Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.

Improving cup positioning using a mechanical navigation instrument

Although surgical navigation reduces the rate of malpositioned acetabular cups in total hip arthroplasty (THA), its use has not been widely adopted. As a result of our perceived need for simple and efficient methods of navigation, we developed a mechanical navigation device for acetabular cup orientation.

Feminist Tigers and Patriarchal Lions: Rhetorical Strategies and Instrument Effects in the Struggle for Definition and Control over Development in Nepal

This article offers an analysis of a struggle for control of a women’s development project in Nepal. The story of this struggle is worth telling, for it is rife with the gender politics and neo-colonial context that underscore much of what goes on in contemporary Nepal. In particular, my analysis helps to unravel some of the powerful discourses, threads of interest, and yet unintended effects inevitable under a regime of development aid. The analysis demonstrates that the employment of already available discursive figures of the imperialist feminist and the patriarchal third world man are central to the rhetorical strategies taken in the conflict. I argue that the trans-discursive or “borderland” nature of development in general and women’s development in particular result in different constructions of “development” goals, means and actors based not only on divergent cultural categories but on historically specific cultural politics. I argue further that the apolitical discourse of development serves to cloak its inherently political project of social and economic transformation, making conflicts such as the one that occurred in this case not only likely to occur but also likely to be misunderstood.