The Study of Short –Term Precision of Calcaneal Quantitative Ultrasound (Achilles Express)

Background and objective:        Dual-energy X-ray absorptiometry  is regarded as reference method for bone density assessment.  Quantitative ultrasound (QUS) has been introduced as an alternative technology to bone densitometry. To study short-term precision (coefficient of variation; CV%) and the intra- and inter-observer reliability of QUS in measuring bone mineral density of the calcaneus.Methods:   This study is cross-sectional descriptive study.  Subjects were 20 persons (10woman ,10 man )in the age group between 20-70 years olds.Results Short-term precision of SOS ,BUA ,SI showed by coefficient of variation (CV%) were  0.99 ,6.42 ,6.27 respectively.  The correlation coefficient (r) for SOS, BUA, SI between the 1st and 2nd observer was 0.821, 0.755 and 0.861 respectively (p

Rusults of epidural steroids injection in patients with Lumbosciatic pain.

 Fourty patients with recalcitrant lumbosciatic pain were treated by epidural steroid injection at Srinagarind hospital, and a private hospital between January 1988 to April 1990, to study the efficacy of epidural steroid injection. the average age was 52.2 years (24.62 years).  All patients were injected with 2 cc. Of methylprednisolone (depo-medrol 40 mg/cc.) plus 3 cc. Of 1% lidocaine at weekly interval for 3 weeks.  The patients were devided into 2 groups; group I includes those patients who had lumbosciatic pain less than 3 mounths, group II more than 3 months.  In this study there were 11 patients in group I and 29 in group II.  The results at one week after completion of the injections were good in both groups (81.81%, 72.42%), at 3 weeks (after completion of the injection) were quite good 63.63% in group I and 58.62% in group II and at 6 weeks after completion of the injection the result were good \< 36.36%.  In this study, it appears that the lumbosciatic pain may receive temporary relief with steroid injection especially in short term (

Computer Assisted Instruction in Orthopaedic Subjects

 Computer assisted instruction (CAI) is an effective instructional medium, especially in medical subjects.  It can be used in many forms such as drill and practice, tutorial, simulation and problem solving etc.  We create CAI in the forms of tutorial and simulation in Orthopaedic subjects and tryout on one group of students, the result was quite satisfactory, We compare the advantage and the limitation of CAI so that other people who are interested in this field can judge its efficiency and effectiveness.  It is hoped that CAI will prove to be an essential instructional medium in the near future.

Below-the-Knee Amputation by Extern.

 This is a prospective study of sixty long posterior flap below-the-knee amputations done by the KhonKaen University externs under closed Supervision of qualified orthopedists. Post-operatively red rubber bulb drainage was used instead of the hemovac.The patients were all leprotic and held in custody by Nonsomboon Leprosarium. Twenty-nine cases were affected by malignant change of the long standing trophic ulcer, while 29 had chronic ulceration and osteomyelittis of the tarsal bones with useless deforned feet. One was due to painful Boyd’s stump and the other form persistent infection after transmetatarsal amputation. Eighteen cases of stitch abscess and two cases of hematoma collection were detceted but no any wound disruption were seen in our series.

The risk of paralysis in vertebral tuberculosis

 Vertebral tuberculosis is still a health problem in Thailand. Apart from spinal deformities it may be associated with paralysis with dreadful consequences. Paralysis at the thoracic level is more common in this condition due to the relative incompatibility of the thoracic spinal canal and the spinal cord. However, the magnitude of the risk of paralysis in this condition does not exist. We therefore carried out a retrospective study of 87 cases of vertebral tuberculosis to find out the risk. There were 52 cases of thoracic and 35 cases of lumbar involvement (No cervical found in this study) The risk for neural deficit or paralysis in the thoracic group was found to be 5 times more than the lumbar group (Chi-square test shows p \< 0.01 , odd ratio = 5.22 and 95% confident interval = 1.69-16.86)

Microcomputer assisted instruction in Orthopedics

 Using an IBM compatible, 16 bit and advanced basic language, microcomputer, we devised a computer assisted instruction (CAI) program of case study in Orthopedics. A trial was then made an our house staffs (2 Orthopedics residents and  5 resident equivalents) . The efficacy of CAI as a teaching aid and users’satisfaction was evaluated with satisfactory outcome. This report aims at showing the favorable acceptance of CAI as a teaching aid and at arousing its acceptance as a new kind of technology suitable for various adaptation in academic use.

The use of microcomputer in item analysis

 Utillizing the Thai version of dbase III, a program for items analysis was developd in the computer unit of the Department of Orthopedics and Rehabillitation Medicine KhonKaen University, for the purpose of1. grading of medical students2. standardization of the examination itemsThe program was used to analyse the items given to medical students in the 4th and 6th year standing for their final examination in 1986-1987 and found to be effective: The well –standardized items could be identified and stored in the examination bank while those less-standardized could be separated for later improvement. These could be accomplished within a day for each class , much more effective than previously.

Self directed learning using computer assisted instruction in topic of Orthopedic trauma

Obfective : The  purposes  of  this  project  were  to  study  (1) the  students’ opinion  about  the  teaching  and  learning  method. (2) The  ability  of  the  computer  assisted  instruction  (CAI)  in  Orthopedic  trauma.Method : One  hundred  and  forty – five  out  of  172 (84.30%) , fourth  year  medical  students,  Khon  Kaen  university,  Khon  Kaen,  Thailand, answer  the  questionnaires  after  finishing  the  study.  The  questionnaires  consisted  of  2  parts,  (1) The  teaching  and  learning  technique  and  (2) CAI  program  in  Orthopedic  r\trauma.  The  questionnaires  consisted  of  the  questions  about  various  aspects  of  the  activety  in  learning  period,  and  the  CAI  program.  Each  specific  question  had  a  possible  score  of  1  to  5,  with  5  indicating  strongly  agree.Results :  The  results  indicated  a  positive  attitude  toward  thes  teaching  and  learning  method (average 4.22).  Also,  the  students  reacted  favorably  to  the  CAI  program  (average 4.11).  The  students  commented  that  they  liked  something  new  which  was  different  from  traditional  teaching,  especially  they  had  more  chance  to  discuss,  solve  the  problem  among  the  group  and  present  their  knowledge  to  the  class. (2) They  received  useful feedback  from  the  teacher  that  enables  them  to  get  to  know  their  weaknesses.  However,  there  were  constraints  such  as  the  process  of  producing  the  CAI,  th  limitation  of  time  in  the  rotational  block,  and  an  inconvenience  of  computer  using.Conclusion  :  The  author  reached  the  objectives  of  the  study,  a  positive  attitude  about  the  teaching  and  learning  using  CAI,  gaining  some  experience  about  student  centered  learning  method  and  recommending  everyone  to  use  this  method.

The Reliability of Calcaneal Quantitative Ultrasound in the Measurement of Bone Mineral Density

Background: Dual-energy X-ray absorptiometry (DXA) is regarded in other countries as the reference method for bone density assessment because of its high reliability and precision. It is an expensive and thus with limited availability in developing countries. Quantitative ultrasound (QUS) has been introduced as an alternative technology to bone densitometry. Advantages of this method for evaluating patients at risk of osteoporosis over X-ray-based techniques include its low cost, portability and no ionizing radiation. Until now, there has been no study in Thailand about the reliability of QUS for its use in diagnosis of osteoporosis.Objectives: To study both the intra- and inter-observer reliability of stiffness index (SI) of QUS in measuring bone mineral density of the calcaneus Study design: Cross-sectional descriptive study Setting: Subject for bone density measurement were 100 Thai elderly women 60-89 years old (average age of 69.97 years), living in urban areas of Khon Kaen province, ThailandOutcome measurement: Stiffness index (SI) of the calcaneus in elderly women measured by two observers twice each.Results: This study was part of the study of “the combination of OSTA index and QUS in diagnosing osteoporosis”. The average weight of the subjects was 49.24 (30-81) Kg. The respective correlation coefficient (r) for SI between the 1st and 2nd measurements of the 1st and 2nd observers and between the 1st and 2nd observer was 0.973, 0.976 and 0.925 (p

Validation of the KKOS Scoring System for Screening of Osteoporosis in Thai Elderly Woman Aged 60 years and Older

Background: Osteoporosis is a major public health problem resulting in disability, deformity, pain and fractures. The “gold standard” for osteoporosis is the bone mineral density (BMD) measurement; however bone densitometers are not widely available and the cost of measurement is high. As a solution, the “Khon Kaen Osteoporosis Study Scoring System (KKOS)” screening tool for osteoporosis was developed. A study of the KKOS index indicated a sensitivity and specificity of 70 and 73 percent, respectively. The receiver operating characteristic (ROC) curve was 0.73.Objectives: The purpose of this study then was to validate the KKOS scoring index for osteoporosis screening in Khon Kaen province in elderly women age\>60 years of age. Design: Retrospective diagnostic studyMethodology: The data was retrospectively collected from 487 medical records (at the Department of Nuclear Medicine, Srinagarind Hospital) of elderly women of \>60 years of age who resided in Khon Kaen province between 2004 and 2007. Body weight, age and BMD were used to calculate the KKOS score. Results: Included were 487 menopausal women of \>60 years of age (mean 75.7+5.3). Mean weight was 51.7+8.8 kg. The prevalence of osteoporosis, as per bone mineral density of the femoral neck by Lunar DPX-IQ densitometer, was 27.10 percent. The KKOS score was calculated basing on age and weight. Individuals with a KKOS score