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  • #91
    Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients

    http://neurosciencenews.com/tbi-cooling-neurology-5768/

    Objective: Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adults and children by analyzing mortality rates, neurologic outcomes, and adverse effects.

    Data Sources: Electronic databases PubMed, Google Scholar, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and manual searches of studies were conducted for relevant publications up until February 2016.

    Study Selection: Forty-one studies in adults (n = 3,109; age range, 18-81 yr) and eight studies in children (n = 454; age range, 3 mo to 18 yr) met eligibility criteria.

    Data Extraction: Baseline patient characteristics, enrollment time, methodology of cooling, target temperature, duration of hypothermia, and rewarming protocols were extracted.

    Data Synthesis: Risk ratios with 95% CIs were calculated. Compared with adults who were kept normothermic, those who underwent therapeutic hypothermia were associated with 18% reduction in mortality (risk ratio, 0.82; 95% CI, 0.70-0.96; p = 0.01) and a 35% improvement in neurologic outcome (risk ratio, 1.35; 95% CI, 1.18-1.54; p < 0.00001). The optimal management strategy for adult patients included cooling patients to a minimum of 33[degrees]C for 72 hours, followed by spontaneous, natural rewarming. In contrast, adverse outcomes were observed in children who underwent hypothermic treatment with a 66% increase in mortality (risk ratio, 1.66; 95% CI, 1.06-2.59; p = 0.03) and a marginal deterioration of neurologic outcome (risk ratio, 0.90; 95% CI, 0.80-1.01; p = 0.06).

    Conclusions: Therapeutic hypothermia is likely a beneficial treatment following traumatic brain injuries in adults but cannot be recommended in children.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #92
      Karolinska requests retraction of 2014 Macchiarini paper

      http://retractionwatch.com/2016/12/2...hiarini-paper/

      KI finds that Paolo Macchiarini and three of the co-authors had insight into and an overview of the process, either in its entirety or in large part, and are thus to be found guilty of scientific misconduct. The remaining authors contributed in ways that are not judged to constitute misconduct, nor were they in a position to have had insight into or an overview of the whole project.

      Regarding penal measures, two senior authors are no longer employed at Karolinska Institutet, so no action in terms of labour law will be taken.

      Given that the two junior researchers were in a position of dependency towards their more senior colleagues in the research group and that the process has been very protracted, their circumstances must be considered mitigating. They have therefore been issued with a caution.

      The four authors are Paolo Macchiarini, Philipp Jungebluth, Sebastian Sjöqvist and Mei Ling Lim. Macchiarini and Jungebluth are no longer at KI (Macchiarini was dismissed in March), and Sjöqvist and Lim have received admonitions.

      Macchiarini told us:

      KI’s announcement will hardly come as a surprise to anyone, and I have nothing more to add that wasn’t in the documents I submitted to the Swedish Justice Office earlier this year regarding both [Central Ethical Review Board] and KI’s behaviour in this matter.

      According to the 15-page report, regarding Sjöqvist and Lim:

      The responsible department head at Karolinska Institutet shall in the next two years or, if their employment is shorter, during their time of employment actively follow up and support the research they conduct at Karolinska Institutet to ensure that the research is conducted in accordance with good research practice.

      The paper — which already has an expression of concern, issued in October, 2016 — described transplanting an esophagus into rats that was seeded with their own stem cells. According to the findings, all animals survived the study period (14 days), and those that received the transplant gained more weight than rats who were given a placebo operation. It has been cited nine times, according to Clarivate Analytics’ Web of Science, formerly part of Thomson Reuters.

      Sebastian Sjöqvist and Philipp Jungebluth did not agree with the EOC, according to the notice.

      In 2015, Macchiarini was initially cleared of misconduct in the 2014 paper — and many other allegations — by then-chancellor Anders Hamsten (who has since resigned). However, after Swedish Television aired a series of documentaries raising new allegations about his work, such as operating on patients whose lives were not in danger, KI ordered a new investigation.

      According to KI, the investigators are taking a second look at several of Macchiarini’s articles; this is the first decision to come out of that re-examination.

      It follows a decision by Sweden’s Central Ethical Review Board earlier this year, which concluded he had committed misconduct by releasing misleading results. According to the board’s full decision (published by Science):

      In the investigation it transpired that the aspects that were reported as being successful were not successful. The rats which were part of the experiment, for example, contrary to what the article maintains, showed very significant weight loss, which would not have been the case if the experiment had been a success. In addition, the rats lost so much weight and deteriorated so much in condition that the experiment should have been stopped. The article also contains a number of references which have resulted in incorrect interpretations, thereby misleading the ethical committee on animal research. The pictures and figures that reportedly demonstrate the success of the experiment are also incorrect and misleading in several places. The raw data that the Expert Group has had access to is not always consistent with the figures in the article, which leads to incorrect conclusions…It is therefore, in the Expert Group’s view, conclusively established that the presentation of the results in the article is inconsistent with the outcome of the research that was conducted, which is scientific misconduct.


      “It’s been three tough years:” Macchiarini whistleblower cleared of previous charges
      http://retractionwatch.com/2017/03/2...vious-charges/

      Karl-Henrik Grinnemo was worried. The doctor and clinical researcher at the Karolinska Institute was working with a high-profile surgeon who was performing a potentially life-saving procedure on patients, but Grinnemo saw that the patients weren’t doing very well. So in 2013, Grinnemo and three other doctors raised concerns about the work of Paolo Macchiarini. The surgeon initially fought back, and accused Grinnemo of misconduct. KI sided with the star surgeon, and found Grinnemo guilty of “carelessness” in a grant application to the Swedish Research Council, including plagiarism. Readers should by now know how the story ends – Macchiarini’s work has since been largely discredited. Recently, to clear his name, Grinnemo asked authorities to take a second look at his case – and he has been exonerated. We talked to him about the last few tumultuous years.
      Update 05/04/2017



      Superstar surgeon fired, again, this time in Russia

      http://www.sciencemag.org/news/2017/...et_cid=1331920

      After Paolo Macchiarini’s star fell in Sweden, the Italian surgeon still had a place to shine: Russia. The Karolinska Institute (KI) in Stockholm fired him in March 2016 for multiple ethical violations, including "breach of KI’s fundamental values" and "scientific negligence." But Russia had long showered Macchiarini with funding and opportunities to perform his experimental surgeries to implant artificial tracheas, and it allowed him to stay. Now, a year later, his Russian refuge has ended as well.

      On 30 March, it became clear that the Russian Science Foundation (RSF) would not renew its funding for Macchiarini’s work, which now focuses on the esophagus rather than the trachea. The decision came 9 days after Nature Communications retracted a paper by Macchiarini that documented successful esophagus transplantations in rats. Minutes of a meeting made public last week show that Kazan Federal University (KFU), Macchiarini’s current employer, decided to end his research project there on 20 April, effectively firing him.

      “They have probably realized that it’s all based on nothing but hot air,” says Pierre Delaere of the University of Leuven in Belgium, one of the first to criticize Macchiarini’s work. Yet despite a passionate plea by four Swedish doctors who blew the whistle on Macchiarini’s work at Karolinska in 2014, Russian authorities appear to have no plans to launch a misconduct investigation of his work in Russia.

      Macchiarini has not said publicly what he plans to do next, and did not respond to an interview request from Science.

      Once considered a pioneer of regenerative surgery, Macchiarini aimed to give patients whose tracheas had been damaged a new windpipe. “Seeded” with stem cells, it was supposed to grow into a new, fully functional organ. (He initially used donor tracheas as a basis, but later switched to an artificial scaffold.) But he has been accused of painting a false picture of his patients in scientific papers, several of which have been retracted; operating without ethical approval; and lying on his CV. At least six of the eight artificial trachea recipients have died. In Sweden, where the case has plunged science into a crisis, investigations continue into allegations including involuntary manslaughter.
      Experimental surgery on those whose life was not in danger was not uncommon in the 1970s, it was also not uncommon for student physiotherapists to be an essential part of the workforce and to be seeing complex surgical patients with a senior physiotherapist available for backup via bleep. Times have changed in the UK and informed consent is more rigorously enforced.

      Update 18/05/2017




      Swedish prosecutor won’t pursue criminal case against Macchiarini


      http://retractionwatch.com/2017/10/1...e-macchiarini/

      Paolo Macchiarini made a name for himself by transplanting synthetic tracheas. After multiple patients died, however, allegations against the researcher have continued to swirl. He was dismissed from the Karolinska Institutet last year, after it reopened its misconduct investigation. The Swedish prosecutor was investigating Macchiarini’s role in the deaths of three out of four patients he operated on five times between 2011-2013.

      Although the prosecution concluded that most of the operations proceeded “negligently,” it could not conclude Macchiarini was criminally responsible.

      According to the public prosecutor Jennie Nordin:


      We have reached the conclusion that four of the five operations were negligently carried out, as the surgeon performed the operations using synthetic tracheas, which is in conflict with science and tried-and-tested practice. However, we have been unable to prove that any crimes have been committed. We cannot prove that the effects of his actions, with sufficient degree of probability, would not have occurred had another method been used. Regarding the fourth individual, we are not of the opinion that the surgeon’s actions were negligent. Expert medical opinion is not unanimous regarding what should have been done instead for these seriously ill individuals, which therefore has made the suspicions difficult to prove…

      Update 12/10/2017



      Swedish review board finds misconduct by Macchiarini, calls for six retractions

      Update 04/11/2017
      Last edited by Jo Bowyer; 04-11-2017, 03:22 PM.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


    • #93
      ‘Falsification’ ruled 20th-century science. Does it need revision in the 21st?

      https://aeon.co/videos/falsification...ad43d-69418129

      The 20th-century Austrian-British philosopher Karl Popper believed that any theory that was not ‘falsifiable’ – capable of being tested and proven incorrect – should be dismissed as unscientific. He was particularly critical of Marxist theory, which he believed was constantly being revised by its adherents to account for its failed predictions, and therefore could not possibly be scientific. The falsification principle is a cornerstone of the modern scientific method, but some contemporary scientists, cosmologists and philosophers believe it might need to be revised as they investigate concepts such as string theory and the multiverse, which come up against the limits of what is testable – at least for now.
      I am encouraged by this, innovations in scanning and testing open new vistas and it is my belief that multiverses will be discovered within physical forms. It was once thought that Pure Mathematics had no useful application, we now find that it does with regards to Code Breaking and Computing amongst others.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #94
        Why Most Clinical Research Is Not Useful

        http://journals.plos.org/plosmedicin...l.pmed.1002049

        Summary Points

        Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.

        Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.

        Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.

        The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.

        Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #95
          Replication Requires Psychological Rather than Statistical Hypotheses: The Case of Eye Movements Enhancing Word Recollection

          http://journal.frontiersin.org/artic...016.02023/full

          Can an experiment be replicated in a mechanical fashion without considering the processes underlying the initial results? Here I will consider a non-replication of Saccade Induced Retrieval Enhancement (SIRE) and argue that it results from focusing on statistical instead of on substantive process hypotheses. Particularly the theoretical integration of SIRE with Eye-Movement Desensitization and Reprocessing (EMDR) therapy, provides clues about when the memory enhancement should occur. A relatively large memory enhancement effect in participants with a consistent (i.e., extreme right or left) handedness should be observed, (a) when explicitly instructed to retrieve and imagine the memories during the eye manipulation, and (b) for emotionally negative material. A finer theoretical analysis may thus well explain the contrast between the original SIRE studies and the non-replication. Also the findings from preregistered confirmatory research (i.e., focusing solely on statistical hypotheses) should be considered preliminary, representing shifts on a gradual scale of evidence, and awaiting interpretation in terms of theoretical hypotheses. Stronger, but still not definitive, conclusions can better be postponed until after multi-study meta-analyses with theoretically motivated moderator variables have been performed.

          “There are many hypotheses in science which are wrong. That’s perfectly all right; they’re the aperture to finding out what’s right. Science is a self-correcting process. To be accepted, new ideas must survive the most rigorous standards of evidence and scrutiny.”

          Carl Sagan (1990, Cosmos: A Personal Voyage, Heaven, and Hell [Episode 4] 33 min 20 s)
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #96
            Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial

            http://bmcmusculoskeletdisord.biomed...891-016-1369-0

            Abstract

            Background
            There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery.

            Methods
            The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied.

            Results
            HOOS/KOOS quality of life [8.25 (95% CI, 0.42 to 16.10)] and QALYs [0.04 (95% CI, 0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of €326 per patient, there was no difference in total cost between groups [€132 (95% CI −3942 to 3679)]. At a threshold of €40,000, preoperative exercise was found to be cost effective at 84% probability.

            Conclusion
            Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group, but only statistically significant for quality of life measures.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #97
              Effects of an Integrated ‘Fast Track’ Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands

              http://journals.plos.org/plosone/art...l.pone.0170047

              Abstract

              Objectives

              The effects on health related outcomes of a newly-developed rehabilitation program, called ‘supported Fast Track multi-trauma rehabilitation service’ (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual).

              Methods

              Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. The Fast Track program involved: integrated coordination between trauma surgeon and rehabilitation physician, shorter stay in hospital with faster transfer to a specialized trauma rehabilitation unit, earlier start of multidisciplinary treatment and ‘non-weight bearing’ mobilization. Primary outcomes were functional status (FIM) and quality of life (SF-36) measured through questionnaires at baseline, 3, 6, 9 and 12 months post-trauma. Outcomes were analyzed using a linear mixed-effects regression model.

              Results

              The FIM scores significantly increased between 0 and 3 months (p<0.001) for both groups showing that they had improved overall, and continued to improve between 3 and 6 months for Fast Track (p = 0.04) and between 3 and 9 months for Care as Usual (p = 0.03). SF-36 scores significantly improved in both groups between 3 and 6 months (Fast Track, p<0.001; Care as Usual, p = 0.01). At 12 months, SF-36 scores were still below (self-reported) baseline measurements of patient health prior to the accident. However, the FIM and SF-36 scores differed little between the groups at any of the measured time points.

              Conclusion

              Both Fast Track and Care as Usual rehabilitation programs were effective in that multi-trauma patients improved their functional status and quality of life. A faster (maximum) recovery in functional status was observed for Fast Track at 6 months compared to 9 months for Care as Usual. At twelve months follow-up no differential effects between treatment conditions were found.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #98
                Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults

                http://journals.plos.org/plosone/art...l.pone.0170002

                Abstract

                Cartilage is responsive to the loading imposed during cyclic routine activities. However, the local relation between cartilage in terms of thickness distribution and biochemical composition and the local contact pressure during walking has not been established. The objective of this study was to evaluate the relation between cartilage thickness, proteoglycan and collagen concentration in the knee joint and knee loading in terms of contact forces and pressure during walking. 3D gait analysis and MRI (3D-FSE, T1ρ relaxation time and T2 relaxation time sequence) of fifteen healthy subjects were acquired. Experimental gait data was processed using musculoskeletal modeling to calculate the contact forces, impulses and pressure distribution in the tibiofemoral joint. Correlates to local cartilage thickness and mean T1ρ and T2 relaxation times of the weight-bearing area of the femoral condyles were examined. Local thickness was significantly correlated with local pressure: medial thickness was correlated with medial condyle contact pressure and contact force, and lateral condyle thickness was correlated with lateral condyle contact pressure and contact force during stance. Furthermore, average T1ρ and T2 relaxation time correlated significantly with the peak contact forces and impulses. Increased T1ρ relaxation time correlated with increased shear loading, decreased T1ρ and T2 relaxation time correlated with increased compressive forces and pressures. Thicker cartilage was correlated with higher condylar loading during walking, suggesting that cartilage thickness is increased in those areas experiencing higher loading during a cyclic activity such as gait. Furthermore, the proteoglycan and collagen concentration and orientation derived from T1ρ and T2 relaxation measures were related to loading.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #99
                  Understanding Minds in Real-World Environments: Toward a Mobile Cognition Approach

                  http://journal.frontiersin.org/artic...016.00694/full

                  There is a growing body of evidence that important aspects of human cognition have been marginalized, or overlooked, by traditional cognitive science. In particular, the use of laboratory-based experiments in which stimuli are artificial, and response options are fixed, inevitably results in findings that are less ecologically valid in relation to real-world behavior. In the present review we highlight the opportunities provided by a range of new mobile technologies that allow traditionally lab-bound measurements to now be collected during natural interactions with the world. We begin by outlining the theoretical support that mobile approaches receive from the development of embodied accounts of cognition, and we review the widening evidence that illustrates the importance of examining cognitive processes in their context. As we acknowledge, in practice, the development of mobile approaches brings with it fresh challenges, and will undoubtedly require innovation in paradigm design and analysis. If successful, however, the mobile cognition approach will offer novel insights in a range of areas, including understanding the cognitive processes underlying navigation through space and the role of attention during natural behavior. We argue that the development of real-world mobile cognition offers both increased ecological validity, and the opportunity to examine the interactions between perception, cognition and action—rather than examining each in isolation.
                  The human mind is a dynamic predictor that perceives, understands and acts within complex and ever-changing environments. To produce flexible and adaptive reactions that are relevant and appropriate to the individual's goals, the brain must integrate concurrent multi-modal sensory and motor signals, using continuous real-time feedback to guide the execution of on-going behavior. Despite this dynamic reality, however, the traditional approach to understanding human cognition has been the collection of empirical findings from experiments taking place in relatively static, often simulated, laboratory settings. Typically, participants sit or lie down, are given explicit and highly constrained instructions, and are required to attend to artificial stimuli whilst performing deliberately stereotyped responses.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • A Principle for Describing and Verifying Brain Mechanisms Using Ongoing Activity

                    http://journal.frontiersin.org/artic...017.00001/full

                    Not even the most informed scientist can setup a theory that takes all brain signals into account. A neuron not only receives neuronal short range and long range input from all over the brain but a neuron also receives input from the extracellular space, astrocytes and vasculature. Given this complexity, how does one describe and verify a typical brain mechanism in vivo? Common to most described mechanisms is that one focuses on how one specific input signal gives rise to the activity in a population of neurons. This can be an input from a brain area, a population of neurons or a specific cell type. All remaining inputs originating from all over the brain are lumped together into one background input. The division into two inputs is attractive since it can be used to quantify the relative importance of either input. Here we have chosen to extract the specific and the background input by means of recording and inhibiting the specific input. We summarize what it takes to estimate the two inputs on a single trial level. The inhibition should not only be strong but also fast and the specific input measurement has to be tailor-made to the inhibition. In essence, we suggest ways to control electrophysiological experiments in vivo. By applying those controls it may become possible to describe and verify many brain mechanisms, and it may also allow the study of the integration of spontaneous and ongoing activity, which in turn governs cognition and behavior.

                    Introduction
                    A neural cell in the brain is submerged into a heterogeneous input field. Neural cells are squeezed between other cells which are pushing, electrifying, feeding, starving, sedating and tickling them. This hetereogenous input works at different timescales and is governed by a range of cells such as astrocytes, neurons and the chemical surrounding of a neuron. The response of any of those cells will be distributed across the whole brain to maintain the complex input field. The result is an extraordinary ongoing dynamics which has the potential to be far from linear. So how do we study the brain? If we put in an electrode we can record the output but we cannot isolate which input was responsible for the output. Although perturbations allow us to “play in” and therefore to isolate the effect of a certain signal, the ever remaining question will be if the perturbation was biologically plausible and/or if it disrupted the balance of the circuit (Buzsáki and Schomburg, 2015). Therefore we need ways to separate input signals in terms of the natural ongoing activity in the brain. We stress that for verifying the importance of a specific input signal to a neuronal population it is not enough to show that it can explain the resulting population activity. It is equally important to show that this activity cannot be explained by the activity caused by the remaining input signals. This remaining input will from now on be referred to the background input. Thus, we suggest to separate the natural ongoing input to each neuron into a background input and a specific input (Figure 1A). Those two inputs will generate the total activity in the target neuron or population. In the next section we summarize the experimental constraints for dividing the total input into those two signals.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis

                      http://journals.sagepub.com/doi/full...69215515622670

                      Abstract
                      Objective:
                      To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life.

                      Methods:
                      Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest.

                      Results:
                      Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life.

                      Conclusion:
                      An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate.
                      Keywords Hip pain, Physiotherapy, meta-analysis, Exercise, manipulation
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • You might be in a medical experiment and not even know it

                        https://aeon.co/ideas/you-might-be-i...36c94-69418129

                        In the long view, modern history is the story of increasing rights of control over your body – for instance, in matters of reproduction, sex, where you live and whom you marry. Medical experimentation is supposed to be following the same historical trend – increasing rights of autonomy for those whose bodies are used for research.

                        Indeed, the Nuremberg Code, the founding document of modern medical research ethics developed after the Second World War in response to Nazi medical experiments, stated unequivocally that the voluntary, informed consent of the human subject is essential. Every research ethics code since then has incorporated this most fundamental principle. Exceptions to this rule are supposed to be truly exceptional.

                        Yet today, more and more medical experimenters in the United States appear to circumvent getting the voluntary, informed consent of those whose bodies are being used for research. What’s more, rather than fighting this retrograde trend, some of the most powerful actors in medical research are defending it as necessary to medical progress.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • Individual courses of low back pain in adult Danes: a cohort study with 4-year and 8-year follow-up

                          http://bmcmusculoskeletdisord.biomed...891-016-1377-0

                          Abstract

                          Background
                          Few longitudinal studies have described the variation in LBP and its impact over time at an individual level. The aims of this study were to: 1) determine the prevalence of LBP in three surveys over a 9-year period in the Danish general population, using five different definitions of LBP, 2) study their individual long-term courses, and 3) determine the odds of reporting subsequent LBP when having reported previous LBP.

                          Methods
                          A cohort of 625 men and women aged 40 was sampled from the general population. Questions about LBP were asked at ages 41, 45 and 49, enabling individual courses to be tracked across five different definitions of LBP. Results were reported as percentages and the prognostic influence on future LBP was reported as odds ratios (OR).

                          Results
                          Questionnaires were completed by 412 (66%), 348 (56%) and 293 (47%) persons respectively at each survey. Of these, 293 (47%) completed all three surveys. The prevalence of LBP did not change significantly over time for any LBP past year: 69, 68, 70%; any LBP past month: 42, 48, 41%; >30 days LBP past year: 25, 27, 24%; seeking care for LBP past year: 28, 30, 36%; and non-trivial LBP, i.e. LBP >30 days past year including consequences: 18, 20, 20%. For LBP past year, 2/3 remained in this category, whereas four out of ten remained over the three time-points for the other definitions of LBP. Reporting LBP defined in any of these ways significantly increased the odds for the same type of LBP 4 years later. For those with the same definition of LBP at both 41 and 45 years, the risk of also reporting the same at 49 years was even higher, regardless of definition, and most strongly for seeking care and non-trivial LBP (OR 17.6 and 18.4) but less than 11% were in these groups.

                          Conclusion
                          The prevalence rates of LBP, when defined in a number of ways, were constant over time at a group level, but did not necessarily involve the same individuals. Reporting more severe LBP indicated a higher risk of also reporting future LBP but less than 11% were in these categories at each survey.
                          Keywords

                          Low back pain Epidemiology Trajectories Risk Course
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • CORP: Minimizing the chances of false positives and false negatives

                            http://jap.physiology.org/content/122/1/91?etoc=

                            Abstract

                            Statistics is essential to the process of scientific discovery. An inescapable tenet of statistics, however, is the notion of uncertainty which has reared its head within the arena of reproducibility of research. The Journal of Applied Physiology’s recent initiative, “Cores of Reproducibility in Physiology,” is designed to improve the reproducibility of research: each article is designed to elucidate the principles and nuances of using some piece of scientific equipment or some experimental technique so that other researchers can obtain reproducible results. But other researchers can use some piece of equipment or some technique with expert skill and still fail to replicate an experimental result if they neglect to consider the fundamental concepts of statistics of hypothesis testing and estimation and their inescapable connection to the reproducibility of research. If we want to improve the reproducibility of our research, then we want to minimize the chance that we get a false positive and—at the same time—we want to minimize the chance that we get a false negative. In this review I outline strategies to accomplish each of these things. These strategies are related intimately to fundamental concepts of statistics and the inherent uncertainty embedded in them.
                            via @SimonGandevia
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects

                              http://journals.plos.org/plosone/art...l.pone.0171296

                              Abstract

                              Background

                              Psychological discomfort, physical disability and functional limitations of the orofacial system have a major impact on everyday life of patients with temporomandibular disorders (TMDs). In this study we sought to determine short and long term effects of stabilization splint (SS) in treatment of TMDs, and to identify factors influencing its efficacy.

                              Methods

                              MEDLINE, Web of Science and EMBASE were searched for randomized controlled trials (RCTs) comparing SS to: non-occluding splint, occlusal oral appliances, physiotherapy, behavioral therapy, counseling and no treatment. Random effects method was used to summarize outcomes. The effect estimates were expressed as odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval. Subgroup analyses were carried out according to the use of Research Diagnostic Criteria (RDC/TMD) and TMDs origin. Strength of evidence was assessed by GRADE. Meta-regression was applied.

                              Results

                              Thirty three eligible RCTs were included in meta-analysis. In short term, SS presented positive overall effect on pain reduction (OR 2.08; p = 0.01) and pain intensity (SMD -0.33; p = 0.02). Subgroup analyses confirmed SS effect in studies used RDC/TMD and revealed its effect in patients with TMDs of muscular origin. Important decrease of muscle tenderness (OR 1.97; p = 0.03) and improvement of mouth opening (SMD -0.30; p = 0.04) were found. SS in comparison to oral appliances showed no difference (OR 0.74; p = 0.24). Meta-regression identified continuous use of SS during the day as a factor influencing efficacy (p = 0.01). Long term results showed no difference in observed outcomes between groups. Low quality of evidence was found for primary outcomes.

                              Conclusion

                              SS presented short term benefit for patients with TMDs. In long term follow up, the effect is equalized with other therapeutic modalities. Further studies based on appropriate use of standardized criteria for patient recruitment and outcomes under assessment are needed to better define SS effect persistence in long term.
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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