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Workshop: “‘Sciatica’: neuropathic or not and does it matter? Outcomes from a NeuPSIG working group”
(2023)
The identification of neuropathic pain in persons with spine-related leg pain is important as this information guides treatment and management, including self-management. The NeuPSIG neuropathic pain grading system was developed to assist clinicians and researchers in determining whether patients have neuropathic pain and the level of confidence associated with that decision. Based on clinical and laboratory examination findings, patients are classified as having no neuropathic pain, possible, probable or definite neuropathic pain. Whereas this grading system works nicely in people with systemic neuropathies where sensory findings and diagnostic tests are mostly present, its application in patients with spine-related leg pain, particular in radicular pain, can be challenging. For example, in the absence of sensory changes and MRI findings, patients with radicular pain would at best reach a classification of possible neuropathic pain according to the current neuropathic pain grading system.
In this presentation I will explain the adaptations to the neuropathic pain grading system for spine-related leg pain recommended by the NeuPSIG working group. I will demonstrate its application in clinical practice using case studies and provide clarity for how the system can be incorporated in clinical trials. This will be an interactive session with audience participation.
Dairy farming has been the subject of public debate on animal welfare for a number of years now. Animal welfare discussions on dairy farming often include the demand for more nature connectedness in this area. This study focuses on the divergent perspectives of consumers and scientists on the importance of more nature connectedness for animal welfare strategies in German dairy farming. Within Europe, Germany is the main producer of cow’s milk and an important industry in many rural areas in Germany is dairy farming. The insights presented are based on qualitative interviews with dairy farming and livestock researchers from Germany and Austria. A key finding of this study is that we need to look more closely at the actual content of nature claims in animal welfare debates. The scientists interviewed tend to see idealized conditions in animal welfare discussions with images of nature which in fact seldom lead to improved conditions in dairy farming and, even then, only to a limited extent. The scientists interviewed rate calls for more nature connectedness in dairy farming from the nonagricultural public as anti-modern, complexity-reducing, and normative. Nevertheless, some of the scientists interviewed did have valuable insights into the nonagricultural public’s criticism of dairy farming practices. These scientists argued, however, that animal welfare needs to differentiate between nature connectedness and the innate needs of cattle when it comes to animal welfare strategies. An important conclusion of the study is that more discussion formats are needed to promote the exchange of ideas between different social groups attempting to understand animal welfare in dairy farming.
Iron deficiency is still widespread as a major health problem even in countries with adequate food supply. It mainly affects women but also vegans, vegetarians, and athletes and can lead to various clinical pictures. Biofortification of vitamin C-rich vegetables with iron may be one new approach to face this nutritional challenge. However, so far, little is known about the consumer acceptance of iron-biofortified vegetables, particularly in developed countries. To address this issue, a quantitative survey of 1000 consumers in Germany was conducted. The results showed that depending on the type of vegetable, between 54% and 79% of the respondents were interested in iron-biofortified vegetables. Regression analysis showed a relationship between product acceptance, gender, and area of residence. In addition, relationships were found between consumer preferences for enjoyment, sustainability, and naturalness. Compared to functional food and dietary supplements, 77% of respondents would prefer fresh iron-rich vegetables to improve their iron intake. For a market launch, those iron-rich vegetables appear especially promising, which can additionally be advertised with claims for being rich in vitamin C and cultivated in an environmentally friendly way. Consumers were willing to pay EUR 0.10 to EUR 0.20 more for the iron-biofortified vegetables.
Hyperhydricity (HH) is one of the most important physiological disorders that negatively affects various plant tissue culture techniques. The objective of this study was to characterize optical features to allow an automated detection of HH. For this purpose, HH was induced in two plant species, apple and Arabidopsis thaliana, and the severity was quantified based on visual scoring and determination of apoplastic liquid volume. The comparison between the HH score and the apoplastic liquid volume revealed a significant correlation, but different response dynamics. Corresponding leaf reflectance spectra were collected and different approaches of spectral analyses were evaluated for their ability to identify HH-specific wavelengths. Statistical analysis of raw spectra showed significantly lower reflection of hyperhydric leaves in the VIS, NIR and SWIR region. Application of the continuum removal hull method to raw spectra identified HH-specific absorption features over time and major absorption peaks at 980 nm, 1150 nm, 1400 nm, 1520 nm, 1780 nm and 1930 nm for the various conducted experiments. Machine learning (ML) model spot checking specified the support vector machine to be most suited for classification of hyperhydric explants, with a test accuracy of 85% outperforming traditional classification via vegetation index with 63% test accuracy and the other ML models tested. Investigations on the predictor importance revealed 1950 nm, 1445 nm in SWIR region and 415 nm in the VIS region to be most important for classification. The validity of the developed spectral classifier was tested on an available hyperspectral image acquisition in the SWIR-region.
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
Novel foods by process are a special case in the catalogue of the ten novel food categories according to Article 3 (2) point (a) of the Novel Food Regulation (EU) 2015/2283, since the other nine categories derive their assessment as possible novel foods from their purely substantial properties. In the case of novel foods by process, the problem of dealing with the reference date of 15 May 1997, which is in the end a random reference date, is particularly significant. It would make more sense to have a dynamic reference date that ‘moves along the timeline’ or at least is reset from time to time and is more up-to-date. The characteristic that a process causes ‘significant changes in the composition or structure of the food, affecting its nutritional value, metabolism or level of undesirable substances’ must be understood in such a way that it is only a question of the generation of undesirable substances through the application of the process, but not their reduction, e.g. the reduction of undesirable microorganisms. Finally, the question also arises as to how the assessment of the process technology relates to the assessment of a food in the context of a novel food by composition category. This concerns the exemption for foods that have a history of use as safe foods, which, according to the view taken here, must also be interpreted into the category of novel foods by process.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.