Musculoskeletal Ailments Research Articles

Audit of drug wastage and its financial cost: A study in the orthopedic discipline

Background: Drug wastage is a major concern in healthcare and more so in an orthopedic setup where musculoskeletal ailments form a major proportion. The principal objective of this study was to ascertain the extent of drug wastage and its financial costs in orthopedics. Materials and Methods: This was a prospective pilot study and was conducted to ascertain the quantity of drug wastage in the orthopedic unit of a tertiary care hospital. The study was conducted in the outpatient facilities where the list of drugs prescribed and the wastage was recorded by telephoning the patients after a week of consultancy. The cost evaluation for the actual use and wastage was undertaken and audit was done to understand which drug generated the maximum wastage. Results: The highest drug wastage was observed in paracetamol (80%), diclofenac (38.36%) glucosamine + diacerein (53.33%), methylcobalamin + folic acid + alpha-lipoic acid (53.33%), methylcobalamin + folic acid (28.57%), and rabeprazole + domperidone (12.5%). Highest cost for wastage of drug was observed for diclofenac (INR434.1) and accounted for 44.72% of the drug cost. Conclusion: As far as the authors are aware, this is the first study addressing the financial impact of drug wastage in orthopedics. Attempts should be directed at minimizing wastage and at cost saving.

Antigenotoxic, antiproliferative and antimetastatic properties of a combination of native medicinal plants from Argentina

Ethnopharmacological relevanceJarilla is the common name of an appreciated group of native plants from the semi-arid region in Argentina (Larrea cuneifolia Cav., Larrea divaricata Cav. and Zuccagnia punctata Cav.) that have been historically consumed to heal respiratory, musculoskeletal and skin ailments, as well as recommended for weakness/tiredness, hypertension, diabetes and cancer treatment. It was previously reported that some biological properties could be improved when these plants are used jointly. Infusions of a defined mixture, composed by three Jarilla species, L. cuneifolia: L. divaricata: Z. punctata (0.5:0.25:0.25) (HM2) showed synergistic and additive effect on antioxidant activity even after passing through the gastro-duodenal tract. Aim of the studyThe main purpose of this work was to evaluate antigenotoxic, antitumor, and anti-metastatic properties of the Jarilla species that grow in the Northwest of Argentina and a herbal combination of them. Material and methodsInfusions of Jarilla mixture (HM2), and of each single plant species were prepared. Phenolic profiles of infusions were analyzed by HPLC-ESI-MS/MS and two relevant chemical markers were quantified. The antigenotoxic activity was evaluated by using the Ames test and the Cytokinesis-Block Micronucleus (CBMN) assay against direct mutagens. Evaluations of both cytotoxicity and antiproliferative effects were conducted on tumor and non-tumor cell lines. Both in vivo tumoral growth and metastasis inhibition were evaluated by using a carcinoma model on Balb/c mice. ResultsHM2 mix could suppress genetic and chromosome mutations induced by 4-nitro-o-phenylendiamine (4-NPD) and doxorubicin. Herbal mixture and single plant infusions showed cytotoxic effect against mammary, uterus, and brain tumoral cells without a selective action vs normal human cell line. HM2 mix was able to reduce mammary tumor mass on the Balb/c mice model and showed a significant reduction in the number of metastatic nodules in the lungs. ConclusionsOur results suggest that the combinations of three Jarilla species from northwest Argentina would be a promising alternative to treat or slow down the development of chronic diseases, such as cancer.

Liposomes for Intra-Articular Analgesic Drug Delivery in Orthopedics: State-of-Art and Future Perspectives. Insights from a Systematic Mini-Review of the Literature.

Background and objectives: Liposomal structures are artificial vesicles composed of one or several lamellae of phospholipids which surround an inner aqueous core. Given the amphoteric nature of phospholipids, liposomes are promising systems for drug delivery. The present review provides an updated synthesis of the main techniques for the production of liposomes for orthopedic applications, focusing on the drawbacks of the conventional methods and on the advantages of high pressure techniques. Materials and Methods: Articles published in any language were systematically retrieved from two major electronic scholarly databases (PubMed/MEDLINE and Scopus) up to March 2020. Nine articles were retained based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. Results: Liposome vesicles decrease the rate of inflammatory reactions after local injections, and significantly enhance the clinical effectiveness of anti-inflammatory agents providing controlled drug release, reducing toxic side effects. Conclusions: This review presents an update on the improvement in musculoskeletal ailments using liposome treatment.

A pilot study to determine the consistency of peak forces during cervical spine manipulation utilizing mannequins.

Cervical spine manipulation is a complex motor skill used to treat musculoskeletal ailments such as neck pain. There is evidence demonstrating the effectiveness of objective feedback and mannequins for the teaching of spinal manipulation (SM) in the thoracic and lumbar spine. This paper examines the effectiveness of an educational intervention combining both mannequins and force-sensing technology for teaching cervical SM. Fourth-year chiropractic interns were separated into 2 groups: an intervention group and a group trained with the standard curriculum. The intervention included a 60-minute educational session focused on targeting 100 N total peak force cervical manipulations on mannequins, with objective feedback through force-sensing table technology. Pre- and post-CMs were recorded on both a mannequin and a paired student partner, with an attempt to have a target total peak force of 100 N. Ninety students were recruited. The invention group (n = 46) scored significantly better at the outcome compared to the control group (n = 44) when manipulating the mannequin (p = .003). These improvements did not carry over when manipulating a paired human partner (p = .067). Following a 1-hour cervical SM educational intervention utilizing thrusting on mannequins and force-sensing table technology, students demonstrated improved peak force control for SM delivered on the mannequin. However, this improvement was not carried over to SM delivered on human subjects.

Value-based Healthcare: Health Literacy's Impact on Orthopaedic Care Delivery and Community Viability.

Value-based Healthcare: Health Literacy's Impact on Orthopaedic Care Delivery and Community Viability.

PAST, CURRENT AND FUTURE INTERVENTIONAL ORTHOBIOLOGICS TECHNIQUES AND HOW THEY RELATE TO REGENERATIVE REHABILITATION: A CLINICAL COMMENTARY

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EFFECTS OF FREQUENT KNEE BENDING AND OCCUPATION RELATED RISK FACTORS WITH KNEE JOINT PATHOLOGIES – A SYSTEMATIC REVIEW

BACKGROUND AND AIMS Knee pathologies are one of the most common musculoskeletal ailments with high rate of prevalence of degenerative knee changes causing functional limitations and participation restriction. Number of occupational exposures has shown positive correlation to Knee OA, associated with varying occupations and their demands. DATABASES AND ELIGIBILITY CRITERIA The observational studies were searched on the databases MEDLINE, PubMed, Google Scholar, PEDro and Cochrane Library from April to May 2019. It was ensured that all articles were full-text in English language whereas screening was executed on relevant titles and abstracts, evaluated on the basis of occupational hazards/risk factors and its impact on knee joint. RESULTS Number of studies represented varying occupational clusters that lead to certain risks factors according to demand. A positive relationship was indicated between age and Knee OA, along with squatting and knee pain that may results in elevated risk of disability and knee joint pathologies. CONCLUSION It was concluded that occupational exposures involved certain risk factors that may altered the knee joint function and increases the risk of Knee OA for future. KEYWORDS Knee Joint, Knee Injuries, Occupations, Risks, Health, Osteoarthritis.

Level of Evidence and Industry Sponsorship Associated with Favorable Outcomes in Publications on Platelet-Rich-Plasma Therapy in Musculoskeletal Disorders.

Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08–0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times ( p < 0.01) and 10.97 times ( p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.

Road ambulances: working conditions of paramedics - pilot studies.

The article presents the results of selected pilot studies conducted in medical ambulances. Their aim was to determine the working conditions and identify troublesome factors accompanying the performance of basic medical procedures by rescue teams. The study of working conditions was carried out in Mercedes-Benz ambulances, type S and P. Fifty-one paramedics of the Emergency Medical Rescue Service in Siedlce took part in the research. The questionnaire expert survey method and the direct observation method were used. As a result of the applied research methods, knowledge was gained on the irregularities and difficulties that occur at the workplace of a paramedic, i.e., in an ambulance, including the lack of access to essential elements of medical equipment and their different location inside the vehicle, and the diversity of solutions for the spatial structure of ambulances, which all cause difficulties at work. Research has shown that paramedics take, on average, 33 min to familiarize themselves with the location of equipment in an ambulance other than the one in which they are usually on duty. There was no correlation between the lifeguard's length of service and the time necessary for getting acquainted with the equipment, which was studied using Pearson's correlation coefficient. In the study, rescuers also pointed to musculoskeletal ailments, mainly spinal pains resulting from taking forced positions during medical activities in an ambulance. The results obtained constitute the basis for the author's methodology of complex research aimed at defining the ergonomic recommendations necessary in the modification process of the operated medical fleet. The next step will be to formulate uniform guidelines for the construction of medical compartments of ambulances, the application of which will lead to the unification of their spatial structure regardless of the vehicle brand. Int J Occup Med Environ Health. 2020;33(1):91-105.

Working and health conditions of female taxi drivers in Mexico City: A comparative analysis between women and men

This paper describes working and health conditions of women who drive a taxi in Mexico City as their main economic activity, and the disparities in comparison to male taxi drivers. Based on a questionnaire given to 285 taxi drivers, 201 men and 84 women, it was found that although women have more years of education (p < .001) and work more hours per day (p < .031), their income is less than that of men (p < .196). Most (73.8%) of the women are single or lack financial support for their household—they are single mothers, widows, or divorcees—and 85.48% have children that they take to school and their educational activities, which means a loss of working hours precisely at rush hour, when demand and income rate are at their highest. Furthermore, women have a higher proportion of illness (p < .001) and musculoskeletal ailments than men drivers (p < .001); and they are more likely to get sick, mainly stemming from psychosocial demands such as feeling their work is unpleasant (OR = 2.11), income dissatisfaction (OR = 3.09), and getting traffic tickets (OR = 3.25). Therefore, there are important differences in working and health conditions between men and women, which need to be combatted with labor, safety, and gender equality policies to improve psychosocial factors for female workers.

Immunohistochemical features of rotator cuff tendinopathy.

Rotator cuff tendinopathy is a common musculoskeletal ailment in sedentary and athletic individuals. Various mediators of inflammation have been detected in human tendons: they are thought to initiate or progress the course of tendinopathy. An online search was conducted using AMED, CINAHL, Embase, The Cochrane Library, PEDro and Pubmed, using the terms tendinopathy, tendon, tendinitis, tendinosis, histology, histopathology, immunohistochemistry, immunohistochemical, rotator cuff and pain. Histological examination of tendinopathic tendons shows degeneration of the collagen structure and infiltration of fat and vessels, together with increased expression of inflammatory cytokines, MMP-1, 2, 3, 9, 13, vascular endothelial growth factor and Hypoxia inducible factor (HIF). Most of the studies about this topic exhibited limited validity because of lack of appropriately matched controls and no inclusion or exclusion criteria. The evidence associated with the histopathological analysis of the rotator cuff is limited. The histochemical and immunohistochemical features of rotator cuff tendinopathy are still unclear. A thorough understanding of the vascularity, innervation and biochemical mediators of pain could be used to target rotator cuff pathology, and possibly guide the therapy of painful rotator cuff disorders. There is a need for a validated reproducible method of rotator cuff tendon biopsy evaluation. We require further studies with improved designs to effectively evaluate the histological and immunohistochemical features of rotator cuff tendinopathy.

Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India

BackgroundSiddha is one of the traditional medical systems of India; previous ethnobotanical survey in Virudhunagar district indicated a high consensus for treating musculoskeletal ailments. ObjectivesThis study was aimed to quantitatively document the medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India. Materials and methodsThis work was the outcome of free-list interviews conducted among 45 informants between April 2016 and January 2017. Sampling sufficiency was assessed by plotting Shannon–Wiener's index and cumulative number of UR. Informant consensus was assessed using Informant Consensus Factor (Fic) and Informant Agreement Ratio (IAR). ResultsThis study recorded the data regarding 116 plant species which were used to prepare 129 formulations; analysis of the data yielded 490 UR. Among these, 65.3% of UR dealt with internal applications and 34.6% dealt with external applications. In the case of internally used formulations, pain and general musculoskeletal ailments had high Fic values. In the case of externally used formulations, headache and pain had high Fic values. ConclusionImportant species prescribed by the informants to treat various musculoskeletal ailments were: Azima tetracantha, Ricinus communis, Sesamum indicum, Moringa oleifera, Cardiospermum halicacabum (internal application), Calophyllum inophyllum, Justicia adhatoda, Curcuma longa, Calotropis gigantea, Zingiber officinale, Withania somnifera, Strychnos nux-vomica, Dodonaea viscosa (external application), Azadirachta indica, Clerodendrum phlomidis,Delonix elata, Pergularia daemia and Vitex negundo (internal and external applications). Robust studies on these local claims will help to improve the community healthcare and will yield some novel agents to treat musculoskeletal ailments.

Health problems among IT professionals in Chennai city, Tamil Nadu

Background: Increasing technological advantage lead to the higher health disadvantages to IT professionals who spent most of the time working in front of the computer. They are experiencing many neural, visual and musculoskeletal ailments. The present study was done with the aim to limelight the health issues among IT employees in IT Park, Chennai.Methods: This cross-sectional quantitative survey related to health issues among IT professionals was done on 417 employees of Chennai IT Park during the period from January 2018 to May 2018. The predesigned questionnaire included socio-demographic and health related issues. It was sent to the employees through various media including Facebook messenger, LinkedIn private messaging and email. The data was analyzed and presented in number and percentages and the related associations were analysed by Chi square test.Results: The prevalence of pain in eye was the major visual problem noticed in 157 (38%) patients and the rate of incidence was similar in both males and females. About 50% of the participants had pain/stiffness in lower back. Feeling nervous ness is the related stress condition experienced by the respondents (49%). Other health correlated issues noticed among the participants was headache (40%). The prevalence rate of these factors was higher in males compared to females.Conclusions: The study concluded that IT professionals face several health issues in terms of visual, musculoskeletal and stress problems in Chennai IT Park.

A service evaluation of prescribed only medications (POMs) issued during a 12-month period in a musculoskeletal physiotherapy primary care service

Purpose: Non-medical prescribing was introduced in the United Kingdom (UK) to improve healthcare service efficiency, access to medicines and support service innovation. From 2013, independent prescribing was extended to include physiotherapists. Patients are facing increasingly long waiting times to see their GPs, and delays getting medication to aid their musculoskeletal ailments. This report aims to explore patient satisfaction of this service in a primary care musculoskeletal physiotherapy setting. IPOPS started provision of independent prescribing during physiotherapy sessions by a single physiotherapy practitioner in March 2017.

The association between patient education level and economic status on outcomes following surgical management of (fracture) non-union

BackgroundSocioeconomic disparities are an inherent and currently unavoidable aspect of medicine. Knowledge of these disparities is an essential component towards medical decision making, particularly among an increasingly diverse population. While healthcare disparities have been elucidated in a wide variety of orthopaedic conditions and management options, they have not been established among patients who present for treatment of an ununited fracture. The purpose of this study is to answer the following questions: 1) Following surgical management of (fracture) non-unions, are there differences in outcomes between differing ethnic groups? 2) Following surgical management of (fracture) non-unions, are there differences in outcomes between patients with differing education levels? 3) Following surgical management of (fracture) non-unions, are there differences in outcome between patients with differing incomes? MethodsBetween September 2004 and December 2017, operatively treated patients who presented with a long bone fracture non-union were prospectively followed. These patients presented with a variety of fracture non-unions that underwent surgical intervention. Sociodemographic factors were recorded at presentation. Long-term outcomes were evaluated using the Short Musculoskeletal Function Assessment (SMFA), pain scores, post-operative complications and physical exam at latest follow up. The SMFA is a 46-item questionnaire, assessing patient functional and emotional response to musculoskeletal ailments. ResultsThree-hundred-twenty-nine patients met inclusion criteria. Patients with a lower education had worse long-term functional outcomes (P < 0.001) and increased pain scores (P = 0.002) at latest follow-up. Patients who made less than $50,000 annually had worse long-term functional outcomes (P = 0.002) and reported higher pain scores (P = 0.003) following surgical management of (fracture) non-unions. Multiple linear regression demonstrated education level to be an independent predictor of long-term functional outcomes following surgical management of (fracture) non-unions (B= -0.154, 95% Confidence Interval [CI]=-10.96 to -1.26, P = 0.014). No differences existed in outcomes or pain scores between those of different ethnic groups. No differences existed regarding post-operative complications and time to union between patients of different ethnic groups, educational levels and income status. ConclusionPatients with lower education levels and individuals who make less than $50,000 annually have worse functional outcomes following surgical management of (fracture) non-unions. Orthopaedic trauma surgeons should therefore be aware of these disparities, and consider early interventions aimed at optimizing patient recovery in these subsets.

Postural workloads on paramedics during patient transport

Abstract Paramedics perform physically demanding tasks during patient transport in daily routine and therefore suffer more often from musculoskeletal ailments, mainly low back pain, than any other profession. We hypothesise, that current transport aids do not offer sufficient support when it comes to obstacles and stairs during patient transport. Therefore we conducted an Ovako Working Posture Analysing System (OWAS) field study to capture postural workloads during patient transport and connected the results to a survey among paramedics about occurring obstacles. The results of the OWAS analysis showed strenuous working conditions during barrier-free transport with classical transport aids, like stretcher and stretcher chair, but enormous postural workloads when barriers occurred. Our survey revealed, that stairs occurred in 38 %, and at least one barrier, like narrow passages, curbs, etc., in 48.1 % of all deployments (n=405), we can quantitatively link postural workloads with occurring obstacles. In conclusion, there is a high demand for ergonomic improvements of current transport aids and a high potential of active assist devices to reduce harmful loads on paramedics.

Fractures and musculoskeletal ailments in persons 20+ years after a traumatic spinal cord injury in Norway.

Cross-sectional study. To gain insights into fracture rate and musculoskeletal ailments among Norwegians with a spinal cord injury (SCI) acquired more than 20 years ago. Sunnaas Hospital, Nesoddtangen, Norway. 165 persons with SCI were interviewed in 2004-2005 by questionnaires and clinical examination. Descriptive statistics and a logistic regression analysis were performed to identify variables associated with bone fractures and musculoskeletal ailments. Around half of the participants experienced a fracture after injury and excessive use of alcohol increased the odds (OR 0.09; CI 0.01-0.74) of suffering a post-injury fracture (p = 0.03). Sixty percent experienced shoulder ailments after the SCI and the use of orthosis to the knee and hip increased the odds (OR 4.4; CI 1.4-13) of experiencing shoulder ailment (p = 0.01). Around half of the 165 participants reported to have suffered a fracture and over 100 to experience musculoskeletal ailment 20 years after injury. We suggest that prevention strategies and symptom management must be embedded in follow-up visits after SCI.

COGNITIVE-BEHAVIORAL APPROACH AND THE ROLE OF PHYSICAL ACTIVITY IN THE TREATMENT OF MUSCULOSKELETAL PAIN IN ATHLETES

The importance of a cognitive-behavioral approach is richly documented in world scientific literature. In the light of the current knowledge about the determinants of pain treatment, the significance of psychological factors for the course and effects of analgesic therapy becomes more comprehensible. Many psychological processes have an influence on both the experience of pain and the treatment outcome. The factors like cognitive interpretation of pain, level of activity and emotional states of musculoskeletal pain sufferers are very important.The research referred to in this work makes a part of a long-term research programme the subsequent stages of which are analysed based on the literature of the subject that can assist in interpreting the new findings within dependencies between psychological factors and functioning in the case of the persons who cope with pain. Integration of psychological findings about attitude to pain into physical therapy treatment would seem to have potential to enhance outcomes. In this work we are presenting the problem in a context i.e. in the context of a role of cognitive-behavioral approach approach. The purpose of the article is to present the role of cognitive-behavioral approach in the field of applications that aim at supporting people who are involved in sport activity and cope with musculoskeletal pain-related ailments.

Musculoskeletal Injuries Affecting Radiologists According to the 2017 ACR Human Resources Commission Workforce Survey

Practice leaders surveyed in the 2017 ACR Human Resources Commission workforce survey reported that 25% of the radiologists or radiation oncologists they supervised had neck pain, 32% had low back pain, and 16% were dealing with a repetitive stress injury. The prevalence rates of these musculoskeletal ailments among radiologists and radiation oncologists were consistent with those reported in the literature in other populations. However, these prevalence rates may be underestimated because practice leaders, not the radiologists themselves, were surveyed, and the leaders may not be aware of all injuries.

Does musculoskeletal health literacy differ between urban and rural orthopaedic patients?

Background: Many patients lack the necessary skills needed to make informed decisions regarding their health. This critical skill set, broadly defined as health literacy, is influenced by various demographic factors including age, gender, ethnicity, education, and socioeconomic status. Patients seeking care for musculoskeletal ailments are afflicted by low health literacy, with several studies identifying higher rates of inadequate musculoskeletal health literacy than general health literacy. This study aimed to evaluate and compare the prevalence of limited musculoskeletal health literacy in patients seeking orthopaedic care in both urban and rural environments, looking at the geographical distribution in a single state. Methods: Validated health literacy assessment instruments and demographic surveys were administered to patients seeking musculoskeletal care in two emergency departments (one rural, one urban). Patients were eligible to participate if they had a single musculoskeletal complaint, were at least 18 yr old, and spoke English. Results: There were 55 participants in the rural emergency department (ED), and 65 in the urban ED. Adequate general health literacy was found in 62% of rural and 52% of urban patients, while 44% of rural and 43% of urban patients had adequate musculoskeletal health literacy. There was no significant difference in the prevalence of adequate health literacy between the two populations, but both cohorts had significantly worse rates of musculoskeletal health literacy as compared to general health literacy (P&lt;0.05). Conclusions: This study confirms that there is a greater prevalence of limited musculoskeletal health literacy as compared to general health literacy, and that this transcends geographic boundaries.