Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity.

The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. PURPOSE: The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH in a group of diverse patients and to compare the results with those obtained with joint-specific measures. METHODS: Two hundred patients with either wrist/hand or shoulder problems were evaluated by use of questionnaires before treatment, and 172 (86%) were re-evaluated 12 weeks after treatment. Eighty-six patients also completed a test-retest questionnaire three to five days after the initial (baseline) evaluation. The questionnaire package included the DASH, the Brigham (carpal tunnel) questionnaire, the SPADI (Shoulder Pain and Disability Index), and other markers of pain and function. Correlations or t-tests between the DASH and the other measures were used to assess construct validity. Test-retest reliability was assessed using the intraclass correlation coefficient and other summary statistics. Responsiveness was described using standardized response means, receiver operating characteristics curves, and correlations between change in DASH score and change in scores of other measures. Standard response means were used to compare DASH responsiveness with that of the Brigham questionnaire and the SPADI in each region. RESULTS: The DASH was found to correlate with other measures (r > 0.69) and to discriminate well, for example, between patients who were working and those who were not (p<0.0001). Test-retest reliability (ICC = 0.96) exceeded guidelines. The responsiveness of the DASH (to self-rated or expected change) was comparable with or better than that of the joint-specific measures in the whole group and in each region. CONCLUSIONS: Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.     

Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast April 19–22, 2001, Philadelphia,PA, USA

A consensus conference on the role of sentinel node biopsy in breast cancer was held in Philadelphia in April, 2001; the participants included many highly respected American and European investigators in this area. This report summarizes the deliberations of the group and promotes its current guidelines for the integration of this new technique into contemporary clinical practice.     

Fractures of the Proximal End of the Femur in Göteborg,Sweden, 1940–1979

A total of 3475 fractures of the proximal femur occurring in Göteborg, Sweden, in 1965, 1969, 1970, 1975, 1978 and 1979 were reviewed, and the information obtained was compared with earlier published epidemiologic data from Göteborg presented by Mårtensson (1962) for the years 1940–1959. A highly statistically significant age specific increase in fracture incidence was found for trochanteric as well as cervical fractures, and for both women and men. The fracture incidence increased from about 3 per 1000 in 1965 to 5 per 1000 in 1979, and the yearly number of fractures in this city from 104 in 1940 to 788 in 1979. With the present trend the fracture incidence will double over the next 20 years.     

Inventary of the Sponge Fauna of the cemitério Paleolake, Catalão, Goiás, Brazil

The Cemitério Paleolake, Catal?o, Goiás, is a lacustrine deposit that is rich in spicules of continental sponges. These spicules, which are present in three sections (1-3), were analyzed for the taxonomic identification of the species in order to reconstruct the late Quaternary palaeoenvironment. An indigenous assemblage of lentic sponges was found, consisting of Metania spinata (Carter 1881), Dosilia pydanieli Volkmer-Ribeiro (1992), Radiospongilla amazonensis Volkmer-Ribeiro and Maciel (1983), Trochospongilla variabilis Bonetto and Ezcurra de Drago (1973), Corvomeyenia thumi (Traxler 1895), Heterorotula fistula Volkmer-Ribeiro and Motta (1995), plus Corvoheteromeyenia australis (Bonetto and Ezcurra de Drago 1966), which here has its first record in an assemblage formed by biosiliceous deposits. Furthermore, at the base of the sections, spicules of sponges from lotic environments were detected, including Corvospongilla seckti Bonetto and Ezcurra de Drago (1966), Oncosclera navicella (Carter 1881) and Eunapius fragilis (Leidy 1851), which suggests a contribution from flowing water. We identified 25 spongofacies horizons caused by sponge assemblages typical of a lentic environment, dated from at least 39,700 years BP., and currently occurring in lakes typical of the Cerrado Biome.     

Outcome of simple decompression of the compressed ulnar nerve at the elbow – influence of smoking,gender, and electrophysiological findings

Background: Compression of the ulnar nerve at elbow is frequently treated with simple decompression. Knowledge about factors influencing results of surgery of the nerve is limited and contradictory. The primary aim was to evaluate outcome of simple decompression of the nerve using a QuickDASH questionnaire, and to investigate any influence of smoking, gender, and preoperative electrophysiological findings. A second aim was to estimate the relation between QuickDASH score and a clinical assessment of outcome by the surgeon.

Methods: Patients who were operated on with simple decompression of the ulnar nerve, excluding reoperations, from September 2009 to February 2011 were evaluated before and at 1 year after surgery using QuickDASH. Data were collected from medical records and from a self-reported health declaration.

Results: There were no differences in QuickDASH scores or change in total score between smokers and non-smokers or between women and men. Nerve pathology, assessed by preoperative electrophysiology, did not affect outcome. The surgeon’s assessment of outcome mirrored QuickDASH score. Among all patients, 12/33 (36%) did not have a decrease in QuickDASH score >8, which is considered as a minimal clinically important difference.

Conclusion: Smoking, gender, and preoperative electrophysiological findings do not affect outcome of surgery. There are a high number of patients who do not benefit from simple decompression of the ulnar nerve at the elbow. Patients who are planned for surgery should be informed that there is a risk for persistent problems. A simple outcome assessment by the surgeon mirrors QuickDASH score at 1 year.     

zhao from the aspects of content,s

terature gifts,two of their representative poems will be illustrated in hopes of provides a completely and thoroughly understanding of their poems.A Comparative Study of love poems from Elizabeth Barrett Browning and Li QingzhaoThe author tries to compare the love poems of Elizabeth Barrett Browning and Li Qingzhao from t     

Record of the genus Lycopodites in the Lower Permian of Paraná Basin, Brazil

The genus Lycopodites, which encompasses the herbaceous forms of the lycopsids, presents broad time and spacial distribution during the Paleozoic in the Northern Hemisphere, with its initial records dating from the European Devonian. As to Gondwanan Paleozoic, to this moment, only Lycopodites amazonica Dolianiti had been reported for the Amazonian Middle Devonian (Curuá Group). Thus, the specimens reported in this study such as Lycopodites sp., coming from sedimentary rocks of the Itararé Subgroup, S?o Paulo State, and Lycopodites riograndensis sp. nov., collected in Rio Bonito Formation, Rio Grande do Sul, represent the oldest fertile forms recorded for Gondwana and the first ones to be described for the Paraná Basin. Its presence in layers, deposited after the end of the Neopaleozoic Glaciation, shows the appearance of new taxa in high latitudes, as well as the diversity of the lycopsids present in the Basin, previously indicated through the abundance of spores associated to the Class Lycopsida present in the palinomorphous assemblages.     

Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, the Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure

The Patient Evaluation Measure (PEM), The Michigan Hand Outcome Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed independent of their originators for reliability, construct and criterion validity and acceptability, using an ease of use questionnaire. These were administered in random order to 100 patients with different hand and wrist disorders and with different impairments of movement, pain, sensation and strength. The internal consistency of all three questionnaires was very high suggesting redundancy in the questions. All questionnaires were reproducible and valid for finger and wrist disorders, but less for nerve disorders. All had poor construct validity. The PEM was the easiest to understand and complete, taking the least time. Correlation between the scales is high and conversion equations were calculated. All three are reliable and reproducible patient completed questionnaires, but the PEM is the easiest to use. The validity of all is suspected for nerve disorders.     

Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?

The different attributes of the Patient Evaluation Measure (PEM) questionnaire were investigated in 80 patients with a fracture of the scaphoid. Assessments were made at 2, 8, 12, 26 and 52 weeks. Reliability was assessed by measurement of the internal consistency of the different questions in 275 completed PEM forms. Cronbach's alpha, which needs to lie between 0.7 and 0.9, was 0.9 for the PEM. Pain, tenderness, swelling, wrist movement and grip strength correlated with the PEM score confirming the validity of the assessment. Changes in the different variables between visits correlated significantly with changes in the PEM score; its effect size and standardised response mean were comparable to those of grip strength and movement, confirming the responsiveness of this questionnaire. Gender, dominance and the side injured did not influence the scores. Older patients had a poorer outcome as assessed by the score which appeared to be a true effect and not age bias. Our study confirmed that the PEM is a reliable, valid and responsive instrument in assessing outcomes of disorders of the hand.     

Does keel size,the use of screws,and the use of bone cement affect fixation of a metal glenoid implant?

The objective of this study was to determine the effect of screws and keel size on the fixation of an all-metal glenoid component. A prototype stainless-steel glenoid component was designed and implanted in 10 cadaveric scapulae. A testing apparatus capable of producing a loading vector at various angles, magnitudes, and directions was used. The independent variables included six directions and three angles of joint load, and five fixation modalities-three different-sized cross-keels (small, medium, and large), screws, and bone cement. Implant micromotion relative to bone was measured by four displacement transducers at the superior, inferior, anterior, and posterior sites. The components displayed a consistent response to loading of ipsilateral compression and contralateral distraction. Use of progressively larger keels did not significantly improve implant stability. Stability decreased as the angle of load application increased (P <.05). Screw and cement fixation resulted in the most stable fixation (P <.05).     

Variations in the abundance of three Parulidae species in the southern portion of the Brazilian Atlantic Forest, state of Paraná

We evaluated the distribution of abundance of three species of warblers in the southern portion of the Brazilian Atlantic Forest (BAF): Tropical Parula (Parula pitiayumi), the Golden-Crowned Warbler (Basileuterus culicivorus) and the White-Rimmed Warbler (Basileuterus leucoblepharus). Three types of forests comprise this region of the Atlantic Forest: seasonal semi-deciduous forest (SF), mixed rain forest (MF) and dense rain forest (DF). These forest types occur at different elevations: SF ranging from 200 to 800 m, MF ranging from 800 to 1,200 m and DF ranging from sea level up to 2,000 m. We used point counts in fifteen study areas distributed in the three forest types. The White-Rimmed Warbler and the Tropical Parula had higher abundances in MF, and their abundance was positively correlated with the elevation. The Golden-Crowned Warbler did not present a significant difference in abundance among the forest types, and no correlation between abundance and elevation was found. We suggest that the difference in the occupancy of the forest strata by the Golden-Crowned Warbler is because this species is more generalist and thus less sensitive to variations in the vegetation structure among the forests types when compared to the other two warbler species.     

At the beginning of the third millennium: what kind of surgery, what kind of surgeon?

Technological progress and the evolution of biological knowledge lead us to expect major developments in the fields of organ replacement, minimally invasive surgery and tumour therapy in the coming decades. It is widely believed that xenotransplantation may offer a possible solution to the problem of the current chronic shortage of donors, though their use at present encounters formidable immunological obstacles, particularly as regards discordant transplants. Genetic engineering and the realisation of transgenic donors as well as new strategies aimed at modifying the immune status of the donor may well be the key to new developments in this sector. Selective culturing of tissues and the production of totally implantable artificial organs are additional lines of research which may provide useful means of meeting the increasing demand for organs. The enormous advances made in the field of high-tech solutions applied to the biomedical disciplines are destined to open up new frontiers in diagnostics, operating technique and the permanent training of surgeons. In particular, we are about to witness an extension of the use of computer technology and robotics, embracing the simulation and reproduction of virtual reality, telemedicine (teleconsulting and telesurgery) and the creation of experimental models. Minimally invasive surgery will unquestionably benefit from this progress with the possibility of extending its range of indications to procedures in which human limitations are more evident owing to difficulties of access and the size of the target, at the same time guaranteeing high-precision manoeuvres. In the oncological field, high expectations accompany the advances in our knowledge of molecular biology with the genetic mapping of tumours which may pave the way for screening programs and gene therapy. Alongside the scientific and technological development of the surgery of the future, we can expect to see the increasing emergence of: a) economic problems related to the progressive increase in healthcare costs, amongst other things as a result of the powerful impact of high-tech solutions; b) social problems in terms of the inevitable conflict between cost-containment policies and the right to healthcare; c) moral and bioethical problems relating to the possible establishment of genetic registries and to the different patient-care provider relationship which is likely to come about as the result of the interference of machines or robots. The surgeon's persona may undergo profound changes, not merely from the technical and professional training standpoint, but also with regard to his or her effective role, which may no longer be that of a central, dominant figure, but may be scaled down in a context of multidisciplinary co-operation.