Bruhnholcomb3361

Level of evidence IV.Twelve patients who had undergone costal osteochondral graft reconstruction of the proximal pole of scaphoid were evaluated with clinical examination, patient-reported outcome scores and radiographs with an average follow-up of 10 years (range 3.5-18). The range of wrist motion was not significantly changed compared with the preoperative range of motion and functional outcomes scores were acceptable. The patients reported low pain scores despite the universal presence of radiographic changes of reduced carpal height and arthritis of the midcarpal and radiocarpal joints. Costal osteochondral graft reconstruction of the proximal pole of scaphoid offers good long-term pain relief and function.Level of evidence IV.Background Moderate hypothermic circulatory arrest (MHCA) has been widely used in aortic arch surgery. However, the renal function after MHCA remains controversial. We performed a systematic review and meta-analysis direct comparison of the postoperative renal function of MHCA versus deep hypothermic circulatory arrest (DHCA) in aortic arch surgery. Methods and Results We searched PubMed, Embase, and the Cochrane Library for postoperative renal function after aortic arch surgery with using MHCA and DHCA, published from inception to January 31, 2020. The primary outcome was renal failure. Secondary outcomes were the need for renal therapy and other major postoperative outcomes. The random-effects model was used for all comparisons to pool the estimates. A total of 14 observational studies with 4142 patients were included. Compared with DHCA, MHCA significantly reduced the incidence of renal failure (odds ratio [OR], 0.76; 95% CI, 0.61-0.94; P=0.011; I2=0.0%) and the need of renal replacement (OR, 0.68; 95% CI, 0.48-0.97; P=0.034; I2=0.0%). Subgroup analysis showed that when the hypothermic circulatory arrest time was 30 minutes (OR, 0.76; 95% CI, 0.51-1.13; P=0.169; I2=17.3%). Conclusions MHCA compared with DHCA reduces the incidence of renal failure and the need for renal replacement. Registration URL https//www.crd.york.ac.uk/prospero; Unique identifier CRD42020169348.

Emergency contraception has been available in pharmacies across England since 2001.There is a paucity of evidence describing those women accessing the service, particularly in rural locations, where pharmacies are integral to improving healthcare accessibility.

Routinely collected data from all pharmacy consultations for emergency contraception in Shropshire, England, were obtained and anonymized for the study period April 1, 2016 to January 31, 2019. Consultations were described by time, age of consultee, rationale for consultation, method dispensed (levonorgestrel or ulipristal acetate), referral for copper intrauterine device fitting, chlamydia screening where appropriate and reason for choosing pharmacy setting. Repeat attenders were also described separately.

3499 consultations occurred during the study period; 39% were aged between 16-20 years, and 52% attended following unprotected sexual intercourse. Levonorgestrel was initially most prescribed, however ulipristal acetate overtook it in 2018. Onward referral for copper intrauterine device and age-appropriate chlamydia screening took place in 3% and 4% of the eligible populations respectively. Women overwhelmingly chose the pharmacy setting owing to its convenience. Repeat attenders tended to be younger than single attenders, but otherwise similar.

Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.

Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.

The aims of this study were to develop a clinical-feature based scoring system for muscle injury screening and to assess its diagnostic accuracy when large number of injuries are suspected.

A prospective diagnostic accuracy study was performed according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. The diagnostic accuracy of the Strength and Pain Assessment (SPA) score (index test) was assessed in relation to muscle ultrasonography (reference standard). A large (n=175) number of male soccer players met the inclusion/exclusion criteria clinical assessment (i.e., evaluation of pain onset modality, location, distribution, impact on performance, and manual muscle strength testing) and ultrasonography were performed in all players after 48hours from the sudden or progressive onset of muscle pain during or after a soccer competition.

91 of 175 cases (52%) were classified as functional muscle disorders, while signs of muscle tear were observed in the remaining 84 of 175 (48%) cases that were classified as structural muscle injuries. The median (1st - 3rd quartile) value of the SPA score was significantly (P<0.001) lower in the functional disorder group [9 (9-10)] compared to the structural injury group [12 (12-13)]. The area under the Receiver Operating Characteristic curve for different cutoff points of the SPA score was 0.977 (95% confidence intervals 0.957-0.998) and the optimal cutoff value of the SPA score providing the greatest sensitivity and specificity (respectively, 99% and 89%) was 11.

This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.

This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.Provision of physical health care to people diagnosed with severe mental illness is widely reported as inadequate. This interview study explored perspectives of a group of key informants on current practices of providing physical health care within two mental health care settings in Denmark. Thematic analysis of their accounts provided insights into 1) barriers to the provision of physical health care in mental health settings, and 2) possible solutions to overcome existing barriers. EN450 Negative attitudes and limited specialist health care knowledge among mental health care professionals constituted serious barriers. To effectively address these barriers, mental health services need to be reoriented towards the prioritisation of physical health alongside mental health. This will require equipping mental health professionals with relevant knowledge and skills and organisational resources, to effectively work with people experiencing or at risk of physical comorbidities.