Publications by authors named "Gaida J"

59 Publications

What tendon pathology is seen on imaging in people who have taken fluoroquinolones? A systematic review.

Fundam Clin Pharmacol 2017 Feb 5;31(1):4-16. Epub 2016 Oct 5.

University of Canberra Research Institute for Sport and Exercise (UCRISE), University Drive, Bruce, ACT, 2617, Australia.

Fluoroquinolones (FQs) are highly effective broad-spectrum antibiotics. Clinical data reveal an increased incidence of tendon pain and rupture in those taking FQs, yet little is known about tendon structural changes. This review synthesises published data on tendon structural changes in people who have taken FQs. Eight databases were searched for potentially relevant articles (Medline, CINAHL, Biological Abstracts, AMED, Web of Knowledge, SCOPUS, SportDiscus and EMBASE) using MeSH and free-text searches. Inclusion and exclusion criteria determined which articles were used for this review. Twenty-six papers met the eligibility criteria. The Achilles tendon was most commonly affected, and ciprofloxacin and levofloxacin were the most commonly implicated FQs. Mean time to onset of symptoms was 16 days following first FQ dose. Imaging modalities used included magnetic resonance imaging (MRI), B-mode ultrasound (US) and computed tomography (CT). Tendon measurements were rarely reported, and intratendinous imaging findings were not reported in a consistent manner. Few studies imaged tendons bilaterally, and only two studies were longitudinal in design. Future studies should report imaging measures such as thickness and cross-sectional area and use consistent descriptions of intratendinous changes during and post-FQ treatment.
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http://dx.doi.org/10.1111/fcp.12228DOI Listing
February 2017

Translating evidence to practice in the health professions: a randomized trial of Twitter vs Facebook.

J Am Med Inform Assoc 2017 03;24(2):403-408

Department of Physiotherapy, Monash University, Frankston, Australia.

Objective: Our objective was to compare the change in research informed knowledge of health professionals and their intended practice following exposure to research information delivered by either Twitter or Facebook.

Methods: This open label comparative design study randomized health professional clinicians to receive "practice points" on tendinopathy management via Twitter or Facebook. Evaluated outcomes included knowledge change and self-reported changes to clinical practice.

Results: Four hundred and ninety-four participants were randomized to 1 of 2 groups and 317 responders analyzed. Both groups demonstrated improvements in knowledge and reported changes to clinical practice. There was no statistical difference between groups for the outcomes of knowledge change (P = .728), changes to clinical practice (P = .11) or the increased use of research information (P = .89). Practice points were shared more by the Twitter group (P < .001); attrition was lower in the Facebook group (P < .001).

Conclusion: Research information delivered by either Twitter or Facebook can improve clinician knowledge and promote behavior change. No differences in these outcomes were observed between the Twitter and Facebook groups. Brief social media posts are as effective as longer posts for improving knowledge and promoting behavior change. Twitter may be more useful in publicizing information and Facebook for encouraging course completion.
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http://dx.doi.org/10.1093/jamia/ocw085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7651891PMC
March 2017

A pilot study on biomarkers for tendinopathy: lower levels of serum TNF-α and other cytokines in females but not males with Achilles tendinopathy.

BMC Sports Sci Med Rehabil 2016 25;8. Epub 2016 Feb 25.

La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Australia.

Background: Achilles tendinopathy is a painful musculoskeletal condition that is common among athletes, and which limits training capacity and competitive performance. The lack of biomarkers for tendinopathy limits research into risk factors and also the evaluation of new treatments. Cytokines and growth factors involved in regulating the response of tendon cells to mechanical load have potential as biomarkers for tendinopathy.

Methods: This case-control study compared serum concentration of cytokines and growth factors (TNF-α, IL-1β, bFGF, PDFG-BB, IFN-γ, VEGF) between individuals with chronic Achilles tendinopathy and controls. These were measured in fasting serum from 22 individuals with chronic Achilles tendinopathy and 10 healthy controls. Results were analysed in relation to gender and physical activity pattern.

Results: TNF-α concentration was lower in the entire tendinopathy group compared with the entire control group; none of the other cytokines were significantly different. TNF-α levels were nevertheless highly correlated with the other cytokines measured, in most of the subgroups. Analysed by gender, TNF-α and PDGF-BB concentrations were lower in the female tendinopathy group but not the male tendinopathy group. A trend was seen for lower IL-1β in the female tendinopathy group. Physical activity was correlated with TNF-α, PDGF-BB and IL-1β to varying extents for control subgroups, but not for the female tendinopathy group. No correlations were seen with BMI or duration of symptoms.

Conclusions: This pilot study indicates a lower level of TNF-α and PDGF-BB, and to some extent IL-1β among females, but not males, in the chronic phase of Achilles tendinopathy. It is suggested that future studies on tendinopathy biomarkers analyse male and female data separately. The lack of correlation between cytokine level and physical activity in the female tendinopathy group warrants further study.
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http://dx.doi.org/10.1186/s13102-016-0026-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768326PMC
February 2016

Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial.

J Sci Med Sport 2016 Sep 7;19(9):702-6. Epub 2015 Dec 7.

Monash University, School of Physiotherapy, Australia.

Objectives: Many athletes with patellar tendinopathy participate in sports with symptoms during or after activities. Current treatments do not decrease pain in-season; eccentric exercises in-season result in an increase in pain. This study examined if isometric and isotonic exercises relieved pain in competing athletes with patellar tendinopathy.

Design: Randomised clinical trial.

Methods: Jumping athletes with patellar tendinopathy playing at least three times per week participated in this study. Athletes were randomised into an isometric or isotonic exercise group. The exercise programs consisted of four isometric or isotonic exercise sessions per week for four weeks. Pain during a single leg decline squat (SLDS) on a Numeric Rating Scale (NRS; 0-10) was used as the main outcome measure; measurements were completed at baseline and at 4-week follow-up.

Results: Twenty-nine athletes were included in this study. Median pain scores improved significantly over the 4-week intervention period in both the isometric group (Z=-2.527, p=0.012, r=-0.63) and isotonic group (Z=-2.952, p=0.003, r=-0.63). There was no significant difference in NRS pain score change (U=29.0, p=0.208, r=0.29) between the isometric group (median (IQR), 2.5 (1-4.5)) and isotonic group (median (IQR), 3.0 (2-6)).

Conclusions: This is the first study to show a decrease in patellar tendon pain without a modification of training and competition load and the first study to investigate isometric exercises in a clinical setting. Both isometric and isotonic exercise programs are easy-to-use exercises that can reduce pain from patellar tendinopathy for athletes in-season.
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http://dx.doi.org/10.1016/j.jsams.2015.11.006DOI Listing
September 2016

Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis.

Br J Sports Med 2016 Aug 23;50(16):982-9. Epub 2015 Nov 23.

Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia University of Canberra Research Institute for Sport and Exercise (UCRISE) Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia.

Background: Musculoskeletal symptoms limit adherence to exercise interventions for individuals with type 2 diabetes. People with diabetes may be susceptible to tendinopathy due to chronically elevated blood glucose levels. Therefore, we aimed to investigate this potential association by systematically reviewing and meta-analysing case-control, cross-sectional, and studies that considered both of these conditions.

Methods: Nine medical databases and hand searching methods were used without year limits to identify all relevant English language articles that considered diabetes and tendinopathy. Two authors applied exclusion criteria and one author extracted data with verification by a second author. Meta-analysis was conducted using a random effects model. Results were expressed as odds ratio (OR), mean difference or standardised mean difference with a confidence intervals (95% CI). Heterogeneity was assessed by I(2).

Findings: 31 studies were included in the final analysis of which 26 recruited people with diabetes and five recruited people with tendinopathy. Tendinopathy was more prevalent in people with diabetes (17 studies, OR 3·67, 95% CI 2·71 to 4·97), diabetes was more prevalent in people with tendinopathy (5 studies, OR 1·28, 95% CI 1·10 to 1·49), people with diabetes and tendinopathy had a longer duration of diabetes than people with diabetes only (6 studies, mean difference 5·26 years, 95% CI 4·15 to 6·36) and people with diabetes had thicker tendons than controls (9 studies, standardised mean difference 0·79 95% CI 0·47 to 1·12).

Interpretation: These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. This is clinically relevant as tendinopathy may affect adherence to exercise interventions for diabetes.
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http://dx.doi.org/10.1136/bjsports-2015-094735DOI Listing
August 2016

Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study.

BMC Musculoskelet Disord 2015 Nov 10;16:345. Epub 2015 Nov 10.

Department of Physiotherapy, Monash University, Frankston, 3199, VIC, Australia.

Background: Achilles tendon structure deteriorates 2-days after maximal loading in elite athletes. The load-response behaviour of tendons may be altered in type 1 diabetes mellitus (T1DM) as hyperglycaemia accelerates collagen cross-linking. This study compared Achilles tendon load-response in participants with T1DM and controls.

Methods: Achilles tendon structure was quantified at day-0, day-2 and day-4 after a 10 km run. Ultrasound tissue characterisation (UTC) measures tendon structural integrity by classifying pixels as echo-type I, II, III or IV. Echo-type I has the most aligned collagen fibrils and IV has the least.

Results: Participants were 7 individuals with T1DM and 10 controls. All regularly ran distances greater than 5 km and VISA-A scores indicated good tendon function (T1DM = 94 ± 11, control = 94 ± 10). There were no diabetic complications and HbA1c was 8.7 ± 2.6 mmol/mol for T1DM and 5.3 ± 0.4 mmol/mol for control groups. Baseline tendon structure was similar in T1DM and control groups - UTC echo-types (I-IV) and anterior-posterior thickness were all p > 0.05. No response to load was seen in either T1DM or control group over the 4-days post exercise.

Conclusion: Active individuals with T1DM do not have a heightened Achilles tendon response to load, which suggests no increased risk of tendon injury. We cannot extrapolate these findings to sedentary individuals with T1DM.
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http://dx.doi.org/10.1186/s12891-015-0803-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641391PMC
November 2015

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study.

J Med Internet Res 2015 Oct 26;17(10):e242. Epub 2015 Oct 26.

Monash University, Frankston, Australia.

Background: Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers.

Objective: The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice.

Methods: The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings.

Results: Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice.

Conclusions: Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice.
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http://dx.doi.org/10.2196/jmir.4763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642790PMC
October 2015

Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review.

Br J Sports Med 2015 Dec 15;49(23):1504-9. Epub 2015 Oct 15.

Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia University of Canberra, Research Institute for Sport and Exercise (UCRISE) Canberra, Australian Capital Territory, Australia.

Background: Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol.

Objective: To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain.

Methods: We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases-MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case-control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain.

Results: 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and -0.19 mmol/L, respectively.

Conclusions: The results of this review indicate that a relationship exists between an individual's lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy.
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http://dx.doi.org/10.1136/bjsports-2015-095100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680137PMC
December 2015

Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review.

Br J Sports Med 2016 Feb 25;50(4):209-15. Epub 2015 Sep 25.

Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia The Australian Centre for Research into Injury in Sport and its Prevention, Ballarat Federation University, Victoria, Australia.

Tendinopathy can be resistant to treatment and often recurs, implying that current treatment approaches are suboptimal. Rehabilitation programmes that have been successful in terms of pain reduction and return to sport outcomes usually include strength training. Muscle activation can induce analgesia, improving self-efficacy associated with reducing one's own pain. Furthermore, strength training is beneficial for tendon matrix structure, muscle properties and limb biomechanics. However, current tendon rehabilitation may not adequately address the corticospinal control of the muscle, which may result in altered control of muscle recruitment and the consequent tendon load, and this may contribute to recalcitrance or symptom recurrence. Outcomes of interest include the effect of strength training on tendon pain, corticospinal excitability and short interval cortical inhibition. The aims of this concept paper are to: (1) review what is known about changes to the primary motor cortex and motor control in tendinopathy, (2) identify the parameters shown to induce neuroplasticity in strength training and (3) align these principles with tendon rehabilitation loading protocols to introduce a combination approach termed as tendon neuroplastic training. Strength training is a powerful modulator of the central nervous system. In particular, corticospinal inputs are essential for motor unit recruitment and activation; however, specific strength training parameters are important for neuroplasticity. Strength training that is externally paced and akin to a skilled movement task has been shown to not only reduce tendon pain, but modulate excitatory and inhibitory control of the muscle and therefore, potentially tendon load. An improved understanding of the methods that maximise the opportunity for neuroplasticity may be an important progression in how we prescribe exercise-based rehabilitation in tendinopathy for pain modulation and potentially restoration of the corticospinal control of the muscle-tendon complex.
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http://dx.doi.org/10.1136/bjsports-2015-095215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752665PMC
February 2016

The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study.

J Med Internet Res 2015 May 20;17(5):e119. Epub 2015 May 20.

Monash University, Frankston, Australia.

Background: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections.

Objective: The aim of this study was to explore health researchers' and clinicians' current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence.

Methods: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey.

Results: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information.

Conclusions: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.
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http://dx.doi.org/10.2196/jmir.4347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468567PMC
May 2015

Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy.

Br J Sports Med 2015 Oct 15;49(19):1277-83. Epub 2015 May 15.

Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia.

Background: Few interventions reduce patellar tendinopathy (PT) pain in the short term. Eccentric exercises are painful and have limited effectiveness during the competitive season. Isometric and isotonic muscle contractions may have an immediate effect on PT pain.

Methods: This single-blinded, randomised cross-over study compared immediate and 45 min effects following a bout of isometric and isotonic muscle contractions. Outcome measures were PT pain during the single-leg decline squat (SLDS, 0-10), quadriceps strength on maximal voluntary isometric contraction (MVIC), and measures of corticospinal excitability and inhibition. Data were analysed using a split-plot in time-repeated measures analysis of variance (ANOVA).

Results: 6 volleyball players with PT participated. Condition effects were detected with greater pain relief immediately from isometric contractions: isometric contractions reduced SLDS (mean±SD) from 7.0±2.04 to 0.17±0.41, and isotonic contractions reduced SLDS (mean±SD) from 6.33±2.80 to 3.75±3.28 (p<0.001). Isometric contractions released cortical inhibition (ratio mean±SD) from 27.53%±8.30 to 54.95%±5.47, but isotonic contractions had no significant effect on inhibition (pre 30.26±3.89, post 31.92±4.67; p=0.004). Condition by time analysis showed pain reduction was sustained at 45 min postisometric but not isotonic condition (p<0.001). The mean reduction in pain scores postisometric was 6.8/10 compared with 2.6/10 postisotonic. MVIC increased significantly following the isometric condition by 18.7±7.8%, and was significantly higher than baseline (p<0.001) and isotonic condition (p<0.001), and at 45 min (p<0.001).

Conclusions: A single resistance training bout of isometric contractions reduced tendon pain immediately for at least 45 min postintervention and increased MVIC. The reduction in pain was paralleled by a reduction in cortical inhibition, providing insight into potential mechanisms. Isometric contractions can be completed without pain for people with PT. The clinical implications are that isometric muscle contractions may be used to reduce pain in people with PT without a reduction in muscle strength.
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http://dx.doi.org/10.1136/bjsports-2014-094386DOI Listing
October 2015

Serum levels of oxylipins in achilles tendinopathy: an exploratory study.

PLoS One 2015 13;10(4):e0123114. Epub 2015 Apr 13.

Department of Pharmacology and Clinical Neuroscience, Pharmacology Unit, Umeå University, Umeå, Sweden.

Background: Linoleic acid-derived oxidation products are found in experimental pain models. However, little is known about the levels of such oxylipins in human pain. In consequence, in the present study, we have undertaken a lipidomic profiling of oxylipins in blood serum from patients with Achilles tendinopathy and controls.

Methodology/principal Findings: A total of 34 oxylipins were analysed in the serum samples. At a significance level of P<0.00147 (<0.05/34), two linoleic acid-derived oxylipins, 13-hydroxy-10E,12Z-octadecadienoic (13-HODE) and 12(13)-dihydroxy-9Z-octadecenoic acid (12,13-DiHOME) were present at significantly higher levels in the Achilles tendinopathy samples. This difference remained significant when the dataset was controlled for age, gender and body-mass index. In contrast, 0/21 of the arachidonic acid- and 0/4 of the dihomo-γ-linolenic acid, eicosapentaenoic acid or docosahenaenoic acid-derived oxylipins were higher in the patient samples at this level of significance. The area under the Receiver-Operator Characteristic (ROC) curve for 12,13-DiHOME was 0.91 (P<0.0001). Levels of four N-acylethanolamines were also analysed and found not to be significantly different between the controls and the patients at the level of P<0.0125 (<0.05/4).

Conclusions/significance: It is concluded from this exploratory study that abnormal levels of linoleic acid-derived oxylipins are seen in blood serum from patients with Achilles tendinopathy. Given the ability of two of these, 9- and 13-HODE to activate transient receptor potential vanilloid 1, it is possible that these changes may contribute to the symptoms seen in Achilles tendinopathy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123114PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395257PMC
January 2016

The sympathetic nervous system and tendinopathy: a systematic review.

Sports Med 2015 May;45(5):727-43

Central Medical School, Monash University, Melbourne, VIC, Australia,

Background: Tendinopathy is a clinical diagnosis of localised tendon pain often confirmed by imaging findings. The pathophysiological cause of the pain is unknown and the sympathetic nervous system (SNS) may be implicated.

Objective: To review what is known regarding the role of the SNS in human tendinopathy.

Study Selection: Published data describing sympathetic innervation or an index of sympathetic activity in human tendons were eligible for inclusion.

Data Sources: Bibliographical databases (AMED, Biological Abstracts, CINAHL Plus, EMBASE, MEDLINE, Scopus, SPORTDiscus and Web of Science) were searched for relevant articles. Reference lists from included articles were screened for additional articles.

Study Appraisal: Studies were scored with a quality assessment tool to identify potential sources of bias. Each question had an explicit decision rule to guide assessment.

Results: Nine case-control and four cross-sectional studies examined sympathetic innervation of tendons. There was evidence suggesting a lack of difference in sympathetic innervation of tendon proper between tendinopathy biopsies and healthy controls. In contrast, the paratendinous tissue showed evidence of increased sympathetic innervation in painful tendons. The most notable increase in SNS markers was seen in abnormal tenocytes from painful tendons. Data from two studies were suitable for meta-analysis. These heterogeneous studies revealed no difference in sympathetic innervation between painful and pain-free tendons. No studies recorded SNS activity in vivo.

Conclusion: Sympathetic innervation in painful tendons depends on tissue type. Abnormal tenocytes may have increased capacity for self-production of sympathetic neurotransmitters. Future insight may be gained by measuring global in vivo sympathetic drive in tendinopathy.
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http://dx.doi.org/10.1007/s40279-014-0300-9DOI Listing
May 2015

Clinical incidents involving students on placement: an analysis of incident reports to identify potential risk factors.

Physiotherapy 2015 Jun 7;101(2):219-25. Epub 2014 Aug 7.

Department of Physiotherapy, Monash University, Frankston, VIC, Australia.

Background: Students are sometimes involved in incidents during clinical training. To the authors' knowledge, no quantitative studies of incidents specifically involving physiotherapy students on clinical placement are available in the literature.

Methods: A retrospective audit (2008 to 2011) of incident reports involving physiotherapy students was conducted to identify the nature and features of incidents. The study aimed to determine if injuries to a student or patient were more or less likely when the supervisor was in close proximity, and whether students with lower academic performance in their preclinical semester were more likely to be involved in an incident.

Results: There were 19 care-delivery-related and three equipment-related incidents. There were no incidents of violent, aggressive or demeaning behaviour towards students. The incident rate was 9.0/100,000 student-hours for third-year students and 6.8/100,000 student-hours for fourth-year students. The majority of incidents (55%) occurred from 11 am to 12-noon and from 3 pm to 3.30 pm. Incidents more often resulted in patient or student injury when the supervisor was not in close proximity (approximately 50% vs approximately 20%), although the difference was not significant (P=0.336). The academic results of students involved in incidents were equivalent to the whole cohort in their preclinical semester {mean 75 [standard deviation (SD) 6] vs 76 (SD 7); P=0.488}.

Conclusions: The unexpected temporal clustering of incidents warrants further investigation. Student fatigue may warrant attention as a potential contributor; however, contextual factors, such as staff workload, along with organisational systems, structures and procedures may be more relevant. The potential relationship between supervisor proximity and injury also warrants further exploration. The findings of the present study should be integrated into clinical education curricula and communicated to clinical educators.
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http://dx.doi.org/10.1016/j.physio.2014.06.006DOI Listing
June 2015

Evidence of the TNF-α system in the human Achilles tendon: expression of TNF-α and TNF receptor at both protein and mRNA levels in the tenocytes.

Cells Tissues Organs 2012 8;196(4):339-52. Epub 2012 May 8.

School of Primary Health Care, Monash University, Melbourne, Vic., Australia.

Unlabelled: Understanding adaption to load is essential for prevention and treatment of tendinopathy/tendinosis. Cytokine release in response to load is one mechanism involved in mechanotransduction. The cytokine tumor necrosis factor alpha (TNF-α) is implicated in tendinosis and can induce apoptotic effects via tumor necrosis factor receptor 1 (TNFR1). The complete absence of information concerning the TNF-α system in Achilles tendon is a limitation as mid-portion Achilles tendinosis is very frequent.

Purpose: To examine expression patterns of TNF-α and its two receptors (TNFR1 and TNFR2) in human Achilles tendinosis and control tissue and to biochemically confirm the presence of TNF-α in tendinosis tissue.

Methods: TNF-α and TNFR1 mRNA were detected via in situ hybridization. TNF-α, TNFR1, and TNFR2 were demonstrated immunohistochemically. Apoptosis markers were utilized. ELISA was used to detect TNF-α.

Results: TNF-α and TNFR1 mRNA was detected in tenocytes of both tendinosis and control tendons. Tenocytes from both groups displayed specific immunoreactions for TNF-α, TNFR1, and TNFR2. The widened/rounded tenocytes of tendinosis samples exhibited the most intense immunoreactions. Apoptosis was detected in only a subpopulation of the tenocytes in tendinosis tissue. TNF-α was measurable in tendinosis tissue. Inflammatory cells were not seen.

Conclusion: This is the first evidence of the existence of the TNF-α system in the human Achilles tendon. Findings are confirmed at mRNA and protein levels as well as biochemically. The TNF-α system was in principle confined to the tenocytes. The connection between tenocyte morphology and the expression pattern of TNF-α, TNFR1, and TNFR2 suggests that the TNF-α system may be involved in tenocyte activation in Achilles tendinosis.
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http://dx.doi.org/10.1159/000335475DOI Listing
April 2013

TNF-Alpha in the Locomotor System beyond Joints: High Degree of Involvement in Myositis in a Rabbit Model.

Int J Rheumatol 2012 7;2012:637452. Epub 2012 Mar 7.

Anatomy Section, Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden.

The importance of TNF-alpha in arthritis is well documented. It may be that TNF-alpha is also markedly involved in muscle inflammation (myositis). An animal model where this can be investigated is needed. A newly developed rabbit myositis model involving pronounced muscle overuse and local injections of substances having proinflammatory effects was therefore used in the present study. The aim was to investigate the patterns of TNF-alpha expression in the developing myositis and to evaluate the usefulness of this myositis model for further TNF-alpha research. Human rheumatoid arthritis (RA) synovial tissue was examined as a reference. TNF-alpha immunoexpression and TNF-alpha mRNA, visualized via in situ hybridization, were detected in cells in the inflammatory infiltrates of the affected muscle (soleus muscle). Coexistence of TNF-alpha and CD68 immunoreactions was noted, suggesting that the TNF-alpha reactive cells are macrophages. Expression of TNF-alpha mRNA was also noted in muscle fibers and blood vessel walls in areas with inflammation. These findings demonstrate that TNF-alpha is highly involved in the myositis process. The model can be used in further studies evaluating the importance of TNF-alpha in developing myositis.
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http://dx.doi.org/10.1155/2012/637452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312332PMC
August 2012

Treatment options for patellar tendinopathy: critical review.

Curr Sports Med Rep 2011 Sep-Oct;10(5):255-70

School of Primary Health Care, Monash University, Frankston, Australia.

Patellar tendinopathy is a painful knee injury due to overuse common among jumping athletes. Because rest from sport is neither a feasible nor an effective treatment for patellar tendinopathy in elite athletes, active treatment options are needed. Treatment may be conservative, injection-based, or surgical. This review synthesizes findings from 32 studies of varying quality published between 2001 and 2011. Painful eccentric squats using a 25°-decline board is supported as a first-line treatment. Extracorporeal shock wave therapy is no more effective than placebo. Sclerosing injections seem to be effective, but the evidence is not definitive. Shaving of abnormal tissue via arthroscopic surgery with real-time ultrasound guidance is superior to sclerosing injections. Steroid injections are inferior to exercise interventions and are not recommended. Injections of autologous blood, platelet-rich plasma, and hyperosmolar dextrose are unproven and experimental. Clinicians need to have a comprehensive knowledge of the evidence in the literature, as well as training and experience, when treating patellar tendinopathy.
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http://dx.doi.org/10.1249/JSR.0b013e31822d4016DOI Listing
September 2013

Physical activity level in Achilles tendinosis is associated with blood levels of pain-related factors: a pilot study.

Scand J Med Sci Sports 2011 Dec 8;21(6):e430-8. Epub 2011 Aug 8.

Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden.

Physical activity affects the pain symptoms for Achilles tendinosis patients. Brain-derived neurotrophic factor (BDNF), tumor necrosis factor-alpha (TNF-α) and their receptors have been detected in human Achilles tendon. This pilot study aimed to compare serum BDNF and soluble tumor necrosis factor receptor I (sTNFRI) levels in Achilles tendinosis patients and healthy controls and to examine the influence of physical activity, and BMI and gender, on these levels. Physical activity was measured with a validated questionnaire, total physical activity being the parameter analyzed. Physical activity was strongly correlated with BDNF among tendinosis women [Spearman's rho (ρ)=0.90, P<0.01] but not among control women (ρ=-0.08, P=0.83), or among tendinosis and control men. Physical activity was significantly correlated with sTNFRI in the entire tendinosis group and among tendinosis men (ρ=0.65, P=0.01), but not in the entire control group or among control men (ρ=0.04, P=0.91). Thus, the physical activity pattern is related to the TNF and BDNF systems for tendinosis patients but not controls, the relationship being gender dependent. This is new information concerning the relationship between physical activity and Achilles tendinosis, which may be related to pain for the patients. This aspect should be further evaluated using larger patient materials.
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http://dx.doi.org/10.1111/j.1600-0838.2011.01358.xDOI Listing
December 2011

Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy: contralateral effects suggest the involvement of central neuronal mechanisms.

Br J Sports Med 2011 Apr 6;45(5):399-406. Epub 2010 Jul 6.

Department of Integrative Medical Biology, Anatomy, Umeå University, Sweden.

Objective: To determine whether there are objective findings of tendinosis in a rabbit tendinopathy model on exercised and contralateral (non-exercised) Achilles tendons.

Design: Four groups of six New Zealand white rabbits per group were used. The animals of one (control) group were not subjected to exercise/stimulation.

Interventions: Animals were subjected to a protocol of electrical stimulation and passive flexion-extension of the right triceps surae muscle every second day for 1, 3 or 6 weeks.

Main Outcome Measures: Tenocyte number and vascular density were calculated. Morphological evaluations were also performed as well as in-situ hybridisation for vascular endothelial growth factor (VEGF) messenger RNA.

Results: There was a significant increase in the tenocyte number after 3 and 6 weeks of exercise, but not after 1 week, in comparison with the control group. This was seen in the Achilles tendons of both legs in experimental animals, including the unexercised limb. The pattern of vascularity showed an increase in the number of tendon blood vessels in rabbits that had exercised for 3 weeks or more, compared with those who had exercised for 1 week or not at all. VEGF-mRNA was detected in the investigated tissue, with the reactions being more clearly detected in the tendon tissue with tendinosis-like changes (6-week rabbits) than in the normal tendon tissue (control rabbits).

Conclusions: There were bilateral tendinosis-like changes in the Achilles tendons of rabbits in the current model after 3 weeks of training, suggesting that central neuronal mechanisms may be involved and that the contralateral side is not appropriate as a control.
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http://dx.doi.org/10.1136/bjsm.2009.068122DOI Listing
April 2011

Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and a peripheral fat distribution in women: a cross sectional study of 298 individuals.

BMC Musculoskelet Disord 2010 Mar 2;11:41. Epub 2010 Mar 2.

School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.

Background: Adiposity is a modifiable factor that has been implicated in tendinopathy. As tendon pain reduces physical activity levels and can lead to weight gain, associations between tendon pathology and adiposity must be studied in individuals without tendon pain. Therefore, the purpose of this study was to determine whether fat distribution was associated with asymptomatic Achilles tendon pathology.

Methods: The Achilles tendons of 298 individuals were categorised as normal or pathological using diagnostic ultrasound. Fat distribution was determined using anthropometry (waist circumference, waist hip ratio [WHR]) and dual-energy x-ray absorptiometry.

Results: Asymptomatic Achilles tendon pathology was more evident in men (13%) than women (5%) (p = 0.007). Men with tendon pathology were older (50.9 +/- 10.4, 36.3 +/- 11.3, p < 0.001), had greater WHR (0.926 +/- 0.091, 0.875 +/- 0.065, p = 0.039), higher android/gynoid fat mass ratio (0.616 +/- 0.186, 0.519 +/- 0.142, p = 0.014) and higher upper-body/lower body fat mass ratio (2.346 +/- 0.630, 2.022 +/- 0.467, p = 0.013). Men older than 40 years with a waist circumference >83 cm had the greatest prevalence of tendon pathology (33%). Women with tendon pathology were older (47.4 +/- 10.0, 36.0 +/- 10.3, p = 0.008), had less total fat (17196 +/- 3173 g, 21626 +/- 7882 g, p = 0.009), trunk fat (7367 +/- 1662 g, 10087 +/- 4152 g, p = 0.003) and android fat (1117 +/- 324 g, 1616 +/- 811 g, p = 0.005). They had lower central/peripheral fat mass ratios (0.711 +/- 0.321 g, 0.922 +/- 0.194 g, p = 0.004) than women with normal tendons. Women with tendon pathology were more often menopausal (63%, 13%, p = 0.002).

Conclusions: Men with Achilles tendon pathology were older and had a central fat distribution. Women with tendon pathology were older and had a peripheral fat distribution. An interaction between age and waist circumference was observed among men.
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http://dx.doi.org/10.1186/1471-2474-11-41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841085PMC
March 2010

Is adiposity an under-recognized risk factor for tendinopathy? A systematic review.

Arthritis Rheum 2009 Jun;61(6):840-9

School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.

Objective: Tendon injuries have been reported to occur more frequently in individuals with increased adiposity. Treatment also appears to have poorer outcomes among these individuals. Our objective was to examine the extent and consistency of associations between adiposity and tendinopathy.

Methods: A systematic review of observational studies was conducted. Eight electronic databases were searched (Allied and Complementary Medicine, Biological Abstracts, CINAHL, Current Contents, EMBase, Medline, SPORTDiscus, and Web of Science) and citation tracking was performed on included reports. Studies were included if they compared adiposity between subjects with and without tendon injury or examined adiposity as a predictor of conservative treatment success.

Results: Four longitudinal cohorts, 14 cross-sectional studies, 8 case-control studies, and 2 interventional studies (28 in total) met the inclusion criteria, providing a total of 19,949 individuals. Forty-two subpopulations were identified, 18 of which showed elevated adiposity to be associated with tendon injury (43%). Sensitivity analyses indicated a clustering of positive findings among studies that included clinical patients (81% positive) and among case-control studies (77% positive).

Conclusion: Elevated adiposity is frequently associated with tendon injury. Published reports suggest that elevated adiposity is a risk factor for tendon injury, although this association appears to vary depending on aspects of study design and measurement. Adiposity is of particular interest in tendon research because, unlike a number of other reported risk factors for tendon injury, it is somewhat preventable and modifiable. Further research is required to determine if reducing adiposity will reduce the risk of tendon injury or improve the results of treatment.
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http://dx.doi.org/10.1002/art.24518DOI Listing
June 2009

Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance.

Med Sci Sports Exerc 2009 Jun;41(6):1194-7

School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.

Unlabelled: Overuse is considered to be a main causative factor for tendinopathies; however, recent reports indicate that tendinopathy is also common among both overweight and inactive individuals. These factors are associated with abdominal obesity, dyslipidemia, hypertension, and insulin resistance. We hypothesized that these features would be associated with tendinopathy.

Purpose: To compare lipid profile between participants with Achilles tendinopathy and matched controls.

Methods: Fasting serum lipids were measured among 60 participants with chronic painful midportion Achilles tendinopathy (54% male) and 60 control subjects matched for gender, age (+/-10 yr), and body mass index (+/-2 kg x m(-2)).

Results: The participants with Achilles tendinopathy showed evidence of underlying dyslipidemia. They had higher triglyceride (TG) levels (P = 0.039), lower %HDL-C (P = 0.016), higher TG/HDL-C ratio (P = 0.036), and elevated apolipoprotein B concentration (P = 0.017) in comparison to the well-matched control group.

Conclusions: This pattern of dyslipidemia is characteristic of the dyslipidemia displayed by individuals with insulin resistance and is common in the metabolic syndrome. Two additional aspects of tendinopathy research support a connection with the metabolic syndrome. First, tendinopathy has been associated with greater waist circumference, as has the metabolic syndrome. Second, insulin resistance has been associated with fat deposition in muscle (primarily intracellular), whereas fat deposition in tendon has been found among those with tendon pain.If tendinopathy is confirmed to be associated with dyslipidemia and the metabolic syndrome in larger studies, it may be appropriate to redefine our concept of tendinopathy to that of a cardiovascular disease (CVD). In this case, we may be able to draw considerably on CVD research to improve our understanding of tendinopathy, and perhaps treating CVD risk factors will improve the treatment of tendinopathy.
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http://dx.doi.org/10.1249/MSS.0b013e31819794c3DOI Listing
June 2009

Adiposity and tendinopathy.

Disabil Rehabil 2008 ;30(20-22):1555-62

Deakin University, Melbourne, Victoria, Australia.

Purpose: Tendon injuries (tendinopathy) are prevalent across the population, affecting active and inactive individuals and manual workers. The aetiology of tendinopathy is not known. However, extrinsic factors such as load are known to affect the prevalence. More recently, intrinsic factors have been shown to also affect tendons; genes, biomechanics, and strength have been shown to influence tendon disease. One intrinsic factor that appears to have an association with tendinopathy is body composition; more specifically central adiposity. Several studies have reported this association, and several studies have found the association when reporting other aspects of tendinopathy.

Method: This paper will detail what is known about the association between tendinopathy and body composition, examine the strength of the association by evaluating studies in the area and speculate on potential mechanisms for the association.

Results: The association between tendon health and adiposity, especially central adiposity, warrants further investigation.

Conclusion: There may be an interaction between adiposity and tendon pathology. Adiposity may be a key intrinsic risk factor that is translated into tendon disease in the presence of additional intrinsic (e.g., diabetes) and extrinsic factors (e.g., load).
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http://dx.doi.org/10.1080/09638280701786864DOI Listing
February 2009

Controlling implant costs.

Healthc Financ Manage 2006 Apr;60(4):suppl 1-6 following 52

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April 2006

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

Br J Sports Med 2004 Oct;38(5):581-5

Musculoskeletal Research Centre, School of Physiotherapy, La Trobe University, Bundoora, 3086, Australia.

Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition.

Objectives: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy.

Methods: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180 degrees /s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero.

Results: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07).

Conclusions: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.
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http://dx.doi.org/10.1136/bjsm.2003.006015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724954PMC
October 2004

A partnership to affect real cost reduction: a guaranteed savings of $20 million.

Authors:
J B Gaida

J Healthc Resour Manag 1996 Oct;14(8):10-3

Partners HealthCare System Inc, Boston, MA, USA.

In 1994 Brigham and Women's Hospital and Massachusetts General Hospital joined forces to form Partners HealthCare System, Inc. (Boston, MA), an integrated healthcare delivery system. Both teaching affiliates of Harvard Medical School, the two hospitals comprise approximately 1,750 beds with 80,000 inpatient admissions and 1.3 million outpatient visits annually. The two campuses have over 16,000 employees in facilities covering 6.5 million square feet. The key goals of their partnership were to reduce cost and improve quality. Partners HealthCare System (PHS) set a goal to save $240 million in the first three years. These savings were to be achieved through consolidating departments and programs, adopting best practices between institutions, and wise purchasing. This article looks at the supplier partnering process followed by PHS to affect a guaranteed savings of $20 million.
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October 1996

Considering making the move from materials management to support services? Here's what you need to succeed.

Authors:
J B Gaida

Hosp Mater Manage 1996 Jul;21(7):16-7

Partners HealthCare System, Inc., Boston, MA, USA.

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July 1996

Focus on internal marketing for a successful department.

Authors:
J B Gaida

Hosp Mater Manage 1988 Aug;13(8):6-8

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August 1988

Computerized exchange cart processing.

J Hosp Supply Process Distrib 1984 Jan-Feb;2(1):40-2

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March 1984
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