Background Chondral defects of the knee can be identified in up to 60% of patients undergoing knee arthroscopy. The use of Autologous Matrix Induced Chondrogenesis (AMIC), which combines subchondral microfracture with a collagen membrane,has been increasingly used to treat these defects. Aims This review assesses the clinical, functional, and radiological outcomes of patients undergoing the AMIC procedure and reports any associated complications. Methods Studies with a minimum of 10 patients and fulfilled at least a 12-month follow up period with more than 70% follow up rate were included. Methodological quality was assessed using MINORS (Methodological Index for Non-Randomised Studies) criteria. The meta-analysis compared Lysholm, VAS (Visual Analog Scale), IKDC (International Knee Documentation Committee), KOOS (Knee Injury and Osteoarthritis Outcome Score) Pain, and Tegner clinical outcome measures at baseline and follow up. Results 18 studies (n = 490 patients) were included. The mean age was 35.2 [SD = 5.0] years and the mean defect size was 3.47 [SD = 0.96] cm2. There was a clinically significant improvement in Lysholm, IKDC, and KOOS scores of 30.36 [95% CI (25.80, 34.93)], 34.05 [95% CI (4.16, 43.95)], and 30.63 [95% CI (24.78, 36.47)] respectively; and reduction in VAS pain score of −4.10 [95%CI (−4.50, −3.71) at follow up. Improvement in Tegner score at follow up was not statistically significant: 0.21 [95% CI (−0.88, 1.30)],(p > 0.05). Conclusion AMIC is a safe, effective, and reliable technique to treat knee chondral defects which can provide significant clinical, functional, and radiological improvements to patients.

Background: Acute cholecystitis is considered the most common complication of cholelithiasis. Annually, around 64,000 people require surgical intervention for this frequent surgical disease. The normal medical practice for individuals with acute cholecystitis is to do an early laparoscopic cholecystectomy (LC). The objective of this research is to present compelling data regarding the impact of laparoscopic cholecystectomy on reducing hospitalization duration, postoperative complications, morbidity, and mortality rate, as well as to assess its overall practicality. This objective was accomplished through carrying out a methodical examination of the existing evidence in the study undertaken in this particular area. Objective: To compare the current evidences of open cholecystectomy Laparoscopic Cholecystectomy (LC) in the management of acute cholecystitis. Methods: Systematic review was carried out in accordance with the PRISMA standards. Relevant searches were conducted using PubMed, EMBASE, and CINAHL. Eligible quasi-experimental & randomized controlled experiments were conducted utilizing various Mesh terms associated with laparoscopic cholecystectomy as well as open cholecystectomy interventions. Four main outcome parameters (hospital stay, post op complications, morbidity and mortality rate) were assess on short, medium, and long-term effect. Result: The initial search yielded a total of 65 items. Following the screening process, a total of 10 publications were collected for the study. Multiple studies have consistently shown that laparoscopic cholecystectomy, when compared to open cholecystectomy, results in shorter hospital stays, reduced morbidity, and decreased postoperative problems. The outcome implies that. Laparoscopic cholecystectomy is a safe procedure for treating acute cholecystitis, with lower mortality rates, shorter hospital stays, and less postoperative problems compared to open cholecystectomy. Conclusion: The evidence of moderate quality indicates that laparoscopic cholecystectomy provides a safe and effective alternative to open cholecystectomy for patients with acute cholecystitis. It has been shown to reduce hospital stay, morbidity, mortality, and post-operative problems.

Fish bone as a foreign body in the throat is common and frequently seen in emergency departments. In most cases, the bone is stuck in the tonsils or oropharynx, some go further to the laryngopharynx, and in rare cases they may go furthest. The authors report a rare case of a fish bone that migrated to the thyroid gland.

Purpose: Data are limited pertaining to the long-term benefits of aflibercept treatment for neovascular age-related macular degeneration (nAMD). The aim of this study was to provide outcomes, safety, durability and quality-of-life data with aflibercept using a modified treat, extend and fixed regime over 4 years. Methods: Prospective, multicentre, single cohort observational study of treatment-naïve nAMD participants treated with aflibercept as 2-year extension of the MATE-trial that compared early and late Treat-and-Extend for 2 years. Refracted ETDRS best corrected visual acuity (BCVA), central retinal thickness (CRT), treatment interval and adverse events were assessed. Quality-of-life was measured using the Macular Disease Dependent Quality of Life (MacDQoL) and Macular Disease Treatment Satisfaction Questionnaires (MacTSQ). Results: Twenty-six of 40 participants completing the MATE-trial were enrolled with 20 completing the total 4-year study. Mean BCVA was 60.7 at Month 0 and 64.8 ETDRS letters at Month 48 while CRT decreased from 423.7 μm to 292.2 μm. Five participants discontinued treatment due to inactivity. The mean number of treatments and visits for the remaining participants was 27 and 30.0, respectively, with treatment intervals extended to 12 weeks in four participants at Month 48. Both AMD-specific QoL and treatment satisfaction remained stable between Months 0 and 48 and mean BCVA significantly correlated with AMD-specific QoL scores at Months 12, 24 and 48. Conclusions: Results suggest that BCVA can be maintained over 48 months when following a treat-extend-and-fix regimen of aflibercept with intervals out to 12 weeks, while maintaining AMD-specific QoL and treatment satisfaction.

Diplopia occurs when two images are subjectively seen of a single object. It has a variety of causes, which range in severity from benign to sight or life threatening if left untreated. Clinical assessment of diplopia includes taking a comprehensive history to delineate the exact type of visual disturbance experienced by the patient and examination to pinpoint the aetiology, which is crucial for further management. This article discusses the causes of diplopia, along with risk factors and other associated symptoms, to facilitate diagnosis and management. Efficient and effective diagnosis is important, as some pathologies require immediate treatment to save the eyesight and/or life of the patient. This article will concentrate solely on binocular diplopia.

Rationale and objectives: Placenta accreta spectrum (PAS) disorders are increasingly common and associated with significant maternal and neonatal morbidity and mortality due to the associated risk of massive haemorrhage. Currently prophylactic interventional radiology (IR) arterial occlusion is being performed occluding either the internal iliac artery (IIA), abdominal aorta (AA) or uterine artery (UA) in order to prevent this blood loss. The aim of this meta-analysis is to identify whether these IR procedures are effective in reducing estimated blood loss (EBL) and hysterectomy rates and if so which method achieves the optimal results METHODS: A literature search was conducted to acquire case-control studies assessing EBL and hysterectomies performed following IR arterial occlusion in PAS patients, yielding 16 results. Studies were analyzed together and later split into groups dependent on the artery occluded. The results of these were then inputted into forest plots to identify their overall estimated effect with confidence intervals. Results: Prophylactic IR arterial occlusion was proven to reduce both EBL and hysterectomies. When separated by artery, IIA achieved the worst outcomes with no proven effect on EBL and a minimal reduction in hysterectomies. UA scored in the middle with a modest reduction in both outcomes, whilst AA occlusion had the most significant reduction in both EBL and hysterectomies. Conclusion: Prophylactic IR arterial occlusion should be routinely considered in PAS patients to reduce both EBL and rates of hysterectomies. Current literature promotes the use of IIA occlusion; however the findings of this analysis propose that AA and UA occlusion should be favoured.

There is clear evidence of a growing workforce gap and this is compounded by demographic data that show the current workforce is ageing. Within the current workforce, more doctors are taking voluntary early retirement and the loss of these experienced clinicians from departments can have wide-ranging effects. Older doctors are at risk of age-related health problems (e.g. sight, musculoskeletal, menopause) and are more susceptible to the effects of fatigue, which may increase the risk of error and or complaint. The purpose of this working party and advocacy campaign was to address concerns over the number of consultants retiring at the earliest opportunity and whether a different approach could extend the working career of consultant anaesthetists and SAS doctors. This could be viewed as ‘pacing your career’. The earlier this is considered in a clinician's career the greater the potential mitigation on individuals.

Background Wikipedia is among the most popular sites on the internet, and around a fifth of all healthcare searches online directs to a Wikipedia page. In recent years steps have been taken to enhance the quality of their healthcare pages, such as the creation of the WikiProject Medicine initiative. In 2014 a partnership was formalised between Wikipedia and Cochrane Collaboration with similar aims. Three years ago, a group of medical students helped to formulate a protocol for the first ever randomised trial, whose aim was to test the value of Wikipedia in informing users about healthcare. Objectives To investigate the effects of adding high-grade quantitative evidence of outcomes of treatments into relevant Wikipedia pages on further information-seeking behaviour by the end-user. Methods: We randomised 70 Wikipedia pages, identified as highly relevant to up-to-date Cochrane Schizophrenia systematic reviews that contained a Summary of Findings table. Eligible Wikipedia pages in the intervention group (35) were seeded with tables listing best evidence of the effects of treatment, and hyperlinks to the source Cochrane review. Eligible pages in the control group (35) remained unchanged. Results The main outcome measures were routinely collected data on access to the full text and summary web page of the relevant Cochrane reviews (after 12 months). There was 100% follow-up of the 70 randomised pages. Six of the 35 in the intervention group had the tabular format deleted by other Wikipedia users during the course of the study, but all pages continued to report the same data within the text. The study found no evidence of significant effect on either of the co-primary outcomes: full text access adjusted ratio of geometric means 1.30, 95% CI: 0.71 to 2.38; page views 1.14, 95% CI: 0.6 to 2.13. Results were similar for all other outcomes, with the exception of Altmetric score for which there was evidence of clear effect (1.36, 95% CI: 1.05 to 1.78). Conclusions The pursuit of fair balance within Wikipedia healthcare pages is impressive and its reach unsurpassed. Enriching Wikipedia content is, potentially, a powerful way to improve health literacy among the public, and it is possible to test the effects of seeding pages with evidence. Though increased traffic to Cochrane reviews in the intervention group lacked statistical significance, there was nonetheless consistently an increase in all outcome measures. For every person that sought and clicked the reference on the 'intervention' Wikipedia page to seek more information (the primary outcome), many more are likely to have been informed by the page alone; the inclusion of high-quality data may have lessened the desire to click out to the original source. If demonstrated that the end-user becomes more informed as a result of such intervention, the potential as a tool for dissemination could be invaluable. Future studies should take such factors into consideration, and aim to replicate, expand and further develop our trial. Trial registration number IRCT2017070330407N2

Background: Despite the known benefits of mobilising critically ill patients, bed rest is still a common practice in intensive care units. The reasons for this are not fully understood. Early mobilisation can reduce the length of stay in the intensive care unit and in hospitals as well. However, the decision to mobilise a patient can be delayed while health professionals decide whose role it is to implement it. Aim and objectives: The aim of this study was to explore the ways in which nurses make decisions to mobilise critically ill patients and what factors influence the decision-making process. Study design and method: This was a qualitative study involving semi-structured interviews with 12 critical care nurses at a large urban district hospital. Interpretative phenomenological analysis was used to analyse verbatim transcripts of the interviews. Results: The findings demonstrated inconsistencies in the nurses' knowledge of the benefits to mobilising patients and that mobilisation was deemed to be a low priority. Decision-making was influenced by time constraints, staffing levels, and unit demands. A lack of communication and collaborative working was identified, along with uncertainty and role ambiguity, with regard to who decides to mobilise a patient. Mobilisation was found to be complicated by existing cultural influences and by previous experiences of complex mobilisation. Conclusion: Re-education strategies are needed to re-enforce the benefits of mobilisation, along with multidisciplinary training sessions to clarify roles and overcome collaborative working issues. Relevance to clinical practice: This study has provided a greater understanding of the influencing factors on nurses' decision-making with regard to mobilising critical ill patients.