300 research outputs found
Recurrent scoliosis one year after surgical correction
A year after anterolateral spondylodesis for progressive scoliosis, the patient showed a flexion gait pattern with recurrent deformity, due to late infection. Surgical debridement resolved all symptoms. Whereas most postoperative infections occur after posterior spondylodesis and present with back pain and mild increase of infection parameters, late infection after anterolateral approach is rare. In this case the patient did not present with the classic symptoms
Nonoperative Treatment of Thoracic and Lumbar Spine Fractures:A Prospective Randomized Study of Different Treatment Options
Objectives: To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures.Design: Prospective randomized controlled trial with long-term follow-up.Setting: Two general hospitals in the Netherlands.Patients/Participants: Patients with a traumatic thoracic or lumbar spine fracture, without neurologic damage, with less than 50% loss of height of the anterior column and less than 30% reduction of the spinal canal were included.Intervention: Patients in the compression group were randomized to physical therapy and postural instructions, a brace for 6 weeks, or a Plaster of Paris cast for 6 or 12 weeks. Patients in the burst group received a brace or a Plaster of Paris cast, both for 12 weeks.Main Outcome Measurements: Follow-up examinations included radiographs, Visual Analogue Scores for toleration of treatment and persistent pain, and an Oswestry Disability Index at long-term follow-up.Results: There were 133 patients: 108 in the compression group and 25 in the burst group. For compression fractures, physical therapy and brace were considered the most tolerable. Brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index. None of the treatments had any significant effect on the residual deformity measurements. For burst fractures, no significant differences were found.Conclusions: Brace treatment with supplementary physical therapy is the treatment of choice for patients with compression fractures of the thoracic and lumbar spine. Furthermore, more than 20% of all patients had moderate or severe back pain at long-term follow-up.</p
Nonoperative Treatment of Thoracic and Lumbar Spine Fractures:A Prospective Randomized Study of Different Treatment Options
Bracing patients with idiopathic scoliosis: Design of the Dutch randomized controlled treatment trial
Background. The effectiveness of bracing patients with IS has not yet been convincingly established due to a lack of RCTs. Some authors suggest that their results confirm that bracing is effective; others conclude that the effectiveness of bracing is doubtful or recommend a RCT. The aim of this study was to establish whether bracing patients with idiopathic scoliosis (IS) in an early stage will result in at least 5 degrees less mean progression of the curvature compared to the control group after two years of follow-up. Methods. A randomized controlled trial was designed. Eligible patients are girls and boys in the age group 8-15 years whose diagnosis of IS has been established by an orthopedic surgeon, who have not yet been treated by bracing or surgery, and for whom further growth of physical height is still expected based on medical examination and maturation characteristics (Risser ? 2). The Cobb angle of the eligible patient should either be minimally 22 and maximally 29 degrees with established progression of more than 5 degrees, or should be minimally 30 and maximally 35 degrees; established progression for the latter is not necessary. A total of 100 patients will be included in this trial. The intervention group will be treated with full-time Boston brace wear; the control group will not be braced. Every four months, each patient will have a physical and an X-ray examination. The main outcomes will be the Cobb angle two years after inclusion and health-related quality of life. Discussion. The results of this trial will be of great importance for the discussion on early treatment for scoliosis. Furthermore, the result will also be important for screening for scoliosis policies. Trial registration. Nederlands Trialregister ISRCTN36964733
Reappraisal of the diagnostic and prognostic value of morning stiffness in arthralgia and early arthritis: results from the Groningen EARC, Leiden EARC, ESPOIR, Leiden EAC and REACH
Interactive seminars or small group tutorials in preclinical medical education: results of a randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>Learning in small group tutorials is appreciated by students and effective in the acquisition of clinical problem-solving skills but poses financial and resource challenges. Interactive seminars, which accommodate large groups, might be an alternative. This study examines the educational effectiveness of small group tutorials and interactive seminars and students' preferences for and satisfaction with these formats.</p> <p>Methods</p> <p>Students in year three of the Leiden undergraduate medical curriculum, who agreed to participate in a randomized controlled trial (RCT, n = 107), were randomly allocated to small group tutorials (n = 53) or interactive seminars (n = 54). Students who did not agree were free to choose either format (n = 105). Educational effectiveness was measured by comparing the participants' results on the end-of-block test. Data on students' reasons and satisfaction were collected by means of questionnaires. Data was analyzed using student unpaired t test or chi-square test where appropriate.</p> <p>Results</p> <p>There were no significant differences between the two educational formats in students' test grades. Retention of knowledge through active participation was the most frequently cited reason for preferring small group tutorials, while a dislike of compulsory course components was mentioned more frequently by students preferring interactive seminars. Small group tutorials led to greater satisfaction.</p> <p>Conclusions</p> <p>We found that small group tutorials leads to greater satisfaction but not to better learning results. Interactive learning in large groups might be might be an effective alternative to small group tutorials in some cases and be offered as an option.</p
Search for CP violation in decays
A model-independent search for direct CP violation in the Cabibbo suppressed
decay in a sample of approximately 370,000 decays is
carried out. The data were collected by the LHCb experiment in 2010 and
correspond to an integrated luminosity of 35 pb. The normalized Dalitz
plot distributions for and are compared using four different
binning schemes that are sensitive to different manifestations of CP violation.
No evidence for CP asymmetry is found.Comment: 13 pages, 8 figures, submitted to Phys. Rev.
First observation of Bs -> D_{s2}^{*+} X mu nu decays
Using data collected with the LHCb detector in proton-proton collisions at a
centre-of-mass energy of 7 TeV, the semileptonic decays Bs -> Ds+ X mu nu and
Bs -> D0 K+ X mu nu are detected. Two structures are observed in the D0 K+ mass
spectrum at masses consistent with the known D^+_{s1}(2536) and
$D^{*+}_{s2}(2573) mesons. The measured branching fractions relative to the
total Bs semileptonic rate are B(Bs -> D_{s2}^{*+} X mu nu)/B(Bs -> X mu nu)=
(3.3\pm 1.0\pm 0.4)%, and B(Bs -> D_{s1}^+ X munu)/B(Bs -> X mu nu)= (5.4\pm
1.2\pm 0.5)%, where the first uncertainty is statistical and the second is
systematic. This is the first observation of the D_{s2}^{*+} state in Bs
decays; we also measure its mass and width.Comment: 8 pages 2 figures. Published in Physics Letters
First observation of the decay and a measurement of the ratio of branching fractions
The first observation of the decay using
data collected by the LHCb detector at a centre-of-mass energy of 7 TeV,
corresponding to an integrated luminosity of 36 pb, is reported. A
signal of events is obtained and the absence of signal is
rejected with a statistical significance of more than nine standard deviations.
The branching fraction is measured relative to
that of : , where the first uncertainty is statistical, the second systematic and
the third is due to the uncertainty on the ratio of the and
hadronisation fractions.Comment: 10 pages, 3 figures, submitted to Phys. Lett. B; ISSN 0370-269
Chronic non-specific low back pain - sub-groups or a single mechanism?
Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a
considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions
for chronic non-specific low back pain indicate limited effectiveness for most commonly applied
interventions and approaches.
Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of
effectiveness is at odds with their clinical experience of managing patients with back pain. A
common explanation for this discrepancy is the perceived heterogeneity of patients with chronic
non-specific low back pain. It is felt that the effects of treatment may be diluted by the application
of a single intervention to a complex, heterogeneous group with diverse treatment needs. This
argument presupposes that current treatment is effective when applied to the correct patient.
An alternative perspective is that the clinical trials are correct and current treatments have limited
efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important
that the sub-grouping paradigm is closely examined. This paper argues that there are numerous
problems with the sub-grouping approach and that it may not be an important reason for the
disappointing results of clinical trials. We propose instead that current treatment may be ineffective
because it has been misdirected. Recent evidence that demonstrates changes within the brain in
chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of
cortical reorganisation and degeneration. This perspective offers interesting insights into the
chronic low back pain experience and suggests alternative models of intervention.
Summary: The disappointing results of clinical research are commonly explained by the failure of
researchers to adequately attend to sub-grouping of the chronic non-specific low back pain
population. Alternatively, current approaches may be ineffective and clinicians and researchers may
need to radically rethink the nature of the problem and how it should best be managed
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