Mobile Protocol Research Articles

AHP SO08 - Weekend physiotherapy pilot for patients on hepatobiliary enhanced recovery pathways: Examining the impact of a 7-day service

Abstract Background Enhanced recovery after surgery (ERAS) is a safe, multi-disciplinary, evidenced-based approach to optimise the perioperative management and outcomes after hepatobiliary (HPB) surgery. Despite the adoption of the ERAS mobilisation protocols to improve recovery time, one limitation is a traditional 5-day service model (Monday-Friday). This can result in an inequality of service provision for those patients operated Thursday or Friday and lead to increased length of stay (LOS) in hospital. Mobilisation across 7 days can ensure improved compliance with ERAS mobilisation protocols, better continuity of care, facilitate improved outcomes and timely discharge from hospital. Method Data was collected pre-introduction of the 7-day physiotherapy service from May-October 2022. During November 2022 – April 2023 a 7-day physiotherapy service was piloted. This service included 1 qualified physiotherapist and 1 non-qualified physiotherapist on Saturday and Sunday. This 7-day service provided continuity of care for patients from intensive care or post-anaesthesia care unit to the ward, facilitating discharges and accelerating return to independence. Data was collected during the 7-day service as well as 6 months post intervention (May 2023-October 2023). Acceptability of the intervention was assessed among the HPB multi-disciplinary team (MDT) using a survey consisting of 5 qualitative questions. Results The table illustrates that a reduction in mean LOS was seen in all 4 HPB surgeries that follow ERAS protocols during the 7-day physiotherapy service. It was also shown that 6-months post intervention (returning to a 5-day service) all 4 HPB ERAS surgeries mean LOS increased. To determine the acceptability of the 7-day physiotherapy service, 22 members of the MDT responded to a survey (5 consultants, 4 physiotherapy staff, 4 sisters, 5 staff nurses, 1 nursing assistant, 2 healthcare assistants). All 22 members of the MDT agreed that a 7-day physiotherapy service was acceptable and improves recovery. Conclusion A 7-day physiotherapy service has shown to reduce mean LOS in comparison to a 5-day physiotherapy service within HPB ERAS pathways. From an MDT perspective the 7-day physiotherapy service was also deemed to be beneficial and improves patient recovery.

PP517 Topic: AS23–Rehabilitation: Early Mobilization/Interdisciplinary Care/Developmental Care/Other: FEASIBILITY AND SHORT-TERM IMPACT OF NURSE-DRIVEN EARLY MOBILIZATION PROTOCOL IN A PICU OF A LOW MIDDLE INCOME COUNTRY: A QUALITY IMPROVEMENT STUDY

PP517 Topic: AS23–Rehabilitation: Early Mobilization/Interdisciplinary Care/Developmental Care/Other: FEASIBILITY AND SHORT-TERM IMPACT OF NURSE-DRIVEN EARLY MOBILIZATION PROTOCOL IN A PICU OF A LOW MIDDLE INCOME COUNTRY: A QUALITY IMPROVEMENT STUDY

Effects of Specific RAMP Protocol Phase on Change of Direction Speed of Police Students.

Background: This study assessed the effects of two distinct RAMP (Raise, Activate, Mobilize, Potentiate) protocols, mobility-focused and reactiveness-focused, on change of direction speed in police students (i.e., tactical athletes). Methods: A longitudinal design with two experimental and one control group was employed. The study sample consisted of 39 police students (aged 19.2 ± 0.2 yrs) who were randomly allocated into three equal groups of 13 participants (7 females and 6 males). Experimental groups were labeled as the mobility group or reactiveness group based on the type of RAMP protocol they performed. During the tactical physical education classes, the mobility group performed four complex mobility exercises, while the reactiveness group performed four exercises for trunk reactiveness. After the specific warm-up, both groups continued with syllabus activities. The control group performed only regular activities based on the study syllabus. All participants performed the Illinois Agility test unloaded (IAT) and loaded (10 kg vest [IATL]) and Functional Movement Screening (FMS) before and after 8 weeks of the applied protocols. Results: In general, improvements were observed across all participants in the IAT (p < 0.001), IATL (p < 0.001), and FMS (p < 0.001). The mobility protocol had a more substantial impact compared to the reactiveness protocol on the IAT (d = 0.55 vs. d = 0.40), IATL (d = 0.44 vs. d = 0.38), and FMS (d = 0.88 vs. d = -0.42). Additionally, the control group, which did not follow either RAMP protocol, did not show significant improvements. Conclusions: These results underscore the importance of incorporating targeted mobility training in the limited time available for strength and conditioning programs, as it improves occupationally relevant movement qualities such as change of direction speed ability. Prioritizing mobility training in young tactical athletes may offer broader benefits compared to reactiveness training.

Setting up light and noise maps to define the contours of a reserve of darkness and silence in Sherbrooke, Québec, Canada

Urban sprawl brings cities closer to natural areas, making them cohabit is a significant environmental challenge. Densification can also increase light and noise pollution, negatively affecting human and biodiversity well-being. Grounded on a collaboration between a college and a university, this work combines brightness and noise maps to establish the contours of a reserve of darkness and silence in Sherbrooke's Mont-Bellevue Park (Québec, Canada). The light and sound environments of the city are mapped by the research team using two devices mounted on vehicles or bicycles: a multispectral and multidirectional brightness sensor and a sound level meter. Long-term and fixed-point light and noise measurements were also conducted to develop the mobile measurement protocol. Wind tunnel measurements in an anechoic chamber were finally used to determine the effect of travel speed on measured noise levels, showing that speeds of less than 15 km/h ensure unbiased acoustic measurements using a windscreen. Perspectives include using the Noise Capture application to provide crowdsourced and additional noise levels at fixed measurement points. The open-source Noise Modelling tool will provide us with calculated environmental noise maps to be compared with measured data.

Slow-Paced Breathing Intervention in Healthcare Workers Affected by Long COVID: Effects on Systemic and Dysfunctional Breathing Symptoms, Manual Dexterity and HRV.

Many COVID-19 survivors still experience long-term effects of an acute infection, most often characterised by neurological, cognitive and psychiatric sequelae. The treatment of this condition is challenging, and many hypotheses have been proposed. Non-invasive vagus nerve stimulation using slow-paced breathing (SPB) could stimulate both central nervous system areas and parasympathetic autonomic pathways, leading to neuromodulation and a reduction in inflammation. The aim of the present study was to evaluate physical, cognitive, emotional symptoms, executive functions and autonomic cardiac modulation after one month of at-home slow breathing intervention. 6655 healthcare workers (HCWs) were contacted via a company email in November 2022, of which N = 58 HCWs were enrolled as long COVID (cases) and N = 53 HCWs as controls. A baseline comparison of the two groups was performed. Subsequently each case was instructed on how to perform a resonant SPB using visual heart rate variability (HRV) biofeedback. They were then given a mobile video tutorial breathing protocol and asked to perform it three times a day (morning, early afternoon and before sleep). N = 33 cases completed the FU. At T0 and T1, each subject underwent COVID-related, psychosomatic and dysfunctional breathing questionnaires coupled with heart rate variability and manual dexterity assessments. After one month of home intervention, an overall improvement in long-COVID symptoms was observed: confusion/cognitive impairment, chest pain, asthenia, headache and dizziness decreased significantly, while only a small increase in manual dexterity was found, and no relevant changes in cardiac parasympathetic modulation were observed.

The effectiveness of early mobilisation on physical function in patients after heart valve surgery: a systematic review

Background/Aims Literature suggests that early mobilisation, defined as the initiation of physical activity within 48 hours following surgery, improves outcomes after cardiac surgery. This systematic review assessed the effectiveness of early mobilisation on physical function and other outcomes, including length of hospital stay and cost following heart valve surgery. Methods The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL and Cochrane Library were systematically searched from inception until May 2022 using relevant key words. Randomised controlled trials comparing early mobilisation and usual care for patients who had received heart valve surgery were included in the review. Methodological quality was assessed using the Physiotherapy Evidence Database scale and risk of bias using the Cochrane Risk of Bias 2 tool. The data were narratively synthesised. Results The search identified 210 articles, with 98 remaining after duplicates were removed. Upon screening for eligibility, nine articles were assessed in full and three randomised controlled trials involving 161 patients were included in the review. Early mobilisation protocols varied across trials. Two trials (n=124) reported significantly greater improvement in physical function with early mobilisation compared to usual care, including handgrip strength (P=0.001). One study (n=41) found early mobilisation significantly reduced the length of hospital stay (P=0.000), in-hospital care costs (P=0.000) and intensive care unit stay (P=0.000) compared to usual care. Methodological quality scores ranged from six to nine on the Physiotherapy Evidence Database scale. The risk of biased judgement was ‘low’ in one study and ‘some concerns’ in two studies. Conclusions Early mobilisation may improve physical function and reduce hospital and intensive care unit stays after heart valve surgery. However, differences in protocols and limited studies indicate further high-quality research is needed, particularly regarding cost-effectiveness. Establishing clear early mobilisation protocols could enhance recovery in this population. Implications for practice Early mobilisation may require the coordinated effort of a multidisciplinary team of physiotherapists, nurses and possibly other medical professionals. For its seamless and effective implementation, it is essential to understand whether this intervention falls under the domain of physiotherapists or requires broader team collaboration. Given these complexities, strategies targeting early mobilisation that balance both safety and resource considerations are advised to improve physical function after heart valve surgery, especially among patients who are frail.

Adaptive Mobility and Reliability-based Routing Protocol for Smart Healthcare Management Systems in Vehicular Ad‐hoc Networks

Ambulances enable digital and widespread remote care for older people in the healthcare sector. The Vehicular Ad Hoc Network (VANET) is critical for allowing the digital and Intelligent Transportation System (ITS) for the smart healthcare world. Enhancing the dependability and flexibility of an adaptive routing algorithm improves vehicular communications' Quality of Service (QoS) effectiveness. An essential concern in vehicular technology is enabling drivers to make reliable judgments. Developing an effective routing system that ensures a suitable QoS takes time and effort. The vehicular network ecosystem is characterized by limited mobility, fast vehicle speeds, and constantly changing configurations. This study makes four distinct contributions. Initially, it presents adaptive routing protocols, capable of recognizing changes in the network environment, aware of the mobility of nodes, and dependable in delivering data packets. The experimental configuration is implemented inside a discrete Network Simulator (NS-3) scenario to enhance the QoS. Mobility-aware routing algorithms can provide ITS with satisfactory mobility, vital dependability, high Packet Delivery Ratio (PDR), high throughput, and low End-to-End (E2E) Delay. The proposed method has an average throughput of 664.3 kbps, a delay of 151.3 ms, and a packet delivery ratio (PDR) of 94.23%.

Early Mobilisation Post-Thrombolysis is Safe and Improves Outcomes in Mild-Moderate Acute-Stroke Patients

Abstract Background Thrombolysis (tPA) is the delivery of a clot-lysing agent used in acute ischemic stroke, typically followed by ≥24-hour bed rest. This study aimed to compare the safety and effectiveness of early mobilisation (≤24 hours post-tPA) versus ≥24-hour bed rest in patients with mild-moderate stroke. Methods A literature review was conducted leading to the development of an early mobilisation protocol post-tPA. Retrospective (January-July 2023: pre-early mobilisation protocol) and prospective (July 2023-April 2024: post-early mobilisation protocol) data were analysed. Baseline demographics and outcomes were compared between the two groups. Primary outcome was physical function (Modified Rankin Scale (mRS) at hospital discharge. Secondary outcomes included adverse effects, length of stay (LOS) and discharge destination. Results 11 patients met the criteria for early mobilisation in both groups. There were no significant differences in age, the National Institutes of Health Stroke Scale (NIHSS) pre-tPA and mRS at baseline between the two groups (p&amp;gt;0.05). 8 patients in the early mobilisation protocol were male (72.73%), the median (IQR) age was 61 (54-78) years, and NIHSS was 6 (3-8) pre-tPA and 1 (0-2) post-tPA. Patients had a median (IQR) mRS score of 0 (0-0) pre-stroke and time to early mobilisation was 12 (12-17) hours. Patients in the early mobilisation group had significantly lower mRS on discharge (p=0.007), shorter LOS (Median (IQR) 5 (4-7) days, P=0.13) and higher rates of discharge directly home compared to those mobilised post ≥24-hour bed rest. No adverse effects of early mobilisation occurred. Conclusion Compared with 24-hour bed rest, early mobilisation for mild-moderate stroke patients was safe and associated with significantly better physical function.

Adding a Mobility Champion to an Existing Progressive Mobility Protocol: An Evidence-Based Initiative.

This evidence-based initiative assessed the effect of adding a mobility champion to an existing progressive mobility protocol on functional decline in hospitalized older adults as evidenced by recommended discharge to home versus an inpatient rehabilitation facility. Older adults admitted from home to a 47-bed medical-surgical telemetry unit who were assessed as ambulatory, either independently or with assistance (Level 5), and with a progressive mobility order in the electronic health record were included in the initiative. Patient care associates who volunteered to be mobility champions were trained how to safely ambulate patients. Patients who worked with a mobility champion were less likely to be referred to inpatient rehabilitation post discharge for further care due to functional decline. Mobility has a critical role in the maintenance of hospitalized older adults' functional abilities and is a determinate of their post discharge disposition. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Virtual Reality Strategies for Promoting Mobility in the Intensive Care Unit: A Case Report.

Prolonged bed rest is a known contributor to muscle atrophy, weakness, and deconditioning. Early active mobilization protocols aim to combat acquired weakness and loss of function in patients in the intensive care unit. Despite these benefits, mobilization of patients in the intensive care unit remains a challenge, most notably for patients with limited ability to get out of bed because of invasive devices and prolonged hospitalization. Virtual reality has gained favor for use in critical care to mitigate patients' stress, pain, and anxiety and to provide distraction and socialization. This case report demonstrates a novel application of virtual reality and the ease with which virtual reality can be used to facilitate early mobility and activity progression in the critically ill.

Surgical or non-operative treatment of acute Achilles tendon rupture : What does the current literature say?

The Achilles tendon is the strongest tendon in humans and is frequently injured, especially in the physically active young to middle-aged population. An increasing frequency of Achilles tendon ruptures (ATR) has been reported in several studies. However, there is no international consensus regarding possible non-operative (N-OP) or operative (surgical) treatment (OP). The aim of this article is to semi-quantitatively compare both treatment options for ATR by analyzing the results reported in the literature. For this purpose, relevant categories were identified, and the literature was then evaluated in aPubMed analysis. Tenmeta-analyses and twocost analyses were included. The data was extracted according to the categories and evaluated comparatively. OP and N‑OP for acute ATR can lead to equally good restitution of clinical function if early functional rehabilitation is applied. The lower re-rupture rate is an advantage of OP, whereas the lower general complications speak in favor of N‑OP. The minimally invasive or percutaneous surgical technique (M-OP) appears to be advantageous over the open surgical technique (O-OP), although studies show an increased rate of lesions of the sural nerve. There is no consensus regarding the superiority of OP or N‑OP for acute ATR, as several studies conducted since the introduction of early mobilization protocols have shown similar results for these two interventions. Results and complications of M‑OP and O‑OP are also comparable. Considering the available data on the various surgical procedures, the authors prefer the M‑OP technique with adequate sural nerve protection for repair of acute ATR, combined with an early mobilization protocol.

Older adults’ compliance with mobile ecological momentary assessments in behavioral nutrition and physical activity research: pooled results of four intensive longitudinal studies and recommendations for future research

BackgroundMobile Ecological Momentary Assessment (EMA) is increasingly used to gather intensive, longitudinal data on behavioral nutrition, physical activity and sedentary behavior and their underlying determinants. However, a relevant concern is the risk of non-random non-compliance with mobile EMA protocols, especially in older adults. This study aimed to examine older adults’ compliance with mobile EMA in health behavior studies according to participant characteristics, and prompt timing, and to provide recommendations for future EMA research.MethodsData of four intensive longitudinal observational studies employing mobile EMA to understand health behavior, involving 271 community-dwelling older adults (M = 71.8 years, SD = 6.8; 52% female) in Flanders, were pooled. EMA questionnaires were prompted by a smartphone application during specific time slots or events. Data on compliance (i.e. information whether a participant answered at least one item following the prompt), time slot (morning, afternoon or evening) and day (week or weekend day) of each prompt were extracted from the EMA applications. Participant characteristics, including demographics, body mass index, and smartphone ownership, were collected via self-report. Descriptive statistics of compliance were computed, and logistic mixed models were run to examine inter- and intrapersonal variability in compliance.ResultsEMA compliance averaged 77.5%, varying from 70.0 to 86.1% across studies. Compliance differed among subgroups and throughout the day. Age was associated with lower compliance (OR = 0.96, 95%CI = 0.93–0.99), while marital/cohabiting status and smartphone ownership were associated with higher compliance (OR = 1.83, 95%CI = 1.21–2.77, and OR = 4.43, 95%CI = 2.22–8.83, respectively). Compliance was lower in the evening than in the morning (OR = 0.82, 95%CI = 0.69–0.97), indicating non-random patterns that could impact study validity.ConclusionsThe findings of this study shed light on the complexities surrounding compliance with mobile EMA protocols among older adults in health behavior studies. Our analysis revealed that non-compliance within our pooled dataset was not completely random. This non-randomness could introduce bias into study findings, potentially compromising the validity of research findings. To address these challenges, we recommend adopting tailored approaches that take into account individual characteristics and temporal dynamics. Additionally, the utilization of Directed Acyclic Graphs, and advanced statistical techniques can help mitigate the impact of non-compliance on study validity.

Gestational Diabetes in Women with Fetal Spina Bifida Repair-Influence of Perioperative Management.

Background/Objectives: Fetal spina bifida (fSB) is the most common neural tube defect, and intrauterine repair has become a valid treatment option for selected cases. If fSB repair is offered, the ideal time for surgery is from 24 to 26 gestational weeks (GWs). The preoperative steroids for lung maturation and preoperative tocolytics that are administered are known to increase the prevalence of gestational diabetes (GD), which normally occurs in about 10-15% of all pregnant women. This study assessed the prevalence, possible influencing factors, and consequences on the course of pregnancy regarding GD in this cohort. Methods: Between 2010 and 2022, 184 fSB cases were operated. Those patients operated on after 24 0/7 GWs received steroids before surgery. All the patients received tocolysis, and an oral glucose tolerance test was performed between 26 and 28 GWs at least 7 days after steroid administration. In 2020, we established an early postoperative mobilization protocol. The perioperative management procedures of those patients with and without GD were compared to each other, and also, the patients treated according to the early mobilization protocol were compared to the remaining cohort. Results: Nineteen percent were diagnosed with GD. Corticosteroids were administered in 92%. Neither the corticoid administration nor the interval between the administration and glucose tolerance test was different in patients with or without GD. Further, 99.5% received postoperative tocolytics for at least 48 h. The women with GD had significantly longer administration of tocolytics. The length of stay (LOS) was higher in those patients with GD. The gestational age (GA) at delivery was significantly lower in the cohort with GD. In the early mobilized group, we found a significantly higher GA at delivery (37.1 GWs vs. 36.2 GWs, p = 0.009) and shorter LOS (p < 0.001), and their GD rate was lower (10% vs. 20%), although not statistically significant. Conclusions: The GD incidence in the women after fSB repair was higher than in the usual pregnant population. Early mobilization, rapid tocolytics decrease, and shorter LOS could benefit the pregnancy course after fSB repair and may decrease the risk for GD in this already high-risk cohort without increasing the risk for preterm delivery.

Mobility and Temperature Sensitive Energy Efficient Routing (MTS-EER) protocol in a wireless body area network

Sensor technology advancements have provided the platform to implement wireless body area networks, thanks to the nanosized sensor units capable of sensing, aggregating, and forwarding physiological information. The collected information is routed to the desired destination unit for data analysis and decision-making in remote healthcare. However, improving energy utilization remains a brain-teasing problem for the research community, especially considering imbalanced energy consumption and postural movements. Mobility contributes to disconnectivity issues, high energy drainage, and retransmission delays. In addition, the sensor node’s thermal level also poses a challenge in maintaining safer and reliable data transmission. To overcome these issues, a novel Mobility and Temperature Sensitive Energy-Efficient Routing ¬(MTS-EER) algorithm has been proposed that includes a two-step process. In step 1, an Intelligent Path Estimation Function (IPEF) is designed considering the sensor’s mobility, temperature, and energy level. IPEF depends on crucial parameters i.e.: - residual energy, signal-to-noise ratio (SNR), distance, total energy, and most importantly temperature of the sensor unit. The sensor node with the least IPEF is selected as the Cluster Head (CH). In step 2, an optimized and sustainable energy conservation model (OSECM) is implemented based on the Adaptive Transmission Power (ATP) and the Power Management Module (PMM). The ATP conserves the energy via intelligently varying the transmission power and PMM manages the sleep pattern of sensor nodes to yield a high network lifetime and efficient energy utilization. The algorithm includes a clustering approach with dual sink nodes to conserve energy and improve reliability. Finally, the results are compared with the recent state-of-the-art research work. The proposed algorithm provides better results considering residual energy, throughput, network lifetime, and end-to-end delay.

Performance Comparison of CC AODV and Optimized AODV K-Means Clustering Using NS3

Nowadays, many studies have been interested in Ad Hoc Wireless Networks because of their low cost, when there is a need to communicate using a network without any infrastructure. Ad Hoc On-Demand Distance Vector (AODV) is a routing protocol for mobile ad hoc networks (MANET) and other wireless ad hoc networks. AODV was co-developed in July 2003 at the NOKIA Research Center, University of California, Santa Barbara and University of Cincinnati by C. Perkins, E. Belding-Rover an S.Das. AODV is a routing protocol used by ZigBee - a low power wireless ad hoc network with low data rates. AODV is included in the proactive routing protocol. The advantage of using this routing protocol is that it has economical resources, because resources are not needed to store information about routes to other nodes. However, this AODV has a drawback, namely the packet that will be sent has a long delay in anti-node origin waiting for the protocol to find the path to be passed. There are many papers that optimize AODV, including CC AODV and K Means Clustering AODV. Based on the paper “CC-AODV: An effective multiple paths congestion control AODV”, a control scheme called CC AODV has been created, namely managing routing conditions by significantly increasing packet sending rates while reducing packet drop rates, and based on the paper “An Energy Efficient Clustering Using K-Means and AODV Routing Protocol in Ad hoc Networks”. Based on both paper, in this study the objectives to be achieved are: a) Analyze the performance of using CC AODV and K Means Clustering AODV based on the number of nodes. b) how much influence the number of nodes has on the performance of CC AODV and K Means clustering AODV c) Performance analysis is performed on throughput, end to end delay, packet loss, packet delivery ratio. This paper begins by looking at the literature covering MANET, AODV, CC AODV, and K-Means Clustering AODV. On the result section the test results such as end to end delay, throughput, packet delivery ratio, and packet loss ratio are documented. The conclusion summarizes key points and is followed by the references.

First In Vivo Electromyographic Analysis of Mechanical Load Scenarios of the Cervicothoracic Junction During Daily Activities as a Basis for Future Postoperative Behavioral Instructions.

Clinical Research. Study participants were twenty- eigth healty volunteers. Soft tissue complications after posterior cervicothoracic fusion surgery occur frequently. Postoperative myofascial dehiscence (PMD) can cause disability and pain. So far, it is unknown whether patients can affect PMD development through behavioral adjustment. Consequently, this study aimed to analyze how much mechanical stress daily activities exert on the posterior muscles and fascia at the cervicothoracic junction. Surface electromyography was applied next to the upper thoracic spine at the trapezius muscle. All volunteers performed 22 different daily activities, such as tooth brushing, dressing, standing up, and different horizontal positions. During the exercises, the electromyographic activity was measured. For each volunteer, root mean square values were determined. All exercises were then repeated with the use of a clavicular bandage to unload the shoulder and cervicothoracic muscles. Afterwards, the rankings were statistically compared interindividually. Among the different tasks, significant differences in regard to the root mean square values were noted. For instance, horizontal positions caused significantly lower muscle activation compared with all other exercises (P≤ 0.001). Notably, no relevant electromyographic differences were detected between the tasks with and without a clavicular bandage. This in vivo electromyographic analysis of cervicothoracic muscle activity during daily activities demonstrates that myofascial strain differs among various daily activities. Data indicate that potential postoperative mobilization protocols and behavioral instructions may have the potential to reduce the biomechanical load and consequently the risk of PMD and, therefore, may reduce the risk for surgical wound-related complications, disability, and need for revision surgery.

Autologous peripheral blood stem cell harvest timing by absolute neutrophil count in children and young adult patients: Single-institute experience

BackgroundMyeloablative, high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) improves outcome in some high-risk malignant solid tumors and lymphomas in children and young adults. MethodsWe performed 16 peripheral blood stem cell (PBSC) harvests in 12 children and 2 young adult patients with a high-risk malignant solid tumor or refractory/relapsed Hodgkin's lymphoma from August 2015 to December 2020. In our chemotherapy mobilization protocol, we used an absolute neutrophil count (ANC) of >1 × 109/L following the nadir after chemotherapy as the criterion for undertaking the apheresis. ResultsThe median CD34+ cell count per kg body weight of the 33 apheresis products was 4.92 × 106 cells/kg (range, 0.34–22.53 × 106 cells/kg). Thirteen of the 14 patients (93%) had successful PBSC collections that met their goals for PBSCT. Three patients did not receive PBSCT due to disease progression prior to transplantation. Prompt engraftment occurred in all the remaining 11 patients with 17 PBSCTs. ConclusionOur data suggest that ANC can be helpful as a surrogate parameter in clinical decision-making when the peripheral blood CD34+ count is unavailable.

Impact of Anti-CD38 Monoclonal Antibody Therapy on CD34+ Hematopoietic Stem Cell Mobilization, Collection, and Engraftment in Multiple Myeloma Patients-A Systematic Review.

This systematic review examines the available clinical data on CD34+ cell mobilization, collection, and engraftment in multiple myeloma patients treated with the anti-CD38 monoclonal antibodies daratumumab and isatuximab in clinical trials and in real life. Twenty-six clinical reports were published between 2019 and February 2024. Most studies documented lower circulating CD34+ cells after mobilization compared to controls, leading to higher plerixafor requirements. Although collection yields were significantly lower in approximately half of the studies, the collection target was achieved in similar proportions of daratumumab- and isatuximab-treated and nontreated patients, and access to autologous stem cell transplant (ASCT) was comparable. This could be explained by the retained efficacy of plerixafor in anti-CD38 monoclonal antibody-treated patients, while no chemotherapy-based or sparing mobilization protocol proved superior. Half of the studies reported slower hematopoietic reconstitution after ASCT in daratumumab- and isatuximab-treated patients, without an excess of infectious complications. While no direct effect on stem cells was observed in vitro, emerging evidence suggests possible dysregulation of CD34+ cell adhesion after daratumumab treatment. Overall, anti-CD38 monoclonal antibodies appear to interfere with CD34+ cell mobilization, without consistently leading to significant clinical consequences. Further research is needed to elucidate the underlying mechanisms and define optimal mobilization strategies in this patient population.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

Effect of Early Mobilization and Bed Positioning on Mobility among Patients with Traumatic Brain Injury

Background: Traumatic brain injury is defined as the disturbance in the function of the brain , or indication of pathology of brain, by the application of an exterior bodily force. Early mobilization exercises are explained as physiotherapy exercises of altering degree that are clinically safe and accurate developmentally started within 2 to 3 days of admission in neurological ICU. This early mobilization exercises helps in improving TBI patients recovery. Objective: The purpose of this study is to validate and evaluate the effect of early mobilization and bed positioning on mobility among patients with traumatic brain injury. Methods: This quasi-experimental study included 28 TBI patients. This study was conducted at general hospital, Lahore, and Jinnah hospital Lahore. Early mobilization and bed positioning therapies protocol were performed for 6 weeks. There were three sessions per week. Each session was 30 minutes. Mobilization scale and Norton scale were used as evaluation parameters before and after 6 weeks. Results: The data’s regularity was assessed by the Shapiro-Wilks test. Following statistical analysis, the regimen for early mobilization and bed positioning therapy’s efficacy for all examined variables was confirmed. The scores on early mobilization and Norton scales differ significantly. Conclusion: The results suggested that early mobilization and bed positioning therapies has improved mobility in TBI patients. This therapy protocol has also improved the TBI patients’ quality of life. Keywords: Bed positioning, Mobility and Traumatic brain injury.