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Aged↗
Biomedical subjects
Margaret Black
Publications and source records attributed to Margaret Black.
Comorbidity and socioeconomic deprivation: an observational study of the prevalence of comorbidity in general practice.
Although inequalities in health between the most affluent and most deprived individuals in our communities have been well documented, the underlying causes are still not completely understood. There has been recent interest in the contribution of multiple morbidity as one explanatory factor, although there is little evidence as yet regarding this. The few general practice based studies investigating the presence of comorbidity have highlighted its significance. However the relationship between multiple morbidity and deprivation is still relatively under-researched and under-reported in the literature. As a result, the full extent of comorbidity and its implications remains unknown. Some argue, however, that there is now recognition that comorbidity is the rule rather than the exception and that this ought to influence approaches to quality of care. If this is to take place there is an urgent need for a greater understanding of the nature and impact of comorbidity.
Adolescent↗
Thoracic pedicle screws: postoperative computerized tomography scanning assessment.
OBJECT: The authors evaluated the accuracy of placement of thoracic pedicle screws by performing postoperative computerized tomography (CT) scanning. A grading system is presented by which screw placement is classified in relation to neurological, bone, and intrathoracic landmarks. METHODS: One hundred eighty-five thoracic pedicle screws were implanted in 27 patients with the assistance of computer image guidance or fluoroscopy. Postoperative CT scanning was conducted to determine a grade for each screw: Grade I, entirely contained within pedicle; Grade II, violates lateral pedicle but screw tip entirely contained within the vertebral body (VB); Grade III, tip penetrates anterior or lateral VB; Grade IV, breaches medial or inferior pedicle; and Grade V, violates pedicle or VB and endangers spinal cord, nerve root, or great vessels and requires immediate revision. Based on anatomical morphometry, the spine was subdivided into upper (T1-2), middle (T3-6), and lower (T7-12) regions. Statistical analyses were performed to compare regions. The mean follow-up period was 37.6 months. The following postoperative CT scanning-documented grades were determined: Grade I, 160 screws (86.5%); Grade II, 15 (8.1%); Grade III, six (3.2%); Grade IV, three (1.6%); and Grade V, one (0.5%). Among cases involving screw misplacements, Grade II placement was most common, and this occurred most frequently in the middle thoracic region. CONCLUSIONS: The authors' grading system has advantages over those previously described; however, further study to determine its reliability, reproducibility, and predictive value of clinical sequelae is warranted. Postoperative CT scanning should be considered the gold standard for evaluating thoracic pedicle screw placement.
Adolescent↗