The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real time ultrasound: should the prone position also be used?

AmsterdamThe standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.In this paper the relationship between academic load (the number of modules attempted) and academic performance is investigated in a Scottish and an Australian university. An engagement approach to academic integration is employed, in which there is feedback between load and performance, and in which there is scope for diminishing returns to the study of additional modules onceloads become high. The results indicate that full-time students reduced module load in response to information on academic performance. At the Scottish business school many non-traditional students had taken up opportunities to enter university under the UK government's drive to widenparticipation. In that school load reduction was undertaken at twice the rate of the Australian businessschool. For women, reductions from full-time loads by one or two modules appear rational in that better average marks result. There are indications that status as a widening participation entrant, the learning and assessment environment, the funding regime and rest-of-life demands have influences on load reduction and on academic performance.sch_rad3pub1152pub8

The Nottingham system of back shape and body appraisal for idiopathic scoliosis

Our Research Report for 2000-2002 reflects an outstanding level of achievement throughout the institution and demonstrates once again our high level of commitment to strategic and applied research particularly in areas that enhance the quality of life.sch_radpub1202pub1

Anthropometry and allometry in girls with right thoracic adolescent idiopathic scoliosis (AIS).

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Torsion in the lower limb bones of patients with adolescent idiopathic scoliosis (AIS) treated surgically.

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Segmental rotation of vertebrae and ribs in scoliosis evaluated by a new real-time ultrasound method.

The importance of human resources management (HRM) to the success or failure of health systemperformance has, until recently, been generally overlooked. In recent years it has been increasinglyrecognised that getting HR policy and management right has to be at the core of any sustainablesolution to health system performance. In comparison to the evidence base on health care reformrelatedissues of health system finance and appropriate purchaser/provider incentive structures,there is very limited information on the HRM dimension or its impact.Despite the limited, but growing, evidence base on the impact of HRM on organisationalperformance in other sectors, there have been relatively few attempts to assess the implications ofthis evidence for the health sector. This paper examines this broader evidence base on HRM inother sectors and examines some of the underlying issues related to good HRM in the healthsector.The paper considers how human resource management (HRM) has been defined and evaluated inother sectors. Essentially there are two sub-themes: how have HRM interventions been defined?and how have the effects of these interventions been measured in order to identify whichinterventions are most effective? In other words, what is good HRM?The paper argues that it is not only the organisational context that differentiates the health sectorfrom many other sectors, in terms of HRM. Many of the measures of organisational performanceare also unique. Performance in the health sector can be fully assessed only by means of indicatorsthat are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff peroccupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated)or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgerycomplications).The paper also stresses the need for a fit between the HRM approach and the organisationalcharacteristics, context and priorities, and for recognition that so-called bundles of linked andcoordinated HRM interventions will be more likely to achieve sustained improvements inorganisational performance than single or uncoordinated interventions.sch_rad7pub1203pub2

Evaluation of a new real-time ultrasound method for measuring segmental rotation of vertebrae and ribs in scoliosis.

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Anthropometry and allometry in girls with right thoracic adolescent idiopathic scoliosis (AIS).

Amsterdamsch_rad37pub1117pu

Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method.

AmsterdamThis paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.Research evidence suggests that UK consumers are facingsignificant problems with goods and services and are inneed of information and advice to avoid or redress suchsituations. Consumers are not always aware of their rightsnor where they can access consumer advice services. In2000, the Department of Trade and Industry launched theConsumer Support Network (CSN) programme in Great Britainto improve consumer access to expert, accurate andtimely advice. One challenge faced by these Networks andmany other agencies is to assess the needs of consumersfor consumer information and advice services. A needsassessment is required as a key element in the effectiveplanning and development of services in each Network at alocal level. The focus of the needs assessment at the locallevel is to encourage Networks to consider suitable solutions to meet the needs of people in their communities. This paper provides a review of the development of Consumer Support Networks in Great Britain and discusses the importance of needs assessment to service providers such as CSNs and other agencies. It reveals the complexity associated with conducting effective needs assessments including the various aspects of needs, consumer segmentation and characteristics of consumer information and advice. Further research is being carried out at Queen Margaret University College, UK, with a view to the development of a scientific model for the assessment of need for consumer information and advice services.sch_rad4pub1155pub9

Torsion in the lower limb bones of children screened for adolescent idiopathic scoliosis (AIS).

Amsterdamsch_rad1pub1115pub3

Back shape assessment in each of three positions in preoperative patients with adolescent idiopathic scoliosis: evaluation of a 10-level Scoliometer method interpolated to 18-levels.

AmsterdamA Scoliometer was used by one observer (RKP) to assess the reproducibility of angle of trunk inclinations (ATIs) in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, age 15.4 years, girls 10). Three positions were used namely standing forward-bending, (FB) sitting FB and prone. Readings of ATI on the back were obtained at each of 10 levels (T1-S1). The subject was repositioned after walking around the room and a second set of readings obtained (repeats). All readings were converted by a computer program to 18 levels and plotted. The readings from 18 levels were analysed by level, as well as summated and averaged both without and with correction for the side of the curve. Conclusions. Back surface asymmetry measured with a Scoliometer in these preoperative patients with AIS is less in the prone position than in each of the forward bending positions. The standing FB position has the best reproducibility which supports the practice of using this position to measure Scoliometer ATIs in preoperative patients with AIS.Research evidence suggests that UK consumers are facingsignificant problems with goods and services and are inneed of information and advice to avoid or redress suchsituations. Consumers are not always aware of their rightsnor where they can access consumer advice services. In2000, the Department of Trade and Industry launched theConsumer Support Network (CSN) programme in Great Britainto improve consumer access to expert, accurate andtimely advice. One challenge faced by these Networks andmany other agencies is to assess the needs of consumersfor consumer information and advice services. A needsassessment is required as a key element in the effectiveplanning and development of services in each Network at alocal level. The focus of the needs assessment at the locallevel is to encourage Networks to consider suitable solutions to meet the needs of people in their communities. This paper provides a review of the development of Consumer Support Networks in Great Britain and discusses the importance of needs assessment to service providers such as CSNs and other agencies. It reveals the complexity associated with conducting effective needs assessments including the various aspects of needs, consumer segmentation and characteristics of consumer information and advice. Further research is being carried out at Queen Margaret University College, UK, with a view to the development of a scientific model for the assessment of need for consumer information and advice services.sch_rad4pub1156pub9