Coracoid process anatomy: implications in radiographic imaging and surgery

The coracoid process forms an important part of scapular-glenoid construct and is involved in many surgical procedures on the glenohumeral joint. The unique three-dimensional orientation of each coracoid pillar makes radiographic imaging difficult. Congenital variations and minimal traumatic/iatrogenic changes in this orientation can predispose to subcoracoid impingement. We performed a quantitative and statistical analysis of the osseous anatomy of the coracoid process in 101 scapulae; the purpose was to determine the anatomical variations and gender-specific differences in the length, breadth, thickness, vertical and horizontal projections, and triplane angulations of each individual coracoid pillar. All parameters were measured in reference to the glenoid plane to ensure surgical and radiological applicability. The mean dimensions of the inferior coracoid pillar were 31.1 x 16.6 x 9.9 mm and that of the superior coracoid pillar were 41.7 x 14.2 x 8.4 mm (medial)/6.6 mm (lateral). The mean maximal harvestable coracoid length measured 19.0 mm. The mean angular orientation of the inferior coracoid pillar, with reference to the glenoid, measured 51.2 degrees (axial), 126.1 degrees (sagittal), and 134.6 degrees (coronal), and that of the superior coracoid pillar measured 146.1 degrees (axial) with an interpillar angulation of 84.9 degrees (axial). A statistically significant gender difference (P < 0.05) was found in the lengths, breadths, and projections of each coracoid pillar. We used data from this study to devise two new radiographic views (for imaging individual coracoid pillars), to calculate dimensions and orientation of internal fixation/prosthetic hardware during surgery, and conceptualize a geometric model to explain the role of measured parameters in coracoid impingement syndrome.     

Development of an observational measure of therapy engagement for pediatric rehabilitation

Purpose: The Pediatric Rehabilitation Intervention Measure of Engagement-Observation (PRIME-O) version was designed to capture signs of affective, cognitive and behavioral involvement for clients and service providers and in the client-provider interaction.

Methods: Phase 1 examined interrater consensus and construct validity of a pilot version, using observer ratings of engagement indicators made while viewing videos of therapy sessions differing in high and low engagement (Sample 1). Phase 2 examined these properties in a 10-item version (Samples 2 and 3). Phase 3 examined the content validity of the 10-item version, using observed signs of child, youth and parent engagement, as reported in an interview study involving 10 service providers.

Results: There was excellent interrater consensus for both versions and ratings significantly discriminated between videos differing in high and low engagement, providing evidence for construct validity. Content validity was demonstrated by service provider reports of engagement signs. More behavioral signs were reported for children and more cognitive signs were reported for youth and parents, providing evidence for the developmental appropriateness of the PRIME-O.

Conclusions: The PRIME-O provides a multifaceted view of affective, cognitive and behavioral components of engagement in pediatric rehabilitation. The PRIME-O has potential utility for research, clinical practice and continuing education.

• Implications for Rehabilitation

• Measures of engagement in therapy are needed to identify factors associated with successful therapy sessions and positive client outcomes.

• The PRIME-O is an observational measure that captures indicators of affective, cognitive and behavioral components of engagement for both clients and service providers.

• The PRIME-O may further help in understanding of the strategies service providers can use to facilitate an optimal state of engagement within a therapy session.

• Clinical practice may be enhanced by attending to the client’s signals of engagement in therapy.

• The PRIME-O can help service providers to more accurately identify signs of engagement and disengagement, monitor their own success in creating an engaging intervention atmosphere, and instigate strategies to optimize engagement.

     

不同剂量rmhTNF治疗晚期肿瘤恶性心包积液的疗效观察

目的 探讨重组改构人肿瘤坏死因子（rmhTNF）在治疗恶性心包积液中的疗效、不良反应及对生活质量的影响;并比较两种不同剂量rmhTNF的疗效差异。方法64例肿瘤患者采用计算机随机法分为A、B两组,分别于心包腔内置管灌注rmhTNF 1500 万IU（大剂量A组）、rmhTNF 500 万IU（常规剂量B组）,连续治疗4次。治疗结束1月后按WHO标准评价疗效和不良反应及对生活质量的影响。结果A组总有效率90.6%,完全缓解率达到62.5%;B组总有效率达到56.2%,完全缓解率达到37.5%,两组比较差异有统计学意义（P<0.05）。不良反应两组相似,差异无统计学意义（P>0.05）。两组患者生活质量都有不同程度改善,在精神好转、食欲增加、体力增加、体重增加上两组比较差异无统计学意义（P>0.05）;在睡眠、KPS评分两组比较有明显差异,A组改善更明显（P<0.05）。结论rmhTNF治疗癌性心包积液疗效好,不良反应小,可以改善患者生活质量。大剂量A组与常规剂量B组比较,完全缓解率更高,疗效更显著,而不良反应差别不明显。     

Development and testing of the Family Caregiving Consequences Inventory for home nursing assessment in Taiwan

This paper describes the development and psychometric testing of the Family Caregiving Consequences Inventory (FCCI). Data were collected from a convenience sample of 97 families in Taiwan to examine the validity and reliability of the three FCCI scales: frail elder outcomes, caregiver outcomes and family outcomes. Acceptable test-retest and internal consistency reliabilities were found, though inter-rater reliability was unsatisfactory. Criterion-related validity was demonstrated by congruence with home nursing specialists' assessment of family caregiving outcomes. Confirmatory factor analysis with a good overall model fit supported the construct validity of FCCI. However, a poor fit of the internal measurement structure was found for the frail elder outcomes scale and the family outcome scale. Studies with larger samples are needed to further verify the measurement models used here. Nevertheless, in its current form, the FCCI can be used to increase the sensitivity of home care nurses to family caregiving situations and provide an instrument for studies of family caregiving in Taiwan and other countries with similar home care needs.