more appropriately sized implants. Level III, retrospective cohort study.