Strength Of Recommendation Taxonomy Research Articles

The Importance of Medication Adherence in the Treatment of Actinic Keratosis: An Expert Consensus Panel

Background: Actinic keratosis (AK) is one of the most common dermatologic diagnoses. While there are several treatment options, many topical therapies have poor adherence due to duration of treatment and local skin reactions (LSRs).
 Objective: To review the available literature on the most commonly used patient-administered field-directed therapies for AK and create consensus statements on the role of medication adherence in improving AK outcomes.
 Methods: A literature search of PubMed was completed for English-language original research articles reporting efficacy, safety, and tolerability data for 5-FU, diclofenac gel, imiquimod cream, and tirbanibulin. Once the articles were selected, they were distributed to a panel consisting of seven dermatologists with extensive expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panelists then met to review and discuss the studies and created consensus statements on the management of AKs and the importance of medication compliance. A modified Delphi process was used to approve the adoption of each statement.
 Results: The literature search produced 1,326 articles that met search criteria. After screening these articles for relevance and applying the inclusion criteria, 17 articles were chosen to be reviewed by the panel and assigned a level of evidence based on SORT criteria. The panel then created six consensus statements that received a unanimous vote for adoption.
 Conclusion: While there are several options for the treatment of AK, there is little consensus on a standard of care. Clearance rates for the most common topical field therapies vary significantly but are also difficult to directly compare due to differences in methodology for measuring and assessing outcomes. Overall, it is clear that an efficacious, tolerable, and convenient treatment for AKs is critical to optimal adherence and management and, given the results of recent studies, tirbanibulin may be the best topical option for meeting these criteria.

Integrating Precision Medicine into Medical Dermatology Clinical Practice: An Expert Consensus Panel.

Precision medicine utilizes an individual’s genomics to improve diagnosis, prognosis, and therapy. The joint American Academy of Dermatology and National Psoriasis Foundation 2019 guidelines recognized the need to identify biomarkers that can predict the optimal biologic agent for an individual patient. This paper examines the current state of precision medicine in dermatology and how its use can improve outcomes in psoriasis. A search of PubMed/MEDLINE using the terms precision medicine, personalized medicine, biomarkers, genomics, and dermatology was performed to identify relevant publications. An expert consensus panel was then convened to assign levels of evidence to each article using strength of recommendation taxonomy and create consensus statements requiring a two-thirds supermajority for agreement utilizing a modified Delphi approach. Thirteen articles met inclusion and exclusion criteria and were assigned levels of evidence. The panel created 10 consensus statements on how precision medicine can improve patient outcomes, all of which received a unanimous (6/6) vote. Choosing a biologic medication for psoriasis often relies on patient preference, provider preference, and a trial-and-error approach. Utilizing precision medicine tests such as Mind.Px can help providers identify biomarkers unique to a patient’s pathophysiology and choose the optimal medication through a targeted and evidence-based approach. Zakria D, Brownstone N, Armstrong AW, et al. Integrating precision medicine into medical dermatology clinical practice: an expert consensus panel. J Drugs Dermatol. 2023;22(6):588-593. doi:10.36849/JDD.7432.

The Relationship Between Stress Fractures and Bone Turnover Markers Is Unclear in Athletic and Military Populations: A Critically Appraised Topic

Clinical Scenario: Having an indication of how bone is remodeling in response to training load could help identify athletes and military personnel at increased stress fracture (SFx) risk. Direct assessment of bone remodeling is impractical. Biochemical markers of bone turnover are used as an indirect measure of bone remodeling and have potential to inform prevention and treatment efforts. To date, the relationship between bone turnover markers and SFxs in athletes or military personnel remains unclear. Clinical Question: Are SFxs related to bone turnover markers in athletes and military personnel? Summary of Key Findings: Seven met eligibility criteria. In five studies, an association between SFxs and bone turnover markers existed. Clinical Bottom Line: The evidence supporting a relationship between SFxs and bone turnover markers in athletes and military personnel is mixed. While five of the seven studies reported some type of relationship, no studies prospectively measured bone turnover markers in a group of athletes or military personnel without an SFx or without SFx history and followed them over time to reassess bone turnover markers upon SFx occurrence. Strength of Clinical Recommendation: In accordance with the Strength of Recommendation Taxonomy, Grade C is the most appropriate strength of recommendation rating.

Incorporating Prognostic Gene Expression Profile Assays into the Management of Cutaneous Melanoma: An Expert Consensus Panel

Background: Cutaneous melanoma (CM) guidelines put forth by the eighth edition of the American Joint Committee on Cancer (AJCC8) and the National Comprehensive Cancer Network (NCCN) do not currently account for lesion genomics when assessing prognosis. Gene Expression Profile (GEP) tests have become a widely adopted tool to help clinicians identify patients at higher risk for metastasis and recurrence.
 Objective: To review the available literature that has been published since a consensus panel in 2018 on three commercially available GEP tests used in the prognostic assessment of CM and create updated guidelines and consensus statements for their optimal use.
 Methods: A comprehensive literature search of PubMed and Google Scholar was conducted for relevant English-language original research articles, meta-analyses, and systematic reviews published from 2019 through 2022. A panel of 6 key opinion leaders in dermatology with specialized expertise in diagnosing and managing CM then convened to review the articles and create guidelines. A modified Delphi process was used to approve each statement. The panel assigned each article a level of evidence and each consensus statement a strength of recommendation using Strength of Recommendation Taxonomy (SORT) criteria.
 Results: The literature search identified 785 articles that met the search criteria. Of these, there were 22 articles that validated the 31-GEP test, 2 that validated the 11-GEP test, and 7 that validated the 8-GEP + CP test. The panel unanimously approved 6 usage guidelines and 5 consensus supporting statements for the appropriate use of these tests.
 Conclusion: Based on the currently available literature, GEP tests provide valuable information beyond AJCC8 and NCCN guidelines for the prognostic assessment of CM. There are significantly more validation studies supporting the use of the 31-GEP test compared to the 11-GEP test and the 8-GEP + CP test.

Kinesiology Therapeutic Taping Does Not Reduce Swelling Caused by an Acute Ankle Sprain: A Critically Appraised Topic

Clinical Scenario: A common rehabilitation goal after an acute lateral ankle sprain is the management of swelling. Traditionally, ice, elevation, and compression are used to manage swelling to create an optimal healing environment. It has been proposed that alternative interventions, such as kinesiology therapeutic (KT) tape, could be used to reduce swelling following acute ankle injury. Clinical Question: Is the application of KT tape an effective modality to address swelling after acute lateral ankle sprains? Summary of Key Findings: A systematic search was completed to identify articles that examined the impact of KT tape on swelling after an acute ankle sprain. A total of 206 articles were retrieved. Three articles were identified that compared KT tape with other interventions in the management of swelling due to acute ankle sprain. All 3 included studies had high critical appraisal scores using the Physiotherapy Evidence Database scale. Clinical Bottom Line: The current evidence suggests that KT tape may have comparable effects on swelling to elastic bandages when both were used in combination with nonsteroidal anti-inflammatory drugs. However, when compared with a sham intervention or when used in combination with acupuncture, the use of KT tape had no effects on swelling. Together, these findings indicate that KT tape has limited to no clinical utility to reduce swelling following an acute lateral ankle sprain. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy, the clinical bottom line is based on grade B evidence.

Which is the superior retrograde filling material? We don't know!

Clinical question Is Biodentine better than MTA as a root-end filling material?Data sources Cochrane, PubMed-Medline and Scopus databases were searched independently by two authors. In addition, a manual search was performed in high-quality endodontic journals.Data extraction and synthesis The name of the authors, the year of publication, sample size, the measurement method used, follow-up time for each of the three and main outcomes (bond strength, marginal gap and sealing ability) were extracted in the form of tables and evidence presented. The level of scientific evidence was assessed using Strength of Recommendation Taxonomy (SORT).Quality of included studies Not performed.Results A total of 13 publications were included and all of them were in vitro studies. With regards to bond strength, two of four studies indicated Biodentine performed better than MTA while the other two showed no significant difference. Microleakage studies and sealing ability indicated no clear superiority of one over the other.Conclusions Lack of scientific evidence regarding the superiority of tricalcium silicate over mineral trioxide aggregate as a root-end filling material in periapical surgery.

The Effectiveness of a Psychoeducational Program in Increasing Mental Health Knowledge in Collegiate Athletes: A Critically Appraised Topic

Focused Clinical Question: Does the implementation of a psychoeducational program increase mental health knowledge among collegiate student-athletes? Clinical Bottom Line: There is consistent, limited-quality patient-oriented evidence to suggest that implementation of a psychoeducational program is effective in increasing mental health knowledge in collegiate student-athletes based on the guidelines of the strength of recommendation taxonomy.

Multidisciplinary Treatment of Non-Spine Bone Metastases: Results of a Modified Delphi Consensus Process

PurposeLocal treatment for bone metastases is becoming increasingly complex. National guidelines traditionally focus only on radiation therapy (RT), leaving a gap in clinical decision support resources available to clinicians. The objective of this study was to reach expert consensus regarding multidisciplinary management of non-spine bone metastases, which would facilitate standardizing treatment within an academic-community partnership. Methods and MaterialsA multidisciplinary panel of physicians treating metastatic disease across the Memorial Sloan Kettering (MSK) Cancer Alliance, including community-based partner sites, was convened. Clinical questions rated of high importance in the management of non-spine bone metastases were identified via survey. A literature review was conducted, and panel physicians drafted initial recommendation statements. Consensus was gathered on recommendation statements through a modified Delphi process from a full panel of 17 physicians from radiation oncology, orthopaedic surgery, medical oncology, interventional radiology, and anesthesia pain. Consensus was defined a priori as 75% of respondents indicating “agree” or “strongly agree” with the consensus statement. Strength of Recommendation Taxonomy was employed to assign evidence strength for each statement. ResultsSeventeen clinical questions were identified, of which 11 (65%) were selected for the consensus process. Consensus was reached for 16 of 17 answer statements (94%), of which 12 were approved after Round 1 and additional 4 approved after Round 2 of the modified Delphi voting process. Topics included indications for referral to surgery or interventional radiology, radiation fractionation and appropriate use of stereotactic approaches, and the handling of systemic therapies during radiation. Evidence strength was most commonly C (n = 7), followed by B (n = 5) and A (n = 3). ConclusionsConsensus among a multidisciplinary panel of community and academic physicians treating non-spine bone metastases was feasible. Recommendations will assist clinicians and potentially provide measures to reduce variation across diverse practice settings. Findings highlight areas for further research such as pathologic fracture risk estimation, pre-operative radiation, and percutaneous ablation.

Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs.

Pruritus is a common clinical sign in many skin disorders and is currently the main complaint in canine dermatology. Pruritic skin diseases can affect the quality of life of dogs and their owners. Several families of antipruritic drugs are available to help control pruritus in dogs. The aim of this review is to help practitioners select the most appropriate symptomatic treatment in the most frequent situations of dermatological pruritus in dogs. The molecules reviewed here are systemic and topical glucocorticoids, antihistamines, ciclosporin, oclacitinib and lokivetmab. A level of evidence (1, 2 or 3) has been established according to a detailed algorithm for each individual study in the literature published between 1990 and March 2021. The guidelines result from evidence grading using the strength of recommendation taxonomy (SoRT) and clinical recommendations using a thorough methodology.

Effect of the Use of High-Fidelity Manikin Simulation for Learning Emergency Cardiovascular Care Skills: A Critically Appraised Topic

Clinical Scenario: Athletic trainers must be confident when performing life-saving skills, such as a cardiovascular assessment and cardiopulmonary resuscitation. Learning and performing skills on high-fidelity simulation manikins may improve athletic training students’ self-confidence and self-efficacy. Clinical Question: What are the effects of high-fidelity manikin simulation on athletic training students’ self-confidence and self-efficacy in performing emergency cardiovascular care? Summary of Key Findings: Three good-quality cohort studies were included. Two studies assessed the effect of high-fidelity cardiopulmonary resuscitation simulation, and one study assessed the effect of high-fidelity cardiovascular assessment. Two studies evaluated self-confidence, while the other study evaluated self-efficacy. All three studies found that high-fidelity simulation improved athletic training students’ self-confidence and self-efficacy. Clinical Bottom Line: There is currently consistent, good-quality evidence that supports the use of high-fidelity manikin simulation to improve athletic training students’ self-confidence and self-efficacy in performing cardiovascular skills and assessment. Future research should examine the effects of high-fidelity manikin simulation on the same academic levels of athletic training students to ensure generalizability of results. Strength of Recommendation: The grade of B is recommended by the Strength of Recommendation Taxonomy for consistent, good-quality evidence.

Dental Implants Survival After Nasal Floor Elevation: A Systematic Review.

The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. A systematic review was conducted using 4 electronic databases: MEDLINE (PubMed), Cochrane Library, Directory of Open Access Journals, and Scopus, following the PRISMA (Preferred Reporting Items for Systematic Reviews) statement recommendations to answer the PICO (Population, Intervention, Comparison, Outcome) question: "In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)? The study was pre-registered in PROSPERO (CRD42021229479). Included article quality was assessed using the "NIH quality assessment tool", "The Newcastle-Ottawa scale," and "JBI critical appraisal tools for case reports." Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range: 89.2%-100%). No statistical differences could be inferred between the treatments performed in 1- or 2-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system and based on the study quality level, the strength of evidence attending the SORT (Strength Of Recommendation Taxonomy) was B.

ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline.

Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians' current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Clinical review. Level 5. Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey-Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. B.

The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis

Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger’s significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0–15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0–43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9–6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8–18.3, p < 0.001, I2 = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5–13.5, p < 0.001, I2 = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.

Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation.

Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury. Nonsystematic review with critical appraisal of existing literature. Clinical review. Level 4. A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load. Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-naive athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads. B.

A Comparison of Treatment Options for Carpal Boss: A Critically Appraised Topic

Context: Carpal bossing is a bony growth or mass that typically occurs at the 2nd or 3rd carpometacarpal joint. Carpal bossing is often overlooked placing the patient at an increased risk for pain or injury, such as osteoarthritis or inflammatory joint disease if left untreated. Individuals such as combat sport athletes who experience repetitive trauma to this area are at a high risk to develop carpal bossing. The literature suggests conservative or surgical interventions to manage symptoms. The goal of this systematic review is to synthesize the current literature for clinical knowledge and intervention outcomes for carpal bossing. Methods: A systematic search of the literature was performed across 3 electronic databases (Science Direct, PubMed, and EBSCOhost) to identify articles that investigated the effects of surgical intervention or conservative management for carpal bossing. A combination of the keywords and Boolean operators (Carpal Bossing, Carpal Boss, Surgical Intervention, Wedge Resection, Excision, Conservative Treatment, and Intervention) related to the research question were used. The search was restricted to full text, human studies (including cadaveric studies) research, and manuscripts available in English. Articles were included if they examined the effect of either conservative or surgical interventions for the treatment of carpal bossing. Articles were excluded from the review if the study did not examine carpal bossing treatment options or did not include pain, range of motion, strength, or functional measures of the hand and wrist. Two independent reviewers used the Joanna Briggs Institute Checklist for Case Reports and the Checklist for Case Studies to appraise the quality of the articles. A score of 50% was used to remove low-quality studies. The Strength of Recommendation Taxonomy (SORT) method was used to grade the evidence for the articles included. Results: After the initial search, 10 articles met the inclusion criteria, while 3 were eliminated due to low quality appraisal scores. The average scores for case reports and case studies were 5.5/7 or 7.5/9 respectively. There was a total of 58 participants across the 7 studies. Generally speaking, conservative treatment reduced average daily pain and patients were able to return to full participation within 2 weeks. Conversely, patients undergoing surgical intervention experienced episodic pain, including over the surgical incision, typically averaging 2/10 on the visual analog scale. Findings from the surgical intervention showed inconsistent measurements for wrist/hand strength and range of motion. There is level C evidence on the treatment for carpal bossing. Conclusion: The limited evidence suggests conservative management may reduce pain and improve clinical outcomes. However, clinicians should consider the level C evidence with skepticism as the quality of evidence on this topic is low. Further investigations should be performed with more rigor.

Longevity of Polymer-Infiltrated Ceramic Network and Zirconia-Reinforced Lithium Silicate Restorations: A Systematic Review and Meta-Analysis

The purpose of this study was to systematically review the existing literature to assess the clinical survival and success of PICN and ZLS indirect restorations as the clinical evidence for them remains lacking. PubMed, SCOPUS, Embase, Cochrane Library, Web of Science, LILACs, and SciElo databases were searched from 1 January 2000 to 1 February 2021. Clinical trials and cohort studies published in English were included while case studies, case series, and in vitro studies were excluded. Results were analyzed qualitatively and a meta-analysis using a random effects model was performed. A strength of recommendation taxonomy (SORT) analysis was conducted and risk of bias (RoB) was assessed using the Newcastle–Ottawa scale and Cochrane RoB tools. An electronic search through the databases yielded 2454 articles, of which 825 remained after duplicate removal. Five studies investigating PICN and four investigating ZLS indirect restorations remained after assessing for eligibility. The overall survival rate of PICN over 1 year was 99.6% and 99.2% over 2 years. The overall survival rate of ZLS over 1 year was 99%. The main mode of failure for both materials was catastrophic fracture. One study had a high RoB, four had a moderate RoB, and four had a low RoB. Both materials demonstrated moderate strength of recommendation at a level 2 evidence for all studies based on SORT analysis. PICN and ZLS show promising short-term clinical performance as full and partial coverage indirect restorations, but longer follow-up studies are required to confirm their long-term performance.

The Comparison Between Instrumented and Observer-Rated Measures of the Modified Balance Error Scoring System: A Critically Appraised Topic

Clinical Scenario: Postural control deficits are one of the most common impairments associated with sport-related concussion. The Modified Balance Error Scoring System (mBESS) is one of the current standard clinical measures for assessing these deficits; however, it is dependent upon observer-rated measurements. Advancements in inertial measurement units (IMUs) lend themselves to be a viable option in objectifying postural control assessments, such as the mBESS. Clinical Question: Are IMU-based measures of the mBESS more effective than observer-rated measures of the mBESS in identifying patients with sport-related concussion? Summary of Key Findings: Following a systematic search, three studies were included. One study compared observer-rated measures of the Balance Error Scoring System and mBESS to instrumented measures of both tests and determined that the instrumented mBESS had the highest diagnostic accuracy. The results of the second study determined that IMU-based measures were successful in both classifying group and identifying task errors. The final study found that using IMUs increased sensitivity of the mBESS, specifically the double-limb stance, to group classification. Clinical Bottom Line: Instrumentation of the mBESS using IMUs provides more objective and sensitive measures of postural control in patients with SRC. Strength of Recommendation: Due to the consistent, good-quality evidence used to answer this critically appraised topic, the grade of A is recommended by the Strength of Recommendation Taxonomy.

Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair.

Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods. A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used. Clinical review. Level 5. No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear. More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients. C.

Communicable Illness Mitigation Strategies for Traveling Elite Sporting Organizations.

Transmission of communicable diseases observed in sporting organizations is often preventable. Early detection, isolation, and treatment can significantly diminish time lost. Until recently, there has been a paucity of standardized guidelines outlining feasible, preventable measures to protect both athletes and staff from contagious illnesses. Therefore, the purpose of this narrative was to highlight optimal prevention practices for transmission mitigation, with a particular focus on hygiene activity and travel considerations in professional sporting organizations. Current recommendations from the Centers for Disease Control and Prevention and peer-reviewed journals. Clinical review. Level 5. Communicable illness prevention strategies begin at the level of sufficient personal hygiene practices. Common area surface cleaning recommendations, including shared equipment sanitization between usage as well as designated equipment use to specific athletes, should be considered to minimize cross-contamination, in particular, for liked-position players. Intelligent design for shared areas can include redistributing the layout of communal spaces, most feasibly, spreading locker designation a minimum distance of 6 ft from one another. Travel considerations can include placing most susceptible passengers closest to window seating, boarding last and exiting first. Team physicians should have knowledge of essential personnel medical histories in an effort to risk stratify staff members and players in the setting of communicable disease. Providing a framework for illness management and prevention is important when considering the effects on player health, missed time, performance, and overall cost. Containment of commonly observed communicable illnesses can be optimized with sufficient personal hygiene practices, common area surface cleaning recommendations, intelligent design for shared areas, travel and hotel considerations, as well as appropriate screening tools and isolation techniques. B.

THE EFFICACY OF LASER THERAPY AND IBUPROFEN ON PAIN AFTER ELASTOMERIC SEPARATOR PLACEMENT: RAPID REVIEW

Background: Separator placement is the first step in orthodontic treatment, which aims to create space between teeth before molar band placement. This procedure can cause pain for the patient. Pain management after separator placement can be done through pharmacological and non-pharmacological approaches.Method: The aim of this rapid review was to determine the efficacy of laser therapy and ibuprofen for pain management after elastomeric separator placement in orthodontic treatment.Result: Ten articles were included in this review, four articles gave laser therapy interventions and six articles gave ibuprofen therapy interventions. The result of the quality assessment using Strength of Recommendation Taxonomy (SORT) was laser therapy intervention has one good quality articles and three limited-quality articles, while ibuprofen therapy has two good quality articles and four limited-quality articles.Conclusion: The efficacy of laser therapy and the efficacy of ibuprofen on pain after separator placement is good, with the strength of the clinical recommendation of ibuprofen is better than laser therapy.