Ambulatory and Hospital-based Quality Improvement Methods in Israel

This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality

Effect of a full pilates group exercise program on transversus abdominis thickness, daily function and pain in women with chronic low back pain

The Pilates method is often used in the treatment of nonspecific low back pain (NSCLBP). The effect of Pilates group exercising (mat and apparatus combined) on women with NSCLBP is unknown. Studies on the Pilates method often use ultrasound (US) to measure transversus abdominis (TrA) thickness in one anatomical location. We recruited 40 women, 22 with NSCLBP and 18 healthy women (active control group), to join five weeks of biweekly Pilates group exercising (apparatus and mat). Measurements included TrA thickness (left and right) at rest, during active draw-in maneuver (ADIM), and its TrA% change in three anatomical areas; Roland-Morris disability questionnaire (RMDQ); and pain level (VAS). Before the study, no asymmetry in TrA thickness was noted as well as no between-group differences in TrA-thickness in three anatomic areas (in rest and ADIM). Following the intervention, TrA thickness increased during rest in the healthy group in two areas. No differences were noted between the two groups in ADIM in the anatomical locations. No between-group differences were found before the intervention in the TrA% change. Following the intervention, an increase in the TrA-% change was noticed in the NSCLBP group. A decrease in the healthy group was observed in area C. No effects were noted on the RMDQ and VAS. Five weeks of Pilates group exercising increased TrA thickness in healthy women and its percentage changed in women with NSCLBP. Measuring TrA thickness with US should be performed in three different anatomical locations on both sides. This measuring procedure has good inter- and intra-rater reliability and the potential to reveal physiological effects

A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females

The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1–L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8°; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9–T10 and L1–L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy

The Lumbar Lordosis in Males and Females, Revisited.

Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females.Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height.Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined).Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing

Males population curve 2-D view.

<p>Male population curve 2-D views: sagittal (top) and coronal (bottom) planes. The coordinates are scaled by the vertical distance between the superior end plate of the sacrum and the inferior end plate of T12.</p