Aziz Ahmadi
Abstract
I have had concerns about a possible decline in the Orthopaedic Residency Program in the recent years. I, therefore, looked at the residency programs in few other countries, namely Canada, England, Russia, Australia, India, and Saudi Arabia. The following fields were looked up and compared with the present ...
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I have had concerns about a possible decline in the Orthopaedic Residency Program in the recent years. I, therefore, looked at the residency programs in few other countries, namely Canada, England, Russia, Australia, India, and Saudi Arabia. The following fields were looked up and compared with the present situation. In Iran: resident selection method, period of residency training, working hours, daily notebook and medical services; mandatory in-training exams; the amount of supervision by the attending staff and mentors; From the six investigated countries, all but Russia had had almost similar orthopaedic residency training programmes. The major difference, however, were in the residency training years that were between 5 to 10 years, and the maximum allowable working hours which varied between 56 to 80 hours per week Orthopaedic residency training in Iran with the approval of the Ministry of Science, the Iranian Orthopaedic Residency Program was established in 1973, at Shafa Yahyaian Hospital simultaneously Shiraz University. The residency curriculum was formulated using the American Academy of Orthopaedics, as a framework. There were subtle differences. Though, i.e., the residency period in America is 5 years, but the Iranian program is 4 years. At its core the programs were equal in caliber, as evidenced by the exam results. The Iranian in-training exams used questions mailed from America. After completion, the exams were sent to the American Academy of Orthopaedics for evaluation. It was reported that the exam results were on par with the average American trained resident. The implementation of Curriculum of the Academy, at the Shafa Training Center, provided a solid foundation for several decades of growth and excellence in Orthopaedic Residency. In more recent years, however the absence of curriculum; the proper attending supervision in the educational centers; and the lack of supervision by regulatory institutions have caused a decline in the quality of the programs. The 4-year residency period has been reduced to 3.5 years. Proper record-keeping in "by books" for the number of surgeries a resident performs is not possible. Supervision of attending staff has gradually decreased to negligent levels. In all the programs examined, daily notebooks and attending supervision are paramount. In 2010, the Iranian Presidential Science Auditing Department audited the current state of the Orthopaedic Residency Program. It was reported that Orthopaedic residents were only taught 20% of the orthopaedic curriculum. In teaching hospitals, 80% of beds are filled with emergency patients. Contrary to the best practices, the staff imposes the emergency burden on the residents. We found only one residency training center that covers residents 24/7 (Shafa Yahyaian Training Center). In other cases, there is no proper supervision. There are a number of factors contributing to the decline and degradation of residency education: lack of supervision by the orthopaedic board; nonadherence of educational centers to the implementation of educational curriculum; lack of attending supervision; and also the emergence of fellowship programs.
Spine
mohammadreza chehrassan; Mohammadreza Shakeri; Farshad Nikouei
Abstract
Background: Congenital kyphosis is a spinal deformity resulting from disruption in the formation of the anterior part of the vertebrae on the sagittal plane during early fetal development. Understanding demographic trends and associated anomalies in affected individuals within specific regions and countries ...
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Background: Congenital kyphosis is a spinal deformity resulting from disruption in the formation of the anterior part of the vertebrae on the sagittal plane during early fetal development. Understanding demographic trends and associated anomalies in affected individuals within specific regions and countries is pivotal for tailoring more suitable treatment approaches within these patients.Methods: This retrospective cross-sectional study was conducted on 108 patients referred to Shafa Yahyaian Hospital in Tehran between 2010 and 2019. Demographic and radiological criteria were assessed in all patients who underwent surgery for congenital kyphosis at this hospital. Parameters such as age, gender, BMI, presence of cardiac, urogenital system, and spinal anomalies, kyphosis type, as well as Cobb's angle before and after surgery, were gathered, reviewed, and analyzed from patients' records.Results: Of the cohort, 74 patients were categorized as congenital kyphosis type 1, 21 as type 2, and 13 as type 3, encompassing 69 female (63.9%) and 39 male patients (36.1%). The mean age at the time of examination and symptom onset was 6.5 years, while the mean age at the time of surgery was 16.5 years. Notably, 38 patients exhibited a cardiac anomaly, 14 had genitourinary system anomalies, and 39 presented with spinal anomalies. A statistically significant correlation existed between the presence of a cardiac anomaly and the type of congenital kyphosis, with type one exhibiting a markedly higher incidence of cardiac anomalies compared to the other two types.Conclusion: The findings revealed a higher frequency of type 1 congenital kyphosis. Moreover, patients with type 3 congenital kyphosis underwent surgery at a significantly younger age than those with the other two types, potentially attributed to its higher progression rate. Spinal cord, cardiac, and genitourinary tract anomalies were respectively observed as the most prevalent anomalies among the patients.
Zahra Rahimi
Abstract
Background: The forward head tilt and round holding of shoulder are the two postural problems, being observed not infrequently in young and middle age people. The present study is aimed at investigating such postural abnormalities in two-age groups of women.Methods: In a relatively randomized ...
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Background: The forward head tilt and round holding of shoulder are the two postural problems, being observed not infrequently in young and middle age people. The present study is aimed at investigating such postural abnormalities in two-age groups of women.Methods: In a relatively randomized sampling, 500 women in two age groups were tested to investigate the incidence of "Forward head" and "Round shoulder" abnormalities. 400 women between the ages of 19-25 (mean 19) years and 100 between 35-50 (mean 40) years were examined for mild, moderate and severe abnormalities. Evaluation of posture was carried out by plumb line. The kyphosis was also documented by a kyphosis goniometer. The subjects were also asked about their back pain, and then correlated with the postures and jobs and sporting activities.Results: There was significant difference between variables of "age" and "round shoulder" (p<0.05), but the relationship between "age" and "forward head" was not significant. (P < 0.05) .Also, a significant correlation was noticed between jobs that are position -dependent and abnormalities and severity of pain with job (p<0.05). The kyphosis angle was higher in older age group. There was also a correlation between the kyphosis angle and pain in inter-scapular region". (r=0.4, p=0.0001)Conclusion: The postural abnormalities of “head tilt” and “round shoulder” are seen in both young and middle -age women. The individuals who do regular exercises have less complaint of pain relative to their postural anomalies. Age and Job are effective elements on incidence of most mentioned postural abnormalities in older subjects.
Bahram Mobini, MD; Ebrahim Ameri, MD; Hamid Behtash, MD; Hassan Ghandhari, MD; Mohammad Khakinahad, MD
Abstract
Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: ...
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Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: from 1991 through 2005, 165 cases (39 male, 126 female) who had a diagnosis of idiopathic postural kyphosis were treated with a Milwaukee brace. The mean age at the initiation of treatment was 13.06 years (8-16 years), at the completion of treatment was 15.06 years (11-17 years) and at the final follow-up was 17.9 years (12-25 years). The mean initial kyphosis was 59.26° (51°-74°). The patients were evaluated after an average follow-up of 34 months (6-102 months).Results: The mean angle of kyphosis was 42° (28°-68°) at completion of treatment, and 47.9° (28°-75°) at the final follow-up. Angle of kyphosis was 50° or less in 85.9% at the end of treatment and in 74.7% of patients at final follow-up. 5.9 degrees of original correction was lost in final follow-up. Two cases underwent surgery. Brace was effective in correction of kyphosis (p < /em>=.001).Conclusion: Milwaukee brace is effective in treatment of postural kyphosis. Longer period of treatment, even after maturity, is needed in more stiff deformities.
