Integrating medical biostatistics into postgraduate medical curriculum.

BACKGROUND: Knowledge of biostatistics is important for a health professional to understand research methods, analyse new information presented in scientific journals and to assess its relevance for their clinical practice. METHODS: We discuss the implementation of biostatistics in medical curricula, give perspectives on medical education in India, and narrate our own experience of integration of biostatistics into the medical curriculum. RESULTS: Biostatistics is still not a part of all postgraduate curricula in spite of its growing importance for all medical practitioners in the 21st century. CONCLUSION: The need for a reliable tool in research and evidence-based medicine is recognized in most postgraduate medical curricula in developed countries to improve teaching-learning outcomes.

The role of kinesitherapy and electrotherapeutic procedures in non-operative management of patients with intermittent claudications.

PURPOSE: To examine the effects of physical therapy (kinesitherapy and electrotherapeutic procedures) on the course of peripheral arterial occlusive disease by monitoring the changes in values of claudication distance and ankle-brachial indexes. METHODS: Prospective randomized study included 47 patients with peripheral arterial occlusive disease manifested by intermittent claudications associated with ankle-brachial indexes values ranging from 0.5 to 0.9. Patients from the first group (25 pts) were treated with medicamentous therapy, walking exercises beyond the pain threshold, dynamic low-burden kinesi exercises and electrotherapeutic ageneses (interference therapy, diadynamic therapy, and electromagnetic field), while the second group of patients (22 pts) was treated with "conventional" non-operative treatment - medicamentous therapy and walking exercises. The values of newly established absolute claudication distance and ankle-brachial indexes were measured. FINDINGS: Significant increase of absolute claudication distance in both groups of patients was registered, independently of therapeutic protocol applied (p < 0.001), as well as the increase in the claudication distance interval in the physical therapy group. There was no significant increase in ankle-brachial indexes values in both groups of patients. CONCLUSION: Methods of physical therapy presented valuable supplement in non-operative treatment of peripheral arterial occlusive disease patients, improving their functional ability and thus postponing surgical treatment. However, further investigations including larger number of patients are needed.

Relationship between spinal mobility measures and quality of life in patients with ankylosing spondylitis.

The aim of this study was to assess spinal mobility status and Quality of life (QoL) of patients with ankylosing spondylitis (AS) and determine the relationship between spinal mobility and measures of clinical condition including QoL. A total of 74 patients with AS were included in this study. Disease specific instruments Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were applied, and mobility testing: occiput-wall distance and chest expansion. QoL was assessed by the Short Form-36 (SF-36). The mean age was 48.5 years; there were significant correlations between BASMI score and age (P < 0.001), disease duration (P < 0.001), symptoms duration (P < 0.001) and BASFI (P < 0.001). BASMI was negatively correlated with SF-36 physical function subscale (P < 0.001) and general health subscale (P = 0.029). In multivariate regression analysis, BASFI score (P < 0.001) was independently associated factor with physical function domain of SF-36. This study showed that in AS spinal mobility measures are associated with physical function, general health, emotional role and mental health domains of QoL.

The assessment of acid-base analysis: comparison of the "traditional" and the "modern" approaches.

Three distinct approaches are currently used in assessing acid-base disorders: the traditional - physiological or bicarbonate-centered approach, the base-excess approach, and the "modern" physicochemical approach proposed by Peter Stewart, which uses the strong ion difference (particularly the sodium chloride difference) and the concentration of nonvolatile weak acids (particularly albumin) and partial pressure of carbon dioxide (pCO(2)) as independent variables in the assessment of acid-base status. The traditional approach developed from the pioneering work of Henderson and Hasselbalch and the base-excess are still most widely used in clinical practice, even though there are a number of problems identified with this approach. The approach works well clinically and is recommended for use whenever serum total protein, albumin and phosphate concentrations are normal. Although Stewart's approach has been largely ignored by physiologists, it is increasingly used by anesthesiologists and intensive care specialists, and is recommended for use whenever serum's total protein, albumin or phosphate concentrations are markedly abnormal, as in critically ill patients. Although different in their concepts, the traditional and modern approaches can be seen as complementary, giving in principle, the same information about the acid-base status.

[The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients]. / Izbor najbolje anestezioloske tehnike za operaciju preloma kuka kod visokorizicnih starijih pacijenata.

INTRODUCTION: Hip fracture is a pathological condition, more common in older age, i.e. in people over 65 years. The prevalence of this disorder is continuously increasing, simultaneously with higher age limit. In evaluation of risk for operation and anesthesia, older age itself represents higher risk and calls for special attention. In selection of anesthesiological technique, it is more usual to apply neuroaxial block or peripheral nerve block, which is more advantageous over general anesthesia. CASE REPORT: A female, 80-year old, patient B.D. was admitted to hospital for hip fracture, with the diagnosis of the right, lateral, basicervical femoral fracture. On admission, heart decompensation (decompensated dilated myocardiopathy), pulmonary edema and the left lateral pleural effusion were established. Due to high risk (ASA III) of intraoperative and postoperative complications, it was decided to apply combined peripheral nerve block. Using the neurostimulators, 3-in-1 block, lumbosacral block and sciatic nerve block were applied. During the operation, the patient was sedated by Propofol and had spontaneous respiration through the laryngeal mask. Intra- and postoperatively, the patient's hemodynamics was stable. CONCLUSION: Peripheral nerve blocks are safe and effective anesthesiological technique, which may reduce the mortality in patients with the hip fracture and maintain the hemodynamic stability, both during and after the surgical intervention.

[Possible factors for ankle fractures].

BACKGROUND/AIM: Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI), height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. METHODS: A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. RESULTS: The proportion of females was significantly higher (p < 0.001) with a significantly higher age (59.9 years, SD +/- 14.2) in relation to males (45.1 years, SD +/- 12.8) (p < 0.0001). Type A fracture was most frequent in the younger patients (34.2 years, SD +/- 8.6), and those with increased physical exercises (p = 0.020). In type B fracture, the risk factor was osteoporosis (p = 0.0180), while in type C fracture, body weight (p = 0.017) and osteoporosis (p = 0.004) were significant parameters. CONCLUSION: Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

Assessment of functional disability and quality of life in patients with ankylosing spondylitis.

INTRODUCTION: Ankylosing spondylitis is a chronic progressive autoimmune inflammatory disorder involving mainly the axial skeleton and larger peripheral joints that progressively limits spinal mobility and may lead to irreversible structural changes and consequently to impaired physical function and reduced quality of life. OBJECTIVE: The aim of this study was to assess functional disability and quality of life of patients with ankylosing spondylitis and determine the correlation between functional disability and quality of life. METHODS: The study enrolled 74 patients with ankylosing spondylitis (16 females and 58 males). The demographic data of the patients were collected. Functional disability was assessed with the Bath Ankylosing Functional Index (BASFI). Quality of life was assessed by the Short-Form 36 (SF-36) and the European Quality of Life Questionnaire (EuroQoL/EQ-5D). RESULTS: In our study, the mean age was 48.5 +/-10.3 years. BASFI was negatively correlated with the SF-36 physical function subscale (p < 0.001), physical role (p = 0.002), bodily pain (p = 0.003), general health (p < 0.001), vitality (p = 0.012) and mental health (p = 0.010) subscale. There was a significantly inverse correlation between the BASFI score and the rating scale of EQ-5D (p = 0.001). In the regression model, the BASFI score (p = 0.000) showed an independent association with the physical function domain of SF-36. CONCLUSION: In conclusion, the BASFI index was associated with physical function, physical role, bodily pain, general health, vitality and mental health domains of SF-36 and also with the rating scale of EQ-5D.

[Assessment of health-related quality of life of patients with chronic arthritis].

The assessment of the quality of life as a subjective measure of therapeutic intervention outcome appears to be increasingly adopted by different fields of medicine. In contrast to conventional indicators of condition, which are recognized as objective outcomes, the health-related quality of life (HRQoL) focuses on the patient himself. HRQoL has been determined as the perception of the individual of his or her situation in the current culture and value system; it includes wishes, expectations and emotional responses of the individual related to his or her health. Chronic arthritis leads to irreversible structural changes in joints and consequently to impaired physical function and reduced HRQoL. Today there are validated disease specific ("target") questionnaires to assess HRQoL in patients with rheumatoid arthritis and ankylosing spondylitis, but not yet in patients with psoriatic arthritis. A disease specific questionnaire makes easier approach to patients suffering from a specific rheumatic condition; it enables the comparison of HRQoL among patients suffering from the different types of chronic arthritis. The most frequently used questionnaire in the assessment of the HRQoL of patients suffering from chronic arthritis is the generic MOS 36-Item Short-Form Health Survey (SF-36) which is considered as the "gold standard". It is a generic questionnaire for the assessment of HRQoL in patients with chronic arthritis. To our knowledge, there are only a few studies focused on the HRQoL of patients suffering from chronic arthritis in Serbia and Montenegro.