Change in Low Back Movement Patterns After Neurosurgical Intervention for Lumbar Spondylosis.

OBJECTIVES: The purpose of this study was to assess the use of computer-aided combined movement examination (CME) to measure change in low back movement after neurosurgical intervention for lumbar spondylosis and to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from lumbar disk disease, disk protrusion, and nerve root compression cases. METHODS: A test-retest, cohort observational study was conducted. Computer-aided CME was used to record lumbar range of motion in 18 patients, along with pain, stiffness, disability, and health self-report questionnaires. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. z Scores were used to compare CME. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions-disk disease, disk protrusion, and nerve root compression-to report intergroup differences in CME. RESULTS: Self-report data indicated that 11, 7, and 10 patients improved by ≥30% in pain, stiffness, and function, respectively. Three patients experienced clinically significant improvement in health survey. A CME pattern reduced in all directions suggested disk disease. Unilaterally restricted movement in side-flexed or extended directions suggested posterolateral disk protrusion with or without ipsilateral nerve root compression. Bilateral restrictions in extension suggested posterior disk protrusion with or without nerve root compression. In 11 of the 18 cases, CME converged toward the NRR after surgery. CONCLUSION: We described the use of CME to identify atypical lumbar movement relative to an NRR. Data from this short-term postoperative study provide preliminary evidence for CME movement patterns suggestive of disk disease, disk protrusion, and nerve root compression.

Structure-Specific Movement Patterns in Patients With Chronic Low Back Dysfunction Using Lumbar Combined Movement Examination.

OBJECTIVE: A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. METHODS: Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. RESULTS: Seven of the 17 participants stated that a "combined" movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. CONCLUSION: The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis.

Ethics of Global Health Photography: A Focus on Being More Human.

This article explores the relationship between ethics and the production of global health photographic images. Through the text, we emphasize the need for greater awareness of potential ethical pitfalls, not just in relationship to the finished product of the image but also throughout the full photographic process. In order to do so, we present and explore three vignettes detailing our personal global health photographic experiences. Using these examples of the process of photographic production, we argue that the ethical emphasis needs to fall as much on the way of making and circulating the images as on the resulting images and their content. In showing that ethics starts long before the decision to publish a photograph, we engage global health photography as a relationship built of unequal power dynamics, where agency is held (albeit lopsidedly) by all of those around the camera-the subject, the photographer, and the bystanders or actors who exist beyond the photograph's composition. By following the concept of "encouraging people to do what is best given certain circumstances and constraints," we as photographers and global health workers advocate for a more fully human interaction through conscious, careful global health visual policy and humane photographic deliberation.

Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills.

INTRODUCTION: In hospital cardiac arrest (IHCA) affects 200,000 adults in the United States each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a program of "mock codes" improves group-level performance of IHCA skills. Our primary outcome of interest was change in CPR fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesized that a sustained program of mock codes would translate to greater than 10% improvement in each of these core metrics over the first three years of the program. METHODS: We conducted mock codes in an urban teaching hospital between August, 2012 and October, 2015. Mock codes occurred on telemetry and medical/surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's "Code Blue" team, and data were recorded by trained observers. Data were summarized using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. RESULTS: Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per six-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. CONCLUSIONS: While we observed a significant improvement in CPR fraction over the course of this program of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.

The organ donor crisis: the missed organ donor potential from the accident and emergency departments.

The critical shortage of cadaveric donor organs for transplant purposes is a worldwide concern. The disparity between the number of cadaveric organs donated for transplant purposes and those patients awaiting transplant operations continues to widen. This article reports on the findings of an audit of deaths undertaken in 10 accident and emergency (A&E) departments in North Thames region, UK. The audit itself was borne out of informal anecdotal accounts from colleagues working in the A&E department who suggested that there was a potential pool of organ and tissue donors that were not being realized. The article discusses how those audit findings helped shape the current A&E education strategy in the North Thames region. The result has been that the North Thames region has seen a dramatic increase in the number of referrals from the A&E departments, resulting in solid organ transplantation. Although the results are very encouraging, the program is still very much in its infancy and a long way from the desired 100% referral rate. In order to maximize the number of organs from the potential donor pool, the transplant community needs to focus more attention toward donation from the A&E departments.

Penile paraffinoma: the delayed presentation.

The injection of foreign substances into the penis for the purpose of augmentation may result in erectile dysfunction, voiding difficulties, and severe deformity. We report a case of penile paraffinoma in a 71-year-old man that developed nearly 40 years after undergoing a series of penile injections with an unknown substance. Penile paraffinoma can therefore present a diagnostic dilemma given its protracted latency period, after which time the initial injections have faded into distant memory.