Bien que la littérature décrive plusieurs vignettes cliniques (associées à des questions) destinées à évaluer les attitudes/comportements des professionnels de la santé face à un patient souffrant de lombalgie, ces vignettes sont généralement incomplètes et n’abordent que peu, voire pas, les facteurs psychosociaux. De plus, celles-ci n’examinent pas l’adéquation entre la prise en charge préconisée et les recommandations récentes de la HAS [1] et l’itinéraire de soins proposés par le KCE [2]. Dès lors, les objectifs de cette étude étaient : 1) de développer 3 vignettes originales (patient fictif souffrant d’une lombalgie non spécifique aiguë, subaiguë/récurrente ou chronique) et un questionnaire (pouvant être utilisé avec chaque vignette) répondant aux limites des outils existants afin d’apprécier les attitudes de (futurs) professionnels de la santé ; 2) de mesurer les qualités psychométriques de base (effet plancher/plafond, validité et reproductibilité) de ce nouvel outil. Une fois les 3 vignettes et le questionnaire (18 affirmations combinées à une échelle de degré d’accord de Likert) développés, deux groupes expérimentaux (un groupe d’experts et un groupe expérimental composé de professionnels de la santé diplômés et d’étudiants de dernière année (en kinésithérapie ou en médecine) ont été invités à compléter un questionnaire en ligne. Ils devaient, après avoir pris connaissance de chacune des 3 nouvelles vignettes cliniques, répondre au questionnaire (permettant l’obtention d’un score pour chaque vignette et d’un score global). Ils étaient également soumis à une vignette (et les questions qui y sont associées) fréquemment utilisée dans la littérature (Rainville et al., 2000). La validité de ce nouvel outil d’évaluation a été examinée, d’une part, en comparant les scores des groupes « experts » et « expérimental » et, d’autre part, en comparant les résultats obtenus à la vignette de Rainville et al. à ceux obtenus pour ces nouvelles vignettes. La reproductibilité test-retest a été évaluée en resoumettant le groupe expérimental au nouvel outil une à deux semaines plus tard. Après l’analyse des réponses des 8 « experts » recrutés, une des questions (sur la médication) a été retirée en raison de désaccords entre les réponses des experts. Cent onze participants ont été recrutés dans le groupe « expérimental ». L’analyse des scores aux questionnaires liés aux vignettes suggère : 1) l’absence d’effet plancher et plafond ; 2) une validité (scores significativement différents entre les 2 groupes et concordants avec les résultats à la vignette de Rainville et al.) ; une bonne reproductibilité (coefficient de corrélation intraclasse supérieure à 0,9 pour le score global et compris entre 0,83 et 0,91 pour chaque vignette). Ce nouvel outil autorisera l’identification des recommandations les moins suivies, la comparaison de différentes disciplines médicales et l’évaluation des effets de formations destinées à présenter les recommandations de bonne pratique. Cette étude a permis de développer 3 nouvelles vignettes permettant d’examiner de façon valide et reproductible si les croyances et attitudes des professionnels de la santé relatives à la prise en charge de la lombalgie sont en adéquation avec les dernières guidelines. La poursuite du développement de ce nouvel outil est nécessaire en examinant notamment ses autres qualités métrologiques telles que sa sensibilité au changement.

Isometric bite force control, via measures of force accuracy, force steadiness and force proprioception, was assessed in patients with myogenic temporomandibular disorders (TMDs) compared to healthy controls. Twelve people with myogenic TMDs and twelve age- and gender-matched asymptomatic controls performed maximal voluntary contractions (MVC) of unilateral jaw clenching followed by submaximal isometric contractions, with and without visual feedback of force, at 10, 30 50% and 70% MVC. Force performance was assessed with indices of accuracy (mean distance, MD) and precision (standard deviation, SD) and reported as a percentage of the MVC. A mixed-effect model was used to evaluate differences in MVC, MD and SD. The MVC was lower in the TMD group when clenching either ipsilateral or contralateral to the side of greatest pain (p < 0.05). No difference in MD was observed between groups. The SD depended on the interaction between group and painful side (p = 0.04) with the TMD group displaying higher SD when executing the task with the most painful side when compared to the ipsilateral or contralateral sides of the control group. The reduced maximal bite force and force steadiness observed in people with myogenic pain may interfere with masticatory function and should be considered when planning therapeutic interventions for TMDs.

s / Manual Therapy 25 (2016) e57ee169 e123 conditions, results in significant losses in productivity at work and incurs billions of dollars in medical expenditure annually. LBP and other musculoskeletal disorders have therefore been prioritized as a global health concern during the Bone and Joint decade (2000-2010, WHO). Despite the GBD 2010 and WHO reports, LBP and other musculoskeletal conditions remain less prioritized in low-to-middle income countries (LMICs), due to more pressing health issues like HIV/AIDS. Purpose: A better understanding of the current burden of LBP in African LMICs was therefore required. An updated search of the current literature into the prevalence of LBP among African nations was therefore conducted. Specific challenges faced in retrieving epidemiological information in Africa, the methodological quality of reported African studies and on conducting meta-analyses of LBP data were also highlighted. Methods: (Protocol reg.#:CRD42014010417) A comprehensive search of all accessible bibliographic databases via the Stellenbosch University’s Medical and Health Sciences Library website was conducted (April 2014October 2014); updated March 2015. Population-based studies into the prevalence of LBP among children/adolescents and adults living in Africa were included. Methodological quality of included studies was appraised using an adapted tool. Meta-analysis were conducted using methods described by Neyeloff et al (2012). Subgroup analyses, sensitivity analyses, publication bias and meta-regression analyses were also conducted. Results: Fifty-four studies were included in this review. Themajority of the studies were conducted in Nigeria (n1⁄422;41%) and South Africa (n1⁄415;28%). Thirty-six included studies (66.7%) were found to be of higher quality. The lifetime, one-year and point prevalence of LBP in Africa was 55.8 (95% CI 19.8;91.8); 57.5 (95% CI 51.6;63.5) and 41.9 (95% CI 29.2;54.6), respectively. There was little difference in LBP prevalence between African males (48.6%,95% CI 36.1;61.1) and African females (49.5%,95% CI 38.6;60.5). The prevalence of LBP was estimated to be higher among African adults (54.3%; 95% CI 44.9;63.7) compared to African children and adolescents (32.1%; 95% CI 18.9,45.3). Conclusion: This review found that the lifetime, one-year and point prevalence of LBP among African nations was considerably higher than or comparable to global LBP prevalence estimates reported. Implications: Despite the high burden of LBP rin Africa, African healthcare budgets and systems may generally be ill-prepared to deal with the management of LBP. Successful development and implementation of strategies and policies to address the burden of LBP on poorer countries or countries with emerging economies, like those in Africa, is therefore warranted. Funding Acknowledgements: Work was not funded. Ethics Approval: This study was exempt from ethical approval since it was a systematic review. Disclosure of Interest: None Declared

The bulk of reviewing for GPS Solutions rests on the shoulders of active editorial board members. However, sometimes it becomes necessary to seek the help of other experts with specialized knowledge or to find additional reviewers when the editorial board members are already busy reviewing. GPS Solutions has greatly benefited from the support of many talented reviewers who volunteered their service. Below is a list of individuals who are not currently on the editorial board but who have reviewed manuscripts for GPS Solutions during October 1, 2015 to October 1, 2016. Thank you very much for your dedicated hard work.

El enfoque del concepto Mulligan en la evaluación y el tratamiento de las disfunciones musculoesqueléticas es relativamente reciente. Desde el punto de vista clínico, es pertinente en casos de limitaciones de movimientos activos a causa de dolor o rigidez o en casos de limitación funcional por una disfunción articular. El concepto Mulligan se basa en un modelo biomecánico combinado con una evaluación específica del paciente, que permite al fisioterapeuta identificar la posición errónea de la articulación y planificar el protocolo de tratamiento para corregir dicha posición y, de este modo, obtener la normalización de la función. Recientemente, a los mecanismos de acción del concepto Mulligan se le han atribuido algunos efectos neurofisiológicos. Este concepto es aplicable a las articulaciones de la columna vertebral y de los miembros superiores e inferiores. Se trata de técnicas indoloras de terapia manual que tienen por objeto modificar la situación patológica inmediatamente después de su aplicación. Además de las técnicas manuales articulares, el concepto Mulligan también comprende técnicas de vendaje neuromuscular (taping) y ejercicios específicos que el paciente debe hacer en su domicilio. El objetivo de este artículo es presentar al lector el concepto Mulligan. Se describirán los orígenes de este enfoque manual y sus principios de evaluación y tratamiento. También se presentará una breve consideración sobre los mecanismos de acción y un resumen de las evidencias científicas respecto a los efectos clínicos.

L’approccio del concetto Mulligan nella valutazione e nel trattamento delle disfunzioni muscoloscheletriche è relativamente recente. Esso è clinicamente pertinente nei casi di limitazione di movimenti attivi causati dal dolore o dalla rigidità o di limitazione funzionale proveniente da una disfunzione articolare. Il concetto Mulligan è fondato su un modello biomeccanico combinato con una valutazione specifica del paziente, che permette al fisioterapista di identificare la posizione di errore dell’articolazione e di pianificare la procedura di trattamento per correggere la posizione di errore e permettere, così, una normalizzazione della funzione. Recentemente, diversi effetti neurofisiologici sono stati associati ai meccanismi d’azione del concetto Mulligan. Questo concetto è applicabile alle differenti articolazioni del rachide e degli arti superiori e inferiori. Queste tecniche di terapia manuale sono non dolorose e hanno l’obiettivo di modificare la situazione patologica subito dopo la loro applicazione. Accanto alle tecniche manuali articolari, il concetto Mulligan comprende anche delle tecniche di taping e degli esercizi specifici da realizzare a domicilio. L’obiettivo di questo articolo è di presentare il concetto Mulligan al lettore. Noi descriveremo le origini di questo approccio manuale e presenteremo i suoi principi di valutazione e di trattamento. Saranno affrontati anche una breve discussione dei meccanismi d’azione e un riassunto delle evidenze scientifiche a proposito degli effetti clinici.

BACKGROUNDOpen-vent jet nebulizers are frequently used to promote drug deposition in the lung, but their clinical efficacy and indications are not clear. Our study compared lung deposition of amikacin using two different configurations of a jet nebulizer (Sidestream(®)): one vented (N1) and one unvented with a corrugated piece of tubing (N2).METHODSIn vitro nebulizer performance was assessed by laser diffraction and filtering. Lung delivery was evaluated by scintigraphy in baboons as a child model, and by amikacin urinary drug concentration in seven healthy spontaneously breathing volunteers. Subjects were randomly assigned to the two nebulizer systems (N1 and N2).RESULTS AND CONCLUSIONSIn vitro results showed a higher efficiency of N2 than N1 in terms of lung deposition prediction (95±3 mg vs. 70±0 mg; p<0.0001). Radioactivity deposition in the baboons' lungs was lower with N1 than with N2 (1.8% vs. 4.7% of nebulizer charge; p<0.05). The total daily amount of amikacin urinary excretion was lower with N1 than with N2 (29.5 mg vs. 40.1 mg; p<0.01). Conversely, in vivo drug output rate was higher with N1 than with N2 (3.1 mg/min vs. 2.2 mg/min; p<0.05). Using a corrugated piece of tubing with standard jet nebulizers delivers higher doses to the lungs than open-vent jet nebulizers. The open-vent jet nebulizer might be recommended for rapid administration of a lower dose to the lungs and the standard jet nebulizer with corrugated piece of tubing for a higher dose in the lungs.

BACKGROUNDOur study investigated the influence of the cannula's inner diameter (ID) and of its removal on the expected respiratory dose of amikacin, using three different jet nebulizer configurations (Sidestream(®)): vented (N1), unvented with a piece of corrugated tubing attached to the expiratory limb of the T attachment (N2), and unvented alone (N3).METHODSThe jet nebulizer was filled with amikacin (500 mg/4 mL) and was attached to the tracheostomy tube. A lung model simulating spontaneous breathing was connected to the tracheostomy tube. A filter was connected between the nebulizer and the tracheostomy tube to measure the inhaled dose, and between the tracheostomy tube and the lung model to measure the respiratory dose. Different cannula IDs were tested (6.5, 8, 8.5, and 10 mm), and aerosol lost in the cannulas was determined.RESULTS AND CONCLUSIONSRespiratory dose varied between 96±1 mg and 44±3 mg, with higher values observed with N2. The aerosol lost in the cannula was significant and represented up to 63% of the inhaled dose. There was a negative correlation between the cannula's ID and the aerosol lost in the cannula. After removal of the internal cannula, an increase in the respiratory dose of up to 31.3% was observed. We recommend removing the inner tracheostomy cannula to nebulize a larger amount of drug through a tracheostomy tube. Among the three jet nebulizer configurations studied, we recommend the unvented one with a piece of corrugated tubing attached to the expiratory limb of the T attachment.

Aim: Intranasal aerosol administration of drugs is widely used by ENT specialists. Although clinical evidence is still lacking, intranasal nebulization appears to be an interesting therapeutic option for local drug delivery, targeting anatomic sites beyond the nasal valve. The sonic nebulizer NL11SN associates a 100 Hertz (Hz) sound to the aerosolization to improve deposition in the nasal/paranasal sinuses. The aim of the present study was: to evaluate in vivo the influence of associating a 100 Hz sound on sinus ventilation and nasal and pulmonary aerosol deposition in normal volunteers, and; to quantify in vitro aerosol deposition in the maxillary sinuses in a plastinated head model.Material and methods: Scintigraphic analysis of Kr-81m gas ventilation and of sonic aerosol (Tc-99m-DTPA) deposition using the NL11SN was performed in vivo in seven healthy volunteers. In parallel, NL11SN gentamicin nebulization was performed, with or without associated 100 Hz sound, in a plastinated human head model; the gross amount of gentamicin delivered to the paranasal sinuses was determined by fluorescence polarization immunoassay.Results: Associating the 100 Hz sound to Kr-81m gas ensured paranasal sinus ventilation in healthy volunteers. Tc-99m-DTPA particles nebulized with the NL11SN were deposited predominantly in the nasal cavities (2/3, vs 1/3 in the lungs). In vitro, the use of NL11SN in sonic mode increased gentamicin deposition threefold in the plastinated model sinuses (P < 0.002); the resulting antibiotic deposit would be sufficient to induce a local therapeutic effect.Conclusion: The NL11SN nebulizer ensured preferential nasal cavity aerosol deposition and successfully targeted the maxillary sinuses. (C) 2011 Published by Elsevier Masson SAS.

L’administration nasale de médicaments sous forme d’aérosol est largement utilisée par les otorhinolaryngologistes. Bien qu’elle manque d’évaluations cliniques, la nébulisation ORL se présente comme une option thérapeutique intéressante pour l’administration nasale de médicaments. Les aérosols permettraient de cibler les sites anatomiques d’intérêt situés derrière la valve nasale. Le nébuliseur sonique NL11SN utilise l’addition d’un son de 100 Hertz (Hz) à l’aérosol produit afin d’améliorer le dépôt dans les sinus. L’objectif de notre étude était : (1) d’évaluer in vivo chez le volontaire sain l’influence du son sur la ventilation sinusienne et le dépôt nasal et pulmonaire d’un aérosol sonique, et (2) de quantifier in vitro le dépôt d’aérosols soniques dans les sinus maxillaires d’un modèle plastiné. In vivo, une scintigraphie de ventilation au gaz 81mKr et une scintigraphie de dépôt d’aérosol (99mTc-DTPA) sonique produit par le NL11SN étaient réalisées chez sept volontaires sains. En parallèle, des nébulisations de gentamicine étaient réalisées en présence ou en absence du son de 100 Hz sur un modèle de tête humaine plastinée avec le NL11SN. La quantité de gentamicine déposée dans les sinus était dosée par FPIA. L’addition du son de 100 Hz au gaz 81mKr permettait la ventilation des cavités sinusiennes des volontaires sains. Le 99mTc-DTPA nébulisé avec le NL11SN chez les volontaires se déposait majoritairement dans les cavités nasales (2/3 vs 1/3 dans les poumons). In vitro, le NL11SN utilisé en mode sonique a permis d’augmenter d’un facteur 3 (p < 0,002) le dépôt de gentamicine dans les sinus du modèle plastiné. Les quantités d’antibiotiques déposées dans les sinus du modèle plastiné pouvaient être considérées comme suffisantes pour avoir un effet thérapeutique local. Le nébuliseur NL11SN assure un dépôt préférentiel de l’aérosol dans les cavités nasales et cible efficacement les sinus maxillaires.

Adenotonsillar hypertrophy is a common paediatric/otolaryngological disorder that may be associated with secondary growth or facial growth impairment, sleep disturbances, neurocognitive deficits, or smell loss. Surgical removal of the hypertrophic tissue eliminates the mechanical obstacle of the airways and is therefore curative in most cases. The purpose of the present review is to outline the impact of adenotonsillar hypertrophy and adenotonsillectomy on growth, facial growth, sleep, behaviour and smell.

72 An open-label study of recombinant human BSSL (rhBSSL) in adult patients with cystic fibrosis (CF) and pancreatic insufficiency (PI) J. Langendonk1, M. Ohman2, H. Mazurek3. 1Erasmus Medical Center, Vascular and Metabolic Diseases, Rotterdam, Netherlands; 2Swedish Orphan Biovitrum, Clinical Development, Stockholm, Sweden; 3Instytut Gruzlicy i Chorob Pluc w Rabce Zdroj, Klinika Pneumonologii i Mukowiscydozy, Rabka, Poland