Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain.

UNLABELLED: The evaluation of postural stability using posturography could be both a valuable functional diagnostic and treatment outcome monitoring tool in rehabilitation practice of patients with chronic low back pain (cLBP). No evidence, however, seems to exist, whether or not such posturographic measures are reliable in these patients and therefore clinically and scientifically useful. The aims of this study were manifold and aimed at investigating (1) differences of posturographic measures between cLBP patients and healthy controls (HCs), (2) short- (intrasession-) and long-term (intersession-) reliability of these measurements, and (3) the relationship between both pain intensity and test-related feelings and significant learning effects of the posturographic measures in cLBP. A total of 32 cLBP patients and 19 non-sportive HCs completed (1) comprehensive clinical examination, (2) quantitative posturographic testing (SMART EquiTest, Neurocom International, Clackamas, Oregon) that included all the sensory organisation test (SOT), the motor control test (MCT) and the adaptation test (ADT) and (3) psychological ratings of pain as well as posturographic test related personal feelings and fear associated beliefs. Of these, 22 cLBP patients who received no therapy repeated all measurements and examinations on a second day, 2-3 weeks later. Results revealed significant differences between cLBP patients and HCs in the more demanding postural test conditions of the SOT and the SOT composite score only. Intra-session reliability testing demonstrated significant improvements of the SOT and ADT measures for both HCs and cLBP patients. Results of long-term reliability testing showed significant improvements of the more challenging SOT conditions and SOT composite score. VAS ratings of pain, feelings and fear associated beliefs were not associated with such longitudinal changes. CONCLUSION: Our findings suggest that the significant learning effects observed for the SOT conditions may limit the clinical application of SMART EquiTest postural stability measures for cLBP patients in rehabilitation everyday practice. Further development in software processing will be necessary to identify new postural parameters that are less prone to learning effects.

Adherence to the Swiss guidelines for management of COPD: experience of a Swiss teaching hospital.

QUESTIONS UNDER STUDY: Swiss guidelines for the management of chronic obstructive pulmonary disease (COPD) were published in 2002. We aimed at assessing adherence to the proposed guidelines by the physicians in charge for all patients referred to our hospital for acute exacerbations of COPD over a one year period. METHODS: In a prospective observational study, data from a questionnaire and from records of all patients referred to our hospital with acute exacerbation of COPD were collected. Diagnostic steps as well as therapeutic and prophylactic interventions were reviewed. Where applicable, interventions were stratified according to proposed levels of evidence A-D. RESULTS: 45 patients in whom the diagnosis of COPD had been made before were included. Diagnosis was established by spirometry in 71%, in the remaining diagnosis was based on clinical grounds only. Non-smoking advice was given to 69%, and 16% were offered a nicotine-replacement trial (level A). Information about a disease management plan was given in 40% of the patients (level B), 22% had done a six minute walking distance test. 27% of the patients had participated in a pulmonary rehabilitation program (level A). 93% were on regular bronchodilator therapy (level B), and 56% had regular inhaled corticosteroids (level B). CONCLUSION: Confirmation of the diagnosis of COPD by spirometry is lacking in a significant number of patients. Most patients were treated with regular bronchodilators, however, relevant over-treatment with beta-adrenergic substances and overuse of inhaled corticosteroids in mild disease stages are common. Efforts for disease prevention and education as well as awareness of the potential benefits of pulmonary rehabilitation programs are still insufficient. Efforts to improve the adherence to the Swiss guidelines for the management of COPD should be intensified.

Shwachman-Diamond syndrome: early bone marrow transplantation in a high risk patient and new clues to pathogenesis.

Shwachman-Diamond syndrome (SDS) is an autosomal recessive disorder characterised by exocrine pancreas insufficiency, metaphyseal dysostosis and bone marrow dysfunction. Recurrent severe bacterial infections and susceptibility to leukaemia are the major causes of morbidity and mortality occurring preferentially in patients with pancytopenia and features of myelodysplasia. Here we report a patient with SDS leading to recurrent bacterial infections and a deteriorating condition since early infancy. Extensive investigations disclosed severe pancytopenia, myelodysplasia and a clonal cytogenetic abnormality, inv(14)(q11q32), as risk factors of leukaemic transformation. He therefore underwent allogeneic geno-identical bone marrow transplantation which resulted in correction of all haematological and immunological abnormalities within an 18-month follow up period. Conclusion Bone marrow transplantation may be considered early as a valuable treatment option especially in high risk Schwachman-Diamond syndrome patients anticipating malignant transformation, life-threatening severe infections or further organ damage.

[Neuroleptics in the newspaper. A mass media analysis]. / Neuroleptika in der Zeitung. Eine Medienanalyse.

OBJECTIVE: Neuroleptic drugs have a dubious public reputation. Many people consider them obnoxious, even in schizophrenia. METHOD: 10 annual editions of six German language opinion leading newspapers are analysed. RESULTS: Only in one of 35 articles neuroleptics are judged positive, in 27 negative. They are seen close to violence and restriction, as punishment or even as torture, as paralyzing or even as "torturetherapy". Informations in the articles are scarce. Most of the articles cover the fields of medicine or psychiatry or of forensics. CONCLUSION: Apart from the negative attitude the extremely low number of articles on neuroleptics is the most outstanding result of our study.

[Tranquilizers in the newspaper. An media analysis]. / Tranquilizer in der Zeitung. Eine Medienanalyse.

OBJECTIVE: For the public the image of psychopharmacological drugs is identical with that of minor tranquilizers. The way of describing and portraying these drugs in the media therefore is of general interest. METHOD: Ten annual volumes of six German language opinion leading daily and weekly papers which exist on CD-Rom in full text editions are screened for the key word "minor tranquilizer". The articles identified are analyzed formally quantatively and qualitatively. RESULTS: The ten annual volumes analyzed contained 45 articles in which tranquilizers were mentioned (4.5 per annual volume). The key words were found in all sections of the papers, most often, however, in the cultural section, followed by the science section. Regarding the themes medicine and law were in the first position (one third), but society, arts and culture and politics contained even more articles dealing with the key word minor tranquilizer. For fifth of the articles only mentioned the key word. Only once minor tranquilizers are the main topic of the article. Tranquilizers are valued negatively ten times as often as they are valued positively. In two fifth of the articles the term is employed as a metaphor. Even in this context minor tranquilizers are valued negatively (10:1). CONCLUSIONS: Three fourth of the articles, employing the term in the non metaphorical way, deal with abuse and dependency. The public image of minor tranquilizers in the media is mainly characterized by their potency to cause dependency.