From satisfaction to expectation: The patient's perspective in lower limb prosthetic care

Neck pain is a common musculoskeletal complaint and a relationship with reduced work-related functional capacity is assumed. A validated instrument to test functional capacity of patients with neck pain is unavailable. The objective of this study was to develop a Functional Capacity Evaluation (FCE), which is content valid for determining functional capacity in patients with work related neck disorders (WRND). A review of epidemiological review literature was conducted to identify physical risk factors for WRND. Evidence was found that physical risk factors contribute in development of WRND. Physical risk factors were related to repetitive movements, forceful movements, awkward positions and static contractions of the neck or the neck/shoulder region. An FCE was designed based on the risk factors identified. Eight tests were selected to cover all risk factors: repetitive side reaching, repetitive reaching overhead, static overhead work, front carry, forward static bend neck, overhead lift and the neck strength test. Content validity of this FCE was established by providing the rationale, specific objectives and operational definitions of the FCE. Further research is needed to establish reliability and other aspects of validity of the neck-FCE Aim Worldwide, family- centred and co- ordinated care are seen as the two most desirable and effective methods of paediatric care delivery. This study outlines current views on how team collaboration comprising professionals in paediatric rehabilitation and special education and the parents of children with disabilities should be organized, and analyses the policies of five paediatric rehabilitation settings associated with the care of 44 children with cerebral palsy ( CP) in the Netherlands. Methods For an overview of current ideas on collaboration, written statements of professional associations in Dutch paediatric rehabilitation were examined. The policy statements of the five participating settings were derived from their institutional files. Documents detailing the collaborative arrangements involving the various professionals and parents were evaluated at the institutional level and at the child level. Involvement of the stakeholders was analysed based on team conferences. Results Also in the Netherlands collaboration between rehabilitation and education professionals and parents is endorsed as the key principle in paediatric rehabilitation, with at its core the team conference in which the various priorities and goals are formulated and integrated into a personalized treatment plan. As to their collaborative approaches between rehabilitation centre and school, the five paediatric settings rarely differed, but at the child level approaches varied. Teams were large ( averaging 10.5 members), and all three stakeholder groups were represented, but involvement differed per setting, as did the roles and contributions of the individual team members. Conclusion Collaboration between rehabilitation and education professionals and parents is supported and encouraged nationwide. Views on collaboration have been formulated, and general guidelines on family- centred and co- ordinated care are available. Yet, collaborative practices in Dutch paediatric care are still developing. Protocols that carefully delineate the commitments to collaborate and that translate the policies into practical, detailed guidelines are needed, as they are a prerequisite for successful teamwork

Exploring the Role of Environmental Quality and Time Perspective in the Academic Performance of Grade 12 Learners

The aim of this study was to determine to what extent environmental quality and time perspective can account for the variance in the academic performance of Grade 12 learners. Time perspective was assessed utilising the Zimbardo Time Perspective Inventory (ZTPI). Environmental quality was measured by means of a self-compiled questionnaire. A total of 413 Grade 12 learners from four English mediumschools in the Mangaung area of the Free State Province in South Africa were involved in the study. It was found that time perspective together with environmental quality accounts for approximately 14% of the variance found in the academic performance of Grade 12 learners. Although statistically significant relationships were found between time perspective and academic performance, these relationships were concluded to be of little practical importance. The academic performance of Grade 12 learners is of great importance as the results obtained from their final examinations are generally viewed as primary selection criteria for access to higher education institutions (Swartz, 1998; Uys, 1993; Huysamen, 2001). Various cognitive, personal and environmental factors have been found to influence learners’ academic performance (Moller, 1995; Louw, Van Ede & Louw, 1998; Malefo, 2000). Only a limited number of researchers have investigated the influence of environmental quality as well as time perspective on academic performance within the South African context. It is the aim of this study to explore the concepts of environmental quality and time perspective and their role in the academic performance of Grade 12 learners

Prescription of prostheric ankle-foot mechanisms after lower limb amputation

BACKGROUND: A prosthesis can be divided into several components: the prosthetic socket; the prosthetic ankle‐foot mechanism; and for higher levels of amputation, the prosthetic knee. This review focuses on the prosthetic ankle‐foot mechanism, which forms an important part of the prosthesis in terms of mobility. A correct prosthetic prescription can be derived by matching the functional abilities of the individual with a lower limb amputation with the technical and functional aspects of the various prosthetic ankle‐foot mechanisms. However, there seems to be no clear clinical consensus on the precise prescription criteria for the various prosthetic ankle‐foot mechanisms in relation to the functional abilities of individuals with a lower limb amputation. OBJECTIVES: To obtain information about aspects of prosthetic ankle‐foot mechanisms and daily functioning of individuals with a lower limb prosthesis, for appropriate prosthetic prescription criteria. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to April 2006), EMBASE (1983 to April 2006), CINAHL (1982 to April 2006), AMED (Allied and Complimentary Medicine) (1985 to April 2006), and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomised controlled trials and quasi‐randomised controlled trials comparing different ankle foot mechanisms for lower limb amputation in adults. No language restrictions were applied. DATA COLLECTION AND ANALYSIS: Two review authors independently identified potential articles from the literature search. Methodological quality was assessed using a checklist comprising 13 criteria. The reviewers extracted data using pre‐defined extraction forms. MAIN RESULTS: Twenty‐six trials were included, with a total of 245 participants. The numbers of participants in the included trials ranged from three to sixteen. The methodological quality was moderate. Only one study was of high quality. All included studies used cross‐over designs allowing sufficient control for confounding. In individuals with a transtibial amputation, there seems to be a small tendency towards a greater stride length when walking with the Flex‐foot in comparison to the SACH (solid‐ankle cushioned heel) foot. When walking speed was increased, the energy cost was lower. In high activity individuals with a transfemoral amputation, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and gait efficiency. AUTHORS' CONCLUSIONS: There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle‐foot mechanism, although there is a small trend towards the Flex‐foot in comparison with the SACH foot for greater stride length and lower energy cost in individuals with a transtibial amputation, and improved gait efficiency and lower energy cost in high activity individuals with a transfemoral amputation. In prescribing prosthetic‐ankle foot mechanisms for individuals with a lower limb amputation, practitioners should take into account availability, patient functional needs, the type of knee mechanism to be prescribed and the inter‐relationship with ankle‐foot mechanisms, and cost

Genetic Studies in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an idiopathic chronic gastrointestinal disease with genetic susceptibility playing an important role 1. This is further explored in this thesis. The initiative for this thesis started within the departments of Gastroenterology and Hepatology, and Internal Medicine of the Erasmus MC University Medical Centre Rotterdam (UMCR). The primary research goal was to explore aspects of the genetic aetiology of IBD by searching for mutations in inflammation-related genes in patients with IBD. Many IBD-affected patients and (non-)affected relatives were recruited to set up a clinical and genetic IBD database. Initially, the research protocol focused on cytokine (receptor) genes. This focus was extended to research on other polymorphic genes based on new findings in the literature. We have mainly focused on mutations within the interleukin-10 (IL-10) and caspase recruitment domain 15 (CARD15) genes, with emphasis on their prevalence, biological (dys)function, and association with disease phenotypes. Furthermore, genetic anticipation in IBD was studied

Prosthetic prescription in the Netherlands:an observational study

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care.The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis.As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation.Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&amp;RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location.In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.</p

Meta-analysis: Acupuncture for osteoarthritis of the knee

Background: Knee osteoarthritis is a major cause of pain and functional limitation. Purpose: To evaluate the effects of acupuncture for treating knee osteoarthritis. Data Sources: Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases to January 2007. No language restrictions were applied. Study Selection: Randomized trials longer than 6 weeks in duration that compared needle acupuncture with a sham, usual care, or waiting list control group for patients with knee osteoarthritis. Data Extraction: Two authors independently agreed on eligibility, assessed methodological quality and acupuncture adequacy, and extracted outcome data on pain and function measures. Data Synthesis: Eleven trials met the selection criteria, and 9 reported sufficient data for pooling. Standardized mean differences were calculated by using differences in improvements from baseline between patients assigned to acupuncture and those assigned to control groups. Compared with patients in waiting list control groups, patients who received acupuncture reported clinically relevant short-term improvements in pain (standardized mean difference, -0.96 [95% CI, -1.21 to -0.70]) and function (standardized mean difference, -0.93 [CI, -1.16 to -0.69]). Patients who received acupuncture also reported clinically relevant short- and long-term improvements in pain and function compared with patients in usual care control groups. Compared with a sham control, acupuncture provided clinically irrelevant short-term improvements in pain (standardized mean difference, -0.35 [CI, -0.55 to -0.15]) and function (standardized mean difference, -0.35 [CI, -0.56 to -0.14]) and clinically irrelevant long-term improvements in pain (standardized mean difference, -0.13 [CI, -0.24 to -0.01]) and function (standardized mean difference, -0.14 [CI, -0.26 to -0.03]). Limitation: Sham-controlled trials had heterogeneous results that were probably due to the variability of acupuncture and sham protocols, patient samples, and settings. Conclusions: Sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects. © 2007 American College of Physicians.link_to_subscribed_fulltex

Trauma unit workload at King Edward VIII Hospital, Durban, KwaZulu-Natal

Each year, 70 000 South Africans are killed by trauma and a further 3.5 million seek trauma care. We analysed 1 465 trauma patients at the regional-level King Edward VIII hospital (KE8H) in eThekwini Municipality. Mean patient age was 29 years. Peaks in patient numbers were observed mid-month, at month-end, between 08h00 and 12h00 daily and on Saturday and Sunday nights. Most injuries occurred on roads, at informal settlements and at bars/shebeens. More than 44% of injuries had a violent cause. The pattern of presentation was more in line with a primary healthcare setting than a referral centre. Reliable and accurate injury trend information is required for effective strategies to curb South Africa’s high injury mortality and morbidity rates. Epidemiological databases are needed, as well as safe, robust and ethical systems for collecting, collating, analysing and disseminating non-fatal injury-related data

Geographical distribution and relative abundance of stock-associated Culicoides species (Diptera: Ceratopogonidae) in southern Africa, in relation to their potential as viral vectors

To determine the geographical distribution and relative abundance of Culicoides species associated with livestock, 220-V down-draught light-traps equipped with 8-W blacklight tubes were operated at 34 sites in different climatic regions in South Africa and Lesotho. From January 1984 to September 1986, 3 041 631 Culicoides, belonging to at least 50 species, were collected in a total of 959 collections. Of these, 572 412 individuals were identified and sexed. Culicoides species were found to be widespread in South Africa and were collected in varying numbers at all the sites sampled. The average catch size, however, was larger in frost-free areas than in areas with extreme winters. The more abundant and widespread species, which have the potential to be vectors of stock-associated viruses such as bluetongue and African horsesickness, were C. imicola, C. leucostictus, C. schultzei s.l., C. pycnostictus, C. nivosus, C. similis, C. zuluensis, C. magnus, C. bedfordi, C. neavei, C. brucei, C. tropicalis, C. exspectator, C. gulbenkiani, C. bolitinos, C. ravus, C. coarctatus and C. onderstepoortensis. Of these, C. imicola was the most abundant species, being dominant at 17 of the 34 sites sampled and accounting for 71,4% of the specimens collected. As C. imicola is relatively uncommon in hot and dry as well as cool and wet areas, this species cannot be regarded as the only vector of stock-associated viruses in southern Africa. Future laboratory vector competence studies, i.e. determination of viral-infection and -transmission rates, should first concentrate on the above-mentioned Culicoides species, especially those known to feed on livestock.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat X Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Seasonal abundance and parity of stock-associated Culicoides species (Diptera: Ceratopogonidae) in different climatic regions in southern Africa in relation to their viral vector potential

Seasonal abundance and parity in Culicoides populations, in the vicinity of livestock, were determined at seven sites in five different climatic regions with 220 V down-draught blacklight-traps. In 418 collections made between October 1983 and December 1986, a total of 2 134 171 Culicoides, of which 342 571 were identified to species level and sexed, were collected; 267 of these collections (182 321 Culicoides) were graded for parity. In the frost-free summer rainfall area, Culicoides were collected in large numbers in light-traps throughout the year; this implies breeding and possible virus transmission throughout the winter in certain parts of South Africa. However, where frost occurred, Culicoides numbers usually peaked in late summer and dropped sharply after the first frost. In the latter areas, small Culicoides collections during winter may be due to low winter temperatures and rainfall; low temperatures negatively affect adult activity and reduce the rate of development of larvae and pupae; low rainfall would lead to a reduction of available larval habitats. Relatively large numbers of Culicoides were collected in winter in the temperate frost-free winter rainfall area. In each of the four summer rainfall areas, one Culicoides species remained dominant throughout the year: at two of these areas this species was C. imicola. Other abundant species in some of these summer rainfall areas were C. schultzei s.I. and C. zuluensis. In the winter rainfall area, C. zuluensis, C. magnus, C. gulbenkiani and C. imicola shared abundance. It was established that abdominal pigmentation is an indicator of parity in C. imicola in South Africa. With the increase in Culicoides numbers towards the end of summer, there was also a rise in the proportion of parous (pigmented) females in most Culicoides species, which signifies a higher vector potential for African horsesickness and bluetongue towards the end of summer. This coincides with the seasonal occurrence of viral diseases transmitted by Culicoides species. Nulliparous (unpigmented) females of all Culicoides species were present throughout the year at all sites where Culicoides were continuously collected, confirming uninterrupted breeding in these areas.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat X Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format