BackgroundGait analysis has been used for decades to quantify knee function in patients with knee osteoarthritis; however, it is unknown whether and to what extent inter-laboratory differences affect the comparison of gait data between studies. Therefore, the aim of this study was to perform an inter-laboratory comparison of knee biomechanics and muscle activation patterns during gait of patients with knee osteoarthritis.MethodsKnee biomechanics and muscle activation patterns from patients with knee osteoarthritis were analyzed, previously collected at Dalhousie University (DAL: n = 55) and Amsterdam UMC, VU medical center (VUmc: n = 39), using their in-house protocols. Additionally, one healthy male was measured at both locations. Both direct comparisons and after harmonization of components of the protocols were made. Inter-laboratory comparisons were quantified using statistical parametric mapping analysis and discrete gait parameters.ResultsThe inter-laboratory comparison showed offsets in the sagittal plane angles, moments and frontal plane angles, and phase shifts in the muscle activation patterns. Filter characteristics, initial contact identification and thigh anatomical frame definitions were harmonized between the laboratories. After this first step in protocol harmonization, the offsets in knee angles and sagittal plane moments remained, but the inter-laboratory comparison of the muscle activation patterns improved.ConclusionsInter-laboratory differences obstruct valid comparisons of gait datasets from patients with knee osteoarthritis between gait laboratories. A first step in harmonization of gait analysis protocols improved the inter-laboratory comparison. Further protocol harmonization is recommended to enable valid comparisons between labs, data-sharing and multicenter trials to investigate knee function in patients with knee osteoarthritis.
MULTIFILE
Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
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The seventh ACL Research Retreat was held March 19–21, 2015, in Greensboro, North Carolina. The retreat brought together clinicians and researchers to present and discuss the most recent advances in anterior cruciate ligament (ACL) injury epidemiology, risk factor identification, and injury risk screening and prevention strategies. Subsequently, our goal was to identify important unknowns and future research directions. The ACL Research Retreat VII was attended by 64 clinicians and researchers from Australia, Canada, India, Ireland, the Netherlands, South Africa, the United States, and the United Kingdom. The meeting featured 3 keynote and 29 podium presentations highlighting recent research. Keynotes were delivered by Bruce Beynnon, PhD (Univer- sity of Vermont), Charles ‘‘Buz’’ Swanik, PhD, ATC (University of Delaware), and Mark Paterno, PhD, PT, ATC, SCS (Cincinnati Children’s Hospital Medical Cen- ter), addressing their ongoing work related to sex-specific multivariate risk factor models for ACL injury,1 the role of the brain in noncontact ACL injury,2 and the incidence and predictors of a second ACL injury after primary ACL reconstruction and return to sport,3 respectively. Podium and poster presentations were organized into thematic sessions of prospective and case-control risk factor studies, anatomical and hormonal risk factors, neuromuscular and biomechanical risk factors, injury risk assessment after ACL injury, and injury-prevention strategies. Time was provided for group discussion throughout the conference. At the end of the meeting, attendees participated in 1 of 3 breakout sessions on the topics of genetic, hormonal, and anatomical risk factors; neuromechanical contributions to ACL injury; and risk factor screening and prevention. From these discussions, we updated the 2012 consensus state- ment4 to reflect the most recent advances in the field and to revise the important unknowns and future directions necessary to enhance our understanding of ACL injury. Following are the updated consensus statement, keynote presentation summaries, and free communication abstracts organized by topic and presentation order.
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