Influence of an outpatient multidisciplinary pain management program on the health-related quality of life and the physical fitness of chronic pain patients

BACKGROUND: Approximately 10 to 20 percent of the population is suffering from chronic pain. Since this represents a major contribution to the costs of the health care system, more efficient measures and interventions to treat these patients are sought. RESULTS: The development of general health and physical activity of patients with chronic pain was assessed in an interdisciplinary outpatient pain management program (IOPP). 36 patients with an average age of 48 years were included in the IOPP. Subjective assessment of well-being was performed at five time points (baseline, post intervention and 3, 6, and 12 months thereafter) by using standardized questionnaires. The study focused on the quality of life survey Medical Outcomes Study Short Form-36, which is a validated instrument with established reliability and sensitivity. In addition, the patients participated in physical assessment testing strength, power, endurance, and mobility. Prior to therapy a substantial impairment was found on different levels. Marked improvements in the psychological parameters were obtained by the end of the program. No success was achieved with regard to the physical assessments. CONCLUSION: Although many different studies have evaluated similar programs, only few of them have attained positive results such as improvements of general quality of life or of physical strength. Often no difference from the control group could be detected only some months after the intervention. In the present study no significant persistent improvement of well-being occurred. Possible reasons are either wrong instruments, wrong selection of patients or wrong interventions

Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

BACKGROUND: The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. METHODS: 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males) were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. RESULTS: The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1). The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3) and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2). The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. CONCLUSION: Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found

Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients

Background: No consensus exists on how rehabilitation programs for lumbar discectomy patients with persistent complaints after surgery should be composed. A better understanding of normal and abnormal postoperative trunk muscle condition might help direct the treatment goals. Methods: A three-dimensional CT scan of the lumbar spine was obtained in 18 symptomatic and 18 asymptomatic patients who had undergone a lumbar discectomy 42 months to 83 months (median 63 months) previously. The psoas muscle (PS), the paraspinal muscle mass (PA) and the multifidus muscle (MF) were outlined at the L3, L4 and L5 level. Of these muscles, fat free Cross Sectional Area (CSA) and fat CSA were determined. CSA of the lumbar erector spinae (LES = longissimus thoracis + iliocostalis lumborum) was calculated by subtracting MF CSA from PA CSA. Mean muscle CSA of the left and right sides was calculated at each level. To normalize the data for interpersonal comparison, the mean CSA was divided by the CSA of the L3 vertebral body (mCSA = normalized fat-free muscle CSA; fCSA = normalized fat CSA). Differences in CSA between the pain group and the pain free group were examined using a General Linear Model (GLM). Three levels were examined to investigate the possible role of the level of operation. Results: In lumbar discectomy patients with pain, the mCSA of the MF was significantly smaller than in pain-free subjects (p = 0.009) independently of the level. The mCSA of the LES was significantly smaller in pain patients, but only on the L3 slice (p = 0.018). No significant difference in mCSA of the PS was found between pain patients and pain-free patients (p = 0.462). The fCSA of the MF (p = 0.186) and of the LES (p = 0.256) were not significantly different between both populations. However, the fCSA of the PS was significantly larger in pain patients than in pain-free patients. (p = 0.012). The level of operation was never a significant factor. Conclusions: CT comparison of MF, LES and PS muscle condition between lumbar discectomy patients without pain and patients with protracted postoperative pain showed a smaller fat-free muscle CSA of the MF at all levels examined, a smaller fat-free muscle CSA of the LES at the L3 level, and more fat in the PS in patients with pain. The level of operation was not found to be of importance. The present results suggest a general lumbar muscle dysfunction in the pain group, in particular of the deep stabilizing muscle system

Μεθοδολογίες Διαχείρισης Ενέργειας σε Πόλεις που φιλοδοξούν να μειώσουν το Ανθρακικό τους Αποτύπωμα

80 σ.Σε ένα μεγάλος αριθμό κοινοτήτων, νέων κτιρίων και περιοχών στοχεύετε η μείωση του αποτυπώματος άνθρακα τους ώστε να γίνουν «μηδενικού άνθρακα» ή «ουδέτερου άνθρακα». Ωστόσο, δεν υπάρχουν σαφείς ορισμοί που να καθορίζουν τα πεδία των εκπομπών, έτσι ώστε ένας τέτοιος χαρακτηρισμός να μπορεί να αποδοθεί σε αστική κλίμακα, ούτε υπάρχει κάποια διαδικασία για την αξιολόγηση των ισχυρισμών μείωσης των εκπομπών άνθρακα. Στη παρούσα διπλωματική εργασίας εξετάζει το πρόβλημα καθορισμού της οικιστικής ανάπτυξης σε μηδενικού, χαμηλού ή ουδέτερου άνθρακα, παρουσιάζοντας ιεραρχικές κατηγορίες εκπομπών, με τρία επίπεδα: (α) εσωτερικές εκπομπές που εδράζονται στα γεωγραφικά όρια , (β) εξωτερικές εκπομπές που προκαλούνται άμεσα από βασικές αστικές δραστηριότητες, (γ) εσωτερικές ή εξωτερικές εκπομπές που οφείλονται σε μη βασικές δραστηριότητες. Κάθε ένα επίπεδο απαιτεί διαφορετική στρατηγική διαχείρισης του άνθρακα (την εξάλειψη, την εξισορρόπηση και την ελαχιστοποίηση, αντίστοιχα), έτσι ώστε να ανταποκρίνεται στο χαρακτηρισμό «Μηδενικού Ισοζυγίου Άνθρακα». Οι αντισταθμίσεις, οι επιπτώσεις και οι δυσκολίες υπολογισμού του ισοζυγίου άνθρακα που βασίζονται σε αυτούς τους ορισμούς αναλύονται περαιτέρω. Στη συνέχεια παρουσιάζεται η εισαγωγή μιας παράλληλης νομισματικής μονάδας με βάση την ενέργεια, ως μέσο διευκόλυνσης της μετάβασης σε ένα τρόπο ζωής που σέβεται την ενέργεια. Η μέχρι τώρα αφθονία των ορυκτών πηγών ενέργειας συγκαλύπτει το ενεργειακό κόστος που βαρύνει τους απερίσκεπτους καταναλωτές ενέργειας. Η κατάσταση αυτή, αποτελεί πρόκληση για τις κοινότητες που αντλούν ένα σημαντικό ποσοστό της πρωτογενούς τους ενεργειακής κατανάλωσης από ανανεώσιμες πηγές ενέργειας. Το σύστημα Masdar Energy Credit (MEC) όπως αναλύεται απο τους S. Kennedy και S. Sgouridis / Energy Policy. αποτελεί ένα τρόπο για να μετατρέψουμε τις βασικές πτυχές πίσω από την παραγωγή και χρήση ενέργειας σε μια απτή πραγματικότητα για όλους τους χρήστες, με ενσωματωμένη υποκαταστασιμότητα ώστε να δοθούν κίνητρα για μια συλλογικά βιώσιμη συμπεριφορά. Η ενεργειακή πιστωτική νομισματική μονάδα (ERGO) όπως επίσης αναλύεται απο τους Sgouridis and kennedy /energy policy αντιστοιχεί σε μια επιλεγμένη μονάδα ενέργειας, ώστε η συνολική ποσότητα τέτοιων μονάδων που εκδίδονται, να είναι ίση με την προσφορά ενέργειας στην κοινότητα. Τα ergos κατανέμονται στους χρήστες (κατοικίες, εμπορικές εταιρείες, εργαζόμενοι και επισκέπτες) σε μορφή μιας καθορισμένης, χρονικά, συνδρομής και μπορούν να δίνονται ως αντάλλαγμα για το ενεργειακό περιεχόμενο κάποιας υπηρεσίας. Υιοθετείται κάποιος μηχανισμός τιμολόγησης της αγοράς σποτ για τη συσχέτιση των ergos με το επίσημο εθνικό νόμισμα, ο οποίος κάνει χρήση μιας συνεχώς μεταβαλλόμενης συναλλαγματικής ισοτιμίας, για την αποφυγή εξάντλησης του βιώσιμου ενεργειακού πόρου. Το σύστημα MEC στοχεύει: (α) στην επίτευξη των στόχων μιας κοινότητας σχετικά με τη βιώσιμη ενεργειακή ισορροπία, (β) στη στήριξη της κάλυψης απαιτήσεων αιχμής φορτίου ή στην επίτευξη στόχων σχετικά με τη μετατόπιση φορτίων ενέργειας και (γ) στην αύξηση της ενεργειακής συνείδησης από τους καταναλωτές.A large number of communities, new developments, and regions aim to lower their carbon footprint and aspire to become ‘‘Ζero Carbon’’ or ‘‘Carbon Neutral.’’ Yet there are neither clear definitions for the scope of emissions that such a label would address on an urban scale, nor is there a process for qualifying the carbon reduction claims. This dissertation thesis, addresses the question of how to define a zero carbon, Low Carbon, or Carbon Neutral urban development by proposing hierarchical emissions categories with three levels: Internal Emissions based on the geographical boundary, external emissions directly caused by core municipal activities, and internal or external emissions due to noncore activities. Each level implies a different carbon management strategy (eliminating, balancing, and minimizing, respectively) needed to meet a Net Zero Carbon designation. The trade-offs, implications, and difficulties of implementing carbon debt accounting based upon these definitions are further analyzed. In addition, the thesis presents the introduction of an energy-based parallel currency as a means to ease the transition to energy-conscious living. Abundant fossil energy resources mask the internal and external energy costs for casual energy consumers. This situation is challenging communities that draw a significant fraction of their primary energy consumption from renewable energy sources. The Masdar Energy Credit (MEC) system is a way of translating the fundamental aspects behind energy generation and usage into a tangible reality for all users with built-in fungibility to incentivize collectively sustainable behavior. The energy credit currency (ergo) corresponds with a chosen unit of energy so that the total amount of ergos issued equals the energy supply of the community. Ergos are distributed to users (residents, commercial entities, employees, and visitors) on a subscription basis and can be surrendered in exchange for the energy content of a service. A spot market pricing mechanism is introduced to relate ergos to ‘‘fiat’’ currency using a continuously variable exchange rate to prevent depletion of the sustainable energy resource. The MEC system is intended to: (i) meet the sustainable energy balance targets of a community (ii) support peak shaving or load shifting goals, and (iii) raise energy awareness.Αντώνης Γ. Λούπαση

Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report

Abstract Introduction We report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. Case presentation A 36-year-old Caucasian man was admitted with this rare fracture combination, and was managed with closed fracture reduction and fixation with a dynamic hip screw combined with an anti-rotational cannulated screw. We found four similar cases on reviewing the literature from 1989 to 2009, but these were reports of older patients after low energy injury. Conclusion We found that segmental fracture of the femoral neck region is an extremely rare and uncategorized hip injury that can occur not only in older people but also in young non-osteoporotic patients, and should be considered for inclusion in femoral fracture classification systems.</p

Seven- to 20-year outcome of lumbar discectomy

Study Design. A retrospective, follow-up study. Objectives. To assess the effects of conventional surgery for lumbar disc herniation over an extended period of time and to examine factors that might correlate with unsatisfactory results. Summary of Background Data. Although the short; term results of lumbar discectomy are excellent When there is a proper patient selection, the reported success; rates in the long-term follow-up studies vary, and few factors have been implicated for an unsatisfactory outcome. Methods. One hundred-nine patients with surgically documented herniated lumbar disc were analyzed, retrospectively, by an independent observer. Long-term follow-up (mean 12.2 years) was done by a mailed, self-report questionnaire that included items about pain relief in the back and leg, satisfaction with the results, need for analgesics, level of activity, working capacity, and reoperations. Subjective disability was measured by the Oswestry questionnaire. Radiographic review was carried out in 66% of patients. End results were assessed using the modified Stauffer-Coventry’s evaluating criteria. Several variables were examined to assess their influence to the outcome. Results. The late results were satisfactory in 64% of patients. The mean Oswestry disability score was 18.9. Of the 101 patients who had primary procedures, 28% still complained of significant back or leg pain. Sixty-five percent of patients were very satisfied with their results, 29% satisfied, and 6% dissatisfied. The reoperation rate was 7.3% (8 patients), about one-third of which was due to recurrent disc herniation. Sociodemographic factors pre disposing to unsatisfactory outcome, including female gender, low vocational education, and jobs requiring significant physical strenuousness. Disc space narrowing was common at the level of discectomy, but was without prognostic significance. Conclusions. The long-term results of standard lumbar discectomy are not very satisfying. More than one-third of the patients had unsatisfactory results and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level were negative predictors of a good out come. These indicators should be used preoperatively to identify patients who are at high risk for an unfavorable long-term result