Disc disease: A summary and review

A review of the etiology, clinical, radiological and laboratory presentation, differential diagnosis and management goals of disc disease is presented. Keywords: Disc disease, disc herniation, disc bulge, disc prolapse, disc lesion, internal disc disruption, annular tear, chemical radiculitis, low back pain, sciatica, chiropracti

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

Intelligent multimedia communication for enhanced medical e-collaboration in back pain treatment

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2004 SAGE PublicationsRemote, multimedia-based, collaboration in back pain treatment is an option which only recently has come to the attention of clinicians and IT providers. The take-up of such applications will inevitably depend on their ability to produce an acceptable level of service over congested and unreliable public networks. However, although the problem of multimedia application-level performance is closely linked to both the user perspective of the experience as well as to the service provided by the underlying network, it is rarely studied from an integrated viewpoint. To alleviate this problem, we propose an intelligent mechanism that integrates user-related requirements with the more technical characterization of quality of service, obtaining a priority order of low-level quality of service parameters, which would ensure that user-centred quality of perception is maintained at an optimum level. We show how our framework is capable of suggesting appropriately tailored transmission protocols, by incorporating user requirements in the remote delivery of e-health solutions

Focal Spot, Summer 2003

https://digitalcommons.wustl.edu/focal_spot_archives/1094/thumbnail.jp

The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy

Background: Good control of trunk and pelvic movements is necessary for well controlled leg movements required to perform activities of daily living. The nature of movement coupling between the trunk and pelvis varies and depends on the type of activity. Children with cerebral palsy often have reduced ability to modulate coupling between the trunk and pelvis but movement patterns of the pelvis can be improved by training. The aim of this study was to examine how pelvis to trunk coupling changed while playing a computer game driven by pelvic rotations

Applications of 3D printing in the management of severe spinal conditions

The latest and fastest-growing innovation in the medical field has been the advent of three-dimensional printing technol- ogies, which have recently seen applications in the production of low-cost, patient-specific medical implants. While a wide range of three-dimensional printing systems has been explored in manufacturing anatomical models and devices for the medical setting, their applications are cutting-edge in the field of spinal surgery. This review aims to provide a com- prehensive overview and classification of the current applications of three-dimensional printing technologies in spine care. Although three-dimensional printing technology has been widely used for the construction of patient-specific ana- tomical models of the spine and intraoperative guide templates to provide personalized surgical planning and increase pedicle screw placement accuracy, only few studies have been focused on the manufacturing of spinal implants. Therefore, three-dimensional printed custom-designed intervertebral fusion devices, artificial vertebral bodies and disc substitutes for total disc replacement, along with tissue engineering strategies focused on scaffold constructs for bone and cartilage regeneration, represent a set of promising applications towards the trend of individualized patient care

Focal Spot, Winter 1983

https://digitalcommons.wustl.edu/focal_spot_archives/1033/thumbnail.jp

The application of generic CAD/CAM systems for the design and manufacture of foot orthoses

For many years, foot orthoses have been manufactured using traditional techniques over plaster of Paris casts or foam impressions. Other types of existing orthoses include pre-fabricated and heat-molded orthoses. More advanced methods of manufacturing orthoses have been developed using Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) technology. However, this type of technology is still presently expensive and thus not available to the majority of practitioners to consider as part of their routine clinical service, notwithstanding the fact that these systems offer various advantages over traditional methods. This paper provides a new methodological approach towards integrating various readily-available technologies into a foot orthoses design and manufacturing system at a cost that is attainable by the majority of practitioners. This should encourage the further utilization of this technology, from which both practitioner services and patients could possibly benefit.peer-reviewe

Computer-aided surface estimation of pain drawings – intra- and inter-rater reliability

Pain drawings are often utilized in the documentation of pain conditions. The aim here was to investigate intra- and inter-rater reliability of area measurements performed on pain drawings consecutively, using the computer program Quantify One. Forty-eight patients with chronic nonmalignant pain had shaded in their experienced pain on the front and back views of a pain drawing. The templates were scanned and displayed on a 17-inch computer screen. Two independent examiners systematically encircled the shaded-in areas of the pain drawings with help of a computer mouse, twice each on two separate days, respectively. With this method it is possible to encircle each marked area and to obtain immediate details of its size. The total surface area (mm2) was calculated for each pain drawing measurement. Each examiner measured about 2400 areas, and as a whole, the number of areas measured varied only by 3%. The intra-rater reliability was high with intraclass correlation coefficients 0.992 in Examiner A and 0.998 in Examiner B. The intra-individual absolute differences were small within patients within one examiner as well as between the two examiners. The inter-rater reliability was also high. Still, significant differences in the absolute mean areas (13%) were seen between the two examiners in the second to fourth measurement sessions, indicating that one of the examiners measured systematically less. The measurement error was ≤10%, indicating that use of the program would be advantageous both in clinical practice and in research, but if repeated, preferably with the same examiner. Since pain drawings with this method are digitized, high quality data without loss of information is possible to store in electronic medical records for later analysis, both regarding precise location and size of pain area. We conclude that the computer program Quantify One is a reliable method to calculate the areas of pain drawings