Metastatic bone disease is increasing in association with ever-improving medical management of osteophylic malignant conditions. The precise timing of surgical intervention for secondary lesions in long bones can be difficult to determine. This paper aims to evaluate a classic scoring system. All radiographs were examined twice by three orthopaedic oncologists and scored according to the Mirels' scoring system. The Kappa statistic was used for the purpose of statistical analysis. The results show agreement between observers (κ=0.35-0.61) for overall scores at the two time intervals. Inter-observer agreement was also seen with subset analysis of size (κ=0.27-0.60), site (κ=0.77-1.0) and nature of the lesion (κ=0.55-0.81). Similarly, low levels of intra-observer variability were noted for each of the three surgeons (κ=0.34, 0.39, and 0.78, respectively). These results indicate a reliable, repeatable assessment of bony metastases. We continue to advocate its use in the management of patients with long bone metastases.
The aim is to model treatment pathways and outcomes of opiate users at intake and at 1-and 3-year follow-up and to assess the implications of these for treatment policy. Opiate users entering a new treatment episode were recruited. Tree diagrams were used to map treatment relapse and re-entry. A within subjects repeated measures analyses of variance was conducted on each of the outcomes. The effect of being in treatment at 1-year on the 3-year outcomes was measured controlling for the value of the outcome variable at intake. A total of 404 opiate users were recruited. Follow-up interview rates were 88.4% at 3-years. Three years after intake 15% were drug free, 70% were in treatment and 15% were not in treatment and were using illegal drugs. Analysis revealed that there were no differences between the three outcome groups at intake. Those who were not in treatment and using at 3-years had displayed little improvement at 1-year and those who were not in treatment and not using at 3-years had displayed improvements in physical and mental health outcomes at 1-year. Regardless of treatment modality, treatment policy needs to reflect, support and encourage individuals during the treatment relapse cycle.
There have been significant developments in the electro'nics industry over the past decade which have led t o the development of a variety of electronic measuring devices that can be placed in packages t o both record and save shock and vibration data related t o shipment. Most of the earlier devices were purely mechanical in nature and used a paper graph or a visual indicator t o quantify shock levels. There are many of these types of mechanical devices t h a t are still being used today because of their low cost. This study was performed t o determine the reliability and error for various types of commercial mechanical shock recorders and impact indicators. The results are presented in the form of mean per cent errors in measuring shock values. The study concluded that the Impact-0-Graph recorder measured shock values more accurately than the Impact Register and that the Omni-G. Mag 2000 and Shockranger were similar in accuracy and were better than the Shockwatch when used in a variety of packages judged t o be typical for instrumented shipment.
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