quality

Introduction: Acupuncture is a practice that has been used to treat multiple medical conditions for thousands of years and is one of the most popular alternative treatments applied in Western medical practice. Acupuncture is a modality that has significant potential for further integration into the treatment of sports medicine conditions. Methodology: The search strategy in this review included electronic databases-MEDLINE, Cochrane Library, PubMed, Web of Science, and Science Direct. Randomized controlled trials and systematic reviews were preferred for article inclusion, but other study types were included when the number or quality of evidence was limited. Results: Back pain, neck pain, shoulder pain, and knee pain related to OA tend to respond well to acupuncture treatment. There is evidence to support the use of acupuncture for the short-term treatment of plantar fasciitis, although long-term efficacy data is lacking. Acupuncture may be a useful treatment modality for epicondylitis and Achilles tendinopathy, but the current data is limited. While acupuncture may improve athletic performance and prevent Delayed-Onset Muscle Soreness (DOMS) symptoms, there is little current evidence to support this use. Conclusion: Further studies are needed to assess the usefulness of acupuncture in sports medicine. However, there is good evidence for the current use of acupuncture in treatment of multiple pain conditions.

Background: There is paucity in studies reporting long-term results following anterior cruciate ligament (ACL) rupture. A UK national ligament registry (NLR) designed to collect demographic, clinical and outcome data on patients undergoing ACL reconstruction was launched in 2013. There was therefore an emergent question on the role of such registry as an additional source of evidence. Study aims: A framework analysis aimed to provide a basis for the evaluation of outcomes following ACL management and formulate a structure of the evidence, which can be derived from the registry. Methods: A systematic approach was adopted to select relevant studies. Qualitative thematic and meta-narrative analyses were conducted. Level-1 registry data were recorded for all primary ACL reconstruction procedures from January to June 2016. Registry data content and validity were evaluated. Results: Seven studies were suitable for analyses yet none defined the pattern of meniscal injury following initial treatment. When reported the incidence varied markedly between 23% and 80%. There was evidence of collection of at least one principal outcome measure in at least 85% of participants across all studies. Thematic analysis identified four key domains of outcome measures (1) intervention selection, (2) Knee stability evaluation, (3) Patient reported outcomes, (4) Radiographic evaluation and risk of secondary osteoarthritis. Graft choice, rate of meniscal and chondral injuries and cumulative risk of revision surgery had incomplete and inconsistent reports. Comparison of demographic and clinical data with the first registry report demonstrated: predominately younger patient population; older female patients at time of intervention; and higher incidence of meniscal tears. Conclusions: Registry data driven quality and research improvement open a new paradigm in ACL reconstruction evidence base and future practice. Early observations have consolidated the importance of associated meniscal injuries in the management of ACL rupture. Further work is needed to improve registry data completeness, accuracy and validity. A proposed data migration process using available technologies can help harmonise data collection without the added burden on clinical services.

The purpose of this study was to assess the peculiarities of vertebral pain syndrome, parameters of physical performance and quality of life indices in women of older age depending on the presence of vertebral fractures (VF). This study was performed with participation of 215 women aged 50-89 years old which were divided into two groups: first one-women without any previous osteoporotic fractures (n=143), second group - patients with VF in thoracic and/or lumbar spine (n=72). The presence and intensity of pain in the thoracic and lumbar spine were evaluated using the 11-component visual analog scale (VAS), physical performance-with following functional tests: 3-, 4- and 15-meter tests (gait speed), static balance (a side-by-side position, a semi-tandem position and a full-tandem position), 8-feet test and «five timed chair stands» (coordination and strength), hand grip strength (by dynamometer), measurement of arterial pressure (systolic and diastolic), heart and respiratory rates, breath holding, chest excursion (mean and on the inhalation and the exhalation), lateral trunk lean, Schober and Thomayer tests. It was demonstrated that the intensity of vertebral pain (pain at the time of investigation, the most common level of pain, pain in the best periods of the disease) and some physical performance tests (lateral trunk lean and chest excursion (mean index, during the inhalation and exhalation), hand grip strength, 15-meter gait speed test and five-repetition sit-to-stand test) are significantly worse in women with VF than corresponding parameters in persons without fractures. It should be taken into account during the assessment of physical performance and development of rehabilitation programs for older age women with vertebral fractures.

The purpose of this study was to determine the relationship between Navicular drop (ND) and Hallux valgus (HV) angles and their effects on foot-specific health related quality of life. Sixty female patients with bilateral HV aged between 32-60 participated in this study. The patients with the HV deformity degree of “2” or “3” according to the Manchester scale were included. HV angle were obtained from standing (weight bearing) bilateral antero-posterior radiographs. HV angle (A angle), intermetatarsal angle (B angle), hallux interphalangeal angle (C angle) were measured. Subtalar pronation was measured the navicular drop (ND) test. ND test were performed for both feet and recorded in millimeters. Foot-specific health related quality of life was measured using the Manhester-Oxford Foot Questionnaire (MOFQ). There was a strong positive correlation between the ND qtest and the angles A, B, and C for the right foot (rho=0.749, 0.761 and 0.749 p<0.001, respectively,). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001). In conclusion, there were relationship between ND, HV angular severity and foot-specific health related quality of life. As the HV angular severity increased, there was greater drop in the navicula and reduction in quality of life.

The aim of our study is to try to give a predictive vision on governance in the field of sports in Algeria. This predictive approach looks at the overall quality of governance in order to be at the continental level or even across the Arab world. To identify this and answer our questions, we conducted a survey of some leaders of the different sports institutions, namely the presidents of clubs (football, handball, athletics and judo), managers also have a sports experience and occupy currently responsible positions as managers of sports facilities. The results of the survey we reveal significant figures on the component related to sports development prospects. However, there are other aspects that are ambiguities in the management and organization that have an impact on good governance in sports.

Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena. Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI. Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires. Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009). Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80)

Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality.

Introduction: Congenital heart diseases (CHD) are leading causes of childhood morbidity and mortality especially in developing countries. Community-based studies are important in ascertaining the burden of the disease. Objectives: The study was set out to determine the prevalence and types of CHD among primary school children in Port Harcourt Local Government Area (PHALGA) of Rivers State, Niger Delta, Nigeria. Methods: A total of 1,712 primary school pupils were selected by multistage sampling from twelve schools in PHALGA. A questionnaire was used to obtain information from pupil’s parents on their child’s biodata and symptoms suggestive of heart disease. General physical and cardiovascular system examinations were carried out on each selected pupil, following which those with symptoms and/or signs suggestive of heart disease had echocardiographic confirmation of their cardiac status. Results: The 1,712 subjects were aged 5-14 (mean 8.48 ± 2.30) years. 874 (51.1%) were females while males were 838 (48.9%). The study revealed that 31 pupils had congenital heart diseases confirmed by echocardiography, giving a prevalence of 18.1 per 1,000 pupils. The commonest cardiac defects seen were acyanotic CHD in 30 (96.8%) pupils while cyanotic CHD was seen in only one (3.2%) pupil. Among the acyanotic CHD, atrial septal defects (83.9%) followed by ventricular septal defects (9.7%) were the commonest. CHD occurred with higher frequency among females (64.5%) and among the younger age group of 5-9 years (61.3%) though these were not statistically significant (p > 0.005). Conclusion: Cardiac examination as part of compulsory health screening at primary school entry will help detect children with CHD, reduce delay in diagnosis for intervention, avert debilitating morbidity and assure a better quality of life. 

Amyloidosis encompasses a heterogeneous group of disorders, characterized by extracellular deposition of insoluble abnormal amyloid aggregates, due to a failure in protein quality control. Cardiac amyloidosis is a disorder in which proteins misfold and deposit as amyloid fibrils that infiltrate the myocardial extracellular space [1]. Transthyretin (ATTR) and light chain (AL) are the most frequent types of cardiac amyloidosis. Transthyretin is a protein mainly synthesized by the liver, it may be hereditary or acquired from either wild-type (ATTRwt) or mutant (ATTRm) amyloid [2]. Cardiomyopathy is a common manifestation of ATTR amyloidosis with a particularly poor life expectancy of 2 to 6 years after diagnosis [3]. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific, and diagnosis largely relies on amyloid detection in tissue biopsies.

Objective: Plaque morphology plays an important prognostic role in the occurrence of cerebrovascular events. Echolucent and heterogeneous plaques, in particular, carry an increased risk of subsequent stroke. Depending on the quality of the plaque echogenicity based on B-mode ultrasound examination, carotid plaques divide into a soft lipid-rich plaque and a hard plaque with calcification. The aim of this study was to investigate structural changes in the basement membrane of different carotid artery plaque types. Patients and methods: Biopsies were taken from 10 male patients (average age; 75 + 1 years) and 7 females (68 + 3 years). The study population included patients suffering from a filiform stenosis of the carotid artery, 8 patients with acute cerebrovascular events and 9 with asymptomatic stenosis. Scanning electron and polarised light microscopic investigations were carried out on explanted plaques to determine the morphology of calcified areas in vascular lesions. Results: By means of scanning electron microscopy, multiple foci of local calcification were identified. The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation. Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics.

We utilized the training impulses method to numerically quantify the volume of physical exercise to be prescribed to postmenopausal obese women in such a way of obtain the best possible improvement of their health-related quality of life. Nine women (57±4 years, 89±2 kg, 157±9 cm) carried out 3-months of exercise training (3 session/week each lasting 80 min) under the supervision of skilled operators which indirectly calculated the volume of physical exercise by assessing heart rate values while patient exercised and making sure that the workload corresponded to 50-60% of their maximum oxygen uptake. Before and after training anthropometric, functional and biomechanical variables were assessed. After training patients shoved statistically signifi cant (P<0.05) reduction in body mass (-2%) and body mass index (-4%), waist circumference (-4%), total (-6%) and LDL (-26%) serum cholesterol and glycaemia (-8%), diastolic arterial blood pressure (-14%), and oxygen cost (-14%) at the maximum workload during incremental cardiopulmonary test, the sway area from unipedal stance (right leg) of 20 s on a pressure platform (-49%), while increased both free fat body mass percentage (+3%) and space covered during the six minute walk test (+11%). It was concluded that, when an exercise protocol is carried out by postmenopausal obese women and the volume of exercise is instrumentally controlled by experienced operators, it could result in an effective benefi t on the quality of life of these patients since they ameliorate some critical anthropometric and functional parameters.

Background: The foot is an important and complex structure that provides support, balance and propulsion to locomotion, thus, its proper care can help to have a better life quality avoiding pain. The medial longitudinal arch is an important structure that is related to injury risks when it shows some impairment. The purpose of this study was to characterize the foot arch index in people in relation to age and gender. Methods: The sample was composed of a total of 122 subjects, 79 healthy young subjects (40 women and 39 men) and 43 healthy elderly subjects (32 women and 11 men). Ten seconds of standing barefoot plantar pressure was measure through Tekscan F-Scan device, and the data processing, filtering, and arch index (AI) calculation were performed using MATLAB™ 7.0. Findings: The elderly group presented a lower arch (AI-0.23) than the young group (AI-0.13) (p=0.000); young female and male groups show similar AI, while the elderly female group showed lower arch (AI-0.23) than the elderly male group (AI-0.18) (p=0.033). Interpretation: The foot arch has a trend to be lower with aging, and even lower within elderly female subjects, probably due to some decrease within plantar muscle’s stiffness, that in turn may be related to lower physical activity and footwear choices.

Background: Accessibility to healthcare is a major component of primary health care campaign for maintaining population health. Owing to this, the government of Ghana has instituted the free maternal care and focused antenatal care policies into the maternal health care policies to woefully control maternal mortality, morbidity and to ensure improved access, quality and continuous ANC use among pregnant women. Despite these interventions, pregnant women in the Kwabre East Municipality do not fully use ANC services as recommended by the World Health Organization. Methods: Using an in-depth interview and two focus groups conducted with women of reproductive age (15-49) in the Kwabre East Municipality. The study investigated women’s opinions, perceptions and experiences on their ANC visits. Results: The study revealed that physical accessibility and the social context of pregnant women continue to influence their ANC use even after the introduction of the free maternal care and focused antenatal care policies. Conclusion: The study suggests that in order to fully utilize ANC visits as recommended by the WHO in the Kwabre East Municipality, the Municipal Health Directorate should liaise with collaborating stakeholders if not eliminating to limit the influence of restrictive factors to women’s quest of using ANC. It is further recommended that management do away with hindrances that delay women who seek for ANC services in health facilities and adopt strategies and procedures that aim at increasing ANC uptake.

This observational study assessed the knowledge of pregnant women attending antenatal clinics at two selected hospitals in Abeokuta South, Nigeria on the causes and risk factors of maternal mortality, identified barriers to knowledge acquisition, and examined the influence of parity of respondents on their knowledge of factors causing maternal mortality. Maternal mortality is extremely high in Nigeria, it is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Descriptive research design was used in this study and qualitative data from 136 respondents selected randomly, were obtained through a self-designed questionnaire that comprised three sections. Data were analyzed and indicated that parity of the pregnant women do not have an influence on their knowledge of factors responsible for maternal mortality. Findings revealed that majority (67.6%) of the respondents had high knowledge on the causes of maternal mortality – haemorrhage, sepsis, prolonged/obstructed labour, anaemia, unsafe abortion, infection, hypertensive disorders, care rendered by unskilled medical practitioners and its risk factors - parity, poverty, place of last delivery and low attendance at antenatal clinic. Educational background, marital status, irregular antenatal visits, socio-cultural practices and occupational status were identified as barriers to knowledge acquisition. This paper concluded that pregnant women may have a high knowledge about the factors responsible for maternal mortality. This is probably due to the fact that all respondents had formal education and because they were interviewed on antenatal clinic days, which suggests that they might have heard about the causes and risk factors for maternal mortality during their visits. Authors recommended that government should employ qualified health professionals and provide medical subsidy, it is hoped that this will ensure that pregnant women get quality care throughout the period of pregnancy and delivery.

Parry-Romberg syndrome is an uncommon condition, self-limiting with slow progressive hemifacial atrophy. This syndrome can lead to several progressive congenital and developmental deformities. It can cause severe facial asymmetry and subsequently lead to esthetic and psychological problems and adversely affect patient’s quality of life, so its treatment holds great importance. Still, there is no exact treatment protocol for this disease, treatment approaches are bounded and patient’s response to the treatment is imponderable. However, most of the patients can benefit from conservative treatments. In this paper, we have reported a moderate case of Parry-Romberg syndrome, with no familial history of any syndromes. We also have discussed about present anomalies and the steps of exerted conservative treatments.

The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques. Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO “Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine” from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in “before hemorrhage” period, in acute or “cold” period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as “Effective”. Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the “effective” reconstructive occlusion of AA cavity. The evaluation of the AA complexity criteria prognostic significance to achieve the “effective” primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II. There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS. It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and “cold” periods. There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p>0.05). It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion. Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn’t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability.

The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium.

Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study. Setting: carried out in operating room of our university hospital. Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017. Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I. Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.

Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could influence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern. Methods: Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed: √ a statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test √ a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off √ a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2 √ a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4 √ a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4 √ in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses Interpretation: In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re-learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability. The proprioceptive profile of our rehabilitative program could promote the pro-adaptive and facilitation properties of a personalized gait control, induced by an innovative dynamic ankle foot orthoses with a modulable ankle joint system called Neuroswing. In the daily clinical practice, the personalized integration of a neurorehabilitative program and DAFONS can perform an individualized peripheral neuro-facilitation of gait cycle (peripheral perceptive facilitation), a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation DAFONS induced) and an increase of patient’s motor abilities and quality of life in all daily performances.

Objective: To describe some aspects of the quality of ambulance care and completeness of information in the transfer forms of emergency patients who arrived in ambulances to the National Hospital of Sri Lanka (NHSL). Methods:This was a descriptive study. All ambulances arrived at the NHSL during the study period with an emergency patient were selected (n=409) and from those 250 transfer forms, which could be traced were taken. An interviewer-administered questionnaire was used for ambulance staff. A Checklist, which has been derived from the standard patent chart, was used to determine the availability of information on transfer forms. Results: Of the 409 ambulances, the patient was accompanied by a doctor in 4% (n=16), a nurse in 4% (n=15) and Emergency Medical Technicians (EMTs) in 1% (n= 4), and there were 675 miner employees and 409 drivers. Twenty six percent (n= 4) of doctors, 12.5% (n= 2) of nurses, 100% (n=4) of EMTs, 56.9% (n=189) of drivers and 24.3% (n=164) of minor employees had received training in emergency medicine/pre-hospital care. The time interval between receipt of the message and loading the patient to the ambulance was >15 minutes on 19% (n= 75) of the occasions and from the latter time to commencement of the journey was >15 minutes on 7% (n=27) of the occasions. The call number of sending facility 0.4% (n=1) and sending time 33.2% (n=83) were poorly documented. The past surgical histories 20.8% (n=52), chronic diseases 48% (n=120), psychological problems 13.2% (n=33) and allergies 9.2% (n=23) were poorly documented. Details of physical examination findings except cardio-vascular system were not documented in >50% of transfer forms. Medications had been documented fairly (>60%) in most of the transfer forms and however, the procedures (IV fluids, ECG) were poorly documented (<30%). Conclusion: The completeness of information in the transfer form was not up to standards. This emphasizes for need of well-structured standard transfer form in the country.