OBJECTIVE: Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation.
METHODS: A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate.
RESULTS: Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability.
CONCLUSIONS: This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
MATERIALS AND METHODS: This study is a quasi-experimental approach in which a non-equivalent control group was used in a post-test design. A comparison was carried out with two separate semester cohort students representing the control and intervention groups which had 24 and 30 students, respectively. This study included first-year nursing students that enrolled in a course called "Anatomy and Physiology" course of nursing education at a private university. The control group received all their teaching face-to-face, and the intervention group used information technology and prescribed activities in their online e-book. The self-directed learning readiness (SDLR) tool measures the learners' readiness in self-directed learning in both groups. This scale comprises three subscales which are "self-management," "desire for learning," and "self-control." An independent-samples t-test was conducted to compare self-directed learning readiness in the control and intervention groups. Data were analyzed using IBM SPSS Statistics 25 software to measure the independent t-test.
RESULTS: The self-directed readiness scores were significantly higher in the intervention group with P = 0.019. The intervention group showed a higher mean value on the subscales of self-management and self-control, which demonstrated a significant difference with P values of 0.018 and 0.028, respectively. The subscale desire for learning was insignificant with a P value of 0.166.
CONCLUSION: This study concluded that the overall results demonstrate that incorporating blended learning using e-books for anatomy and physiology courses in nursing education can contribute to students' readiness for self-directed learning. Specifically, the blended learning teaching and learning strategy had a positive impact on nursing students' capacity for self-management and self-control.
METHODOLOGY: A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997.
RESULTS: Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred.
CONCLUSIONS: Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.