Reduced nondominant lumbar multifidi cross-sectional area is a precursor of low back injury in cricket fast bowlers.

Asymmetry in the lumbar multifidi muscle (LM) cross-sectional area (CSA) is associated with low back injury. The aim of this prospective cohort study was to investigate the symmetry of the CSA of LM at L3, L4, and L5, in the context of simultaneous injury monitoring. Injury free, male, right-handed cricket fast bowlers playing at a nonprofessional level participated in this study. LM CSA at L3, L4, and L5 vertebral levels was measured through the use of ultrasound imaging in prone. The primary outcome measure of the study was the incidence of an injury during a cricket season of eight-month duration. Twenty-six fast bowlers (aged 21.8 ± 1.8 years) participated. No difference was found between the nondominant and the dominant LM CSA among injury free bowlers (P>.05). However, in bowlers who sustained a lower back injury during the cricket season, the nondominant CSA at L3 (nondominant median 5.80 cm2 , range 3.69 cm2 ; dominant median 7.38 cm2 , range 2.61 cm2 ; P=.04) and L5 (nondominant median 6.94 cm2 , range 2.10 cm2 ; dominant median 7.38 cm2 , range 3.54 cm2 ; P=.04) is smaller compared to the dominant side. These findings may indicate that a side-to-side difference in LM CSA may be a precursor of injury.

Static and dynamic balance ability, lumbo-pelvic movement control and injury incidence in cricket pace bowlers.

OBJECTIVES: This study aimed to establish the difference in lumbo-pelvic movement control, static and dynamic balance at the start and at the end of a cricket season in pace bowlers who sustained an injury during the season and those who did not. DESIGN: This is a longitudinal, observational study. METHODS: Thirty-two, healthy, injury free, male premier league fast, fast-medium and medium pace bowlers between the ages of 18 and 26 years (mean age 21.8 years, standard deviation 1.8 years) participated in the study. The main outcome measures were injury incidence, lumbo-pelvic movement control, static and dynamic balance ability. RESULTS: Fifty-three percent of the bowlers (n=17) sustained injuries during the reviewed cricket season. Lumbo-pelvic movement control tests could not discriminate between bowlers who sustained an injury during the cricket season and bowlers who did not. However, performance in the single leg balance test (p=0.03; confidence interval 4.74-29.24) and the star excursion balance test (p=0.02; confidence interval 1.28-11.93) as measured at the start of the season was better in bowlers who did not sustain an injury during the season. CONCLUSIONS: The improvement in the lumbo-pelvic movement control and balance tests suggests that the intensity and type of physical conditioning that happens throughout the season may have been responsible for this improvement. Poor performance in the single leg balance test and the star excursion balance test at the start of the cricket season may be an indication that a bowler is at heightened risk of injury.

Development of a measure of family-centred care for resource-poor South African settings: the experience of using a modified version of the MPOC-20.

BACKGROUND: The Measure of Processes of Care (MPOC) is a widely used tool to assess parents' self-reported experiences of family-centred behaviours of paediatric rehabilitation services. It has never been used in resource-constrained settings or in a cross-cultural environment where cultural and language differences may complicate effective implementation of family-centred services. In this study, the MPOC-20 was used as the starting point for the development of a measure of family-centred care in disadvantaged South African settings. The objective was to establish to what extent the MPOC-20 needed to be adapted for these settings. METHODS: After modifying MPOC-20 through focus groups, the adapted scale was translated into six local languages. Trained interviewers administered the scale to a convenience sample of 267 caregivers of children aged between 1 and 18 years with a diagnosis of cerebral palsy living in poorly resourced areas in two provinces in South Africa. RESULTS: The modified MPOC-20 was neither reliable nor valid in the new setting. Cronbach's alpha for each of the sub-scales varied between 0.30 and 0.66 while for the test-retest reliability, the Intraclass Correlation Coefficients were between 0.51 and 0.61. The first two criteria for item convergent validity were not met. Repeated multi-trait scaling identified eight items that when combined into a scale [named the MPOC-8(SA)] had acceptable reliability and validity. Factor analysis of the MPOC-8(SA) yielded two factors: an interpersonal factor and an informational factor. CONCLUSIONS: Although extreme caution has to be used when using measures created in one socio-cultural setting in a different context, the MPOC-20 provides a useful starting point for the development of a measure of family-centred care in a poor resourced setting. Caregivers in different settings have more in common than they have differences. However, the process of asking the questions and the words used to capture caregivers' experiences needs to be different.

Canine hip extension range during gait.

Assessment of canine gait is frequently used by veterinary clinicians to establish the presence of orthopaedic pain. As up to 30% of canine orthopaedic conditions affect the pelvic limb, knowledge of pelvic limb biomechanics during gait is very important. Previous studies have investigated the biomechanics at the tarsus and stifle, but little information is available regarding hip motion during gait. The aim of this study was to determine the maximum hip extension range achieved during the stance phase of gait in normal canines. In addition, this study aimed to determine the difference between maximum passive hip extension and maximum hip extension during gait. Using a sample of 30 morphologically similar normal dogs, mean maximum passive hip extension was measured using a goniometer and mean maximum hip extension range during gait was determined videographically. Inter- and intra-assessor reliability studies performed at the start of the study showed that the measurement tools and techniques used in this study were valid and reliable. The goniometric data showed that mean maximum passive hip extension range was 162.44 degrees (+/-3.94) with no significant difference between the left and the right hind limbs. The videographic data showed that mean maximum hip extension range during gait was 119.9 degrees (+/-9.26) with no significant difference between the left and right hind limbs. The results of this study provided reference values for active and passive hip extension range and showed that the degree of hip extension range required for normal gait is significantly less than maximum passive hip extension range.

Predictors of the successful outcome of one-year survivors of coronary artery bypass surgery.

This study was conducted on a South African cohort to establish the actors that may predict the successful outcome of coronary artery bypass surgery when assessed in terms of improved quality of life one year after the surgery. Information was sought on the socio-economic status of patients, their risk-factor profiles and clinical history. From the patient files, information was recorded on left ventricular ejection fraction, number of vessels bypassed, bypass time, and aortic cross-clamp time. The characteristics that were predictive of a successful outcome one year after surgery were identified. Patients in this study represented a high-risk population with multiple risk factors (obese, heavy smokers, hypertensive, hypercholesterolaemic, inactive, family history of heart disease, diabetes, and regular intake of alcohol). Measured medical parameters could not distinguish between the group with an improved quality of life and the group who did not have improved quality of life. One year after CABG all patients with an improved quality of life were men. The additional identified predictor variables for a successful outcome were: being married, patients' height, the knowledge that smoking affects the cardiovascular system, number of years that sporting activities were stopped prior to CABG surgery, a better quality sex life after the operation, acceptance of self-responsibility for rehabilitation, and the spouse knowing the diet the patient should follow. The predictors of a successful outcome at the time of the operation were: being married (OR = 22.6; p = 0.02); taller than 170 cm (OR = 15.5; p = 0.01); stopped all sporting activities for a period less than 20 years prior to their surgery (OR 11.4; p = 0.01). We concluded that the outcome of coronary artery bypass surgery could not be predicted on the basis of a medical model that considers exclusively the extent of the patient's disease and associated co-morbidities. Patients should be carefully selected and an intensive post-operative educational intervention should be provided to patients and their spouses/caregivers.

Ephedrine requirements are reduced during spinal anaesthesia for caesarean section in preeclampsia.

BACKGROUND: Despite controversy over the haemodynamically safest blockade for caesarean section in women with severe preeclampsia, an increasing number of anaesthetists now opt for spinal anaesthesia. In a previous study we found that spinal compared to epidural anaesthesia offered an equally safe but more effective option for these patients. The current study was designed to compare the hypotension induced by spinal anaesthesia, as measured by ephedrine requirement, between 20 normotensive and 20 severely preeclamptic but haemodynamically stabilised women. METHOD: Standardised spinal anaesthesia was instituted and ephedrine was given in boluses of 6 mg if the systolic pressure fell >20% from the baseline, or if the patient exhibited symptoms of hypotension. RESULTS: The mean ephedrine requirement of the normotensive group (27.9+/-11.6 mg) was significantly greater (P<0.01) than that of the preeclamptic group (16.4+/-15.0 mg). CONCLUSION: This suggests that the hypotension induced by spinal anaesthesia in women with severe but haemodynamically stabilised preeclampsia, is less than that of normotensive patients.

Small-dose selective spinal anaesthesia for short-duration outpatient gynaecological laparoscopy: recovery characteristics compared with propofol anaesthesia.

A randomized controlled trial compared recovery characteristics after selective spinal anaesthesia (SSA) or propofol general anaesthesia (GA) for short-duration outpatient laparoscopic surgery. Forty women were randomized to receive either SSA (1% lidocaine 10 mg, sufentanil 10 microg and sterile water 1.8 ml) or GA (propofol and nitrous oxide 50% in oxygen). Compared with the GA group, times to leaving the operating room, performing a straight leg raise, performing deep knee-bends and achieving an Aldrete score >9 and the time in Phase II recovery were significantly shorter (P < 0.05) in the SSA group.

Charge-coupled device panoramic radiography: effect of beam energy on radiation exposure.

OBJECTIVE: To determine the consequences for entrance exposure of varying the beam energy and operating current for panoramic radiography using a charge-coupled device receptor. MATERIAL AND METHODS: Images were made of a RANDO average man phantom (Alderson Research Laboratories, Stamford, CT) at kVcp settings of 60, 66, 70 and 80 and an mA of 2.0, 3.2, 6.4 and 10.0. The exposure cycle was set as recommended by the manufacturer at 17.6 s. Diagnostic image quality was rated by a panel of two oral and maxillofacial radiologists and one oral and maxillofacial pathologist. Entrance exposures were assessed using a 3 cc ionization chamber placed at the beam entry points while imaging the molar, premolar, and anterior teeth both using the DigiPan (Trophy Radiologie, Vincennes, France) CCD receptor and conventional T-Mat G film/Lanex Regular screens (Eastman Kodak, Rochester, NY, USA). RESULTS: Acceptable image quality was attained with combinations of 60 kVcp and 3.2, 6.4 or 10 mA, 70 kVcp and 2.0, 3.2 or 6.4 mA; at 80 kVcp irrespective of the mA it was unacceptable. The maximum reduction in entrance dose was 77%, averaged over the three sites, at 70 kVcp and 2 mA. CONCLUSION: The DigiPan receptor produces satisfactory images with saving in entry exposure saving of approximately 70% when compared with a conventional film/rare earth screen combination.

The exercise capacity of three socio-economic groups of elderly hypertensive patients.

A third of all persons over the age of 65 suffer from hypertension. The incidence in South African blacks is particularly high. Exercise, although effective in lowering blood pressure, has not gained acceptance for its antihypertensive benefits. It would certainly be an inexpensive management option in community-based clinics in South Africa. In this paper, the exercise profiles of a group of elderly hypertensive patients are examined in three different socio-economic settings: a tertiary care hospital (Group 1); an urban community-based clinic (Group 2); and a rural clinic (Group 3). All the patients completed the six-minute walking test and the Duke Activity Status Index (Hlarky et al., 1984). All test values were expressed as means and standard deviations. A p value of < 0.05 was considered significant. Both resting and exercise pulse rates were higher at the urban clinic (p = 0.019). The blood pressure (BP) was higher in the urban clinic, but not significant so. The mean arterial pressure (MAP) of all three groups was high (115 mm HG). The distance covered in the six-minute walking test was surprisingly low at the urban and the rural clinic. Overall, in all three settings patients' hypertension was not well-controlled. The patients were not fit when compared to their age-predicted metabolic equivalent (MET) values. This lack of fitness may indicate that exercise programmes could be of value.