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PubMed1996

European Spine Society--the AcroMed Prize for Spinal Research 1995. Unexpected load and asymmetric posture as etiologic factors in low back pain.

Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of "sudden load" on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain patients. The subjects were fatigued by holding a 20% maximum voluntary contraction for 1 min. A functional restoration program was tested for its efficacy in reducing reaction time and EMG amplitude in chronic low back pain patients. Reaction time was longer and EMG amplitude lower in patients than in their matched controls. EMG reaction time and magnitude decreased in patients after a 2-week rehabilitation program, including specific training of coordination and posture control. The results of the modelling showed higher spinal compressive load and lower shear forces when the load was expected than when the load was unexpected. The effect of sudden loads can be exacerbated if a worker is not standing on a flat surface or is fatigued. Chronic low back pain patients have less ability to protect themselves from sudden loads, but they can be trained to improve their response by means of an appropriate rehabilitation program.

Adult↗
PubMedDate not supplied

[Infantile mortality in Ile-et-Vilaine (1970-1986)].

The rates and the causes of infantile mortality between 1970 and 1986 in the district of Ille-et-Vilaine are reported. During that period, infantile mortality rate decreased from 18.7 to 7.06% and from 12.4 to 3.6% during the first week (0-6 days), thereby suggesting the efficacy of medical care programs for this pediatric age group in France. Since 1980, with more accurate record keeping, using the recommended international classifications, there is a relative stagnation in the rate or early neonatal deaths (3.97 to 3.67) as compared to a sizable drop in the rates of late neonatal deaths (1.90 to 0.73) and post neonatal deaths (4.63 to 2.57). Congenital abnormalities have become the most important cause of death (34%) before prematurity (24.58%). However, the number of congenital anomalies should quickly decrease with prenatal screening programs leading to interruption of pregnancies. Although the percentage of infantile deaths due to prematurity has decreased from 66% between 1970 and 1974 to 24.58% in recent years, prematurity remains an important cause of death. Infections have decreased and the Sudden Infant Death Syndrome is currently the most important cause of death during the postneonatal period. The well known factors of risks are confirmed and particularly increased vulnerability of the population with a low socio-economic status which should lead to appropriate prevention programs. Despite these very impressive results, birth remains the most vulnerable period of life and current efforts should continue. Priority must be given to the improvement of prenatal care which requires good ongoing collaboration between obstetrics and pediatrics and the use of the Maternity Health Booklet.

Congenital Abnormalities↗
PubMed2001

What's the use of faculty development? Program evaluation using retrospective self-assessments and independent performance ratings.

BACKGROUND: The assessment of the effectiveness of faculty development programs is increasingly important in medical schools and academic medical centers but is difficult to accomplish. PURPOSE: We investigated the usefulness of retrospective self-assessments by program participants in combination with independent ratings of teaching performance by their trainees. METHODS: We used a single sample, prepost intervention design using multiple measures. Our assessment instruments were based on our institution's accepted teaching competencies. We measured participants' self-assessments of their teaching competencies before the program and their retrospective self-assessed improvements in these competencies after the program. We also used independent ratings of the participants' teaching competencies before and after their involvement in the program, as rated by their own trainees (fellows, residents, and medical students). Selected teaching competencies comprised the intended learning outcomes of the faculty development program. RESULTS: Participants' preprogram self-assessments showed that the program was appropriately matched to several topics identified as needy, but also included topics that participants did not identify as needs. The retrospective self-assessments showed improvements in teaching skills that previously were identified as needs, as well as those in which participants originally felt quite competent. The independent ratings by trainees showed overall positive improvements (some significantly). The retrospective self-assessed improvements correlated positively with the independent ratings by their trainees (p < .01). CONCLUSIONS: This evaluation strategy showed that the faculty development program improved the teaching competencies of the participants. Both the program participants' retrospective self-assessments and the independent ratings by their trainees showed postprogram improvements and were positively intercorrelated. The use of these multiple measures is a viable approach to evaluate the impact of a faculty development program. Potentially either approach could be used, but in combination, they provide a feasible, valid, and reliable evaluation.

Education, Medical↗
PubMed2003

Rehabilitation after total femur replacement: a report of 2 cases.

We describe the rehabilitation of 2 patients who underwent total femur replacement after neoplastic involvement of the bone. In the past, patients with cancer of the femur were generally advised to undergo a hip disarticulation or transfemoral amputation. It is now feasible to salvage the limb in selected patients, by excising the entire femur together with any contiguous soft tissue tumor and replacing it with an endoprosthesis. The surgical literature contains a number of reports on total femur replacement, which mention the rehabilitation aspects only briefly, but we found nothing on this relatively uncommon form of surgery in the rehabilitation literature. Physiotherapy techniques such as active assisted exercises, isometric exercises, and hydrotherapy are extremely useful during the early phase of rehabilitation to facilitate a graduated strengthening program. Certain exercises, such as active hip abduction or knee flexion, may not be permitted for several weeks to protect muscles that have been reattached to the prosthesis. Partial weight bearing may be required to allow incorporation of bone allograft around the prosthetic hip joint. Because of these factors patients with total femur replacement may need a longer period of rehabilitation (6-8wk) than patients with total hip or knee replacement. Patients with total femur replacement can, however, achieve full independence with an appropriate rehabilitation program.

Activities of Daily Living↗
PubMedDate not supplied

Clinical feasibility of a free-weight strength-training program for older adults.

BACKGROUND: An emerging trend in the field of gerontology is the recognition that older adults, especially the frail elderly population, can increase their levels of strength and thus improve functional capability. Social acceptance of physical frailty and provision of care and assistance to dependent persons has now turned to helping the frail elderly adults maintain or improve functional independence. METHODS: The purpose of our study was to show the feasibility and effectiveness of a low-cost strength-training program using free weights for increasing strength and functional fitness among older adult volunteers. Participants aged 73 to 94 years were residents of a multilevel care retirement community in Columbia, SC. The strength-training program, led by an instructor, used dumbbells and ankle weights and was conducted in a multipurpose recreation room at the retirement facility. RESULTS: Functional performance measures (timed chair stand, 6-meter walk, stair climb, balance) handgrip strength, and self-assessment of activity level were outcome measures. All 25 participants completed the strength-training program. The average program adherence rate of all participants was 87 percent. No participant injuries or other adverse effects were observed. Functional performance measures improved significantly among program participants, with the greatest improvement in the timed chair stand (33.5 percent improvement) and the stair climb (17.6 percent improvement). CONCLUSION: Free-weight strength-training programs are appropriate for older adults, can be implemented in community settings, and are associated with significant improvement in functional performance.

Activities of Daily Living↗
PubMed1988

Pacemaker-mediated tachycardia: engineering solutions.

This discussion summarizes the interaction of refractory periods and upper rate behaviors in modern dual-chamber demand (DDD) devices, the data regarding and nine events initiating VA conduction and engineering solutions proposed and/or implemented to address the problem of pacemaker-mediated tachycardia (PMT). Among the causes of PMT are premature atrial depolarization, loss of atrial capture, a return to the demand mode after asynchronous magnet mode pacing, programming from a mode that does not guarantee AV synchrony to a mode in which atrial tracking can occur, noise, certain situations involving Wenckebach behavior, loss of sensing, and the inability of a rate-smoothing algorithm to allow a rapid change in ventricular rate. Engineering solutions to prevent the occurrence of PMT include a programmable postventricular atrial refractory period (PVARP), differential AV delay, adaptive AV delay, and the ability to discriminate between P waves of atrial origin and those resulting from retrograde conduction from the ventricle. Features such as the ability to lengthen the PVARP for one cycle after exiting the magnet or noise reversion modes or programming to a new mode, lengthen the PVARP for a single cycle following a PVC or revert to DVI pacing for one cycle following a PVC have been developed to recognize initiating events. A third solution, a tachycardia termination algorithm, can recognize and terminate PMT; varying the AV delay to determine whether P waves move in a corresponding manner and using a metabolic sensor to confirm the need for a fast heart rate are other possibilities in the detection of PMT. Diagnostic data features may also be used to evaluate the appropriateness of programmed settings. This discussion concludes that PMT is no longer a significant clinical entity when more advanced DDD pacemakers are utilized.

Algorithms↗
PubMed1997

When to recommend compulsory versus optional CME programs? A study to establish criteria.

When should remedial continuing medical education (CME) be compulsory for family physicians? When should it be optional? Should it be structured or not? In 1993-1994, the authors addressed this need for criteria by conducting a study that used reports on 14 physicians who had undergone a structured oral interview (SOI) at the College of Physicians of Quebec. (The SOI is a day-long encounter during which two specially trained physician-interviewers present a physician with standardized clinical cases that focus on ten specific aspects of a family physician's competence.) The 14 SOI reports were reviewed by 12 external physician-judges in an attempt to see how consistently they could link the ten aspects of competence, as shown in the reports, to five particular types of recommended remedial CME programs (the strictest being "compulsory program with suspended license" and the most lenient being "simple suggestions for improvement"). There was substantial agreement among the judges when choosing between compulsory and optional programs (kappa = 0.63, p < .05). The main criteria used when recommending an optional program were overall strengths and the quality of clinical reasoning. The same two criteria were also used for recommending a compulsory program, but the judges also considered three additional factors: the physician's ability to recognize his or her limits and how he or she handled referrals and prescribed medications. Many of the criteria used by the judges were based on unique information that came out of observations and interactions during the SOIs, such as quality of argumentation, sustaining a train of thought, sense for the case as a whole, or awareness of one's limits. Finally, the external judges corroborated the decisions previously made by the College of Physicians of Quebec concerning the appropriate CME programs for the 14 physicians.

Attitude of Health Personnel↗
PubMed2006

Endocrine disrupting chemicals research program of the U.S. Environmental Protection Agency: summary of a peer-review report.

At the request of the U.S. Environmental Protection Agency (EPA) Office of Research and Development, a subcommittee of the Board of Scientific Counselors Executive Committee conducted an independent and open peer review of the Endocrine Disrupting Chemicals Research Program (EDC Research Program) of the U.S. EPA. The subcommittee was charged with reviewing the design, relevance, progress, scientific leadership, and resources of the program. The subcommittee found that the long-term goals and science questions in the EDC Program are appropriate and represent an understandable and solid framework for setting research priorities, representing a combination of problem-driven and core research. Long-term goal (LTG) 1, dealing with the underlying science surrounding endocrine disruptors, provides a solid scientific foundation for conducting risk assessments and making risk management decisions. LTG 2, dealing with defining the extent of the impact of endocrine-disrupting chemicals (EDCs), has shown greater progress on ecologic effects of EDCs compared with that on human health effects. LTG 3, which involves support of the Endocrine Disruptor Screening and Testing Program of the U.S. EPA, has two mammalian tests already through a validation program and soon available for use. Despite good progress, we recommend that the U.S. EPA a) strengthen their expertise in wildlife toxicology, b) expedite validation of the Endocrine Disruptors Screening and Testing Advisory Committee tests, c) continue dependable funding for the EDC Research Program, d) take a leadership role in the application of "omics" technologies to address many of the science questions critical for evaluating environmental and human health effects of EDCs, and e) continue to sponsor multidisciplinary intramural research and interagency collaborations.

Endocrine System↗
PubMed2001

The relationship between trauma center volume and outcome.

In spite of the limited direct evidence available, increasing data support a positive volume-outcome association in trauma care. When coupled with the extensive indirect data suggesting that regions with organized systems of trauma care are associated with lower trauma-related mortality rates than regions where the number of centers and their level of commitment are unlimited and untested, there is little doubt that experience improves outcome and that volume plays a critical role in the accrual of experience. Although regionalization of trauma care has the inevitable consequence of increased prehospital transport times, particularly in rural areas remote from large trauma centers, some states have designed inclusive systems where a large number of smaller centers have been verified and designated as lower level trauma centers (i.e., level 3-5). The process of trauma center verification holds these smaller volume centers to a standard of care such that the quality of care of the trauma patient may exceed that of other, less-regulated aspects of medical or surgical care. Several reports have suggested that trauma outcomes in smaller rural level 3 centers or centers with dedicated trauma programs with appropriate, functional triage protocols are comparable to national norms, thus reflecting the importance of commitment to outcome. These data suggest that quality of care does not only follow volume, particularly when stipulations and requirements are clear regarding the process of care and ongoing quality assurance.

Hospital Mortality↗
PubMed2006

Osteogenesis imperfecta : current treatment options and future prospects.

Osteogenesis imperfecta is a heritable condition characterized by abnormally brittle bones, with an approximate prevalence of 1/20 000 births. Fractures are the main cause of suffering and disability, but owing to the abundance and wide distribution of the defective type I collagen in the body, a variety of symptoms occur. Several types of osteogenesis imperfecta (I-VII) have been described that vary in severity. For many years, therapy consisted of rehabilitation and orthopedic surgery. Presently, pharmacologic therapies aimed at strengthening bone are available, which decrease the pain and fracture rate associated with this condition, and allow more appropriate rehabilitation programs that will hopefully result in a less marked failure to thrive in affected children. In particular, the bisphosphonates, especially pamidronate, have been used for several years. They have been successful in increasing bone mineral density (BMD) and improving bone resistance, leading to a decrease in the fracture rate. Various regimens have been proposed, but it is the therapeutic regimen first used by Glorieux and co-workers in Montreal that has been the most frequently applied.However, as yet there is no definite consensus regarding the indications for therapy, the osteogenesis imperfecta types that are of the greatest concern, the appropriate age at the outset of therapy, and the treatment duration, without yet speaking about the best bisphosphonate regimen for use. The authors have proposed some personal recommendations for the clinical use of bisphosphonates, based on their own experience with the management of patients with this condition; these include the indications for therapy, based on the clinical status, and the treatment duration. These recommendations will certainly not be unanimously endorsed, but they should help to stimulate discussion. Ameliorating BMD is an important step, but will not prevent all fractures because bisphosphonate therapy does not correct the underlying genetic defect. More recently, stem cell replacement therapy in the child or fetus has been proposed as a therapeutic option.All in all, it is possible that, in order to dramatically decrease the fracture rate, combined therapies aimed at both circumventing the consequences of the gene defect using stem cells and reinforcing bone strength with bisphosphonates will have to be considered. Much work is still necessary before recommending these techniques in clinical practice.

Bone Density↗
PubMed2004

[Long-term results of early primary repair of flexor pollicis longus tendon injuries].

OBJECTIVES: We evaluated the long-term results of early primary repair of flexor pollicis longus (FPL) tendon injuries with the modified Kessler method and circumferential sutures. METHODS: Thirty patients (10 females, 20 males; mean age 26 years; range 4 to 52 years) were treated primarily with end-to-end anastomosis for FPL tendon injuries at the level of zone I to IV. Injuries were in the left thumb in 16 patients and in the right thumb in 14 patients. They were localized in zone I in one patient, zone II in 15 patients, zone III in nine patients, and zone IV in five patents. Twenty-five patients were treated within the first few hours after injury, while five patients were treated within a period ranging from 1 to 34 days. Associated digital artery and nerve injuries in 23 patients were treated during the same session. A rehabilitation program was implemented according to the modified Duran method. Functional evaluations were made according to the Buck-Gramcko system. The mean follow-up was 34 months (range 5 to 71 months). RESULTS: Functional results were excellent in 17 patients (56.6%), good in five patients (16.6%), fair in five patients (16.6%), and poor in three patients (9.9%). Excellent and good results accounted for 73.3% and 88.8% in zone II and zone III injuries, respectively. No significant differences existed between functional results obtained from patients with and without associated neurovascular injuries. CONCLUSION: Early primary end-to-end repair followed by an appropriate rehabilitation program yields very good functional results in patients with FPL tendon injuries, whether or not they are associated with neurovascular injuries.

Adolescent↗
PubMed1993

["To be blind", blindness between an epidemiological and a sociological definition].

From an epidemiological point of view, blindness refers to a visual acuity inferior to 1/20 in each eye. Though such a definition is necessary for the installation of public health programs, it is insufficient as far as the elaboration of actions aimed at prevention and rehabilitation are concerned. Qualitative data reveal that a similar physical deficiency is lived in various ways according to precise social context. In addition to the physical handicap objectively defended and to its social interpretation, the same must also be analysed in the light of another important linking factor; the individuals' social status and specific task and obligations of various groups in a given population. Considered together, these factors provide a better understanding of the social condition of blind persons, their economic and matrimonial resulting in the conception of appropriate health programs.

Activities of Daily Living↗
PubMed1993

Using research to guide culturally appropriate drug abuse prevention.

Several ways in which research can be an important tool in creating culturally appropriate prevention programs are suggested. To illustrate cultural variability, we present data from a study of 5th-grade African-American and European-American students. These data describe rates of early initiation, levels of exposure to identified risk factors, and degree to which identified risk factors predict substances initiated. Results indicate that European-American Ss have higher rates of tobacco and alcohol initiation, that the same risk factors predict the variety of substances initiated for African-American and European-American Ss, and that several differences exist in the level of exposure to risk factors between the 2 groups. Implications of the findings for developing culturally appropriate drug abuse prevention are discussed.

Black or African American↗
PubMed2006

Measles, rubella, mumps, and varicella seroprevalence among health care workers in Turkey: is prevaccination screening cost-effective?

BACKGROUND: To investigate the immune status of health care workers (HCWs) against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to define an appropriate vaccination program among HCWs. METHODS: Voluntary HCWs from a children's hospital and a general hospital were included in the study between March and May 2005. The specific IgG antibodies against MMRV viruses were screened by ELISA. RESULTS: Three hundred sixty-three HCWs participated in the study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and varicella, 98%. No association was found between the susceptibility to at least 1 of MMRV virus infections and gender, age, duration of work, profession, and department of work in analysis either among the whole study group, or each hospital. The positive predictive value for the history of varicella was 100%, whereas it was 92% for MMR. The cost of vaccination for varicella was significantly expensive without screening before vaccination. However, there was not much difference for MMR infections. CONCLUSION: A policy based on obtaining the history of varicella infection from the staff and then screening the ones with negative history and vaccination of only seronegative HCWs was found to be appropriate.

Adolescent↗
PubMed2001

2001 Joseph E. and Nancy O. Whitley Award. Teaching noninterpretive skills to radiology residents: a collaborative effort between the American College of Radiology and the Association of Program Directors in Radiology.

RATIONALE AND OBJECTIVES: The authors' purpose was to develop, implement, and evaluate a series of videotapes for teaching noninterpretive skills to radiology residents. MATERIALS AND METHODS: An Association of Program Directors in Radiology/American College of Radiology working group developed a series of seven videotapes to teach residents job search and contracting skills; business aspects of radiology; American College of Radiology standards, accreditation programs, and appropriateness criteria; critical thinking skills; ethics; service orientation and interpersonal skills; and medical organizational politics. Residents viewed the videotapes, evaluated the learning experience, and completed both pre- and posttests. RESULTS: From 85 to 264 residents completed each of six pre- and posttests. Mean total pretest scores ranged from 55.0% to 76.9% and improved significantly (P < .05) to 73.8% to 94.9% on posttests. Each videotape was evaluated by 90-336 residents using a Likert-type scale, with a rating of 5 representing the most positive response. The proportion of residents who gave each tape an overall rating of either 4 or 5 varied from 75.9% to 95.9%. CONCLUSION: Significant resident learning occurred as a result of viewing the videotapes. Program director support of the learning experience was strong, and use of the videotapes as a teaching modality received strong support by residents. Local moderators and question-and-answer sessions would optimize the learning experience.

Awards and Prizes↗
PubMed2001

Exercise testing in cardiac rehabilitation. Exercise prescription and beyond.

The prescription of exercise, either as a part of a formal exercise training program or as a means to increase physical activity in general, has been and will remain a primary component of cardiac rehabilitation and secondary prevention programming. Wherever possible, this prescription should be based on a recent exercise test that documents the cardiac patient's functional capacity, cardiac and hemodynamic responses to exercise, and signs and symptoms associated with exertion. Clearly the prescription of exercise and suggestions for increasing levels of physical activity must be based on accepted principles of exercise physiology and expected training responses. Nonetheless, the art of exercise prescription should guarantee flexible methodologies to meet the specific needs of each individual patient. Although the patient must accept ultimate responsibility for participation, the clinician bears the burden of continually attempting to reinforce the importance of increasing caloric expenditure and motivating patients to initiate and commit to long-term participation in a safe and appropriately designed program of exercise and increasing physical activity.

Cardiac Rehabilitation↗
PubMed1972

Kinetic studies on the two common inherited forms of human erythrocyte adenylate kinase.

1. The kinetic properties of two genetic variants of human erythrocyte adenylate kinase were studied at limiting concentrations of both ADP and MgADP(-) in the forward direction and at limiting concentrations of both AMP and MgATP(2-) in the reverse direction. 2. Primary reciprocal plots rule out the possibility of a Ping Pong mechanism for both forms of the enzyme. 3. Analysis of the kinetic data by an appropriate computer program gave the following K(m) values for the type 1 enzyme: AMP, 0.33mm+/-0.1; MgATP(2-), 0.95mm+/-0.13; ADP, 0.12mm+/-0.03; MgADP(-), 0.22mm+/-0.04. Values for the type 2 enzyme were: AMP, 0.27mm+/-0.03; MgATP(2-), 0.40mm+/-0.05; ADP, 0.08mm+/-0.07; MgADP(-), 0.20mm+/-0.04. 4. Product inhibition studies were done by studying the reverse reaction. With ADP as product inhibitor competitive inhibition patterns were obtained with AMP and/or MgATP(2-) as variable substrate. Similar results were obtained for product inhibition by MgADP(-) with AMP as variable substrate. The results are consistent with a Rapid Equilibrium Random mechanism. 5. Secondary plots of slope versus product concentration were linear. The data were fitted to the appropriate equation and analysed by computer to give values for the product inhibition constants. 6. Differences between the values of certain kinetic constants for the two forms of the enzyme were observed.

Adenosine Diphosphate↗
PubMedDate not supplied

A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients.

BACKGROUND: Patients with chronic renal failure (CRF) are restricted in physical, emotional and social dimensions of life due to their treatment and their comorbid medical conditions. We aimed to evaluate the effects of a 12-week exercise program on the functional capacity, functional mobility, walking capacity, quality of life and depression in patients with renal failure on hemodialysis (HD). METHODS: Twenty patients with renal failure on HD were included and 14 of them completed the study. The patients went through a 12-week exercise program of 90 min/day, 3 days a week. Exercise and walking capacity, functional mobility, psychological status and quality of life were evaluated pre- and post-training. RESULTS: Following the exercise, peak oxygen consumption, exercise duration and peak workload improved significantly (respectively, p=0.006, p=0.002 and p=0.002). There were significant improvements in the sit-to-stand-to-sit test and the 6- min walk test (p<0.001 and p=0.002). There was a significant reduction in the depression score (p<0.001). Both physical component scale (PCS) and mental component scale (MCS) of the Kidney Disease Quality of Life Short-Form 36 (SF-36) questionnaire showed significant increases (respectively, p=0.002 and p=0.004). CONCLUSION: The application of an appropriate exercise program would improve psychological status and quality of life, as well as work capacity in long-term maintenance HD patients.

Adult↗