Pilates-based exercise in the treatment of a patient with persistent low back pain following transforaminal lumbar interbody fusion.

Background: Low back pain (LBP) is the most commonly reported cause of disability in people under the age of 45 and is estimated to occur in 60-70% of the adult population in the industrialized world. This case report describes the use of Pilates-based exercise (PBE) in the physical therapy management of a patient with persistent chronic low back pain (CLBP) following transforaminal lumbar interbody fusion.Case Description: The patient was a 24-year-old female with a 7-year history of LBP presenting 17 months following surgery. The patient remained with constant LBP and right hip pain at 8/10 on the Numeric Pain Rating Scale (NPRS) after completing a course of physical therapy following the lumbar fusion.Outcomes: The PBE intervention lasted for 22 sessions during which the patient demonstrated complete resolution of right hip pain and remained with intermittent LBP (2/10 NPRS) at discharge. Minimally Clinically Important Difference levels for all self-reported outcome measure instruments were exceeded at discharge. The patient returned to work with lifting restrictions.Discussion: Patients following spine surgery are often excluded in studies of spine stabilization and PBE interventions. This case report describes the use of PBE in the treatment of a patient following spine fusion. Research to elucidate the impact of PBE on patients with CLBP is needed.

Alaska Native parental attitudes on cervical cancer, HPV and the HPV vaccine.

OBJECTIVES: To describe Alaska Native parents' knowledge of and attitudes towards cervical cancer, the human papillomavirus (HPV) and the HPV vaccine. STUDY DESIGN: This was a qualitative study composed of 11 focus groups (n = 80) that were held in 1 small village, 2 towns and 1 large urban centre in Alaska. METHODS: A convenience sample of Alaska Native parents/guardians was recruited in each community to participate in focus groups and to fill out a quantitative survey. RESULTS: While many parents had heard about HPV, most were unaware of its link with cervical cancer. The majority wanted to vaccinate their daughters because they had health and safety concerns; believed that vaccines work; had personal experiences with cancer; or believed that their daughters were susceptible to HPV. Reasons for refusal included general concerns about vaccines; a need for more information; a fear of side effects; wanting more vaccine research; and a fear of being in an experimental trial. CONCLUSIONS: The majority of parents were interested in having their daughters vaccinated. Acceptance of the vaccine was primarily based on a parent's desire to protect her/his child from cancer; while reasons for refusal revolved around trust issues and fear of unknown negative consequences of the vaccine.

Patient-centered informed consent in surgical practice.

OBJECTIVES: To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery and its complications, particularly for an incapacitated patient who requires a surrogate decision maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses consent for surgical complications, and emphasize the importance of communication and shared decision making in the context of the patient-surgeon relationship; and to discuss patient and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective communication, the role of the hospital ethics committee in resolving disputes over treatment, and how to reconceptualize surgical consent in the context of patient-centered medicine. DATA SOURCES: We reviewed PubMed citations for informed consent in surgery, patient-physician communication, shared decision making, patient-centered medicine, and consent guidelines published by specialty societies, particularly the American College of Surgeons and the Society for Critical Care Medicine. STUDY SELECTION: We selected articles in which issues of consent for surgical treatment were discussed or measured. DATA EXTRACTION: We extracted data relevant to questions of consent in surgical practice. DATA SYNTHESIS: We studied qualitative aspects of the consent doctrine. CONCLUSIONS: Surgical consent is not an event or a signature on a form but is an ongoing process of communication that continues throughout preoperative, perioperative, and postoperative care. In the context of patient-centered medicine, consent is best conceptualized as shared decision making with patients or their surrogates.