Brace Treatment for Adults with Spinal Deformities

The bracing indication for adults with spinal deformities is two-fold: (1) pain and (2) deformity. Although pain is more frequent in the adult population with scoliosis, there is no correlation between the angle of curvature and pain intensity. Pain is reportedly more frequent in patients who were operated. Non-specific pain can successfully be treated with stabilisation exercises; however, some patients may need brace treatment to improve their pain. Today, with the help of a simple clinical test, we can distinguish between different types of lower back pain allowing a differential approach to the symptom. There is some evidence that pain can successfully be reduced by these approaches mainly influencing the sagittal profile. In patients with bigger deformities and in patients aiming at reducing their deformity, pattern-specific scoliosis braces are a successful choice according to published research cases. The different specific brace types/designs along with the differential indication for these brace types will be described in this chapter

Brace Treatment for Children and Adolescents with Scoliosis

The aim of brace treatment in patients with scoliosis during growth is (1) to stop curve progression and (2) to improve appearance/cosmesis. There is high quality evidence available supporting brace treatment. According to recent publications, the outcomes of different braces vary to a high extent. Although most of the scoliosis cases will not affect the patient’s health, the impact of braces on the cosmetic outcome to date is not well determined. Standardised asymmetric braces (mainly Chêneau derivatives) have better outcomes than symmetric compression braces and may also lead to significant improvements of the deformity. For symmetric braces, no evidence exists that these could significantly change the deformity. Soft braces have no indication and the use of night-time braces should be largely restricted due to poor outcomes when compared to current standards of full-time bracing

Cybrary Support for Learning, Teaching and Research at The University of Queensland - the 1998 University of the Year

The Library has taken a leadership role in addressing the real needs of students in the 21st Century. It is working collaboratively with students and staff to meet their learning and teaching needs as new technological and service possibilities become available. The Library has integrated new web developments with traditional services to create Australia's first Cybrary - a 'virtual library' in a 'wired university'. The Cybrary is an indispensable, integrated approach to meet the information demands of lifelong learning and problem based teaching. It is a powerful support for flexible learning and an enhancement to flexible teaching. The University of Queensland Library has traditionally been an early adopter of technology. In the early 1970s online databases were searched for clients; then an electronic catalogue was introduced. When CD-ROM technology opened up the world of enduser access to electronic bibliographic databases the Library was among the first to provide its clients with these products. As a proactive electronic service provider, the Library has adopted and utilized Internet and Web technology as a vehicle to provide better service to its clients. As a result of its prompt and innovative adoption of leading edge technologies the Library has developed the Cybrary. The services offered through the Cybrary support the complex and varied learning journeys that both students and staff undertake in the current educational environment. Students and staff are able to control their own research and learning to a degree not known before. Last year the Library was recognised for its innovative Cybrary services when it jointly won the highly regarded Institutional Award for Services to Australian Students in the Australian Awards for University Teaching. The paper describes the Cybrary's components and the challenges faced in its implementation

Management of Spinal Deformities and Evidence of Treatment Effectiveness

Introduction:The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults.Material and Methods:The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann’s disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included.Results:The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn.For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis, refractory pain and loss of balance.Discussion:The available evidence reviewed has suggested that different approaches are needed towards the management of different spinal deformities. Specific exercises should be prescribed in children and adolescents with a Cobb angle in excess of 15°. In progressive curves, they should be used in conjunction with bracing. Clarity regarding differences and similarities is given as to what makes PSSE and PSSR specific exercises. As AIS is relatively benign in nature, conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered. Similarly, bracing and exercises should be prescribed for patients with hyperkyphosis, particularly when the lumbar spine is afflicted. Surgery should be considered only when the symptoms cannot be managed conservatively.Conclusion:There is at present high quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications.There is, however a lack of evidence in support of any treatment of choice for hyperkyphosis in adolescents and spinal deformities in adults. Yet, conservative treatment should be considered first. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS and hyperkyphosis. Additionally, surgery needs to be considered with caution, as it is associated with a number of long-term complications.</jats:sec

Patient satisfaction with treatment for alcohol use disorders: comparing patients with and without severe mental health symptoms

BACKGROUND: Previous studies suggest patients with co-occurring alcohol use disorders (AUDs) and severe mental health symptoms (SMHS) are less satisfied with standard AUD treatment when compared to patients with an AUD alone. This study compared patient satisfaction with standard AUD treatment among patients with and without SMHS and explored how standard treatment might be improved to better address the needs of these patients. METHODS: Eighty-nine patients receiving treatment for an AUD either at an inpatient hospital, outpatient clinic, inpatient detoxification, or residential/therapeutic community services were surveyed. Patient satisfaction with treatment was assessed using the Treatment Perception Questionnaire (range: 0-40). Patients were stratified according to their score on the Depression Anxiety Stress Scale. Forty patients scored in the extremely severe range of depression (score &gt;14) and/or anxiety (score &gt;10) (indicating SMHS) and 49 patients did not. An inductive content analysis was also conducted on qualitative data relating to areas of service improvement. RESULTS: Patients with SMHS were found to be equally satisfied with treatment (mean =25.10, standard deviation =8.12) as patients with an AUD alone (mean =25.43, standard deviation =6.91). Analysis revealed that being an inpatient in hospital was associated with reduced treatment satisfaction. Patients with SMHS were found to be significantly less satisfied with staffs\u27 understanding of the type of help they wanted in treatment, when compared to patients with AUDs alone. Five areas for service improvement were identified, including staff qualities, informed care, treatment access and continuity, issues relating to inpatient stay, and addressing patients\u27 mental health needs. CONCLUSION: While findings suggest that AUD treatment services adequately meet the needs of patients with SMHS in treatment, patients with SMHS do feel that staff lack understanding of their treatment needs. Findings have important implications as to how current health care practice might be improved according to the patient\u27s perspective of care

Demographic associations with stage of readiness to screen for colorectal cancer

Objective: To describe the distribution of a population in southern urban Adelaide in terms of readiness to screen for colorectal cancer (CRC) by Faecal Occult Blood Test (FOBT) or colonoscopy according to the stages in the Transtheoretical Model (TTM) of behaviour change and to compare the stages according to demographic variables. Methods: A random sample of 664 South Australians aged 50 to 74 were surveyed in June 2006. Chi-squared analyses were performed to determine if statistically significant differences on demographic variables existed between participants at different stages of readiness to screen