Why and how should we measure outcomes in spine surgery?

The objectives of spinal surgery for degenerative disorders are to reduce pain and disability and improve patients' quality of life while allowing an early return to work. The incongruence between surgeons' perspectives, findings of imaging exams in terms of fusion statuses or adequate decompression, and patients' satisfaction levels with treatment have underscored the need to evaluate outcomes of spinal surgery with a specific focus on patients' perspectives. Patient-reported outcomes [PRO] are reports on health status taken directly from patients without interference from physicians. In recent decades, several generic and disease-specific PRO instruments have been developed and validated in patients with spinal disorders. In this paper, we review the most commonly used PRO instruments in patients with spinal disorders, focussing on their characteristics, applicability and minimum clinically important differences

Publish or perish mantra in the medical field: a systematic review of the reasons, consequences and remedies

Objectives: Generally, academic promotions, job retention, job mobility, and professional development of a medical faculty members are judged primarily by the growth in publication outputs. Universities and research institutions are more likely to recruit and promote those academics carrying voluminous resumes with larger number of published articles. This review elaborates the causes and consequences of the pressure to publish and the ways and means to cope with this paradigm

Methods: In 2015, database of Abstracts of Reviews of Effects, LISTA [EBSCO], Medline and Oxford University Library were searched for the English language full-text articles published during 2000-2015, by using MeSH terms "pressure to publish", "urge to publish", "research ethics", "plagiarism", "article retraction", "medical field". This search was further refined by selecting the articles in terms of relevancy and contents

Results: This research showed that some universities offer generous grants to researchers with a high h-index and with more publications in elite journals, which promise an enhanced prospect of citations and elevation in the scientific rankings of the funding institutions. This generates an involuntary obsession to publish with the primary intention to obtain promotions, high scientific rankings, and improved job security. This compelling pressure to publish results in widespread publication of non-significant research with a high index of plagiarism that eventually leads to an increased frequency of retractions

Conclusion: Research centers and academic institutions have an obligation to train their academics in sound scientific writing and to apprise them of the publication ethics and the grave consequences of plagiarism and research misconduct

Does type 1 diabetes mellitus affect bone quality in prepubertal children?

Type 1 diabetes mellitus [T1DM] in children often starts before the achievement of peak bone mass. This may constitute a landmark in predicting bone fracture risk later in their lives. This study aims to determine the serum levels of bone markers in children with T1DM in combination with their bone mineral density [BMD]. Children diagnosed with T1DM for 3 years or more without signs of puberty were included in the diabetic group. Another group of age-matched healthy non-diabetic controls was recruited froma local school. The serum levels of a group of biochemical markers for bone formation and resorption were determined in both study groups, and BMD was measured by ultrasound absorptiometry. Thirty six children with T1DM and 39 normal children were included in this study. The results showed that 24/36 [66.7%] diabetic children had a Z score below zero. Of these, five scored below -1. In contrast, 12/39 [30.8%] children from the control group had a Z score below zero, but none had a score below -1. Significantly lower levels of osteocalcin and procollagen N-terminal peptide were detected in the diabetic group. The serum levels of bone resorption markers were significantly higher in the diabetic group. T1DM decreases BMD and some bone formation and increases some bone resorption biomarkers. BMD and bone markers are useful diagnostic tools for the early detection of alterations in the bone quality of children with T1DM. This, if treated in a timely manner, may decrease future bone fracture susceptibility

Radiate ligament shortening and idiopathic scoliosis

To investigate the possible role of radiate ligament in idiopathic scoliosis. This study was designed as a case-control study adapted to cadavers. Eighteen human cadavers, 12 males and 6 females of Caucasian race, with a mean age of 55 years were studied at the Department of Anatomy, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from November 2010 to February 2012. Among the studied subjects, 15 were with normal spines, and 3 were scoliotic. The upper and lower bands of radiate ligaments were identified and measured. All cadavers were examined grossly. Scoliotic cadavers were also examined radiologically. The present study revealed that the mean of the lengths of the upper bands of radiate ligaments, on the concave side, in each scoliotic cadaver showed a highly significant shortening compared with that of the upper bands of the corresponding segments in cadavers with normal spines, while no significant change was detected when comparing those of the lower bands to normal values. The study suggested a possible relationship between radiate ligament shortening and the etiology of idiopathic scoliosis

Normal knee angles in the adult Saudi population

To study knee angles in the adult Saudi population and compare their values to the published data from other populations. Antero-posterior bilateral radiographs of 333 normal knees of 120 males and 213 females, with age range of 18-65 years, were studied retrospectively at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from January 2009 to December 2009. Tibiofemoral [TFA], lateral distal femoral [LDFA], and lateral proximal tibial [LPTA] angles were measured and the mean of each angle was calculated. The relationship between each angle and age, gender, and side of the body was tested, and compared with the international figures. The mean for TFA in Saudis was 174.41 degrees, LDFA was 90.07 degrees and LPTA was 89.42 degrees. All angles were not significantly related to gender. Significant relations existed between TFA and side of the body, and between LDFA and age. Variations in means and ranges of knee angles between the Saudi and other populations were determined. A significant difference existed between means of TFA, LDFA, and LPTA of Saudis and those of Caucasians, between mean of TFA of Saudis and that of Chinese, and between mean of LPTA of Saudi males and that of Chinese males. The means of TFA of selected age groups in Saudis differed significantly when compared to those in the corresponding age groups in Japanese and Australian Caucasians. Knee angles are like many other skeletal angles that may have ethnic variation between different populations. The study reinforces the need for reference values of knee angles in a given population

Predictive radiographic factors in DDH management

This study aims to assess the value of certain radiographic features of the pelvis associated with developmental dysplasia of the hip [DDH], in predicting the method of treatment; whether conservative or operative, in patients between 12 and 24 months of age where both options are valid. A retrospective review of the radiographs and the clinical files of children diagnosed with DDH during their second year of life [mean age 18.2 months], including only children who had a follow up of clinically and radiologically for a minimum of 5 years. The initial plain AP pelvic radiograph before commencing any treatment was used to measure 12 different measurements and 2 ratios. Each radiograph was studied individually and blindly, without knowing to which group of patients it belonged. A total of 72 dislocated hips in 54 patients were studied. The mean, standard deviation and P. values of age and radiographic measurements were calculated. Patients were divided into 2 groups according to the treatment modality used whether conservative or operative then they were compared. The measurement of the width of the femoral head ossific nucleus was significantly higher in the conservative group. The measurements of lateralization, superior migration of the femoral head and the acetabular angle were found to be significantly higher in the operative group. Study results suggest the possibility of using specific radiographic measurements in patients with DDH during the second year of life to determine the most feasible way of management

Response of families to the treatment of a child with a Hip spica cast

The aim was to identify the impact of treatment of a child with a hip spica cast on the family. This is a retrospective study of 100 families who experienced a child treated with a hip spica cast analyzed by questionnaire. The greatest concern encountered by families caring for children in a spica cast, was toileting, whereas mobilisation and transportation indoor and outdoor and carrying were the most frequent problems. Proper information was not received by one third of the families. Proper information and instructions for the care of children in hip spica casts need to be given, and special devices that help in mobilisation and transportation should be provided

Bohlerls and Gissane's angles of the Calcaneus in the Saudi population

The purpose of this study is to measure Bohler s angle [BA] and Gissane s angle [GA] in the Saudi population and compare their values to the published data. Lateral plain radiographs of 229 normal feet and ankles of 158 females and 71 males, with age range of 15-72 years, were studied retrospectively at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2002 and 2003. Bohler's angle and GA were measured and the mean and standard deviation of each angle were calculated. The relationship between each angle and age, gender, and side of body was tested, and compared to international figures. The mean BA in the Saudi population was 31.21 degree with a range of 16-47 degree. The mean GA was 116.16 degree with a range of 96-152 degrees. Bohler's angle and GA are not significantly related to age, gender, or side of body. Moreover, the range of both angles was wider than that reported in the literature. The study shows the difference between the Saudi and various other populations in regard to BA and GA, and reinforces the need to establish the normal ranges of BA and GA in a given population