Effectiveness and characteristics of multifaceted osteoporosis group education--a systematic review.

UNLABELLED: The characteristics and effectiveness of osteoporosis multifaceted group education were determined from a systematic review of international literature. Findings showed that these educational programmes may be beneficial in a variety of important factors for the prevention, treatment and management of osteoporosis. INTRODUCTION: This systematic review investigated quantitative studies on osteoporosis multifaceted group education. The purpose was to investigate the characteristics as well as the effectiveness of this form of osteoporosis patient education. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. Relevant databases were searched until January 2013. RESULTS: Seven studies published between 1993 and 2011 including osteoporosis patients with or without fractures were found. The multifaceted educational programmes all consisted of three overall themes: (1) Knowledge of osteoporosis, (2) Medication and diet and (3) Exercise, but with different foci across the studies. Overall, 24 outcome measures representing six topics were applied: (1) Health-related quality of life, (2) Psychosocial function, (3) Pain, (4) Physical activity, (5) Knowledge and (6) Medication and diet. The review showed that multifaceted osteoporosis group education can increase the patients' knowledge of osteoporosis as well as their health-related quality of life, physical activity and psychosocial functioning. It has the potential to increase adherence to both pharmacological and non-pharmacological treatments. CONCLUSIONS: Multifaceted group education may have a positive impact on the patients' ability to engage in preventing and managing osteoporosis. Further research directed towards the complexity of multifaceted group education is needed. In addition, research investigating the educational needs of specific groups of osteoporotic patients is required.

A framework based on 2-D Taylor expansion for quantifying the impacts of sub-pixel reflectance variance and covariance on cloud optical thickness and effective radius retrievals based on the bi-spectral method.

The bi-spectral method retrieves cloud optical thickness (τ) and cloud droplet effective radius (r e ) simultaneously from a pair of cloud reflectance observations, one in a visible or near infrared (VIS/NIR) band and the other in a shortwave-infrared (SWIR) band. A cloudy pixel is usually assumed to be horizontally homogeneous in the retrieval. Ignoring sub-pixel variations of cloud reflectances can lead to a significant bias in the retrieved τ and r e . In the literature, the retrievals of τ and r e are often assumed to be independent and considered separately when investigating the impact of sub-pixel cloud reflectance variations on the bi-spectral method. As a result, the impact on τ is contributed only by the sub-pixel variation of VIS/NIR band reflectance and the impact on r e only by the sub-pixel variation of SWIR band reflectance. In our new framework, we use the Taylor expansion of a two-variable function to understand and quantify the impacts of sub-pixel variances of VIS/NIR and SWIR cloud reflectances and their covariance on the τ and r e retrievals. This framework takes into account the fact that the retrievals are determined by both VIS/NIR and SWIR band observations in a mutually dependent way. In comparison with previous studies, it provides a more comprehensive understanding of how sub-pixel cloud reflectance variations impact the τ and r e retrievals based on the bi-spectral method. In particular, our framework provides a mathematical explanation of how the sub-pixel variation in VIS/NIR band influences the r e retrieval and why it can sometimes outweigh the influence of variations in the SWIR band and dominate the error in r e retrievals, leading to a potential contribution of positive bias to the r e retrieval. We test our framework using synthetic cloud fields from a large-eddy simulation and real observations from MODIS. The predicted results based on our framework agree very well with the numerical simulations. Our framework can be used to estimate the retrieval uncertainty from sub-pixel reflectance variations in operational satellite cloud products and to help understand the differences in τ and r e retrievals between two instruments.

Disabilities of the arm, shoulder and hand (DASH) questionnaire: Determining functional activity profiles in patients with upper extremity disorders.

The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.

[Does the disability of shoulder, arm and hand questionnaire (DASH) replace grip strength and range of motion in outcome-evaluation?]. / Ersetzt der Disability of Arm, Shoulder and Hand Questionnaire (DASH-Fragebogen) die Erfassung von Bewegungsausmass und Kraft bei der Bewertung von Ergebnissen?

Scoring systems currently used to evaluate functional disabilities in upper extremity conditions frequently combine so-called "objective" parameters such as grip strength and range of motion with "subjective" parameters such as pain. Since its introduction, the Disabilities of Arm, Shoulder and Hand Questionnaire has proven useful in the pre- and postoperative evaluation of functional limitations of the upper extremity. This study examines the relationship between DASH scores, the so-called "objective" parameters of grip strength and range of motion and those of "mixed scores" such as Krimmer and Cooney Scores. Based on the data of six diagnostic groups, Spearman's correlation coefficients were calculated. There was no correlation between DASH scores and range of motion, however, some of the diagnostic groups showed a moderate correlation between DASH scores and grip strength. Both the Krimmer and Cooney scores showed a significant correlation with the DASH scores, indicating that these "mixed-scores" can be replaced by the DASH. Since it has been shown that grip strength and range of motion do not capture patients' functional limitations adequately, their continued use in the evaluation of upper extremity conditions should be the topic of further discussion.

Bright-light amaurosis fugax: an unusual symptom of retinal hypoperfusion corrected by external carotid revascularization.

The eye often serves as an important monitor of carotid artery disease by manifesting visual disturbances before cerebral events. The most typical ocular symptom complex is amaurosis fugax characterized by loss of vision in one eye that occurs suddenly and clears within seconds to minutes. This symptom is a hallmark of carotid artery disease and is usually caused by an embolic event. Although monocular visual disturbance on a hemodynamic basis is a more unusual manifestation of carotid artery disease, significant stenosis in combination with a low-flow state can cause transient, unilateral telescoping of vision. This report describes another visual disturbance associated with carotid artery disease in which unilateral visual loss occurred upon exposure to bright light. We term this syndrome bright-light amaurosis fugax and document successful treatment by external carotid artery revascularization in two patients.

Three-dimensional image reconstruction for planning of a complex cardiovascular procedure.

A rare left subclavian artery aneurysm associated with a congenital arch anomaly was difficult to visualize using standard radiographic techniques. Three-dimensional computer imaging produced a clear depiction of this unusual anatomy and simplified the preoperative planning.

Tortuous and aberrant external iliac artery precluding radical retropubic prostatectomy for prostate cancer.

A sixty-eight-year-old black man with clinical Stage A1 (T1a) adenocarcinoma of the prostate was found to have a tortuous and redundant left external iliac artery directly overlying the superior aspect of the prostate gland. The location of this blood vessel precluded radical retropubic prostatectomy. To our knowledge, this is the first reported example of this clinical situation. Computer-generated three-dimensional imaging from the computed tomography scan allowed accurate assessment of the vascular anomaly.

Microcomputer reconstruction for analysis of spinal deformity and lung volume in hypokyphotic scoliosis.

Current techniques for imaging chest deformity are limited to two-dimensional representations, and clinical testing for lung volume measurements are based on pulmonary function studies that are effort-dependent. The authors evaluated spine deformity and lung volume by using a new three-dimensional microcomputer imaging technique. Results from preoperative and postoperative chest computed tomograms underwent boundary detection by expert human observers. Data were then processed by polygon surface tiling to create three-dimensional color images of the spine and lungs for display. This computer technique allowed: 1) visualization of the anatomic relationships from any angle, 2) assessment of spinal deformity in relation to lung volume, and 3) measurement of individual lung volumes. Three-dimensional microcomputer imaging is a useful technique in objectively measuring lung volume and assessing postoperative changes.

Computer graphic modeling in surgery.

The application of computer-based solid modeling techniques to human anatomy shows great promise for enhancing surgical instruction and research. Such advances will directly benefit patient care. The increasing availability of powerful modeling programs for the microcomputer and the interactive peripheral technologies make the delivery of this new modality practical at the present time. We continue to refine our methodology for producing accurate and esthetic anatomic models and have developed a technique for three-dimensional "sculpting" of elongated structures. We continue to explore the possibility of using sectional scanning data to create anatomic images. Several applications have been described, ranging from surgical simulations to a ballistic injury model, in order to indicate the potential scope of this powerful technology.

[The DASH(Disability of Arm-Shoulder-Hand) Questionnaire--a new instrument for evaluating upper extremity treatment outcome]. / Der DASH-Fragebogen--Ein neues Instrument zur Beurteilung von Behandlungsergebnissen an der oberen Extremität.

The paper presents the translation of a new measurement tool, the DASH Questionnaire. The DASH (Disability of Arm--Shoulder--Hand) is an outcomes data collection instrument which has been developed by the "American Academy of Orthopaedic Surgeons", the Council of the "Musculoskeletal Specialty Societies", and the "Institute for Work and Health", in order to assess outcomes among patient groups with musculoskeletal disorders. Using a self-report system, patients attribute scores of 1 to 5 on 30 items relating to functional activities and symptoms; a further optional module contains four items relating to disability levels among musicians and athletes. The raw score is then transformed to a 0 to 100 scale, whereby 0 reflects minimum and 100 maximum disability. The subjective nature of this instrument makes it suitable for both postal or in situ clinical surveys. The instrument is in the process of validation for use with a German population.

Laparoscopic repair of a large interstitially incarcerated inguinal hernia.

A 68 year old female presented for elective repair of an abdominal wall hernia. Preoperative CT imaging revealed a right inguinal hernia defect with hernia contents coursing cephalad between the external and internal abdominal oblique muscles. This was consistent with an interstitial inguinal hernia, a rare entity outside of post- traumatic hernias. At operation the hernia contents were reduced laparoscopically. The hernia was then repaired by transitioning to the totally extraperitoneal (TEP) approach using a 15cm X 15cm piece of polyester mesh. The patient had an uneventful recovery. Interstitial hernias are rare, difficult to diagnose and potentially dangerous if left untreated. There is no consensus on the ideal repair of these unique hernias. This represents a minimally invasive repair of an unusual hernia, with a novel approach to diagnose and manage the hernia and its redundant sac.

Obstructive jaundice secondary to hepatoma. Case report and literature review.

A 67-year old male, who presented a clinical picture of obstructive jaundice with cholangitis, was found to have hepatoma tumor embolus blocking the common duct. The site of invasion was the right hepatic duct. There are 15 such cases reported in the literature. Hepatoma rarely presents with obstructive jaundice. A clinical picture of biliary colic or cholangitis is frequently misleading. Invasion of a hepatic duct large enough to allow formation of a tumor embolus implies tumor close to the bifurcation of right and left hepatic ducts and has precluded effective surgical treatment in all but one case.

Hypertext and three-dimensional computer graphics in an all digital PC-based CAI workstation.

In the past several years there has been an enormous increase in the number of computer-assisted instructional (CAI) applications. Many medical educators and physicians have recognized the power and utility of hypertext. Some developers have incorporated simple diagrams, scanned monochrome graphics or still frame photographs from a laser disc or CD-ROM into their hypertext applications. These technologies have greatly increased the role of the microcomputer in education and training. There still remain numerous applications for these tools which are yet to be explored. One of these exciting areas involves the use of three-dimensional computer graphics. An all digital platform increases application portability.

[Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder,Hand (DASH) questionnaire]. / Standardisierung und Validierung der deutschen Version 2.0 des "Disability of Arm, Shoulder, Hand" (DASH)-Fragebogens zur Outcome-Messung an der oberen Extremität.

The Disability of Arm, Shoulder, Hand (DASH) Version 2.0 questionnaire captures the subjective experience of patients regarding their own health. This 78-item instrument was developed by the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies and the Institute for Work and Health,Toronto and measures components of health-status relevant to upper-extremity conditions. We translated and validated DASH with the aim of producing a tool which could also be used in German-speaking countries. The paper reports the method of translation and cross-cultural adaptation which was carried out according to the AAOS guidelines. The result was a standardised German version of DASH. Psychometric testing of the translated questionnaire was carried out with 6 samples (n=342) who had undergone hand surgery for a variety of conditions. The study yielded good results across all groups with regard to the construct, criterion and content validity. We confirm that the German version is suitable for use in future studies.

[The "Shoulder, Arms and Hand Disability Questionnaire" as a scale for identification of the diagnosis-specific activity profile]. / Der "Disability of shoulder, arms and hand"-Fragebogen als Instrument zur Identifikation diagnosespezifischer Aktivitätsprofile.

Functional disabilities of the upper extremities have a considerable social and economic impact so that interest was aroused in developing a valid and reliable instrument suitable for international use. The Disabilities of the Arm, Shoulder, and Hand questionnaire is a self-report measure recording functional limitations in the upper extremity. A German version is now available in German-speaking countries. Previous studies have been concerned with the evaluation of DASH scores. Based on the data of four diagnostic groups, this study explores DASH's ability to identify diagnosis-specific limitations at the item level. The data were pooled and examined with regard to significant differences within the groups. Diagnosis-specific limitations could be identified within all groups, indicating that DASH is capable of expressing diagnostic entities as well as summed scores. Consideration of the individual profiles opens the possibility of using DASH as a prognostic tool to anticipate functional problems arising during rehabilitation following surgical interventions.

Three-dimensional computer graphic modeling of ballistic injuries.

Multiple variables affect the tissue destruction caused by missiles, and the interaction of these variables is incompletely understood. The recently developed technology of computerized solid modeling now makes it possible to analyze these parameters in three dimensions. A technique for creating solid models of organic structures is described. The tissues within the boundaries thus defined are ascribed physical attributes by means of finite element analysis with data derived from empirical studies. An interactive user-friendly program is being developed combining this modeling with a probabilistic scheme (Monte Carlo simulation) to describe a variety of wounding scenarios. The data from these predictions will be compared with information from wound registries and the model refined until it can project consistently accurate patterns of injury.

Study of upper extremity growth and development using human embryos and computer-reconstructed models.

This study investigated the apical ectodermal ridge and early vasculature of the human limb bud by use of histologic techniques and a new method of computer modeling. Fourteen human embryos were studied (more than 10,000 sections) microscopically and the embryonic limbs were reconstructed three-dimensionally by use of a serialized programming method. The apical ectodermal ridge consists of an extensive band of specialized cells, located over the rim of the limb surmounting a strip of rapidly-dividing mesenchymal cells. It is consistently supplied by a large vessel that shows extensive central branching.