Background:Numerous physical, psychological, and emotional benefits have been attributed to marijuana since its first reported use in 2,600 BC in a Chinese pharmacopoeia. The phytocannabinoids, cannabidiol (CBD), and delta-9-tetrahydrocannabinol (Δ9-THC) are the most studied extracts from cannabis sativa subspecies hemp and marijuana. CBD and Δ9-THC interact uniquely with the endocannabinoid system (ECS). Through direct and indirect actions, intrinsic endocannabinoids and plant-based phytocannabinoids modulate and influence a variety of physiological systems influenced by the ECS.Methods:In 1980, Cunha et al. reported anticonvulsant benefits in 7/8 subjects with medically uncontrolled epilepsy using marijuana extracts in a phase I clinical trial. Since then neurological applications have been the major focus of renewed research using medical marijuana and phytocannabinoid extracts.Results:Recent neurological uses include adjunctive treatment for malignant brain tumors, Parkinson's disease, Alzheimer's disease, multiple sclerosis, neuropathic pain, and the childhood seizure disorders Lennox-Gastaut and Dravet syndromes. In addition, psychiatric and mood disorders, such as schizophrenia, anxiety, depression, addiction, postconcussion syndrome, and posttraumatic stress disorders are being studied using phytocannabinoids.Conclusions:In this review we will provide animal and human research data on the current clinical neurological uses for CBD individually and in combination with Δ9-THC. We will emphasize the neuroprotective, antiinflammatory, and immunomodulatory benefits of phytocannabinoids and their applications in various clinical syndromes.
Introduction: The TruFUSE ® lumbar facet fusion system is a unique allograft milled bone dowel used to fuse facet joints. We evaluated subjects undergoing TruFUSE ® fusion for stable grade I spondylolisthesis and stenosis comparing operative time, length of stay, blood loss and outcome to a similar literature-based cohort of patients undergoing pedicle screw fusion (PSF). Methods: From 2009 to 2011, 41 subjects (17 M, 24 F, aver. age 69.5 yr) underwent TruFUSE ® facet fusion along with transverse process bone fusion and laminectomy. Length of stay, operative time, blood loss and outcomes were compared to eight literature-based cohort that analyzed similar parameters following pedicle screw fusion. Results: The 41 subjects' mean operative time for laminectomy, transverse process fusion and TruFUSE ® facet fusion was 106 min, with a mean blood loss of 145 cm 3 , and a mean hospital stay of 1.7 days (77% one day). A follow-up at average six months, 33 (80%) subjects reported subjective outcomes of "excellent" or "somewhat improved", four (10%) "unchanged" and four (10%) "worse". Flexion and extension radiographs showed 39 of the 41 patients (95%) had spinal stability at an average six months post-op and all (100%) had signs of early fusion. Discussion: TruFUSE ® subjects had significantly (p < 0.0001) shorter surgeries (106 min compared to the literature data range of 185-240 min); significantly (p < 0.0001) shorter hospitalization (1.7 days compared to 4-19 days range). Mean estimated blood loss (EBL) was significantly lower (p < 0.001) (145 cm 3 compared to 321 cm 3 and 1082 cm 3 range for PSF). Subjective outcome and radiographic stability were comparable between groups. Conclusion: This comparison using the TruFUSE ® lumbar facet fusion system demonstrates improvements in length of stay, surgical blood loss, and operative time in our selected patient population compared to several published lumbar pedicle screw fusion systems outcomes. There may be potential economic benefits as a result of these improvements.
This article examines an evaluation currently being undertaken in Papua New Guinea. The evaluation is designed to assist an organisation (comprising a donor agency, a recipient government department and a managing contractor) with the management and further development of an aid program set in the education sector. The challenge facing the organisation has been how to devise and implement a comprehensive managerial approach that will enable improvement of the existing program, the subsequent design of a new program and, at the same time, support a third objective of creating an ongoing culture of evaluation. In responding to that challenge the organisation has committed to the use of structured evaluation processes. Specifi cally, it has decided to implement a range of ‘front end’ evaluative approaches-developmental, evaluability assessment and program logic-drawn from the interactive and clarifi cative forms presented in Owen's (1999) conceptual framework. The article outlines the interventions that have been undertaken and assesses progress to date. Examples of completed activities are outlined and some innovative monitoring evaluative tools are introduced, such as the ‘capacity scale’ and the monitoring and evaluation (M&E) template. The paper concludes with some thoughts on the role of evaluation for management and development for achieving continuous improvement.
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