Subjective and objective outcome in congenital clubfoot; a comparative study of 204 children

<p>Abstract</p> <p>Background</p> <p>Outcome following management of congenital talipes equinovarus (clubfoot) can be assessed in a number of ways. Bjonness stated simply that <it>"the patient is the final judge of whether he has a good foot</it>"; a purely subjective assessment. Others have employed objective measures. Combining subjective evaluation with a more objective assessment of movement and position of the foot, is likely to give a more comprehensive picture of the final result of clubfoot. The purpose of this study was to compare subjective and objective outcome following management of clubfoot, and evaluate sex differences in outcome.</p> <p>Methods</p> <p>We used a patient-administered subjective assessment of outcome following treatment of clubfoot and compared it with objective anthropometry and range of movement of the ankle to assess and compare subjective and objective outcome in clubfoot. Statistical analysis was performed using Pearson correlation coefficients. Significance was tested using Student's t-test test.</p> <p>Results</p> <p>Objective outcome can be assessed using length of the foot, calf circumference and range of movement at the ankle. These are easy to measure, reproducible, and correlate well with subjective outcome. Objective outcome is comparable for boys and girls. However, subjectively, female patients and their parents are less happy with the results of management of clubfoot.</p> <p>Conclusion</p> <p>There is a correlation between the anthropometric measures and the subjective outcome and an objective grading can be designed using foot length, calf muscle bulk and range of movement at the ankle.</p

The clubfoot assessment protocol (CAP); description and reliability of a structured multi-level instrument for follow-up

BACKGROUND: In most clubfoot studies, the outcome instruments used are designed to evaluate classification or long-term cross-sectional results. Variables deal mainly with factors on body function/structure level. Wide scorings intervals and total sum scores increase the risk that important changes and information are not detected. Studies of the reliability, validity and responsiveness of these instruments are sparse. The lack of an instrument for longitudinal follow-up led the investigators to develop the Clubfoot Assessment Protocol (CAP). The aim of this article is to introduce and describe the CAP and evaluate the items inter- and intra reliability in relation to patient age. METHODS: The CAP was created from 22 items divided between body function/structure (three subgroups) and activity (one subgroup) levels according to the International Classification of Function, Disability and Health (ICF). The focus is on item and subgroup development. Two experienced examiners assessed 69 clubfeet in 48 children who had a median age of 2.1 years (range, 0 to 6.7 years). Both treated and untreated feet with different grades of severity were included. Three age groups were constructed for studying the influence of age on reliability. The intra- rater study included 32 feet in 20 children who had a median age of 2.5 years (range, 4 months to 6.8 years). The Unweighted Kappa statistics, percentage observer agreement, and amount of categories defined how reliability was to be interpreted. RESULTS: The inter-rater reliability was assessed as moderate to good for all but one item. Eighteen items had kappa values > 0.40. Three items varied from 0.35 to 0.38. The mean percentage observed agreement was 82% (range, 62 to 95%). Different age groups showed sufficient agreement. Intra- rater; all items had kappa values > 0.40 [range, 0.54 to 1.00] and a mean percentage agreement of 89.5%. Categories varied from 3 to 5. CONCLUSION: The CAP contains more detailed information than previous protocols. It is a multi-dimensional observer administered standardized measurement instrument with the focus on item and subgroup level. It can be used with sufficient reliability, independent of age, during the first seven years of childhood by examiners with good clinical experience. A few items showed low reliability, partly dependent on the child's age and /or varying professional backgrounds between the examiners. These items should be interpreted with caution, until further studies have confirmed the validity and sensitivity of the instrument

Bruk av alternativ behandling blant pasienter med multippel sklerose : - en kartlegging

Introduction: Multiple sclerosis (MS) is a chronic neurological disease. No curable treatment is available. Previous studies show that 30 to 90% of patients with MS have used alternative medicine. Our objective was to assess the frequency of use of alternative medicine among MS patients in Oslo. Methods: MS patients admitted at Ullevål University Hospital (UUS) were asked to complete a questionnaire about the use of alternative medicine. Clinical data were collected from the patients’ medical records. The data were compared to the MS-population of Oslo. Results: In total, 99 questionnaires were analysed. Of these, 72.7 % of the patients had used alternative medicine, women more frequently than men. The patients used this as a supplement to the conventional medicine. One third of the patients considered the treatment effective, one third were unsure of the effect. There was a trend towards more frequent use in patients with relapsing-remitting compared to primary progressive disease. We found no significant association between use of alternative medicine and disability. Average cost per year was 6978.35 Norwegian crowns. Vitamins and minerals in high dosages, food supplements and acupuncture were the most frequently used therapies. One third of the patients did not discuss alternative treatments with anyone in the health system. The MS-population in Oslo was quite similar to the population in our study. Conclusion: The use of alternative therapies by MS patients is quite frequent, and our results may represent the general MS population in Norway

Sensorless Control of Synchronous Machines used in ASH

Sensorøs kontroll av maskiner har blitt mer populært de seneste årene, siden man kan redusere kostnadene og øke påliteligheten ved å unngå posisjonssensor. Rotorens posisjon og hastighet kan istedenfor estimeres ved hjelp av strømmene og spenningene, ved å bruke fluksmodeller. Sensorløs styring av en separat magnetisert synkronmaskin har blitt analysert i denne masteroppgaven. En vanlig ulempe med sensorløs kontroll er den dårlige evnen til å estimere rotorposisjonen ved lave hastigheter. I denne oppgaven har eksisterende fluksmodeller blitt modifisert og forbedret slik at denne estimeringen kan bli mer nøyaktig ved lave hastigheter. Hovedmålet med denne oppgaven var å undersøke sensorløs styring av motoren ved lave turtall, og parametersensitiviteten til fluksmodellen. En tre-fase synkronmaskin har blitt simulert ved hjelp av en Simulink-modell. En kombinasjon av spenningsmodellen og strømmodellen har blitt brukt til å estimere statorfluksforslyngningen, med en PI-regulator i tilbakesløyfen. Parametrene til PI-regulatoren har blitt dimensjonert med symmetrisk optimum. Hvordan feilestimeringer av statorresistansen, induktansene i d- og q-aksene og motstanden i dempeviklingene påvirker estimeringen av statorfluksforslyngningen har blitt testet og analysert. Simuleringene viste at kombinasjonen av strøm- og spennings-modellen estimerte statorfluksforslyngningen med stor nøyaktighet, unntatt ved lave turtall. Det ble observert at feilestimering av statorresistansen og en offset i spenningsmålingene førte til de største feilene, selv om disse feilene kunne reduseres til en viss grad ved å bruke en PLL. PLL ble brukt til å filtrere rotorposisjonen som er input til strømmodellen, og det viste seg at ved å bruke PLL ble ytelsen kraftig forbedret når statorresistansen var underestimert. Når en spenningsoffset på 2V ble lagt til en av statorspenningene, fungerte modellen bedre uten PLL ved lave hastigheter. Ved høyere hastigheter derimot ble estimeringen av statorfluksforslyngningen noe mer nøyaktig ved bruk av PLL