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Sample records for national orthopaedic hospital

  1. Epsom General Hospital orthopaedic theatre.

    PubMed

    1992-11-01

    The Surrey Section of the London Branch held a very successful meeting on Wednesday 9th September 1992 at which Mr Stephen Kirby BSc, CEng, Director of Estates, gave a talk and tour of the new Private Ward Unit and Ultra Clean Ventilation Theatre at Epsom General Hospital. The new Northey Ward, is a result of the refurbishment of what was a 31 bed section of the Hospital Surgical Block on the 5th floor. The new Ward provides a total of 18 single bed Wards, each complete with bathroom/WC, the Unit also accommodates a 5 bed Day Ward. All the facilities provided are of extremely high standard, which given the very tight building programme, detailed elsewhere, is indicative of the dedication of both the Designers and Contractors who are congratulated on their achievement. With regard to the UCV Theatre the following information was prepared by Aidan Hardy who is a Project Engineer with Epsom General Hospital. We are delighted to be able to print this report for our readers. PMID:10122458

  2. Orthopaedic implant removal at Royal Naval Hospital Stonehouse: a three-year review.

    PubMed

    Howell, G E; Hand, C J; Dodenhoff, R

    1995-01-01

    A recent study stated that 11% of all elective orthopaedic procedures performed at a Regional Orthopaedic Unit involved removal of orthopaedic implants. Indications for certain orthopaedic implant removal remain unclear. As budgets are squeezed even tighter throughout all branches of the Royal Navy, we looked at each operation performed for orthopaedic implant removal at Royal Naval Hospital Stonehouse and questioned their effectiveness with respect to finance and working days lost for serving personnel. PMID:7562705

  3. Orthopaedic implant removal at Royal Naval Hospital Stonehouse: a three-year review.

    PubMed

    Howell, G E; Hand, C J; Dodenhoff, R

    1995-01-01

    A recent study stated that 11% of all elective orthopaedic procedures performed at a Regional Orthopaedic Unit involved removal of orthopaedic implants. Indications for certain orthopaedic implant removal remain unclear. As budgets are squeezed even tighter throughout all branches of the Royal Navy, we looked at each operation performed for orthopaedic implant removal at Royal Naval Hospital Stonehouse and questioned their effectiveness with respect to finance and working days lost for serving personnel.

  4. Venous thromboembolism (VTE) risk assessment and prophylaxis in acute orthopaedic admissions: improving compliance with national guidelines.

    PubMed

    Watts, Laura; Grant, David

    2014-01-01

    "Each year over 25,000 people die from Venous Thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents". (1) Orthopaedic patients are at particular risk of VTE. In 2011, the project team carried out an audit into compliance with national VTE assessment guidelines on all acute trauma and orthopaedic admissions during a two week period at a District General Hospital. The study demonstrated that compliance was initially low, but showed a large improvement following the implementation of simple measures. The measures included: asking consultants to remind junior doctors, putting posters up in the trauma doctors office, asking nursing staff to check for a VTE assessment on admission to the ward, and putting reminders on the patient name board. The project team subsequently recommended an alteration to the hospital's computer system to incorporate a check of VTE assessment and prophylaxis. A second assessment using the same methodology sought to assess whether the previous improvements were sustained and the impact of this computer system alteration. Overall, compliance with national VTE guidance improved further.

  5. Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

    PubMed

    Dei Giudici, L; Giampaolini, N; Panfighi, A; Marinelli, M; Procaccini, R; Gigante, A

    2015-01-01

    The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards "where" and "when" to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient's outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

  6. Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

    PubMed Central

    V, Dei Giudici; N, Giampaolini; A, Panfighi; M, Marinelli; R, Procaccini; A, Gigante

    2015-01-01

    The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards “where” and “when” to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient’s outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

  7. Orthopaedic Surgery Under National Health Reform: An Analysis of Power, Process, Adaptation, and Leadership: AOA Critical Issues.

    PubMed

    Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J

    2014-07-01

    Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford. PMID:24990985

  8. Orthopaedic Surgery Under National Health Reform: An Analysis of Power, Process, Adaptation, and Leadership: AOA Critical Issues.

    PubMed

    Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J

    2014-07-01

    Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford.

  9. Linking the orthopaedic office-hospital continuum: results before and after implementation of an automated patient health history project.

    PubMed

    Mansfield, J A; Dodds, K L; Mallory, T H; Lombardi, A V; Adams, J B

    2001-01-01

    This article introduces an innovative collaboration between an orthopaedic surgeon's office and the hospital to assure complete and accurate admission information without duplication. With the use of point-of-care software, the assessment process was re-tooled. This change involved the patient/family assuming responsibility for completing paper and pencil in-depth history and systems review that was then used as part of the evaluation process and inputted into the database allowing for more effective outcomes assessment. In this re-tooling process, the concept of "sharing" information with the partnering hospital was explored. In collaborative discussions, the nursing admission assessment was targeted as a process where there was significant duplication. In fact, much of the information required on the 4-page form was already assessed and documented in the office setting. Consequently it was agreed that the majority of the inpatient nursing history/admission assessment form would be replaced with the assessment completed by the professional office staff. Because of incompatible software, the systems could not be linked but a printed copy of the form was sent to the hospital. Results measuring satisfaction, timesaving, and compliance with JCAHO documentation standards were part of the evaluation. Patients and clinicians were satisfied with the process. There was a significant timesaving for the in-patient RN which facilitated more direct contact with the patient and family.

  10. Orthopaedic management in a mega mass casualty situation. The Israel Defence Forces Field Hospital in Haiti following the January 2010 earthquake.

    PubMed

    Bar-On, Elhanan; Lebel, Ehud; Kreiss, Yitshak; Merin, Ofer; Benedict, Shaike; Gill, Amit; Lee, Evgeny; Pirotsky, Anatoly; Shirov, Taras; Blumberg, Nehemia

    2011-10-01

    Following the January 2010 earthquake in Haiti, the Israel Defence Forces (IDF) established a field hospital in Port au Prince. The hospital started operating 89 h after the earthquake. We describe the experience of the orthopaedic department in a field hospital operating in an extreme mass casualty situation. The hospital contained 4 operating table and 72 hospitalization beds. The orthopaedic department included 8 orthopaedic surgeons and 3 residents. 1111 patients were treated in the hospital, 1041 of them had adequate records for inclusion. 684 patients were admitted due to trauma with a total of 841 injuries. 320 patients sustained 360 fractures, 18 had joint dislocations and 22 patients were admitted after amputations. 207 patients suffered 315 soft tissue injuries. 221 patients were operated on under general or regional anaesthesia. External fixation was used for stabilization of 48 adult femoral shaft fractures, 24 open tibial fractures and 1 open humeral fracture. All none femoral closed fractures were treated non-operatively. 18 joint reductions and 23 amputations were performed. Appropriate planning, training, operational versatility, and adjustment of therapeutic guidelines according to a constantly changing situation, enabled us to deliver optimal care to the maximal number of patients, in an overwhelming mass trauma situation.

  11. [Treatment of displaced supracondylar fractures of the humerus in children at the orthopaedic ward of the Children's Hospital in Kielce].

    PubMed

    Zajac, Piotr; Hudzik, Dariusz

    2003-01-01

    Ninety five children in age from 4 to 12 years (61 boys and 34 girls) with displaced supracondylar distal humerus fractures were treated at the orthopaedic ward of The Children's Hospital in Kielce between I 2000-XII 2001. The method of choice was closed reduction and percutaneous fixation with Kirschner wires (74 children). We also used closed reduction and application of an above elbow cast (12 children), skeletal traction with fixation after swelling resignation (5 children), and open reduction and internal fixation (4 children). In 90 cases we did not observe any neurovascular disorders, and early functional results were good or satisfactory. 2 cases were associated with transient, postreduction radial nerve palsy. In 2 children surgical intervention was necessary due to external compression of the brachial artery in one case, and contusion with brachial artery spasm in another. In one girl we observed development of Volkmann's contracture (treated surgically with good functional result). The authors conclude that the closed reduction and percutaneous K-wire fixation can be used as a treatment of choice for displaced supracondylar fractures of the humerus in children.

  12. National hospital input price index.

    PubMed

    Freeland, M S; Anderson, G; Schendler, C E

    1979-01-01

    The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 per cent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies. PMID:10309052

  13. National hospital input price index.

    PubMed

    Freeland, M S; Anderson, G; Schendler, C E

    1979-01-01

    The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 per cent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies.

  14. Towards a National Pediatric Musculoskeletal Trauma Outcomes Registry: the Pediatric Orthopaedic Trauma Outcomes Research Group (POTORG) experience.

    PubMed

    Vitale, Michael G; Vitale, Mark A; Lehmann, Charles L; Hyman, Joshua E; Roye, David P; Skaggs, David L; Schmitz, Michael L; Sponseller, Paul D; Flynn, John M

    2006-01-01

    This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient's parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach.

  15. Orthopaedic Footwear Design

    NASA Technical Reports Server (NTRS)

    1992-01-01

    Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.

  16. An information revolution in orthopaedics.

    PubMed

    Goldberg, A J; MacGregor, A; Spencer, S A

    2012-04-01

    With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.

  17. Orthopaedic radiology

    SciTech Connect

    Park, W.M.; Hughes, S.P.F.

    1987-01-01

    This book is an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim is to show radiology as a dynamic subject. Orthopaedic Radiology is divided into two sections with the first part focusing on the principles of diagnostic imaging and interpretation and the second applying this information to practical clinical problems.

  18. Congenital dislocation of hip in children: a review of patients treated in the Institute of Orthopaedics and Traumatology, General Hospital, Kuala Lumpur, 1975-1988.

    PubMed

    Chai, A L; Sivanantham, M

    1990-06-01

    A retrospective review of patients with congenital dislocation of the hip (CDH) seen in the Institute of Orthopaedics, Kuala Lumpur General Hospital from 1975 to 1988 is presented. There was a female predominance of 17 to five. The average follow-up was 43 months and the average age at final assessment was 63 months. The results were assessed clinically and radiographically using Severin criteria. Eighty eight percent of the hips had excellent or good clinical results at final review compared with 40% of the hips which had excellent or good radiological grading (Severin I and II). Initial acetabular angle before treatment and types of treatment appeared to have a correlation with the final result. The incidence of avascular necrosis was 16%.

  19. [The national union for private hospital oncology].

    PubMed

    Parmentier, Gérard

    2013-06-01

    In the French health system, social security is the same for both public and private hospitals regardless of their status. In terms of number of patients screened, diagnosed, or treated, independant medicine is the most important sector in the French oncology. The multitude of organizations representing private hospitals or independant oncologists, physicians, radiologists or pathologists have a common organization, the National Union for Private Hospital Oncology (UNHPC). It bases its action on two founding postulates to ensure the quality of the oncology practice : the medical and managerial cultures are complementary and should be articulated ; the quality of organizations is as important as professional competence.

  20. What is orthopaedic triage? A systematic review

    PubMed Central

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-01-01

    Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. PMID:25410703

  1. The American Orthopaedic Association-Japanese Orthopaedic Association 2010 traveling fellowship.

    PubMed

    Patel, Alpesh A; Cheng, Ivan; Yao, Jeffrey; Huffman, G Russell

    2011-12-21

    We started this journey excited by the prospects of visiting Japan, a country with a proud and historic past. We ended the fellowship accomplishing those goals, and we left with a great deal of admiration for our orthopaedic colleagues halfway around the world for their excellence in education, clinical care, and research. Their hospitality and attention to the details of our visit were exemplary and a lesson to us as we host visiting fellows in the future. Japan reflects its past, but it also offers a preview into our own nation's future: an aging population, a shrinking workforce, a stagnant economy, nationalized health care, and a mushrooming national debt. Of all of these factors, it is the aging population that we, as orthopaedic surgeons, will be most acutely aware of and involved with. The degenerative disorders that affect elderly patients dominate the landscape of surgical care in Japan. Osteoporosis and osteopenia permeate many aspects of care across orthopaedic subspecialties. The surgeons in Japan are developing innovative and cost-effective means of treating the large volume of older patients within the fiscal constraints of a nationalized health-care system. We learned, and will continue to learn more, from Japan about the management of this growing patient population with its unique pathologies and challenges. With the recent natural disaster and ongoing safety concerns in Japan, the character and will of the people of Japan have been on display. Their courage and resolve combined with order and compassion are a testament to the nation's cultural identity. The seeds of the Traveling Fellowship were planted shortly after Japan's last wide-scale reconstruction, and the ties that have bound the JOA and the AOA together are strengthened through this trying time. We strongly urge our colleagues in the U.S. to help support the people, the physicians, and the health-care system of Japan through its most recent tribulations and offer them the same care and

  2. The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.

    PubMed

    Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S

    2005-07-01

    The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.

  3. Why veteran orthopaedic trauma surgeons are being fired and what we can do about it?

    PubMed

    Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J

    2013-06-01

    The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients.

  4. Why veteran orthopaedic trauma surgeons are being fired and what we can do about it?

    PubMed

    Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J

    2013-06-01

    The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients. PMID:23571292

  5. Orthopaedic Surgeons as Clinical Leaders in the National Health Service, United Kingdom (NHS UK): Can the World Learn From Us?

    PubMed

    Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr

    2015-07-01

    This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction. PMID:26208560

  6. Orthopaedic Surgeons as Clinical Leaders in the National Health Service, United Kingdom (NHS UK): Can the World Learn From Us?

    PubMed

    Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr

    2015-07-01

    This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction.

  7. Robotics and computer-assisted orthopaedic surgery.

    PubMed

    Specht, L M; Koval, K J

    These are just a few representative applications of the synergistic use of computer and robotic technology assisting the orthopaedic surgeon. While the individual systems are certain to change over time, the basic principles of correlating radiographic and anatomic data through a registration process, and displaying additional instrument or implant information through smart tools and surgical navigation are certain to become an increasingly important aspect of joint arthroplasty, deformity correction, and spinal and trauma surgery. Only the orthopaedic surgeon who clearly understands the goals, applications, and limitations of these systems can decide which are appropriate for his patients, his hospital, and his practice. Determining the cost and time benefits, both before and after an obligatory "learning curve" requires a complex interaction of capital investments, time savings, and outcome research on both safety and efficacy issues. The orthopaedist who understands and applies these technologies will help his patients to achieve the best possible care. Excellent resources in the literature on this topic include the September, 1998, issue of Clinical Orthopaedics and Related Research, a symposium on "Computer-Assisted Orthopaedic Surgery: Medical Robots and Image Guided Surgery"; Guest editor, Anthony M. DiGioia, III, MD. Also, the January, 2000, issue of Operative Techniques in Orthopaedics, "Medical Robotics and Computer-Assisted Orthopaedic Surgery. Guest editors: Anthony M. DiGioia, III, M.D. and Branislav Jaramaz, Ph.D. Additional Internet based information is available from the Journal of Computer Aided Surgery (formerly: Journal of Image Guided Surgery), at http://journals.wiley.com/.

  8. Orthopaedics in the Buddhist kingdom of Bhutan.

    PubMed

    Regan, Elizabeth A; Stein, Robert E

    2002-03-01

    Volunteering as the only orthopaedic surgeon in the small Asian country of Bhutan provided a fascinating introduction to international work. The orthopaedic work predominantly was trauma and osteomyelitis. Treatment of most problems was complicated by patient delays in obtaining medical care, usually related to transportation difficulties in a steep mountainous land with few roads. The complexities of enhancing orthopaedic care in developing countries include patient access to care, availability of adequate sterility for implantation of fixation devices, and determining in concert with the local government what is a sustainable level of care that can be taught to interested physicians in the country. Among the developing nations, Bhutan is one with a strong interest in the welfare of its people and has an economy that can afford to invest in healthcare. Despite these strengths, there remain interesting challenges for the orthopaedic volunteer. Exposure of the volunteer to the people and their culture enhanced the experience and provides a lure to continue volunteering. PMID:11859218

  9. Developing Orthopaedic Trauma Capacity in Uganda: Considerations From the Uganda Sustainable Trauma Orthopaedic Program.

    PubMed

    OʼHara, Nathan N; OʼBrien, Peter J; Blachut, Piotr A

    2015-10-01

    Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia and Makerere University that was initiated in 2007 to reduce the consequences of neglected orthopaedic trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through clinical training, skills workshops, system support, technology development, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anaesthesia, nursing, rehabilitation, and sterile reprocessing. Since the program's inception, the number of trained orthopaedic surgeons practicing in Uganda has more than doubled. Many of these newly trained surgeons provide clinical care in the previously underserved regional hospitals. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda. PMID:26356209

  10. Leadership and business education in orthopaedic residency training programs.

    PubMed

    Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

    2011-01-01

    Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future. PMID:21838073

  11. Leadership and business education in orthopaedic residency training programs.

    PubMed

    Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

    2011-01-01

    Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.

  12. Types of gowns used in trauma and orthopaedic theatres.

    PubMed

    Karagkevrekis, B; Madhavan, P; Leslie, I

    1997-04-01

    Trauma and orthopaedic surgeons are at an increased risk of acquiring viral blood-borne infections during elective and especially trauma surgery. The British Orthopaedic Association (BOA) published guidelines in 1991 for the prevention of cross-infection between patients and staff. It was recommended that only waterproof gowns be used in orthopaedic and trauma theatres. The aim of this study was to determine the compliance with the BOA recommendations. A telephone survey of 79 hospitals in England shows that only a minority (41 per cent) of hospitals use waterproof gowns exclusively.

  13. One hundred years of orthopaedic education in Singapore.

    PubMed

    Wang, W; Lee, E H; Wong, H K

    2005-07-01

    The Department of Orthopaedic Surgery at the University of Malaya (in Singapore) was established in 1952. Prior to this, the teaching of Orthopaedic Surgery at the University was undertaken by the Department of Surgery under the Professor of Surgery and Professor of Clinical Surgery. From a course consisting of 15 weekly classes on fractures for 18 undergraduates in the late 1930s, and the clinical postings in orthopaedic surgery for over 40 students in 1952, the programme now encompasses an exposure to musculoskeletal diseases and trauma in all 5 years of the undergraduate course. Over this time, the spectrum of clinical conditions has also changed, and with it the emphasis on the conditions to be taught; from that dealing primarily with tuberculosis of bones and joints, poliomyelitis, and childhood deformity, to those resulting from degenerative disorders, sports injuries, industrial and motor vehicle accidents, and cancer. The students are now taught orthopaedic surgery in all the major public hospitals. Local postgraduate training programmes for orthopaedic surgery started in the 1980s. From 1993, a more structured training and assessment programme was introduced for basic and advanced training in surgery and orthopaedics. Advanced trainees rotate through the various teaching hospitals to expose them to a wider range of orthopaedic problems as well as teachers. The postgraduate training programme is now well established, and Singapore is accredited by the Royal College of Surgeons of Edinburgh as an orthopaedic training centre for higher surgical training. PMID:16010393

  14. Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case–control study in a Scottish hospital

    PubMed Central

    Dancer, Stephanie J; Christison, Fraser; Eslami, Attaolah; Gregori, Alberto; Miller, Roslyn; Perisamy, Kumar; Robertson, Chris; Graves, Nick

    2016-01-01

    Background With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. Methods We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs. Findings Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened. Conclusions MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits. PMID:27601492

  15. The Orthopaedic Trauma Patient Experience: A Qualitative Case Study of Orthopaedic Trauma Patients in Uganda

    PubMed Central

    O'Hara, Nathan N.; Mugarura, Rodney; Slobogean, Gerard P.; Bouchard, Maryse

    2014-01-01

    The disability adjusted life years (DALYs) associated with injuries have increased by 34% from 1990 to 2010, making it the 10th leading cause of disability worldwide, with most of the burden affecting low-income countries. Although disability from injuries is often preventable, limited access to essential surgical services contributes to these increasing DALY rates. Similar to many other low- and middle-income countries (LMIC), Uganda is plagued by a growing volume of traumatic injuries. The aim of this study is to explore the orthopaedic trauma patient's experience in accessing medical care in Uganda and what affects the injury might have on the socioeconomic status for the patient and their dependents. We also evaluate the factors that impact an individual's ability to access an appropriate treatment facility for their traumatic injury. Semi-structured interviews were conducted with patients 18 year of age or older admitted with a fractured tibia or femur at Mulago National Referral Hospital in Kampala, Uganda. As limited literature exists on the socioeconomic impacts of disability from trauma, we designed a descriptive qualitative case study, using thematic analysis, to extract unique information for which little has been previously been documented. This methodology is subject to less bias than other qualitative methods as it imposes fewer preconceptions. Data analysis of the patient interviews (n = 35) produced over one hundred codes, nine sub-themes and three overarching themes. The three overarching categories revealed by the data were: 1) the importance of social supports; 2) the impact of and on economic resources; and 3) navigating the healthcare system. Limited resources to fund the treatment of orthopaedic trauma patients in Uganda leads to reliance of patients on their friends, family, and hospital connections, and a tremendous economic burden that falls on the patient and their dependents. PMID:25360815

  16. Financial Analysis of National University Hospitals in Korea

    PubMed Central

    Lee, Munjae

    2015-01-01

    Objectives This paper provides information for decision making of the managers and the staff of national university hospitals. Methods In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. Results The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. Conclusion These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry. PMID:26730356

  17. Retractions in orthopaedic research

    PubMed Central

    Yan, J.; MacDonald, A.; Baisi, L-P.; Evaniew, N.; Bhandari, M.

    2016-01-01

    Objectives Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (www.retractionwatch.com). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10

  18. Enhanced recovery after surgery (ERAS): an orthopaedic perspective.

    PubMed

    White, Jonathan J E; Houghton-Clemmey, Robert; Marval, Paul

    2013-10-01

    Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery. PMID:24279038

  19. Database and Registry Research in Orthopaedic Surgery: Part I: Claims-Based Data.

    PubMed

    Pugely, Andrew J; Martin, Christopher T; Harwood, Jared; Ong, Kevin L; Bozic, Kevin J; Callaghan, John J

    2015-08-01

    The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be grossly categorized as either administrative claims or clinical registries. Administrative claims data comprise the billing records associated with the delivery of health-care services. Orthopaedic researchers have used both government and private claims to describe temporal trends, geographic variation, disparities, complications, outcomes, and resource utilization associated with both musculoskeletal disease and treatment. Medicare claims comprise one of the most robust data sets used to perform orthopaedic research, with >45 million beneficiaries. The U.S. government, through the Centers for Medicare & Medicaid Services, often uses these data to drive changes in health policy. Private claims data used in orthopaedic research often comprise more heterogeneous patient demographic samples, but allow longitudinal analysis similar to that offered by Medicare claims. Discharge databases, such as the U.S. National Inpatient Sample, provide a wide national sampling of inpatient hospital stays from all payers and allow analysis of associated adverse events and resource utilization. Administrative claims data benefit from the high patient numbers obtained through a majority of hospitals. Using claims, it is possible to follow patients longitudinally throughout encounters irrespective of the location of the institution delivering health care. Some disadvantages include lack of precision of ICD-9 (International Classification of Diseases, Ninth Revision) coding schemes. Much of these data are expensive to purchase, complicated to organize, and labor-intensive to manipulate--often requiring trained specialists for analysis. Given the changing health-care environment, it is likely that databases will provide valuable information that has the potential to influence clinical practice improvement and health policy for

  20. Complex M&E for new orthopaedic centre.

    PubMed

    Briars, Paul

    2016-03-01

    Paul Briars, North West regional director for independent engineering, IT, and facilities services business, NG Bailey (pictured), discusses the company's part in a major redevelopment at one of the UK's top orthopaedic hospitals, Wrightington Hospital in Lancashire --famous as the site, in the early 1960s, of first ever hip replacement operations, by pioneering surgeon, Professor Sir John Charnley (HEJ --April 2013).

  1. Support for hospital-based HIV testing and counseling: a national survey of hospital marketing executives.

    PubMed Central

    Boscarino, J A; Steiber, S R

    1995-01-01

    Today, hospitals are involved extensively in social marketing and promotional activities. Recently, investigators from the Centers for Disease Control and Prevention (CDC) estimated that routine testing of hospital patients for human immunodeficiency virus (HIV) could identify more than 100,000 patients with previously unrecognized HIV infections. Several issues are assessed in this paper. These include hospital support for voluntary HIV testing and AIDS education and the impact that treating AIDS patients has on the hospital's image. Also tested is the hypothesis that certain hospitals, such as for-profit institutions and those outside the AIDS epicenters, would be less supportive of hospital-based AIDS intervention strategies. To assess these issues, a national random sample of 193 executives in charge of hospital marketing and public relations were surveyed between December 1992 and January 1993. The survey was part of an ongoing annual survey of hospitals and included questions about AIDS, health education, marketing, patient satisfaction, and hospital planning. Altogether, 12.4 percent of executives indicated their hospital had a reputation for treating AIDS patients. Among hospitals without an AIDS reputation, 34.1 percent believed developing one would be harmful to the hospital's image, in contrast to none in hospitals that had such a reputation (chi 2 = 11.676, df = 1, P = .0006). Although 16.6 percent did not know if large-scale HIV testing should be implemented, a near majority (47.7 percent) expressed some support. In addition, 15 percent reported that HIV-positive physicians on the hospital's medical staff should not be allowed to practice medicine, but 32.1 percent indicated that they should.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7638335

  2. Biomaterials in orthopaedics

    PubMed Central

    Navarro, M; Michiardi, A; Castaño, O; Planell, J.A

    2008-01-01

    At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field. PMID:18667387

  3. Orthopaedic Management of Spasticity.

    PubMed

    Pidgeon, Tyler S; Ramirez, Jose M; Schiller, Jonathan R

    2015-12-01

    Spasticity is a common manifestation of many neurological conditions including multiple sclerosis, stroke, cerebral palsy, traumatic brain injury, and spinal cord injuries. Management of spasticity seeks to reduce its burden on patients and to limit secondary complications. Non-operative interventions including stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections may help patients with spasticity. Surgical management of these conditions, however, is often necessary to improve quality of life and prevent complications. Orthopaedic surgeons manage numerous sequelae of spasticity, including joint contractures, hip dislocations, scoliosis, and deformed extremities. When combined with the efforts of rehabilitation specialists, neurologists, and physical/occupational therapists, the orthopaedic management of spasticity can help patients maintain and regain function and independence as well as reduce the risk of long-tem complications. PMID:26623452

  4. Smartphones in orthopaedics.

    PubMed

    Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

    2012-08-01

    With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to immediately complete work-based assessments, in the absence of computers, hopefully increasing completion rates and reliability. Some journals now provide podcasts and video tutorials which may be accessed on smartphones, which is useful for higher examinations. Smartphones can also be used in the clinical setting to take photographs of wounds. Smartphones are enjoying increased uptake and application in the workplace and we review their use for orthopaedic surgeons and trainees to allow them to make the most out of their training opportunities.

  5. Neurology and orthopaedics

    PubMed Central

    Houlden, Henry; Charlton, Paul; Singh, Dishan

    2007-01-01

    Neurology encompasses all aspects of medicine and surgery, but is closer to orthopaedic surgery than many other specialities. Both neurological deficits and bone disorders lead to locomotor system abnormalities, joint complications and limb problems. The main neurological conditions that require the attention of an orthopaedic surgeon are disorders that affect the lower motor neurones. The most common disorders in this group include neuromuscular disorders and traumatic peripheral nerve lesions. Upper motor neurone disorders such as cerebral palsy and stroke are also frequently seen and discussed, as are chronic conditions such as poliomyelitis. The management of these neurological problems is often coordinated in the neurology clinic, and this group, probably more than any other, requires a multidisciplinary team approach. PMID:17308288

  6. Global Musculoskeletal Health: Inaugural Meeting of the International Society of Orthopaedic Centers

    PubMed Central

    Sculco, Thomas P.

    2008-01-01

    The International Society of Orthopaedic Centers (ISOC) was founded in 2006 to function as a think tank for leading international orthopaedic academic centers. ISOC’s mission is to facilitate the exchange of ideas and cutting edge practices among these centers and to work together on patient care, education, and research in order to make global improvements in orthopaedic care. The inaugural meeting, hosted by Hospital for Special Surgery on May 17–19, 2007, is described here. PMID:18958528

  7. Registries in orthopaedics.

    PubMed

    Delaunay, C

    2015-02-01

    The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future. PMID:25553603

  8. A national study of transitional hospital services in mental health.

    PubMed Central

    Dorwart, R A; Hoover, C W

    1994-01-01

    OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. PMID:8059877

  9. Nationwide Databases in Orthopaedic Surgery Research.

    PubMed

    Bohl, Daniel D; Singh, Kern; Grauer, Jonathan N

    2016-10-01

    The use of nationwide databases to conduct orthopaedic research has expanded markedly in recent years. Nationwide databases offer large sample sizes, sampling of patients who are representative of the country as a whole, and data that enable investigation of trends over time. The most common use of nationwide databases is to study the occurrence of postoperative adverse events. Other uses include the analysis of costs and the investigation of critical hospital metrics, such as length of stay and readmission rates. Although nationwide databases are powerful research tools, readers should be aware of the differences between them and their limitations. These include variations and potential inaccuracies in data collection, imperfections in patient sampling, insufficient postoperative follow-up, and lack of orthopaedic-specific outcomes. PMID:27579813

  10. Seoul National University Bundang Hospital's Electronic System for Total Care

    PubMed Central

    Yoo, Sooyoung; Lee, Kee Hyuck; Lee, Hak Jong; Ha, Kyooseob; Lim, Cheong; Chin, Ho Jun; Yun, Jonghoar; Cho, Eun-Young; Chung, Eunja; Baek, Rong-Min; Chung, Chin Youb; Wee, Won Ryang; Lee, Chul Hee; Lee, Hai-Seok; Byeon, Nam-Soo

    2012-01-01

    Objectives Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS). Methods SNUBH opened in 2003 as a fully digital hospital by successfully launching a new HIS named BESTCare, "Bundang hospital Electronic System for Total Care". Subsequently, the system has been continuously improved with new applications, including close-loop medication administration (CLMA), clinical data warehouse (CDW), health information exchange (HIE), and disaster recovery (DR), which have resulted in the achievement of Stage 7 status. Results The BESTCare system is an integrated system for a university hospital setting. BESTCare is mainly composed of three application domains: the core applications, an information infrastructure, and channel domains. The most critical and unique applications of the system, such as the electronic medical record (EMR), computerized physician order entry (CPOE), clinical decision support system (CDSS), CLMA, CDW, HIE, and DR applications, are described in detail. Conclusions Beyond our achievement of Stage 7 hospital status, we are currently developing a next-generation HIS with new goals of implementing infrastructure that is flexible and innovative, implementing a patient-centered system, and strengthening the IT capability to maximize the hospital value. PMID:22844650

  11. Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

    ERIC Educational Resources Information Center

    Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

    2011-01-01

    We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…

  12. Rural hospitals' experience with the National Practitioner Data Bank.

    PubMed Central

    Neighbor, W E; Baldwin, L M; West, P A; Hart, L G

    1997-01-01

    OBJECTIVES: This study examined hospital administrators' experiences with the National Practitioner Data Bank. METHODS: One hundred forty-nine rural hospital administrators completed questionnaires assessing their perceptions of the data bank. RESULTS: Nearly 90% of respondents rated the data bank as an important source of information for credentialing. Three percent indicated it had directly affected privileging decisions; 43% and 34%, respectively, believed the costs exceeded or equaled the benefits. Twenty percent reported changes that could decrease disciplinary action reports to the data bank. CONCLUSIONS: While the National Practitioner Data Bank is an important source of information to rural hospitals, it may, affect few credentialing decisions and motivate behavioral changes that could have a paradoxical effect on quality assurance. Images FIGURE 1 PMID:9146450

  13. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  14. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  15. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  16. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  17. ASHP national survey of pharmaceutical services in federal hospitals--1993.

    PubMed

    Crawford, S Y; Santell, J P

    1994-10-01

    The results of a national mail survey of pharmaceutical services in federal hospitals conducted by ASHP from May to July 1993 are reported. Mailing lists were compiled of all Air Force, Army, Navy, Public Health Service, and Department of Veterans Affairs (VA) hospitals, as well as some federal prison hospitals. Questionnaires were mailed to each chief of pharmacy. The adjusted gross population size was 326. The net response rate was 76%. Complete unit dose drug distribution was offered by 85% of respondents, and 83% offered complete, comprehensive i.v. admixture programs. About half of the pharmacies provided decentralized services. Over 99% provided services to ambulatory care patients. A computerized pharmacy system was present in 99% of the departments. More than 95% of hospitals participated in adverse drug reaction, medication error management, and drug-use-evaluation programs. A total of 93% provided drug therapy monitoring, and 89% provided patient education. About 70% provided written documentation of pharmacist interventions in the medical records, and 57% participated in drug research. A total of 42% provided pharmacist-managed drug clinics, 41% participated in drug management of medical emergencies, 30% provided written medication histories, and 30% provided drug therapy management planning. Pharmacokinetic consultations were provided by 64% of departments. About 90% had a well-controlled formulary system and prescribing restrictions. Therapeutic interchange was practiced by 64%. Diversified pharmaceutical services included telephone or mail-in refill services (80%), mail-out pharmaceutical services (58%), and services to long-term-care facilities (49%). A total of 70% of the hospitals were affiliated with a pharmacy school. The first ASHP national survey of pharmaceutical services in federal hospitals showed that comprehensive distributive and clinical services were offered by most of the facilities. PMID:7847403

  18. Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

    PubMed Central

    2012-01-01

    Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher

  19. Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.

    PubMed

    Veney, Amy J

    2013-01-01

    Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care. PMID:24247310

  20. Cost of Hospitalization and Length of Stay in People with Down Syndrome: Evidence from a National Hospital Discharge Claims Database

    ERIC Educational Resources Information Center

    Hung, Wen-Jiu; Lin, Lan-Ping; Wu, Chia-Ling; Lin, Jin-Ding

    2011-01-01

    The present paper aims to describe the hospitalization profiles which include medical expenses and length of stays, and to determine their possible influencing factors of hospital admission on persons with Down syndrome in Taiwan. We employed a population-based, retrospective analyses used national health insurance hospital discharge data of the…

  1. Reno Orthopaedic Trauma Fellowship business curriculum.

    PubMed

    Althausen, Peter L; Bray, Timothy J; Hill, Austin D

    2014-07-01

    The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a

  2. Reno Orthopaedic Trauma Fellowship business curriculum.

    PubMed

    Althausen, Peter L; Bray, Timothy J; Hill, Austin D

    2014-07-01

    The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a

  3. American Academy of Orthopaedic Surgeons

    MedlinePlus

    ... Portfolio Examination & ResStudy Center Education by Area of Interest Adult Reconstruction Foot and Ankle Hand and Wrist ... October, 2016 Volume 24, Number 11 Item Response Theory and Computerized Adaptive Testing for Orthopaedic Outcomes Measures ...

  4. Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network 'PREZIES'.

    PubMed

    Muilwijk, J; Walenkamp, G H I M; Voss, A; Wille, J C; van den Hof, S

    2006-03-01

    In the Dutch surveillance for surgical site infections (SSIs), data from 70277 orthopaedic procedures with 1895 SSIs were collected between 1996 and 2003. The aims of this study were: (1) to analyse the trends in SSIs associated with Gram-positive and Gram-negative bacteria; (2) to estimate patient-related risk factors for deep and superficial SSIs after all orthopaedic procedures, with special attention to primary total hip arthroplasty (THA); and (3) to analyse inherent differences in infection risk between hospitals. A random effect model was used to estimate the odds ratios of patient-related risk factors for developing an SSI, and to describe the distribution of the most widespread bacterial species responsible for SSIs among hospitals. Gram-positive organisms, mainly staphylococci, were the main cause of both deep (84.0%) and superficial SSIs (69.1%) after orthopaedic procedures. The percentage of SSIs after THA caused by coagulase-negative staphylococci decreased over the surveillance period, while the contribution of Staphylococcus aureus increased. Temporary elevations in the incidence of the most widespread pathogen species were observed within hospitals. Patient-related factors such as the National Nosocomial Infections Surveillance System risk index or age had little effect on the predictive power of the random effect models. This study underlines the usefulness of a random effect model, which adjusts risk estimates for random variation between hospitals, in a multicentre study on risk factors for SSIs.

  5. Sexual abuse of children as seen at Kenyatta National Hospital.

    PubMed

    Nduati, R W; Muita, J W

    1992-07-01

    A retrospective study of 21 sexually abused children admitted to the Kenyatta National Hospital, Nairobi, Kenya, between January 1984 and December 1985 is presented. The peak incidence of sexual abuse was in the age group of 10-15 years (38.1%) followed by the 5-9 years age group (28.6%). Strangers and people familiar to the child were equally implicated as assailants. Fourteen out of the twenty one (66.7%) victims, presented with injuries ranging from perineal tears (19%), vaginal tears (19%), recto-vaginal fistulae (RVP) (4.8%) and vesico-vaginal-fistulae (VVF) and abdominal haematoma (4.8%). The victims presented to hospital within two days of the event usually accompanied by their mothers.

  6. Incapacity for work in elective orthopaedic surgery: a study of occurrence and the probability of returning to work after treatment.

    PubMed Central

    Rossvoll, I; Benum, P; Bredland, T R; Solstad, K; Arntzen, E; Jørgensen, S

    1993-01-01

    STUDY OBJECTIVE--The extent to which patients undergoing elective surgery for orthopaedic disorders were incapacitated for work while they were on the waiting list and whether they were able to return to work after surgery were studied. DESIGN--This was a prospective cohort study of patients admitted to hospital for elective orthopaedic surgery. Main outcome measures were occurrence of sickness certification during the waiting time, and whether those incapacitated for work at the time of surgery returned to work during the first year after treatment. Multivariate logistic regression was used to estimate adjusted odds ratios for factors influencing return to work. SETTING--Orthopaedic department in charge of all elective orthopaedic surgery in a population of 197,354 persons in central Norway. SUBJECTS--All 2803 patients admitted to hospital for chronic orthopaedic disorders in the defined population between 1 September 1988 and 31 August 1990 were included in the study. MAIN RESULTS--Of the 1333 patients who were employed, 42% had been certified sick due to the orthopaedic disorder for some period of the waiting time. Sickness benefits from the national insurance scheme (paid from the 15th day of sickness certification) had been received by 33% and were received by 29% at the time of surgery. Of 380 patients incapacitated for work at the time of surgery, 53% returned to work within the first year after surgery. Using those treated within one month of being placed on the waiting list as the reference group, the adjusted odds ratios for not returning to work during the first year after surgery were 9.2 (p < 0.0001) for those who waited more than a year for surgery, 6.2 (p = 0.002) for those waiting nine to 12 months, and 4.9 (p = 0.02) for those waiting for six to nine months. CONCLUSIONS--A high proportion of these patients were incapacitated for work, 53% of those incapacitated returned to work within the first year after surgery. The probability of returning to

  7. Find an Orthopaedic Foot and Ankle MD/DO

    MedlinePlus

    ... AOFAS / FootCareMD / Find a Surgeon Find an Orthopaedic Foot & Ankle Surgeon Page Content The Orthopaedic Distinction Who are Orthopaedic Foot & Ankle Surgeons? Orthopaedic foot and ankle surgeons are ...

  8. Orthopaedic surgeons in Yorkshire--are we ATLS positive?

    PubMed Central

    Kelley, S. P.; McMurray, D. H. M.; Hinsche, A. F.; Deacon, P.

    2005-01-01

    INTRODUCTION: In 1993, the Major Trauma Working Group of Yorkshire proposed that hospitals should be accredited as Trauma Reception Hospitals with a policy for the response to the arrival of a trauma patient. These requirements include specific criteria for orthopaedics. METHODS: To evaluate if these criteria are being fulfilled, we carried out an audit comparing the response in the hospitals within the Yorkshire deanery to the arrival of major trauma. All consultant and middle-grade orthopaedic surgeons on call for trauma were contacted and questioned as to their ATLS provider status and involvement in the "trauma call". RESULTS: 16 hospitals were included of which 13 have a "trauma team". 191 surgeons (96% response) were included. 175 have completed an ATLS course. Of these, 72 (41%) had out-of-date qualifications. Only 9 (13%) were waiting to revalidate. Variation was seen in the frequency of accident and emergency department attendance by different grades of surgeon for major trauma. DISCUSSION: All hospitals have a response for major trauma although variations occur. The vast majority of orthopaedic surgeons in Yorkshire have been adequately trained in ATLS management (more so than any study has previously shown), particularly the middle grades, who are usually first to attend. The level of revalidation is low and reasons for this are discussed with recommendations for revalidation in the future. PMID:15720907

  9. New Integrated Information System for Pusan National University Hospital

    PubMed Central

    Kim, Hyung Hoi; Cho, Kyung-Won; Kim, Hye Sook; Kim, Ju-Sim; Kim, Jung Hyun; Han, Sang Pil; Park, Chun Bok; Kim, Seok

    2011-01-01

    Objectives This study presents the information system for Pusan National University Hospital (PNUH), evaluates its performance qualitatively, and conducts economic analysis. Methods Information system for PNUH was designed by component-based development and developed by internet technologies. Order Communication System, Electronic Medical Record, and Clinical Decision Support System were newly developed. The performance of the hospital information system was qualitatively evaluated based on the performance reference model in order to identify problem areas for the old system. The Information Economics approach was used to analyze the economic feasibility of hospital information system in order to account for the intangible benefits. Results Average performance scores were 3.16 for input layer, 3.35 for process layer, and 3.57 for business layer. In addition, the cumulative benefit to cost ratio was 0.50 in 2011, 1.73 in 2012, 1.76 in 2013, 1.71 in 2014, and 1.71 in 2015. The B/C ratios steadily increase as value items are added. Conclusions While overall performance scores were reasonably high, doctors were less satisfied with the system, perhaps due to the weak clinical function in the systems. The information economics analysis demonstrated the economic profitability of the information systems if all intangible benefits were included. The second qualitative evaluation survey and economic analysis were proposed to evaluate the changes in performance of the new system. PMID:21818459

  10. Robotic systems in orthopaedic surgery.

    PubMed

    Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H

    2011-10-01

    Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies.

  11. Robotic systems in orthopaedic surgery.

    PubMed

    Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H

    2011-10-01

    Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies. PMID:21969424

  12. [Representatives of orthopaedic and trauma surgery residents in Germany].

    PubMed

    Merschin, D; Doepfer, A-K; Wenzel, L; Mutschler, M

    2016-08-01

    In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position.The Junges Forum O&U presents survey data, which were collected from members of the German Society for Trauma Surgery (DGU), the German Society for Orthopaedics and Orthpaedic Surgery (DGOOC) and the German Society for Orthopaedics and Trauma (DGOU). All had an age below 40 years. The Survey was carried out in a period between 27th of January 2015 and 26th of March 2015.These data allowed the Junges Forum O&U to analyse the duties and numbers of representatives for residents in orthopaedic and trauma surgery in Germany. Questionnaires from 316 representatives were fully analysed. Of these, 92 % work at university hospitals. The conditions of election and the duties are not defined. The activity as representative was mainly fulfilled in spare time. The major aspect was conflict resolution between colleagues.The Junge Forum O&U presents the recommendation for election, field of duty and meetings on a regular basis with the other residents or even the first-line management. PMID:27277936

  13. Few Hospital Palliative Care Programs Meet National Staffing Recommendations.

    PubMed

    Spetz, Joanne; Dudley, Nancy; Trupin, Laura; Rogers, Maggie; Meier, Diane E; Dumanovsky, Tamara

    2016-09-01

    The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed. PMID:27605652

  14. Few Hospital Palliative Care Programs Meet National Staffing Recommendations.

    PubMed

    Spetz, Joanne; Dudley, Nancy; Trupin, Laura; Rogers, Maggie; Meier, Diane E; Dumanovsky, Tamara

    2016-09-01

    The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.

  15. Evolution of acute orthopaedic care.

    PubMed

    Mamczak, Christiaan N; Born, Christopher T; Obremskey, William T; Dromsky, David M

    2012-01-01

    Current combat battlefield injuries are among the most complex and challenging orthopaedic cases. These injuries carry high risks for exsanguination and global contamination of extensive soft-tissue and complicated bony injuries. Military orthopaedic surgeons must employ the latest advances in acute combat casualty care to achieve favorable outcomes. Adaptive changes over the past 10 years of war have given today's surgeons the armamentarium to optimize patient care. Innovative methods of damage control resuscitation and surgery have led to increased survival. However, the fundamentals of surgical hemostasis and decontamination remain critical to successful management. The acute treatment of combat casualties involves a continuum of care from the point of injury through transport out of theater. Future research and education are paramount to better prepare military orthopaedic surgeons to further increase survivability and enhance the outcomes of service members with complex wounds.

  16. Orthopaedic service lines-revisited.

    PubMed

    Patterson, Cheryl

    2008-01-01

    This article revisits the application of orthopaedic service lines from early introduction and growth of this organizational approach in the 1980s, through the 1990s, and into the current decade. The author has experienced and worked in various service-line structures through these three decades, as well as the preservice-line era of 1970s orthopaedics. Past lessons learned during earlier phases and then current trends and analysis by industry experts are summarized briefly, with indication given of the future for service lines. Variation versus consistency of certain elements in service-line definitions and in operational models is discussed. Main components of service-line structures and typical processes are described briefly, along with a more detailed section on the service-line director/manager role. Current knowledge contained here will help guide the reader to more "out-of-the-box" thinking toward comprehensive orthopaedic centers of excellence.

  17. Orthopaedic Injuries in Equestrian Sports

    PubMed Central

    Young, Jason David; Gelbs, Jared Craig; Zhu, David Shiyu; Gallacher, Stacey Elisa; Sutton, Karen Michelle; Blaine, Theodore Alton

    2015-01-01

    Background: Despite the common nature of orthopaedic injuries in equestrian sports, there is no published review to specifically characterize orthopaedic injuries in equestrian athletes. Purpose: To characterize orthopaedic injury patterns in equine sports–related injuries and their treatment. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed through a PubMed, EMBASE, and Scopus query (from 1978 to June 2014) in the English literature using search terms “(equine-related OR equestrian-related OR horse-related OR equestrian OR equestrians) AND (injury OR injuries).” Only full-text studies reporting on orthopaedic injury patterns pertinent to equestrian sports in the United States (US) and the United Kingdom (UK) were included. Orthopaedic injuries were defined as those resulting in a fracture or dislocation. In all, 182 studies were excluded, leaving a total of 27 studies for evaluation. The studies included were analyzed for demographic and epidemiological data for orthopaedic injuries, including fractures and dislocations. Cranial and facial injuries were excluded from analysis. Results: The majority of those injured in the US were female (64.5%). The leading cause of injury in the US was falling from a horse. The use of protective equipment seemed to vary widely, with helmet use ranging from less than 6% up to 66.7%. In the UK, fractures were found to account for 17.4% of reported injures, compared with 33.6% of injuries in the US. The majority of fractures in US riders occurred in the upper extremities (50.7%). Conclusion: This review helps characterize the epidemiology of equestrian injuries based on currently available data. PMID:26535400

  18. Social Media and Orthopaedics: Opportunities and Challenges.

    PubMed

    Suryavanshi, Tanishq; Geier, C David; Leland, J Martin; Silverman, Lance; Duggal, Naven

    2016-01-01

    Social media presents unique opportunities and challenges for practicing orthopaedic surgeons. Social media, such as blogging, Facebook, and Twitter, provides orthopaedic surgeons with a new and innovative way to communicate with patients and colleagues. Social media may be a way for orthopaedic surgeons to enhance communication with patients and healthcare populations; however, orthopaedic surgeons must recognize the limitations of social media and the pitfalls of increased connectedness in patient care.

  19. Social Media and Orthopaedics: Opportunities and Challenges.

    PubMed

    Suryavanshi, Tanishq; Geier, C David; Leland, J Martin; Silverman, Lance; Duggal, Naven

    2016-01-01

    Social media presents unique opportunities and challenges for practicing orthopaedic surgeons. Social media, such as blogging, Facebook, and Twitter, provides orthopaedic surgeons with a new and innovative way to communicate with patients and colleagues. Social media may be a way for orthopaedic surgeons to enhance communication with patients and healthcare populations; however, orthopaedic surgeons must recognize the limitations of social media and the pitfalls of increased connectedness in patient care. PMID:27049230

  20. Novel Strategies for the Diagnosis of Posttraumatic Infections in Orthopaedic Trauma Patients.

    PubMed

    Firoozabadi, Reza; Alton, Timothy; Wenke, Joseph

    2015-07-01

    Orthopaedic infections that occur after trauma are common. Clinical examination, laboratory markers, imaging modalities, and culture and molecular technologies are used to aid the diagnosis of infection. Culture methods comprise the backbone of diagnostic systems used in hospital laboratory settings; however, several studies have questioned the ability of these techniques to adequately identify infections, particularly in cases where orthopaedic implants were used or when the presence of biofilm bacteria is suspected. Advances in imaging and molecular diagnostics can provide orthopaedic surgeons with an improved means of diagnosing and treating infections.

  1. Trends in Inpatient Hospital Deaths: National Hospital Discharge Survey, 2000-2010

    MedlinePlus

    ... Has the inpatient hospital death rate decreased for all patients and for those with selected first-listed ... 2010 differ from the length of stay for all hospitalizations? Inpatients who died in the hospital stayed ...

  2. Step up in orthopaedic care for Stockport Trust.

    PubMed

    Baillie, Jonathan

    2009-04-01

    Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports. PMID:19452799

  3. Prophylactic antibiotics in orthopaedic surgery.

    PubMed

    Prokuski, Laura; Clyburn, Terry A; Evans, Richard P; Moucha, Calin S

    2011-01-01

    The use of prophylactic antibiotics in orthopaedic surgery has been proven effective in reducing surgical site infections after hip and knee arthroplasty, spine procedures, and open reduction and internal fixation of fractures. To maximize the beneficial effect of prophylactic antibiotics, while minimizing any adverse effects, the correct antimicrobial agent must be selected, the drug must be administered just before incision, and the duration of administration should not exceed 24 hours.

  4. Planning for life after orthopaedics.

    PubMed

    Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

    2014-01-01

    The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics.

  5. Review of orthopaedic manipulator arms.

    PubMed

    Hurst, K S; Phillips, R; Viant, W J; Mohsen, A M; Sherman, K P; Bielby, M

    1998-01-01

    Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.

  6. The American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Associations/Pediatric Orthopaedic Association Disaster Response and Preparedness Course.

    PubMed

    Johnson, Anthony E; Gerlinger, Tad L; Born, Christopher T

    2015-10-01

    A disaster is a catastrophic event that disrupts normal infrastructure to such a degree that normal response mechanisms and capabilities cannot manage what is required to respond appropriately to the event. Launched after the largest urban disaster in modern history--the 2010 Haiti Earthquake--the American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Association/Pediatric Orthopaedic Association of North America (AAOS/SOMOS/OTA/POSNA) Disaster Response Course (DRC) is designed to prepare orthopaedic surgeons for service in disaster response and humanitarian assistance efforts in both the acute phases as well as in the recovery and reconstructions phases. To date, 395 orthopaedic surgeons have completed the DRC and 286 (72.4%) have opted to become registered disaster responders.

  7. Performance Analysis of Hospital Information System of the National Health Insurance Corporation Ilsan Hospital

    PubMed Central

    Han, Jung Mi; Boo, Eun Hee; Kim, Jung A; Yoon, Soo Jin; Kim, Seong Woo

    2012-01-01

    Objectives This study evaluated the qualitative and quantitative performances of the newly developed information system which was implemented on November 4, 2011 at the National Health Insurance Corporation Ilsan Hospital. Methods Registration waiting time and changes in the satisfaction scores for the key performance indicators (KPI) before and after the introduction of the system were compared; and the economic effects of the system were analyzed by using the information economics approach. Results After the introduction of the system, the waiting time for registration was reduced by 20%, and the waiting time at the internal medicine department was reduced by 15%. The benefit-to-cost ratio was increased to 1.34 when all intangible benefits were included in the economic analysis. Conclusions The economic impact and target satisfaction rates increased due to the introduction of the new system. The results were proven by the quantitative and qualitative analyses carried out in this study. This study was conducted only seven months after the introduction of the system. As such, a follow-up study should be carried out in the future when the system stabilizes. PMID:23115744

  8. Orthopaedic inpatient rehabilitation conducted by nursing staff in acute orthopaedic wards in Taiwan.

    PubMed

    Lin, Pi-Chu; Wang, Ching-Hui; Liu, Yo-Yi; Chen, Chyang-Shiong

    2013-12-01

    The purpose of this study was to understand the postoperative rehabilitation patterns of orthopaedic patients and to explore factors which affected the patients' functional recovery. A descriptive study with convenience sampling was performed. Study participants included orthopaedic inpatients from two hospitals in Taipei. In total, 100 patients were selected with an average age of 60.88 ± 17.61 years, of which the most common type of surgery was a total knee replacement (49.0%). Among these participants, 79.0% received rehabilitation guided by nursing staff, while only 6.0% were instructed by a physical therapist. The predictive factor for the time to first ambulation was the intensity of pain experienced on the second day after the operation, which accounted for 4.5% of the total variance. As for the functional status prior to discharge, predictive factors included the time to first ambulation and whether nursing staff provided instructions on rehabilitation, which accounted for 11.2% of the total variance. We recommend that professional staff should promote patient guidance toward postoperative rehabilitation, assistance in achieving the first ambulation and a resolution of obstacles to rehabilitation.

  9. American Orthopaedic Society for Sports Medicine

    MedlinePlus

    ... Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal of Sports Medicine Journal Apps Sports Medicine Update Other Professional ...

  10. Hospital-Sponsored Child Care: A 1988 National Survey.

    ERIC Educational Resources Information Center

    American Coll. of Healthcare Executives, Chicago, IL.

    A representative sample of 965 U.S. hospitals was surveyed for the purpose of obtaining information about: (1) current and projected involvement in provision of child care services to employees and their communities; and (2) hospitals' views of the costs and benefits of offering child care services, and of appropriate governmental policies.…

  11. Safety net hospital performance on national quality of care process measures.

    PubMed

    Marshall, Lindsey; Harbin, Vanessa; Hooker, Jane; Oswald, John; Cummings, Linda

    2012-01-01

    Several studies have found poor or mixed performance by safety net hospitals on national measures of quality. The study's purposes were to determine whether safety net hospital performance is similar to the average U.S. hospital, both currently and during earlier reporting periods, and to summarize features commonly used to assess performance, including definition of safety net and patient characteristics. This study reviewed quality performance data for the Joint Commission's accountability measures for hospitals that are members of the National Association of Public Hospitals and Health Systems (NAPH)-safety net hospitals that serve a large proportion of Medicaid and uninsured patients. Analyses of quality performance on the earliest data show that on average there was no statistically significant difference in performance between NAPH members and other hospitals on 6 of 15 measures. According to the most recent data, NAPH hospitals on average had no statistically significant differences as other hospitals on 13 of 18 measures and had statistically significantly better scores on two measures. These results are an important addition to the literature regarding safety net hospitals that serve a high proportion of Medicaid, low income, and uninsured patients, and support the case that quality of care at safety net hospitals is equivalent to that of non-safety net hospitals.

  12. Essentials of disaster management: the role of the orthopaedic surgeon.

    PubMed

    Born, Christopher T; Monchik, Keith O; Hayda, Roman A; Bosse, Michael J; Pollak, Andrew N

    2011-01-01

    Disaster preparedness and management education is essential for allowing orthopaedic surgeons to play a valuable, constructive role in responding to disasters. The National Incident Management System, as part of the National Response Framework, provides coordination between all levels of government and uses the Incident Command System as its unified command structure. An "all-hazards" approach to disasters, whether natural, man-made, intentional, or unintentional, is fundamental to disaster planning. To respond to any disaster, command and control must be established, and emergency management must be integrated with public health and medical care. In the face of increasing acts of terrorism, an understanding of blast injury pathophysiology allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents and their attendant clinical symptoms is also prerequisite. Credentialing and coordination between designated organizations and the federal government are essential to allow civilian orthopaedic surgeons to access systems capable of disaster response. PMID:21553757

  13. Current problems in national hospitals of Phnom Penh: finance and health care.

    PubMed

    Uy, Sophoat; Akashi, Hidechika; Taki, Kazumi; Ito, Katsuki

    2007-01-01

    The current problems in Cambodia's national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital finances, and other related issues in five national hospitals in Phnom Penh, using annual reports of the five hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of five hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the five hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not significant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coefficient 0.70, p = 0.188). This study showed the differences in the hospital indicators among five national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance. PMID:17378183

  14. The case for orthopaedic medicine in Israel

    PubMed Central

    2013-01-01

    Background Musculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons. But in Israel, there is significant ambivalence with various aspects of the consultations provided by orthopaedic surgeons, both among the public and among various groups of clinicians, particularly family practitioners and physiotherapists. Methods In order to understand this problem we integrate new data we have collected with previously published data. New data include the rates of visits to orthopaedic surgeons per annum in one of Israel’s large non-profit HMO’s, and the domains of the visits to an orthopaedic surgeon. Results Orthopaedic surgeons are the third most frequently contracted secondary specialists in one of the Israeli HMO’s. Between 2009 and 2012 there was a 1.7% increase in visits to orthopaedists per annum (P < 0.0001, after correction for population growth). Almost 80% of the domains of the problems presented to an orthopaedic surgeon were in fields orthopaedic surgeons have limited formal training. Discussion While orthopaedic surgeons are clearly the authority on surgical problems of the musculoskeletal system, most musculoskeletal problems are not surgical, and the orthopaedic surgeon often lacks training in these areas which might be termed orthopaedic medicine. Furthermore, in Israel and in many other developed countries there is no accessible medical specialty that studies these problems, trains medical students in the subject and focuses on treating these problems. The neglect of this area which can be called the “Orthopaedic Medicine Lacuna” is responsible for inadequate treatment of non-surgical problems of the

  15. Is anybody managing the store? National trends in hospital performance.

    PubMed

    Griffith, John R; Pattullo, Andrew; Alexander, Jeffrey A; Jelinek, Richard C; Foster, David A

    2006-01-01

    Nine standardized measures compiled from Medicare data show trends in the safety, quality, financial management, and efficiency for more than 2,500 community hospitals over five years ending in 2003. Although much public attention has been given to hospital performance, along with exhortations to improve, few measures show substantial positive trends, either in variance reduction or overall improvement. The authors conclude that environmental forces are not stimulating improvement and that the overall picture is one of randomness rather than management. PMID:17184003

  16. Abortion a business hurdle for nation's Catholic hospitals.

    PubMed

    Burda, D

    1989-08-25

    Abortion is the foremost moral issue for 626 Catholic hospitals nationwide since church teachings prohibit the performance of elective abortions. This and the fact that Catholic hospitals can not do voluntary sterilizations can hinder their ability to get managed care contracts. In some cases a hospital will not join a network because abortions and sterilizations are done in other hospitals in the network. In other cases they have been in plans where abortions are performed in other contract facilities; this does not violate the Catholic church policy since the abortions are not performed in their facility. When a Catholic and secular hospital plan a merger, Catholic ideals seem to take precedence. A Catholic hospital that went bankrupt in Philadelphia, was turned over to investors, and was under no obligation to follow the Catholic church's directives, but did not perform abortions anyway. In Washington state there are merger talks going on between a secular facility and the Franciscan Health System. The cessation of abortion and sterilization services appear to be outweighed by the financial benefits. Besides, these procedures can be performed through other providers in the area. In Michigan similar merger talks may fail because of the abortion issue. The government justice system is investigating and is likely to challenge any merger there.

  17. Orthopaedic research and education foundation and industry.

    PubMed

    Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M

    2003-07-01

    Members of orthopaedic industry commit a significant amount of funds each year to support research and education programs that are directly related to their product(s). In addition, industry supports organizations such as the Orthopaedic Research and Education Foundation. The relationship between the Orthopaedic Research and Education Foundation and industry began in the early 1980s. The support to the Orthopaedic Research and Education Foundation from industry primarily has come in the form of unrestricted grants. These grants best can be looked at as an investment rather than a contribution. This form of giving, once called corporate philanthropy is more accurately referred to as strategic philanthropy. Members of industry make these investments to enhance their reputations, build brand awareness, market their products and services, improve employee morale, increase customer loyalty, and establish strategic alliances. The specialty of orthopaedics is among the leaders in medicine in the amount of funding raised within the specialty for research and education programs. This is because of the amount of support from members of industry and the surgeons. During the past 15 years, 40% of the annual support to the Orthopaedic Research and Education Foundation has come from industry and the balance has come from surgeons and members of lay public. Future industry support of the Orthopaedic Research and Education Foundation and other organizations within the specialty of orthopaedics will be dependent on the continued demonstration of tangible returns in areas described. PMID:12838052

  18. 45 CFR 60.12 - Information which hospitals must request from the National Practitioner Data Bank.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Disclosure of Information by the National Practitioner Data Bank § 60.12 Information which hospitals must request from the National Practitioner Data Bank. (a) When information...

  19. [Orthopaedic footwear against foot ulcers in diabetes].

    PubMed

    Bus, Sicco A

    2014-01-01

    In people with diabetes mellitus, foot ulcers are a major problem because they increase the risk of a foot infection and amputation and reduce quality of life. After a foot ulcer has healed, the risk of recurrence is high. Orthopaedic shoes and orthotics are often prescribed to high risk patients and aim to reduce the mechanical pressure on the plantar surface of the foot. Orthopaedic footwear that is modified to reduce pressure is not much more effective in preventing foot ulcer recurrence than orthopaedic footwear that did not undergo such modification, unless the shoes are worn as recommended. In that case, the risk of ulcer recurrence is reduced by 46%. In patients with a history of ulceration, compliance in wearing orthopaedic shoes at home is low, while these patients walk more inside the house than outside the house. Foot pressure measurements should be part of the prescription and evaluation of orthopaedic footwear for patients at high risk for foot ulceration.

  20. Incidence of surgical site infections and accompanying risk factors in Vietnamese orthopaedic patients.

    PubMed

    Thu, L T A; Dibley, M J; Ewald, B; Tien, N P; Lam, L D

    2005-08-01

    A cohort study of surgical site infections (SSIs) was conducted in 582 orthopaedic surgical patients at Cho Ray Hospital, a reference hospital in Ho Chi Minh City, Vietnam, in order to determine the incidence and analyse risk factors for SSIs in this population. The SSI incidence rate was 12.5% (73 of 582); 3.6% incisional SSIs, 6.8% deep incisional SSIs and 2.1% organ/space SSIs. The incidence increased from 2% in clean wounds to 44.6% in dirty wounds, or 1.3% in patients with a National Nosocomial Infections Surveillance (NNIS) risk index of 0 to 75% in patients with an NNIS risk ratio of 3. In multi-variate analysis, having a dirty wound [odds ratio (OR) 8.7; 95% confidence intervals (CI) 4.6--16.4], American Society of Anesthesiologists' score >2 (OR 3.9; 95%CI 1.8-8.8), procedures with external fixation (OR 2.9; 95%CI 1.4-5.9), emergency surgery with motor-vehicle-related trauma (OR 2.1; 95%CI 1.2-3.9), or duration of procedure >2h (OR 2.1; 95%CI 1.1-4.2) were independent risk factors for SSI. Lack of appropriate prophylaxis was of borderline significance (OR 3.2; 95%CI 0.9-11.1, P=0.06). Among 76 patients with SSIs, 22 patients were discovered during postdischarge follow-up. These late SSIs had age as an additional risk factor (OR 2.8; 95%CI 1.1-7.2). Our data show that SSIs were frequent and differed widely by wound class. The NNIS risk index was predictive of SSI for this population. With a high number of motor vehicle accidents in Vietnam, the majority of orthopaedic operations are trauma related. Emergency surgery for injuries sustained in these accidents, and procedures with external fixation were especially prone to infections.

  1. The First World War and its influence on the development of orthopaedic surgery.

    PubMed

    Scotland, T

    2014-01-01

    By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.

  2. The impact of snow on orthopaedic trauma referrals.

    PubMed

    Weston-Simons, John; Jack, Christopher M; Doctor, Cyrus; Brogan, Kit; Reed, Daniel; Ricketts, David

    2012-07-01

    Adverse weather has been shown to increase orthopaedic referrals and place strain on services. This retrospective study undertaken at a teaching hospital concerned referrals between April 2009 and April 2010 comparing days when snow fell to days when it did not. Referrals increased significantly on snow days (to 74.9 per day) in comparison to normal weather days (33.5 per day). During snow days there were significant increases in the number of distal radius and ankle fractures referred but not of fractured necks of femur. Complications during the snow fall period were related to procedures performed outside of the trauma unit with further difficulties related to a lack of operating equipment and implant availability. As a result of our study, we recommend that during periods of heavy snow fall orthopaedic and trauma units should place senior orthopaedic trainees in Accident and Emergency to review patients as a triage service, organise trauma lists related to surgeon specific expertise and avoid sending trauma patients outside the unit for operation.

  3. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

    PubMed

    Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

    2016-10-01

    The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. PMID:27601396

  4. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

    PubMed

    Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

    2016-10-01

    The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods.

  5. Quality measurement in orthopaedics: the purchasers' view.

    PubMed

    Lansky, David; Milstein, Arnold

    2009-10-01

    While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability. PMID:19641973

  6. Using PubMed effectively to access the orthopaedic literature.

    PubMed

    Clough, J F Myles; Hitchcock, Kristin; Nelson, David L

    2011-01-01

    PubMed is the free public Internet interface to the US National Library of Medicine's MEDLINE database of citations to medical scientific articles. Many orthopaedic surgeons use PubMed on a regular basis, but most orthopaedic surgeons have received little or no training in how to use PubMed effectively and express frustration with the experience. Typical problems encountered are data overload with very large numbers of returns to look through, failure to find a specific article, and a concern that a search has missed important papers. It is helpful to understand the system used to enter journal articles into the database and the classification of the common types of searches and to review suggestions for the best ways to use the PubMed interface and find sources for search teaching and assistance. PMID:21553803

  7. Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

    PubMed

    Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

    2016-08-01

    The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

  8. Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital

    PubMed Central

    Yoo, Sooyoung; Hwang, Hee

    2016-01-01

    The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience. PMID:27651940

  9. Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

    PubMed

    Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

    2016-08-01

    The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience. PMID:27651940

  10. Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital

    PubMed Central

    Yoo, Sooyoung; Hwang, Hee

    2016-01-01

    The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

  11. Study rates U.S. hospitals vs. other nations, industries.

    PubMed

    Burda, D

    1991-10-01

    American hospitals generally are further along with their total quality management programs than their Canadian counterparts but lag behind companies in other U.S. industries, according to a comprehensive international study that examined four industries--healthcare, automotive, banking and computer--in four countries--the United States, Canada, Germany and Japan. PMID:10114178

  12. National hospital survey of anaerobic culture and susceptibility methods: III.

    PubMed

    Goldstein, Ellie J C; Citron, Diane M; Goldman, Pamela J; Goldman, Ronald J

    2008-04-01

    To assess the current status of anaerobic bacteriology in the United States, we surveyed, by means of a questionnaire, 150 hospitals selected at random with bed capacities of 200-1000 and we received responses from 98 (65%). Ninety-eight percent processed anaerobic culture specimens with 21% sending them to reference laboratories. Almost all these hospitals processed blood and wound cultures for anaerobes and all used selective media for identification, including BBE (52%), LKV (77%), and PEA (53%) agars. All hospital laboratories attempted identification of blood culture isolates including 80% that attempted speciation. Wound cultures for anaerobic bacteria and sterile site cultures were also processed for anaerobes by almost all labs. Identification of B. fragilis group species to species level was performed only in 56% of labs always and 37% sometimes. Preformed enzyme kits were used by 66% of labs and 30% used special potency disks for identification. Susceptibility testing was performed in-house by 21% of hospital labs and sent out to reference labs an additional 20%. Susceptibility testing was attempted for all blood culture isolates by both hospital (21% of total labs) and reference laboratories, but only performed by 17% for sterile body site and 14% of the time for wound isolates. Etest was used most often followed by broth microdilution. No labs used the agar dilution or disk elution methods. The antimicrobials most often tested in hospital labs, predicated on the commercial panel used, were penicillin/ampicillin and clindamycin (15/18; 83%; 15% of total labs), metronidazole (16/18; 89%; 16% of total labs) and cefotetan and ampicillin/sulbactam (12/18; 67%; 12% of total labs), piperacillin/tazobactam (7/18; 39%; 7% of total labs), cefoxitin (9/18; 50%), imipenem (8/18; 44%), and chloramphenicol (6/18; 33%). Our current survey suggests that while many labs are processing anaerobic cultures, especially blood cultures, the identification of isolates and the

  13. The Vienna Heritage of Iowa Orthopaedics

    PubMed Central

    Buckwalter, Joseph A

    2003-01-01

    Strong traditions of basic research, clinical innovation, teaching and integrating science and evaluation of outcomes into clinical practice have characterized University of Iowa orthopaedics for ninety years. These traditions were brought to Iowa City from Vienna when Iowa City was a town of fewer than 10,000 people in a sparsely populated rural state. In the last third of the 19th century, surgeons at the University of Vienna, led by Theodore Billroth (1829-1894), helped transform the practice of surgery. They developed new more effective procedures, analyzed the results of their operations, promoted the emergence and growth of surgical specialties and sought understanding of tissue structure, physiology and pathophysiology. Their efforts made Vienna one of the world's most respected centers for operative treatment, basic and clinical research and surgical education. Two individuals who followed Billroth, Eduard Albert (1841-1900) and Adolf Lorenz (1854-1946) focused their research and clinical practice on orthopaedics. Their successes in the study and treatment of musculoskeletal disorders led one of their students, Arthur Steindler (1878-1959), a 1902 graduate of the Vienna Medical School, to pursue a career in orthopaedics. Following medical school, he worked in Lorenz's orthopaedic clinic until 1907 when he joined John Ridlon (1852-1936) at the Chicago Home for Crippled Children. In 1910, Steindler became Professor of Orthopaedics at the Drake Medical School in Des Moines, Iowa, and, in 1913, John G. Bowman, the President of the University of Iowa, recruited him to establish an orthopaedic clinical and academic program in Iowa City. For the next third of a century he guided the development of the University of Iowa Orthopaedics Department, helped establish the fields of orthopaedic biomechanics and kinesiology and tirelessly stressed the importance of physiology, pathology and assessment of the outcomes of operations. From the legacy of Billroth, Albert and

  14. Algodystrophy in major orthopaedic surgery

    PubMed Central

    Tarantino, Umberto; Buharaja, Rodrigo; Piccirilli, Eleonora; Riccardi, Mariastella; Gasbarra, Elena; Feola, Maurizio; Iolascon, Giovanni

    2015-01-01

    Summary Complex Regional Pain Syndrome (CRPS) describes a diversity of painful conditions following trauma, associated with abnormal regulation of blood flow and sweating, trophic changes, and edema of skin. Epidemiology of this disease is not convincing because of the difficulties and inaccuracies in the diagnosis. Several mechanisms are involved in the genesis of CRPS. The higher incidence of CRPS in women over 65 suggests that some changes involving natural and pathologic processes of aging predispose to onset a CRPS. Many features of the orthopaedic management (surgical time, immobilization, surgical incision, fracture osteosynthesis or prosthetic implants) might influence inflammation status in different way. It is mandatory to improve the understanding of both the pathogenesis of CRPS and the conditions that play a decisive role in its genesis. Furthermore it is important to find some biomarkers that allow early diagnosis before the onset of typical clinical signs. PMID:27134627

  15. Orthopaedic perspective on bone metastasis

    PubMed Central

    Molloy, Alan P; O’Toole, Gary C

    2013-01-01

    The incidence of cancer is increasing worldwide, with the advent of a myriad of new treatment options, so is the overall survival of these patients. However, from an orthopaedic perspective, there comes the challenge of treating more patients with a variety of metastatic bone lesions. The consequences of such lesions can be significant to the patient, from pain and abnormal blood results, including hypercalcemia, to pathological fracture. Given the multiple options available, the treatment of bone metastasis should be based on a patient-by patient manner, as is the case with primary bone lesions. It is imperative, given the various lesion types and locations, treatment of bone metastasis should be performed in an individualised manner. We should consider the nature of the lesion, the effect of treatment on the patient and the overall outcome of our decisions. The dissemination of primary lesions to distant sites is a complex pathway involving numerous cytokines within the tumour itself and the surrounding microenvironment. To date, it is not fully understood and we still base a large section of our knowledge on Pagets historic “seed and soil” theory. As we gain further understanding of this pathway it will allow us develop more medical based treatments. The treatment of primary cancers has long been provided in a multi-disciplinary setting to achieve the best patient outcomes. This should also be true for the treatment of bone metastases. Orthopaedic surgeons should be involved in the multidisciplinary treatment of such patients given that there are a variety of both surgical fixation methods and non-operative methods at our disposal. PMID:23878778

  16. National Survey of Children's Hospitals on Legacy-Making Activities

    PubMed Central

    Dietrich, Mary S.; Friedman, Debra L.; Gordon, Jessie E.; Gilmer, Mary J.

    2012-01-01

    Abstract Objective Many hospitals offer legacy-building activities for children with serious illnesses or their family members, yet legacy-making has received little empirical attention. This descriptive cross-sectional study examined healthcare provider perceptions of legacy-making activities (e.g., memory books) currently offered by hospitals to pediatric patients and their families. Methods Healthcare providers in seventy-seven (100%) teaching children's hospitals across the United States completed an electronic survey. Results Nearly all providers surveyed reported offering legacy-making activities to ill children and their families, with patients and families usually completing the activity together. Most activities were offered before a patient died and when cure is no longer being sought. Perceived outcomes included benefit to bereaved families and a tangible memento of their deceased child. Conclusion Legacy-making may enhance life and decrease suffering for dying children and their families. Healthcare professionals can facilitate opportunities for children and their families to build legacies. Additional research is needed to examine activities across different age groups and conditions, the best time to offer such activities, and associations with positive and negative outcomes for ill children, their family members, and the bereaved. PMID:22577785

  17. Hospital liability and AIDS treatment: the need for a national standard of care.

    PubMed

    Hermann, D H; Gorman, R D

    1989-08-01

    This Article examines the current rules governing hospital liability in relation to the potential liability arising from Acquired Immunodeficiency Syndrome (AIDS). Traditional limitations on hospital liability have eroded while doctrines of corporate negligence and apparent agency have increased the basis for hospital liability. At the same time, the use of the locality rule, which established a standard of care based on community practice, increasingly has been replaced by the adoption of a national standard of care. With no existing precedent concerning the standard of care in AIDS treatment, both hospitals and courts require an authoritative basis for establishing the appropriate national standard of care. The authors contend that the guidelines established by the Centers for Disease Control (CDC) provide the most appropriate basis for establishing a national standard of care for AIDS treatment. PMID:10314361

  18. Organizational and market factors associated with leadership development programs in hospitals: a national study.

    PubMed

    Kim, Tae Hyun; Thompson, Jon M

    2012-01-01

    Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.

  19. The incomplete circle of the National Disaster Medical System: what Arkansas hospitals learned from hurricane Gustav.

    PubMed

    Mason, William L

    2010-06-01

    On August 31, 2008, during Hurricane Gustav, 225 patients from Louisiana hospitals were evacuated to 12 hospitals in the central region of Arkansas. The evacuation was a success for the National Disaster Medical System (NDMS) but left Arkansas NDMS hospitals on their own to repatriate patients and negotiate payments for care. This article examines repatriation and reimbursement issues of Arkansas hospitals that provided care for these NDMS patients. Consensus statements were obtained from key organization stakeholders focused on repatriation of NDMS patients and reimbursement to Arkansas NDMS hospitals. The stakeholders concurred with recommendations addressing changes in both federal and state agreements related to repatriation of NDMS patients and reimbursement for care. Surveys from 10 of 12 participating hospitals showed Medicare was the primary payer for 57% of NDMS patients, higher than the usual community average of 43%. Length of stay was 3 days longer for NDMS patients than for the patients usually served by the hospital. Thirty percent of hospitals reported that they would be unlikely to take NDMS patients in the future. Private sector hospitals were adversely affected by system difficulties in repatriation and reimbursement. The federal government should consider a new paradigm for reimbursement of hospitals and develop a single payer for all NDMS patients.

  20. Happy crisis tests hospitals' PR plan. Septuplets' arrival swamps Iowa hospitals with national, international media. Blank Children's Hospital, Iowa Methodist Medical Center, Des Moines.

    PubMed

    1998-01-01

    The public relations staff believed the birth of healthy septuplets would become a human interest story for local media. But the staff was stunned at the outpouring of international and national media knocking at their front doors. The staff of both Iowa Methodist Medical Center and Blank Children's Hospital in Des Moines, Iowa, organized a communications plan for 14 official press conferences, constant updates to the media and a website to handle ongoing inquiries from the public. As a result, the story of the McCaughey septuplets was shown in more than 10,000 television stories around the world. The hospitals received more than 36,000 magazine and newspaper articles. The public relations staff not only fielded more than 2,000 phone calls in the days following the Nov. 19 birth, but more than 15 major networks parked their vehicles and satellite dishes in front of the hospital.

  1. The Nanaimo and Charles Camsell Indian Hospitals: First Nations' narratives of health care, 1945 to 1965.

    PubMed

    Drees, Laurie Meijer

    2010-01-01

    First Nations' perspectives on health and health care as delivered by doctors, nurses, and Canada's former Indian hospital system form a significant part of Canada's medical history, as well as a part of First Nations people's personal histories. Oral histories collected in Alberta and British Columbia suggest that First Nations people who experienced the Nanaimo and Charles Camsell Indian hospitals between 1945 and 1965 perceive the value of their experiences to be reflected in their survivance, a concept recalled through narratives emphasizing both humour and pain, as well as past and present personal resilience.

  2. Organizational and environmental determinants of hospital EMR adoption: a national study.

    PubMed

    Kazley, Abby Swanson; Ozcan, Yasar A

    2007-10-01

    The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology. The purpose of this paper is to determine the national prevalence of EMR adoption in acute care hospitals while examining the organizational and environmental correlates using a Resource Dependence Theoretical Perspective. Significant predictors of hospital EMR use may indicate barriers to use for some hospitals and can be used to guide policy. This study uses a non-experimental cross sectional design to examine hospital EMR use in 2004. A logistic regression approach is used to determine the correlations between hospital EMR use and organizational and environmental characteristics. Hospital EMR use was identified using the HIMSS Analytics data. Organizational and environmental variables were measured using data from the AHA, CMS (financial and case mix) and ARF. Hospital EMR adoption is significantly associated with environmental uncertainty, type of system affiliation, size, and urbanness. The effects of competition, munificence, ownership, teaching status, public payer mix, and operating margin were not statistically significant. Significant predictors of hospital EMR adoption represent barriers that may prevent certain hospitals from obtaining and using EMRs. These hospitals include those that are smaller, more rural, non-system affiliated, and in areas of low environmental uncertainty. Since EMR adoption may be an organizational survival strategy for hospitals to improve quality and efficiency, hospitals that are at risk of missing the wave of implementation should be offered services and incentives to enable them to implement and maintain EMR systems.

  3. [Fates at the psychiatric hospital of Klagenfurt during National Socialism].

    PubMed

    Oberlerchner, Herwig; Stromberger, Helge

    2013-01-01

    In this article the fate of Mr. B. is described as an example for the fate of hundreds of mentally ill patients of the "Landes-Irrenanstalt of Klagenfurt", murdered during the era of National Socialism. This extraordinary fate marks two outstanding aspects of history of medicine, the treatment of syphilis with malaria and the organised mass murder of mentally ill people during the cynic era of National Socialism. Beyond this historical perspective reconstructive biographical work together with relatives is presented as a proactive duty of psychiatric institutions.

  4. Surgical simulation in orthopaedic skills training.

    PubMed

    Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

    2012-07-01

    Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated. PMID:22751160

  5. National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia

    PubMed Central

    Murray, Sara G.; Schmajuk, Gabriela; Trupin, Laura; Gensler, Lianne; Katz, Patricia P.; Yelin, Edward H.; Gansky, Stuart A.; Yazdany, Jinoos

    2016-01-01

    Objective Infection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study. Methods Data derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections. Results We identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations. Conclusions Among patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications. PMID:26731012

  6. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

    PubMed Central

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-01-01

    Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients

  7. The Impact of National Cultural Differences on Nurses' Acceptance of Hospital Information Systems.

    PubMed

    Lin, Hsien-Cheng

    2015-06-01

    This study aims to explore the influence of national cultural differences on nurses' perceptions of their acceptance of hospital information systems. This study uses the perspective of Technology Acceptance Model; national cultural differences in terms of masculinity/femininity, individualism/collectivism, power distance, and uncertainty avoidance are incorporated into the Technology Acceptance Model as moderators, whereas time orientation is a control variable on hospital information system acceptance. A quantitative research design was used in this study; 261 participants, US and Taiwan RNs, all had hospital information system experience. Data were collected from November 2013 to February 2014 and analyzed using a t test to compare the coefficients for each moderator. The results show that individualism/collectivism, power distance, and uncertainty avoidance all exhibit significant difference on hospital information system acceptance; however, both masculinity/femininity and time orientation factors did not show significance. This study verifies that national cultural differences have significant influence on nurses' behavioral intention to use hospital information systems. Therefore, hospital information system providers should emphasize the way in which to integrate different technological functions to meet the needs of nurses from various cultural backgrounds. PMID:25899441

  8. A national system for monitoring the performance of hospitals in Ethiopia

    PubMed Central

    McNatt, Zahirah; Linnander, Erika; Endeshaw, Abraham; Tatek, Dawit; Conteh, David

    2015-01-01

    Abstract Many countries struggle to develop and implement strategies to monitor hospitals nationally. The challenge is particularly acute in low-income countries where resources for measurement and reporting are scarce. We examined the experience of developing and implementing a national system for monitoring the performance of 130 government hospitals in Ethiopia. Using participatory observation, we found that the monitoring system resulted in more consistent hospital reporting of performance data to regional health bureaus and the federal government, increased transparency about hospital performance and the development of multiple quality-improvement projects. The development and implementation of the system, which required technical and political investment and support, would not have been possible without strong hospital-level management capacity. Thorough assessment of the health sector’s readiness to change and desire to prioritize hospital quality can be helpful in the early stages of design and implementation. This assessment may include interviews with key informants, collection of data about health facilities and human resources and discussion with academic partners. Aligning partners and donors with the government’s vision for quality improvement can enhance acceptability and political support. Such alignment can enable resources to be focused strategically towards one national effort – rather than be diluted across dozens of potentially competing projects. Initial stages benefit from having modest goals and the flexibility for continuous modification and improvement, through active engagement with all stakeholders. PMID:26600614

  9. The Impact of National Cultural Differences on Nurses' Acceptance of Hospital Information Systems.

    PubMed

    Lin, Hsien-Cheng

    2015-06-01

    This study aims to explore the influence of national cultural differences on nurses' perceptions of their acceptance of hospital information systems. This study uses the perspective of Technology Acceptance Model; national cultural differences in terms of masculinity/femininity, individualism/collectivism, power distance, and uncertainty avoidance are incorporated into the Technology Acceptance Model as moderators, whereas time orientation is a control variable on hospital information system acceptance. A quantitative research design was used in this study; 261 participants, US and Taiwan RNs, all had hospital information system experience. Data were collected from November 2013 to February 2014 and analyzed using a t test to compare the coefficients for each moderator. The results show that individualism/collectivism, power distance, and uncertainty avoidance all exhibit significant difference on hospital information system acceptance; however, both masculinity/femininity and time orientation factors did not show significance. This study verifies that national cultural differences have significant influence on nurses' behavioral intention to use hospital information systems. Therefore, hospital information system providers should emphasize the way in which to integrate different technological functions to meet the needs of nurses from various cultural backgrounds.

  10. Battered baby syndrome at Kenyatta National Hospital, Nairobi.

    PubMed

    Muita, J W; Nduati, R W

    1990-12-01

    Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

  11. Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda.

    PubMed

    Bwire, Godfrey; Malimbo, Mugagga; Kagirita, Atek; Makumbi, Issa; Mintz, Eric; Mengel, Martin A; Orach, Christopher Garimoi

    2015-09-01

    During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered.

  12. Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda

    PubMed Central

    Bwire, Godfrey; Malimbo, Mugagga; Kagirita, Atek; Makumbi, Issa; Mintz, Eric; Mengel, Martin A.; Orach, Christopher Garimoi

    2015-01-01

    During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered. PMID:26195468

  13. Transforming safety and effectiveness in pediatric hospital care locally and nationally.

    PubMed

    Mandel, Keith E; Muething, Stephen E; Schoettker, Pamela J; Kotagal, Uma R

    2009-08-01

    Achieving dramatic, sustainable improvements in the safety and effectiveness of care for children requires a transformational approach to how hospitals individually focus on improvement and learn from each other to achieve national goals. The authors describe a theoretic framework for transformation that includes setting system-level priorities, aligning measures with each priority, identifying breakthrough targets, testing interventions to get results, and spreading successful interventions throughout the organization. Essential key drivers of transformation include leadership, building will, transparency, a business case for quality, patient and family engagement, improvement infrastructure, improvement capability, and reliability and standardization. Improving national system-level measures requires each hospital to pursue its own transformation journey while collaborating with hospitals and other organizations. PMID:19660634

  14. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions

    PubMed Central

    Kim, Jinkyung; Han, Woosok

    2012-01-01

    Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria. PMID:24159497

  15. Building the Capacity to Manage Orthopaedic Trauma After a Catastrophe in a Low-Income Country.

    PubMed

    Furey, Andrew; Rourke, James; Larsen, Hans

    2015-10-01

    Providing trauma care in an austere environment is very challenging, especially when the country is faced with a natural disaster. Unfortunately the combination of these elements highlights the deficiencies in managing orthopaedic trauma both in a developing country and in the face of a natural disaster, exponentially amplifying the effects of each. When considering the implementation and practice of orthopaedic trauma care in such an environment, one must consider the initial phase of program development and look further to the future in the development of a resilient program, which is sustainable. Through the use of the example of Haiti and a specific Non-Governmental Organization, we discuss the evidence for and thoughts behind developing orthopaedic trauma care program immediately after a natural disaster. This program aims to build capacity and empower a developing nation's health professionals to advance the care of orthopaedic trauma patients. We describe a model of capacity building that serves as a framework to highlight the strengths and weaknesses of low-to middle-income countries in providing orthopaedic trauma care when faced with such a challenge.

  16. Building the Capacity to Manage Orthopaedic Trauma After a Catastrophe in a Low-Income Country.

    PubMed

    Furey, Andrew; Rourke, James; Larsen, Hans

    2015-10-01

    Providing trauma care in an austere environment is very challenging, especially when the country is faced with a natural disaster. Unfortunately the combination of these elements highlights the deficiencies in managing orthopaedic trauma both in a developing country and in the face of a natural disaster, exponentially amplifying the effects of each. When considering the implementation and practice of orthopaedic trauma care in such an environment, one must consider the initial phase of program development and look further to the future in the development of a resilient program, which is sustainable. Through the use of the example of Haiti and a specific Non-Governmental Organization, we discuss the evidence for and thoughts behind developing orthopaedic trauma care program immediately after a natural disaster. This program aims to build capacity and empower a developing nation's health professionals to advance the care of orthopaedic trauma patients. We describe a model of capacity building that serves as a framework to highlight the strengths and weaknesses of low-to middle-income countries in providing orthopaedic trauma care when faced with such a challenge. PMID:26356206

  17. Stanley Paris Award Lecture. Reflections on the history and future of orthopaedic physical therapy.

    PubMed

    Wadsworth, C

    1998-09-01

    Carolyn Wadsworth, MS, PT, CHT, OCS, deliver the 1998 Paris Distinguished Service Award Lecture at the Combined Sections Meeting in Boston in February. Wadsworth is the fifth recipient of the Paris Award, which is the Orthopaedic Section's highest honor given to commemorate a member's exceptional and enduring service. The Paris Distinguished Service Award was established in 1990 and is named after Stanley V. Paris, PhD, PT, founder and first president of the Orthopaedic Section. Born in Dunedin, New Zealand, Paris immigrated to the U.S. in 1966. He developed physical therapy practices in Boston, Hamilton, Bermuda, and Atlanta; established the Institute of Graduate Health Sciences in Atlanta, GA; and is currently president of the University of St. Augustine, St. Augustine, FL. Paris is a strong advocate of assertive professional practice, clinical specialization, and strengthening leadership in physical therapy. He also champions wellness, exemplified by his personal achievements in sailing the Atlantic Ocean, swimming the English Channel, and completing the Ironman Triathlon. Carolyn Wadsworth, recipient of the 1998 Paris Award, has served as secretary and president of the Orthopaedic Section and is currently editor of the Orthopaedic Section's Home Study Course. She owns a private practice, teaches nationally, and has written two books, Examination and Mobilization of the Spine and Extremities (1988) and Orthopedic Review for Physical Therapists (1998). Major components of the speech she presented at the Orthopaedic Section Awards Ceremony are highlighted in this article.

  18. Tuberculosis Hospitalization Fees and Bed Utilization in China from 1999 to 2009: The Results of a National Survey of Tuberculosis Specialized Hospitals

    PubMed Central

    Ma, Yan; Mi, Fengling; Liu, Yuhong; Li, Liang

    2015-01-01

    Background China is transitioning towards concentrating tuberculosis (TB) diagnostic and treatment services in hospitals, while the Centers of Disease Control and Prevention (CDC) system will retain important public health functions. Patient expenditure incurred through hospitalization may lead to barriers to TB care or interruption of treatment. Methodology/Principal Findings We conducted a national survey of TB specialized hospitals to determine hospitalization fees and hospital bed utilization in 1999, 2004, and 2009. Hospitalization of TB patients increased 185.3% from 1999 to 2009. While the average hospitalization fees also increased, the proportion of those fees in relation to GDP per capita decreased. Hospitalization fees differed across the three regions (eastern, central, and western). Using a least standard difference (LSD) paired analysis, in 2004, the difference in hospitalization fees was significant when comparing eastern and central provinces (p<0.001) as well as to western provinces (p<0.001). In 2009, the difference remained statistically significant when comparing eastern province hospitalization fees with central provinces (p<0.001) and western provinces (p = 0.008). In 2004 and 2009, the cost associated with hospitalization as a proportion of GDP per capita was highest in the western region. The average in-patient stay decreased from 33 days in 1999 to 26 and 27 days in 2004 and 2009 respectively. Finally, hospital bed utilization in all three regions increased over this period. Conclusions/Significance Our findings show that both the total number of in-patients and hospitalization fees increased from 1999 to 2009, though the proportion of hospitalization fees to GDP per capita decreased. As diagnostic services move to hospitals, regulatory and monitoring mechanisms should be established, and hospitals should make use of the experience garnered by the CDC system through continued strong collaborations. Infrastructure and social protection

  19. Orthopaedic trauma from road crashes: is enough being done?

    PubMed

    Donaldson, Lachlan H; Brooke, Kathryn; Faux, Steven G

    2009-02-01

    A file review of patients presenting to the Emergency Department of St Vincent's Hospital with fractures sustained in a road crash was completed to describe patterns of orthopaedic injury, acute intervention and separation as well as the cost of care for adult road crash victims. One-hundred and eighty-seven patients were included. 65.8% were male; 48.1% were pedestrians. Differing patterns of injury corresponded to the role of the patient in the road crash (eg, pedestrian, driver of vehicle, etc). The mean length of stay was 8.8 days. 35.2% of patients were prescribed a different analgesic at discharge to that which they had received in the previous 24 hours. 35.8% had a documented discussion regarding insurance matters, usually with a social worker. 11.9% were discharged to inpatient rehabilitation. 56.2% had orthopaedic follow-up arranged at discharge, while 4.8% were discharged to an outpatient rehabilitation clinic. The mean overall cost was $13 336, with patients aged over 65 costing the most. The quality of acute care for fractures sustained in road crashes could be improved with evidence-based analgesia management, increased screening for psychiatric sequelae, enhanced assistance with insurance matters and vocational issues, and closer follow-up. Further research into the impact of these factors on long-term recovery is warranted. PMID:19203336

  20. The prevention of orthopaedic implant and vascular graft infections.

    PubMed

    Strachan, C J

    1995-06-01

    The infection rate for any surgical prosthesis insertion should be less than 1% in the first postoperative year. If infection occurs the patients will lose their new found mobility, lose their independence, be hospitalized with sepsis, both local and systemic, and perhaps die. Preoperative and intraoperative measures to prevent infection are well established in orthopaedic surgery but less scientifically applied in peripheral vascular surgery. In both specialties the problem of late infection has promoted research on the protection of the peri-prosthetic environment against both bacteria and biofilm. In orthopaedics, the incorporation of various antibiotics into bone cement is well accepted in revision surgery, but still debated for the primary operation. On-going research on bioresorbable ceramics and the incorporation of antibiotics more effective against coagulase-negative staphylococci should eventually counter late infections. As HIV-positive patients increasingly present with sepsis around implanted prostheses this need will increase. In vascular surgery as the risk factors for biomaterial infection are better understood, new generations of protein-sealed grafts are permitting ionically compatible antibiotic coatings. Large well-designed clinical trials have begun and are needed to confirm the forecast of improved long-term clinical outcomes.

  1. Antimicrobial biocompatible bioscaffolds for orthopaedic implants.

    PubMed

    Qureshi, Ammar T; Terrell, Lekeith; Monroe, W Todd; Dasa, Vinod; Janes, Marlene E; Gimble, Jeffrey M; Hayes, Daniel J

    2014-05-01

    Nationally, nearly 1.5 million patients in the USA suffer from ailments requiring bone grafts and hip and other joint replacements. Infections following internal fixation in orthopaedic trauma can cause osteomyelitis in 22-66% of cases and, if uncontrolled, the mortality rate can be as high as 2%. We characterize a procedure for the synthesis of antimicrobial and biocompatible poly-l-lactic acid (PLLA) and poly-ethyleneglycol (PEG) bioscaffolds designed to degrade and absorb at a controlled rate. The bioscaffold architecture aims to provide a suitable substrate for the controlled release of silver nanoparticles (SNPs) to reduce bacterial growth and to aid the proliferation of human adipose-derived stem cells (hASCs) for tissue-engineering applications. The fabricated bioscaffolds were characterized by scanning transmission microscope (SEM) and it showed that the addition of tncreasing concentrations of SNPs results in the formation of dendritic porous channels perpendicular to the axis of precipitation. The antimicrobial properties of these porous bioscaffolds were tested according to a modified ISO 22196 standard across varying concentrations of biomass-mediated SNPs to determine an efficacious antimicrobial concentration. The bioscaffolds reduced the Staphylococcus aureus and Escherichia coli viable colony-forming units by 98.85% and 99.9%, respectively, at an antimicrobial SNPs concentration of 2000 ppm. Human ASCs were seeded on bioscaffolds and cultured in vitro for 20 days to study the effect of SNPs concentration on the viability of cells. SEM analysis and the metabolic activity-based fluorescent dye, AlamarBlue®, demonstrated the growth of cells on the efficacious antimicrobial bioscaffolds. The biocompatibility of in vitro leached silver, quantified by inductively coupled plasma optical emission spectroscopy (ICP-OES), proved non-cytotoxic when tested against hASCs, as evaluated by MTT assay.

  2. Incidence Rate of Needlestick and Sharps Injuries in 67 Japanese Hospitals: A National Surveillance Study

    PubMed Central

    Yoshikawa, Toru; Wada, Koji; Lee, Jong Ja; Mitsuda, Toshihiro; Kidouchi, Kiyoshi; Kurosu, Hitomi; Morisawa, Yuji; Aminaka, Mayumi; Okubo, Takashi; Kimura, Satoshi; Moriya, Kyoji

    2013-01-01

    Background Determining incidence rates of needlestick and sharps injuries (NSIs) using data from multiple hospitals may help hospitals to compare their in-house data with national averages and thereby institute relevant measures to minimize NSIs. We aimed to determine the incidence rate of NSIs using the nationwide EPINet surveillance system. Methodology/Principal Findings Data were analyzed from 5,463 cases collected between April 2009 and March 2011 from 67 Japanese HIV/AIDS referral hospitals that participated in EPINet-Japan. The NSI incidence rate was calculated as the annual number of cases with NSIs per 100 occupied beds, according to the demographic characteristics of the injured person, place, timing, device, and the patients’ infectious status. The NSI incidence rates according to hospital size were analyzed by a non-parametric test of trend. The mean number of cases with NSIs per 100 occupied beds per year was 4.8 (95% confidence interval, 4.1–5.6) for 25 hospitals with 399 or fewer beds, 6.7 (5.9–7.4) for 24 hospitals with 400–799 beds, and 7.6 (6.7–8.5) for 18 hospitals with 800 or more beds (p-trend<0.01). NSIs frequently occurred in health care workers in their 20 s; the NSI incidence rate for this age group was 2.1 (1.6–2.5) for hospitals having 399 or fewer beds, 3.5 (3.0–4.1) for hospitals with 400–799 beds, and 4.5 (3.9–5.0) for hospitals with 800 or more beds (p-trend<0.01). Conclusions/Significance The incidence rate of NSIs tended to be higher for larger hospitals and in workers aged less than 40 years; injury occurrence was more likely to occur in places such as patient rooms and operating rooms. Application of the NSI incidence rates by hospital size, as a benchmark, could allow individual hospitals to compare their NSI incidence rates with those of other institutions, which could facilitate the development of adequate control strategies. PMID:24204856

  3. Implementation of a Comprehensive Orthopaedic Registry System.

    PubMed

    Tokish, John M; Alexander, Thomas C

    2016-01-01

    Advances in information technology have allowed for improvements in the collection and analysis of large-scale outcomes data. These data can be used in the practice of orthopaedics for benchmarking, value analysis, and comparative effectiveness research. The implementation of registries within a busy surgical practice can be challenging, costly, and inefficient. Content, platform, and characteristics are the key elements required to successfully implement a patient-based orthopaedic outcomes data registry. Specific barriers to implementing registries are discussed, and solutions are proposed, to provide an example for optimal integration within clinical practices that may have varying goals.

  4. Does Illicit Drug Use Influence Inpatient Adverse Events, Death, Length of Stay, and Discharge After Orthopaedic Trauma?

    PubMed

    Babatunde, Victor D; Menendez, Mariano E; Ring, David

    2016-01-01

    Illicit drug use among adults is increasing, but its associated risk following orthopaedic trauma remains largely unexplored. This study assessed the relationship of illicit drug use with inpatient adverse events, in-hospital mortality, prolonged length of stay, and nonroutine discharge. With the use of the Nationwide Inpatient Sample database, 7,118,720 orthopaedic trauma inpatients from 2002 to 2011 were identified and separated into illicit drug users (1.5%) and non-illicit drug users (98.5%). Multivariable regression modeling was used to determine the association between illicit drug use and each outcome variable. Illicit drug use was associated with higher odds of inpatient adverse events, but not greater likelihood of inpatient death. Illicit drug users were also more likely to experience prolonged hospital stay and nonroutine discharge. Prompt recognition and effective treatment interventions for orthopaedic trauma patients with a history of illicit drug use may improve inpatient outcomes. PMID:27082887

  5. The Orthopaedically Handicapped and Computer Usage: The Case of TRNC

    ERIC Educational Resources Information Center

    Dincyurek, Sibel; Arsan, Nihan; Caglar, Mehmet

    2011-01-01

    Although various studies have been conducted in the field of orthopaedic impairment, research regarding computer education for orthopaedically impaired individuals remains insufficient. This study aimed to evaluate the use of computers by orthopaedically impaired individuals from a wider perspective. The findings of the study emphasise the…

  6. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.

    PubMed

    Himmelstein, David U; Jun, Miraya; Busse, Reinhard; Chevreul, Karine; Geissler, Alexander; Jeurissen, Patrick; Thomson, Sarah; Vinet, Marie-Amelie; Woolhandler, Steffie

    2014-09-01

    A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures--a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme.

  7. [Problems in career planning for novice medical technologists in Japanese national hospitals].

    PubMed

    Ogasawara, Shu; Tsutaya, Shoji; Akimoto, Hiroyuki; Kojima, Keiya; Yabaka, Hiroyuki

    2012-12-01

    Skills and knowledge regarding many different types of test are required for medical technologists (MTs) to provide accurate information to help doctors and other medical specialists. In order to become an efficient MT, specialized training programs are required. Certification in specialized areas of clinical laboratory sciences or a doctoral degree in medical sciences may help MTs to realize career advancement, a higher earning potential, and expand the options in their career. However, most young MTs in national university hospitals are employed as part-time workers on a three-year contract, which is too short to obtain certifications or a doctoral degree. We have to leave the hospital without expanding our future. We need to take control of our own development in order to enhance our employability within the period. As teaching and training hospitals, national university hospitals in Japan are facing a difficult dilemma in nurturing MTs. I hope, as a novice medical technologist, that at least university hospitals in Japan create an appropriate workplace environment for novice MTs.

  8. National Hospital Management Portal (NHMP): a framework for e-health implementation.

    PubMed

    Adetiba, E; Eleanya, M; Fatumo, S A; Matthews, V O

    2009-01-01

    Health information represents the main basis for health decision-making process and there have been some efforts to increase access to health information in developing countries. However, most of these efforts are based on the internet which has minimal penetration especially in the rural and sub-urban part of developing countries. In this work, a platform for medical record acquisition via the ubiquitous 2.5G/3G wireless communications technologies is presented. The National Hospital Management Portal (NHMP) platform has a central database at each specific country's national hospital which could be updated/accessed from hosts at health centres, clinics, medical laboratories, teaching hospitals, private hospitals and specialist hospitals across the country. With this, doctors can have access to patients' medical records more easily, get immediate access to test results from laboratories, deliver prescription directly to pharmacists. If a particular treatment can be provided to a patient more effectively in another country, NHMP makes it simpler to organise and carry out such treatment abroad.

  9. [Problems in career planning for novice medical technologists in Japanese national hospitals].

    PubMed

    Ogasawara, Shu; Tsutaya, Shoji; Akimoto, Hiroyuki; Kojima, Keiya; Yabaka, Hiroyuki

    2012-12-01

    Skills and knowledge regarding many different types of test are required for medical technologists (MTs) to provide accurate information to help doctors and other medical specialists. In order to become an efficient MT, specialized training programs are required. Certification in specialized areas of clinical laboratory sciences or a doctoral degree in medical sciences may help MTs to realize career advancement, a higher earning potential, and expand the options in their career. However, most young MTs in national university hospitals are employed as part-time workers on a three-year contract, which is too short to obtain certifications or a doctoral degree. We have to leave the hospital without expanding our future. We need to take control of our own development in order to enhance our employability within the period. As teaching and training hospitals, national university hospitals in Japan are facing a difficult dilemma in nurturing MTs. I hope, as a novice medical technologist, that at least university hospitals in Japan create an appropriate workplace environment for novice MTs. PMID:23427696

  10. The Hospital for the Ruptured and Crippled Eugene H. Pool, Fourth Surgeon-in-Chief 1933–1935 Followed by Philip D. Wilson, Fifth Surgeon-in-Chief 1935

    PubMed Central

    2008-01-01

    In 1933, for the second time in the history of the Hospital for the Ruptured and Crippled (R & C), a general surgeon, Eugene Hillhouse Pool, MD, was appointed Surgeon-in-Chief by the Board of Managers of the New York Society for the Relief of the Ruptured and Crippled. R & C (whose name was changed to the Hospital for Special Surgery in 1940), then the oldest orthopaedic hospital in the country, was losing ground as the leading orthopaedic center in the nation. The R & C Board charged Dr. Pool with the task of recruiting the nation’s best orthopaedic surgeon to become the next Surgeon-in-Chief. Phillip D. Wilson, MD, from the Massachusetts General Hospital in Boston and the Harvard Medical School was selected and agreed to accept this challenge. He joined the staff of the Hospital for the Ruptured and Crippled in the spring of 1934 as Director of Surgery and replaced Dr. Pool as Surgeon-in-Chief the next year. It was the time of the Great Depression, which added a heavy financial toll to the daily operations of the hospital. With a clear and courageous vision, Dr. Wilson reorganized the hospital, its staff responsibilities, professional education and care of patients. He established orthopaedic fellowships to support young orthopaedic surgeons interested in conducting research and assisted them with the initiation of their new practices. Recognizing that the treatment of crippling conditions and hernia were becoming separate specialties, one of his first decisions was to restructure the Hernia Department to become the General Surgery Department. His World War I experiences in Europe helped develop his expertise in the fields of fractures, war trauma and amputations, providing a broad foundation in musculoskeletal diseases that was to be beneficial to him in his future role as the leader of R & C. PMID:18815851

  11. The impact of ongoing national terror on the community of hospital nurses in Israel.

    PubMed

    Ron, Pnina; Shamai, Michal

    2014-04-01

    The main goal of this study was to explore the connections between the exposure of nurses in Israel to national terror and the levels of distress experienced due to ongoing terror attacks. The data were collected from 214 nurses from various parts of Israel who work in three types of heath services (mainly hospital departments) and provide help to victims of terror. The nurses reported very high levels of burnout, high levels of stress and medium-to high levels of intrusive memories. Levels of exposure were associated with burnout, intrusive memories and level of stress. More professional attention should be given to hospital nurses who provide care for trauma patients.

  12. Recognizing and Preventing Burnout among Orthopaedic Leaders

    PubMed Central

    Quick, James Campbell; Sime, Wesley E.; Novicoff, Wendy M.; Einhorn, Thomas A.

    2008-01-01

    Stress, emotional exhaustion, and burnout are widespread in the medical profession in general and in orthopaedic surgery in particular. We attempted to identify variables associated with burnout as assessed by validated instruments. Surveys were sent to 282 leaders from orthopaedic surgery academic departments in the United States by e-mail and mail. Responses were received from 195 leaders for a response rate of 69%. The average surgeon worked 68.3 hours per week and more than ½ of this time was allocated to patient care. Highest stressors included excessive workload, increasing overhead, departmental budget deficits, tenure and promotion, disputes with the dean, and loss of key faculty. Personal-professional life imbalance was identified as an important risk factor for emotional exhaustion. Withdrawal, irritability, and family disagreements are early warning indicators of burnout and emotional exhaustion. Orthopaedic leaders can learn, and potentially model, ways to mitigate stress from other high-stress professions. Building on the strength of marital and family bonds, improving stress management skills and self-regulation, and improving efficiency and productivity can combine to assist the orthopaedic surgery leader in preventing burnout and emotional exhaustion. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0622-8) contains supplementary material, which is available to authorized users. PMID:19030943

  13. A Psychomotor Skills Course for Orthopaedic Residents

    ERIC Educational Resources Information Center

    Lippert, Frederick G.; And Others

    1975-01-01

    The course described and evaluated here was developed at the University of Washington School of Medicine to teach 20 orthopaedic residents operative techniques, instrument usage, and safety precautions outside of the operating room without hazard to the patient or regard to time constraints. (JT)

  14. The Orthopaedic Training Study. Final Report.

    ERIC Educational Resources Information Center

    Miller, George E.; And Others

    A four year study was initiated to systematically improve the certification procedures of the American Board of Orthopaedic Surgery. Consequently, the immediate research aim was the development of more valid and reliable techniques in assessing professional competence in orthopedics. A definition of professional competence was reached through…

  15. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID

  16. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols.

  17. The Payment by Results (PbR) national tariff severely penalises efficiency and early hospital discharge.

    PubMed

    Alam, Syed Munawer; Brown, Alex; Moreea, Sulleman

    2009-01-01

    The system of Payment by Results (PbR) was instituted in 2005 to reimburse secondary care for its activity. One of the features of PbR is the short stay tariff (SST), in which only 20-50% of the national tariff is paid if patients have a length of stay (LoS) of less than 2 days in hospital for certain Healthcare Resource Groups (HRGs) - or conditions. We analysed the admissions under Acute Medicine at Bradford Teaching Hospitals over a period of one year and identified the HRGs to which the SST applied. We used the 2007 PbR national tariff to calculate the additional income that would have been generated if these patients were kept in hospital for at least 2 days in order to avoid SST. We calculated an extra theoretical income of approximately £5 million if all these patients had a length of stay (LoS) more than 2 days to avoid the SST. Sixteen additional beds (assuming 85% occupancy) would have been required at a cost of around £1million per year to accommodate these patients. We show that the current PbR system is flawed and penalises hospitals with a higher turnover of patients.

  18. Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

    PubMed

    Hung, Jung-Hua; Chang, Li

    2008-03-01

    Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

  19. Palliative care: a challenge for orthopaedic nursing care.

    PubMed

    Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry

    2005-01-01

    Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

  20. Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery.

    PubMed

    Cozowicz, C; Poeran, J; Memtsoudis, S G

    2015-12-01

    Recent studies have linked the use of regional anaesthesia to improved outcomes. Epidemiological research on utilization, trends, and disparities in this field is sparse; however, large nationally representative database constructs containing anaesthesia-related data, demographic information, and multiyear files are now available. Together with advances in research methodology and technology, these databases provide the foundation for epidemiological research in anaesthesia. We present an overview of selected studies that provide epidemiological data and describe current anaesthetic practice, trends, and disparities in orthopaedic surgery in particular. This literature suggests that that even among orthopaedic surgical procedures, which are highly amenable to regional anaesthetic techniques, neuraxial anaesthetics and peripheral nerve blocks are used in only a minority of procedures. Trend analyses show that peripheral nerve blocks are gaining in popularity, whereas use of neuraxial anaesthetics is remaining relatively unchanged or even declining over time. Finally, significant disparities and variability in anaesthetic care seem to exist based on demographic and health-care-related factors. With anaesthesia playing an increasingly important part in population-based health-care delivery and evidence indicating improved outcome with use of regional anaesthesia, more research in this area is needed. Furthermore, prevalent disparities and variabilities in anaesthesia practice need to be specified further and addressed in the future.

  1. Rehabilitation and restoration: orthopaedics and disabled soldiers in Germany and Britain in the First World War.

    PubMed

    Anderson, Julie; Perry, Heather R

    2014-01-01

    This article offers a comparative analysis of the evolution of orthopaedics and rehabilitation within German and British military medicine during the Great War. In it, we reveal how the field of orthopaedics became integral to military medicine by tracing the evolution of the discipline and its practitioners in each nation during the war. In doing so, however, we document not only when and why both medical specialists and military officials realized that maintaining their respective national fighting forces depended upon the efficient rehabilitation of wounded soldiers, but also how these rehabilitative practices and goals reflected the particularities of the military context, civilian society and social structure of each nation. Thus, while our comparison reveals a number of similarities in the orthopaedic developments within each nation as a response to the Great War, we also reveal significant national differences in war-time medical goals, rehabilitation treatments and soldierly 'medical experiences'. Moreover, as we demonstrate, a social and cultural re-conceptualization of the disabled body accompanied the medical advancements developed for him; however, this re-conceptualization was not the same in each nation. Thus, what our article reveals is that although the guns of August fell silent in 1918, the war's medical experiences lingered long thereafter shaping the future of disability medicine in both nations.

  2. Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

    PubMed Central

    Martínez, Cristina; Fu, Marcela; Martínez-Sánchez, Jose M; Ballbè, Montse; Puig, Montse; García, Montse; Carabasa, Esther; Saltó, Esteve; Fernández, Esteve

    2009-01-01

    Background Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smoke-free Hospitals before and after a comprehensive national smoking ban. Methods We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two cross-sectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results The mean of the implementation score of tobacco control policies was 52.4 (95% CI: 45.4–59.5) in 2005 and 71.6 (95% CI: 67.0–76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35–39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network. PMID:19473549

  3. A national, cross-sectional survey of children's hospital-based safety resource centres

    PubMed Central

    Kendi, Sadiqa; Zonfrillo, Mark R; Seaver Hill, Karen; Arbogast, Kristy B; Gittelman, Michael A

    2014-01-01

    Objective To describe the location, staffing, clientele, safety product disbursement patterns, education provided and sustainability of safety resource centres (SRCs) in US children's hospitals. Methods A cross-sectional survey was distributed to children's hospital-based SRC directors. Survey categories included: funding sources, customer base, items sold, items given free of charge, education provided and directors’ needs. Results 32/38 (84.2%) SRC sites (affiliated with 30 hospitals) completed the survey. SRCs were in many hospital locations including lobby (28.1%), family resource centres (12.5%), gift shop/retail space (18.8%), mobile units (18.8%) and patient clinics (12.5%). 19% of respondents reported that their SRC was financially self-sustainable. Sales to patients predominated (mean of 44%); however, hospital employees made up a mean of 20% (range 0–60%) of sales. 78.1% of SRCs had products for children with special healthcare needs. Documentation kept at SRC sites included items purchased (96.9%), items given free of charge (65.6%) and customer demographics (50%). 56.3% of SRCs provided formal injury prevention education classes. The SRCs’ directors’ most important needs were finances (46.9%), staffing (50%) and space (46.9%). All of the directors were ‘somewhat interested’ or ‘very interested’ in each of the following: creation of a common SRC listserv, national SRC data bank and multisite SRC research platform. Conclusions SRCs are located in many US children's hospitals, and can be characterised as heterogeneous in location, products sold, data kept and ability to be financially sustained. Further research is needed to determine best practices for SRCs to maximise their impact on injury prevention. PMID:24667383

  4. Longitudinal Association of Registered Nurse National Nursing Specialty Certification and Patient Falls in Acute Care Hospitals

    PubMed Central

    Boyle, Diane K.; Cramer, Emily; Potter, Catima; Staggs, Vincent S.

    2015-01-01

    Background Researchers have studied inpatient falls in relation to aspects of nurse staffing, focusing primarily on staffing levels and proportion of nursing care hours provided by registered nurses (RNs). Less attention has been paid to other nursing characteristics, such as RN national nursing specialty certification. Objective The aim of the study was to examine the relationship over time between changes in RN national nursing specialty certification rates and changes in total patient fall rates at the patient care unit level. Methods We used longitudinal data with standardized variable definitions across sites from the National Database of Nursing Quality Indicators. The sample consisted of 7,583 units in 903 hospitals. Relationships over time were examined using multilevel (units nested in hospitals) latent growth curve modeling. Results The model indices indicated a good fit of the data to the model. At the unit level, there was a small statistically significant inverse relationship (r = −.08, p = .04) between RN national nursing specialty certification rates and total fall rates; increases in specialty certification rates over time tended to be associated with improvements in total fall rates over time. Discussion Our findings may be supportive of promoting national nursing specialty certification as a means of improving patient safety. Future study recommendations are (a) modeling organizational leadership, culture, and climate as mediating variables between national specialty certification rates and patient outcomes and (b) investigating the association of patient safety and specific national nursing specialty certifications which test plans include patient safety, quality improvement, and diffusion of innovation methods in their certifying examinations. PMID:26049719

  5. Southern Orthopaedic Association Abstract Publication Rate.

    PubMed

    Tait, Mark Adam; Petrus, Cara; Barnes, C Lowry

    2016-01-01

    The purpose of this study was to determine the publication rate of manuscripts presented at the Southern Orthopaedic Association's (SOA) annual meetings. An extensive literature search was performed using Google Scholar and PubMed search engines and all accepted abstracts (posters or podium presentations) presented at an SOA annual meeting from 2005 to 2011 were evaluated. A total of 568 abstracts were presented at SOA meetings between 2005 and 2011. Of these, 234 (41%) were published in the peer-reviewed literature. The publication rate was 66% in 2005 and 28% in 2010. The average time from presentation to peer-reviewed publication was 1.6 ± 0.24 years (range, 2 years in 2006 to 1 year in 2011). The SOA publication rate was comparable with other major orthopaedic conference publication rates, yet more than half of all abstracts remain unpublished. SOA attendees should be aware that approximately 40% of all accepted presentations will go unpublished. PMID:27518291

  6. Setting standards for medical writing in orthopaedics.

    PubMed

    Mauffrey, Cyril; Scarlat, Marius M; Pećina, Marko

    2014-01-01

    Once the privilege of few clinical scholars in the field of orthopaedics, medical writing has become a must for career advancement. The number of papers submitted and published yearly has increased steadily, and with the development of the Internet, manuscript and journals have become easily accessible. Medical writing has risen to become a discipline in itself, with rules and standards. However, heterogeneity in the quality of papers submitted still prevails, with large variations in both form and content. With countries such as China and India submitting an exponential number of manuscripts, it is important and helpful that standards of medical writing be emphasised to help writers who do not always have the required support to produce an outstanding manuscript. In this paper, we summarise what may become standards for medical writing in the field of orthopaedics.

  7. "Orthobot, to your station!" The application of the remote presence robotic system in orthopaedic surgery in Ireland: a pilot study on patient and nursing staff satisfaction.

    PubMed

    Daruwalla, Zubin J; Collins, D Ronan; Moore, David P

    2010-09-01

    The remote presence robotic system (RPRS) enables an individual to "be in two places at once". Its application includes various uses in medicine and surgery. However, its usefulness in the field of orthopaedic surgery has not been described. The objective of our pilot study was to determine patient and nursing staff satisfaction with the RPRS in an orthopaedic clinical setting in Ireland. We performed evening and weekend ward rounds to gain feedback and determine patient and nursing staff satisfaction with this innovative system. Questionnaires were handed to all patients and staff nurses involved. Both patients and nursing staff had very positive reactions to the RPRS in an orthopaedic postoperative care setting. Potential uses in orthopaedic surgery include clinical outreach in the setting of trauma, supervision in theatre, or watching theatre cases from outside the hospital, providing both patient and parent reassurance in paediatric orthopaedic cases, and, finally, in the setting of outpatient departments. Integration of the RPRS in an orthopaedic clinical setting has exciting and limitless potential. More so in this era in which it would allow trainees to benefit from teaching and training while also cutting down their in-house time and thus hospitals costs.

  8. National Audit of Seizure management in Hospitals (NASH): results of the national audit of adult epilepsy in the UK

    PubMed Central

    Dixon, Peter A; Kirkham, Jamie J; Marson, Anthony G; Pearson, Mike G

    2015-01-01

    Objectives About 100 000 people present to hospitals each year in England with an epileptic seizure. How they are managed is unknown; thus, the National Audit of Seizure management in Hospitals (NASH) set out to assess prior care, management of the acute event and follow-up of these patients. This paper describes the data from the second audit conducted in 2013. Setting 154 emergency departments (EDs) across the UK. Participants Data from 4544 attendances (median age of 45 years, 57% men) showed that 61% had a prior diagnosis of epilepsy, 12% other neurological problems and 22% were first seizure cases. Each ED identified 30 consecutive adult cases presenting due to a seizure. Primary and secondary outcome measures Details were recorded of the patient's prior care, management at hospital and onward referral to neurological specialists onto an online database. Descriptive results are reported at national level. Results Of those with epilepsy, 498 (18%) were on no antiepileptic drug therapy and 1330 (48%) were on monotherapy. Assessments were often incomplete and witness histories were sought in only 759 (75%) of first seizure patients, 58% were seen by a senior doctor and 57% were admitted. For first seizure patients, advice on further seizure management was given to 264 (27%) and only 55% were referred to a neurologist or epilepsy specialist. For each variable, there was wide variability among sites that was not explicable. For the sites who partook in both audits, there was a trend towards better care in 2013, but this was small and dwarfed by the intersite variability. Conclusions These results have parallels with the Sentinel Audit of Stroke performed a decade earlier. There is wide intersite variability in care covering the entire care pathway, and a need for better organised and accessible care for these patients. PMID:25829372

  9. The impact of disruptive innovations in orthopaedics.

    PubMed

    Hansen, Erik; Bozic, Kevin J

    2009-10-01

    The US healthcare system is currently facing daunting demographic and economic challenges. Because musculoskeletal disorders and disease represent a substantial and growing portion of this healthcare burden, novel approaches will be needed to continue to provide high-quality, affordable, and accessible orthopaedic care to our population. The concept of "disruptive innovations," which has been studied and popularized by Harvard Business School Professor Clayton Christensen, may offer a potential framework for developing strategies to improve quality and control costs associated with musculoskeletal care. The introduction of mobile fluoroscopic imaging systems, the development of the Surgical Implant Generation Network intramedullary nail for treatment of long bone fractures in the developing world, the expanding role and contributions of physician assistants and nurse practitioners to the orthopaedic team, and the rise of ambulatory surgery centers are all examples of disruptive innovations in the field of orthopaedics. Although numerous cultural and regulatory barriers have limited the widespread adoption of these "disruptive innovations," we believe they represent an opportunity for clinicians to regain leadership in health care while at the same time improving quality and access to care for patients with musculoskeletal disease.

  10. Tissue engineering principles in orthopaedic surgery.

    PubMed

    Jackson, D W; Simon, T M

    1999-10-01

    Advances in the fields of biotechnology and biomaterials offer the orthopaedic surgeon the exciting possibility of repair or regeneration of tissue lost to injury, disease, or aging. The promising area of tissue engineering represents a multidisciplinary approach aimed at solving some of the most perplexing biologic problems, namely, the creation of new tissues and organs similar to the original tissues and organs. In addition, strategies using new synthetic polymer formulations can facilitate tissue replacement and represent alternatives to tissue regeneration in certain conditions. Although biotechnology has broad application over many medical specialties, orthopaedics is receiving a large focus of the research effort devoted to techniques for developing bone, articular cartilage, ligaments, and tendons. Because bioengineered tissue and/or techniques to stimulate tissue regeneration soon may be used clinically, orthopaedic surgeons should have a working knowledge of the basic concepts involved. Terms, such as biomaterial, biotechnology, matrices of synthetic or biologic polymers or both, adhesion, cohesion, porosity, induction, conduction, stem cell, progenitor cell, mesenchymal cell, tissue growth factor, bone morphogenetic protein, mitogenic and chemotactic factors, and numerous other terms will become part of the working language of clinicians of the twenty-first century.

  11. Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

    PubMed Central

    New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

    2016-01-01

    Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

  12. Activity-based funding for National Health Service hospitals in England: managers' experience and expectations.

    PubMed

    Sussex, Jonathan; Farrar, Shelley

    2009-05-01

    Activity-based funding of hospital services has been introduced progressively since 2003 in the National Health Service (NHS) in England, under the name 'Payment by Results' (PbR). It represents a major change from previous funding arrangements based on annual "block" payments for large bundles of services. We interviewed senior local NHS managers about their experience and expectations of the impact of PbR. A high degree of 'NHS solidarity' was apparent, and competition between NHS hospitals was muted. PbR has been introduced against a background of numerous other efficiency incentives, and managers did not detect a further PbR-specific boost to efficiency. No impact on care quality, either positive or negative, is yet evident.

  13. Dutch Hospital Drug Formularies: pharmacotherapeutic variation and conservatism, but concurrence with national pharmacotherapeutic guidelines

    PubMed Central

    Fijn, R; Engels, S A G; Brouwers, J R B J; Knaap, R J; De Jong-Van den Berg, L T W

    2000-01-01

    Aims This research examines current hospital drug formularies (HDFs) of all Dutch general hospitals. It assesses the extent to which they recommend the same drugs, the breadth of their coverage in terms of therapeutic areas, drug groups incorporated and individuals drugs included, and their extent of conservatism by considering the year of introduction of the drugs included within groups. Furthermore, it considers the extent to which their recommendations concur and comply with those of national pharmacotherapeutic guidelines and the WHO Essential Drugs List (EDL). Methods Seventy-eight (81%) out of all 96 current Dutch HDFs were received of which 62 were suitable for study. Differences between HDFs and eventual associations with hospital characteristics were researched by statistical testing and case-control studies. To evaluate HDFs' concurrence with national guidelines and compliance with the WHO EDL, nine drug groups were studied in detail: benzodiazepines, calcium channel blockers, β-adrenoceptor blocking agents, ACE-inhibitors, angiotensin-II inhibitors, NSAIDs, H2-receptor antagonists, 5HT3-antagonists, and H+-pump inhibitors. Concurrence and compliance with national guidelines and the WHO EDL was defined as inclusion of recommended drugs. Non-concurrence was defined as inclusion of nonrecommended drugs. Results The total number of indications addressed and drug groups incorporated within HDFs varied from 28 to 72 (median 56) and from 30 to 123 (median 97), respectively. The total number of individual drug entities (pharmacological substances) included ranged from 239 to 658 (median 430) and the total number of drug products, including all different dosage forms, from 412 to 1121 (median 655). Within drug groups, drug entities first marketed were most frequently included. Teaching hospitals were most likely to include recently marketed drugs. Depending on the drug group, HDFs' concurrence and compliance with national guidelines and the WHO EDL ranged from

  14. Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data

    PubMed Central

    Ahmadi, Ali; Soori, Hamid; Mehrabi, Yadollah; Etemad, Koorosh; Sajjadi, Homeira; Sadeghi, Mehraban

    2015-01-01

    Background: Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis. Methods: This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data. Results: Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality. Conclusions: Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI. PMID:26730342

  15. Translational research in thoracic surgery—the National Taiwan University Hospital experience

    PubMed Central

    Lin, Mong-Wei; Yang, Pei-Wen

    2016-01-01

    Thoracic surgeons should be more aware of the latest information about histopathological, genetic and epigenetic alterations that may influence treatment policy and patient outcome in the biomolecular era. Translational research studies often produce a promising diagnostic tool or new treatment that can be used clinically. The results of these translational studies may even change the practical guidelines and current staging system in thoracic malignancies. The following article summarizes the experiences of translational research in esophageal cancer and non-small cell lung cancer (NSCLC) at National Taiwan University Hospital in Taiwan.

  16. Translational research in thoracic surgery—the National Taiwan University Hospital experience

    PubMed Central

    Lin, Mong-Wei; Yang, Pei-Wen

    2016-01-01

    Thoracic surgeons should be more aware of the latest information about histopathological, genetic and epigenetic alterations that may influence treatment policy and patient outcome in the biomolecular era. Translational research studies often produce a promising diagnostic tool or new treatment that can be used clinically. The results of these translational studies may even change the practical guidelines and current staging system in thoracic malignancies. The following article summarizes the experiences of translational research in esophageal cancer and non-small cell lung cancer (NSCLC) at National Taiwan University Hospital in Taiwan. PMID:27651941

  17. Translational research in thoracic surgery-the National Taiwan University Hospital experience.

    PubMed

    Lin, Mong-Wei; Yang, Pei-Wen; Lee, Jang-Ming

    2016-08-01

    Thoracic surgeons should be more aware of the latest information about histopathological, genetic and epigenetic alterations that may influence treatment policy and patient outcome in the biomolecular era. Translational research studies often produce a promising diagnostic tool or new treatment that can be used clinically. The results of these translational studies may even change the practical guidelines and current staging system in thoracic malignancies. The following article summarizes the experiences of translational research in esophageal cancer and non-small cell lung cancer (NSCLC) at National Taiwan University Hospital in Taiwan.

  18. Translational research in thoracic surgery-the National Taiwan University Hospital experience.

    PubMed

    Lin, Mong-Wei; Yang, Pei-Wen; Lee, Jang-Ming

    2016-08-01

    Thoracic surgeons should be more aware of the latest information about histopathological, genetic and epigenetic alterations that may influence treatment policy and patient outcome in the biomolecular era. Translational research studies often produce a promising diagnostic tool or new treatment that can be used clinically. The results of these translational studies may even change the practical guidelines and current staging system in thoracic malignancies. The following article summarizes the experiences of translational research in esophageal cancer and non-small cell lung cancer (NSCLC) at National Taiwan University Hospital in Taiwan. PMID:27651941

  19. 75 FR 32210 - United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-07

    ... Antitrust Division United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports.... Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine Institute, John Kloss..., Plaintiffs, vs. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...

  20. [Does the National HIV /AIDS Control programme provide support for district hospitals in Cameroon?].

    PubMed

    Keugoung, Basile; Fotsing, Richard; Macq, Jean; Buve, Anne; Marchal, Bruno; Meli, Jean; Criel, Bart

    2015-01-01

    The aim of this study was to investigate the effects of the national HIV/AIDS control programme on district hospitals in Cameroon. A multiple case study was conducted in two district hospitals- one public and one faith-based. Data were collected by document review, semi-structured interviews and observation of managerial processes and health care delivery. Programme interventions result in a series of positive and negative effects on the functioning of district hospitals and local health systems. High input and support of staff skills were observed for antiretroviral therapy and the management of opportunistic infections. However, the impact of the programme on the stewardship function is problematic. The low implication of district management teams in the implementation of HIV /AIDS activities reduces their structural capacity to run the local health systems. Programme and health system managers failed to take advantage of opportunities to develop synergies between the HIV/AIDS programme and local health systems. The HIV/AIDS programme weakens the systemic and structural capacity of local health systems. Managers of both programmes and general health systems should analyse and adapt their interventions in order to effective' strengthen health systems. One of the research questions is to understand why health system stakeholders do not seize opportunities to develop synergies between programmes and the general system and to strengthen health systems.

  1. Biological aging and social characteristics: gerontology, the Baltimore city hospitals, and the National Institutes of Health.

    PubMed

    Park, Hyung Wook

    2013-01-01

    The intramural gerontological research program in the National Institutes of Health underwent a substantial growth after its creation within the precincts of the Baltimore City Hospitals in 1940. This paper analyzes its development and the associated problems of its early years. Gerontologists aimed at improving the social and economic life of the elderly through scientific research. With this aim in mind, they conducted various investigations using the indigent aged patients of the Baltimore City Hospitals. Yet the scientists of aging, who hoped to eliminate negative social factors that might bias their research and heighten the confusion between pathology and aging per se, eventually stopped using these patients in the hospital as human subjects. Instead they sought educated affluent subjects in order to eliminate the impact of poverty. By doing so, however, they introduced a new source of social bias to their work, especially within the novel project begun in 1958, the Baltimore Longitudinal Study of Aging. This article thus examines the context of the development of gerontologists' research by analyzing their agenda, institutional environment, and research subjects in the 1940s and the 1950s.

  2. Establishment of national laboratory standards in public and private hospital laboratories.

    PubMed

    Anjarani, Soghra; Safadel, Nooshafarin; Dahim, Parisa; Amini, Rana; Mahdavi, Saeed; Mirab Samiee, Siamak

    2013-01-01

    In September 2007 national standard manual was finalized and officially announced as the minimal quality requirements for all medical laboratories in the country. Apart from auditing laboratories, Reference Health Laboratory has performed benchmarking auditing of medical laboratory network (surveys) in provinces. 12(th) benchmarks performed in Tehran and Alborz provinces, Iran in 2010 in three stages. We tried to compare different processes, their quality and accordance with national standard measures between public and private hospital laboratories. The assessment tool was a standardized checklist consists of 164 questions. Analyzing process show although in most cases implementing the standard requirements are more prominent in private laboratories, there is still a long way to complete fulfillment of requirements, and it takes a lot of effort. Differences between laboratories in public and private sectors especially in laboratory personnel and management process are significant. Probably lack of motivation, plays a key role in obtaining less desirable results in laboratories in public sectors.

  3. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system

    PubMed Central

    Petrie, J; Easton, S; Naik, V; Lockie, C; Brett, S J; Stümpfle, R

    2015-01-01

    Objectives There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY). Setting We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention). Participants Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system. Results Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1–2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50 000, cost per CPC 1–2 survivor was £65 000. Cost and length of stay of CPC 1–2 patients was considerably lower than CPC 3–4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1–2 survivor per QALY was £16 000. Conclusions The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective. PMID:25838503

  4. 'Shell shock' revisited: an examination of the case records of the National Hospital in London.

    PubMed

    Linden, Stefanie Caroline; Jones, Edgar

    2014-10-01

    During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain's leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient's military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

  5. Nation-wide prospective surveillance of Clostridium difficile infections in hospitals in Belgium, July 2007-June 2008.

    PubMed

    Lambert, M L; Mertens, K; Ramboer, I; Delmée, M; Suetens, C

    2009-01-01

    We report here baseline data from the first year of compulsory surveillance of Clostridium difficile infections (CDI) in hospitals in Belgium. Between 1 July 2007 and 30 June 2008, 2,704 CDI were reported: 12% were recurrent and 66% were hospital-associated (half of which occurred 15 days or more after admission). CDI was considered the cause of death (direct or indirect) for 10% of the episodes. The median incidence of CDI was 1.5 per 1,000 admissions and 1.9 per 10,000 hospital-days for all cases, and 0.9 per 1,000 admissions, and 1.1 per 10,000 hospital-days for hospital-associated cases. Further investigation of risk stratification by average length of stay in the reporting hospitals is warranted as a way to improve the comparability of indicators across hospitals and surveillance systems. In spite of methodological issues, the surveillance of CDI in Belgian hospitals has been able to produce robust baseline data that should allow monitoring of trends at hospital and national level, and provide a basis for international comparisons. Remaining challenges are to define and monitor targets for the control of CDI, and to improve the individual feed-back of data at hospital level. PMID:19371509

  6. The reconstructive microsurgery ladder in orthopaedics.

    PubMed

    Tintle, Scott M; Levin, L Scott

    2013-03-01

    Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article.

  7. Nanostructured diamond coatings for orthopaedic applications

    PubMed Central

    CATLEDGE, S.A.; THOMAS, V.; VOHRA, Y.K.

    2013-01-01

    With increasing numbers of orthopaedic devices being implanted, greater emphasis is being placed on ceramic coating technology to reduce friction and wear in mating total joint replacement components, in order to improve implant function and increase device lifespan. In this chapter, we consider ultra-hard carbon coatings, with emphasis on nanostructured diamond, as alternative bearing surfaces for metallic components. Such coatings have great potential for use in biomedical implants as a result of their extreme hardness, wear resistance, low friction and biocompatibility. These ultra-hard carbon coatings can be deposited by several techniques resulting in a wide variety of structures and properties. PMID:25285213

  8. The reconstructive microsurgery ladder in orthopaedics.

    PubMed

    Tintle, Scott M; Levin, L Scott

    2013-03-01

    Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article. PMID:23352571

  9. Irish National Joint Registry: a concept.

    PubMed

    Oduwole, K O; Codd, M B; Byrne, F; O'Byrne, J; Kenny, P J

    2008-12-01

    Despite the well-documented benefits, some countries have yet to agree on the establishment of a national joint register. A questionnaire study was undertaken to ascertain the opinions of the consultant orthopaedic surgeons and specialist registrars, regarding establishment of an Irish National Joint Register. The aim was to find out the possible reasons why a national joint register has not been established in Ireland. A 69% first response rate was recorded. Ninety-seven percent believe it is time to set up a registry and 81% say it should be made compulsory for unwilling surgeons and hospitals to participate. Despite the overwhelming support, privacy and liability issues were major concerns. Fifty-eight percent agree that access to registry report by general public can expose surgeons and hospitals to medico-legal implications. Legislation may be required to protect the integrity of a national joint replacement registry to ensure that the data are used as intended.

  10. Surgeons' knowledge about the costs of orthopaedic implants.

    PubMed

    Rohman, Lebur; Hadi, Saifullah; Whitwell, George

    2014-08-01

    PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed. PMID:25163960

  11. Incidence of “never events” among weekend admissions versus weekday admissions to US hospitals: national analysis

    PubMed Central

    Attenello, Frank J; Cen, Steven Y; Ng, Alvin; Kim-Tenser, May; Sanossian, Nerses; Amar, Arun P; Mack, William J

    2015-01-01

    Objective To evaluate the association between weekend admission to hospital and 11 hospital acquired conditions recently considered by the Centers for Medicare and Medicaid as “never events” for which resulting healthcare costs are not reimbursed. Design National analysis. Setting US Nationwide Inpatient Sample discharge database. Participants 351 million patients discharged from US hospitals, 2002-10. Main outcome measures Univariate rates and multivariable likelihood of hospital acquired conditions among patients admitted on weekdays versus weekends, as well as the impacts of these events on prolonged length of stay and total inpatient charges. Results From 2002 to 2010, 351 170 803 patients were admitted to hospital, with 19% admitted on a weekend. Hospital acquired conditions occurred at an overall frequency of 4.1% (5.7% among weekend admissions versus 3.7% among weekday admissions). Adjusting for patient and hospital cofactors the probability of having one or more hospital acquired conditions was more than 20% higher in weekend admissions compared with weekday admissions (odds ratio 1.25, 95% confidence interval 1.24 to 1.26, P<0.01). Hospital acquired conditions have a negative impact on both hospital charges and length of stay. At least one hospital acquired condition was associated with an 83% (1.83, 1.77 to 1.90, P<0.01) likelihood of increased charges and 38% likelihood of prolonged length of stay (1.38, 1.36 to 1.41, P<0.01). Conclusion Weekend admission to hospital is associated with an increased likelihood of hospital acquired condition, cost, and length of stay. Future protocols and staffing regulations must be tailored to the requirements of this high risk subgroup. PMID:25876878

  12. Social Competence and Temperament in Children with Chronic Orthopaedic Disability

    ERIC Educational Resources Information Center

    Yagmurlu, Bilge; Yavuz, H. Melis

    2015-01-01

    The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds.…

  13. Do Politics Matter to an Orthopaedic Surgeon? (They Should!).

    PubMed

    Lee, Adam K; Sethi, Manish K

    2015-11-01

    Orthopaedic trauma care is intimately tied with health policy, and current changes with health care reform may change how trauma care is delivered. This article offers a brief history of modern health care and the implications of new policies on the practice of orthopaedic trauma.

  14. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System.

    PubMed

    Volpe, M; Scaldaferri, F; Ojetti, V; Poscia, A

    2013-01-01

    The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease.

  15. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System.

    PubMed

    Volpe, M; Scaldaferri, F; Ojetti, V; Poscia, A

    2013-01-01

    The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease. PMID:24443075

  16. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic

    PubMed Central

    2013-01-01

    Background In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model. Methods 120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen’s kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care. Results The majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly

  17. The Hospital for the Ruptured and Crippled Renamed The Hospital for Special Surgery 1940; The War Years 1941–1945

    PubMed Central

    2008-01-01

    In 1939, the 75th anniversary program marking the founding of the Hospital for the Ruptured and Crippled (R & C), the oldest orthopaedic hospital in the nation, was held at the hospital site in New York City. Dr. Philip D. Wilson, Surgeon-in-Chief since 1935, used this event to mark the return of the hospital to its leadership role in the country. When the Hospital for the Ruptured and Crippled first opened its doors on May 1, 1863, the name of the hospital was not unusual; it described the type of patients treated. In 1940, the Board of Managers with guidance from Dr. Wilson changed the name to the Hospital for Special Surgery (HSS). In 1941, with Britain engaged in a European war, Dr. Wilson felt there was a need for the Americans to support the British. He personally organized the American Hospital in Britain, a privately funded voluntary unit, to help care for the wounded. After the United States actually entered World War II in December 1941, HSS quickly organized support at all levels with a significant number of professional and auxiliary staff, eventually enlisting in the military. Even with such staff turnover, the hospital continued to function under Dr. Wilson’s leadership. After the war ended in 1945, Wilson forged ahead to further restore HSS as a leader in musculoskeletal medicine and surgery. PMID:19048348

  18. Validity of NBME Parts I and II for the Selection of Residents: The Case of Orthopaedic Surgery.

    ERIC Educational Resources Information Center

    Case, Susan M.

    The predictive validity of scores on the National Board of Medical Examiners (NBME) Part I and Part II examinations for the selection of residents in orthopaedic surgery was investigated. Use of NBME scores has been criticized because of the time lag between taking Part I and entering residency and because Part I content is not directly linked to…

  19. Awareness of, responsiveness to and practice of patients’ rights at Uganda's national referral hospital

    PubMed Central

    Kibuule, Dan; Mitonga-Kabwebwe, Honoré; Ekirapa-Kiracho, Elizabeth; Ssempebwa, John C.

    2013-01-01

    Abstract Background The realisation of patients’ rights in resource-constrained and patient-burdened public health care settings in Uganda remains an obstacle towards quality health care delivery, health care-seeking behaviour and health outcomes. Although the Uganda Patients’ Charter of 2009 empowers patients to demand quality care, inequitable access and abuse remain common. Aim The study aimed to assess level of awareness of, responsiveness to and practice of patients’ rights amongst patients and health workers (HWs) at Uganda's national referral hospital, Mulago Hospital in Kampala. Methods A three-phase cross-sectional questionnaire-based descriptive survey was conducted amongst 211 patients, 98 HWs and 16 key informants using qualitative and quantitative data collection methods. The study was conducted in May–June 2012, 2.5 years after the launch of the Uganda Patients’ Charter. Results At least 36.5% of patients faced a challenge regarding their rights whilst seeking health care. Most of the patients (79%) who met a challenge never attempted to demand their rights. Most patients (81.5%) and HWs (69.4%) had never heard of the Uganda Patients’ Charter. Awareness of patients’ rights was significantly higher amongst HWs (70%) than patients (40%) (p < 0.01). Patients’ awareness was associated with education level (χ2 = 42.4, p < 0.001), employment status (χ2 = 33.6, p < 0.001) and hospital visits (χ2 = 3.9, p = 0.048). For HWs it was associated with education level (χ2 = 155.6, p < 0.001) and length of service (χ2 = 154.5, p <0.001). Patients feel powerless to negotiate for their rights and fear being discriminated against based on their ability to bribe HWs with money to access care, and political, socio-economic and tribal status. Conclusion and recommendations Awareness of, responsiveness to and practice of patients’ rights remains limited at Mulago Hospital. There is a need for urgent implementation of an integrated multilevel

  20. The management of pain in orthopaedics.

    PubMed

    Fetrow, K O

    1989-01-01

    The three general methods of treating pain are pharmacologic, physical and psychological. The goal of medical management of the patient with pain and inflammation is to relieve these symptoms with minimal side effects and inconvenience. Pain associated with inflammation may be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin. All NSAIDs relieve pain and stiffness in a similar manner; their primary action appears to be the inhibition of the cyclo-oxygenase system in the arachidonic acid cascade. When prescribing NSAIDs for orthopaedic pain and inflammation, it seems sensible to start with aspirin because of its low cost and safety at analgesic doses. However, if safety and low incidence of side effects are the most important factors in determining appropriate therapy, newer NSAIDs such as ketoprofen will be preferred. The relief of pain is an important aspect of postoperative care. Parenteral and oral opiates serve as the standard against which other therapies for severe pain are compared. When pain cannot be adequately controlled with intramuscular or subcutaneous opiates, intravenous opiates controlled by the patient (patient-controlled analgesia) are often useful. Relatively small doses of epidural or intrathecal opiates can also be used to achieve postoperative pain relief. Thus, treatment for orthopaedic pain begins with NSAIDs, followed by an oral opiate combined with acetaminophen, aspirin, or another NSAID. If these regimens are ineffective, oral opiates followed by parenteral opiates may be tried.

  1. Health-promoting organization and organizational effectiveness of health promotion in hospitals: a national cross-sectional survey in Taiwan.

    PubMed

    Lin, Yea-Wen; Lin, Yueh-Ysen

    2011-09-01

    To assess the organizational health-promotion (HP) status and its effect on the organizational effectiveness of HP in a national cross-sectional survey of all hospitals above the local community hospital level in Taiwan's hospitals, questionnaires were sent to 474 hospitals, of which 162 (34.18%) hospitals returned them and were rendered valid. The results of the organizational HP status reveal that the standardized overall score achieved is 76.26, suggesting that there is considerable room for improvement. The results of correlation analysis partially support the proposition of this study, suggesting that the higher the organizational HP status, the better the self-evaluated overall organizational and administrative effectiveness of its HP. When hierarchical multiple regression was performed, support for ownership (private hospitals), hospital accreditation grades (academic medical centers) and overall score of the Organizational Health of Hospital Assessment Scale were significant predicators of self-evaluated overall organizational effectiveness (F = 11.097, p < 0.01, R(2) = 0.369). Moreover, drafted annually, HP policies and plans and the number of staff HP training activities were found to partially mediate the relation between the organizational HP status, hospital characteristics and self-evaluated overall organizational effectiveness. The results contribute to clarify the conception of health-promoting hospital organizations and to identify a number of dimensions of health-promoting organizations related to the organizational effectiveness of HP in hospitals, which could allow hospitals to establish a healthier organization and more effective HP programs. This study also supplies the research field with important data and insights that can be used in future research.

  2. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012

    PubMed Central

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-01-01

    Objectives Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. Setting and design A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. Primary outcome measures (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. Results National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Conclusions Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by

  3. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    PubMed Central

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. Materials and Methods A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. Results The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. Conclusions This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant. PMID:26104740

  4. Biomaterials use in Mulago National Referral Hospital in Kampala, Uganda: Access and affordability.

    PubMed

    Bakwatanisa, Bosco; Enywaku, Alfred; Kiwanuka, Martin; Lamunu, Claire; Mbowa, Nicholas; Mukiibi, Denis; Namayega, Catherine; Ngabirano, Beryl; Ntambi, Henry; Reichert, William

    2016-01-01

    Students in Biomaterials BBE3102 at Makerere University in Kampala, Uganda were assigned semester long group projects in the first semester of the 2014-15 academic year to determine the biomaterials type and usage in Mulago National Referral Hospital, which is emblematic of large public hospitals across East Africa. Information gathering was conducted through student interviews with Mulago physicians because there were no archival records. The students divided themselves into seven project groups covering biomaterials use in the areas of wound closure, dental and oral surgery, cardiology, burn care, bone repair, ophthalmology and total joint replacement. As in the developed world, the majority of biomaterials used in Mulago are basic wound closure materials, dental materials, and bone fixation materials, all of which are comparatively inexpensive, easy to store, and readily available from either the government or local suppliers; however, there were significant issues with the implant supply chain, affordability, and patient compliance and follow-up in cases where specialty expertise and expensive implants were employed. PMID:26190587

  5. [From the medieval hospitals hospices to modern National public Health Institutes].

    PubMed

    de Micheli, Alfredo

    2016-01-01

    Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the xvii century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez. PMID:25862293

  6. [From the medieval hospitals hospices to modern National public Health Institutes].

    PubMed

    de Micheli, Alfredo

    2016-01-01

    Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the xvii century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez.

  7. High Survival Rates and Associated Factors Among Ebola Virus Disease Patients Hospitalized at Donka National Hospital, Conakry, Guinea

    PubMed Central

    Qureshi, Adnan I.; Chughtai, Morad; Bah, Elhadj Ibrahima; Barry, Moumié; Béavogui, Kézély; Loua, Tokpagnan Oscar; Malik, Ahmed A.

    2015-01-01

    Background Anecdotal reports suggesting that survival rates among hospitalized patients with Ebola virus disease in Guinea are higher than the 29.2% rate observed in the current epidemic in West Africa. Methods Survival after symptom onset was determined using Kaplan Meier survival methods among patients with confirmed Ebola virus disease treated in Conakry, Guinea from March 25, 2014, to August 5, 2014. We analyzed the relationship between survival and patient factors, including demographics and clinical features. Results Of the 70 patients analyzed [mean age ± standard deviation (SD), 34 ± 14.1; 44 were men], 42 were discharged alive with a survival rate among hospitalized patients of 60% (95% confidence interval, 41.5–78.5%). The survival rate was 28 (71.8%) among 39 patients under 34 years of age, and 14 (46.7%) among 30 patients aged 35 years or greater (p = 0.034). The rates of myalgia (3 of 42 versus 7 of 28, p = 0.036) and hiccups (1 of 42 versus 5 of 28, p = 0.023) were significantly lower among patients who survived. Conclusions Our results provide insights into a cohort of hospitalized patients with Ebola virus disease in whom survival is prominently higher than seen in other cohorts of hospitalized patients. PMID:25992182

  8. [Complicated chickenpox in a national pediatric Peruvian hospital, 2001-2011].

    PubMed

    Miranda-Choque, Edwin; Candela-Herrera, Jorge; Díaz-Pera, Javier; Farfán-Ramos, Sonia; Muñoz-Junes, Edith María; Escalante-Santivañez, Imelda Rita

    2013-03-01

    The objective of the study was to describe the clinical and epidemiological characteristics of complicated chickenpox cases seen at the National Institute of Children's Health (INSN, Spanish acronym) of Peru from 2001 to 2011. A case series was collected, including a total of 1,073 children with complicated chickenpox. The median age was 2.5 years (IQR 1.1-4.8 years), of which 578 (54%) were male. The most frequent complications were secondary skin and soft tissue infections with 768 cases (72%). 13 deaths (1.4%) were recorded. In conclusion, the hospitalizations due to complicated chickenpox in the INSN included mostly children under five, with a short stay and a low proportion of deaths most complications being related to secondary skin and soft tissue infections.

  9. Multiple sclerosis in Mexico: hospital cases at the National Institute of Neurology and Neurosurgery, Mexico City.

    PubMed

    Corona, T; Rodrigues, J L; Otero, E; Stopp, L

    1996-05-01

    The frequency and clinical features of multiple sclerosis (MS) at the National Institute of Neurology and Neurosurgery in Mexico City for the period spanning 1984-1993 is presented. Hospital records of patients with clinically diagnosed MS were selected, the frequency and cumulative frequency of this diagnosis were determined and demographic information and clinical features were recorded. It was found that 70% of the patients were women, 25% were professionals, and 95% were of mixed race. The clinical features of our patients and their neuroimages were consistent with those of MS patients in other populations. Importantly, we found that the frequency of MS has almost doubled over the last 10 years. The reason for this phenomenon is discussed as resulting from better health screening, the availability of nuclear magnetic resonance imaging, and the cultural, demographic and dietary changes that have occurred due to the rapid urbanization of our country.

  10. The Dutch Hospital Standardised Mortality Ratio (HSMR) method and cardiac surgery: benchmarking in a national cohort using hospital administration data versus a clinical database

    PubMed Central

    Siregar, S; Pouw, M E; Moons, K G M; Versteegh, M I M; Bots, M L; van der Graaf, Y; Kalkman, C J; van Herwerden, L A; Groenwold, R H H

    2014-01-01

    Objective To compare the accuracy of data from hospital administration databases and a national clinical cardiac surgery database and to compare the performance of the Dutch hospital standardised mortality ratio (HSMR) method and the logistic European System for Cardiac Operative Risk Evaluation, for the purpose of benchmarking of mortality across hospitals. Methods Information on all patients undergoing cardiac surgery between 1 January 2007 and 31 December 2010 in 10 centres was extracted from The Netherlands Association for Cardio-Thoracic Surgery database and the Hospital Discharge Registry. The number of cardiac surgery interventions was compared between both databases. The European System for Cardiac Operative Risk Evaluation and hospital standardised mortality ratio models were updated in the study population and compared using the C-statistic, calibration plots and the Brier-score. Results The number of cardiac surgery interventions performed could not be assessed using the administrative database as the intervention code was incorrect in 1.4–26.3%, depending on the type of intervention. In 7.3% no intervention code was registered. The updated administrative model was inferior to the updated clinical model with respect to discrimination (c-statistic of 0.77 vs 0.85, p<0.001) and calibration (Brier Score of 2.8% vs 2.6%, p<0.001, maximum score 3.0%). Two average performing hospitals according to the clinical model became outliers when benchmarking was performed using the administrative model. Conclusions In cardiac surgery, administrative data are less suitable than clinical data for the purpose of benchmarking. The use of either administrative or clinical risk-adjustment models can affect the outlier status of hospitals. Risk-adjustment models including procedure-specific clinical risk factors are recommended. PMID:24334377

  11. Time Trends in Hospital Admissions for Bronchiectasis: Analysis of the Spanish National Hospital Discharge Data (2004 to 2013)

    PubMed Central

    Sánchez-Muñoz, Gema; López de Andrés, Ana; Jiménez-García, Rodrigo; Carrasco-Garrido, Pilar; Hernández-Barrera, Valentín; Pedraza-Serrano, Fernando; Puente-Maestu, Luis; de Miguel-Díez, Javier

    2016-01-01

    Objective To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) for patients with bronchiectasis who were hospitalized in Spain over a 10-year period. Methods We included all admissions for patients diagnosed with bronchiectasis as primary or secondary diagnosis during 2004–2013. Results 282,207 patients were admitted to the study. After controlling for possible confounders, we observed a significant increase in the incidence of hospitalizations over the study period when bronchiectasis was a secondary diagnosis. When bronchiectasis was the primary diagnosis we observed a significant decline in the incidence. In all cases, this pathology was more frequent in males, and the average age and comorbidity increased significantly during the study period (p<0.001). When bronchiectasis was the primary diagnosis, the most frequent secondary diagnosis was Pseudomonas aeruginosa infection. When bronchiectasis was the secondary diagnosis, the most frequent primary diagnosis was COPD. IHM was low, tending to decrease from 2004 to 2013 (p<0.05). The average LOHS decreased significantly during the study period in both cases (p<0.001). The mean cost per patient decreased in patients with bronchiectasis as primary diagnosis, but it increased for cases of bronchiectasis as secondary diagnosis (p<0.001). Conclusions Our results reveal an increase in the incidence of hospital admissions for patients with bronchiectasis as a secondary diagnosis from 2004 to 2013, as opposed to cases of bronchiectasis as the primary diagnosis. Although the average age and comorbidity significantly increased over time, both IHM and average LOHS significantly decreased. PMID:27622273

  12. Approach to pain management in chronic opioid users undergoing orthopaedic surgery.

    PubMed

    Devin, Clinton J; Lee, Dennis S; Armaghani, Sheyan J; Bible, Jesse; Shau, David N; Martin, Peter R; Ehrenfeld, Jesse M

    2014-10-01

    Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. Preoperative evaluation provides an opportunity to estimate a patient's preoperative opioid intake, discuss pain-related fears, and identify potential psychiatric comorbidities. Patients using high levels of opioids may also require referral to an addiction specialist. Various regional blockade and pharmaceutical options are available to help control perioperative pain, and a multimodal pain management approach may be of particular benefit in chronic opioid users undergoing orthopaedic surgery. PMID:25281256

  13. 45 CFR 60.12 - Information which hospitals must request from the National Practitioner Data Bank.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... be requested. Each hospital, either directly or through an authorized agent, must request information... (courtesy or otherwise), or for clinical privileges at the hospital; and (2) Every 2 years concerning any...), or has clinical privileges at the hospital. (b) Failure to request information. Any hospital...

  14. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.

    PubMed

    Romanova, K; Vassileva, J; Alyakov, M

    2015-07-01

    The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens.

  15. Multiple myeloma: diagnosis and orthopaedic implications.

    PubMed

    Scharschmidt, Thomas J; Lindsey, Joshua D; Becker, Pamela S; Conrad, Ernest U

    2011-07-01

    Multiple myeloma is a hematologic malignancy that commonly affects the skeletal system. The disease is primarily managed medically with chemotherapeutic agents. Pathologic fractures are common in patients with diagnosed and undiagnosed disease. The number of patients diagnosed with multiple myeloma is increasing, as is the incidence of associated pathologic fractures. Novel chemotherapeutic agents and radiation therapy protocols have been used to extend the average life span of patients with this disease. Various methods that allow for restoration of function and pain reduction can be used to stabilize and manage fractures associated with multiple myeloma. The orthopaedic surgeon and oncology team must work together to develop an individualized treatment plan to improve patient quality of life and provide pain relief.

  16. Fabricating specialised orthopaedic implants using additive manufacturing

    NASA Astrophysics Data System (ADS)

    Unwin, Paul

    2014-03-01

    It has been hypothesised that AM is ideal for patient specific orthopaedic implants such as those used in bone cancer treatment, that can rapidly build structures such as lattices for bone and tissues to in-grow, that would be impossible using current conventional subtractive manufacturing techniques. The aim of this study was to describe the adoption of AM (direct metal laser sintering and electron beam melting) into the design manufacturing and post-manufacturing processes and the early clinical use. Prior to the clinical use of AM implants, extensive metallurgical and mechanical testing of both laser and electron beam fabrications were undertaken. Concurrently, post-manufacturing processes evaluated included hipping, cleaning and coating treatments. The first clinical application of a titanium alloy mega-implant was undertaken in November 2010. A 3D model of the pelvic wing implant was designed from CT scans. Novel key features included extensive lattice structures at the bone interfaces and integral flanges to fix the implant to the bone. The pelvic device was implanted with the aid of navigation and to date the patient remains active. A further 18 patient specific mega-implants have now been implanted. The early use of this advanced manufacturing route for patient specific implants has been very encouraging enabling the engineer to produce more advanced and anatomical conforming implants. However, there are a new set of design, manufacturing and regulatory challenges that require addressing to permit this technique to be used more widely. This technology is changing the design and manufacturing paradigm for the fabrication of specialised orthopaedic implants.

  17. [Functional and orthopaedic aspects of dystrophinopathies].

    PubMed

    Boulay, C; Finidori, G

    2015-12-01

    Although the clinical picture and the natural progression of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) differ, borderline forms exist. Classical orthopaedic treatment is based on self-rehabilitation (by the parents and the patient), physical therapy, posture alignment with orthotics, ergotherapy to set up technical aides, notably positioning in an electric wheelchair to provide more satisfactory autonomy. The functional aspect predominates over pure orthopaedics. Although surgical indications have evolved for the lower limbs, pelvic-spinal arthrodesis for treatment of scoliosis remains the reference treatment, but the methods have evolved since the advent of corticotherapy for DMD. Corticotherapy slows the progression of motor deficits, the age at which walking ability is lost is delayed (shifting from 10 years to 13-14 years depending on the studies), scoliosis progresses later, respiratory insufficiency is better controlled, and therefore survival is prolonged (between 20 and 40 years). However, although this functional aspect seems to respond better to the progress in overall treatment, it also results from a multidisciplinary approach to the disease. Nevertheless, assessment is required, not at a time t as reflected by the scales currently in use, but during daily activities as proposed by qualitative and quantitative monitoring seeking to model nyctohemeral functional motor skills. The principle is to characterize the type of activity (sitting, standing, lying down, walking), its duration, its intensity (walking speed), its frequency (number of activity changes, number of walking episodes), and their sequence (temporal sequence, organization of activity variation). The goal is to identify the variety of functional motor skills and their occurrence over time to determine whether treatment contributes a functional benefit and whether this benefit is put into practice daily. PMID:26773586

  18. Major ablative procedures in orthopaedic surgery.

    PubMed

    Soucacos, P N; Dailiana, Z H; Beris, A E; Xenakis, T H; Malizos, K N; Chrisovitsinos, J

    1996-01-01

    In the presence of the notable progress in limb-sparing techniques afforded by the developments in microsurgery and musculoskeletal oncology, major ablative surgery of the extremities still remains a last-resort, yet powerful tool in managing patients with primary tumors in whom wide excision is not possible, as well as in cases with severe trauma to the limbs. During the last thirteen years, eight major ablative procedures were performed at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Seven out of the eight procedures were performed in patients with primary malignant tumors either because the anatomical location or multiple recurrences of the tumor did not allow removal by wide local excision or by amputation at a lower level. In one patient, the procedure was related to a severe, mangling trauma. Four illustrative cases of the eight major ablative procedures performed are reported to highlight the current indications of this rarely used, complex, and extensive surgery. The characteristic cases presented are: hemipelvectomy in a patient with chondrosarcoma of the pelvis, disarticulation of the hip in a patient with a malignant histiocytoma of the supracondylar area of the knee, forequarter amputation in a patient with a basal cell carcinoma of the axilla, and disarticulation of the shoulder in a patient with an incomplete nonviable amputation at the level of the shoulder girdle associated with severe damage to the brachial plexus and axillary artery. After a five to over a ten year follow-up, six of the eight patients who where subjected to major ablative procedures are doing well and are satisfactorily active. These cases reflect the dilemma that orthopaedic surgeons geons still face in selecting limb salvage or major ablative surgery in cases of aggressive malignant tumors to severe trauma. PMID:8771355

  19. Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands

    PubMed Central

    Hofstede, Stefanie N; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J; van Bodegom-Vos, Leti

    2015-01-01

    Objectives National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons. Setting We performed two cross-sectional internet-based surveys among patients and orthopaedic surgeons throughout the Netherlands. Participants 195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate. Primary and secondary outcome measures The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections. Results 174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients. Conclusions While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy

  20. The relationship between healthy lifestyle and hospital utilization among adults with diabetes: results from a national cohort in Taiwan.

    PubMed

    Li, Chia-Lin; Sheu, Ji-Tian; Wang, Ting-Ann; Wen, Yu-Ping; Chao, Minston; Chang, Hsing-Yi

    2015-04-01

    The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.

  1. Acute pain services in Europe: a 17-nation survey of 105 hospitals. The EuroPain Acute Pain Working Party.

    PubMed

    Rawal, N; Allvin, R

    1998-05-01

    A 17-nation survey was undertaken with the aim of studying the availability of acute pain services (APS) and the use of newer analgesic techniques, such as epidural and patient-controlled analgesia (PCA). A questionnaire was mailed to selected anaesthesiologists in 105 European hospitals from 17 countries. Depending on the population, between five and ten representative hospitals from each country were selected by a country coordinator. A total of 101 (96.2%) completed questionnaires were returned. A majority of respondents were dissatisfied with pain management on surgical wards. Pain management was better in post-anaesthesia care units (PACUs); however, 27% of participating hospitals did not have PACUs. There were no organized APS in 64% of hospitals, although anaesthesiologists from chronic pain centres were available for consultation. In the hospitals that had APS, the responsible person for the APS was either: (1) a junior anaesthesiologist (senior anaesthesiologist available for consultation); or (2) a specially trained nurse (supervised by consultant anaesthesiologists). Many anaesthesiologists were unable to introduce techniques such as PCA on wards because of the high equipment costs. Although 40% of hospitals used a visual analogue scale (VAS) or other methods for assessment of pain intensity, routine pain assessment and documenting on a vital sign chart was rarely practised. There was a great variation in routines for opioid prescription and documentation procedures. Nursing regulations regarding injection of drugs into epidural and intrathecal catheters also varied considerably between countries. This survey of 105 hospitals from 17 European countries showed that over 50% of anaesthesiologists were dissatisfied with post-operative pain management on surgical wards. Only 34% of hospitals had an organized APS, and very few hospitals used quality assurance measures such as frequent pain assessment and documentation. There is a need to establish organized

  2. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort.

    PubMed

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang; Bonde, Jens Peter; Nøhr, Ellen-Aagaard; Llopis-González, Agustín; Olsen, Jørn

    2009-01-01

    In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working during pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards. PMID:19886351

  3. Disability and Hospital Care Expenses among National Health Insurance Beneficiaries: Analyses of Population-Based Data in Taiwan

    ERIC Educational Resources Information Center

    Lin, Lan-Ping; Lee, Jiunn-Tay; Lin, Fu-Gong; Lin, Pei-Ying; Tang, Chi-Chieh; Chu, Cordia M.; Wu, Chia-Ling; Lin, Jin-Ding

    2011-01-01

    Nationwide data were collected concerning inpatient care use and medical expenditure of people with disabilities (N = 937,944) among national health insurance beneficiaries in Taiwan. Data included gender, age, hospitalization frequency and expenditure, healthcare setting and service department, discharge diagnose disease according to the ICD-9-CM…

  4. The Implications of the National Minimum Wage for Training Practices and Skill Utilisation in the United Kingdom Hospitality Industry

    ERIC Educational Resources Information Center

    Norris, Gill; Williams, Steve; Adam-Smith, Derek

    2003-01-01

    Two key issues thrown up by the 1999 introduction of the National Minimum Wage (NMW) in the United Kingdom are its likely impact on employers' training practices in low paying sectors of the economy and the implications for skills. Based on a study of the hospitality industry, this article assesses the limited significance of the differential,…

  5. Regulatory authorities and orthopaedic clinical trials on expanded mesenchymal stem cells.

    PubMed

    Gómez-Barrena, Enrique; Solá, Cristina Avendaño; Bunu, Carmen Painatescu

    2014-09-01

    Skeletal injuries requiring bone augmentation techniques are increasing in the context of avoiding or treating difficult cases with bone defects, bone healing problems, and bone regeneration limitations. Musculoskeletal severe trauma, osteoporosis-related fractures, and conditions where bone defect, bone collapse or insufficient bone regeneration occur are prone to disability and serious complications. Bone cell therapy has emerged as a promising technique to augment and promote bone regeneration. Interest in the orthopaedic community is considerable, although many aspects related to the research of this technique in specific indications may be insufficiently recognised by many orthopaedic surgeons. Clinical trials are the ultimate research in real patients that may confirm or refute the value of this new therapy. However, before launching the required trials in bone cell therapy towards bone regeneration, preclinical data is needed with the cell product to be implanted in patients to ensure safety and efficacy. These preclinical studies support the end-points that need to be evaluated in clinical trials. Orthopaedic surgeons are the ultimate players that, through their research, would confirm in clinical trials the benefit of bone cell therapies. To further foster this research, the pathway to eventually obtain authorisation from the National Competent Authorities and Research Ethics Committees under the European regulation is reviewed, and the experience of the REBORNE European project offers information and important clues about the current Voluntary Harmonization Procedure and other opportunities that need to be considered by surgeons and researchers on the topic.

  6. National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

    PubMed

    Best, Matthew J; Buller, Leonard T; Miranda, Alejandro

    2015-01-01

    Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care. PMID:26213159

  7. National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

    PubMed

    Best, Matthew J; Buller, Leonard T; Miranda, Alejandro

    2015-01-01

    Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care.

  8. A systems approach to managing conflict in orthopaedic nursing.

    PubMed

    Maher, C A

    1991-01-01

    Conflict management is considered from a psychologic perspective. Therein, a systems approach to managing conflict is described with particular reference to orthopaedic nursing practice. Within that context, conflict management is portrayed as a process that is applied by orthopaedic nurses to particular conflict situations by means of separate, yet interrelated phases: clarification of the conflict situation; design of a conflict resolution plan; implementation of the plan; and evaluation of the extent to which conflict has been resolved. Application of this systems approach by orthopaedic nursing managers or by staff nurses may be valuable in focusing their attention and that of other health care providers on important behaviors, tasks, and accomplishments rather than on personality constructs and other noncontrollable correlates of managing conflict effectively. Directions for empirical inquiry relating to conflict management in orthopaedic nursing are briefly considered. PMID:2052411

  9. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

    PubMed

    Watters, William; Rethman, Michael P; Hanson, Nicholas Buck; Abt, Elliot; Anderson, Paul A; Carroll, Karen C; Futrell, Harry C; Garvin, Kevin; Glenn, Stephen O; Hellstein, John; Hewlett, Angela; Kolessar, David; Moucha, Calin; O'Donnell, Richard J; O'Toole, John E; Osmon, Douglas R; Evans, Richard Parker; Rinella, Anthony; Steinberg, Mark J; Goldberg, Michael; Ristic, Helen; Boyer, Kevin; Sluka, Patrick; Martin, William Robert; Cummins, Deborah S; Song, Sharon; Woznica, Anne; Gross, Leeaht

    2013-03-01

    The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

  10. A basic introduction to statistics for the orthopaedic surgeon.

    PubMed

    Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

    2012-02-01

    Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values. PMID:22523921

  11. Indications for percutaneous coronary interventions performed in U.S. Hospitals: a report from the National Cardiovascular Data Registry

    PubMed Central

    Cram, Peter; House, John A.; Messenger, John; Piana, Robert N.; Horwitz, Phillip A; Spertus, John A.

    2011-01-01

    Background There are many factors hypothesized as contributing to overuse of percutaneous coronary intervention (PCI) in the United States (U.S.), including financial ties between physicians and hospitals, but empirical data are lacking. We examined PCI indications in not-for-profit (NFP), major teaching, for-profit (FP) and physician-owned specialty hospitals. Methods A retrospective cohort study of 1,113,554 patients who underwent PCI in 694 hospitals (NFP=471, teaching=131, FP=79, specialty=13) participating in the National Cardiovascular Data Registry® (NCDR®) CathPCI Registry® between January 1, 2004 and December 31, 2007. PCI indications derived from American College of Cardiology (ACC) Guidelines were classified as: survival benefit (patients with primary reperfusion for STEMI); potential quality of life (QOL) benefit (patients with NSTEMI, ACS, positive stress test, or chest pain); or unclear indications (patients receiving PCI without an obvious potential survival or QOL benefit). Results The percentage of PCI performed for unclear indications was somewhat higher for specialty hospitals (5.1% of all procedures) as compared with other hospital categories (FP 4.7%, NFP 4.2%, teaching 4.5%; P<0.001). Overall, 17% of hospitals had 20% or more of their total PCI procedures performed for unclear indications but the proportion of FP, NFP, teaching, and specialty hospitals reaching this threshold was not statistically different (20%, 16%, 17% and 15% respectively; P=.84). Conclusions A small proportion of PCI procedures were performed in patients with unclear indications, but there was wide variation across hospitals. On average, specialty hospitals performed more PCIs for unclear indications. Efforts to reduce variability should be pursued. PMID:22305839

  12. Implementation Issues of Virtual Desktop Infrastructure and Its Case Study for a Physician's Round at Seoul National University Bundang Hospital

    PubMed Central

    Yoo, Sooyoung; Kim, Seok; Kim, Taegi; Kim, Jon Soo; Baek, Rong-Min; Suh, Chang Suk; Chung, Chin Youb

    2012-01-01

    Objectives The cloud computing-based virtual desktop infrastructure (VDI) allows access to computing environments with no limitations in terms of time or place such that it can permit the rapid establishment of a mobile hospital environment. The objective of this study was to investigate the empirical issues to be considered when establishing a virtual mobile environment using VDI technology in a hospital setting and to examine the utility of the technology with an Apple iPad during a physician's rounds as a case study. Methods Empirical implementation issues were derived from a 910-bed tertiary national university hospital that recently launched a VDI system. During the physicians' rounds, we surveyed patient satisfaction levels with the VDI-based mobile consultation service with the iPad and the relationship between these levels of satisfaction and hospital revisits, hospital recommendations, and the hospital brand image. Thirty-five inpatients (including their next-of-kin) and seven physicians participated in the survey. Results Implementation issues pertaining to the VDI system arose with regard to the highly availability system architecture, wireless network infrastructure, and screen resolution of the system. Other issues were related to privacy and security, mobile device management, and user education. When the system was used in rounds, patients and their next-of-kin expressed high satisfaction levels, and a positive relationship was noted as regards patients' decisions to revisit the hospital and whether the use of the VDI system improved the brand image of the hospital. Conclusions Mobile hospital environments have the potential to benefit both physicians and patients. The issues related to the implementation of VDI system discussed here should be examined in advance for its successful adoption and implementation. PMID:23346476

  13. A national study of the efficiency of hospitals in urban markets.

    PubMed Central

    Ozcan, Y A; Luke, R D

    1993-01-01

    Using a sample of 3,000 urban hospitals, this article examines the contributions of selected hospital characteristics to variations in hospital technical efficiencies, while it accounts for multiple products and inputs, and controls for local environmental variations. Four hospital characteristics are examined: hospital size, membership in a multihospital system, ownership, and payer mix (managed care contracts, percent Medicare, and percent Medicaid). Ownership and percent Medicare are consistently found to be related significantly to hospital efficiency. Within the ownership variable, government hospitals tend to be more efficient and for-profit hospitals less efficient than other hospitals. Higher percentages of Medicare payment are negatively related to efficiency. While not consistently significant across all five of the MSA size categories in which the analyses are conducted, possession of managed care contracts, membership in a multihospital system, and size all are consistently related positively to hospital technical efficiency. These variables are also all significant when the hospitals are examined in a combined analysis. Percent Medicaid was not significant in any of the analyses. Implications for policy and the need for methodological work are discussed. PMID:8428810

  14. Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

    PubMed

    Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

    2015-12-01

    Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

  15. [Scorpion envenomation treated in the Infectious and Tropical Diseases at the Donka National Hospital, Guinea].

    PubMed

    Sako, F B; Bangoura, E F; Traoré, F A; Soumah, M M; Tounkara, T M; Djessanglar, R; Baldé, H; Baldé, O

    2014-12-01

    A retrospective descriptive study was conducted from 1(st) October 2010 to 30 November 2012 on the records of patients admitted for scorpion envenomation in the Department of Infectious and Tropical Diseases at the Donka National Hospital. The objective of this study is to describe the epidemiological profile and clinical characteristics of scorpion envenomation in Maritime Guinea, from scorpion stings recently covered in this service. We collected 75 cases of scorpion envenomation. The median age was 21.5 with interquartile 8 and 20 and sex ratio was 1.29. The upper limbs were involved in 55% of cases, followed by the lower limbs (35%), trunk (6%), head and neck (4%). We observed 63% of patients with local signs, 30% mild and general clinical signs of 7% severe systemic symptoms. All patients received an analgesic and a heterologous antitoxin, associated with an antibiotic (87% of patients), a corticosteroid (72%), diazepam (13%) and furosemide (34.6%). The incidence of scorpion envenomation is not negligible despite underreporting of cases, most often treated in traditional medicine.

  16. [Scorpion envenomation treated in the Infectious and Tropical Diseases at the Donka National Hospital, Guinea].

    PubMed

    Sako, F B; Bangoura, E F; Traoré, F A; Soumah, M M; Tounkara, T M; Djessanglar, R; Baldé, H; Baldé, O

    2014-12-01

    A retrospective descriptive study was conducted from 1(st) October 2010 to 30 November 2012 on the records of patients admitted for scorpion envenomation in the Department of Infectious and Tropical Diseases at the Donka National Hospital. The objective of this study is to describe the epidemiological profile and clinical characteristics of scorpion envenomation in Maritime Guinea, from scorpion stings recently covered in this service. We collected 75 cases of scorpion envenomation. The median age was 21.5 with interquartile 8 and 20 and sex ratio was 1.29. The upper limbs were involved in 55% of cases, followed by the lower limbs (35%), trunk (6%), head and neck (4%). We observed 63% of patients with local signs, 30% mild and general clinical signs of 7% severe systemic symptoms. All patients received an analgesic and a heterologous antitoxin, associated with an antibiotic (87% of patients), a corticosteroid (72%), diazepam (13%) and furosemide (34.6%). The incidence of scorpion envenomation is not negligible despite underreporting of cases, most often treated in traditional medicine. PMID:25158841

  17. Posttransfusion Haematocrit Equilibration: Timing Posttransfusion Haematocrit Check in Neonates at the National Hospital, Abuja, Nigeria

    PubMed Central

    Audu, L. I.; Otuneye, A. T.; Mairami, A. B.; Mshelia, L. J.; Nwatah, V. E.

    2015-01-01

    Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of posttransfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours posttransfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) P = 0.516, but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs (P = 0.237 and 0.063, resp.). We concluded that, in stable nonhaemorrhaging and nonhaemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, posttransfusion PCV is 12 hours after red blood cell transfusion. PMID:25861284

  18. Consenting operative orthopaedic trauma patients: challenges and solutions.

    PubMed

    Kheiran, Amin; Banerjee, Purnajyoti; Stott, Philip

    2014-01-01

    Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P = 0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient's copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

  19. Plaster of Paris: the orthopaedic surgeon heritage.

    PubMed

    Hernigou, Philippe

    2016-08-01

    Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation.

  20. Tissue engineering skeletal muscle for orthopaedic applications

    NASA Technical Reports Server (NTRS)

    Payumo, Francis C.; Kim, Hyun D.; Sherling, Michael A.; Smith, Lee P.; Powell, Courtney; Wang, Xiao; Keeping, Hugh S.; Valentini, Robert F.; Vandenburgh, Herman H.

    2002-01-01

    With current technology, tissue-engineered skeletal muscle analogues (bioartificial muscles) generate too little active force to be clinically useful in orthopaedic applications. They have been engineered genetically with numerous transgenes (growth hormone, insulinlike growth factor-1, erythropoietin, vascular endothelial growth factor), and have been shown to deliver these therapeutic proteins either locally or systemically for months in vivo. Bone morphogenetic proteins belonging to the transforming growth factor-beta superfamily are osteoinductive molecules that drive the differentiation pathway of mesenchymal cells toward the chondroblastic or osteoblastic lineage, and stimulate bone formation in vivo. To determine whether skeletal muscle cells endogenously expressing bone morphogenetic proteins might serve as a vehicle for systemic bone morphogenetic protein delivery in vivo, proliferating skeletal myoblasts (C2C12) were transduced with a replication defective retrovirus containing the gene for recombinant human bone morphogenetic protein-6 (C2BMP-6). The C2BMP-6 cells constitutively expressed recombinant human bone morphogenetic protein-6 and synthesized bioactive recombinant human bone morphogenetic protein-6, based on increased alkaline phosphatase activity in coincubated mesenchymal cells. C2BMP-6 cells did not secrete soluble, bioactive recombinant human bone morphogenetic protein-6, but retained the bioactivity in the cell layer. Therefore, genetically-engineered skeletal muscle cells might serve as a platform for long-term delivery of osteoinductive bone morphogenetic proteins locally.

  1. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...; screening mammography services; critical access hospitals; or clinic, rehabilitation agency, or public health agency providers of outpatient physical therapy, occupational therapy or speech pathology...

  2. Has incentive payment improved venous thrombo-embolism risk assessment and treatment of hospital in-patients?

    PubMed Central

    Child, Sue

    2013-01-01

    This paper focuses on financial incentives rewarding successful implementation of guidelines in the UK National Health Service (NHS). In particular, it assesses the implementation of National Institute for Health and Clinical Excellence (NICE) venous thrombo-embolism (VTE) guidance in 2010 on the risk assessment and secondary prevention of VTE in hospital in-patients and the financial incentives driving successful implementation introduced by the Commissioning for Quality and Innovation for Payment Framework (CQUIN) for 2010-2011. We systematically compared the implementation of evidence-based national guidance on VTE prevention across two specialities (general medicine and orthopaedics) in four hospital sites in the greater South West of England by auditing and evaluating VTE prevention activity for 2009 (i.e. before the 2010 NICE guideline) and late 2010 (almost a year after the guideline was published). Analysis of VTE prevention activity reported in 816 randomly selected orthopaedic and general medical in-patient medical records was complemented by a qualitative study into the practical responses to revised national guidance. This paper’s contribution to knowledge is to suggest that by financially rewarding the implementation of national guidance on VTE prevention, paradoxes and contradictions have become apparent between the ‘payment by volume system’ of Healthcare Resource Groups and the ‘payment by results’ system of CQUIN. PMID:24358864

  3. Best practices of hospital security planning for patient surge--a comparative analysis of three national systems.

    PubMed

    Downey, Erin; Hebert, Anjanette

    2010-01-01

    This paper examines three international healthcare security systems as they relate to patient surge in Canada, Israel, and the United States. Its purpose is to compare the systems, to highlight unique characteristics that define those systems, and to initiate the development of best practices that transcend national boundaries. Several significant national characteristics of demographics, healthcare systems, and political climate, among others, present challenges to translating best practices among these three countries. However, we have found that best practice strategies exist in areas of communications, coordination, building design, space adaptability, and patient routing (both from the community to the hospital, as well as within the hospital) that can be shared and incorporated into the healthcare preparedness efforts in all three countries. PMID:20873500

  4. Horizontal and vertical integration-diversification in rural hospitals: a national study of strategic activity, 1983-1988.

    PubMed

    Mick, S S; Morlock, L L; Salkever, D; de Lissovoy, G; Malitz, F E; Wise, C G; Jones, A S

    1993-01-01

    This study examines both the magnitude of and factors influencing the adoption of 13 horizontal and vertical integration and diversification strategies in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Using organization theory, hypotheses were posed relating environmental and market factors, geographic location, and hospital characteristics to the adoption of horizontal and vertical integration and diversification. Results indicate that only one of 13 strategies was adopted by more than 50 percent of all rural hospitals during the study period, and that most of the directional hypotheses were not confirmed using Cox's proportional hazards models. In particular, environmental and market factors were unrelated to the strategies studied. Issues of methodology and theory are discussed; however, during an historically turbulent period, both relatively low levels of rural hospital strategic activities and lack of predictive power of the theory suggest caution in relying heavily on a policy for rural hospital survival that is dependent on individual market-oriented strategic behavior.

  5. Framing in policy processes: a case study from hospital planning in the National Health Service in England.

    PubMed

    Jones, Lorelei; Exworthy, Mark

    2015-01-01

    This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered.

  6. Framing in policy processes: a case study from hospital planning in the National Health Service in England.

    PubMed

    Jones, Lorelei; Exworthy, Mark

    2015-01-01

    This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered. PMID:25461877

  7. Army orthopaedic surgery residency program directors' selection criteria.

    PubMed

    Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J

    2015-01-01

    Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants.

  8. Army orthopaedic surgery residency program directors' selection criteria.

    PubMed

    Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J

    2015-01-01

    Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants. PMID:25988694

  9. Current diversity in orthopaedics. Issues of race, ethnicity, and gender.

    PubMed

    England, S P; Pierce, R O

    1999-05-01

    The size and diversity of the United States orthopaedic workforce continues to interest academic graduate medical education analysts. Numerous medical groups have expressed the need for diversity in orthopaedics and in general medicine. The Association of American Medical Colleges has had two policies since the early 1970s concerning minorities in medicine. It was thought that special attention should be given to minority groups underrepresented in medicine and that the minority groups should be represented in medicine in the same proportion as in the population as a whole. The purpose of this paper was to examine the selection of orthopaedic residents during the past 12 years based on the candidates documented race, ethnicity, and gender. The diversity of orthopaedic residents changed minimally during the period of the study. The percentage of African American, Hispanic, Native American, Puerto Rican, and Mexican American orthopaedic residents essentially has remained unchanged. The percentage of Asian and Pacific Islander women has remained unchanged whereas the percentage of Asian and Pacific Islander men has quadrupled (2.2% in 1983 to 9.8% in 1995) during the 12 years of the study. The percentage of white women has remained virtually unchanged whereas that of white men has declined in direct relation to the increase in Asian or Pacific Islander men.

  10. Pharmacological prevention of venous thromboembolism in orthopaedic surgery

    PubMed Central

    Prisco, Domenico; Cenci, Caterina; Silvestri, Elena; Emmi, Giacomo; Ciucciarelli, Lucia

    2014-01-01

    Summary The prophylaxis of venous thromboembolism (VTE) with anticoagulant drugs is a long-established practice in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, while there are few data regarding the prevention of VTE in other fields of orthopaedic surgery and traumatology. In order to provide practical recommendations for daily management of VTE prophylaxis in orthopaedic patients, recently the Italian Societies of Thrombosis and Haemostasis, Orthopaedics and Traumatology and Anaesthesia have drawn up a first Intersociety Consensus on antithrombotic prophylaxis in total hip and knee replacement surgery, and in the treatment of femoral neck fracture, then updated in 2013, and a subsequent Intersocietary Consensus, in cooperation also with the Society of general practitioners, concerning antithrombotic prophylaxis in other types of orthopaedic surgery and traumatology. Before starting any prophylactic treatment it is of crucial importance the assessment of both thrombotic and bleeding risk of patients undergoing surgery. Thromboembolic prophylaxis is recommended with low molecular weight heparins (LMWH), fondaparinux (FON) or with the new oral anticoagulants (NOA) in patients undergoing hip and knee replacement surgery while patients undergoing treatment of femoral neck fracture should be treated with LMWH or FON. Regarding the non-prosthetic orthopaedic surgery and traumatology, it is recommended prophylaxis with LMWH or FON in situations of high thromboembolic risk or in the case of interventions or trauma involving pelvis, acetabulum or knee. PMID:25568652

  11. Development of a method to analyze orthopaedic practice expenses.

    PubMed

    Brinker, M R; Pierce, P; Siegel, G

    2000-03-01

    The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses were assigned to 17 activities that encompass all the tasks and processes typically performed in an orthopaedic practice. These 17 activities were identified in a practice expense study conducted for the American Academy of Orthopaedic Surgeons. To calculate the cost of each activity, financial data were used from a group of 19 orthopaedic surgeons in Houston, Texas. The activities that consumed the largest portion of the employee work force (person hours) were service patients in office (25.0% of all person hours), maintain medical records (13.6% of all person hours), and resolve collection disputes and rebill charges (12.3% of all person hours). The activities that comprised the largest portion of the total expenses were maintain facility (21.4%), service patients in office (16.0%), and sustain business by managing and coordinating practice (13.8%). The five-step process of analyzing practice expenses was relatively easy to perform and it may be used reliably by most orthopaedic practices. PMID:10738440

  12. The orthopaedic profession and industry: conflict or convergence of interests.

    PubMed

    Crowninshield, Roy

    2003-07-01

    Many improvements in orthopaedic care have been enabled by the relationship that exists between the orthopaedic profession and the orthopaedic industry. This relationship is multifactorial and includes new technology development, medical education, orthopaedic research, and patient education. Acting individually and collectively, the profession and the industry advance their standing by focusing on improved patient care. Although the industry, the profession, and the patient have many shared interests, they also may have real or potential conflicts of interests. The patient's interest in the quality of treatment outcome is shared by the profession and industry. However, the interests of the profession may include issues related to the success of their practices, management of their time, and advancement of their skills. Industry's interests, in turn, include the support of their customers and the success of their businesses. Conflicts of interest between these parties are potentially neither avoidable nor undesirable. Managed well, the relationship of the orthopaedic profession and the industry achieves the goals of each while advancing patient care. As the profession and the industry each experience change, continued attention should be directed to ensuring that the interest of each is advanced only in the context of serving the interest of the patient with musculoskeletal disorders.

  13. Development of a method to analyze orthopaedic practice expenses.

    PubMed

    Brinker, M R; Pierce, P; Siegel, G

    2000-03-01

    The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses were assigned to 17 activities that encompass all the tasks and processes typically performed in an orthopaedic practice. These 17 activities were identified in a practice expense study conducted for the American Academy of Orthopaedic Surgeons. To calculate the cost of each activity, financial data were used from a group of 19 orthopaedic surgeons in Houston, Texas. The activities that consumed the largest portion of the employee work force (person hours) were service patients in office (25.0% of all person hours), maintain medical records (13.6% of all person hours), and resolve collection disputes and rebill charges (12.3% of all person hours). The activities that comprised the largest portion of the total expenses were maintain facility (21.4%), service patients in office (16.0%), and sustain business by managing and coordinating practice (13.8%). The five-step process of analyzing practice expenses was relatively easy to perform and it may be used reliably by most orthopaedic practices.

  14. Treatment concepts of day hospitals for general psychiatric patients. Findings from a national survey in Germany.

    PubMed

    Seidler, Klaus-Peter; Garlipp, Petra; Machleidt, Wielant; Haltenhof, Horst

    2006-03-01

    Psychiatric day hospital treatment concepts have to deal with a wide spectrum of mental disorders. We raised the question, if day hospitals can be differentiated concerning their treatment concepts and if so how much this is reflected in their structural and procedural features. In 1999 a survey was initiated concerning structure, concept and method of treatment in psychiatric day hospitals for adults in Germany. Furthermore data concerning rate of utilization, patients' characteristics and aspects of referral and further treatment were ascertained. One hundred and seventy-three (63.4%) of 273-day hospitals contacted took part in the inquiry. The data were interpreted using multivariate as well as non-parametric procedures. The results show that treatment concepts of day hospitals can be specified as three main areas of function (psychotherapy, crisis intervention orientated treatment alternative, rehabilitation) and four therapeutic orientations (psychodynamic social psychiatric, behavioral social psychiatric, psychodynamic, sociotherapeutic). Structural features are predominantly comparable and the differences found concerning the treatment concepts are especially related to patients' characteristics and some procedural features. The conclusion is that the differentiation of day hospital treatment concepts should be taken into consideration in planning psychosocial treatment services as well as in day hospital evaluation research.

  15. OASYS: a computerized auditing system for orthopaedic surgery.

    PubMed

    Stoodley, M A; Sikorski, J M

    1991-11-01

    Medical auditing based on individual diagnoses or specific therapies is well established. Auditing of all medical activity has an expanding role in quality assurance and research. In an attempt to overcome the limitations of existing auditing systems, a fundamentally different, flexible, high quality and easily accessible orthopaedic auditing system has been developed. This records a description of each component of patients' orthopaedic diagnoses, records treatment and complications, produces discharge letters and surgical log books and allows flexible and comprehensive audits. It has been in use in an orthopaedic service since January 1990 and has been successful in identifying problems and monitoring the effectiveness of changes. It is anticipated that the system will become more widely used and provide the basis for a 'user group' which will share the accumulated data and further development costs. PMID:1757163

  16. Orthopaedic implications of multiple gestation pregnancy with triplets.

    PubMed

    Bielski, Robert J; Gesell, Mark W; Teng, Andelle L; Cooper, Daniel H; Muraskas, Jonathan K

    2006-01-01

    Intrauterine crowding has been implicated as a risk factor in several orthopaedic conditions, such as developmental dysplasia of the hip (DDH), metatarsus adductus, and torticollis. The goal of this study was to see whether orthopaedic conditions associated with intrauterine crowding were more frequent in multiple gestation pregnancies, specifically in triplets. The authors reviewed their experience over a 10-year period with 261 children who were products of triplet pregnancies. They surveyed 13 orthopaedic conditions and found only one condition, torticollis, that had a greater incidence than that reported in single gestation pregnancies. A 0% incidence of DDH was found in these patients. Routine ultrasound screening cannot be recommended in these patients based on these results.

  17. Orthopaedic surgery in patients with von Willebrand disease.

    PubMed

    Siboni, S M; Biguzzi, E; Solimeno, L P; Pasta, G; Mistretta, C; Mannucci, P M; Peyvandi, F

    2014-01-01

    Patients with von Willebrand disease (VWD) may need orthopaedic surgery because of disabling chronic arthropathy due to recurrent joint bleeding. They may also require this surgery independently of their haemostasis disorder. Knowledge regarding the management of orthopaedic surgery in VWD is limited. Description of management of orthopaedic surgery in patients with VWD, based upon retrospective data collection and analysis of 32 orthopaedic procedures carried out over a period of 33 years in 23 patients was the aim of this study. Of 32 procedures, six were minor (three hand surgery, one foot surgery, two others) and 26 were major (seven joint replacements, nine arthroscopic procedures, two foot surgery, eight others). Twenty-two procedures were performed using replacement therapy with plasma-derived concentrates containing both factor VIII (FVIII) and von Willebrand factor (VWF). Two procedures in patients with acquired von Willebrand syndrome (AWVS) were performed using FVIII-VWF concentrates associated with intravenous immunoglobulins, or desmopressin plus tranexamic acid. Seven procedures were performed using desmopressin alone and one using intravenous immunoglobulins in AVWS. Bleeding complications occurred in seven procedures (22%). In one patient, an anti-VWF antibody was diagnosed after surgery. Anticoagulant prophylaxis of venous thromboembolism was implemented in four cases only and in two instances there was excessive bleeding. In conclusion, control of surgical haemostasis was achieved in most patients with VWD undergoing orthopaedic surgery. The control of haemostasis combined with an adequate surgical technique and early post-operative rehabilitation are warranted for the successful performance of orthopaedic surgery in VWD, which requires the involvement of specialized haemophilia centres.

  18. Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals

    PubMed Central

    Griffiths, Peter; Sloane, Douglas M; Rafferty, Anne Marie; Ball, Jane E; Aiken, Linda H

    2015-01-01

    Objectives To examine whether patient satisfaction with nursing care in National Health Service (NHS) hospitals in England is associated with the proportion of non-UK educated nurses providing care. Design Cross-sectional analysis using data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. Logistic regression models with corrections for clustering were used to determine whether the proportions of non-UK educated nurses were significantly related to patient satisfaction before and after taking account of other hospital, nursing and patient characteristics. Setting 31 English NHS trusts. Participants 12 506 patients 16 years of age and older with at least one overnight stay that completed a satisfaction survey; 2962 bedside care nurses who completed a nurse survey; and 31 NHS trusts. Main outcome measure Patient satisfaction. Results The percentage of non-UK educated nurses providing bedside hospital care, which ranged from 1% to 52% of nurses, was significantly associated with patient satisfaction. After controlling for potential confounding factors, each 10-point increase in the percentage of non-UK educated nurses diminished the odds of patients reporting good or excellent care by 12% (OR=0.88), and decreased the odds of patients agreeing that they always had confidence and trust in nurses by 13% (OR=0.87). Other indicators of patient satisfaction also revealed lower satisfaction in hospitals with higher percentages of non-UK educated nurses. Conclusions Use of non-UK educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care. PMID:26634400

  19. Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.

    PubMed

    Florschutz, Anthony V; Parsley, Brian S; Shapiro, Irving M

    2015-04-01

    Greater documentation of patient history and clinical course is crucial for identifying factors that can influence surgical outcomes. The Centers for Medicare and Medicaid Services have already begun public reporting of hospital data on readmission, complication, and infection rates and will soon launch a website to make physician-specific outcomes data public. The orthopaedic community has the opportunity to lead the way in ensuring that adequate and accurate data is collected to facilitate appropriate comparisons that are based on patients' true risk of complications and the complexity of treatment. Several studies have reported a link between oral pathogens and periprosthetic infection, although it remains unclear whether organisms unique to dental tissues are also present in osteoarthritic joints and tissues affected by periprosthetic joint infection. The American Academy of Orthopaedic Surgeons and the American Dental Association are aware of these concerns and have created guidelines for antibiotic prophylaxis in patients who have undergone total hip or knee arthroplasty and require high-risk dental procedures. Because these guidelines have received considerable criticism, recommendations that are based on scientific and case-controlled clinical studies and provide effective guidance on this important subject are needed.

  20. Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues.

    PubMed

    Black, Kevin P; Armstrong, April D; Hutzler, Lorraine; Egol, Kenneth A

    2015-11-01

    Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them.The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow.Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety.Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety. PMID:26537169

  1. Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues.

    PubMed

    Black, Kevin P; Armstrong, April D; Hutzler, Lorraine; Egol, Kenneth A

    2015-11-01

    Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them.The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow.Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety.Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety.

  2. Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study

    PubMed Central

    Ackland, G. L.; Harris, S.; Ziabari, Y.; Grocott, M.; Mythen, M.

    2010-01-01

    Background The revised cardiac risk index (RCRI) is associated strongly with increased cardiac ischaemic risk and perioperative death. Associations with non-cardiac morbidity in non-cardiac surgery have not been explored. In the elective orthopaedic surgical population, morbidity is common but preoperative predictors are unclear. We hypothesized that RCRI would identify individuals at increased risk of non-cardiac morbidity in this surgically homogenous population. Methods Five hundred and sixty patients undergoing elective primary (>90%) and revision hip and knee procedures were studied. A modified RCRI (mRCRI) score was calculated, weighting intermediate and low risk factors. The primary endpoint was the development of morbidity, collected prospectively using the Postoperative Morbidity Survey, on postoperative day (POD) 5. Results Morbidity on POD 5 was more frequent in patients with mRCRI ≥3 {relative risk 1.7, [95% confidence interval (CI): 1.4–2.1]; P<0.001}. Time to hospital discharge was delayed in patients with mRCRI score ≥3 (log-rank test, P=0.0002). Pulmonary (P<0.001), infectious (P=0.001), cardiovascular (P=0.0003), renal (P<0.0001), wound (P=0.02), and neurological (P=0.002) morbidities were more common in patients with mRCRI score ≥3. Pre/postoperative haematocrit, anaesthetic/analgesic technique, and postoperative temperature were similar across mRCRI groups. There were significant associations with hospital stay, as measured by the area under the receiver-operating characteristic curves for mRCRI 0.64 (95% CI: 0.58–0.70) and POSSUM 0.70 (95% CI: 0.63–0.75). Conclusions mRCRI score ≥3 is associated with increased postoperative non-cardiac morbidity and prolonged hospital stay after elective orthopaedic procedures. mRCRI can contribute to objective risk stratification of postoperative morbidity. PMID:20876700

  3. Robotic surgery in trauma and orthopaedics: a systematic review.

    PubMed

    Karthik, K; Colegate-Stone, T; Dasgupta, P; Tavakkolizadeh, A; Sinha, J

    2015-03-01

    The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics. PMID:25737510

  4. Increasing Capacity for the Treatment of Common Musculoskeletal Problems: A Non-Inferiority RCT and Economic Analysis of Corticosteroid Injection for Shoulder Pain Comparing a Physiotherapist and Orthopaedic Surgeon

    PubMed Central

    Bisset, Leanne; Comans, Tracy; Thomas, Michael; Ng, Shu Kay; O’Leary, Shaun; Conaghan, Philip G.; Scuffham, Paul A.

    2016-01-01

    Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the physiotherapist and the orthopaedic surgeon, with 64 randomised (physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified physiotherapist is

  5. Epidemiology of Endometriosis in France: A Large, Nation-Wide Study Based on Hospital Discharge Data.

    PubMed

    von Theobald, Peter; Cottenet, Jonathan; Iacobelli, Silvia; Quantin, Catherine

    2016-01-01

    We aimed to assess the prevalence of hospitalization for endometriosis in the general population in France and in each French region and to describe temporal trends, rehospitalization rates, and prevalence of the different types of endometriosis. The analyses were carried out on French hospital discharge data and covered the period 2008-2012 and a population of 14,239,197 women of childbearing age. In this population, the prevalence of hospitalization for endometriosis was 0.9%, ranging from 0.4% to 1.6% between regions. Endometriosis affected 1.5% of hospitalized women of childbearing age, ranging from 1.0% to 2.4% between regions. The number of patients hospitalized for endometriosis significantly increased over the study period (p < 0.01). Of these, 4.2% were rehospitalized at least once at one year: ranging from 2.7% to 6.3% between regions. The cumulative rehospitalization rate at 3 years was 6.9%. The types of endometriosis according to the procedures performed were as follows: ovarian (40-50%), peritoneal (20-30%), intestinal (10-20%), and ureteral or bladder (<10%), with significant differences between regions. This is the first detailed epidemiological study of endometriosis in France. Further studies are needed to assess the reasons for the increasing prevalence of endometriosis and for the significant differences in regional prevalence of this disease.

  6. Epidemiology of Endometriosis in France: A Large, Nation-Wide Study Based on Hospital Discharge Data

    PubMed Central

    von Theobald, Peter; Cottenet, Jonathan; Iacobelli, Silvia; Quantin, Catherine

    2016-01-01

    We aimed to assess the prevalence of hospitalization for endometriosis in the general population in France and in each French region and to describe temporal trends, rehospitalization rates, and prevalence of the different types of endometriosis. The analyses were carried out on French hospital discharge data and covered the period 2008–2012 and a population of 14,239,197 women of childbearing age. In this population, the prevalence of hospitalization for endometriosis was 0.9%, ranging from 0.4% to 1.6% between regions. Endometriosis affected 1.5% of hospitalized women of childbearing age, ranging from 1.0% to 2.4% between regions. The number of patients hospitalized for endometriosis significantly increased over the study period (p < 0.01). Of these, 4.2% were rehospitalized at least once at one year: ranging from 2.7% to 6.3% between regions. The cumulative rehospitalization rate at 3 years was 6.9%. The types of endometriosis according to the procedures performed were as follows: ovarian (40–50%), peritoneal (20–30%), intestinal (10–20%), and ureteral or bladder (<10%), with significant differences between regions. This is the first detailed epidemiological study of endometriosis in France. Further studies are needed to assess the reasons for the increasing prevalence of endometriosis and for the significant differences in regional prevalence of this disease. PMID:27148550

  7. Life of a partnership: the process of collaboration between the National Tuberculosis Program and the hospitals in Yogyakarta, Indonesia.

    PubMed

    Probandari, Ari; Utarini, Adi; Lindholm, Lars; Hurtig, Anna-Karin

    2011-11-01

    Public-private partnerships (PPP) for improving the health of populations are currently attracting attention in many countries with limited resources. The Public-Private Mix for Tuberculosis Control is an example of an internationally supported PPP that aims to engage all providers, including hospitals, to implement standardized diagnosis and treatment. This paper explores mainly the local actors' views and experiences of the process of PPP in delivering TB care in hospitals in Yogyakarta Province, Indonesia. The study used a qualitative research design. By maximum variation sampling, 33 informants were purposefully selected. The informants were involved in the Public-Private Mix for Tuberculosis Control in Yogyakarta Province. Data were collected during 2008-2009 by in-depth interview and analyzed using content analysis techniques. Triangulation, reference group checking and peer debriefing were conducted to improve the trustworthiness of the data. This analysis showed that the process of partnership was dynamic. In the early phase of partnership, the National Tuberculosis Program and hospital actors perceived barriers to interaction such as low enthusiasm, lack of confidence, mistrust and inequality of relationships. The existence of an intermediary actor was important for approaching the National Tuberculosis Program and hospitals. After intensive interactions, compromises and acceptance were reached among the actors and even enabled the growth of mutual respect and feelings of programme ownership. However, the partnership faced declining interactions when faced with scarce resources and weak governance. The strategies, power and interactions between actors are important aspects of the process of collaboration. We conclude that good partnership governance is needed for the partnership to be effective and sustainable. PMID:21940084

  8. The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea.

    PubMed

    Lim, Y A; Kim, H H; Joung, U S; Kim, C Y; Shin, Y H; Lee, S W; Kim, H J

    2010-04-01

    We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea. PMID:20015060

  9. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); establishment of national differentials for children's hospitals--DoD. Notice.

    PubMed

    1995-04-28

    The Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) is announcing the national differential rates for children's hospitals which go into effect April 1, 1995. This notice is issued as required in 32 CFR 199.14 in which OCHAMPUS announced that a notice would be published setting forth the national differential and eliminating the hospital-specific differentials. PMID:10142479

  10. Hospital contacts with infection and risk of schizophrenia: a population-based cohort study with linkage of Danish national registers.

    PubMed

    Nielsen, Philip R; Benros, Michael E; Mortensen, Preben B

    2014-11-01

    Infections and immune responses have been suggested to play an important role in the etiology of schizophrenia. Several studies have reported associations between maternal infections during pregnancy and the child's risk of schizophrenia; however, infection during childhood and adolescence unrelated to maternal infection during pregnancy has not been studied to nearly the same extent and the results are far from conclusive. Data were drawn from 2 population-based registers, the Danish Psychiatric Central Register and the Danish National Hospital Register. We used a historical population-based cohort design and selected all individuals born in Denmark between 1981 and 1996 (n = 843 390). We identified all individuals with a first-time hospital contact with schizophrenia from 1991 through 2010. Out of the 3409 individuals diagnosed with schizophrenia, a total of 1549 individuals had had a hospital contact with infection before their schizophrenia diagnosis (45%). Our results indicate that individuals who have had a hospital contact with infection are more likely to develop schizophrenia (relative risk [RR] = 1.41; 95% CI: 1.32-1.51) than individuals who had not had such a hospital contact. Bacterial infection was the type of infection that was associated with the highest risk of schizophrenia (RR = 1.63; 95% CI: 1.47-1.82). Our study does not exclude that a certain type of infection may have a specific effect; yet, it does suggest that schizophrenia is associated with a wide range of infections. This association may be due to inflammatory responses affecting the brain or genetic and environmental risk factors aggregating in families.

  11. Education Program Cost Reimbursement in University Hospitals. Is There a Coherent National Policy?

    ERIC Educational Resources Information Center

    Jeddeloh, Norman P.

    1981-01-01

    Medicare reimbursement for educational program costs is a quagmire of conflicting rules, regulations, laws, procedures, and precedents. The reimbursement principles in force fail to recognize the special value to patient care provided by the integration of the university hospital with an academic health sciences center and are illogical and…

  12. Risk Factors for Violent Offending in Autism Spectrum Disorder: A National Study of Hospitalized Individuals

    ERIC Educational Resources Information Center

    Langstrom, Niklas; Grann, Martin; Ruchkin, Vladislav; Sjostedt, Gabrielle; Fazel, Seena

    2009-01-01

    Little is known about risk factors for violence among individuals with autism spectrum disorder (ASD). This study uses data from Swedish longitudinal registers for all 422 individuals hospitalized with autistic disorder or Asperger syndrome during 1988-2000 and compares those committing violent or sexual offenses with those who did not. Thirty-one…

  13. Language, Literacy and Numeracy in National Training Packages: Case Studies in Aged Care and Hospitality.

    ERIC Educational Resources Information Center

    Haines, Christine; Brand, Jennie Bickmore

    The implementation and effectiveness of the inclusion of literacy and numeracy in industry training packages was examined in case studies of three programs in Western Australia. Two were certificate programs in cooking and food and beverage as specified in the hospitality training package, and the third was an aged care program based on the…

  14. Skeletal metastases - the role of the orthopaedic and spinal surgeon.

    PubMed

    Eastley, Nicholas; Newey, Martyn; Ashford, Robert U

    2012-09-01

    Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention

  15. Military Orthopaedic Trauma Registry: Quality Data Now Available.

    PubMed

    Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E

    2016-01-01

    The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury. PMID:27518292

  16. Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change?

    PubMed

    Joskowicz, Leo; Hazan, Eric J

    2016-10-01

    Computer Aided Orthopaedic Surgery (CAOS) is now about 25 years old. Unlike Neurosurgery, Computer Aided Surgery has not become the standard of care in Orthopaedic Surgery. In this paper, we provide the technical and clinical context raised by this observation in an attempt to elucidate the reasons for this state of affairs. We start with a brief outline of the history of CAOS, review the main CAOS technologies, and describe how they are evaluated. We then identify some of the current publications in the field and present the opposing views on their clinical impact and their acceptance by the orthopaedic community worldwide. We focus on total knee replacement surgery as a case study and present current clinical results and contrasting opinions on CAOS technologies. We then discuss the challenges and opportunities for research in medical image analysis in CAOS and in musculoskeletal radiology. We conclude with a suggestion that while CAOS acceptance may be more moderate than that of other fields in surgery, it still has a place in the arsenal of useful tools available to orthopaedic surgeons. PMID:27407004

  17. Moire Topography For The Detection Of Orthopaedic Defects

    NASA Astrophysics Data System (ADS)

    Kamal, Syed A.; Lindseth, Richard E.

    1981-02-01

    Moire topography is applied for the follow-up of scoliosis patients. The results are then compared with the X-rays. A special lamp and scale arrangement is utilized for patient alignment. It is suggested that this technique will be used for the detection of all orthopaedic defects.

  18. Clubfoot: An Orthopaedic Surgeon Describes Clubfoot and Current Treatment Methods

    ERIC Educational Resources Information Center

    Vitale, Michael

    2007-01-01

    As an orthopaedic surgeon who has treated numerous cases of clubfoot in his career, the author knows that it takes exceptional parents to deal with the challenges of having a child born with a clubfoot. However, it should be noted that a clubfoot diagnosis does not mean a life of pain, deformity, and disability for a child. Today's treatment…

  19. Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change?

    PubMed

    Joskowicz, Leo; Hazan, Eric J

    2016-10-01

    Computer Aided Orthopaedic Surgery (CAOS) is now about 25 years old. Unlike Neurosurgery, Computer Aided Surgery has not become the standard of care in Orthopaedic Surgery. In this paper, we provide the technical and clinical context raised by this observation in an attempt to elucidate the reasons for this state of affairs. We start with a brief outline of the history of CAOS, review the main CAOS technologies, and describe how they are evaluated. We then identify some of the current publications in the field and present the opposing views on their clinical impact and their acceptance by the orthopaedic community worldwide. We focus on total knee replacement surgery as a case study and present current clinical results and contrasting opinions on CAOS technologies. We then discuss the challenges and opportunities for research in medical image analysis in CAOS and in musculoskeletal radiology. We conclude with a suggestion that while CAOS acceptance may be more moderate than that of other fields in surgery, it still has a place in the arsenal of useful tools available to orthopaedic surgeons.

  20. Orthopaedic trauma and the evolution of healthcare policy in America.

    PubMed

    Mitchell, Phillip M; Thakore, Rachel; Obremskey, Alexandra; Sethi, Manish K

    2014-10-01

    Healthcare policy has changed drastically, and with the 50-year anniversary of the passage of Medicare approaching in 2015, the authors evaluate the development of the current healthcare system and its relationship to the development of modern orthopaedic trauma. With more changes in healthcare policy forthcoming, it is increasingly important for the orthopaedic traumatologist to understand how changes in policy will affect practice. Historically, the motivators for change have remained largely the same over the past 50 years. The development of diagnosis-related groups, the resource-based relative value scale, and the sustainable growth rate are 3 defining policies that were designed to control costs, but which had an unexpected effect on those caring for the trauma population. Healthcare reform has a unique effect on those systems where care is dictated by a defining event or injury. Evaluating the development of trauma systems, the authors find that legislation directed toward the trauma population has been driven by the study of patient outcomes, providing an opportunity for orthopaedic traumatologists to contribute to future changes in policy. As healthcare policy changes begin to take effect, having a thorough understanding of reform and its drivers will be increasingly important in taking an active role in advocating for the field of orthopaedic trauma and its patients.

  1. Your first job in orthopaedic trauma: strategies for your career.

    PubMed

    Roberts, Craig S; Cannada, Lisa K

    2014-09-01

    Your first job in orthopaedic surgery is the culmination of years of training and hard work. This article will cover strategies for your first job search and your future career. We discuss job searching strategies prioritizing what is important. And once you start your first job, we discuss tips for how to make a good first impression and begin a successful career.

  2. Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania.

    PubMed

    Makubi, Abel N; Meda, Collins; Magesa, Alex; Minja, Peter; Mlalasi, Juliana; Salum, Zubeda; Kweka, Rumisha E; Rwehabura, James; Quaresh, Amrana; Magesa, Pius M; Robert, David; Makani, Julie; Kaaya, Ephata

    2012-10-01

    In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists' practices on handling and assessing the from donor selection to administration 6f blood during transfusion. Both interview and observations were used. A total of 195 LRF were audited and 100% of had incomplete information such as patients' identification numbers, time sample ordered, reason for request, summary of clinical assessment and differential diagnoses. The labelling of specimens was poorly done by phlebotomists/clinicians in 82% of the specimens. Also 65% (132/202) of the blood samples delivered in the haematology laboratory did not contain the recommended volume of blood. There was no laboratory request form specific for ordering blood and there were no guidelines for indication of blood transfusion in the wards/ clinics. The blood transfusion laboratory section was not participating in external quality assessment and the hospital transfusion committee was not in operation. It is recommended that a referral hospital like MNH should have a transfusion committee to provide an active forum to facilitate communication between those involved with transfusion, monitor, coordinate and audit blood transfusion practices as per national

  3. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

    PubMed

    Loveday, H P; Wilson, J A; Pratt, R J; Golsorkhi, M; Tingle, A; Bak, A; Browne, J; Prieto, J; Wilcox, M; UK Department of Health

    2014-01-01

    National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and

  4. National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2001–2010

    PubMed Central

    Langley, Ricky; Mack, Karin; Haileyesus, Tadesse; Proescholdbell, Scott; Annest, Joseph L.

    2015-01-01

    Objective Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP). Methods The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. Results From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9–447.3). Insects accounted for 67.5% (95% CI, 45.8–89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8–27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold—from 2156 visits in 2007 to 15,945 visits in 2010. Conclusions This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually. PMID:24433776

  5. High-tech and low-tech orthopaedic surgery in Sub-Saharan Africa.

    PubMed

    Kluge, Wolfram H; Bauer, Heike I

    2002-01-01

    BACKGROUND: Zambia's governmental health system suffers from shortage of surgical supplies and poor management skills for the sparse resources at hand. The situation has been worsened by the dual epidemics of HIV disease and tuberculosis. On the other hand the private medical sector has benefited greatly from less bureaucracy under the goverment of the Movement for Multi-party Democracy. DISCUSSION: The Zambian-Italian Orthopaedic Hospital in Lusaka is a well organized small unit providing free treatment of physically disabled children. The running costs are met from the fees charged for private consultations, supplemented by donations. State of the art surgical techniques are being used for congenital and acquired musculo-skeletal abnormalities. Last year 513 patients were operated upon free of charge and 320 operations were performed on private patients.

  6. Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit.

    PubMed

    Tea, Christine; Ellison, Michael; Feghali, Fadia

    2008-01-01

    Customer service and patient satisfaction have become increasingly important in the healthcare industry. Given limited resources and a myriad of choices, on which facets of patient satisfaction should healthcare providers focus? An analysis of 40,000 observations across 4 hospitals found 1 important intervention: timely staff responsiveness. Using the Plan-Do-Check-Act (PDCA) quality methodology, the goal was set to improve staff responsiveness to orthopaedic patient needs and requests, thus improving patient satisfaction. A model to improve staff responsiveness was systematically developed and implemented. The I Care Rounding model places the emphasis on proactively meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode. After full implementation, positive improvement was demonstrated. PMID:18677250

  7. Variations in Implementation of Acute Care Surgery: Results from a national survey of university-affiliated hospitals

    PubMed Central

    Santry, Heena P.; Madore, John C.; Collins, Courtney E.; Ayturk, M. Didem; Velmahos, George C.; Britt, LD; Kiefe, Catarina I.

    2015-01-01

    BACKGROUND To date, no studies have reported nationwide adoption of Acute Care Surgery (ACS) or identified structural and/or process variations for the care of emergency general surgery (EGS) patients within such models. METHODS We surveyed surgeons responsible for EGS coverage at University HealthSystems Consortium hospitals using an 8-page postal/email questionnaire querying respondents on hospital and EGS structure/process measures. Survey responses were analyzed using descriptive statistics, univariate comparisons, and multivariable regression models. RESULTS 258 of 319 (81%) potential respondents completed surveys. 81 hospitals (31%) had implemented ACS while 134 (52%) had a traditional general surgeon on-call model (GSOC). 38 (15%) hospitals had another model (HYBRID). Larger bed, university-based, teaching hospitals with Level 1 trauma center verification status located in urban areas were more likely to have adopted ACS. In multivariable modeling, hospital type, setting, and trauma center verification predicted ACS implementation. EGS processes of care varied with 28% GSOC having block time vs 67% ACS (p<0.0001); 45% GSOC providing ICU care to EGS patients in a surgical/trauma ICU vs 93% ACS (p<0.0001); GSOC sharing call among 5.7 (+/− 3.2) surgeons vs 7.9 (+/−2.3) ACS surgeons (p<0.0001); and 13% GSOC taking in-house EGS call vs 75% ACS (p<0.0001). Among ACS hospitals there were variations in patient cohorting (25% EGS patients alone; 21% EGS+trauma; 17% EGS+elective; 30% EGS+trauma+elective), data collection (26% had prospective EGS registries), and patient handoffs (56% had attending surgeon presence), call responsibilities (averaging 4.8 (+/− 1.3) calls per month with 60% providing extra call stipend and 40% with no post-call clinical duties). CONCLUSION The potential of the ACS on the national crisis in access to EGS care is not fully met. Variations in EGS processes of care among adopters of ACS suggest that standardized criteria for ACS

  8. National Trends in Main Causes of Hospitalization: A Multi-Cohort Register Study of the Finnish Working-Age Population, 1976–2010

    PubMed Central

    Kouvonen, Anne; Koskinen, Aki; Varje, Pekka; Kokkinen, Lauri; De Vogli, Roberto; Väänänen, Ari

    2014-01-01

    Background The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change. Methodology National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years. Principal Findings Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed. Conclusions/Significance A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010. PMID:25379723

  9. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance

    PubMed Central

    Simor, Andrew E.; Ofner-Agostini, Marianna; Bryce, Elizabeth; Green, Karen; McGeer, Allison; Mulvey, Michael; Paton, Shirley

    2001-01-01

    Background To better understand the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals, surveillance has been conducted in sentinel hospitals across the country since 1995. We report the results of the first 5 years of the program. Methods For each newly identified inpatient with MRSA, medical records were reviewed for demographic and clinical data. Isolates were subjected to susceptibility testing and molecular typing by pulsed-field gel electrophoresis. Results A total of 4507 patients infected or colonized with MRSA were identified between January 1995 and December 1999. The rate of MRSA increased each year from a mean of 0.95 per 100 S. aureus isolates in 1995 to 5.97 per 100 isolates in 1999 (0.46 per 1000 admissions in 1995 to 4.12 per 1000 admissions in 1999) (p < 0.05). Most of the increase in MRSA occurred in Ontario, Quebec and the western provinces. Of the 3009 cases for which the site of MRSA acquisition could be determined, 86% were acquired in a hospital, 8% were acquired in a long-term care facility and 6% were acquired in the community. A total of 1603 patients (36%) were infected with MRSA. The most common sites of infection were skin or soft tissue (25% of MRSA infections), pulmonary tissues (24%) and surgical sites (23%); 13% of the patients were bacteremic. An epidemiologic link with a previously identified MRSA patient was suspected in 53% of the cases. Molecular typing indicated that most (81%) of the isolates could be classified as related to 1 of the 4 Canadian epidemic strains of MRSA. Interpretation There has been a significant increase in the rate of isolating MRSA in many Canadian hospitals, related to the transmission of a relatively small number of MRSA strains. PMID:11468949

  10. Interim Results of a National Test of the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD)

    PubMed Central

    Traino, H. M.; Alolod, G. P.; Shafer, T.; Siminoff, L. A.

    2012-01-01

    Organ donation remains a major public health challenge with over 114 000 people on the waitlist in the United States. Among other factors, extant research highlights the need to improve the identification and timely referral of potential donors by hospital health-care providers (HCPs) to organ procurement organizations (OPOs). We implemented a national test of the Rapid Assessment of hospital Procurement barriers in Donation (RAPiD) to identify assets and barriers to the organ donation and patient referral processes; assess hospital–OPO relationships and offer tailored recommendations for improving these processes. Having partnered with seven OPOs, data were collected at 70 hospitals with high donor potential in the form of direct observations and interviews with 2358 HCPs. We found that donation attitudes and knowledge among HCPs were high, but use of standard referral criteria was lacking. Significant differences were found in the donation-related attitudes, knowledge and behaviors of physicians and emergency department staff as compared to other staff in intensive care units with high organ donor potential. Also, while OPO staff were generally viewed positively, they were often perceived as outsiders rather than members of healthcare teams. Recommendations for improving the referral and donation processes are discussed. PMID:22900761

  11. ‘Shell shock’ Revisited: An Examination of the Case Records of the National Hospital in London

    PubMed Central

    Linden, Stefanie Caroline; Jones, Edgar

    2014-01-01

    During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain’s leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient’s military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria. PMID:25284893

  12. A Retrospective Case Series of Surgical Implant Generation Network (SIGN) Placement at the Afghan National Police Hospital, Kabul, Afghanistan.

    PubMed

    Ertl, Christian W; Royal, David; Arzoiey, Humayoon Abdul; Shefa, Azizullah; Sultani, Salim; Mosafa, Mohammed Omar; Sadat, Safiullah; Zirkle, Lewis

    2016-01-01

    In Afghanistan, adequate and cost-effective medical care for even routine conditions is lacking; especially for complex injuries like long-bone fractures. The Surgical Implant Generation Network (SIGN) intramedullary nail is used for treatment of long-bone fractures from blunt injuries and does not require imaging. We are reporting for the first time results of the SIGN intramedullary nail at the Afghan National Police Hospital, a tertiary care facility in Kabul. 71 records from the SIGN Online Surgical Database were reviewed for gender, age, date of injury, implant date, patient's home of record, and type/ mechanism of injury. Mean age was 26.7 years, all but one being male; time from injury to implant ranged 1 to 401 days, with mean of 40.6 days. Long-bone fractures from motor vehicle accidents remained constant, and war injuries peaked in summer. Follow-up is limited because of security and financial burdens of travel. However, personal communication with Afghan National Police Hospital surgeons suggests that patients included in the current study have not experienced any adverse outcomes. While it remains to be seen if the SIGN Online Surgical Database will facilitate more comprehensive outcome studies, our results provide support for the efficacy of SIGN nails in treating long-bone fractures from war injuries. PMID:26741473

  13. Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study

    PubMed Central

    2011-01-01

    Background We aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH) in China where the disease is more common than in Western populations. Methods Data on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62 hospital registry in China during 2006-07. Results Nearly all ICH patients (n = 1572) received an intravenous haemodiluting agent such as mannitol (96%) or a neuroprotectant (72%), and there was high use of intravenous traditional Chinese medicine (TCM) (42%). Neurosurgery was undertaken in 137 (9%) patients; being overweight, having a low Glasgow Coma Scale (GCS) score on admission, and Total Anterior Circulation Syndrome (TACS) clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p < 0.001). Continuation of antihypertensives in-hospital and at 3 and 12 months post-stroke was reported in 732/935 (78%), 775/935 (83%), and 752/935 (80%) living patients with hypertension, respectively. Conclusions The management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH. PMID:21276264

  14. Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981–92: analysis of a national hospital discharge database

    PubMed Central

    Quinlan, K.; Wallace, L; Furner, S.; Brewer, R.; Bolen, J.; Schieber, R.

    1998-01-01

    Objective—To describe national trends in hospitalizations for motor vehicle related injuries among children and youth (0–24 years) of the United States Indian Health Service (IHS) from 1981–92. Design—Descriptive epidemiologic study of the E coded national hospital discharge database of the IHS. Results—From 1981 to 1992, the age standardized annual incidence of motor vehicle related injury hospitalizations (per 100 000 population) among American Indian and Alaskan Native (AI/AN) youth decreased more than 65% from 269 to 93. Substantial declines in hospitalization rates for all age and sex groups, all IHS areas, and most injury types were seen over this time. Injuries to vehicle occupants accounted for 78% of all motor vehicle related injury hospitalizations. The annual incidence of hospitalization (per 100 000 population) ranged from 291 in the Billings (Wyoming/Montana) and Aberdeen (the Dakotas) areas to 38 in the Portland area (Pacific Northwest). Conclusions—National motor vehicle related injury hospitalization rates of AI/AN children and youth decreased significantly from 1981–92. This may be due to a reduction in the incidence of severe motor vehicle related trauma, changing patterns of medical practice, and changes in the use of services. Additional measures, such as passage and enforcement of tribal laws requiring the use of occupant restraints and stronger laws to prevent alcohol impaired driving, might further reduce the incidence of serious motor vehicle related injuries in this high risk population. PMID:9887418

  15. Mortality as an indicator of patient safety in orthopaedics: lessons from qualitative analysis of a database of medical errors

    PubMed Central

    2012-01-01

    Background Orthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA) over a four-year period (2005–2009), using a qualitative approach. Methods Reports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created. Results A total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1) stages of the surgical journey – 118/191 (62%) of deaths occurred in the post-operative phase; (2) causes of patient deaths – 32% were related to severe infections; (3) reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4) skills of healthcare professionals – 44% of deaths had a failure in non-technical skills. Conclusions Most complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care. PMID:22682470

  16. Considerations in the Radiologic Evaluation of the Pregnant Orthopaedic Patient.

    PubMed

    Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K

    2015-08-01

    Radiographic imaging of the pregnant patient represents a diagnostic and management dilemma for the orthopaedic surgeon. Imaging is often necessary in the setting of trauma; however, in utero radiation exposure can result in deleterious developmental effects in the embryo and fetus. The likelihood of a negative effect is proportional to the radiation dose and the gestational age of the embryo or fetus at the time of exposure. Ionizing radiation doses >100 mGy in the first trimester of pregnancy may lead to spontaneous abortion, malformation, and mental retardation. Whereas plain radiographs of the extremities and cervical spine expose the fetus to minimal doses of radiation of <10 mGy, other commonly performed orthopaedic diagnostic studies, such as CT of the pelvis, emit significantly higher exposure doses of approximately 35 mGy. Non-emitting modalities, such as ultrasonography and MRI, are alternatives for evaluation in the clinical setting. PMID:26116850

  17. Composite Bone Models in Orthopaedic Surgery Research and Education

    PubMed Central

    Elfar, John; Stanbury, Spencer; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas

    2014-01-01

    Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education—applications that traditionally relied on cadavers. Cadaver bones are suboptimal for myriad reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757

  18. Minimally invasive surgery in orthopaedics. Small is beautiful?

    PubMed

    Yeung, S H

    2008-08-01

    With the blooming of minimally invasive procedures in surgical specialties, many orthopaedic subspecialties have been evolving along such lines. Despite the apparent paradox that many orthopaedic implants are quite bulky to start off with, different methods have been adopted to insert them safely with the least possible trauma. Altering time-honoured incisions and surgical techniques has often been helpful. The industry is also very keen to re-design implants for this purpose and has contributed substantial momentum in this direction. Coupled with the use of operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and lesser trauma. The advent of computer-assisted technology is another step forward. It is through constant attention to minimising tissue trauma and a combination of different methods available, that surgeons can achieve the ultimate goals of minimally invasive surgery.

  19. Bone and metal: an orthopaedic perspective on osseointegration of metals.

    PubMed

    Goriainov, Vitali; Cook, Richard; M Latham, Jeremy; G Dunlop, Douglas; Oreffo, Richard O C

    2014-10-01

    The area of implant osseointegration is of major importance, given the predicted significant rise in the number of orthopaedic procedures and an increasingly ageing population. Osseointegration is a complex process involving a number of distinct mechanisms affected by the implant bulk properties and surface characteristics. Our understanding and ability to modify these mechanisms through alterations in implant design is continuously expanding. The following review considers the main aspects of material and surface alterations in metal implants, and the extent of their subsequent influence on osseointegration. Clinically, osseointegration results in asymptomatic stable durable fixation of orthopaedic implants. The complexity of achieving this outcome through incorporation and balance of contributory factors is highlighted through a clinical case report.

  20. Radiation safety for anaesthesia providers in the orthopaedic operating room.

    PubMed

    Rhea, E B; Rogers, T H; Riehl, J T

    2016-04-01

    In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units.

  1. Competency-based education: a new model for teaching orthopaedics.

    PubMed

    Alman, Benjamin A; Ferguson, Peter; Kraemer, William; Nousiainen, Markku T; Reznick, Richard K

    2013-01-01

    The current methods used to train residents to become orthopaedic surgeons are based on tradition, not evidence-based models. Educators have only a limited ability to assess trainees for competency using validated tests in various domains. The reduction in resident work hours limits the time available for clinical training, which has resulted in some calls for lengthening the training process. Another approach to address limited training hours is to focus training in a program that allows residents to graduate from a rotation based on demonstrated competency rather than on time on a service. A pilot orthopaedic residency curriculum, which uses a competency-based framework of resident training and maximizes the use of available training hours, has been designed and is being implemented.

  2. Orthopaedic applications of nanoparticle-based stem cell therapies

    PubMed Central

    2012-01-01

    Stem cells have tremendous applications in the field of regenerative medicine and tissue engineering. These are pioneering fields that aim to create new treatments for disease that currently have limited therapies or cures. A particularly popular avenue of research has been the regeneration of bone and cartilage to combat various orthopaedic diseases. Magnetic nanoparticles (MNPs) have been applied to aid the development and translation of these therapies from research to the clinic. This review highlights contemporary research for the applications of iron-oxide-based MNPs for the therapeutic implementation of stem cells in orthopaedics. These MNPs comprise of an iron oxide core, coated with a choice of biological polymers that can facilitate the uptake of MNPs by cells through improving endocytic activity. The combined use of these oxides and the biological polymer coatings meet biological requirements, effectively encouraging the use of MNPs in regenerative medicine. The association of MNPs with stem cells can be achieved via the process of endocytosis resulting in the internalisation of these particles or the attachment to cell surface receptors. This allows for the investigation of migratory patterns through various tracking studies, the targeting of particle-labelled cells to desired locations via the application of an external magnetic field and, finally, for activation stem cells to initiate various cellular responses to induce the differentiation. Characterisation of cell localisation and associated tissue regeneration can therefore be enhanced, particularly for in vivo applications. MNPs have been shown to have the potential to stimulate differentiation of stem cells for orthopaedic applications, without limiting proliferation. However, careful consideration of the use of active agents associated with the MNP is suggested, for differentiation towards specific lineages. This review aims to broaden the knowledge of current applications, paving the way to

  3. Orthodontic/orthopaedic adjunct of fixed orthodontic appliances.

    PubMed

    Loh, K W

    1986-07-01

    In the treatment of malocclusion more emphasis is now placed on obtaining an excellent facial result as well as a set of teeth which is well aligned and in good function. The use of dento facial orthopaedic appliances have made these objectives possible. Not only can cases be finished better, they can also be completed in a shorter period of time. This paper reviews some of such appliances and case reports will also be presented.

  4. Image guidance in orthopaedics and traumatology: A historical perspective.

    PubMed

    Székely, Gabor; Nolte, Lutz-P

    2016-10-01

    In this note we summarize the history of computer aided surgery in orthopaedics and traumatology from the end of the nineteenth century to currently observable future trends. We concentrate on the two major components of such systems, pre-operative planning and intra-operative execution. The evolution of the necessary technological components, the numerous platforms and components offered commercially as well as their clinical use are surveyed. PMID:27377330

  5. An Assessment of the Application of Pharma Cloud System to the National Health Insurance Program of Taiwan and the Result in Hospitals.

    PubMed

    Yan, Yu-Hua; Lu, Chen-Luan

    2016-01-01

    National Health Insurance Administration established Pharma Cloud System in July 2014. The purpose is to decrease therapeutic duplications and enhance public medication safety. Comparison will be made among individual hospitals and the administering branches of National Health Insurance Bureau (NHIB) on the statistical data on the inquiry of the cloud medication history record system to understand the result of the installation and advocacy of this system. The results show (1) there were 2,329,846 entries of data collected from the branches of the NHIB from 2015 on cloud medication history record and 50,224 entries of data from individual hospitals. (2) The inquiry rate at the branches of the NHIB was 43.2% from January to April, 2015 and at individual hospitals was 18.8%. (3) The improvement rate at the branches of the NHIB was 32.5% and at the individual hospitals was 47.0% from January to April, 2015.

  6. [Cardiovascular emergencies and their morbimortality at the hospital. Report of 733 cases at the CHU campus in Lome (national reference hospital in Togo)].

    PubMed

    Damorou, F; Pessinaba, S; Lawson, B; Abdoulaye, S; Soussou, B; Grunitzky, K

    2008-01-01

    Due to the recent establishment of the emergencies Units in Black Africa, their epidemiological aspects are not well known. Our aims was to describe the epidemiology of this desease in Togo. Through a retrospective analysis we study over a period of 42 mouths. From January first, 2001 to June 30th, 2004. It was carried out exclusively at CHU-Campus, the hospital of Lomé Campus, the second national medical center of reference. Included were all the patients with cardio-vascular emergency cases. We have studied the epidemilogical aspects according to the age, sex, profession, morbidity, and mortality. The treatment of results have been done by Computer. The registered emergency cases were 733 il all with is a frequency of the patients admitted at CHU-CAMPUS. The average age is 56 +/- 13 years with extreme ages from 20 to 97 years. The age group most affected is between 30 and 69 years--The ratio according to the sex is 1.09 in favour of men. Housewives are the professional category most affected (42.3%). Constitute the essential of the cardiovascular emergency cases with a ratio of the 78.3%. The mortality is 17.1% which in most registered between 30 and 69 years. The morbidity ratio is 64.1% We have to keep in mind that cardio-vascular emergency cases are very frequent in Togo. A very active population of young people is concerned. The poor are the most threatened. Henceforth the establishment and equipment of cardiological units are absolutely necessary, for they constitute the only solution by which the level of morbi-mortality can be reduced. PMID:19434971

  7. Management of orthopaedic surgery in rare bleeding disorders.

    PubMed

    Siboni, S M; Biguzzi, E; Pasta, G; Mannucci, P M; Mistretta, C; Fantini, N N; Solimeno, L P; Peyvandi, F

    2014-09-01

    Knowledge regarding the management of orthopaedic surgery in patients with rare bleeding disorders (RBDs) is limited. Retrospective data collection and analysis of 35 orthopaedic procedures (6 minor and 29 major) carried out in 22 patients with RBD between 1982 and 2013. These surgeries were performed using heterogeneous regimens of hemostatic therapy, except for seven procedures performed with no hemostatic treatment in four patients with mild factor deficiency. Of the 28 procedures carried out with hemostatic treatment, nine (32%) were performed using replacement therapy with dosages of concentrates of the deficient factor aimed to achieve perioperative plasma levels judged to be compatible with hemostasis; three (11%) using factor replacement therapy associated with fresh frozen plasma (FFP); four (14%) using recombinant activated factor VII; four (14%) using virus inactivated plasma alone; three (11%) using virus inactivated plasma associated with desmopressin; one (4%) using FFP alone; and four (14%) procedures using tranexamic acid alone. Bleeding complications occurred in 7 of 35 procedures (20%) involving five patients. Prophylaxis of venous thromboembolism was performed only in one case with no excessive bleeding, but two patients not on thromboprophylaxis developed superficial thrombophlebitis. A satisfactory control of hemostasis was achieved in most patients. In some of those characterized by mild factor deficiency (FVII, FXI) hemostatic treatment could be avoided in some instances. The control of hemostasis combined with an adequate surgical technique is needed for the successful outcome of orthopaedic surgery in RBDs that requires the involvement of specialized haemophilia centres.

  8. Hip arthroscopy: a report on a cohort of orthopaedic surgeons

    PubMed Central

    Byrd, J. W. Thomas; Jones, Kay S.; Chin, Paul C.

    2016-01-01

    Successful hip arthroscopy depends on proper patient selection and reasonable patient expectations. The purpose of this study is to report the results of hip arthroscopy in orthopaedic surgeons who represent the most informed cohort. This report is based on a retrospective review of prospectively collected data among 24 orthopaedic surgeons (1 bilateral). Follow-up averaged 48 months (range 12–120 months). They were all males with an average age of 45 years (range 30–64 years). All improved with an average of 18 points (preoperative 75; post-operative 93); although one underwent repeat arthroscopy and one was converted to total hip arthroplasty at 54 months. There were numerous diagnoses and procedures performed and one complication (acute coronary artery occlusion). They resumed seeing patients at an average of 1.6 weeks (range 2 days–4 weeks) and operating at an average of 3.1 weeks (range 6 days–8 weeks). This report spans three decades, thus representing a heterogeneous population in terms of diagnoses and treatment. Nonetheless, successful results are noted. As a cohort, orthopaedic surgeons possess the greatest insight into hip arthroscopy, but as patients, often they must modulate their expectations in order to match the understanding of the realities of the procedure. PMID:27583146

  9. Neoprene Orthopaedic Supports: An Underrecognised Cause of Allergic Contact Dermatitis.

    PubMed

    Hawkey, S; Ghaffar, S

    2015-01-01

    Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD) in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports' material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication. PMID:26236520

  10. Surgical skills simulation in trauma and orthopaedic training.

    PubMed

    Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

    2014-12-19

    Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons.

  11. Surgical skills simulation in trauma and orthopaedic training.

    PubMed

    Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

    2014-01-01

    Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons. PMID:25523023

  12. Regenerative orthopaedics: in vitro, in vivo...in silico.

    PubMed

    Geris, Liesbet

    2014-09-01

    In silico, defined in analogy to in vitro and in vivo as those studies that are performed on a computer, is an essential step in problem-solving and product development in classical engineering fields. The use of in silico models is now slowly easing its way into medicine. In silico models are already used in orthopaedics for the planning of complicated surgeries, personalised implant design and the analysis of gait measurements. However, these in silico models often lack the simulation of the response of the biological system over time. In silico models focusing on the response of the biological systems are in full development. This review starts with an introduction into in silico models of orthopaedic processes. Special attention is paid to the classification of models according to their spatiotemporal scale (gene/protein to population) and the information they were built on (data vs hypotheses). Subsequently, the review focuses on the in silico models used in regenerative orthopaedics research. Contributions of in silico models to an enhanced understanding and optimisation of four key elements-cells, carriers, culture and clinics-are illustrated. Finally, a number of challenges are identified, related to the computational aspects but also to the integration of in silico tools into clinical practice.

  13. Musculoskeletal ultrasound education: orthopaedic resident ability following a multimedia tutorial.

    PubMed

    Piposar, Jonathan R; Easley, Mark; Nunley, James A; DeOrio, James K; Talusan, Paul G; Gubler, Kyle E; Reach, John S

    2015-01-01

    Musculoskeletal ultrasound (MSK-US) is a quick and effective imaging tool that can be utilized by orthopaedic surgeons to identify common musculoskeletal pathology such as ankle tendinopathy. This study evaluated the ability of 15 orthopaedic surgery residents to identify and measure ankle tendons after attending a multimedia tutorial on MSK-US. Afterwards, proficiency of usage was assessed by identification and quantification of three ankle tendons (Achilles, tibialis posterior, and flexor hallucis longus) in a cadaver limb. Resident comfort level and plan for future use were also assessed. After completing the tutorial, accuracy measuring the Achilles, tibialis posterior, and flexor hallucis longus tendons was 94.8%, 90.2%, and 90.1%, respectively. Resident comfort level improved from a level of 2.3 before the tutorial to 6.8 afterwards. Seventy-one percent of residents plan to use ultrasound in clinical practice. These results show that orthopaedic surgery residents can identify and assess tendon size via MSK-US with sufficient accuracy after a multimedia tutorial. PMID:25830266

  14. Publication rate of presentations at an annual military orthopaedic meeting.

    PubMed

    Schoenfeld, Andrew J; Carey, Paul A; Frye, Brandon D; Weaver, Courtney R; Belmont, Philip J

    2012-01-01

    Many research abstracts presented at orthopaedic conferences do not undergo a formal editorial, or peer-review process; however, abstracts are frequently referenced in textbooks and influence clinical practice. The purpose of this study was to determine the publication rate of abstracts formally presented at the Society of Military Orthopaedic Surgeons (SOMOS) annual meetings from 1998 to 2006 that went to full-text publication. Using Google Scholar and PubMed, a literature search was performed for each abstract presented at the annual SOMOS meeting in the years 1998-2006, to calculate the overall full-text publication rate, the average duration from presentation to publication, and the distribution of publications in the various journals. A total of 770 abstracts were presented at the annual SOMOS meetings. The overall full-text publication rate at a minimum of 3 years was 45.7% (352 publications). The average time from presentation to publication was 2.7 years. The published articles appeared in 65 peer-reviewed journals, with notable distribution in Spine (10.0%), The American Journal of Sports Medicine (9.4%), and The Journal of Bone and Joint Surgery (9.4%). The full-text publication rate of abstracts presented at the annual SOMOS meetings compares favorably with that of other major orthopaedic conferences in the United States. Nonetheless, more than half of abstracts presented at the SOMOS meetings remain unpublished. PMID:23327844

  15. Orthopaedic Trauma Care Specialist Program for Developing Countries.

    PubMed

    Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew

    2015-10-01

    The dire challenges faced in Haiti, both preearthquake and postearthquake, highlight the need for developing surgical infrastructure to care for traumatic musculoskeletal injuries. The proposed Orthopaedic Trauma Care Specialist (OTCS) residency program aims to close the critical human resource gap that limits the appropriate care of musculoskeletal trauma in Haiti. The OTCS program is a proposal for a 2-year residency program that will focus primarily on the management of orthopaedic trauma. The proposed program will be a comprehensive approach for implementing affordable and sustainable strategies to improve orthopaedic trauma care. Its curriculum will be tailored to the injuries seen in Haiti, and the treatments that can be delivered within their health care system. Its long-term sustainability will be based on a "train-the-trainers" approach for developing local faculty to continue the program. This proposal outlines the OTCS framework specifically for Haiti; however, this concept is likely applicable to other low- and middle-income environments in a similar need for improved trauma and fracture care. PMID:26356211

  16. Material properties of common suture materials in orthopaedic surgery.

    PubMed

    Najibi, S; Banglmeier, R; Matta, Jm; Tannast, M

    2010-01-01

    Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977

  17. MATERIAL PROPERTIES OF COMMON SUTURE MATERIALS IN ORTHOPAEDIC SURGERY

    PubMed Central

    Najibi, S; Banglmeier, R; Matta, JM; Tannast, M

    2010-01-01

    Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977

  18. Factors associated with hospital retention of RNs in the New York City Metropolitan Area: an analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses.

    PubMed

    Rosenfeld, Peri; Adams, Richard E

    2008-08-01

    The nursing shortage is well documented, and government estimates indicate that shortfalls will worsen in the future. As the largest employer of registered nurses (RNs), hospitals are the most seriously affected by shortages, as they compete with other employment settings for limited nursing resources. Recruitment remains the primary avenue for ensuring staffing levels, but retention is increasingly important as applicant pools shrink because of demographic and employment trends. Effective retention strategies must address the factors that contribute to exodus of RNs from hospitals, as well as isolating the factors that enable RNs to remain in hospital employment. This secondary analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses examines the demographic, employment, and educational factors associated with working in hospitals, having full-time status, and holding patient care positions. The findings suggest that hospitals must address nonwork issues to retain nursing personnel. Relevant policy issues are examined and strategies for effective retention are offered. PMID:18509198

  19. In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

    PubMed Central

    2016-01-01

    Background & Objectives The aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC), to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs. Methods We performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10) codes for renal cell carcinoma (C64) and codes for metastases (C77 to C79). Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals. Results A total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18–102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906) in 2008 to 10,216€ (SD: €10,527) in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs. Conclusion This study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs. PMID:27649305

  20. The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

    PubMed

    Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi

    2014-01-01

    Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.

  1. Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

    PubMed Central

    Nyongole, Obadia; Akoko, Larry; Mwanga, Ally; Mchembe, Mabula; Kamala, Benjamin; Mbembati, Naboth

    2015-01-01

    Introduction Antimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment. Methods This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software. Results Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention. Conclusion Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication. PMID:26952184

  2. Orthopaedic interventions in patients with psoriatic arthritis: a descriptive report from the SPAR cohort

    PubMed Central

    Haque, Naba; Lories, Rik J; de Vlam, Kurt

    2016-01-01

    Objectives To evaluate the current needs for joint surgery in patients with psoriatic arthritis (PsA). Methods The patient database at the Rheumatology Department of the University Hospitals Leuven, was cross-sectionally analysed using demographic, medical, laboratory, radiological and surgical data of 269 patients with PsA. Patients were grouped by the presence or absence of orthopaedic surgery and compared for gender, age, mean health assessment questionnaire (HAQ) score, current medication and disease duration. The data were assessed using descriptive statistics and Student's t-tests. Results Overall 48.33% of the patients underwent 1 or more orthopaedic surgeries at some point of time. A total of 280 surgical interventions were flagged in the database, including both joint sacrificing and non-joint sacrificing procedures. Mean disease duration±SD at the time of surgery was 1.58 years±12.05. Age of the patients with surgeries was 54.13 years±11.03 SD and not different from those without surgeries (53.73 years±12.81 SD; p=0.78). 41.54% of the patients underwent a single surgery while 58.46% had multiple surgeries. A significant difference in the mean HAQ score was observed among the patients with and without surgeries (p<0.001). Of all the surgeries 63.92% were performed after diagnosis whereas 36.07% were performed before a diagnosis of PsA was made. Among the surgeries performed before diagnosis 40.59% were arthroscopies including 9.90% of diagnostic arthroscopies. Conclusions The number of surgical interventions has significantly increased in patients with PsA compared with historical cohorts even with a relatively shorter disease duration. There was a significant difference in HAQ score between the patients with or without surgeries.

  3. Orthopaedic interventions in patients with psoriatic arthritis: a descriptive report from the SPAR cohort

    PubMed Central

    Haque, Naba; Lories, Rik J; de Vlam, Kurt

    2016-01-01

    Objectives To evaluate the current needs for joint surgery in patients with psoriatic arthritis (PsA). Methods The patient database at the Rheumatology Department of the University Hospitals Leuven, was cross-sectionally analysed using demographic, medical, laboratory, radiological and surgical data of 269 patients with PsA. Patients were grouped by the presence or absence of orthopaedic surgery and compared for gender, age, mean health assessment questionnaire (HAQ) score, current medication and disease duration. The data were assessed using descriptive statistics and Student's t-tests. Results Overall 48.33% of the patients underwent 1 or more orthopaedic surgeries at some point of time. A total of 280 surgical interventions were flagged in the database, including both joint sacrificing and non-joint sacrificing procedures. Mean disease duration±SD at the time of surgery was 1.58 years±12.05. Age of the patients with surgeries was 54.13 years±11.03 SD and not different from those without surgeries (53.73 years±12.81 SD; p=0.78). 41.54% of the patients underwent a single surgery while 58.46% had multiple surgeries. A significant difference in the mean HAQ score was observed among the patients with and without surgeries (p<0.001). Of all the surgeries 63.92% were performed after diagnosis whereas 36.07% were performed before a diagnosis of PsA was made. Among the surgeries performed before diagnosis 40.59% were arthroscopies including 9.90% of diagnostic arthroscopies. Conclusions The number of surgical interventions has significantly increased in patients with PsA compared with historical cohorts even with a relatively shorter disease duration. There was a significant difference in HAQ score between the patients with or without surgeries. PMID:27651927

  4. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

    PubMed Central

    Atun, Rifat; Gurol–Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-01-01

    Background Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Methods Using routinely collected health billing records for 2005–2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co–morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply–side variables, and PHC use. Findings Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow–up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Interpretation Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions. PMID:27175280

  5. Peer mentors, mobile phone and pills: collective monitoring and adherence in Kenyatta National Hospital's HIV treatment programme

    PubMed Central

    Moyer, Eileen

    2014-01-01

    In 2006, the Kenyan state joined the international commitment to make antiretroviral treatment free in public health institutions to people infected with HIV. Less than a decade later, treatment has reached over 60% of those who need it in Kenya. This paper, which is based on an in-depth ethnographic case study of the HIV treatment programme at Kenyatta National Hospital, conducted intermittently between 2008 and 2014, examines how HIV-positive peer mentors encourage and track adherence to treatment regimens within and beyond the clinic walls using mobile phones and computer technology. This research into the everyday practices of patient monitoring demonstrates that both surveillance and adherence are collective activities. Peer mentors provide counselling services, follow up people who stray from treatment regimens, and perform a range of other tasks related to patient management and treatment adherence. Despite peer mentors’ involvement in many tasks key to encouraging optimal adherence, their role is rarely acknowledged by co-workers, hospital administrators, or public health officials. Following a biomedical paradigm, adherence at Kenyatta and in Kenya is framed by programme administrators as something individual clients must do and for which they must be held accountable. This framing simultaneously conceals the sociality of adherence and undervalues the work of peer mentors in treatment programmes. PMID:25175291

  6. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

    PubMed Central

    Atun, Rifat; Gurol–Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-01-01

    Background Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Methods Using routinely collected health billing records for 2005–2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co–morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply–side variables, and PHC use. Findings Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow–up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Interpretation Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions. PMID:27648258

  7. Understanding the recruitment and retention of overseas nurses: realist case study research in National Health Service Hospitals in the UK.

    PubMed

    O'Brien, Terri; Ackroyd, Stephen

    2012-03-01

    This paper illustrates one of the possible applications of critical realist ideas to the analysis of health services, in the use of comparative case study research design, to elucidate the causal social processes underlying events. In the research reported here, a comparative research design was used as a basis for improving our understanding of the processes involved in the assimilation of overseas nurses (OSN) into the salient long-term workforce of the National Health Service (NHS) hospitals in the UK. The work brought to light the salient experiences of overseas nurses during their initial work in the NHS hospitals, and these were used as a basis for developing an account of the general mechanisms typically underlying the recruitment and assimilation at work. The authors conclude that successful assimilation is often hindered by the presence of occupational closure mechanisms, by which home nurses effectively excluded recruits from participation and promotion; these mechanisms, which articulate with everyday racism, threaten successful assimilation for obvious reasons. If the treatment recruits receive does not lead to withdrawal, it is because they typically have very strong economic motives to continue despite unfavourable and sometimes inhumane treatment. Thus, the research offered substantial reasons why recruitment policies should be reviewed by policy-makers.

  8. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

    PubMed Central

    Atun, Rifat; Gurol–Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-01-01

    Background Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Methods Using routinely collected health billing records for 2005–2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co–morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply–side variables, and PHC use. Findings Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow–up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Interpretation Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.

  9. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study

    PubMed Central

    Langan Martin, Julie; McLean, Gary; Cantwell, Roch; Smith, Daniel J

    2016-01-01

    Objective To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates. Methods Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models. Results Women from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09). Conclusions Rates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity

  10. The impact of new national HIV testing guidelines at a district general hospital in an area of high HIV seroprevalence.

    PubMed

    Page, I; Phillips, M; Flegg, P; Palmer, R

    2011-03-01

    The latest UK national human immunodeficiency virus (HIV) testing guidelines, released in September 2008, state that HIV testing should be offered to all patients with indicator conditions and considered in all general medical admissions in high-prevalence areas. We audited testing rates at Blackpool Victoria Hospital, a high-prevalence area, one year before and one year after the publication of the new guidelines. In the year after publication the rate of HIV testing in patients with indicator diseases was as follows: hepatitis B 6%, hepatitis C 28%, tuberculosis 9% and lymphoma 14%. The overall rate of HIV testing in acute medical admissions was 0.5%. Our results demonstrate that traditional methods of guideline dissemination did not lead to implementation. We are now assessing alternative methods such as marking all positive laboratory results for indicator diseases with the phrase 'HIV testing should be considered' and implementing universal opt-out screening in our Clinical Decisions Unit.

  11. The EASTR Study: indications for transfusion and estimates of transfusion recipient numbers in hospitals supplied by the National Blood Service.

    PubMed

    Wells, A W; Llewelyn, C A; Casbard, A; Johnson, A J; Amin, M; Ballard, S; Buck, J; Malfroy, M; Murphy, M F; Williamson, L M

    2009-12-01

    This study provides data on National Blood Service (NBS) red blood cell (RBC, n = 9142), platelet (PLT, n = 4232) and fresh frozen plasma (FFP, n = 3584) recipients independently sampled by monthly quota from 29 representative hospitals over 12 months in 2001-2002. Hospitals were stratified by size according to total yearly RBC issues. Transfusion indications were chosen from diagnostic and procedural codes, and recipients grouped into Epidemiology and Survival of Transfusion Recipients Case-mix Groups (E-CMGs). The main E-CMGs were digestive [19% of RBC recipients; including 5% gastrointestinal (GI) bleeds and 3% colorectal surgery], musculoskeletal (15%; 12% hip and knee replacement), haematology (13%) and obstetrics and gynaecology (10%). Renal failure, fractured neck of femur, cardiac artery by-pass grafting (CABG) and paediatrics, each accounted for 3-4% recipients. FFP recipients: the main E-CMGs were digestive (21% of FFP recipients; including 7% GI bleeds and 3% colorectal surgery), hepatobiliary (15%; 7% liver disease and 2% liver transplant), cardiac (12%) and paediatrics (9%) The renal, paediatrics, vascular and haematology E-CMGs each had 6-7% of recipients. PLT recipients: the main E-CMGs were haematology (27% of PLT recipients; including 9% lymphoma and 8% acute leukaemia), cardiac (17%), paediatrics (13%), hepatobiliary (10%) and digestive (9%). Back-weighting gave national estimates of 433 000 RBC, 57 500 FFP and 41 500 PLT recipients/year in England and North Wales, median age 69, 64 and 59 years, respectively. Digestive and hepatobiliary indications emerged as the top reason for transfusion in RBC and FFP recipients, and was also a frequent indication in PLT recipients.

  12. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

    PubMed Central

    Morton, A.; Anderson, G.; Van Der Meer, R. B.; Rymaszewski, L. A.

    2016-01-01

    Objectives “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings. Cite this article: P. J. Jenkins. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. DOI: 10.1302/2046-3758.52.2000506 PMID:26851287

  13. Reliability and validity of the American Hospital Association's national longitudinal survey of health information technology adoption

    PubMed Central

    Everson, Jordan; Lee, Shoou-Yih D; Friedman, Charles P

    2014-01-01

    Objective To evaluate the internal consistency, construct validity, and criterion validity of a battery of items measuring information technology (IT) adoption, included in the American Hospital Association (AHA) IT Supplement Survey. Methods We analyzed the 2012 release of the AHA IT Supplement Survey. We performed reliability analysis using Cronbach's α and part-whole correlations, construct validity analysis using principal component analysis (PCA), and criterion validity analysis by assessing the items’ sensitivity and specificity of predicting attestation to Medicare Meaningful Use (MU). Results Twenty-eight items of the 31-item instrument and five of six functionality subcategories defined by the AHA all produced reliable scales (α’s between 0.833 and 0.958). PCA mostly confirmed the AHA's categorization of functionalities; however, some items loaded only weakly onto the factor most associated with their survey category, and one category loaded onto two separate factors. The battery of items was a valid predictor of attestation to MU, producing a sensitivity of 0.82 and a specificity of 0.72. Discussion The battery of items performed well on most indices of reliability and validity. However, they lack some components of ideal survey design, leaving open the possibility that respondents are not responding independently to each item in the survey. Despite measuring only a portion of the objectives required for attestation to MU, the items are a moderately sensitive and specific predictor of attestation. Conclusions The analyzed instrument exhibits satisfactory reliability and validity. PMID:24623194

  14. Catering & Hospitality, Serving Food & Drink, Levels 1-3. 2nd Edition. Catering & Hospitality, Reception & Housekeeping, Levels 1-3. Catering & Hospitality, Supervisory Management, Level 3. Catering & Hospitality Management, Level 4. 2nd Edition. National Vocational Qualifications.

    ERIC Educational Resources Information Center

    Business and Technology Education Council, London (England).

    Britain's National Vocational Qualifications (NVQs) are work qualifications that measure what an employee or potential employee can do as well as how much he or she knows and understands about a particular job. Used as written proof of usable workplace skills that can be put to profitable use by an employer, NVQs range from basic Level 1, for…

  15. Management of long bone metastases: recommendations from the Italian Orthopaedic Society bone metastasis study group.

    PubMed

    Capanna, Rodolfo; Piccioli, Andrea; Di Martino, Alberto; Daolio, Primo Andrea; Ippolito, Vincenzo; Maccauro, Giulio; Piana, Raimondo; Ruggieri, Pietro; Gasbarrini, Alessandro; Spinelli, Maria Silvia; Campanacci, Domenico Andrea

    2014-10-01

    The purpose of this article is to outline the current approach to patients affected by metastasis to the long bones and to present a clinical and surgical algorithm available for clinicians and for future research. A modern approach to patients affected by long bone metastasis in fact requires a multidisciplinary contest where oncologists, radiotherapists, surgeons and physical therapists cooperate with a shared vision, in order to provide the best possible integrated treatments available. The authors of this article constitute the Bone Metastasis Study Group of the Italian Orthopaedic Society (SIOT): a national group of orthopedic tumor surgeons who are dedicated to studying the approach, techniques and outcomes of surgery for metastatic tumours of the musculoskeletal system.

  16. Executive Function, Survival, and Hospitalization in Chronic Obstructive Pulmonary Disease. A Longitudinal Analysis of the National Emphysema Treatment Trial (NETT)

    PubMed Central

    Dodd, James W.; Novotny, Paul; Sciurba, Frank C.

    2015-01-01

    Rationale: Cognitive dysfunction has been demonstrated in chronic obstructive pulmonary disease (COPD), but studies are limited to cross-sectional analyses or incompletely characterized populations. Objectives: We examined longitudinal changes in sensitive measures of executive function in a well-characterized population of patients with severe COPD. Methods: This study was performed on patients enrolled in the National Emphysema Treatment Trial. To assess executive function, we analyzed trail making (TM) A and B times at enrollment in the trial (2,128 patients), and at 12 (731 patients) and 24 months (593 patients) after enrollment, adjusted for surgery, marriage status, age, education, income, depression, PaO2, PaCO2, and smoking. Associations with survival and hospitalizations were examined using Cox regression and linear regression models. Measurements and Main Results: The average age of the patients was 66.4 years, and the average FEV1 was 23.9% predicted. At the time of enrolment, 38% had executive dysfunction. Compared with those who did not, these patients were older, less educated, had higher oxygen use, higher PaCO2, worse quality of life as measured by the St. George’s Respiratory Quotient, reduced well-being, and lower social function. There was no significant change over 2 years in TM A or B times after adjustment for covariables. Changes in TM B times were modestly associated with survival, but changes in TM B − A times were not. Changes in TM scores were not associated with frequency of hospitalization. Lung function, PaO2, smoking, survival, and hospitalizations were not significantly different in those with executive dysfunction. Conclusions: In this large population of patients with severe emphysema and heavy cigarette smoking exposure, there was no significant decline over 2 years in cognitive executive function as measured by TM tests. There was no association between executive function impairment and frequency of hospitalization, and

  17. Variations in U.S. pediatric burn injury hospitalizations using the national burn repository data.

    PubMed

    Kramer, C Bradley; Rivara, Frederick P; Klein, Matthew B

    2010-01-01

    An understanding of population-specific variation in pediatric burn injuries is essential to the development of effective prevention strategies. The purpose of this study was to examine the etiology of pediatric burn injury considering age and race categories using the National Burn Repository. The authors reviewed the records of all pediatric patients (age <18 years) in the American Burn Association's National Burn Registry injured between 1995 and 2007. The authors compared patient and injury characteristics across race, age, etiology, and payor status. A total of 46,582 patients were included in this study. The etiology of burn injury varied by both age and race. Populations of color were younger, constituting 53.8% of patients younger than 5 years, whereas 53.9% of the total study population identified as Caucasian. Scald etiology was disproportionately less common in patients identifying as Caucasian (39.9 vs 61.4%, P < .001), and scald was a common etiology in older children identifying as African American, Asian, and Hispanic. Inhalation injuries were also higher in patients identifying as Native American (5.4%), Hispanic (4.2%), and African American (3.7%). Pediatric burn injury etiology varies with age and race. These data should encourage careful consideration of race, age, and other differences in formulating the most effective, population-specific prevention and outreach strategies.

  18. Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

    PubMed Central

    2011-01-01

    Background Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. Methods Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. Results Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. Conclusions Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low

  19. Improving Peripherally Inserted Central Catheter (PICC) care on a Trauma and Orthopaedics ward.

    PubMed

    Piorkowska, Marta; Al-Raweshidy, Zahra; Yeong, Keefai

    2013-01-01

    Peripherally Inserted Central Catheter (PICC) blockage rate was audited over a two month period on the Trauma & Orthopaedics ward at our District General Hospital. A 70% (five out of seven) PICC blockage rate was observed. High blockage rates lead to potential treatment complications, delays in delivery of treatment, increase in costs, and reduction in patient satisfaction. The factors contributing to the significant blockage rate include, long and contradictory PICC care guidelines, no information sheets in the patient notes, lack of training and awareness about care of, and flushing of, PICC lines, and lack of accountability for PICC flushing. Our project aimed to achieve a greater rate of PICC patency. We produced one succinct and comprehensive PICC care guideline, carried out staff training sessions, introduced a sticker reminding staff to flush the PICC line after use, and introduced a prescription of weekly heparin saline and PRN saline flushes (for monitoring and accountability). We used questionnaires to assess competency of hospital staff pre-teaching (doctors 6%, nurses 0%), and post-teaching (doctors 70%, nurses 38%). Blockage rate data post-intervention is pending. Education improved awareness of guidelines amongst staff and we anticipate that the proposed interventions will translate into reduced blockage rates, improving patient outcomes and reducing costs.

  20. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases

    PubMed Central

    2014-01-01

    Background The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery. Methods The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once. Results Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations. Conclusions In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process. PMID:24955115

  1. [Optimalisation of the antibiotic policy in The Netherlands. XI. The national electronic antibiotic guide'SWAB-ID' for use in hospitals].

    PubMed

    van Vonderen, M G A; Gyssens, I C; Hartwig, N G; Kullberg, B J; Leverstein-van Hall, M A; Natsch, S; Prins, J M

    2006-11-18

    The 'Stichting Werkgroep Antibioticabeleid' (Dutch Working Party on Antibiotic Policy) has developed an electronic national antibiotic guide for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals. This guide also contains information on the most important characteristics of antimicrobial drugs. Advice on antibiotic treatment is based on existing national evidence-based guidelines, where available. Where no guideline is available, the advice is based on an inventory of the antibiotic policies of the 12 Dutch centres with an infectious disease or medical microbiology training programme. The national antibiotic guide can be accessed through the SWAB website (www.swab.nl) and can also be downloaded on PDA/PocketPC, free of charge. Every hospital antibiotic formulary committee in the Netherlands will be offered the opportunity to edit The national version for local use.

  2. A national system for monitoring the performance of hospitals in Ethiopia.

    PubMed

    McNatt, Zahirah; Linnander, Erika; Endeshaw, Abraham; Tatek, Dawit; Conteh, David; Bradley, Elizabeth H

    2015-10-01

    De nombreux pays s'efforcent d'élaborer et de mettre en œuvre des stratégies pour contrôler les hôpitaux à l'échelle nationale. C'est un défi de taille, en particulier pour les pays à faible revenu, qui disposent de peu de ressources pour effectuer des mesures et des comptes-rendus. Nous avons analysé l'expérience qui a consisté à élaborer et mettre en œuvre un système national de contrôle des performances de 130 hôpitaux publics en Éthiopie. Des observations participatives ont révélé que ce système de contrôle a entraîné une communication plus systématique des données sur les performances aux bureaux régionaux de la santé et au gouvernement fédéral de la part des hôpitaux, a amélioré la transparence concernant les performances de ces derniers et a permis d'élaborer plusieurs projets d'amélioration de la qualité. L'élaboration et la mise en œuvre de ce système, qui ont nécessité des investissements et des soutiens techniques et politiques, n'auraient pas été possibles sans d'importantes capacités de gestion dans les hôpitaux. Il peut être utile, aux premiers stades de la conception et de la mise en œuvre, d'évaluer de manière approfondie l'ouverture au changement du secteur de la santé ainsi que son souhait de placer au premier plan la qualité des services hospitaliers. Cette évaluation peut s'appuyer sur des entretiens avec des informateurs clés, sur la collecte de données au sujet des établissements de santé et des ressources humaines, ou encore sur une discussion avec des partenaires universitaires. Le fait d'associer des partenaires et des donateurs à l'objectif d'amélioration de la qualité visé par le gouvernement peut permettre de renforcer son acceptabilité ainsi que le soutien politique en la matière. Cela peut permettre de faire converger les ressources de façon stratégique vers un même effort national, plutôt que de les éparpiller dans des dizaines de projets potentiellement concurrents

  3. Interrater reliability in grading abstracts for the orthopaedic trauma association.

    PubMed

    Bhandari, Mohit; Templeman, David; Tornetta, Paul

    2004-06-01

    Only a small proportion of submitted abstracts to the annual meeting of the Orthopaedic Trauma Association can be accepted for podium presentation. Annual program committee members must ensure that the selection of abstracts is free from bias and transparent to investigators. The objectives of this study are to examine the consistency of reviewers in grading abstracts submitted for podium presentations at the 2001 and 2002 Annual Meetings of the Orthopaedic Trauma Association and to evaluate whether the grades of the actual podium presentations at the meeting are consistent with the grades based on abstracts only. Reviewers independently graded all abstracts submitted to the Orthopaedic Trauma Association for presentation in a blinded manner. Abstracts submitted by members of the review panel were independently adjudicated by six reviewers who were not members of the committee. Before final decision-making, all reviewers met to discuss the abstracts submitted for oral presentation. Among the 440 papers reviewed in 2001 and 438 papers reviewed in 2002, the interreviewer reliability for abstract review was 0.23 and 0.27, respectively. Despite disagreements in the quality of the abstracts, reviewers achieved consensus by discussions to determine the final program. Agreement among unblinded reviewers of the 67 and 73 podium presentations during the 2001 and 2002 meetings, respectively, did not improve interreviewer agreement. Of the papers of the 2002 meeting that ultimately ranked in the top 20 after the full presentation of the papers, 15 papers originally had been ranked less than 20 in the initial grading. Only one of the top three papers of the meeting originally was ranked in the top three before the meeting.

  4. Efficacy of hand rubs with a low alcohol concentration listed as effective by a national hospital hygiene society in Europe

    PubMed Central

    2013-01-01

    Background Some national hospital hygiene societies in Europe such as the French society for hospital hygiene (SFHH) have positive lists of disinfectants. Few hand disinfectants with a rather low concentration of ethanol are listed by one society as effective for hygienic hand disinfection with 3 mL in 30 s including a virucidal activity in 30 s or 60 s, but published data allow having doubts. We have therefore evaluated the efficacy of three commonly used hand disinfectants according to EN 1500 and EN 14476. Methods Products 1 (Aniosgel 85 NPC) and 2 (Aniosrub 85 NPC) were based on 70% ethanol, product 3 (ClinoGel derma+) on 60% ethanol and 15% isopropanol (all w/w). They were tested in 3 laboratories according to EN 1500. Three mL were applied for 30 s and compared to the reference treatment of 2 × 3 mL applications of isopropanol 60% (v/v), on hands artificially contaminated with Escherichia coli. Each laboratory used a cross-over design against the reference alcohol with 15 or 20 volunteers. The virucidal activity of the products was evaluated (EN 14476) in one laboratory against adenovirus and poliovirus in different concentrations (80%, 90%, 97%), with different organic loads (none; clean conditions; phosphate-buffered saline) for up to 3 min. Results Product 1 revealed a mean log10-reduction of 3.87 ± 0.79 (laboratory 1) and 4.38 ± 0.87 (laboratory 2) which was significantly lower compared to the reference procedure (4.62 ± 0.89 and 5.00 ± 0.87). In laboratory 3 product 1 was inferior to the reference disinfection (4.06 ± 0.86 versus 4.99 ± 0.90). Product 2 revealed similar results. Product 3 fulfilled the requirements in one laboratory but failed in the two other. None of the three products was able to reduce viral infectivity of both adenovirus and poliovirus by 4 log10 steps in 3 min according to EN 14476. Conclusions Efficacy data mentioned in a positive list published by a society for hospital hygiene should still be regarded with caution

  5. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

    PubMed Central

    2011-01-01

    Background Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills

  6. Renal and Gastrointestinal Considerations in Patients Undergoing Elective Orthopaedic Surgery.

    PubMed

    Pyrko, Peter; Parvizi, Javad

    2016-01-01

    To minimize perioperative complications after orthopaedic procedures, patients may undergo medical optimization, which includes an assessment of their renal function and gastrointestinal (GI) system. The GI and renal systems are complex, and their proper optimization in the preoperative period can influence the success of any procedure. Several factors can prevent complications and reduce morbidity, mortality, and the cost of care, including a thorough evaluation and screening, with particular emphasis on anemia and its renal and GI causes; management of medications that are metabolized by the liver and excreted by the kidneys; and careful attention to the patient's nutritional status.

  7. The Orthopaedic Training Study, Phase II 1968-1972. Final Report, Volume I.

    ERIC Educational Resources Information Center

    Olson, Carl J.; And Others

    Phase two of the Orthopaedic Training Study was designed to examine time, sequence, and content requirements of existing orthopaedic programs. Specifically, the proposal was designed to achieve the following objectives: (1) to provide a model of individualized graduate education in medicine in which the demonstration of individual competence marks…

  8. Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery: results from the ETHOS registry.

    PubMed

    Bergqvist, David; Arcelus, Juan I; Felicissimo, Paulo

    2012-02-01

    Venous thromboembolism (VTE) risk persists for several weeks following high-risk orthopaedic surgery (HROS). The ETHOS registry evaluated post-operative VTE prophylaxis prescribed, and actual VTE prophylaxis received, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in HROS patients. We performed a subanalysis of ETHOS to assess patient compliance with ACCP-adherent prophylaxis after discharge and the factors predicting poor compliance. Consecutive patients undergoing hip fracture surgery, total hip arthroplasty, or knee arthroplasty were enrolled at discharge from 161 centres in 17 European countries if they had received adequate in-hospital VTE prophylaxis. Data on prescribed and actual prophylaxis received were obtained from hospital charts and patient post-discharge diaries. Good compliance was defined as percentage treatment intake ≥80% with no more than two consecutive days without treatment. A total of 3,484 patients (79.4%) received ACCP-adherent anticoagulant prescription at discharge and 2,999 (86.0%) had an evaluable patient diary. In total, 87.7% of evaluable patients were compliant with prescribed treatment after discharge. The most common reason for non-compliance (33.4%) was "drug was not bought". Injection of treatment was not a barrier to good compliance. Main factors affecting compliance related to purchase of and access to treatment, patient education, the person responsible for administering injections, country, and type of hospital ward at discharge. Within our study population, patient compliance with ACCP-adherent thromboprophylaxis prescribed at discharge was good. Improvements in patient education and prescribing practices at discharge may be important in further raising compliance levels in high-risk orthopaedic surgery patients.

  9. Evaluation of the duration of thromboembolic prophylaxis after high-risk orthopaedic surgery: the ETHOS observational study.

    PubMed

    Bergqvist, David; Arcelus, Juan I; Felicissimo, Paulo

    2012-02-01

    Real-life data on post-discharge venous thromboembolism (VTE) prophylaxis practices and treatments are lacking. We assessed post-operative VTE prophylaxis prescribed and received in a prospective registry, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in high-risk orthopaedic surgery patients. Consecutive patients undergoing total hip arthroplasty (THA), hip fracture surgery (HFS), or knee arthroplasty (KA) were enrolled at discharge from 161 centres in 17 European countries if they had received in-hospital VTE prophylaxis that was considered in accordance with the ACCP guidelines by the treating physician. Data on prescribed and actual prophylaxis were obtained from hospital charts and patient post-discharge diaries. Post-operative prophylaxis prescribed and actual prophylaxis received were considered adherent or adequate, respectively, if recommended therapies were used for ≥28 days (HFS and THA) or ≥10 days (KA). Among 4,388 patients, 69.9% were prescribed ACCP-adherent VTE prophylaxis (THA: 1,411/2,217 [63.6%]; HFS: 701/1,112 [63.0%]; KA: 955/1,059 [90.2%]). Actual prophylaxis received was described in 3,939 patients with an available diary after discharge (non-evaluability rate of 10%). Mean actual durations of pharmacological prophylaxis from surgery were: 28.4 ± 13.7 (THA), 29.3 ± 13.9 (HFS), and 28.7 ± 14.1 days (KA). ACCP-adequate VTE prophylaxis was received by 66.5% of patients (60.9% THA, 55.4% HFS, and 88.7% KA). Prophylaxis inadequacies were mainly due to inadequate prescription, non-recommended prophylaxis prescription at discharge, or too short prophylaxis prescribed. In high-risk orthopaedic surgery patients with hospital-initiated prophylaxis, there is a gap between ACCP recommendations, prescribed and actual prophylaxis received, mainly due to inadequate prescription at discharge.

  10. Frequent use of blood-saving measures in elective orthopaedic surgery: a 2012 Dutch blood management survey

    PubMed Central

    2013-01-01

    Background Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands. Methods An internet-based questionnaire was sent to all heads of orthopaedic departments of Dutch hospitals and private clinics (n = 99). Questions were asked on how often BSMs were used, reported on a 5-point Likert scale (never, almost never, regularly, almost always, always). In addition there were questions about discontinuation of anticoagulants preoperatively, the number of annually performed arthroplasties (size) and hospital setting. Results The survey was completed by 81 (82%) departments. BSMs used frequently (regularly, almost always, always) were erythropoietine (EPO), with 55 (68%) departments being frequent users; acute normovolemic hemodilution, used frequently in 26 (32%) departments; cell saver in 25 (31%) and postoperative drainage and re-infusion in 56 (69%) departments. When compared by size, frequent EPO use was more common in large departments (with 22 (88%) large departments being frequent users versus 13 (63%) small departments and 16 (55%) intermediate departments, p = 0.03). No differences by size or type were observed for other BSMs. Conclusions Compared with previous survey’s there is a tremendous increase in use of BSMs. EPO and autologous blood salvage techniques are the most often used modalities. Costs might be saved if use of non-cost-effective BSMs is stopped. PMID:23915322

  11. Quality of operation notes in orthopaedic hip arthroplasty surgery: are we complying with British Orthopaedic Association's guide to good practice?

    PubMed

    Menakaya, C U; Ingoe, H; Malhotra, R; Shah, M; Boddice, T; Mohsen, A

    2013-12-01

    This retrospective audit evaluates the compliance of our operation notes with the British Orthopaedic Society Primary Hip Arthroplasty 'A guide to good practice' using a 24-data point question (BOA 2006). Ninety-nine notes reviewed, of which 94% had patient identifiers, the surgical team was documented in 92.5%, post-operative instruction in 97%, and prosthesis stability in 97% of cases. Despite high standards, we did not achieve the 100% gold standard. We suggest that increased awareness of the 24-point BOA guideline via education and proformas would help to ensure better practice

  12. Relationship between mean daily ambient temperature range and hospital admissions for schizophrenia: Results from a national cohort of psychiatric inpatients.

    PubMed

    Sung, Tzu-I; Chen, Mu-Jean; Lin, Chuan-Yao; Lung, Shih-Chun; Su, Huey-Jen

    2011-12-01

    Environmental temperature is known to correlate with schizophrenia, but little is known about the association with changes in temperature. This 12-year study aimed to evaluate the relationship between the mean daily range of ambient temperature and schizophrenia admissions in a national cohort of psychiatric inpatients in Taiwan. Meteorological data provided by the Central Weather Bureau of Taiwan were interpolated to create representative estimates. Psychiatric inpatient admissions in all hospitals with medical services enrolled in the current health care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim dataset of the National Health Insurance Research Database. Generalized linear models with Poisson distributions were used to analyze the impact of mean diurnal change of temperature on schizophrenia admissions, controlling for internal correlations and demographic covariates. The daily temperature range varied between 1.7°C and 12.1°C (1st to 99th percentile). The relative risk of schizophrenia admission was significantly increased at a temperature range of 3.2°C (10th percentile), and the maximum was at 12.1°C (99th percentile); however, no such association was found with schizoaffective disorder. When restricted to the capital and largest city, the effects of temperature range were prominent and may correlate with temperature itself. The joint effect of temperature and temperature range was associated with elevated risk, particularly at cooler temperatures. A positive correlation was found between increasing temperature range and schizophrenia admissions. The increase in morbidity at high percentiles suggests that the increasing dynamics of temperature range are a valid reflection of risk, highlighting the need for precautionary action. PMID:22018962

  13. Task-Shifting and Quality of HIV Testing Services: Experiences from a National Reference Hospital in Zambia

    PubMed Central

    Mwangala, Sheila; Moland, Karen M.; Nkamba, Hope C.; Musonda, Kunda G.; Monze, Mwaka; Musukwa, Katoba K.; Fylkesnes, Knut

    2015-01-01

    Background With new testing technologies, task-shifting and rapid scale-up of HIV testing services in high HIV prevalence countries, assuring quality of HIV testing is paramount. This study aimed to explore various cadres of providers’ experiences in providing HIV testing services and their understanding of elements that impact on quality of service in Zambia. Methods Sixteen in-depth interviews and two focus group discussions were conducted with HIV testing service providers including lay counselors, nurses and laboratory personnel at purposively selected HIV testing sites at a national reference hospital in Lusaka. Qualitative content analysis was adopted for data analysis. Results Lay counselors and nurses reported confidentiality and privacy to be greatly compromised due to limited space in both in- and out-patient settings. Difficulties in upholding consent were reported in provider-initiated testing in in-patient settings. The providers identified non-adherence to testing procedures, high workload and inadequate training and supervision as key elements impacting on quality of testing. Difficulties related to testing varied by sub-groups of providers: lay counselors, in finger pricking and obtaining adequate volumes of specimen; non-laboratory providers in general, in interpreting invalid, false-negative and false-positive results. The providers had been participating in a recently established national HIV quality assurance program, i.e. proficiency testing, but rarely received site supervisory visits. Conclusion Task-shifting coupled with policy shifts in service provision has seriously challenged HIV testing quality, protection of confidentiality and the process of informed consent. Ways to better protect confidentiality and informed consent need careful attention. Training, supervision and quality assurance need strengthening tailored to the needs of the different cadres of providers. PMID:26605800

  14. Nanobiotechnology Perspectives on Prevention and Treatment of Ortho-paedic Implant Associated Infection.

    PubMed

    Borse, Vivek; Pawar, Vaishali; Shetty, Gautam; Mullaji, Arun; Srivastava, Rohit

    2016-01-01

    Implants are an inevitable part of orthopaedic surgery. However, implant associated infection remains a major challenge for orthopaedic surgeons and researchers. This review focuses on current options available for prevention of implant associated infection, their drawbacks and future promising applications of nanotechnology-based approaches. Nanobiotechnology has shown remarkable progress in recent years especially in biomaterials, diagnostics, and drug delivery system. Although several applications of nanobiotechnology in orthopaedics have been described, few have elaborated their role in the prevention of implant related infection in orthopaedics. Novel "smart" drug delivery systems that release antibiotics locally in response to stimuli such as pH, temperature, enzymes or antigens; implant surface modification on a nanoscale to inhibit bacterial adhesion and propagation at the surgical site and biological approaches such as gene therapy to neutralize bacterial virulence and biomolecules to inhibit the quorum sensing adhesion of bacteria and disruption of biofilms can be used effectively to prevent orthopaedic implant related bacterial infection. PMID:26263909

  15. [Noma and HIV infection: apropos of a case at the National Hospital Center in Bobo-Dioulasso (Burkina Faso)].

    PubMed

    Ki-Zerbo, G A; Guigma, Y

    2001-12-01

    Noma (Cancrum oris) is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles. Recently, cases have been reported in adults especially elderly patients or during immunodeficiency states. Reconstructive surgery is often necessary to deal with destruction and sequel but is rarely accessible in developing countries. We report one case of noma (cancrum oris) in an HIV seropositive patient at the National Hospital in Bobo-Dioulasso. The noma was inaugural of AIDS in a 40 years old labourer coming back from Ivory Coast and no major opportunistic infection was associated. The course was fulminant leading to extensive facial gangrene with recurrent bacterial infections. The disease was fatal in this depressive, malnourished and diarrhoeic patient despite local surgical treatment, prolonged antibiotherapy and supportive care. Pathogenic mechanisms, management and preventive issues are discussed. PMID:11887587

  16. [Noma and HIV infection: apropos of a case at the National Hospital Center in Bobo-Dioulasso (Burkina Faso)].

    PubMed

    Ki-Zerbo, G A; Guigma, Y

    2001-12-01

    Noma (Cancrum oris) is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles. Recently, cases have been reported in adults especially elderly patients or during immunodeficiency states. Reconstructive surgery is often necessary to deal with destruction and sequel but is rarely accessible in developing countries. We report one case of noma (cancrum oris) in an HIV seropositive patient at the National Hospital in Bobo-Dioulasso. The noma was inaugural of AIDS in a 40 years old labourer coming back from Ivory Coast and no major opportunistic infection was associated. The course was fulminant leading to extensive facial gangrene with recurrent bacterial infections. The disease was fatal in this depressive, malnourished and diarrhoeic patient despite local surgical treatment, prolonged antibiotherapy and supportive care. Pathogenic mechanisms, management and preventive issues are discussed.

  17. Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

    PubMed Central

    IMANI NASAB, Mohammad Hasan; MOHAGHEGH, Bahram; KHALESI, Nader; JAAFARIPOOYAN, Ebrahim

    2013-01-01

    Background European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. Conclusion: The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable. PMID:23967429

  18. Stem cell-based tissue engineering in veterinary orthopaedics.

    PubMed

    Brehm, Walter; Burk, Janina; Delling, Uta; Gittel, Claudia; Ribitsch, Iris

    2012-01-28

    Regenerative medicine is one of the most intensively researched medical branches, with enormous progress every year. When it comes to translating research from bench to bedside, many of the pioneering innovations are achieved by cooperating teams of human and veterinary medical scientists. The veterinary profession has an important role to play in this new and evolving technology, holding a great scientific potential, because animals serve widely as models for human medicine and results obtained from animals may serve as preclinical results for human medicine. Regenerative veterinary medicine utilizing mesenchymal stromal cells (MSC) for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. As orthopaedic disorders represent a major part of all cases in veterinary clinical practice, it is not surprising that they are currently taking a leading role in MSC therapies. Therefore, the purpose of this paper is to give an overview on past and current achievements as well as future perspectives in stem cell-based tissue engineering in veterinary orthopaedics. PMID:22287044

  19. The need for research training in orthopaedic residency education.

    PubMed

    Anderson, Robert W

    2006-08-01

    Orthopaedic surgery residents should be exposed during their clinical training to the processes of creativity and innovation that are the basis of research. The definition of a research experience for surgery residents should be broad and include not only traditional bench research in a basic science environment but also translational and clinical research to move innovation from bench to bedside and validate its value in a scientific manner. Additionally, there are enormous opportunities for surgeons to study healthcare delivery and policy and to develop new approaches to educating colleagues, other medical personnel, and patients. The question that must be addressed is how can the knowledge and human resources residing in orthopaedic surgery best be used to meet the challenges future residents will face as healthcare undergoes profound changes? How these issues are managed in a rapidly changing environment is the critical issue and the challenge faced by surgical training programs wishing to remain viable and provide trainees with the opportunity to adapt and be successful in the future. What is state of the art today will not be tomorrow and unless trainees are encouraged and taught to be creative and innovative they risk becoming surgical dinosaurs.

  20. Orthopaedic applications for PLA-PGA biodegradable polymers.

    PubMed

    Athanasiou, K A; Agrawal, C M; Barber, F A; Burkhart, S S

    1998-10-01

    Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), play an increasingly important role in orthopaedics. These polymers degrade by hydrolysis and enzymatic activity and have a range of mechanical and physical properties that can be engineered appropriately to suit a particular application. Their degradation characteristics depend on several parameters including their molecular structure, crystallinity, and copolymer ratio. These biomaterials are also rapidly gaining recognition in the fledging field of tissue engineering because they can be fashioned into porous scaffolds or carriers of cells, extracellular matrix components, and bioactive agents. Although their future appears to be bright, several questions regarding the biocompatibility of these materials linger and should be addressed before their wide-scale use. In the context of musculoskeletal tissue, this report provides a comprehensive review of properties and applications of biodegradable PLA/PGA polymers and their copolymers. Of special interest are orthopaedic applications, biocompatibility studies, and issues of sterilization and storage of these versatile biomaterials. Also discussed is the fact that terms such as PLA, PGA, or PLA-PGA do not denote one material, but rather a large family of materials that have a wide range of differing bioengineering properties and concomitant biological responses. An analysis of some misconceptions, problems, and potential solutions is also provided. PMID:9788368

  1. Nanotechnology: current concepts in orthopaedic surgery and future directions.

    PubMed

    Sullivan, M P; McHale, K J; Parvizi, J; Mehta, S

    2014-05-01

    Nanotechnology is the study, production and controlled manipulation of materials with a grain size < 100 nm. At this level, the laws of classical mechanics fall away and those of quantum mechanics take over, resulting in unique behaviour of matter in terms of melting point, conductivity and reactivity. Additionally, and likely more significant, as grain size decreases, the ratio of surface area to volume drastically increases, allowing for greater interaction between implants and the surrounding cellular environment. This favourable increase in surface area plays an important role in mesenchymal cell differentiation and ultimately bone-implant interactions. Basic science and translational research have revealed important potential applications for nanotechnology in orthopaedic surgery, particularly with regard to improving the interaction between implants and host bone. Nanophase materials more closely match the architecture of native trabecular bone, thereby greatly improving the osseo-integration of orthopaedic implants. Nanophase-coated prostheses can also reduce bacterial adhesion more than conventionally surfaced prostheses. Nanophase selenium has shown great promise when used for tumour reconstructions, as has nanophase silver in the management of traumatic wounds. Nanophase silver may significantly improve healing of peripheral nerve injuries, and nanophase gold has powerful anti-inflammatory effects on tendon inflammation. Considerable advances must be made in our understanding of the potential health risks of production, implantation and wear patterns of nanophase devices before they are approved for clinical use. Their potential, however, is considerable, and is likely to benefit us all in the future.

  2. Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.

    PubMed

    DiGioia, A M; Jaramaz, B; Colgan, B D

    1998-09-01

    Technologies are emerging that will influence the way in which orthopaedic surgery is planned, simulated, and performed. Recent advances in the fields of medical imaging, computer vision, and robotics have provided the enabling technologies to permit computer aided surgery to become an established area which can address clinical needs. Although these technologies have been applied in industry for more than 20 years, the field of computer assisted orthopaedic surgery is still in its infancy. Image guided and surgical navigation systems, robotic assistive devices, and surgical simulators have begun to emerge from the laboratory and hold the potential to improve current surgical practice and patients' outcomes. The goals of these new clinically focused technologies are to develop interactive, patient specific preoperative planners to optimize the performance of surgery and the postoperative biologic response, and develop more precise and less invasive interactive smart tools and sensors to assist in the accurate and precise performance of surgery. The medical community is beginning to see the benefit of these enabling technologies which can be realized only through the collaboration and combined expertise of engineers, roboticists, computer scientists, and surgeons.

  3. Myths and Legends in Orthopaedic Practice: Are We All Guilty?

    PubMed Central

    Immerman, Igor

    2008-01-01

    Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient’s knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices. PMID:18726654

  4. Clinical presentation and treatment of orthopaedic implant-associated infection.

    PubMed

    Zimmerli, W

    2014-08-01

    Orthopaedic implants are highly susceptible to infection. The aims of treatment of infection associated with internal fixation devices are fracture consolidation and prevention of chronic osteomyelitis. Complete biofilm eradication is not the primary goal, as remaining adherent microorganisms can be removed with the device after fracture consolidation. By contrast, in periprosthetic joint infection (PJI), biofilm elimination is required. Surgical treatment of PJI includes debridement with retention, one- or two-stage exchange and removal without reimplantation. In addition, prolonged antibiotic treatment, preferably with an agent that is effective against biofilm bacteria, is required. Rifampicin is an example of an antibiotic with these properties against staphylococci. However, to avoid the emergence of resistance, rifampicin must always be combined with another antimicrobial agent. With this novel treatment approach, orthopaedic implant-associated infection is likely to be eradicated in up to 80-90% of patients. Because most antibiotics have a limited effect against biofilm infections, novel prophylactic and therapeutic options are needed. Surface coating with antimicrobial peptides that reduce bacterial attachment and biofilm formation can potentially prevent implant-associated infection. In addition, quorum-sensing inhibitors are a novel therapeutic option against biofilm infections.

  5. Intranet-based multi-purpose medical records in orthopaedics.

    PubMed

    Dugas, M; Bosch, R; Paulus, R; Lenz, T

    1999-01-01

    Quality assurance in orthopaedics--as in any medical speciality--relies on precise medical records. Data quality is crucial for statistical evaluation; missing values cannot be avoided but must be minimized. The quality assurance system must be accessible from many locations within the clinic; given the complex and heterogeneous computing infrastructure this is a technological challenge. Intranet technology--the application of internet-tools in local networks--can help to solve the technical problems. A generic Intranet-based quality assurance system in orthopaedics was designed, implemented and evaluated. The basic concept is an intranet data entry form which is generated semi-automatically from the data definition. This form is adapted according to the individual needs of the doctors (intelligent data entry). By flexible data transformation the same data set is used for clinical reports as well as scientific evaluations. The first use was for ultrasound examinations of neonatal hips. A report form consisting of 56 items was designed. Within the first 9-month period 1303 cases have been documented.

  6. What Do Reported Learning Curves Mean for Orthopaedic Surgeons?

    PubMed

    Gofton, Wade T; Solomon, Michael; Gofton, Tyson; Pagé, Alex; Kim, Paul R; Netting, Caleb; Bhandari, Mohit; Beaulé, Paul E

    2016-01-01

    Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan. Learning curve reports from single-surgeon series have several limitations that result from the limited dataset reported and inconsistencies in the way data are reported. Conversely, learning curve reports from registry data are likely to have greater generalizability, but are largely beneficial retrospectively, after data from a sufficient number of surgeons are assessed. There is a pressing need for surgeons to develop improved and consistent standards for learning curve reporting. Although registry data may provide better prospective measures in the future, the implementation of such registries faces several challenges. Despite substantial limitations, single-surgeon series remain the most effective way for practicing surgeons to assess their learning challenge and develop an appropriate learning plan.

  7. 'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist

    PubMed Central

    Dhar, Shabir Ahmed; Bhat, Masood Iqbal; Mustafa, Ajaz; Mir, Mohammed Ramzan; Butt, Mohammed Farooq; Halwai, Manzoor Ahmed; Tabish, Amin; Ali, Murtaza Asif; Hamid, Arshiya

    2008-01-01

    Background Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. Results At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. Conclusion In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases. PMID:18271951

  8. The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice

    PubMed Central

    Lynch, T. Sean; Parker, Richard D.; Patel, Ronak M.; Andrish, Jack T.; Spindler, Kurt P.

    2015-01-01

    With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction. PMID:25667401

  9. The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice.

    PubMed

    Lynch, T Sean; Parker, Richard D; Patel, Ronak M; Andrish, Jack T; Spindler, Kurt P; Amendola, Annunziata; Brophy, Robert H; Dunn, Warren R; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Kaeding, Christopher C; Marx, Robert G; Matava, Matthew J; McCarty, Eric C; Pedroza, Angela D; Reinke, Emily K; Wolf, Brian R; Wright, Rick W

    2015-03-01

    With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction.

  10. Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database

    PubMed Central

    Tamiya, Hiroyuki; Yasunaga, Hideo; Matusi, Hiroki; Fushimi, Kiyohide; Ogawa, Sumito; Akishita, Masahiro

    2015-01-01

    Background Preventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture. Methods We used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months between April 2012 and March 2013. The primary outcome was the occurrence of bone fracture during hospitalization. Use of hypnotics was compared between patients with and without bone fracture in this matched case-control study. Results Of 140,494 patients, 830 patients suffered from in-hospital fracture. A 1:4 matching with age, sex and hospital created 817 cases with fracture and 3,158 matched patients without fracture. With adjustment for the Charlson comorbidity index, emergent admission, activities of daily living, and scores for level walking, a higher occurrence of fractures were seen with short-acting benzodiazepine hypnotics (odds ratio, 1.43; 95% confidence interval, 1.19–1.73; P<0.001), ultrashort-acting non-benzodiazepine hypnotics (1.66; 1.37–2.01; P<0.001), hydroxyzine (1.45; 1.15–1.82, P=0.001), risperidone and perospirone (1.37; 1.08–1.73; P=0.010). Other drug groups were not significantly associated with the occurrence of in-hospital fracture. Conclusions Short-acting benzodiazepine hypnotics and ultrashort-acting non-benzodiazepine hypnotics may increase risk of bone fracture in hospitalized dementia patients. PMID:26061231

  11. Evaluation of the sterilization efficacy of domestic electric drills used in orthopaedic surgeries

    PubMed Central

    Goveia, Vania Regina; Pinto, Flavia Morais Gomes; Machoshvili, Irene Alexeevna; Penna, Thereza Christina Vessoni; Graziano, Kazuko Uchikawa

    2009-01-01

    It is estimated that electric drills (ED) have been used in orthopaedic surgeries for bone drilling for more than 50 years in Brazilian hospitals. It is an electric, thermosensitive equipment, not indicated for surgical use, which has not been previously evaluated regarding the sterilization efficacy, being suspect of infection risk. This study evaluated the efficacy of sterilization by ethylene oxide (EtO) of new drills that were intentionally contaminated with Bacillus atrophaeus spores. An experimental, laboratory, randomized applied research was developed, where 16 electric drills were analyzed, in addition to positive and negative controls. All the previously cleaned and sterilized equipment were submitted to contamination by spores. The experimental group was submitted to cleaning and sterilization by EtO and test of sterility by filtration through a 0.45 >m membrane. The membranes were cultivated and Gram and Wirtz-Conklin staining were carried out in positive results for spore visualization. An efficacy of 99.99999881% of the process of sterilization by EtO was confirmed, with a probability of survival of 1.19 x 10 -8. Under the development conditions of the experiment, the efficacy of the sterilization of ED by EtO was confirmed. PMID:24031397

  12. The Basics of the Sunshine Act: How It Pertains to the Practicing Orthopaedic Surgeon.

    PubMed

    Parisi, Thomas J; Ferre, Isabella M; Rubash, Harry E

    2015-08-01

    The Physician Payments Sunshine Act is a disclosure law requiring all drug, medical device, and biologics companies to report transfers of value to physicians and teaching hospitals. It was passed into law in 2010 as part of the Affordable Care Act. The first set of data was released via an online public database on September 30, 2014, with subsequent annual reports to come. Three categories of payments are recorded: general payments, ownership interests, and research payments. With few exceptions, any transfer of value greater than $10 is reported. The first dataset of 4.4 million payments totaling more than $3.5 billion was released amidst controversy and technical problems. Identified data constituted $1.3 billion in transfer payments; de-identified data constituted $2.2 billion in payments. Data regarding an additional $1.1 billion in payments were not published, in part because of unresolved disputes. The largest amount of funding went to research payments. The highest proportion of general payments went to licensing and royalty payments. Orthopaedic surgeons comprised 3.5% of the physicians represented, and they were responsible for more than 20% of total payments. The full impact of the Sunshine Act will not be clear until several years after its implementation.

  13. Case study: analysis of end-user requests on electronic medical record and computerized physician order entry system of Seoul National University Hospital in Korea.

    PubMed

    Kim, Young-Ah; Shin, Soo-Yong; Jo, Eun-Mi; Park, Chan-Hee; Hwang, Min-A; Kim, Kyung Hwan; Chung, Chun Kee

    2010-01-01

    Seoul National University Hospital (SNUH) in Korea has utilized the full Electronic Medical Record (EMR) system since October 2004. Unlike other countries, most EMR systems in Korean teaching and general hospitals are in-house development systems. Therefore, we can actively respond to user requests on EMR. Here, based on 5 years of experience in EMR system operation, we analyzed 2,339 SNUH EMR user requests from 2006 to 2008 for improvement of EMR system operation and management. We classify user requests into 9 criteria based on guidelines from the SNUH medical information management team. In conclusion, the most common requests (73%) are for improvement of improving quality of care. However, requests associated with hospital enterprise, public policy, and customer service are gradually increased every year. Therefore, we suggest that suitable EMR management criteria are necessary for reliable EMR operation and management.

  14. Nasal carriage rate of methicillin resistant Staphylococcus aureus among at National Medical College Teaching Hospital, Birgunj, Nepal.

    PubMed

    Shakya, B; Shrestha, S; Mitra, T

    2010-03-01

    Present study was conducted to assess the nasal carriage rate of methicilin resistant Staphylococcus aureus (MRSA) among patients, visitors/patient attendants and healthcare personnel at National Medical College Teaching Hospital, Birgunj, Nepal. A total of 112 nasal swabs (patients: 31, visitors/patient attendants: 61, and healthcare personnel: 20) were subjected to bacteriological investigation following standard protocol. S. aureus isolates were identified by mannitol fermentation and coagulase positivity. Antimicrobial susceptibility test was performed by Kirby-Bauer's disc diffusion method on Muller-Hinton agar medium. S. aureus was isolated in 14 (12.5%) of participants (M: 11.3%, F: 13.6%). Highest nasal colonization rate was found among healthcare personnel (25.0%) followed by the visitors/patient attendants (13.1%) and the patients (3.2%) (P>0.05). Highest positive rate was observed in the age group d"14 years (33.3%), followed by 15 to 50 years (13.2%) and >50 years (5.6%) (P>0.05). Out of 14 S. aureus isolates, 57.1% were methicillin resistant, prevalence rate of MRSA among total subjects being 7.1%. MRSA prevalence rate were 5.6% and 8.5% in total male and female participants, respectively (P>0.05). Highest MRSA prevalence rate was among health-care personnel (10.0%), followed by visitors/patient attendants (8.2%) and the patients (3.2%) (P>0.05). All MRSA isolates were resistant to Ampicillin, followed by Cephalexin (37.5%), Ciprofloxacin (37.5%), Tetracycline (37.5%), Gentamycin (25.0%), Erythromycin (0.0%) and Vancomycin (0.0%). High rate of nasal MRSA carriage rate found in this study indicates the need for standard infection control to prevent MRSA transmission.

  15. Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial.

    PubMed

    Samsson, Karin; Larsson, Maria E H

    2014-10-01

    A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation, but only a small number of these patients are appropriate for orthopaedic intervention. Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders. The primary aim of this randomised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to standard practice in primary care. Patients referred for orthopaedic consultation (n=203) were randomised to physiotherapy screening or standard practice. Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis. Patient views of the quality of care were analysed with Mann-Whitney U-test, waiting time with Independent t-test. There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group (p=0.002). A smaller proportion of patients in the screening group were referred back to their general practitioner (GP) (p<0.001) and a larger proportion to the physiotherapy clinic (p<0.001) compared to standard practice. The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group (p<0.039). Waiting time was shorter in the screening group (p<0.001). A large proportion of the patients reported no hesitation to attend the clinic for future care, no difference between the groups (p<0.95). The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare.

  16. Ambulatory care for cancer in the United States: results from two national surveys comparing visits to physicians' offices and hospital outpatient departments.

    PubMed Central

    Richardson, Lisa C.; Tangka, Florence K.

    2007-01-01

    BACKGROUND: Among the general population, type of health insurance has been reported to affect the location of ambulatory visits and the content of those visits. We examined where cancer patient visits occurred (physicians' offices or hospital clinics), and whether anticancer therapy is administered or prescribed. METHODS: Cross-sectional study using National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey (NAMCS/NHAMCS) data to characterize ambulatory cancer patient visits from 2001-2003. Multivariable logistic regression analyses were performed to identify factors associated with where a cancer patient went for care (office practice versus hospital clinic) and anticancer therapy received. RESULTS: Thirteen percent of patients visited hospital clinics, with the remainder visiting office-based settings. Younger cancer patients and those with Medicaid were more likely to visit hospital clinics compared to older and privately insured cancer patients. Cancer patients with <6 visits in the last year were less likely to be seen in the office setting. Patients with lung cancer, lymphoma/leukemia and melanoma were less likely to have anticancer therapy administered or prescribed compared to breast cancer patients. The uninsured were less likely to have anticancer administered or prescribed compared with the privately insured. CONCLUSIONS: Cancer patients with Medicaid were more likely to visit hospital clinics than privately insured patients. Treatment was associated with cancer type, not where care occurred and health insurance type, though there was a trend for the uninsured and those insured by Medicaid to be less likely to be administered or be prescribed anticancer therapy. PMID:18229771

  17. Diagnostic virology practices for respiratory syncytial virus and influenza virus among children in the hospital setting: a national survey.

    PubMed

    Jafri, Hasan S; Ramilo, Octavio; Makari, Doris; Charsha-May, Deborah; Romero, José R

    2007-10-01

    A survey was sent to the emergency room and laboratory directors of 400 randomly selected US hospitals to assess the diagnostic testing practices for respiratory syncytial virus and influenza virus in children. The results demonstrate that the majority of hospitals routinely perform viral testing for both viruses and use virology testing practices appropriate for the reasons reported for testing.

  18. Understanding the Determinants of Australian Hospital Nurses' Hand Hygiene Decisions Following the Implementation of a National Hand Hygiene Initiative

    ERIC Educational Resources Information Center

    White, Katherine M.; Starfelt, Louise C.; Jimmieson, Nerina L.; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G.; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David

    2015-01-01

    Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The "5 critical moments" of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this…

  19. International patients on operation vacation – perspectives of patients travelling to Hungary for orthopaedic treatments

    PubMed Central

    Kovacs, Eszter; Szocska, Gabor; Knai, Cécile

    2014-01-01

    Background: The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods: A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results: The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion: Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments. PMID:25396209

  20. Nonspinal orthopaedic problems in familial dysautonomia (Riley-Day syndrome).

    PubMed

    Laplaza, F J; Turajane, T; Axelrod, F B; Burke, S W

    2001-01-01

    Familial dysautonomia (FD) is a rare autosomal recessive disease occurring in Ashkenazi Jews. It affects the autonomic, central, and peripheral nervous systems. The purpose of this study was to assess the prevalence and characteristics of orthopedic deformities, other than spinal deformities, in this population. A retrospective review of the medical records and radiographs of 182 patients was made. Three main groups of orthopaedic conditions were evaluated: (a) Fractures: 60% of the patients had one or more fractures; the average fracture rate was 1.4/patient. (b) Neuropathic joints: 11% of the cases had one or more neuropathic joints, the knee being the most common. (c) Other musculoskeletal deformities: 26% of the patients had one or more deformities. Lower extremity rotational problems and foot anomalies accounted for most of these deformities. Patients with FD have a higher prevalence of fractures and neuropathic joints than do their peers. The fracture pattern also is different, with a higher incidence of proximal femoral fractures.

  1. [Success factors of work-related orthopaedic rehabilitation].

    PubMed

    Bethge, M

    2011-06-01

    Work-related rehabilitation has for several years been gaining greater importance in orthopaedic rehabilitation. High-quality studies have confirmed that work-related medical rehabilitation has favourable effects on earning capacity and work-life participation. This does however not hold true for all work-related rehabilitation programmes. In this context, 5 theses concerning success factors of work-related medical rehabilitation are developed. It is set out that the effects of work-related medical rehabilitation on work ability and work-life participation can be improved if programmes realize a needs-oriented assignment, include cognitive-behavioural components, follow a multimodal approach, step up treatment intensity, and if treatments are manualized.

  2. Direct Observation: Assessing Orthopaedic Trainee Competence in the Ambulatory Setting.

    PubMed

    Phillips, Donna P; Zuckerman, Joseph D; Kalet, Adina; Egol, Kenneth A

    2016-09-01

    The Accreditation Council of Graduate Medical Education requires that residency programs teach and assess trainees in six core competencies. Assessments are imperative to determine trainee competence and to ensure that excellent care is provided to all patients. A structured, direct observation program is feasible for assessing nontechnical core competencies and providing trainees with immediate constructive feedback. Direct observation of residents in the outpatient setting by trained faculty allows assessment of each core competency. Checklists are used to document residents' basic communication skills, clinical reasoning, physical examination methods, and medical record keeping. Faculty concerns regarding residents' professionalism, medical knowledge, fatigue, or ability to self-assess are tracked. Serial observations allow for the reinforcement and/or monitoring of skills and attitudes identified as needing improvement. Residents who require additional coaching are identified early in training. Progress in educational milestones is recorded, allowing an individualized educational program that ensures that future orthopaedic surgeons excel across all domains of medical and surgical competence. PMID:27479831

  3. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate. PMID:27564793

  4. Sir Robert Jones: orthopaedic surgeon and war hero.

    PubMed

    Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Kon, Elizaveta; Marcacci, Maurilio

    2015-05-01

    The First World War was a very harsh conflict and statistics recorded a great number of victims, both soldiers and civilians. One hundred years later, the whole world is commemorating the Great War by celebrating people and events that contributed to shaping the XX century. Beyond remembering political figures, war heroes or even famous battles, it is also important to underline the contribution of those who devoted their efforts to improve the living conditions during war campaigns. This is the case of Sir Robert Jones, one of the fathers of XX century orthopaedics, who contributed to re-organize the military medical assistance during war times and whose teachings, coming directly from his "on the field" experience, inspired an entire generation of European surgeons.

  5. Scoring the SF-36 in Orthopaedics: A Brief Guide

    PubMed Central

    Laucis, Nicholas C.; Hays, Ron D.; Bhattacharyya, Timothy

    2015-01-01

    Abstract: The Short Form-36 (SF-36) is the most widely used health-related quality-of-life measure in research to date. There are currently two sources for the SF-36 and scoring instructions: licensing them from Optum, Inc., or obtaining them from publicly available documentation from the RAND Corporation. The SF-36 yields eight scale scores and two summary scores. The physical component summary (PCS) and mental component summary (MCS) scores were derived using an orthogonal-factor analytic model that forced the PCS and MCS to be uncorrelated, and it has been shown to contribute to an inflation of the MCS in patients with substantial physical disability. Oblique scoring can reduce this inflation of the MCS in orthopaedic studies. Spreadsheets to score the SF-36, along with a copy of the questionnaire, are provided. PMID:26446970

  6. Biodegradable metallic materials for orthopaedic implantations: A review.

    PubMed

    Yeung, Kelvin W K; Wong, Karen H M

    2012-09-01

    Non-degradable metals such as stainless steel, cobalt-chromium-based alloys, titanium and its alloys may lead to stress shielding effect after fractured bone has healed. This complication may attribute to the non-degradability and the mismatch of the mechanical properties between these metallic implants and human bone. Biodegradable metallic materials have been therefore studied as alternative implantable metals in orthopaedics for some years. Magnesium is a potential candidate, as its mechanical properties are similar to human. Additionally, it is degradable and its ions are essential for cell functions. However, rapid degradation and release of hydrogen gas may inhibit its applications clinically. Hence, this paper reviews the development of the biodegradable metallic implants and various methods to improve the degradation of magnesium alloys.

  7. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate.

  8. Scoring the SF-36 in Orthopaedics: A Brief Guide.

    PubMed

    Laucis, Nicholas C; Hays, Ron D; Bhattacharyya, Timothy

    2015-10-01

    The Short Form-36 (SF-36) is the most widely used health-related quality-of-life measure in research to date. There are currently two sources for the SF-36 and scoring instructions: licensing them from Optum, Inc., or obtaining them from publicly available documentation from the RAND Corporation. The SF-36 yields eight scale scores and two summary scores. The physical component summary (PCS) and mental component summary (MCS) scores were derived using an orthogonal-factor analytic model that forced the PCS and MCS to be uncorrelated, and it has been shown to contribute to an inflation of the MCS in patients with substantial physical disability. Oblique scoring can reduce this inflation of the MCS in orthopaedic studies. Spreadsheets to score the SF-36, along with a copy of the questionnaire, are provided.

  9. Biodegradable metallic materials for orthopaedic implantations: A review.

    PubMed

    Yeung, Kelvin W K; Wong, Karen H M

    2012-09-01

    Non-degradable metals such as stainless steel, cobalt-chromium-based alloys, titanium and its alloys may lead to stress shielding effect after fractured bone has healed. This complication may attribute to the non-degradability and the mismatch of the mechanical properties between these metallic implants and human bone. Biodegradable metallic materials have been therefore studied as alternative implantable metals in orthopaedics for some years. Magnesium is a potential candidate, as its mechanical properties are similar to human. Additionally, it is degradable and its ions are essential for cell functions. However, rapid degradation and release of hydrogen gas may inhibit its applications clinically. Hence, this paper reviews the development of the biodegradable metallic implants and various methods to improve the degradation of magnesium alloys. PMID:23949163

  10. [Recent progress in orthopaedic managements of osteoporosis-related fractures].

    PubMed

    Yamamoto, Seizo

    2011-07-01

    Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371

  11. Northern Latitude but Not Season Is Associated with Increased Rates of Hospitalizations Related to Inflammatory Bowel Disease: Results of a Multi-Year Analysis of a National Cohort

    PubMed Central

    Stein, Adam C.; Gaetano, John Nick; Jacobs, Jeffrey; Kunnavakkam, Rangesh; Bissonnette, Marc; Pekow, Joel

    2016-01-01

    Background and Aims There is growing evidence that the incidence and severity of inflammatory bowel disease (IBD) may be geographically and seasonally related. Why these associations are observed remains unclear. We assessed the impact of geographic location, season, and exposure to ultraviolet light on disease severity by measuring national hospital IBD-related discharge rates. Methods Utilizing the Nationwide Inpatient Sample (NIS), we identified all patients with IBD-related discharges from 2001–2007. Patients were included if they were discharged from states above the 40th parallel (north) or at or below the 35th parallel (south); and their discharge fell within the winter (January, February, and March) or summer (July, August, and September). Groups of patients were assessed comparing north to south within each season, and summer to winter within each region. UV index was recorded from the National Weather Service data and compared to monthly discharge rates. Results There was a consistent pattern of increased IBD-related hospitalization rates in northern states compared to southern states for both ulcerative colitis and Crohn’s disease. Differences in IBD-related hospitalization rates by season, however, were not uniform across the years studied. UV index was significantly inversely associated although not proportional to discharge rates for both Crohn’s disease and ulcerative colitis. Conclusions In the US, there is a significant increased rate of IBD-related hospitalizations in the northern compared to southern states, which not fully explained by differences in UV exposure. PMID:27579718

  12. Effects of a modified maxillary orthopaedic splint: a cephalometric evaluation.

    PubMed

    Uner, O; Yücel-Eroğlu, E

    1996-06-01

    Taking the presence of an interplay between the vertical and sagittal components of craniofacial development into consideration, the beneficial therapeutic potential impacts of controlling vertical development on the correction of Class II discrepancies has been previously investigated. In the present study, a modified maxillary orthopaedic splint combined with an anterior high-pull headgear was used for early correction of the vertical and consequently sagittal dentoskeletal discrepancy as the initial stage of treatment. The aim was to evaluate its effects on the maxillary and mandibular dentoskeletal development, as well as rotational growth pattern. In order to compare with and distinguish from the uninterrupted growth changes, a control group was formed by matching each one of the control subjects to a subject in the treatment group according to certain criteria. The initial and second standardized lateral cephalograms of each subject was evaluated by means of an adopted and biologically more substantial cephalometric analysis. Evaluation of the changes induced by the splint in comparison with the uninterrupted growth changes revealed that the splint had both orthopaedic and orthodontic effects on the growth pattern of the dentoskeletal structures. There seemed to exist a relationship between the direction of total mandibular and maxillary rotations. In addition, it was believed that in order to cause a forward mandibular rotation, i.e. to change the rotational mandibular growth pattern from a backward into a forward direction, the posterior vertical maxillary development should be restrained, but anterior vertical maxillary development should be relatively more restrained or reversed and, thereby, the rotational growth pattern of the maxilla should be changed from a backward into a forward direction. Moreover, the bite block effect of the splint seemed to cause a favourable change in the condylar growth direction from a backward to an upward direction.

  13. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

    PubMed Central

    2012-01-01

    Background While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair. Methods A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors. Results Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis. Conclusions Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not. PMID:22257790

  14. Automatic Bone Drilling - More Precise, Reliable and Safe Manipulation in the Orthopaedic Surgery

    NASA Astrophysics Data System (ADS)

    Boiadjiev, George; Kastelov, Rumen; Boiadjiev, Tony; Delchev, Kamen; Zagurski, Kazimir

    2016-06-01

    Bone drilling manipulation often occurs in the orthopaedic surgery. By statistics, nowadays, about one million people only in Europe need such an operation every year, where bone implants are inserted. Almost always, the drilling is performed handily, which cannot avoid the subjective factor influence. The question of subjective factor reduction has its answer - automatic bone drilling. The specific features and problems of orthopaedic drilling manipulation are considered in this work. The automatic drilling is presented according the possibilities of robotized system Orthopaedic Drilling Robot (ODRO) for assuring the manipulation accuracy, precision, reliability and safety.

  15. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic.

    PubMed

    Maqbool, Talha; Raju, Sneha; In, Eunji

    2016-01-01

    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

  16. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic

    PubMed Central

    Maqbool, Talha; Raju, Sneha; In, Eunji

    2016-01-01

    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21”×32” patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic

  17. National Bloodstream Infection Surveillance in Switzerland 2008-2014: Different Patterns and Trends for University and Community Hospitals.

    PubMed

    Buetti, Niccolò; Marschall, Jonas; Atkinson, Andrew; Kronenberg, Andreas

    2016-09-01

    OBJECTIVE To characterize the epidemiology of bloodstream infections in Switzerland, comparing selected pathogens in community and university hospitals. DESIGN Observational, retrospective, multicenter laboratory surveillance study. METHODS Data on bloodstream infections from 2008 through 2014 were obtained from the Swiss infection surveillance system, which is part of the Swiss Centre for Antibiotic Resistance (ANRESIS). We compared pathogen prevalences across 26 acute care hospitals. A subanalysis for community-acquired and hospital-acquired bloodstream infections in community and university hospitals was performed. RESULTS A total of 42,802 bloodstream infection episodes were analyzed. The most common etiologies were Escherichia coli (28.3%), Staphylococcus aureus (12.4%), and polymicrobial bloodstream infections (11.4%). The proportion of E. coli increased from 27.5% in 2008 to 29.6% in 2014 (P = .04). E. coli and S. aureus were more commonly reported in community than university hospitals (34.3% vs 22.7%, P<.001 and 13.9% vs 11.1%, P<.001, respectively). Fifty percent of episodes were community-acquired, with E. coli again being more common in community hospitals (41.0% vs 32.4%, P<.001). The proportion of E. coli in community-acquired bloodstream infections increased in community hospitals only. Community-acquired polymicrobial infections (9.9% vs 5.6%, P<.001) and community-acquired coagulase-negative staphylococci (6.7% vs 3.4%, P<0.001) were more prevalent in university hospitals. CONCLUSIONS The role of E. coli as predominant pathogen in bloodstream infections has become more pronounced. There are distinct patterns in community and university hospitals, potentially influencing empirical antibiotic treatment. Infect Control Hosp Epidemiol 2016;37:1060-1067.

  18. Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997–2010

    PubMed Central

    Lin, Yu-Wen; Huang, Hui-Chuan; Lin, Mei-Feng; Shyu, Meei-Ling; Tsai, Po-Li; Chang, Hsiu-Ju

    2016-01-01

    Background Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. Objectives To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. Design This is a cohort study of Taiwan’s national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. Participants The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950–E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. Results Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide

  19. Finding your first job in a community hospital.

    PubMed

    Osborne, Aaron G

    2011-12-01

    Community hospitals offer excellent opportunities for graduating orthopaedic trauma fellows. To successfully compete for these jobs, applicants today must be better prepared than their predecessors. Organizing your practice aspirations and researching job opportunities before the interview are necessary for an effective job search. Often, a collaborative effort with hospital administrators is required to establish a viable practice that fulfills the unique needs of the hospital and surrounding community while concurrently satisfying your practice goals. Issues to consider in defining your desired practice, guidelines on how to prepare for an interview with a community hospital, and suggestions on how to justify the expense of establishing your practice are presented.

  20. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    PubMed Central

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  1. Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study

    PubMed Central

    2011-01-01

    Background Population ageing may threaten the sustainability of future health care systems. Strengthening primary health care, including long-term care, is one of several measures being taken to handle future health care needs and budgets. There is limited and inconsistent evidence on the effect of long-term care on hospital use. We explored the relationship between the total use of long-term care within public primary health care in Norway and the use of hospital beds when adjusting for various effect modifiers and confounders. Methods This national population-based observational study consists of all Norwegians (59% women) older than 66 years (N = 605676) (13.2% of total population) in 2002-2006. The unit of analysis was defined by municipality, age and sex. The association between total number of recipients of long-term care per 1000 inhabitants (LTC-rate) and hospital days per 1000 inhabitants (HD-rate) was analysed in a linear regression model. Modifying and confounding effects of socioeconomic, demographic and geographic variables were included in the final model. We defined a difference in hospitalization rates of more than 1000 days per 1000 inhabitants as clinically important. Results Thirty-one percent of women and eighteen percent of men were long-term care users. Men had higher HD-rates than women. The crude association between LTC-rate and HD-rate was weakly negative. We identified two effect modifiers (age and sex) and two strong confounders (travel time to hospital and mortality). Age and sex stratification and adjustments for confounders revealed a positive statistically significant but not clinically important relationship between LTC-rates and hospitalization for women aged 67-79 years and all men. For women 80 years and over there was a weak but negative relationship which was neither statistically significant nor clinically important. Conclusions We found a weak positive adjusted association between LTC-rates and HD-rates. Opposite to common

  2. Bioactive coatings for orthopaedic implants-recent trends in development of implant coatings.

    PubMed

    Zhang, Bill G X; Myers, Damian E; Wallace, Gordon G; Brandt, Milan; Choong, Peter F M

    2014-01-01

    Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.

  3. Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings

    PubMed Central

    Zhang, Bill G. X.; Myers, Damian E.; Wallace, Gordon G.; Brandt, Milan; Choong, Peter F. M.

    2014-01-01

    Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants. PMID:25000263

  4. A Review of THE ROLE OF SIMULATION IN DEVELOPING AND ASSESSING ORTHOPAEDIC SURGICAL SKILLS

    PubMed Central

    Thomas, Geb W; Johns, Brian D; Marsh, J Lawrence; Anderson, Donald D

    2014-01-01

    Orthopaedic surgical skill is traditionally acquired during training in an apprenticeship model that has been largely unchanged for nearly 100 years. However, increased pressure for operating room efficiency, a focus on patient safety, work hour restrictions, and a movement towards competency-based education are changing the traditional paradigm. Surgical simulation has the potential to help address these changes. This manuscript reviews the scientific background on skill acquisition and surgical simulation as it applies to orthopaedic surgery. It argues that simulation in orthopaedics lags behind other disciplines and focuses too little on simulator validation. The case is made that orthopaedic training is more efficient with simulators that facilitate deliberate practice throughout resident training and more research should be focused on simulator validation and the refinement of skill definition. PMID:25328480

  5. Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.

    PubMed

    Markatos, Konstantinos; Efstathopoulos, Nikolaos; Kaseta, Kiriaki Maria; Nikolaou, Vasileios; Tsoucalas, Gregory; Sgantzos, Markos

    2015-11-01

    The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery.

  6. Significance of Nano- and Microtopography for Cell-Surface Interactions in Orthopaedic Implants

    PubMed Central

    Jäger, M.; Zilkens, C.; Zanger, K.; Krauspe, R.

    2007-01-01

    Cell-surface interactions play a crucial role for biomaterial application in orthopaedics. It is evident that not only the chemical composition of solid substances influence cellular adherence, migration, proliferation and differentiation but also the surface topography of a biomaterial. The progressive application of nanostructured surfaces in medicine has gained increasing interest to improve the cytocompatibility and osteointegration of orthopaedic implants. Therefore, the understanding of cell-surface interactions is of major interest for these substances. In this review, we elucidate the principle mechanisms of nano- and microscale cell-surface interactions in vitro for different cell types onto typical orthopaedic biomaterials such as titanium (Ti), cobalt-chrome-molybdenum (CoCrMo) alloys, stainless steel (SS), as well as synthetic polymers (UHMWPE, XLPE, PEEK, PLLA). In addition, effects of nano- and microscaled particles and their significance in orthopaedics were reviewed. The significance for the cytocompatibility of nanobiomaterials is discussed critically. PMID:18274618

  7. Creating a “culture of research” in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program

    PubMed Central

    St. Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

    2015-01-01

    Background The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute’s Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. Methods To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. Limitations The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important

  8. Impact of tobacco control policies in hospitals: Evaluation of a national smoke-free campus ban in Spain

    PubMed Central

    Sureda, Xisca; Ballbè, Montse; Martínez, Cristina; Fu, Marcela; Carabasa, Esther; Saltó, Esteve; Martínez-Sánchez, Jose M.; Fernández, Esteve

    2014-01-01

    Introduction On January 2, 2011, the Spanish government passed a new smoking law that banned smoking in hospital campuses. The objective of this study was to evaluate the implementation of smoke-free campuses in the hospitals of Catalonia based on both airborne particulate matter and observational data. Methods This cross-sectional study included the hospitals registered in the Catalan Network of Smoke-free Hospitals. We measured the concentration of particulate matter < 2.5 µm in μg/m3 at different locations, both indoors and outdoors before (2009) and after (2011) the implementation of the tobacco law. During 2011, we also assessed smoke-free zone signage and indications of smoking in the outdoor areas of hospital campuses. Results The overall median particulate matter < 2.5 µm concentration fell from 12.22 μg/m3 (7.80–19.76 μg/m3) in 2009 to 7.80 μg/m3 (4.68–11.96 μg/m3) in 2011. The smoke-free zone signage within the campus was moderately implemented after the legislation in most hospitals, and 55% of hospitals exhibited no indications of tobacco consumption around the grounds. Conclusions After the law, particulate matter < 2.5 µm concentrations were much below the values obtained before the law and below the annual guideline value recommended by the World Health Organization for outdoor settings (10 μg/m3). Our data showed the feasibility of implementing a smoke-free campus ban and its positive effects. PMID:26844041

  9. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals

    PubMed Central

    Cornford, Tony; Barber, Nicholas; Avery, Anthony; Takian, Amirhossein; Lichtner, Valentina; Petrakaki, Dimitra; Crowe, Sarah; Marsden, Kate; Robertson, Ann; Morrison, Zoe; Klecun, Ela; Prescott, Robin; Quinn, Casey; Jani, Yogini; Ficociello, Maryam; Voutsina, Katerina; Paton, James; Fernando, Bernard; Jacklin, Ann; Cresswell, Kathrin

    2011-01-01

    Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS

  10. Bone graft materials in fixation of orthopaedic implants in sheep.

    PubMed

    Babiker, Hassan

    2013-07-01

    Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA/Collagen composite alone and in combination with BMA on the early fixation of porous coated titanium implants. In addition, the study compares also the effect of autograft with the gold standard allograft. By using a sheep model, the implants were inserted in the trabecular bone of femoral condyles. The test biomaterials were placed in a well defined peri-implant gap. After the observation period, the bone-implant specimens were harvested and evaluated mechanically by a destructive push

  11. Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

    PubMed

    Gorsky, Martin

    2012-06-01

    Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

  12. Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies.

    PubMed

    Fakih, Mohamad G; George, Christine; Edson, Barbara S; Goeschel, Christine A; Saint, Sanjay

    2013-10-01

    Catheter-associated urinary tract infection (CAUTI) represents a significant proportion of healthcare-associated infections (HAIs). The US Department of Health and Human Services issued a plan to reduce HAIs with a target 25% reduction of CAUTI by 2013. Michigan's successful collaborative to reduce unnecessary use of urinary catheters and CAUTI was based on a partnership between diverse hospitals, the state hospital association (SHA), and academic medical centers. Taking the lessons learned from Michigan, we are now spreading this work throughout the 50 states. This national spread leverages the expertise of different groups and organizations for the unified goal of reducing catheter-related harm. The key components of the project are (1) centralized coordination of the effort and dissemination of information to SHAs and hospitals, (2) data collection based on established definitions and approaches, (3) focused guidance on the technical practices that will prevent CAUTI, (4) emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges), and (5) partnering with specialty organizations and governmental agencies who have expertise in the relevant subject area. The work may serve in the future as a model for other large improvement efforts to address other hospital-acquired conditions, such as venous thromboembolism and falls.

  13. Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?

    PubMed Central

    McCusker, Darren; Gupta, Nidhi; Bunn, Jonathon; Murnaghan, Mark

    2016-01-01

    Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of

  14. Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?

    PubMed Central

    McCusker, Darren; Gupta, Nidhi; Bunn, Jonathon; Murnaghan, Mark

    2016-01-01

    Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of

  15. US hospitals violate WHO policy on the distribution of formula sample packs: results of a national survey.

    PubMed

    Merewood, Anne; Grossman, Xena; Cook, John; Sadacharan, Radha; Singleton, Marcella; Peters, Karen; Navidi, Tina

    2010-11-01

    The World Health Organization's International Code of Marketing of Breast-Milk Substitutes, as well as most major medical authorities, opposes hospital-based distribution of free infant formula at discharge. The goal of this cross-sectional telephone survey of 3209 US maternity sites, conducted from 2006 to 2007, was to determine the extent of this practice. It was found that 91% of hospitals distributed formula sample packs, and a trend toward discontinuation of the practice was statistically significant (P < .001). It was concluded that most US hospitals distribute infant formula samples, in violation of the WHO Code and the recommendations of organizations including the US Government Accountability Office, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention. PMID:20871089

  16. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data

    PubMed Central

    Nair, Manisha; Kurinczuk, Jennnifer J.; Knight, Marian

    2016-01-01

    Introduction As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator. Methods We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies. Results EMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out. Conclusion While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate. PMID:27054761

  17. Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010

    MedlinePlus

    ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did rural hospital inpatients differ from urban hospital inpatients ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did patients' first-listed diagnoses differ in rural and ...

  18. An examination of inpatient medical record keeping in the Orthopaedic Department of Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania

    PubMed Central

    Hollis, Alexander Conor; Ebbs, Samuel Robert

    2016-01-01

    Introduction There is a lack of published evidence examining the quality of patient notes in African healthcare settings. We aim to examine the completeness of the orthopaedic inpatient notes and begin development of a formal audit framework in a large Tanzanian Hospital. Methods A retrospective review of 155 orthopaedic inpatient notes at Kilimanjaro Christian Medical Centre (KCMC) was conducted spanning 3 months. Notes were reviewed using an agreed data collection pro forma considering 3 main outcomes; i) quantity of complete entries, ii) percentage completeness of individual sections, iii) documentation of follow-up. Results: Primary outcome 8% (n = 13) of the inpatient documents were complete (10/10 sections). 11% (n = 17) of the inpatient documents had 9 of 10 sections completed. 30% (n = 46) of the inpatient documents had 8 of 10 sections completed. Therefore, 51% (n = 79) of inpatient entries had 7 or fewer sections filled in. Secondary outcome Admission information and Demographics were both completed 88% (n = 137) of the time. History and the Examination sections were complete in 96% (n = 149) of cases. Investigations were complete in 77% (n = 119) and Diagnosis in 88% (n = 137). The Treatment section was complete 85% (n = 132) of the time and the Attending doctor 50% (n = 78). Procedures were 27% (n = 42) filled in while Summary of a day and Follow-up were 32% (n = 49) and 0% (n = 0) respectively. Tertiary outcome Follow-up was not completed in any entries. Conclusion There are a number of sections of the inpatient pro forma that remain inadequately completed. Regular auditing is essential for the continued progress in patient care. PMID:27347296

  19. Nanostructured glass-ceramic coatings for orthopaedic applications.

    PubMed

    Wang, Guocheng; Lu, Zufu; Liu, Xuanyong; Zhou, Xiaming; Ding, Chuanxian; Zreiqat, Hala

    2011-08-01

    Glass-ceramics have attracted much attention in the biomedical field, as they provide great possibilities to manipulate their properties by post-treatments, including strength, degradation rate and coefficient of thermal expansion. In this work, hardystonite (HT; Ca2ZnSi2O7) and sphene (SP; CaTiSiO5) glass-ceramic coatings with nanostructures were prepared by a plasma spray technique using conventional powders. The bonding strength and Vickers hardness for HT and SP coatings are higher than the reported values for plasma-sprayed hydroxyapatite coatings. Both types of coatings release bioactive calcium (Ca) and silicon (Si) ions into the surrounding environment. Mineralization test in cell-free culture medium showed that many mushroom-like Ca and phosphorus compounds formed on the HT coatings after 5 h, suggesting its high acellular mineralization ability. Primary human osteoblasts attach, spread and proliferate well on both types of coatings. Higher proliferation rate was observed on the HT coatings compared with the SP coatings and uncoated Ti-6Al-4V alloy, probably due to the zinc ions released from the HT coatings. Higher expression levels of Runx2, osteopontin and type I collagen were observed on both types of coatings compared with Ti-6Al-4V alloy, possibly due to the Ca and Si released from the coatings. Results of this study point to the potential use of HT and SP coatings for orthopaedic applications.

  20. Clinical applications of vibration therapy in orthopaedic practice

    PubMed Central

    Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco

    2016-01-01

    Summary Background Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. Methods a literature review using the key words “vibration therapy” and “whole-body vibration” and “orthopaedics” was performed. After checking the available abstracts 71 full text articles were evaluated. Results fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. Conclusions VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement. PMID:27331044

  1. New modalities of pain treatment after outpatient orthopaedic surgery.

    PubMed

    Beaussier, M; Sciard, D; Sautet, A

    2016-02-01

    Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored. PMID:26803223

  2. Force and torque modelling of drilling simulation for orthopaedic surgery.

    PubMed

    MacAvelia, Troy; Ghasempoor, Ahmad; Janabi-Sharifi, Farrokh

    2014-01-01

    The advent of haptic simulation systems for orthopaedic surgery procedures has provided surgeons with an excellent tool for training and preoperative planning purposes. This is especially true for procedures involving the drilling of bone, which require a great amount of adroitness and experience due to difficulties arising from vibration and drill bit breakage. One of the potential difficulties with the drilling of bone is the lack of consistent material evacuation from the drill's flutes as the material tends to clog. This clogging leads to significant increases in force and torque experienced by the surgeon. Clogging was observed for feed rates greater than 0.5 mm/s and spindle speeds less than 2500 rpm. The drilling simulation systems that have been created to date do not address the issue of drill flute clogging. This paper presents force and torque prediction models that account for this phenomenon. The two coefficients of friction required by these models were determined via a set of calibration experiments. The accuracy of both models was evaluated by an additional set of validation experiments resulting in average R² regression correlation values of 0.9546 and 0.9209 for the force and torque prediction models, respectively. The resulting models can be adopted by haptic simulation systems to provide a more realistic tactile output. PMID:23167723

  3. [Regenerative medicine: orthopaedical applications and medico legal questions].

    PubMed

    Ricci, S; Ricci, O; Tucci, C E; Massoni, F; Sarra, M V; Ricci, S

    2012-01-01

    Over the last decades, the increase in the global population's mean age has implied a corresponding increase in degenerative disease affecting various anatomical areas and tissues, including bones and cartilages, thus provoking a rising number of disabilities and a wider usage of drugs, mostly anti-inflammatory and cortisone. New developments in technologic and biomedical fields gave birth to new subjects, such as tissue engineering, cell therapy, gene therapy that, by and large, create a knowledge network falling under the concept of Regenerative Medicine. This science is essentially based on the usage of stem cells that can replicate and renovate themselves originating, if adequately stimulated, a number of cell types. Inter alia, in orthopaedic field a particular type of adult stem cells is used, the mesenchymal stem cells (MSCs). If combined with synthetic material produced in laboratories, the usage of these cells has provided inspiration for new study interests; today, it can be applied in various degenerative and post-traumatic pathologies, with great therapeutic benefits for the patient. Actually, many studies write about an improvement in patients' life quality. In this sense appear significant reflections on legal medicine, both in accidents and insurance, of this innovative therapeutic alternative and is hopefully an equally valid process of improvement of regulatory and case law.

  4. Nano-Engineered Cubic Zirconia for Orthopaedic Implant Applications

    NASA Astrophysics Data System (ADS)

    Namavar, F.; Rubinstein, A.; Sabirianov, R.; Thiele, G.; Sharp, J.; Pokharel, U.; Namavar, R.; Garvin, K.

    2012-02-01

    Osseointegration failure of the prosthesis prevents long-term stability, which contributes to pain, implant loosening, and infection that usually necessitates revision surgery. Cell attachment and spreading in vitro is generally mediated by adhesive proteins such as fibronectin and vitronectin. We designed and produced pure cubic zirconia (ZrO2) ceramic coatings by ion beam assisted deposition (IBAD) with nanostructures comparable to the size of proteins. Our ceramic coatings exhibit high hardness and a zero contact angle with serum. In contrast to Hydroxyapatite (HA), nano-engineered zirconia films possess excellent adhesion to all orthopaedic materials. Adhesion and proliferation experiments were performed with a bona fide mesenchymal stromal cells cell line (OMA-AD). Our experimental results indicated that nano-engineered cubic zirconia is superior in supporting growth, adhesion, and proliferation. We performed a comparative analysis of adsorption energies of the FN fragment using quantum mechanical calculations and Monte Carlo simulation on both types of surfaces: smooth and nanostructured. We have found that the initial FN fragment adsorbs significantly stronger on the nanostructured surface than on the smooth surface.

  5. Thermal cycling can extend tool life in orthopaedic operating rooms.

    PubMed

    Katchky, Ryan N; McLachlin, Stewart D; Wong, Edwin K Y; Finkelstein, Joel; Kreder, Hans J; Whyne, Cari M

    2016-03-01

    Thermal cycling is a temperature modulation process developed to improve the performance, durability and longevity of materials. This process has been successfully utilized in the automotive, aeronautic and manufacturing industries. Surgical cutting tools undergo cyclical loading and generally fail by dulling, suggesting that thermal cycling may improve their performance and longevity. Ten 2.5 mm orthopaedic drill bits were randomized, with five undergoing thermal cycling within their sterile packaging and five serving as untreated controls. Using a servohydraulic testing machine, 100 drilling cycles were performed with each drill bit into the diaphyseal region of bovine femurs. After every 25 cycles, data was collected by performing identical drilling cycles into simulated human cortical bone material. Maximum force, maximum normalized torque and drilling work were measured, and a scanning electron microscope was used to measure outer corner wear. After 100 drilling cycles, the maximum drilling force, maximum normalized torque, drilling work and microscopic outer corner wear were all significantly lower for the treated drill bits (p < 0.05). Thermal cycling has the potential to decrease operating room costs and thermal necrosis associated with dull cutting tools. Application of this technology may also be relevant to surgical cutting tools such as saw blades, burrs and reamers.

  6. Diversity of patients microflora on orthopaedic and dental implants.

    PubMed

    Obst, Ursula; Marten, Silke-Mareike; Niessner, Christoph; Hartwig, Erich; Korsch, Michael; Walther, Winfried

    2012-10-01

    The aim of this study was to compare the diversity of microbial colonization on implant material from different individuals. Eubacterial DNA was extracted, separated and sequenced from orthopaedic metallic implant material, tissues or body fluids, and skin of 4 patients as well as from identical dental cement material from 10 individuals after revision and routine removal. Additionally, the composition of the bacterial population of the dental cement and the oral swab sample from one individual after direct extraction of bacterial DNA was compared to extraction after conventional microbiological enrichment. The latter investigation proved that the commonly used cultivation technique gave different results than direct extraction of DNA, especially as regards the detection of anaerobes. Comparing the bacterial colonization of implant materials from different patients showed significant individual diversity. The common focus on a constricted pathogen spectrum may have to be expanded toward a multispecies population. Moreover, the dependence of the bacterial population on the individual host has to be integrated in discussing implant colonization and infection.

  7. Tissue Engineering Strategies for the Regeneration of Orthopaedic Interfaces

    PubMed Central

    Lu, Helen H.; Subramony, Siddarth D.; Boushell, Margaret K.; Zhang, Xinzhi

    2013-01-01

    A major focus in the field of orthopaedic tissue engineering is the development of tissue engineered bone and soft tissue grafts with biomimetic functionality to allow for their translation to the clinical setting. One of the most significant challenges of this endeavor is promoting the biological fixation of these grafts with each other as well as the implant site. Such fixation requires strategic biomimicry to be incorporated into the scaffold design in order to re-establish the critical structure-function relationship of the native soft tissue-to-bone interface. The integration of distinct tissue types (e.g. bone and soft tissues such as cartilage, ligaments, or tendons), requires a multi-phased or stratified scaffold with distinct yet continuous tissue regions accompanied by a gradient of mechanical properties that mimics that of the multi-tissue transition between bone and soft tissues. This review discusses tissue engineering strategies for regenerating common tissue-to-tissue interfaces (ligament-to-bone, tendon-to-bone or cartilage-to-bone), and the strategic biomimicry implemented in stratified scaffold design for multi-tissue regeneration. Potential challenges and future directions in this emerging field will also be presented. It is anticipated that interface tissue engineering will enable integrative soft tissue repair, and will be instrumental for the development of complex musculoskeletal tissue systems with biomimetic complexity and functionality. PMID:20422291

  8. Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China.

    PubMed

    Yang, Lianping; Liu, Chaojie; Ferrier, J Adamm; Zhang, Xinping

    2015-11-01

    This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income

  9. Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China.

    PubMed

    Yang, Lianping; Liu, Chaojie; Ferrier, J Adamm; Zhang, Xinping

    2015-11-01

    This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income

  10. Comparison of Evidence-Based Practice between Physicians and Nurses: A National Survey of Regional Hospitals in Taiwan

    ERIC Educational Resources Information Center

    Chiu, Ya-Wen; Weng, Yi-Hao; Lo, Heng-Lien; Hsu, Chih-Cheng; Shih, Ya-Hui; Kuo, Ken N.

    2010-01-01

    Introduction: Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. Methods: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551…

  11. Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Claims Database Analysis

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im

    2011-01-01

    There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…

  12. Quality of human-computer interaction - results of a national usability survey of hospital-IT in Germany

    PubMed Central

    2011-01-01

    Background Due to the increasing functionality of medical information systems, it is hard to imagine day to day work in hospitals without IT support. Therefore, the design of dialogues between humans and information systems is one of the most important issues to be addressed in health care. This survey presents an analysis of the current quality level of human-computer interaction of healthcare-IT in German hospitals, focused on the users' point of view. Methods To evaluate the usability of clinical-IT according to the design principles of EN ISO 9241-10 the IsoMetrics Inventory, an assessment tool, was used. The focus of this paper has been put on suitability for task, training effort and conformity with user expectations, differentiated by information systems. Effectiveness has been evaluated with the focus on interoperability and functionality of different IT systems. Results 4521 persons from 371 hospitals visited the start page of the study, while 1003 persons from 158 hospitals completed the questionnaire. The results show relevant variations between different information systems. Conclusions Specialised information systems with defined functionality received better assessments than clinical information systems in general. This could be attributed to the improved customisation of these specialised systems for specific working environments. The results can be used as reference data for evaluation and benchmarking of human computer engineering in clinical health IT context for future studies. PMID:22070880

  13. National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010).

    PubMed

    Minges, Karl E; Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Curtis, Jeptha P; Desai, Mayur M; Krumholz, Harlan M

    2015-11-01

    Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes in older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized from 1999 to 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (p <0.001). Black patients had the highest rate of increase (174 to 548/100,000 person-years) among all age, gender, and race categories. The mean (standard deviation) length of hospital stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95% confidence interval [CI] 50.5 to 51.6) to 44.1% (95% CI 43.7 to 44.6), whereas more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95% CI 8.0 to 8.6) in 1999 to 4.4% (95% CI 4.2 to 4.5) in 2010, as did adjusted 30-day (from 12.3% [95% CI 11.9 to 12.6] to 9.1% [95% CI 8.5 to 9.7]) and 6-month mortality rates (from 23.0% [95% CI 22.5 to 23.4] to 19.6% [95% CI 18.8 to 20.5]). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for black patients. All mortality rates decreased but remained high. The increase in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults. PMID:26409636

  14. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

    PubMed Central

    Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti

    2016-01-01

    Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions

  15. Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012)

    PubMed Central

    de Miguel-Yanes, José Ma; Esteban-Hernández, Jesús; Jiménez-Trujillo, Isabel; Alvaro-Meca, Alejandro; Carrasco-Garrido, Pilar; de Miguel-Díez, Javier

    2015-01-01

    Background Type 2 Diabetes (T2DM) is the most rapidly increasing risk factor for ischemic stroke. We aimed to compare trends in outcomes for ischemic stroke in people with or without diabetes in Spain between 2003 and 2012. Methods We selected all patients hospitalized for ischemic stroke using national hospital discharge data. We evaluated annual incident rates stratified by T2DM status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, and in-hospital outcomes. We calculated in-hospital mortality (IHM), length of hospital stay (LOHS) and readmission rate in one month after discharge. Time trend on the incidence of hospitalization was estimated fitting Poisson regression models by sex and diabetes variables. In-hospital mortality was analyzed using logistic regression models separate for men and women. LOHS were compared with ANOVA or Kruskal-Wallis when necessary. Results We identified a total of 423,475 discharges of patients (221,418 men and 202,057 women) admitted with ischemic stroke as primary diagnosis. Patients with T2DM accounted for 30.9% of total. The estimated incidence rates of discharges increased significantly in all groups. The incidence of hospitalization due to stroke (with ICD9 codes for stroke as main diagnosis at discharge) was higher among those with than those without diabetes in all the years studied. T2DM was positively associated with ischemic stroke with an adjusted incidence rate ratio (IRR) of 2.27 (95% CI 2.24–2.29) for men and 2.15 (95%CI 2.13–2.17) for women. Over the 10 year period LOHS decreased significantly in men and women with and without diabetes. Readmission rate remained stable in diabetic and non diabetic men (around 5%) while slightly increased in women with and without diabetes. We observed a significant increase in the use of fibrinolysis from 2002–2013. IHM was positively associated with older age in all groups, with Charlson Comorbidity Index > 3 and atrial

  16. Do consultant obstetricians and gynaecologists comply with motor traffic regulations when recalled to hospital to attend emergencies? A national audit.

    PubMed

    Ogah, J; Pring, D W

    2009-10-01

    Consultant obstetricians and gynaecologists are often recalled from home back into hospital to attend emergencies. We audited their driving practices and compliance to motor traffic regulations on recall to these emergencies with the aid of a questionnaire survey. A total of 218 of the 300 UK consultants surveyed responded. Some 65% of those who owned a green warning light beacon (GWL) admitted to speeding on some journeys and 46% ignored red lights; 84% of non-owners of a GWL would speed and 28% would ignore a red light. A total of 37 consultants had been stopped for traffic violations, nine with a GWL and 28 without. Five consultants had been involved in accidents returning to hospital to attend an emergency. Obstetricians and gynaecologists are disregarding motor traffic regulations in order to attend emergencies.

  17. Age differences in alcohol drinking patterns among Norwegian and German hospital doctors – a study based on national samples

    PubMed Central

    Rosta, Judith; Aasland, Olaf G.

    2010-01-01

    Aims: To describe and discuss the alcohol drinking patterns of the younger generation of hospital doctors in Norway and Germany – respectively the abstainers, frequent drinkers, episodic heavy drinkers and hazardous drinkers. Methods: Data were collected in nationwide postal surveys among doctors in Norway (2000) and Germany (2006). A representative sample of 1898 German and 602 Norwegian hospital doctors aged 27–65 years were included in the analyses (N=2500). Alcohol drinking patterns were measured using the first three items of AUDIT in Norway and the AUDIT-C in Germany, scores of ≥5 (ranking from 0 to 12) indicating hazardous drinking. Episodic heavy drinking was defined by the intake of ≥60g of ethanol, on one occasion, at least once a week. Frequent drinkers were who drank alcoholic beverages at least twice a week. Abstainers were persons who drank no alcohol. The analyses were performed separately for age groups (27–44 years versus 45–65 years) and genders. Results: Compared to the age groups 45 to 65 years in the Norwegian and German samples, the younger age groups (27–44 years) tend to have higher rates of abstainers, higher rates of infrequent drinking of moderate amount of alcoholic drinks, lower rates of episodic heavy drinking and lower rates of hazardous drinking. Conclusion: The younger generation of hospital doctors in Norway and Germany showed tendencies to healthier drinking habits. Changes in professional life, and in the attitude towards alcohol consumption, may go some way towards explaining these findings. PMID:20200658

  18. Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative.

    PubMed

    White, Katherine M; Starfelt, Louise C; Jimmieson, Nerina L; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David

    2015-12-01

    Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The '5 critical moments' of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses' hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses' hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence. PMID:26590244

  19. [Longer working hours of pharmacists in the ward resulted in lower medication-related errors--survey of national university hospitals in Japan].

    PubMed

    Matsubara, Kazuo; Toyama, Akira; Satoh, Hiroshi; Suzuki, Hiroshi; Awaya, Toshio; Tasaki, Yoshikazu; Yasuoka, Toshiaki; Horiuchi, Ryuya

    2011-04-01

    It is obvious that pharmacists play a critical role as risk managers in the healthcare system, especially in medication treatment. Hitherto, there is not a single multicenter-survey report describing the effectiveness of clinical pharmacists in preventing medical errors from occurring in the wards in Japan. Thus, we conducted a 1-month survey to elucidate the relationship between the number of errors and working hours of pharmacists in the ward, and verified whether the assignment of clinical pharmacists to the ward would prevent medical errors between October 1-31, 2009. Questionnaire items for the pharmacists at 42 national university hospitals and a medical institute included the total and the respective numbers of medication-related errors, beds and working hours of pharmacist in 2 internal medicine and 2 surgical departments in each hospital. Regardless of severity, errors were consecutively reported to the Medical Security and Safety Management Section in each hospital. The analysis of errors revealed that longer working hours of pharmacists in the ward resulted in less medication-related errors; this was especially significant in the internal medicine ward (where a variety of drugs were used) compared with the surgical ward. However, the nurse assignment mode (nurse/inpatients ratio: 1 : 7-10) did not influence the error frequency. The results of this survey strongly indicate that assignment of clinical pharmacists to the ward is critically essential in promoting medication safety and efficacy. PMID:21467804

  20. A glimpse into Texas Scottish Rite Hospital's educational, clinical care, and research development.

    PubMed

    Herring, J Anthony; Birch, John G; Johnston, Charles E; Richards, B Stephens

    2015-03-01

    This article describes four areas of pediatric orthopaedic education, research, and clinical care undertaken at Texas Scottish Rite Hospital (TSRH) over the past 25 years. These areas include the weekly preoperative conferences, the evolution of the limb lengthening and deformity correction program, the development of the TSRH instrumentation system, and the evolution of the clubfoot treatment program.

  1. An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit

    PubMed Central

    Hernandez, Fabien; Majoul, Elyes; Montes-Palacios, Carlota; Antignac, Marie; Cherrier, Bertrand; Doursounian, Levon; Feron, Jean-Marc; Robert, Cyrille; Hejblum, Gilles; Fernandez, Christine; Hindlet, Patrick

    2015-01-01

    Aim To assess the impact of the implementation of a Computerized Physician Order Entry (CPOE) associated with a pharmaceutical checking of medication orders on medication errors in the 3 stages of drug management (i.e. prescription, dispensing and administration) in an orthopaedic surgery unit. Methods A before-after observational study was conducted in the 66-bed orthopaedic surgery unit of a teaching hospital (700 beds) in Paris France. Direct disguised observation was used to detect errors in prescription, dispensing and administration of drugs, before and after the introduction of computerized prescriptions. Compliance between dispensing and administration on the one hand and the medical prescription on the other hand was studied. The frequencies and types of errors in prescribing, dispensing and administration were investigated. Results During the pre and post-CPOE period (two days for each period) 111 and 86 patients were observed, respectively, with corresponding 1,593 and 1,388 prescribed drugs. The use of electronic prescribing led to a significant 92% decrease in prescribing errors (479/1593 prescribed drugs (30.1%) vs 33/1388 (2.4%), p < 0.0001) and to a 17.5% significant decrease in administration errors (209/1222 opportunities (17.1%) vs 200/1413 (14.2%), p < 0.05). No significant difference was found in regards to dispensing errors (430/1219 opportunities (35.3%) vs 449/1407 (31.9%), p = 0.07). Conclusion The use of CPOE and a pharmacist checking medication orders in an orthopaedic surgery unit reduced the incidence of medication errors in the prescribing and administration stages. The study results suggest that CPOE is a convenient system for improving the quality and safety of drug management. PMID:26207363

  2. [Collaboration between Fukushimura Brain Bank,based in a private geriatric hospital and a national/international network].

    PubMed

    Akatsu, Hiroyasu

    2010-10-01

    Fukushimura Brain Bank (FBB) was established in 1994, and to date, has accumulated 477 fresh frozen brain tissue samples. Our brain bank is based in Choju Medical Institute, Fukushimura Hospital, Toyohashi in Japan. At the time of its foundation, the institute could not establish working relationships with clinicopathological investigators and others engaged in basic neuroscience research. At this stage, we received the assistance of Yokohama City University in setting up standards for neuropathological diagnosis as well as the aid of Chiba University in establishing a method for Vancouver style snap-frozen sampling of brain tissue. However, both systems require considerable manpower and time. We now plan to introduce several improvements in these systems. At its inception, the Brain Bank operated without financial support from grants or foundation funding and was managed only as a hospital expense. However, since 1998, we have collaborated with researchers from several institutes, and the results of our labors have been presented at congresses, in journal publications and in foundation reports. In 2004, we obtained the status required to apply for a grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Fukushimura Hospital is a geriatric institution that specializes in dementia. There are no other hospitals or nursing homes in the Toyohashi area that specialize in this field. Half of our patients have Alzheimer's disease,and a number of them have enormous plaques and huge neurofibrillary tangles patient for over 10 years. In general,private geriatric hospitals that care for such patients with severe AD lack the systems required for performing autopsies. Research carried out with animal models are not comparable with neuropathological and biochemical investigations using human tissues,and in terms of the quality,the range and size of our collection at FBB is unique. In the future,we intend to expand our network in order to share

  3. Multiscale Inorganic Hierarchically Materials: Towards an Improved Orthopaedic Regenerative Medicine.

    PubMed

    Ruso, Juan M; Sartuqui, Javier; Messina, Paula V

    2015-01-01

    Bone is a biologically and structurally sophisticated multifunctional tissue. It dynamically responds to biochemical, mechanical and electrical clues by remodelling itself and accordingly the maximum strength and toughness are along the lines of the greatest applied stress. The challenge is to develop an orthopaedic biomaterial that imitates the micro- and nano-structural elements and compositions of bone to locally match the properties of the host tissue resulting in a biologically fixed implant. Looking for the ideal implant, the convergence of life and materials sciences occurs. Researchers in many different fields apply their expertise to improve implantable devices and regenerative medicine. Materials of all kinds, but especially hierarchical nano-materials, are being exploited. The application of nano-materials with hierarchical design to calcified tissue reconstructive medicine involve intricate systems including scaffolds with multifaceted shapes that provides temporary mechanical function; materials with nano-topography modifications that guarantee their integration to tissues and that possesses functionalized surfaces to transport biologic factors to stimulate tissue growth in a controlled, safe, and rapid manner. Furthermore materials that should degrade on a timeline coordinated to the time that takes the tissues regrow, are prepared. These implantable devices are multifunctional and for its construction they involve the use of precise strategically techniques together with specific material manufacturing processes that can be integrated to achieve in the design, the required multifunctionality. For such reasons, even though the idea of displacement from synthetic implants and tissue grafts to regenerative-medicine-based tissue reconstruction has been guaranteed for well over a decade, the reality has yet to emerge. In this paper, we examine the recent approaches to create enhanced bioactive materials. Their design and manufacturing procedures as well

  4. A review of virtual reality based training simulators for orthopaedic surgery.

    PubMed

    Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

    2016-02-01

    This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. PMID:26751581

  5. Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

    PubMed

    Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B

    2013-07-01

    The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research. PMID:23689761

  6. Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

    PubMed

    Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B

    2013-07-01

    The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research.

  7. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984.

    PubMed

    Evans, R; Mullally, D I; Wilson, R W; Gergen, P J; Rosenberg, H M; Grauman, J S; Chevarley, F M; Feinleib, M

    1987-06-01

    National population-based data systems of the National Center for Health Statistics (NCHS) were used to study the epidemiology of asthma in the United States over the last 20 years. Asthma is more prevalent among males, those living below the poverty level, persons living in the South and West, and blacks; however, this difference did not attain statistical significance. Death rates from asthma among the older age groups probably increased between 1968 and 1982, with a substantial increase since 1979. For children, the evidence is less clear, but the death rate has increased for children over five years of age during the period from 1979 to 1982. Between 1964 and 1980, asthma has become more prevalent in children under 17 years of age, but this does not reflect an increase in the severity of asthma over this same time period. Hospitalization rates for asthma between 1965 and 1983 increased by 50 percent in adults and by over 200 percent in children. Rates for black patients are 50 percent higher in adults and 150 percent greater in children. It is concluded that there has been a marked increase in hospitalization rates for asthma, a moderate increase in death rates from asthma and a smaller increase in overall prevalence of the disease in the United States.

  8. Atherosclerotic Risk Factors and Their Association With Hospital Mortality Among Patients With First Myocardial Infarction (from the National Registry of Myocardial Infarction)

    PubMed Central

    Canto, John G.; Kiefe, Catarina I.; Rogers, William J.; Peterson, Eric D.; Frederick, Paul D.; French, William J.; Gibson, C. Michael; Pollack, Charles V.; Ornato, Joseph P.; Zalenski, Robert J.; Penney, Jan; Tiefenbrunn, Alan J.; Greenland, Philip

    2013-01-01

    Few studies have examined associations between atherosclerotic risk factors and short-term mortality after first myocardial infarction (MI). Histories of 5 traditional atherosclerotic risk factors at presentation (diabetes, hypertension, smoking, dyslipidemia, and family history of premature heart disease) and hospital mortality were examined among 542,008 patients with first MIs in the National Registry of Myocardial Infarction (1994 to 2006). On initial MI presentation, history of hypertension (52.3%) was most common, followed by smoking (31.3%). The least common risk factor was diabetes (22.4%). Crude mortality was highest in patients with MI with diabetes (11.9%) and hypertension (9.8%) and lowest in those with smoking histories (5.4%) and dyslipidemia (4.6%). The inclusion of 5 atherosclerotic risk factors in a stepwise multivariate model contributed little toward predicting hospital mortality over age alone (C-statistic = 0.73 and 0.71, respectively). After extensive multivariate adjustments for clinical and sociodemographic factors, patients with MI with diabetes had higher odds of dying (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.20 to 1.26) than those without diabetes and similarly for hypertension (OR 1.08, 95% CI 1.06 to 1.11). Conversely, family history (OR 0.71, 95% CI 0.69 to 0.73), dyslipidemia (OR 0.62, 95% CI 0.60 to 0.64), and smoking (OR 0.85, 95% CI 0.83 to 0.88) were associated with decreased mortality (C-statistic = 0.82 for the full model). In conclusion, in the setting of acute MI, histories of diabetes and hypertension are associated with higher hospital mortality, but the inclusion of atherosclerotic risk factors in models of hospital mortality does not improve predictive ability beyond other major clinical and sociodemographic characteristics. PMID:22840346

  9. Atherosclerotic risk factors and their association with hospital mortality among patients with first myocardial infarction (from the National Registry of Myocardial Infarction).

    PubMed

    Canto, John G; Kiefe, Catarina I; Rogers, William J; Peterson, Eric D; Frederick, Paul D; French, William J; Gibson, C Michael; Pollack, Charles V; Ornato, Joseph P; Zalenski, Robert J; Penney, Jan; Tiefenbrunn, Alan J; Greenland, Philip

    2012-11-01

    Few studies have examined associations between atherosclerotic risk factors and short-term mortality after first myocardial infarction (MI). Histories of 5 traditional atherosclerotic risk factors at presentation (diabetes, hypertension, smoking, dyslipidemia, and family history of premature heart disease) and hospital mortality were examined among 542,008 patients with first MIs in the National Registry of Myocardial Infarction (1994 to 2006). On initial MI presentation, history of hypertension (52.3%) was most common, followed by smoking (31.3%). The least common risk factor was diabetes (22.4%). Crude mortality was highest in patients with MI with diabetes (11.9%) and hypertension (9.8%) and lowest in those with smoking histories (5.4%) and dyslipidemia (4.6%). The inclusion of 5 atherosclerotic risk factors in a stepwise multivariate model contributed little toward predicting hospital mortality over age alone (C-statistic = 0.73 and 0.71, respectively). After extensive multivariate adjustments for clinical and sociodemographic factors, patients with MI with diabetes had higher odds of dying (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.20 to 1.26) than those without diabetes and similarly for hypertension (OR 1.08, 95% CI 1.06 to 1.11). Conversely, family history (OR 0.71, 95% CI 0.69 to 0.73), dyslipidemia (OR 0.62, 95% CI 0.60 to 0.64), and smoking (OR 0.85, 95% CI 0.83 to 0.88) were associated with decreased mortality (C-statistic = 0.82 for the full model). In conclusion, in the setting of acute MI, histories of diabetes and hypertension are associated with higher hospital mortality, but the inclusion of atherosclerotic risk factors in models of hospital mortality does not improve predictive ability beyond other major clinical and sociodemographic characteristics. PMID:22840346

  10. Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001–2011)

    PubMed Central

    de Miguel-Díez, Javier; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Carrasco-Garrido, Pilar; Bueno, Héctor; Puente-Maestu, Luis; Jimenez-Trujillo, Isabel; Alvaro-Meca, Alejandro; Esteban-Hernandez, Jesús; de Andrés, Ana López

    2015-01-01

    Background People with COPD suffering from coronary artery disease are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of these procedures in COPD and non-COPD patients in Spain between 2001 and 2011. Methods We identified all patients who had undergone percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped into: COPD and no COPD. Results From 2001 to 2011, 428,516 PCIs and 79,619 CABGs were performed. The sex and age-adjusted use of PCI increased by 21.27% per year from 2001 to 2004 and by 5.47% per year from 2004 to 2011 in patients with COPD. In-hospital mortality (IHM) among patients with COPD who underwent a PCI increased significantly from 2001 to 2011 (odds ratio 1.11; 95% confidence interval 1.03–1.20). Among patients with COPD who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 9.77% per year from 2001 to 2003, and then decreased by 3.15% through 2011. The probability of dying during hospitalization in patients who underwent a CABG did not change significantly in patients with and without COPD (odds ratio, 1.06; 95% confidence interval 0.96–1.17). Conclusion The annual percent change in PCI procedures increased in COPD and non-COPD patients. We found a decrease in the use of CABG procedures in both groups. IHM was higher in patients with COPD who underwent a PCI than in those without COPD. However, COPD did not increase the probability of dying during hospitalization in patients who underwent a CABG. PMID:26543361

  11. Atherosclerotic risk factors and their association with hospital mortality among patients with first myocardial infarction (from the National Registry of Myocardial Infarction).

    PubMed

    Canto, John G; Kiefe, Catarina I; Rogers, William J; Peterson, Eric D; Frederick, Paul D; French, William J; Gibson, C Michael; Pollack, Charles V; Ornato, Joseph P; Zalenski, Robert J; Penney, Jan; Tiefenbrunn, Alan J; Greenland, Philip

    2012-11-01

    Few studies have examined associations between atherosclerotic risk factors and short-term mortality after first myocardial infarction (MI). Histories of 5 traditional atherosclerotic risk factors at presentation (diabetes, hypertension, smoking, dyslipidemia, and family history of premature heart disease) and hospital mortality were examined among 542,008 patients with first MIs in the National Registry of Myocardial Infarction (1994 to 2006). On initial MI presentation, history of hypertension (52.3%) was most common, followed by smoking (31.3%). The least common risk factor was diabetes (22.4%). Crude mortality was highest in patients with MI with diabetes (11.9%) and hypertension (9.8%) and lowest in those with smoking histories (5.4%) and dyslipidemia (4.6%). The inclusion of 5 atherosclerotic risk factors in a stepwise multivariate model contributed little toward predicting hospital mortality over age alone (C-statistic = 0.73 and 0.71, respectively). After extensive multivariate adjustments for clinical and sociodemographic factors, patients with MI with diabetes had higher odds of dying (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.20 to 1.26) than those without diabetes and similarly for hypertension (OR 1.08, 95% CI 1.06 to 1.11). Conversely, family history (OR 0.71, 95% CI 0.69 to 0.73), dyslipidemia (OR 0.62, 95% CI 0.60 to 0.64), and smoking (OR 0.85, 95% CI 0.83 to 0.88) were associated with decreased mortality (C-statistic = 0.82 for the full model). In conclusion, in the setting of acute MI, histories of diabetes and hypertension are associated with higher hospital mortality, but the inclusion of atherosclerotic risk factors in models of hospital mortality does not improve predictive ability beyond other major clinical and sociodemographic characteristics.

  12. [The Development and Application of the Orthopaedics Implants Failure Database Software Based on WEB].

    PubMed

    Huang, Jiahua; Zhou, Hai; Zhang, Binbin; Ding, Biao

    2015-09-01

    This article develops a new failure database software for orthopaedics implants based on WEB. The software is based on B/S mode, ASP dynamic web technology is used as its main development language to achieve data interactivity, Microsoft Access is used to create a database, these mature technologies make the software extend function or upgrade easily. In this article, the design and development idea of the software, the software working process and functions as well as relative technical features are presented. With this software, we can store many different types of the fault events of orthopaedics implants, the failure data can be statistically analyzed, and in the macroscopic view, it can be used to evaluate the reliability of orthopaedics implants and operations, it also can ultimately guide the doctors to improve the clinical treatment level.

  13. Design and management of an orthopaedic bone bank in The Netherlands.

    PubMed

    Zwitser, Eline W; Jiya, Timothy U; George Licher, H; van Royen, Barend J

    2012-03-01

    The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified 'law of security and quality for using human materials' (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe.

  14. Surgical advances during the First World War: the birth of modern orthopaedics.

    PubMed

    Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

    2016-02-01

    The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict.

  15. A distributed health data network analysis of survival outcomes: the International Consortium of Orthopaedic Registries perspective.

    PubMed

    Banerjee, Samprit; Cafri, Guy; Isaacs, Abby J; Graves, Stephen; Paxton, Elizabeth; Marinac-Dabic, Danica; Sedrakyan, Art

    2014-12-17

    The International Consortium for Orthopaedic Registries is a multinational initiative established by the United States Food and Drug Administration to develop a health data network aimed at providing a robust infrastructure to facilitate evidence-based decision-making on performance of medical devices. Through the International Consortium for Orthopaedic Registries, individual data holders have complete control of their data and can choose to participate in studies of their choice. In this article, we present an overview of the data extraction process and the analytic strategy employed to answer several device performance-related questions in total hip arthroplasty and total knee arthroplasty. In the process, we discuss some nuances pertinent to International Consortium for Orthopaedic Registries data that pose certain statistical challenges, and we briefly suggest strategies to be adopted to address them. PMID:25520413

  16. Publication rates of abstracts presented at the annual meeting of the Society of Military Orthopaedic Surgeons.

    PubMed

    Fuller, Brian C; Dowd, Thomas C; Masini, Brendan D; Gerlinger, Tad L

    2012-01-01

    Previous studies have reported publication rates of abstracts presented at orthopaedic meetings from 22 to 68 percent. The objective of this study was to determine the publication rate of papers presented at the Society of Military Orthopaedic Surgeons (SOMOS) meetings from 1999 to 2003. A database was created including all abstracts presented at SOMOS meetings from 1999 to 2003 as listed in official program books. To assess whether each abstract resulted in publication in a peer-reviewed journal, a computerized PubMed search of the presenting author and appropriate keywords from the title was conducted. Overall, 191 of the 435 abstracts presented at SOMOS from 1999 to 2003 were published in a peer-reviewed journal, giving a publication rate of 44%. The publication rate of abstract presentations at annual SOMOS meetings compares favorably with the rates for other orthopaedic meetings. However, less than 50% result in peer-reviewed publication. PMID:22995357

  17. Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.

    ERIC Educational Resources Information Center

    McClurg, Ronald B.

    An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…

  18. Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact on the Functional Status in Older Patients Undergoing Orthopaedic Surgery: A Prospective Cohort Study

    PubMed Central

    Liang, Chih-Kuang; Chu, Chin-Liang; Chou, Ming-Yueh; Lin, Yu-Te; Lu, Ti; Hsu, Chien-Jen; Chen, Liang-Kung

    2014-01-01

    Background The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. Method This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1–12-month postoperative ADL and IADL functional status were collected for analysis. Results Overall, 9.1% of 232 patients (mean age: 74.7±7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08–35.70 and RR: 12.54, 95% CI: 1.88–83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65–99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35–46.99 at the 12th month; RR: 13.68, 95% CI: 1.94–96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94–318.54 at the 12th month, respectively). Conclusion Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status

  19. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    PubMed

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury. PMID:23533394

  20. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    PubMed

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  1. Emerging Infectious Diseases in Free-Ranging Wildlife–Australian Zoo Based Wildlife Hospitals Contribute to National Surveillance

    PubMed Central

    Cox-Witton, Keren; Reiss, Andrea; Woods, Rupert; Grillo, Victoria; Baker, Rupert T.; Blyde, David J.; Boardman, Wayne; Cutter, Stephen; Lacasse, Claude; McCracken, Helen; Pyne, Michael; Smith, Ian; Vitali, Simone; Vogelnest, Larry; Wedd, Dion; Phillips, Martin; Bunn, Chris; Post, Lyndel

    2014-01-01

    Emerging infectious diseases are increasingly originating from wildlife. Many of these diseases have significant impacts on human health, domestic animal health, and biodiversity. Surveillance is the key to early detection of emerging diseases. A zoo based wildlife disease surveillance program developed in Australia incorporates disease information from free-ranging wildlife into the existing national wildlife health information system. This program uses a collaborative approach and provides a strong model for a disease surveillance program for free-ranging wildlife that enhances the national capacity for early detection of emerging diseases. PMID:24787430

  2. Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons

    PubMed Central

    Eltorai, Adam E. M.; P. Thomas, Nathan; Yang, Heejae; Daniels, Alan H.; Born, Christopher T.

    2016-01-01

    Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommended readability guidelines for medical information. Evidence Acquisition: Ninety-nine articles from the “Broken Bones and Injuries” section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). Results: The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). Conclusions: The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population. PMID:27218045

  3. Education and Indigenous Knowledge in Africa: Traditional Bonesetting and Orthopaedic Medicine in West Africa

    NASA Astrophysics Data System (ADS)

    Ezeanya, Chika A.

    The underlying philosophy of education in contemporary Africa has been established to be alien, and detached from the indigenous knowledge of the people. Modern day formal education in sub-Saharan Africa came about, for the most part, as a result of missionary activities and colonial efforts of Europe. The education bequeathed to Africa was, therefore, fundamentally European in paradigm and lacking in authenticity. The end of colonialism across sub-Saharan Africa did not herald any tangible transformation in the curriculum of study. Education in Africa is still dependent on foreign input for sustainability, thereby stifling research, creativity and innovation. Sustainable development is founded on indigenous knowledge. When such grassroots knowledge assumes the foundation of learning, home-grown development is easily fostered in all sectors of a national economy. In the field of medicine, indigenous knowledge of healing has been considered unscientific by western biomedical practitioners. Since the days of the missionaries, many Africans have considered indigenous medicine to be fetish; the Christian converts would not be associated with its practice and patronage. However, traditional bonesetting has been proven to be highly efficacious with little supernatural content, it continues to attract huge patronage from Africans, cutting across social and religious boundaries. This study attempts an exploration of the disconnect between indigenous knowledge, practices and learning, on the one hand, and formal education in Africa, on the other. With a focus on traditional bonesetting, the study seeks to determine why that branch of indigenous medicine attracts huge patronage, but is granted very little recognition by modern orthopaedic medical education.

  4. Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

    PubMed Central

    Wasko, Marcin K.; Kaminski, Rafal

    2015-01-01

    Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection. PMID:26509153

  5. An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania

    PubMed Central

    2014-01-01

    Background A well functioning Health Information System (HIS) is crucial for effective and efficient health service delivery. In Tanzania there is a national HIS called Mfumo wa Taarifa za Uendeshaji Huduma za Afya (MTUHA). It comprises a guideline/manual, a series of registers for primary data collection and secondary data books where information from the registers is totalled or used for calculations. Methods A mix of qualitative methods were used. These included key informant interviews; staff interviews; participant observations; and a retrospective analysis of the hospital’s 2010 MTUHA reporting documents and the hospital’s development plan. Results All staff members acknowledged data collection as part of their job responsibilities. However, all had concerns about the accuracy of MTUHA data. Access to training was limited, mathematical capabilities often low, dissemination of MTUHA knowledge within the hospital poor, and a broad understanding of the HIS’s full capabilities lacking. Whilst data collection for routine services functioned reasonably well, filling of the secondary data tools was unsatisfactory. Internal inconsistencies between the different types of data tools were found. These included duplications, and the collection of data that was not further used. Sixteen of the total 72 forms (22.2%) that make up one of the key secondary data books (Hospital data/MTUHA book 2) could not be completed with the information collected in the primary data books. Moreover, the hospital made no use of any of the secondary data. The hospital’s main planning document was its development plan. Only 3 of the 22 indicators in this plan were the same as indicators in MTUHA, the information for 9 more was collected by the MTUHA system but figures had to be extracted and recalculated to fit, while for the remaining 10 indicators no use could be made of MTUHA at all. Conclusion The HIS in Tanzania is very extensive and it could be advisable to simplify it to the

  6. Measuring Hospital Productivity

    PubMed Central

    Ruchlin, Hirsch S.; Leveson, Irving

    1974-01-01

    This study presents a comprehensive method for quantifying hospital output and estimating hospital productivity. A number of less comprehensive productivity measures that can be quantified from data available from regional third-party payers and from the American Hospital Association are also developed and evaluated as proxies for the comprehensive measure, which is based on local area data. Methods are discussed for estimating the necessary variables on a regional or national level. PMID:4461703

  7. The virgin land of quality management: a first measure of patient safety climate at the National Hospital of the Faroe Islands

    PubMed Central

    Kristensen, Solvejg; Túgvustein, Naina; Zachariassen, Hjørdis; Sabroe, Svend; Bartels, Paul; Mainz, Jan

    2016-01-01

    Purpose The Faroe Islands are formally part of the Kingdom of Denmark, but the islands enjoy extensive autonomy as home ruled. In Denmark, extensive quality management initiatives have been implemented throughout hospitals, this was not the case in the Faroese Islands in 2013. The purpose of this study is to investigate the patient safety culture in the National Hospital of the Faroe Islands prior to implementation of quality management initiatives. Methods The Danish version of the Safety Attitudes Questionnaire (SAQ-DK) was distributed electronically to 557 staff members from five medical centers of the hospital, and one administrative unit. SAQ-DK has six cultural dimensions. The proportion of respondents with positive attitudes and mean scale scores were described, and comparison between medical specialties, and between clinical leaders and frontline staff was made using analysis of variance and chi-square test, respectively. Results The response rate was 65.8% (N=367). Job satisfaction was rated most favorable, and the perceived culture of the top management least favorable. Safety climate was the dimension with the greatest variability across the 28 units. The diagnostic center had the most favorable culture of all centers. More leaders than frontline staff had positive attitudes toward teamwork and safety climate, and working conditions, respectively. Also, the leaders perceived these dimensions more positive than the frontline staff, P<0.05. Among three management levels, the unit management was perceived most favorable and the top management least favorable. Conclusion The management group is recommended to raise awareness of their role in supporting a safe and caring environment for patients and staff, moreover the leaders should ensure that every day work achieves its objectives; keeping the patients safe. Furthermore, following the development in patient safety culture over time is recommended. PMID:27217800

  8. The evolution of epilepsy theory and practice at the National Hospital for the Relief and Cure of Epilepsy, Queen Square between 1860 and 1910.

    PubMed

    Shorvon, Simon

    2014-02-01

    In the years between 1860 and 1910, a revolution in epilepsy theory and practice occurred. The National Hospital for the Relief and Cure of the Paralysed and the Epileptic at Queen Square in London was at the center of this revolution. A series of remarkable physicians and surgeons were appointed to the staff. The four greatest were John Hughlings Jackson, Sir David Ferrier, Sir Victor Horsley, and Sir William Gowers. Their lasting contribution to epilepsy is discussed. Other physicians who made notable contributions to epilepsy were Jabez Spence Ramskill, Charles Eduard Brown-Séquard, Charles Bland Radcliffe, Sir John Russell Reynolds, Sir Edward Henry Sieveking, Walter Stacy Colman, and William Aldren Turner. At the hospital in this period, amongst the lasting contributions to epilepsy were the following: the development of a new conceptual basis of epilepsy, the development of a theory of the physiological structure of the nervous system in relation to epilepsy, the demonstration and investigation of cortical localization of epileptic activity, the establishment of the principle of focal epilepsy and the description of focal seizure types, the discovery of the first effective drug treatment for epilepsy (bromide therapy, indeed one of the first effective drug treatments in the whole of neurology), and the performance of the first surgical operation for epilepsy. This paper is based on the 2013 Gowers Memorial Lecture, delivered in May 2013.

  9. Role of National Accreditation Board of Hospitals and Healthcare Providers (NABH) core indicators monitoring in quality and safety of blood transfusion

    PubMed Central

    Gupta, Anshu; Gupta, Chhavi

    2016-01-01

    Context: Certain quality indicators are mandatory in the maintenance and improvement of quality in blood transfusion. Monitoring of such indicators should be done regularly and deficiencies are to be corrected for effective blood transfusion services. Aims: To study the usefulness of monitoring of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) core indicators in blood transfusion and in the maintenance of hemovigilance. Settings and Design: Hemovigilance is a quality process to improve quality and increase the safety of blood transfusion. It covers and surveys all activities of the blood transfusion chain from donors to recipients. Core indicators’ monitoring is a part of the hemovigilance process. Materials and Methods: A 2-year retrospective study was conducted in a blood storage unit of a NABH accredited tertiary care hospital of a metropolitan city. Four NABH core indicators in blood transfusion were observed and monitored by the clinical and blood storage unit staff of different levels. Results: It was observed that there was an improvement in quality by core indicators monitoring with decreased wastage of blood and blood components, decreased average turnaround time for issue of blood and blood components, and lesser number of transfusion reactions. Conclusion: This study demonstrated that monitoring of NABH core indicators results in the enhancement of quality and safety in blood transfusion services, reducing the incidence of transfusion reactions. PMID:27011668

  10. The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample.

    PubMed

    Boyd, Jennifer E; Katz, Emerald P; Link, Bruce G; Phelan, Jo C

    2010-11-01

    The stigma of mental illness has been shown to be affected by personal contact with mental illness and by a belief in the genetic heritability of mental illness. We use data from a nationally representative survey to test whether the relationship of stigma with contact remains after taking into account the effects of genetic beliefs and other background characteristics. Contact was defined as a history of psychiatric hospitalization among respondents themselves, their family members, or their friends. Respondents answered questions about a vignette character with a mental illness. We found that respondents with contact felt less anger and blame toward the character, thought that the character had a more serious problem, and would want less social distance from the character, including both casual and intimate aspects of social distance. Respondents with contact were not significantly different from the general population in the degree to which they expressed sympathy, thought the problem would last a lifetime, or wanted to restrict reproduction. Thus, contact is associated with having a less ostracizing, critical attitude toward a stranger with mental illness. The results underscore the importance of this experienced group as a resource in fighting stigma in society. Since many people who have had a psychiatric hospitalization have not told their friends or family members about it, this lower-stigma group could be enlarged.

  11. [Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Peru].

    PubMed

    Rivas-Nieto, Andrea C; Málaga, Germán; Ruiz-Grosso, Paulo; Huayanay-Espinoza, Carlos A; Curioso, Walter H

    2015-01-01

    This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them.

  12. [Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Peru].

    PubMed

    Rivas-Nieto, Andrea C; Málaga, Germán; Ruiz-Grosso, Paulo; Huayanay-Espinoza, Carlos A; Curioso, Walter H

    2015-01-01

    This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them. PMID:26338388

  13. Is Survival After Out-of-Hospital Cardiac Arrests Worse During Days of National Academic Meetings in Japan? A Population-Based Study

    PubMed Central

    Kitamura, Tetsuhisa; Kiyohara, Kosuke; Matsuyama, Tasuku; Hatakeyama, Toshihiro; Shimamoto, Tomonari; Izawa, Junichi; Nishiyama, Chika; Iwami, Taku

    2016-01-01

    Background Outcomes after out-of-hospital cardiac arrests (OHCAs) might be worse during academic meetings because many medical professionals attend them. Methods This nationwide population-based observation of all consecutively enrolled Japanese adult OHCA patients with resuscitation attempts from 2005 to 2012. The primary outcome was 1-month survival with a neurologically favorable outcome. Calendar days at three national meetings (Japanese Society of Intensive Care Medicine, Japanese Association for Acute Medicine, and Japanese Circulation Society) were obtained for each year during the study period, because medical professionals who belong to these academic societies play an important role in treating OHCA patients after hospital admission, and we identified two groups: the exposure group included OHCAs that occurred on meeting days, and the control group included OHCAs that occurred on the same days of the week 1 week before and after meetings. Multiple logistic regression analysis was used to adjust for confounding variables. Results A total of 20 143 OHCAs that occurred during meeting days and 38 860 OHCAs that occurred during non-meeting days were eligible for our analyses. The proportion of patients with favorable neurologic outcomes after whole arrests did not differ during meeting and non-meeting days (1.6% [324/20 143] vs 1.5% [596/38 855]; adjusted odds ratio 1.02; 95% confidence interval, 0.88–1.19). Regarding bystander-witnessed ventricular fibrillation arrests of cardiac origin, the proportion of patients with favorable neurologic outcomes also did not differ between the groups. Conclusions In this population, there were no significant differences in outcomes after OHCAs that occurred during national meetings of professional organizations related to OHCA care and those that occurred during non-meeting days. PMID:26639754

  14. Cholera in pregnant women: the 2012 epidemic at the reference center at the Donka National Hospital in Conakry.

    PubMed

    Sako, F B; Traoré, F A; Camara, M K; Sylla, M; Bangoura, E F; Baldé, O

    2016-05-01

    Cholera is an epidemic diarrheal disease transmitted through the digestive tract; it can cause obstetric complications in pregnant women. The objective of this study was to describe the epidemiological, clinical, and therapeutic aspects of cholera in pregnant women, as well as its course, during the 2012 epidemic in Conakry. This retrospective, descriptive studied examined the records of this epidemic over a 7-month period (from May 15 to December 15, 2012). Of 2,808 cholera patients at our hospital, 80 were pregnant, that is, 2.85%. Their mean age was 30 years [range: 15-45 years], 94% were from Conakry (94%), and 69% were in the third trimester of pregnancy. Choleriform diarrhea and vomiting were the main signs, found respectively in 100% and 95% of the women; dehydration was mild for 16%, moderate for 45%, and severe for 39%. Support consisted of rehydration, by plans A (16%), B (45%) or C (39%) and antibiotic treatment based on erythromycin (85%), doxycycline (14%), or azithromycin (1%). Other drugs that were used included phloroglucinol-trimethylphloroglucinol (Spasfon(®)) for 45%, acetaminophen for 65%, and iron/folic acid for 1% of cases. The major obstetric complications were 4 intrauterine deaths (5%), 2 cases of threatened abortion (2%), 1 preterm delivery (1%), and 1 maternal death. The cholera outbreak in 2012 affected a large number of pregnant women in Conakry, most during their third trimester. The classic clinical manifestations were associated with obstetric complications and maternal-fetal risks. PMID:27412979

  15. Implementation of the presence of companions during hospital admission for childbirth: data from the Birth in Brazil national survey.

    PubMed

    Diniz, Carmen Simone Grilo; d'Orsi, Eleonora; Domingues, Rosa Maria Soares Madeira; Torres, Jacqueline Alves; Dias, Marcos Augusto Bastos; Schneck, Camilla A; Lansky, Sônia; Teixeira, Neuma Zamariano Fanaia; Rance, Susanna; Sandall, Jane

    2014-08-01

    Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about women's rights to companionship. PMID:25167174

  16. Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications.

    PubMed

    Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna

    2016-11-01

    Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. PMID:27524097

  17. 76 FR 17422 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-29

    ... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...

  18. 77 FR 71195 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-29

    ... July 6, 2012 (77 FR 39953), FDA issued a proposed rule which, if made final, would make Shortwave... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION:...

  19. Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications.

    PubMed

    Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna

    2016-11-01

    Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications.

  20. Dentofacial orthopaedic correction of maxillary retrusion with the protraction facemask--a literature review.

    PubMed

    GekKiow, G; Kaan, S K

    1992-10-01

    The retruded maxilla in the Class III skeletal pattern could be effectively corrected with the protraction facemask in selected cases. A review of the different types of orthopaedic appliances used in Class III treatment, the rationale for facemask therapy, the effect of this treatment and the factors affecting stability is presented.

  1. Can the orthopaedic surgeon forget the proctoscope? The proctoscope as tissue protector during intra medullary nailing.

    PubMed

    Devadoss, V G; Howell, F R

    1999-06-01

    We report the value and usefulness of the proctoscope in one of the modern orthopaedic procedures. We have found the proctoscope more effective than the currently available instruments as tissue protector during intramedullary nailing. We briefly describe our technique of using the proctoscope and discuss its advantages.

  2. 75 FR 33995 - Safety Zone; Michigan Orthopaedic Society 50th Anniversary Fireworks, Lake Huron, Mackinac Island...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-16

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Michigan Orthopaedic Society 50th... Society 50th Anniversary Fireworks display, June 19, 2010. This temporary safety zone is necessary to..., alcohol use, and debris falling into the water presents a significant risk of serious injuries...

  3. Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.

    PubMed

    Tekin, Fatma; Findik, Ummu Yildiz

    2015-01-01

    Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients. PMID:26575511

  4. Does Change in Functional Performance Affect Quality of Life in Persons with Orthopaedic Impairment?

    ERIC Educational Resources Information Center

    Ostir, Glenn V.; Berges, Ivonne-Marie; Smith, Pamela M.; Smith, David; Rice, Janida L.; Ottenbacher, Kenneth J.

    2006-01-01

    Background and Purpose: Examine the association between change in functional status and quality of life for individuals with orthopaedic impairments approximately 90 days after discharge from in-patient medical rehabilitation. Methods: A retrospective study from 2001 to 2002 using information from the IT HealthTrack database. The study included…

  5. The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Psychomotor Skills, Part B.

    ERIC Educational Resources Information Center

    Olson, Carl J.; And Others

    This document, as a supplement to the final report of the Orthopaedic Training Study, presents a discussion of the rationale behind the implementation of a laboratory course in psychomotor skills development for medical students. Medical educators examined resident training in terms of 3 components of cognitive elements of learning: cognitive,…

  6. The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Part A.

    ERIC Educational Resources Information Center

    Olson, Carl J.; And Others

    This document, as a supplement to the final report of the Orthopaedic Training Study, contains the documents considered to be important in providing the background for the study. The materials are organized into four major areas: initial correspondence, instrumentation, special reports, and psychomotor skills. See also HE 003 275 and HE 003 276.…

  7. A Physiotherapy Triage Service for Orthopaedic Surgery: An Effective Strategy for Reducing Wait Times

    PubMed Central

    McCormack, Robert G.; Hunt, Michael A.; Brooks-Hill, Alexandra

    2013-01-01

    ABSTRACT Purpose: To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians. Methods: A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (κw) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals. Results: The analysis found substantial agreement (κw=0.77; 95% CI, 0.60–0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being “satisfied” or “very satisfied” with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician. Conclusion: More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists. PMID:24396164

  8. Telling: An Orthopaedic Resident’s Review of a New Book about Physician-Patient Communication

    PubMed Central

    Potter, Michael Q.

    2012-01-01

    Former Iowa Orthopaedics residency graduate Kevin b. Jones has written a book about the challenges of uncertainty in medicine and their impact on every individual’s interaction with the healthcare system. In What Doctors Cannot Tell You, Jones seeks to open a new conversation between physicians and patients about the unknowns in delivering medical care.

  9. Implications of humanitarian orthopaedic surgery in a combat zone: Operation Enduring Freedom and Iraqi Freedom experience.

    PubMed

    Robins, R Judd; Porta, C Rees; Eastridge, Brian J; Holcomb, John B; Martin, Matthew J

    2014-01-01

    The primary mission of deployed military orthopaedic surgeons in a combat zone is to treat musculoskeletal battlefield trauma and associated wartime injuries. The role of humanitarian surgical care during combat operations has not been defined. An anonymous online survey was sent to databases containing all U.S. military active-duty orthopaedic surgeons as well as to members of the Society of Military Orthopaedic Surgeons. Inclusion criteria for the study were defined as at least one deployment to Iraq (Operation Iraqi Freedom, OIF) or Afghanistan (Operation Enduring Freedom, OEF). Three hundred fifty-six invitations were sent with 107 orthopaedic surgeons completing the survey. Respondents reported approximately 3,000 humanitarian surgeries performed in the combat zone, with 70% to 80% involving chronic deformity and nonunion surgeries. Seventy-nine percent of the respondents believed that humanitarian surgery was a key component of the mission, improved skills (73%), benefited population (76%), and improved security (61%). A significant amount of humanitarian surgery in the combat zone has been performed in OEF/OIF. PMID:25153810

  10. Decellularized Tissue and Cell-Derived Extracellular Matrices as Scaffolds for Orthopaedic Tissue Engineering

    PubMed Central

    Cheng, Christina W.; Solorio, Loran D.; Alsberg, Eben

    2014-01-01

    The reconstruction of musculoskeletal defects is a constant challenge for orthopaedic surgeons. Musculoskeletal injuries such as fractures, chondral lesions, infections and tumor debulking can often lead to large tissue voids requiring reconstruction with tissue grafts. Autografts are currently the gold standard in orthopaedic tissue reconstruction; however, there is a limit to the amount of tissue that can be harvested before compromising the donor site. Tissue engineering strategies using allogeneic or xenogeneic decellularized bone, cartilage, skeletal muscle, tendon and ligament have emerged as promising potential alternative treatment. The extracellular matrix provides a natural scaffold for cell attachment, proliferation and differentiation. Decellularization of in vitro cell-derived matrices can also enable the generation of autologous constructs from tissue specific cells or progenitor cells. Although decellularized bone tissue is widely used clinically in orthopaedic applications, the exciting potential of decellularized cartilage, skeletal muscle, tendon and ligament cell-derived matrices has only recently begun to be explored for ultimate translation to the orthopaedic clinic. PMID:24417915

  11. Hallmarks in the history of orthopaedic implants for trauma and joint replacement.

    PubMed

    Markatos, Konstantinos; Tsoucalas, Gregory; Sgantzos, Markos

    2016-08-01

    This manuscript represents an attempt to review orthopaedic implants and reconstructive orthopaedic surgery for lower limbs lesions or trauma mainly in the 20th century. We emphasized on the type of implants, the biomaterials and their evolution, and we also engaged in a special reference for the pioneers of orthopaedic implant surgery and the innovative designers of those implants, in such a way to understand the ways and the stages through which they evolved to their present forms, as well as the scientific principles that affected their design and progress. A correlation between the evolution of implants and several relevant disciplines (biomaterial chemists and engineers, biomechanics) that developed simultaneously with orthopaedic reconstructive joint surgery is present since the first attempts to reconstruct a damaged joint. In the future, further progress is anticipated in the use of biomaterials, more compatible towards human biology, with minimally invasive applications and a perpetually increased life span. This progress depicts a phenomenon directly related to a multilevel, multifactorial and interdisciplinary scientific and technological field with many expectations. PMID:27598960

  12. Assessment of an electronic mailing list for orthopaedic and trauma surgery.

    PubMed

    McLauchlan, G J; Cadogan, M; Oliver, C W

    1999-02-01

    Medical electronic mailing lists have grown rapidly with the evolution of the Internet. The purpose of this paper was to assess the content and academic quality and of an electronic mail discussion list "Orthopod" dedicated to research in orthopaedic and trauma surgery. A retrospective analysis was undertaken of four months of web-based archive of communication through the Orthopod mailing list http:(/)/www.mailbase.ac.uk/lists/Orthopod. At the end of this study period there were 505 members of the Orthopod list. The main outcome measures of this paper were number of messages, type of messages, number of contributors, designation of contributor and number of topics referenced. On average 276 messages were posted each month. The mean number of messages per contributor per month only varied between 2.3 and 2.5. On average 54% of message threads contained at least one reference. At least 77% of the patient history and general threads had input from senior orthopaedic staff. The quantity of information on the Internet need not be a substitute for quality in orthopaedic and trauma surgery mailing lists. The Orthopod Electronic mail discussion list is another medium for the circulation of good quality surgical information. Orthopod provides a unique international electronic forum list for trauma and orthopaedic surgeons worldwide.

  13. 75 FR 36660 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...

  14. A standardized treatment regimen for patients with severe haemophilia A undergoing orthopaedic or trauma surgery: a single centre experience.

    PubMed

    Hart, Christina; Heindl, Bernhard; Spannagl, Michael; Lison, Susanne

    2015-06-01

    Recommendations on the administration of clotting factor concentrates in patients with severe haemophilia undergoing surgery are usually determined by monitoring target clotting factor levels. In this retrospective cohort study, we enrolled patients with severe haemophilia A who underwent major orthopaedic or trauma surgery. We wanted to evaluate the feasibility and the safety of a standardized medical treatment procedure. Further on, we wanted to assess whether our standardized treatment regimen enables surgical procedures in certain situations in which measuring clotting factor VIII (FVIII) activity is not available. We created a standardized medical treatment procedure that included a medical protocol and close cooperation with the Haemophilic Treatment Centre. Thirteen surgical procedures in nine patients were examined. The feasibility and safety of this standardized treatment concept were assessed by identifying perioperative complications and by means of a questionnaire. Depending on the surgery, the amount of FVIII administered within the first 10 days ranged between 653 and 1027 units/kg body weight. No allogeneic blood transfusion was required. The measurement of FVIII activity was performed repeatedly in five patients. In all patients activated partial thromboplastin time monitoring was performed during the hospital stays. The surgeons and patients were satisfied with our treatment concept and adhered to the medical regimen protocol. By means of a detailed, standardized medical protocol and by ensuring close cooperation between the patient, the surgeons and the Haemophilic Treatment Centre, we could show that elective and emergency operations can be safely performed even in situations in which FVIII activity could not be monitored.

  15. Adherent Lipopolysaccharide Inhibits the Osseointegration of Orthopaedic Implants by Impairing Osteoblast Differentiation

    PubMed Central

    Bonsignore, Lindsay A.; Anderson, J. Robert; Lee, Zhenghong; Goldberg, Victor M.; Greenfield, Edward M.

    2012-01-01

    Osseointegration is the process by which an orthopaedic implant makes direct bone-to-implant contact and is crucial for the long-term function of the implant. Surface contaminants, such as bacterial debris and manufacturing residues, may remain on orthopaedic implants after sterilization and impair osseointegration. For example, specific lots of implants that were associated with impaired osseointegration and high failure rates were discovered to have contaminants including bacterial debris. Therefore, the goals of this study were to determine if bacterial debris exists on sterile orthopaedic implants and if adherent bacterial debris inhibits the osseointegration of orthopaedic implants. We found that debris containing lipopolysaccharide (LPS) from Gram-negative bacteria exists on both sterile craniofacial implants and wrist implants. Levels of bacterial debris vary not only between different lots of implants but within an individual lot. Using our murine model of osseointegration, we found that ultrapure LPS adherent to the implants inhibited bone-to-implant contact and biomechanical pullout measures. Analysis of osseointegration in knock-out mice demonstrated that adherent LPS inhibited osseointegration by signaling through its primary receptor, Toll-like receptor 4, and not by signaling through Toll-like receptor 2. Ultrapure LPS adherent to titanium alloy discs had no detectable effect on early stages of MC3T3-E1 osteogenesis in vitro such as attachment, spreading or growth. However, later stages of osteogenic differentiation and mineralization were inhibited by adherent LPS. Thus, LPS may inhibit osseointegration in part through cell autonomous effects on osteoblasts. These results highlight bacterial debris as a type of surface contaminant that can impair the osseointegration of orthopaedic implants. PMID:22995462

  16. Self-reported use of internet by cervical cancer clients in two National Referral Hospitals in Kenya

    PubMed Central

    2012-01-01

    Background Cervical cancer remains a devastating disease in Kenya accounting for more than 2000 deaths each year. Lack of information on cervical cancer prevention and management has been attributed to the apathy among women in seeking health interventions. Use of internet-based and mobile e-health tools could increase information access among cervical cancer patients. The objective of the study was; to establish the extent of use of mobile phones and internet by cervical cancer patients in accessing information related to cancer treatment and management.; find out the characteristics of patients associated with internet use and identify barriers faced by the patients in internet use. A cross sectional descriptive survey of 199 cervical patients visiting the two main referral hospitals in Kenya was done. A structured questionnaire was used to collect data. Findings The average length of illness was 2.43 years (SD ± 3.0). Only 7.5 %( n=15) reported to having used the internet as a source of information. 92.5 %( n=184) did not use internet. With Multiple options, 70.9% did not know how to use a computer, 29.2% did not have access to a computer, 14.6% lacked the money to use computers at the local cyber cafe while other barriers identified accounted for 11.1%. Patients reported that the internet had an important role in the management of cancer of the cervix in health education (17.6%), online consultation (14.6%), booking of patients (13.6%), referrals (8.5%) and collecting data (7%). The 96.5% of the respondents who had access to a mobile phone, recommended mobile phones for health education messages (31.7%), reminder alerts for medication (29.7%) and booking appointments (21.6%). There was a statistically significant association between income of the patients and internet use (p = 0.026) in this study. Conclusions There is low level use of the internet by cervical cancer clients attended in Public referral facilities in Kenya. This was attributed to; lack of

  17. The state of UK pediatric anesthesia: a survey of National Health Service activity.

    PubMed

    Sury, Michael R J; Arumainathan, Renuka; Belhaj, Alla M; MacG Palmer, James H; Cook, Tim M; Pandit, Jaideep J

    2015-11-01

    This secondary analysis of the 2013 United Kingdom National Health Service (NHS) Anaesthesia Activity Survey of the Fifth National Audit Project (of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland) shows pediatric anesthesia activity in detail. A local coordinator (LC) in every NHS hospital collected data on patients undergoing any procedure managed by an anesthetist. Questionnaires had 30 question categories. Each LC was randomized to a 2-day period. The pediatric age groups were infants, (<1 year), preschool age (1-5 year), and school age children (6-15 year). The median questionnaire return rate was 98%. The annual caseload was estimated to be 486 900 children: 36 500 infants, 184 700 preschool age, and 265 800 school age children. Almost 90% of children (1-15 year) were ASA 1 or 2 and the substantial majority underwent routine nonurgent ear nose and throat, dental, orthopaedics, or general surgery procedures; 65% were 'day cases'. One in six children were managed outside operating theater sites compared with one in 12 adults. Forty one per cent was in district general hospitals. Almost all ASA 4 and 5 children (89%) and infants (92%) were managed in specialist hospitals. 'Awake' cases and sedation accounted for only 2% of cases. There were notable differences in demography and anesthetic care compared with adults and between different age groups of children. These data enable analysis of the current state of UK pediatric anesthetic practice and highlight dif