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By H. Shakyor. University of North Carolina at Asheville.

In contrast with scoliosis buy voltaren 100mg without a prescription can arthritis in fingers be reversed, a kyphosis can not disease are often painful in adolescence buy voltaren 50 mg online arthritis in middle foot, and the prog- only be stabilized by brace treatment but also corrected nosis in terms of pain during adulthood is poor be- in a patient with sufficient growth potential [4, 8, 14]. Lumbar The wedge vertebrae are straightened by the compensa- kyphoses shift the center of gravity anteriorly, which tory growth of the anterior sections (⊡ Fig. Of has to be compensated for by increased postural work course, a precondition for a successful outcome is good by the paravertebral muscles. Possible braces for thoracic Scheuermann disease are Treatment straightening braces with a three-point action (e. However, we generally use ▬ Brace treatment the smaller Becker brace (⊡ Fig. While the kyphosis remains flexible and no radiographic changes are ap- parent, the patient is merely suffering from a postural abnormality rather than Scheuermann’s disease. It is more effective to manage postural abnormalities by encouraging the patient to practice some sporting activity than by expen- a b sive physiotherapy. If growth potential is still present, wedge-shaped verte- and are almost never able to perform regular exercises on bral bodies can still be straightened out with brace treatment. It is more useful to persuade adolescents to vertebrae in Scheuermann disease in a 14-year old girls. The specific sport ened vertebral bodies two years later, after 18 months of brace treat- involved is of secondary importance. Active, corrective ment (figures refer to wedge angle in degrees) physiotherapy is indicated, however, in a case of fixed ky- phosis. The only inappropriate sports are rowing, cycling with drop handlebars (⊡ Fig. Brace treatment Brace treatment should be considered for a thoracic kyphosis of more than 50° in a patient who is still ⊡ Fig. Principle of Becker brace preparation for the treatment of thoracic Scheuermann disease. Only when the brace kyphoses the lumbar spine to a substantial extent is the patient forced to straighten his thoracic spine otherwise he will fall forwards. For the preparation of the cast (whether as a case for a plastic brace or a definitive plaster brace), the patient must support himself by placing his hands on a chair to ensure adequate kyphosing of the lumbar spine. The brace should not extend up as far as the apex of the kyphosis, but should ⊡ Fig. Inappropriate sports for patients with Scheuermann dis- end roughly at the level of the lower end vertebra of the kyphosis so ease include cycling in a racing cyclist’s position that the patient is able to straighten up 99 3 3. The principle of this Becker brace relies also be achieved with the use of the reclination bracket on its being fitted while the patient’s lumbar spine is (⊡ Fig. At the back the brace extends Results for brace treatment with good compliance: 2/3 only to just below the start of the kyphosis. However, a certain amount of criticism the kyphosing of the lumbar spine, forcing the patient is also now being aimed at brace treatment, calling its actively to straighten his thoracic spine to prevent him- effectiveness into question, primarily because of the self from toppling forward. Authors rightly complain that the (few) existing studies are inadequately controlled. Since the kyphotic posture often represents a protest against the parents, the intrinsic motivation to correct it is sometimes completely lacking. If optimal compliance is desired, a plaster cast must be prepared in a similar manner. A lordosing 3-point brace can be used for thoraco- lumbar and lumbar Scheuermann disease. Since the prog- nosis in this form of the disease is poor in relation to later back pain, we tend to use a cast brace, prepared while the patient is in a position of ventral suspension. This will en- able the lumbar kyphosis to be corrected back to lordosis while the patient is still growing (⊡ Fig. When the brace is ready, its effect must be checked radiologi- cally by lateral views.

This should then be followed by the main results including specific data and their statistical significance voltaren 50mg arthritis pain log. To ensure that the abstract contains all of the necessary information order 50 mg voltaren fast delivery arthritis dogs natural, many journals now require that you structure your abstract formally. The BMJ suggests objectives, design, setting, participants, main outcome measures, results, and conclusions as the subheadings of its structured abstracts. Other journals, particularly journals that publish both clinical and laboratory studies, limit their abstract headings to the standard aims, methods, results, and conclusions. Even if the journal does not specify any subheadings, write your abstract as though they were there. Finally, the interpretation of the findings is clearly stated in the conclusion. Participants 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year. Main outcome measures Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure. Results 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio − 0·61, 95% confidence interval 0·33 to 0·96). Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 versus 114, P = 0·018), fewer admissions for any reason (86 v 114), fewer admissions for heart failure (19 v 45, P < 0·001) and spent fewer days in hospital for heart failure (mean 3·43 v 7·46 days, P = 0·0051). Conclusions Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure. When writing your abstract, put your most concise and important sentences on a page, join them into an abstract and then count the words. Some journals such as Science and Nature that are very well regarded in scientific circles request very short abstracts, which may be as low as 100 words. MEDLINE® accepts only 250 words before it truncates the end of the abstract and cuts off your most important sentences, that is the conclusion and interpretation in the final sentences. Other people can often be more objective and ruthless than you can be with your own writing. A friend of mine says that the first draft is the down draft – you just get it down. Anne Lamott1 Introductions should be short and arresting and tell the reader why you undertook the study. In essence, this section should be brief rather than expansive and the structure should funnel down from a broad perspective to a specific aim as shown in Figure 3. This should lead directly into the second paragraph that summarises what other people have done in this field, what limitations have been encountered with work to date, and what questions still need to be answered. This, in turn, will lead to the last paragraph, which should clearly state what you did and why. This sequence is logical and naturally provides a good format in which to introduce your story. Paragraph 1: What we know Paragraph 2: What we don’t know Paragraph 3: Why we did this study Figure 3. Topic sentences, especially for the first introductory sentence, are a great help. Richard Smith, editor of the BMJ, stresses the importance of trying as hard as you can to hook your readers in the first line. Few readers want to plough through a detailed history of your research area that goes over two or more pages. In the introduction section, you do not need to review all of the literature available, although you do need to find it all and read it in the context of writing the entire paper. In appraising the literature, it is important to discard the scientifically weak studies and only draw evidence from the most rigorous, most relevant, and most valid studies.

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