Background Lateral flow devices (LFDs) are viral antigen tests for the detection of SARS-CoV-2 that produce a rapid result, are inexpensive and easy to operate. They have been advocated for use by the World Health Organisation to help control outbreaks and break the chain of transmission of COVID-19 infections. There are now several studies assessing their accuracy but as yet no systematic review. Our aims were to assess the sensitivity and specificity of LFDs in a systematic review and summarise the sensitivity and specificity of these tests. Methods A targeted search of Pubmed and Medxriv, using PRISMA principles, was conducted identifying clinical studies assessing the sensitivity and specificity of LFDs as their primary outcome compared to reverse transcriptase polymerase chain reaction (RT-PCR) for the detection of SARS-CoV-2. Based on extracted data sensitivity and specificity was calculated for each study. Data was pooled based on manufacturer of LFD and split based on operator (self-swab or by trained professional) and sensitivity and specificity data were calculated. Results Twenty-four papers were identified involving over 26,000 test results. Sensitivity from individual studies ranged from 37.7% (95% CI 30.6–45.5) to 99.2% (95% CI 95.5–99.9) and specificity from 92.4% (95% CI 87.5–95.5) to 100.0% (95% CI 99.7–100.0). Operation of the test by a trained professional or by the test subject with self-swabbing produced comparable results. Conclusions This systematic review identified that the performance of lateral flow devices is heterogeneous and dependent on the manufacturer. Some perform with high specificity but a great range of sensitivities were shown (38.32–99.19%). Test performance does not appear dependent on the operator. Potentially, LFDs could support the scaling up of mass testing to aid track and trace methodology and break the chain of transmission of COVID-19 with the additional benefit of providing individuals with the results in a much shorter time frame.

Purpose To investigate the effects of four office chairs on the postural angles of the lumbopelvic and cervical regions. Research question Which chair(s) produce an ''ideal'' spinal posture? Methods An experimental same subject design was used involving healthy subjects (n = 14) who conducted a typing task whilst sitting on four different office chairs; two ''dynamic'' chairs (Vari-Kneeler and Swopper), and two static chairs (Saddle and Standard Office with back removed). Data collection was via digital photogrammetry, measuring pelvic and lumbar angles, neck angle and head tilt which were then analysed within MatLab. A repeated measures ANOVA with Bonferroni corrections for multiple comparisons was conducted. Results Statistically significant differences were identified for posterior pelvic tilt and lumbar lordosis between the Vari-Kneeler and Swopper chairs (p = 0.006, p = 0.001) and the Vari-Kneeler and Standard Office chairs (p = 0.000, 0.000); and also for neck angle and head tilt between the Vari-Kneeler and Swopper chairs (p = 0.000, p = 0.000), the Vari-Kneeler and Saddle chairs (p = 0.002, p = 0.001), the Standard Office and Swopper chairs (p = 0.000, p = 0.000), and the Standard Office and Saddle chairs (p = 0.005, p = 0.001). This study confirms a within region association between posterior pelvic tilt and lumbar lordosis, and between neck angle and head tilt. It was noted that an ideal lumbopelvic position does not always result in a corresponding ideal cervical position resulting in a spinal alignment mismatch. Conclusion In this study, the most appropriate posture for the lumbopelvic region was produced by the Saddle chair and for the cervical region by both the Saddle and Swopper chairs. No chair consistently produced an ideal posture across all regions, although the Saddle chair created the best posture of those chairs studied. Chair selection should be based on individual need.

Introduction  Currently there are no consensuses in the national guidance on thromboprophylaxis following major elective lower limb surgery. Emerging clinical evidence suggests that aspirin could be just as effective as anticoagulants with a lower cost. The aim of this study was to provide an update based on literature of the past 3 years for the use of aspirin as thromboprophylaxis after knee and hip arthroplasty. Materials and Methods  MEDLINE/EMBASE search was performed with appropriate terms for original articles from 2014 to 2017. Results  Eight articles were found. Five articles concluded that aspirin was an effective prophylactic. The collation of results on the deep vein thrombosis rate involved 43,012 patients who were prescribed aspirin, of which 283 (0.66%) suffered from symptomatic deep vein thromboses. Aspirin was noted for its good side effect profile and cost effectiveness. It was noted that anticoagulants had a higher rate of complications, including bleeding and wound-oozing. Conclusion  Aspirin is an effective and safe prophylactic against deep vein thrombosis following major elective lower limb arthroplasty surgery.

Background  The incidence of osteoarthritis is increasing and it is one of the most common causes of chronic conditions. Total knee replacement is the mainstay of treatment for end-stage knee osteoarthritis; however, with long waiting lists and high levels of dissatisfaction, a treatment like knee braces could potentially delay surgery. Unicompartmental knee osteoarthritis is associated with misalignment of the knee, and unloader bracing has been recommended by various guidelines to correct this misalignment. The aim of this report was to provide an update of evidence from the past 10 years on knee braces. Methods  MEDLINE/EMBASE search was performed from the past 10 years. Results  We reviewed the evidence from 14 published articles. Almost all articles supported knee brace use and showed it to decrease pain, improve function, and improve the quality of life of patients. One study in 2017 followed patients for long term and found knee bracing to be more cost effective than total knee replacement, and could replace the need for surgery. Several minor complications were reported with bracing, like soft tissue irritation, which could be due to poor fitting. A management strategy for this could be regular follow-up at a nurse-led clinic. Conclusions  Unloader braces are an economical and effective treatment for unicompartmental knee osteoarthritis. They can significantly improve a patient's quality of life and potentially delay the need for surgery. Patients should be managed with a multidisciplinary approach with conservative management and knee bracing, before surgery is considered.