Self-management education program (SMEP) is essential in the knee osteoarthritis (OA) management. While the benefits of tailored SMEP have been highlighted in the literature, evidence on the effects of tailored knee OA SMEP for multiethnic populations, such as in Malaysia, remains limited. Therefore, the aim of this study was to conduct an intervention study on a tailored SMEP among Malaysian older adults who aged 60 years and above with knee OA. Participants aged 60 years and over with a diagnosis of knee OA were recruited. The intervention comprised four weekly structured group SMEP which was developed specifically for the multicultural population in Malaysia. Symptom’s severity and functional performance were assessed at baseline and six-week follow-up using the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS), 30 seconds sit to stand (30sST), time up and go (TUG), chair sit and reach (CSR), back stretch (BS), handgrip strength (HGS) and two-minute walk (2MW) tests. Of the 32 individuals recruited, 30 participants, mean age of 66.77 (±6.42) years, completed the post-intervention assessment. Improvements in mean KOOS domains scores were observed by between 1.3% - 8.6% from baseline to follow-up. Significant differences between baseline and followup scores were identified for 30sST (p < 0.05), TUG ( p < 0.001) and 2MW (p < 0.001) tests. A 4-week tailored SMEP delivered face to face by a physiotherapist, improved lower limb muscle strength, mobility, balance and endurance. Larger randomized controlled trials regarding the long-term effects of SMEP for older adults with OA is warranted.

Blunt trauma to the abdomen can result in various injuries which are potentially fatal if not promptly recognized and treated. Mechanism of injury, anatomical location, patient demographics, and clinical profile play crucial roles in diagnosis and management. The article presents 2 cases illustrating the challenges, and successful management of isolated jejunal injuries, and highlight the significance of early recognition and surgical intervention. These injuries are rare and there needs to be a high index of suspicion, especially in cases with atypical presentation. The cases in this article underscore the critical role of early surgical intervention in achieving optimal recovery and reducing the morbidity and mortality associated with isolated jejunal injuries. Clinicians need to consider the possibility of small bowel perforation following apparently trivial injuries, and employ a comprehensive approach to managing abdominal trauma.

Methods: We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation. Results: FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device. Conclusions The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.

Methods: We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation. Results: FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device. Conclusions The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.

Blunt trauma to the abdomen can result in various injuries which are potentially fatal if not promptly recognized and treated. Mechanism of injury, anatomical location, patient demographics, and clinical profile play crucial roles in diagnosis and management. The article presents 2 cases illustrating the challenges, and successful management of isolated jejunal injuries, and highlight the significance of early recognition and surgical intervention. These injuries are rare and there needs to be a high index of suspicion, especially in cases with atypical presentation. The cases in this article underscore the critical role of early surgical intervention in achieving optimal recovery and reducing the morbidity and mortality associated with isolated jejunal injuries. Clinicians need to consider the possibility of small bowel perforation following apparently trivial injuries, and employ a comprehensive approach to managing abdominal trauma.

Methods: We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation. Results: FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device. Conclusions The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.

Blunt trauma to the abdomen can result in various injuries which are potentially fatal if not promptly recognized and treated. Mechanism of injury, anatomical location, patient demographics, and clinical profile play crucial roles in diagnosis and management. The article presents 2 cases illustrating the challenges, and successful management of isolated jejunal injuries, and highlight the significance of early recognition and surgical intervention. These injuries are rare and there needs to be a high index of suspicion, especially in cases with atypical presentation. The cases in this article underscore the critical role of early surgical intervention in achieving optimal recovery and reducing the morbidity and mortality associated with isolated jejunal injuries. Clinicians need to consider the possibility of small bowel perforation following apparently trivial injuries, and employ a comprehensive approach to managing abdominal trauma.

Adrenal Glands ; Humans ; Hyperaldosteronism ; Retrospective Studies ; Singapore

Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR) and Google Scholar were searched for relevant articles in February 2018, using key words ‘older adults’, ‘Internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools by two independent reviewers. Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281). Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The web feature preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population.

Results: Pullout strength decreased by 36% when the size of the revision screw was increased by 1 mm, while it increased by 35% when the size of the revision screw was increased by 2 mm compared to the index screw value. While the morphologies of the load paths were similar in all cases, they differ between the two groups: the larger screw responded with generally elevated stiffer path than the smaller screw, suggesting that revision surgery using a larger screw has more purchase along the inserted body-pedicle axis. Conclusions A larger screw enhances strength and increases biomechanical stability in revision surgeries, although the final surgical decision is made by the clinician, which includes the patient’s anatomy and associated characteristics.