Statistical Significance In Favour Research Articles

Undergraduate students’ differential performance in introductory course to guidance and counselling at Delta State University, Abraka

The study examined the differential performance of guidance and counselling and non-guidance and counselling students. The two categories of students received tuition in EDUCATION 402, an introductory course in guidance and counselling. Additionally, guidance and counselling students took other counselling courses in pursuance of their bachelor’s degree. The counterparts from the departments of Educational Management and Foundations as well as Library and Information Science, relied on the knowledge of the introductory course in guidance and counselling. Descriptive survey design was employed in the study. A sample size of 121 students (50 from guidance and counselling department, 32 from Educational Management and Foundations, 39 from Library and Information Science) was drawn from the population of final year students (2020/2021 session) Faculty of Education, Delta State University, Abraka, A 3-item essay test items was the instrument the students responded to. The statistical tool was the independent samples t-test. The data analysed showed statistical significance in favour of guidance and counselling students. This is attributable to their knowledge of other courses in guidance and counselling. It is hereby recommended that students from other departments should be encouraged to take more courses in counselling to enhance their academic performances.

The Relationship between Reading Comprehension and Writing Skills of Fourth Grade Students and Their Motivation to Read and Write

Motivation is well-known to have a crucial influence in the growth and acquisition of language skills, including reading comprehension and writing. From this point of view, the goal of this study was to find out how 4th graders' reading comprehension, writing skills, and motivation to read and write are connected. Conducted according to the correlational research design, the study consisted of a total of 581 students, 297 boys and 284 girls, studying at the 4th grade of the public primary schools located in the central districts of Kars, Konya, and Zonguldak provinces. Data collection tools included the “Reading Comprehension Test”, “Motivation to Read Profile”, “Motivation to Write Profile”, and “Story Text Assessment Analytic Rubric”. Data analysis results indicated that the reading comprehension skills of female and male students were close to each other with statistical significance in favour of female students considering the scores of story writing and of motivation to read and write. A major positive correlation was found between the motivation to read and its sub-factors and the sub-factors of motivation to write, as well as between the motivation to read and motivation to write. Furthermore, motivation to read was found to be a considerable predictor of reading comprehension skill, while motivation to write was found to be a major predictor of writing skill. At the conclusion of the study, a number of recommendations were made for future researchers and teachers.

Efficacy of a new sonic powered toothbrush versus a manual toothbrush in a young population. A randomized cross-over clinical trial.

To compare the effectiveness of dental plaque removal between a new sonic toothbrush and a manual toothbrush. In total, 75 healthy dental students participated in this randomized double-blind crossover clinical trial. Subjects were randomly assigned to one of the two groups (manual or sonic toothbrush) and underwent a single toothbrushing exercise. Seven days after, patients were asked to repeat the same procedure with the other toothbrush. Plaque scores were recorded before and after brushing. A significant mean reduction in the full-mouth plaque index was observed after the use of both type of brushes: 46.2% ± 0.28% (p=0.000) and 50.5% ± 0.24% (p=0.000) for the manual and sonic toothbrush, respectively. However, there were no statistically significant differences between the two types of brushes (p=0.277). Regarding plaque reduction on the distinct tooth surfaces, differences between the groups reached statistical significance in favour of the sonic toothbrush only on the buccal sites (p=0.003). Both devices lead to similar plaque score reduction after a single tooth brushing.

Online teaching in physiotherapy education during COVID-19 pandemic in Italy: a retrospective case-control study on students\u2019 satisfaction and performance

BackgroundDuring COVID-19 pandemic, physiotherapy lecturers faced the challenge of rapidly shifting from face-to-face to online education. This retrospective case-control study aims to compare students’ satisfaction and performances shown in an online course to a control group of students who underwent the same course delivered face-to-face in the previous five years.MethodsBetween March and April 2020, a class (n = 46) of entry-level physiotherapy students (University of Verona - Italy), trained by an experienced physiotherapist, had 24-hours online lessons. Students exposed to the same course in the previous five academic years (n = 112), delivered with face-to-face conventional lessons, served as a historical control. The course was organized in 3 sequential phases: (1) PowerPoint presentations were uploaded to the University online platform, (2) asynchronous video recorded lectures were provided on the same platform, and (3) between online lectures, the lecturer and students could communicate through an email chat to promote understanding, dispel any doubts and collect requests for supplementary material (e.g., scientific articles, videos, webinars, podcasts). Outcomes were: (1) satisfaction as routinely measured by University with a national instrument and populated in a database; (2) performance as measured with an oral examination.ResultsWe compared satisfaction with the course, expressed on a 5-point Likert scale, resulting in no differences between online and face-to-face teaching (Kruskal-Wallis 2 = 0.24, df = 1, p = 0.62). We weighted up students’ results by comparing their mean performances with the mean performances of the same course delivered face-to-face in the previous five years, founding a statistical significance in favour of online teaching (Wilcoxon rank sum test W = 1665, p < 0.001).ConclusionsOnline teaching in entry-level Physiotherapy seems to be a feasible option to face COVID-19 pandemic, as satisfies students as well as face-to-face courses and leading to a similar performance. Entry-level Bachelors in Physiotherapy may consider moving to eLearning to facilitate access to higher education. Universities will have to train lecturers to help them develop appropriate pedagogical skills, and supply suitable support in terms of economic, organizational, and technological issues, aimed at guaranteeing a high level of education to their students.Trial registrationRetrospectively registered.

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta-analysis

Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as “gatekeepers” for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data’s heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54–0.89, I2 = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23–0.90, I2 = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.

Is local anaesthesia superior to general anaesthesia in endovascular repair of abdominal aortic aneurysm?

A best evidence topic in cardiovascular surgery was written in accordance to a structured protocol. The question addressed was: in patients undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is local anaesthetic (LA) superior to general anaesthetic in terms of perioperative outcomes? Altogether, 630 publications were found using the reported search protocol, of which 3 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and primary outcomes were tabulated. The 3 included studies are systematic reviews with meta-analyses, with no randomized trials identified. Within the studies, there is a degree of heterogeneity in terms of surgical case-mix (elective or emergency EVAR or both) and anaesthetic technique (LA, regional anaesthetic, local-regional anaesthetic and general anaesthetic). With 1 study not providing pooled estimates, the second study demonstrated statistical significance in favour of local-regional anaesthetic within the elective setting in terms of mortality [pooled odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52-0.95; P = 0.02], morbidity (pooled OR 0.73, 95% CI 0.55-0.96; P = 0.0006) and total length of hospital admission (pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P = 0.00001). The third study failed to demonstrate a statistically significant mortality benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P = 0.211). While the results of these studies fail to provide a clear answer to a complex surgical problem, it would be appropriate, in the light of current evidence, to recommend LA as non-inferior to general anaesthetic in both emergency and elective settings.

A randomized, multicentre trial evaluating the efficacy and safety of fast-acting insulin aspart in continuous subcutaneous insulin infusion in adults with type 1 diabetes (onset 5).

AimTo evaluate the efficacy and safety of fast‐acting insulin aspart (faster aspart) vs insulin aspart (IAsp) used in continuous subcutaneous insulin infusion (CSII) in participants with type 1 diabetes (T1D).Materials and MethodsThis was a double‐blind, treat‐to‐target, randomized, 16‐week trial investigating CSII treatment with faster aspart (n = 236) or IAsp (n = 236). All available information, regardless of treatment discontinuation, was used for the evaluation of effect.ResultsFaster aspart was non‐inferior to IAsp regarding the change from baseline in glycated haemoglobin (HbA1c; primary endpoint). The mean HbA1c changed from 58.4 mmol/mol (7.5%) at baseline to 57.8 mmol/mol (7.4%) with faster aspart and to 56.8 mmol/mol (7.4%) with IAsp after 16 weeks' treatment, with an estimated treatment difference (ETD) of 1.0 mmol/mol (95% confidence interval [CI] 0.14; 1.87) or 0.09% (95% CI 0.01; 0.17; P < 0.001) for non‐inferiority (0.4% margin; P < 0.02 for statistical significance in favour of IAsp). Faster aspart was superior to IAsp in change from baseline in 1‐hour postprandial glucose (PPG) increment after a meal test (ETD −0.91 mmol/L [95% CI −1.43; −0.39] or −16.4 mg/dL [95% CI −25.7; −7.0]; P = 0.001), with statistically significant reductions also at 30 minutes and 2 hours. The improvement in PPG was reflected in the change from baseline in 1‐hour interstitial glucose increment after all meals (ETD −0.21 mmol/L [95% CI −0.31; −0.11] or −3.77 mg/dL [95% CI −5.53; −2.01]). There was no statistically significant difference in the overall rate of severe or blood glucose‐confirmed hypoglycaemia (estimated rate ratio 1.00 [95% CI 0.85; 1.16]). A numerical imbalance in severe hypoglycaemic episodes between faster aspart and IAsp was seen in the treatment (21 vs 7) and 4‐week run‐in periods (4 vs 0).ConclusionsFaster aspart provides an effective and safe option for CSII treatment in T1D.

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy.

The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a "4 hours-proficiency". However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.

Achilles Tendon Repair- A Systematic Review of Overlapping Meta-Analyses

Category: Sports Introduction/Purpose: Acute Achilles tendon ruptures (ATR) are a common sports-related injury with an incidence of between 8-37 per 100,000 per year. While there are several meta-analyses published on the optimal treatment of ATR based on randomized control trials, the reported outcomes conflict between each meta-analysis due to different methodologies. The aim of this study is to systematically review the clinical results represented in meta-analyses in the current literature on acute ATR. Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines to identify meta-analyses on Achilles tendon repair. Clinical results, including the re-rupture rates, wound infection rates and overall complication rates were analyzed. Level of evidence (LOE) and methodological quality of evidence (MQOE), using the AMSTAR score, were evaluated. A statistically significant difference (SSD) was defined as p &lt; 0.05. Each meta-analysis was categorized into one of the following subgroupings: 1) Operative vs Non-Operative Treatment (with Conservative Rehabilitation) [OC vs NOC], 2) Operative vs Non-Operative Treatment (with Functional Rehabilitation) [OF vs NOF], 3) Conservative Rehabilitation vs Functional Rehabilitation (with Operative Treatment) [OC vs OF], and 4) Open vs. Percutaneous Repair (with Conservative Rehabilitation) [OC vs POC]. Results: Four studies compared OC and NOC. Re-rupture rates ranged from 3.1-6.4% in OC and 10.0-13.0% in NOC. Two of these studies showed statistical significance in favour of OC. There was no SSD was seen in other complications. Three studies compared OF and NOF. Re-rupture rates ranged from 3.8-5.0% in OF and 6.0-11.9% in NOF, no study showed a SSD. There was no SSD in other complications. Three studies compared OF and OC. Re-rupture rates ranged from 2.13-3% in OF and 1.1-2.1% in OC, no study showed a SSD. Four studies compared OC and PSC. Re-rupture rates ranged from 2.2-4.4% in OC and 1.1-2.1% in PSC, no study showed a SSD. In all included studies there was SSD in wound infection rates, in favour of PSC. Conclusion: Overall there exists a large volume of high quality meta-analyses on Achilles tendon repair. The re-rupture rates were lower in operative treatment in all studies, even when early functional rehabilitation was used. However, while early functional rehabilitation may allow early mobility but the rehabilitation method can be demanding. Although there was no difference between percutaneous and open repair on the re-rupture rate, there was an overall reduction in wound infection after percutaneous repair. The results within this study can help determine the optimal treatment for patients.

Walking ability in patients with glioblastoma: prognostic value of the Berg Balance Scale and the 10meter walk test.

Primary brain tumors frequently cause considerable functional impairments and the survival time when diagnosed with glioblastoma is 14.6months. The aim of this study was to examine if baseline postural control and walking ability in patients with glioblastoma could predict long term walking ability and 1year mortality. Data were gathered from prospective recordings in a brain cancer database supplemented by retrospective review of electronic patient records. We included 109 patients with glioblastoma, 47 women and 62 men with mean age 65years. At admission 84 patients were tested with Berg Balance Scale and 57 were tested with 10meter walk test. Binary logistic regression analysis showed no statistical significance in favour of the 10meter walk test. Berg Balance Scale showed an ability to predict walking ability 4-8months after admission. The risk of dying within a year was 6.9 times higher in patients who lost their ability to walk within 4-8months of the first admission. This study showed that Berg Balance Scale has some ability to predict the loss of walking ability 4-8months after admission. This could be an important indicator pin pointing patients most in need of more intensive specialized neurorehabilitation efforts early in the disease course.

A comparative study of virtual hand prosthesis control using an inductive tongue control system

ABSTRACTThis study compares the time required to activate a grasp or function of a hand prosthesis when using an electromyogram (EMG) based control scheme and when using a control scheme combining EMG and control signals from an inductive tongue control system (ITCS). Using a cross-over study design, 10 able-bodied subjects used a computer model of a hand and completed simulated grasping exercises. The time required to activate grasps was recorded and analyzed for both control schemes. End session mean activation times (ATs; seconds) for the EMG control scheme grasps 1 -5 were 0.80, 1.51, 1.95, 2.93, and 3.42; for the ITCS control scheme grasps 1 ‒5 they were 1.19, 1.89, 1.75, 2.26, and 1.80. Mean AT for grasps 1 and 2 was statistically significant in favor of the EMG control scheme (p = 0.030; p = 0.004). For grasp 3 no statistical significance occurred, and for grasps 4 and 5 there was a statistical significance in favour of the ITCS control scheme (p = 0.048; p = 0.004). Based on the amount of training and the achieved level of performance, it is concluded that the proposed ITCS control scheme can be used as a means of enhancing prosthesis control.

Topical Anaesthesia in Flexible Nasofibrolaryngoscopy

IntroductionThe emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. Materials and methodsThis was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine)+epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. ResultsWe evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine–epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine–epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine–epinephrine (P<.05). When we compared the use of lidocaine–epinephrine with the placebo, the result was also statistically significant in favour of lidocaine–epinephrine (P<.05). ConclusionsIn this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploration.

Evaluation of a skin barrier cream for managing IAD in elderly patients using high-frequency ultrasound.

Incontinence-associated dermatitis (IAD) is a defined pathological entity and presents a significant burden for patients and health-care systems. The main objective of this evaluation was to test the efficacy and safety of a skin barrier cream in the management of uncomplicated IAD in elderly patients. Ten incontinent patients with mobility problems that presented with signs of IAD were included in the evaluation. The evaluation took place during a 2-week period. The product's efficacy was objectively evaluated in each patient with high-frequency ultrasound scans taken from the irritated skin compared with an ultrasound scan taken from normal adjacent (control) skin. Data analysis showed a statistical significance in favour of the capacity of the product to help reduce inflammatory signs. Photographic follow-up allowed correlation of ultrasound findings and clinical signs. The product was effective in treating the skin irritation and preventing further skin breakdown. There were no adverse events during the evaluation.

Anestesia tópica en la nasofibrolaringoscopia flexible

IntroductionThe emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. Material and methodsThis was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. ResultsWe evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). ConclusionsIn this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploration.

Trends in immediate perioperative morbidity and delay in discharge after open and minimally invasive radical prostatectomy (RP): a 20‐year institutional experience

The present very interesting article reflects on two decades of radical prostatectomy (RP) in perhaps historically the most influential centre in the world for this surgery 1. From the setting of a single high-volume prostatectomy centre (>18 000 cases under review), it offers a contemporary and relevant ‘gold standard’ with regard to the current hospitalisation pathways for men undergoing this surgery. Furthermore, the article enjoyably traces the pathway of change over two decades, culminating in an alluring comparison of open with minimally invasive RP in the modern era. While Pierorazio et al. admit that length of stay in hospital (LOS) as a pure outcome measure may not be able to be fairly compared between institutions (certainly when international, cultural and financial factors are included), the authors make valid observations about change over time and comparison of subsets within their analysis. All urologists around the world are probably aware that patients who have undergone RP now spend a considerably shorter time in hospital than at the start of this series. The experience reported in this article shows clearly that the achievable short-term morbidity borders on negligible for the vast majority of men undergoing surgery in the high-volume setting. Importantly, it must be remembered that long-term outcomes cannot be touched upon in an analysis such as this, and indeed there is no strong reason to believe that LOS has any correlation with long term oncological or functional outcomes. Perhaps what I found most interesting in this article was the comparison between open and minimally invasive prostatectomy. In the absence of good evidence regarding oncological or long-term functional differences, there has been much lauding of the benefits of robot-assisted prostatectomy in terms of an enhanced early recovery, both in terms of comparison with the open and laparoscopic alternatives 2, 3. Pierorazio et al. beg to differ, as they report an array of early complications, including bleeding, none of which show in favour of robot-assisted surgery. In fact, three defined complications (transfusion rate, P = 0.01; operative urine leak, P = 0.009; and postoperative ileus, P < 0.001) achieved statistical significance in favour of open surgery. Of course it is not a fair comparison as learning curves are not factored in, and it is of course possible (and perhaps even likely) that future justification of the robot will be provided from other centres with less wealth of expertise in the open technique; however, I suspect the business managers for many hospitals who have already invested in robotic technology will not relish the lack of demonstrable difference in LOS in this sizeable and relevant series. Furthermore, the statistically significant findings in favour of open surgery will no doubt be music to the ears of those who have continued to pursue open surgery and thereby resist the considerable temptations posed by the overt attraction of the robotic surgical technique. In unpublished correspondence about this article, the authors state that in the last 30 years >50 surgeons have performed a prostatectomy at this centre and they claim there is no detectable difference based on a specific surgeon. As always, this powerful American institution continues to offer observations on prostatectomy surgery that demand considerable attention. None declared

THU0308 Indirect comparison of ACR response of biologic treatments in active SJIA

BackgroundTo date, no biologic treatments other than tocilizumab (TCZ) have been approved in active Systemic Juvenile Idiopathic Arthritis (SJIA). Some however are used off label. Published evidence on their efficacy...

Bendamustine

Bendamustine (Levact®) is an alkylating agent consisting of three structural elements: a 2-chloroethylamine alkylating group; a butyric acid side chain; and a benzimidazole ring. Although its precise mechanism of action is as yet unknown, it appears to exert its antineoplastic effects via a different mechanism to those of other alkylating agents. This article reviews the utilization of intravenous bendamustine in patients with chronic lymphocytic leukaemia (CLL), rituximab-refractory indolent non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM), focusing on indications for which the agent is approved in the EU. As monotherapy, bendamustine was effective in the first-line treatment of adults with CLL, significantly prolonging progression-free survival (PFS) and improving the overall response (OR) rate after a median duration of follow-up of 35 months compared with chlorambucil in a randomized, open-label, multinational, phase III study. PFS and the OR rate were at least 2-fold greater with bendamustine than with chlorambucil when data from the overall patient population were stratified by Binet stage. In the treatment of adults with rituximab-refractory indolent NHL, monotherapy with bendamustine was efficacious, with an OR achieved by at least three-quarters of patients in two noncomparative multicentre studies. Patients with follicular histology or those who had responded or were refractory to their previous chemotherapy regimen (including alkylator therapy) also appeared to respond to bendamustine monotherapy. Front-line combination therapy with bendamustine plus prednisone was significantly more effective than combination therapy with melphalan plus prednisone in prolonging the time to treatment failure, according to a randomized, open-label multicentre, phase III study in adults with MM. Moreover, the benefits of bendamustine plus prednisone appeared to be maintained beyond 30 months, with a retrospective calculation of PFS demonstrating a borderline statistical significance in favour of bendamustine plus prednisone over melphalan plus prednisone. The tolerability profile of bendamustine in adults with CLL, indolent NHL or MM was mostly consistent with the known toxicities of the agent, with adverse events often managed with dose modifications. Although further data are required to fully establish the comparative efficacy of intravenous bendamustine in the management of CLL, rituximab-refractory indolent NHL or MM, it appears to be a useful addition to the armamentarium of currently available therapies for these haematological malignancies.

Follow-up for improving psychological well being for women after a miscarriage

Miscarriage is the premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy and weighing up to 500 grams. International studies using diagnostic tools have identified that some women suffer from anxiety, depression and grief after miscarriage. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review is necessary as the evidence is equivocal on the benefits of psychological follow-up after miscarriage. Whether follow-up affects the psychological well being of women following miscarriage. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2011), reference lists of all retrieved papers and contacted professional and lay organisations to obtain any ongoing trials or unpublished data. Randomised controlled trials only. All potential trials for eligibility according to the criteria specified in the protocol by screening the titles and abstracts, retrieving full reports of potentially relevant trials for assessment. All review authors extracted data and checked for accuracy. No studies were published in duplicate. When data were missing and only the abstract was available, we attempted to contact the trial authors. We resolved any disagreement through discussion. Six studies involving 1001 women were included. Three trials compared one counselling session with no counselling. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame. One trial compared three one-hour counselling sessions with no counselling at four and 12 months. Some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling. Evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. Further trials should be good quality, adequately-powered using standardised interventions and outcome measures at specific time points. The economic implications and women's satisfaction with psychological follow-up should also be explored in any future study.

The effect of steroid-abuse on anatomic reinsertion of ruptured distal biceps brachii tendon

Introduction There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group. Purpose The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol. Methods We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B ( n = 11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52 weeks postoperatively, with a final follow-up at 24 months. Results Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score. Discussion The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

Effects of a Topical Microemulsion in House Dust Mite Allergic Rhinitis

We have previously demonstrated that a topical microemulsion can attenuate symptoms and signs of seasonal allergic rhinitis. This likely reflects that the microemulsion interferes with the interaction between the allergen and the mucosa. Whether or not the finding translates to conditions caused by other inhaled agents such as house dust mite allergen is unknown. Patients with perennial allergic rhinitis caused by house dust mite were subjected to topical microemulsion treatment in a randomized, double-blinded and crossover design with isotonic saline as control. Morning symptoms were monitored, change from baseline was assessed and the treatments were compared. On the first days of the isotonic saline and microemulsion runs, before any treatment was given, total nasal symptoms were scored to 2.8 and 3.1 (range 0-9), respectively. Nasal symptoms were reduced by intervention with the microemulsion: the change from baseline was consistent for the microemulsion and the difference between the microemulsion and isotonic saline reached statistical significance in favour of the former. We conclude that intervention with a microemulsion may reduce symptoms of house dust mite allergic rhinitis at natural allergen exposure. Our findings suggest the possibility that topical microemulsions can be a useful option to reduce nasal mucosal exposure to allergen in perennial allergic rhinitis..