Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial.

Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation.

The Effectiveness of Digital Health Interventions in the Management of Musculoskeletal Conditions: Systematic Literature Review.

Background: Musculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations that address time and resource constraints.

Quality improvement in physiotherapy services.

Purpose The purpose of this paper is to evaluate a process change in physiotherapy services and to explore factors that may have influenced the outcomes. Design/methodology/approach This is a multiple case study and information was gathered from eight physiotherapy teams over 24 months. Findings The process change was successfully implemented in six teams.

A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties.

Background: Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community.

Study Designs: comparative study and cross-sectional study.

Evaluation of a primary care musculoskeletal clinical assessment service: a preliminary study.

Objectives: To evaluate the clinical effectiveness of a primary care musculoskeletal clinical assessment service (MCAS). The MCAS is a triage and treatment service for the management of patients with musculoskeletal conditions.

Design: Prospective observational cohort study.

Expectations and satisfaction of patients with low back pain attending a multidisciplinary rehabilitation service.

Background And Purpose: To identify the expectations of service, and degree of satisfaction, with a multidisciplinary service for patients with low back pain, and to examine the strength of association between patients' satisfaction and expectations.

Method: A three-stage study design was used. concerns were identified by a focus group; priority issues were identified by ranking by use of a Delphi consensus questionnaire; satisfaction or expectation questionnaires were also used to rate patients' satisfaction and the degree to which expectations were met.

Local shielding of high dose rate brachytherapy in an operating theatre.

A high-dose rate brachytherapy facility was installed into an established operating theatre by using local shielding in the form of mobile lead screens and by taking advantage of the ease with which staff movements can be controlled in an operating suite. This facility was inexpensive to develop, and has proved clinically efficient and entirely adequate from a radiation safety standpoint.

A pharmacokinetic and phase II study of gallium nitrate in patients with non-small cell lung cancer.

This study investigated the pharmacokinetics and activity of gallium nitrate in non-small cell lung cancer when 700 mg/m2 was given as a 30-min infusion with prehydration every 2 weeks. Gallium was measured in plasma and urine using flameless atomic absorption spectrophotometry, and pharmacokinetics of total and ultrafilterable gallium were calculated. Twenty-five patients with non-small cell lung cancer received 1-12 (median 2) courses of gallium nitrate every 2 weeks.

Radioprotection by DNA ligands.

Molecular studies on the mechanism of radioprotection by Hoechst 33342 have suggested that radioprotective activity might be improved by addition of electron-donating substituents to the ligand. This paper reports the results of experiments with proamine, in which the ethoxy group of Hoechst 33342 has been replaced with a dimethylamino group. Clonogenic survival studies with V79 cells confirmed the expectation of increased radioprotective activity of proamine.

A diagnostic-quality electronic portal imaging system.

Initial clinical experience is presented, on the use of a prototype portal imaging system which is designed to provide diagnostic-quality images on-line at the accelerator. The system comprises a compact diagnostic X-ray unit mounted on the accelerator head, with its source in the isocentric plane exactly 37 degrees around from the therapy source. The image detector is an image intensifier with digital image storage/processing facilities.

Current concepts in radiobiology applied to radiotherapy.

The main research themes in radiobiology are reviewed, with an emphasis on those currently in preclinical or clinical testing. They come largely from recent insights in tumour or cellular biology and include in vivo tumour proliferation kinetics, hypoxic radioresistance, cellular or intrinsic radioresistance, the tumour's abnormal vascular bed. In order to exploit fully their therapeutic possibilities, more specific but clinically-practical methods of gauging each individual tumour's vulnerability may need to be available, so an associated line of research is the development of laboratory assays of biopsied samples to document the relevant tumour characteristics.

A relationship between microdosimetric spectra and cell survival for high-LET irradiation.

A method of calculating cell survival from microdosimetric spectra for high-LET radiations and exponential cell survival is discussed. The basis of the calculation is that a cell nucleus receiving a specific dose D has a probability of survival of exp(-D/Do), where Do, the specific lethal dose, is assumed to be independent of cell size and shape. A relationship between specific lethal dose and mean lethal dose is derived.

Computed tomographic assessment of vertebral bone mineral in childhood.

Quantitative computed tomography (QCT) was used to assess trabecular bone mineral concentration in the vertebrae of 132 children, 45 with suspected disorder of bone mineralisation, 54 with thalassaemia and 37 controls. The range for bone mineral concentration in controls, expressed as equivalent K2HPO4 concentrations, was 90-190 mg cm-3. Abnormally low values were seen in all untreated children with idiopathic juvenile osteoporosis, 3/9 steroid recipients, and three patients with osteogenesis imperfecta.

A new system for port films.

A novel system for port films is described which incorporates a high-quality fluorescent screen lying behind a flat, heavy-metal screen or filter and the film pressed between them is not an X ray type but a single-emulsion, very high contrast graphics or line-type film. In experimental comparisons using 4 MV, 6 MV, and 25 MV photon beams, the new Peter MacCallum Cancer Institute (PMCI) system produced clearer images, about X2 higher in contrast yet lower in relative noise levels, than did the conventional commercially-available systems which use x-ray film between heavy-metal screens. Direct clinical comparisons, chiefly using 6 MV accelerators, confirmed that anatomical details were correspondingly better visualized and in general, the PMCI port film could be matched against the simulator radiograph with greater confidence.

Human macrophage maturation in vitro: expression of functional transferrin binding sites of high affinity.

Human blood monocytes (mo) when cultured in suspension on hydrophobic teflon membranes undergo terminal maturation to macrophages (MO). Together with the appearance of new lineage-restricted differentiation antigens, mature MO but not blood mo, express transferrin (TF) receptor molecules as detected by immunostaining methods. Here we report that radio- and fluorescein-labelled TF binds to a single class of high-affinity binding sites on MO but not on mo.

The potential accuracy of dual-energy computed tomography for the determination of hepatic iron.

Physical experiments are described which simulated the main practical and technical problems encountered in estimating iron concentrations in liver by dual-energy computed tomography. In aqueous solutions located in an oval water phantom, the presence of Fe at concentrations of 1 and 2 mg/ml was detected and estimated with good accuracy and reproducibility. The main physical problem was that water showed a non-zero dual-energy difference reading whose magnitude varied with location, but this potential error was largely eliminated by measuring the location-specific water values using a technique readily adapted to patient studies.

Mechanisms of distribution of gallium 67 in mouse tumour hosts.

In several mouse tumour models iron given parenterally not only inhibited the transport of 67Ga by plasma transferrin but also accelerated the binding of 67Ga in tumour tissue, particularly during the first hour after 67Ga injection. By 30 min, the tumour had already attained a high concentration though the 67Ga accumulated was still potentially reversible. With the passage of time equally high 67Ga concentrations were attained in tumour in iron-treated and untreated animals alike, and were maintained high as 67GA was totally cleared from the plasma.

Modification of distribution of gallium 67 in man by administration of iron.

In mice bearing tumours, the clearance of 67Ga from blood and the attainment of high tumour-to-normal soft-tissue concentration ratios are accelerated if the serum unsaturated iron-binding capacity (UIBC) is low. A preliminary clinical trial is described, concerning the administration of iron as a means of creating favourable imaging distributions within 6 h of injection of 67Ga. Iron was given intramuscularly at a dosage in the range 50-100 mg, depending on the patient's UIBC and generally about 3 h post 67Ga.