The Relationship between Magnetic Resonance Imaging and Functional Tests Assessment in Patients with Lumbar Disk Hernia.

Although magnetic resonance imaging (MRI) findings are the gold standard for diagnosing herniated discs, there are many limitations to accessing MRI scanning devices in practice. This study aimed to evaluate the relationship between functional tests (the visual analog scale (VAS), the SLUMP test, the Sciatica Bothersomeness Index (SBI), the Oswestry Disability Index (ODI), and the LASEGUE test and MRI findings (LSA, IVDH L4-L5, IVDH L5-S1, DHS L4-L5, and DHS L5-S1) in patients diagnosed with disc herniation. Seventy-eight patients who met the inclusion criteria participated in the study. Radiologists and neurologists evaluated patients with disc herniation. After the disc hernia diagnosis, the patients were referred to a physical therapist for conservative management of the disk hernia. The physical therapists assessed the pain level and performed functional tests on patients. All statistical analyses were performed using R (Core Team) software. The correlation between the measured variables was conducted using the Pearson and Spearman tests. The study results indicated statistically significant correlations between DHS L4-L5 vertebral level and functional tests (VAS: r = 0.49, p = 0.00; SBI: r = 0.44, p = 0.00; ODI: r = 0.49, p = 0.00; LASEGUE: r = -0.48, p = 0.00; SLUMP: r = 0.50, p = 0.00). In conclusion, physiotherapists may prefer functional tests to diagnose the herniated disc, and these functional tests may contribute to performing evidence-based assessments.

Postoperative complications after head and neck operations that require free tissue transfer - prevalent, morbid, and costly.

To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive.

The evolution of productivity performance on China's dairy farms in the new millennium.

China's dairy farm structure has experienced fundamental changes across farm types. As the number of backyard farms has dramatically declined, the share of dairy cows from backyard farms has decreased by 22.4% from 2003 to 2008. However, the herd numbers of larger dairy farms have increased. In particular, the share of dairy cows has risen by 18.8% on small farms, by 22.2% on medium farms, and by 80.8% on large farms over the same period. Total factor productivity was decomposed into technical efficiency and technological change on China's dairy farms using the stochastic production frontier framework. The estimated results indicate that patterns of productivity growth appear to have shifted in the 2000s compared with the 1990s, from generally driven by technological change to exclusively driven by technological change on backyard and small farms and uniquely driven by the improvement of technical efficiency on large farms. Tests of the econometric assumption indicate that the variations in total factor productivity growth patterns across farm types and regions are likely caused by the feed input biases and cropping production practice.

Assessment by general practitioners of suitability of thrombolysis in patients with suspected acute myocardial infarction.

OBJECTIVE: To assess the clinical ability of general practitioners to decide to give thrombolytic therapy to patients with suspected myocardial infarction and to assess the contribution of the electrocardiograph (ECG) to this decision-making process. SETTING: 7 practices on the North side of Glasgow and the coronary care unit of Stobhill General Hospital. SUBJECTS: 137 patients presenting with chest pain who required direct admission to the coronary care unit. MAIN OUTCOME MEASURES: Agreement between the general practitioner's clinical decision to give thrombolytic therapy with or without reference to the ECG and the prescription of thrombolytic therapy in the coronary care unit. RESULTS: The predictive accuracy of the general practitioner's assessment of the necessity for thrombolytic therapy was 71.5%. The ECG had no impact on the accuracy of this decision and there were problems with the recording and interpretation of the ECG. Clinical decision making was altered in six cases by the ECG: wrongly in four. CONCLUSION: The diagnostic accuracy among general practitioners would result in some patients who did not have acute myocardial infarction being given thrombolytic therapy. In this study the ECG did not contribute towards diagnostic accuracy. Substantial improvement in both the recording and interpretation of ECGs is needed before thrombolytic agents can be routinely prescribed at home.

Electrophysiologic assessment of antiarrhythmic drug efficacy for ventricular tachyarrhythmias associated with dilated cardiomyopathy.

To determine the benefit of serial electrophysiologic drug testing in patients with ventricular tachyarrhythmias related to dilated cardiomyopathy, programmed ventricular stimulation was performed in 38 patients. In the baseline study, sustained ventricular tachycardia (VT) was induced in 18 patients, ventricular fibrillation in 7 and nonsustained VT in 13. The patients underwent a total of 84 trials of drug therapy (mean 2.3 +/- 1.4 trials/patient). Complete success (induction of fewer than 6 repetitive responses) was recorded in 19 trials and partial success (induction of at least 6 but no more than 15 repetitive responses) in 7. Potential proarrhythmic effects were observed in 9 trials. Overall, at least 1 successful regimen was identified for 20 patients (53%). During a mean follow-up of 21 +/- 13 months, there were no arrhythmia recurrences or episodes of sudden death among patients discharged with a drug regimen determined to be effective by serial drug testing. In comparison, among patients taking regimens that failed to prevent arrhythmia induction, there were 3 arrhythmia recurrences and 2 sudden deaths (p less than 0.05). Serial electrophysiologic drug testing provides an effective method of identifying successful medical therapy for patients with ventricular arrhythmia related to dilated cardiomyopathy.

Non-invasive cardiovascular assessment of indapamide in patients with essential hypertension.

The antihypertensive effect and a non-invasive cardiovascular assessment of indapamide in patients with idiopathic hypertension have been investigated in an uncontrolled study. Indapamide was found to be an effective antihypertensive agent in a dose of 2.5 mg per day with a mean fall in blood pressure of 25/18 mmHg. Apart from the development of impotence in one patient, no side effects were encountered. Its effect on heart rate and cardiac output suggest that vasodilatation may contribute to its mode of action. Exercise performance is well maintained and cardiac performance appears to improve when blood pressure is lowered with this drug.

Home dialysis: its costs and problems.

A short description is given of the starting and the running of a home dialysis unit for chronic renal failure. The cost of training and treating 22 home dialysis patients, over an 18-month period is recorded. The annual maintenance costs of patients on home hemodialysis are found to be no more, and often less, than those of the institutional care of any other chronic malady. Furthermore, the prospects for full rehabilitation are good. This being so, home dialysis cannot be regarded as a costly luxury but a treatment which every suitable candidate may reasonably expect.