Ganglions of the proximal interphalangeal joint.

Ganglions of the proximal interphalangeal joint are uncommon. Six patients (nine ganglions) were treated surgically. The lesions presented on the ulnar aspect of the extensor mechanism between the lateral band and the central slip and communicated with the joint by means of a stalk. Mild degenerative joint disease was noted in each case. Surgical excision provided relief of symptoms, and no patient has experienced any recurrence to date

Comparative Clinical Effectiveness of Management Strategies for Sciatica: Systematic Review and Network Meta-Analyses

Background There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. Purpose To compare the clinical effectiveness of different treatment strategies for sciatica simultaneously. Study design Systematic review and network meta-analysis. Methods: We searched 28 electronic databases and online trial registries, along with bibliographies of previous reviews, for comparative studies evaluating any intervention to treat sciatica in adults, with outcome data on global effect or pain intensity. Network meta-analysis methods were used to simultaneously compare all treatment strategies and allow indirect comparisons of treatments between studies. The study was funded by the UK National Institute for Health Research (NIHR) HTA programme; there are no potential conflict of interests. Results Of 122 relevant studies, 90 were randomised controlled trials (RCTs) or quasi-RCTs. Interventions were grouped into 21 treatment strategies. Internal and external validity of included studies was very low. For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, non-opioid analgesia, manipulation, and acupuncture. Traction, percutaneous discectomy and exercise therapy were significantly inferior to epidural injections or surgery. For pain reduction as the outcome, epidural injections and biological agents were significantly better than inactive control, but similar findings for disc surgery were not statistically significant. Biological agents were significantly better for pain reduction than bed rest, non-opioids, and opioids, or radiofrequency treatment. Opioids, education/advice alone, bed rest, and percutaneous discectomy and radiofrequency treatment were inferior to most other treatment strategies; although these findings represented large effects, they were statistically equivocal. Conclusions For the first time many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data to assist shared decision-making. The findings support the effectiveness of non-opioid medication, epidural injections and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments such as anti-inflammatory biological agents, may be considered. The findings do not support the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy or traction. The issue of how best to estimate the effectiveness of treatment approaches according to their order within a sequential treatment pathway remains an important challenge

Hacia el uso sostenible del agua en la producción. Proyecto Custodia del Agua en la Cuenca del Santa Lucía.

El concepto de custodia del agua surge como una respuesta a problemas comunes en el uso responsable y sostenible del agua dulce y propone esfuerzos colectivos con origen en iniciativas individuales, voluntarias y colaborativas para gestionarla de manera sostenible

Minhas experienciações no espaço tempo da sala de aula: é possível integrar os saberes? Em que condições?

In this survey, done from teaching experience, I intend to discuss about reflexive education as an agent for transformation of daily practice, by finding in higher education, the difficulty of generating new forms of relations, especially regarding the practice of activities in classroom. The research was developed in two stages: first, in relation to my activities with the Postgraduate Program in the Faculdade de Educação and second, in a class composed of 40 students registered in the Atividade de Integração Curricular, the first year of the bachelor of Sistemas de Informação, during the year 2010. Based on the uncertainty of the way to go, the survey search evidences of engaging of the students with the educational relationship. Offer moments of reflection about the dynamics of education with the aim to discuss the production of subjectivities in classroom activities. Within the qualitative perspective, as a matter of field, I used the methodology of researchaction. This technique aims to identify strategies of planned action which are implemented, and then systematically submitted to observation, questioning and transformation. Together, I chose to use the cartography method, which is presented as a way to promote access to that which stimulates thinking, thus tracking what is not relevant to a systemic representation. While this process of reflection and significant buildings asked for students to answer a questionnaire and prepare reports. When I connected the data points have emerged producing voice to thoughts, doubts, fears and expectations of students. I understood how necessary it is to learn to learn, especially in times of uncertainty. Even viewing that the educational system, largely is based on principles of instrumental rationality associated with students experiences in teaching conservative and traditional I see that they have a called to introduce a other order, especially in terms dialogical relations and collective.Neste estudo, realizado a partir de experiências pedagógicas, intenciono problematizar a educação reflexiva como agente de transformação da prática diária, a partir da constatação, na educação superior, da dificuldade de engendrar novas formas de relações, de modo especial no que tange à prática das atividades no espaço tempo da sala de aula. A pesquisa foi elaborada em dois momentos: o primeiro, em relação às minhas atividades junto ao Programa de Pós-Graduação na Faculdade de Educação e, o segundo, em uma turma composta por 40 estudantes matriculados na Atividade de Integração Curricular, do primeiro ano do curso de bacharelado em Sistemas de Informação, durante o ano de 2010. A proposta de estudo, embasada na incerteza do caminho a ser trilhado, busca evidências do engajamento dos estudantes frente à relação educacional. Oportunizei momentos de reflexão acerca da dinâmica educacional, no intuito de problematizar as atividades em sala de aula. Dentro da perspectiva qualitativa, como procedimento de campo, utilizei a metodologia de pesquisa–ação. Nesta procurei mapear estratégias de ação planejada as quais são implementadas e, a seguir, sistematicamente submetidas à observação, problematização e transformação. Conjuntamente, optei por utilizar o método cartográfico, o qual se apresentou como um caminho para promover o acesso àquilo que estimula o pensar, possibilitando o acompanhamento ao que foge a uma representação sistêmica. Em meio a esse processo de significativas reflexões e construções solicitei aos estudantes responderem um questionário e elaborarem relatos. Ao relacionar os dados, emergiram aspectos produzindo voz a pensamentos, dúvidas, medos e expectativas dos estudantes. Compreendi o quão necessário é aprender a aprender, de modo especial, em tempos de incertezas. Mesmo verificando que o sistema educacional, em grande parte, é baseado em princípios de racionalidade instrumental associados às experiências dos estudantes em atividades de ensino conservador e tradicional, percebo que estes apresentam um apelo à introdução de outra ordem, principalmente, no que tange às relações dialógicas e coletivas