Clinical effect of continuous corrective force delivery in the non-operative treatment of idiopathic scoliosis: a prospective cohort study of the triac-brace

A prospective cohort study of skeletally immature idiopathic scoliotic patients treated with the TriaC brace. To determine if the TriaC brace is effective in preventing curve progression in immature adolescent idiopathic scoliotic patients with a very high risk of curve progression based on reported natural history data. The aim of the newly introduced TriaC brace is to reverse the pathologic transverse force pattern by externally applied and continuously present orthotic forces. In the frontal plane the force system used in the TriaC brace is similar to the force system of the conventional braces. However, in the sagittal plane the force system acts only on the thoracic region. In addition, the brace allows upper trunk flexibility without affecting the corrective forces during body motion. In a preliminary study it is demonstrated that the brace prevents further progression of both the Cobb angle and axial rotation in idiopathic scoliosis. Skeletally immature patients with idiopathic scoliosis with curves between 20 and 40° were studied prospectively. Skeletally immature was defined as a Risser sign 0 or 1 for both boys and girls, or pre-menarche or less than 1-year post-menarche for girls. Curves of less than 30° had to have documented progression before entry. The mean age of the patients at the start of treatment was 11.3 ± 3.1 years. All measurements were collected by a single observer, and all patients were followed up to skeletal maturity. Treatment was complete for all participants when they had reached Risser sign 4 and did not show any further growth at length measurements. This was at a mean age of 15.6 ± 1.1 years, with a mean follow-up of 1.6 years post bracing. In our study a successful outcome was obtained in 76% of patients treated with the TriaC brace. Comparing our data to literature data on natural history of a similar cohort shows that the TriaC brace significantly alters the predicted natural history. The current study demonstrates that treatment with the TriaC brace reduces the scoliosis, and that the achieved correction is maintained in some degree after skeletal maturity is reached and bracing is discontinued. It also prevents further progression of the Cobb angle in idiopathic scoliosis. The new brace does not differ from the conventional braces as far as maintaining the deformity is concerned

Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available.Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis.Systematic overview of systematic reviews.Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute's hierarchies were applied to analyze the levels of evidence from included reviews.From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established.Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers labeled as systematic reviews need to be considered in terms of their methodological rigor; otherwise they may be mistakenly regarded as high quality sources of evidence.CRD42013003538, PROSPERO

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

Development and implementation of a medical record system for the Istituti Clinici di Perfezionamento public network of outpatient specialty clinics in Milano, Italy

The Istituti Clinici di Perfezionamento of Milano (ICP) Hospital, Italy took the charge of managing the network of 22 outpatient specialty clinics of Milano in 2008. Within these clinics 650.000 visits are performed yearly by 255 specialists of 26 different specialties. Until 2008 these clinics have been managed by several different Public Hospitals, there was no unique standard for paper medical records and only a minority of patients encounters were registered electronically. ICP is one Public Hospital of the Lombardia Region, which had developed a Health Information System called SISS. SISS allows all the entitled public health professionals to gain access to individual patient records which contain demographic, clinical and service utilisation data registered with SISS standards. Furthermore, standards for both paper and electronic hospital records have been clearly defined by the Regione Lombardia. In this context ICP started a program for the development and implementation of an outpatient specialty clinics medical record system that took off at the end of 2009. A project team was settled, composed of specialists\u2019 representatives, quality management and organization experts from within the ICP. In six months the group defined: \u2022 The outpatient medical records general structure and format standards \u2022 The structure and content of the medical documentation for 10 main specialties that cover more than 90% the ambulatory visits and more than 75% of the specialists \u2022 The functions needed to integrate patient clinical and administrative management \u2022 The implementation plan of the medical record system, comprehensive of the evaluation of logistic, hardware, medical education and quality control needs within each of the 22 clinics \u2022 The overall medical record system architecture in order to integrate future development with the opportunities offered by the SIS

Flow cytometry measurement of cytokine receptors in acute leukemias. Clinical and biologic implications

In the last few years, the molecular cloning and purification of several hemopoietic growth factors (GF) and cytokines has made it possible to use them (at least some of these GF) in the clinical setting of many haematological disorders. The main clinical use of G- CSF and GM-CSF is to stimulate recovery of’ neutropenia and/or monocytopenia following myeloablative chemotherapy, radiotherapy, and/or bone marrow transplantation. Although the administration of these CF in patients affected by neoplastic proliferaiion of 1 lymphoid origin (ALL, MM, and MI.) is widely accepted, their clinical usefulness and safety in lhe management of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) is still controversial. However, a number of reports have shown that CM-CSF anti G-NSF could be given to AML patients, without increasing the remission and the relapse rates or shortening the life expectancy of the disease. In othter words, the risk of stimulating the leukcrnic clone using GF seems to be very low even in patients with myeloid maligriancies