Care for children with special health care needs in a managed care system: a patient satisfaction survey

In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

Seroprevalence of blood borne transmissible diseases in trauma orthopaedic surgical patients

OBJECTIVE: The purpose of this study is to determine the seroprevalence of blood borne transmissible diseases of the orthopaedic trauma surgical patients who deny or did not have knowledge of having disease or risk factors, but are positive for either human immunodeficiency virus, hepatitis B virus, and hepatitis C virus. BACKGROUND: Orthopaedic surgeons practicing in areas with a high prevalence of HIV infection may expect that up to 7 per cent of their patients who undergo emergency procedures and 1 per cent to 3per cent of those who undergo elective surgery will be HIV-positive. METHOD: All conscious adult patients consecutively admitted for surgical management by the orthopaedic service were evaluated. A detailed questionnaire was completed asking the patient of knowledge of having a transmissible disease and documenting certain risk factors. Blood samples were taken to test for HIV, HBV and HCV and all positive patients were sent to a follow up clinic. RESULTS: Out of 100 patients the following results were found: 7 per cent were positive for HIV, 12 per cent positive for HBV, 12 per cent positive for HCV, 19 per cent were positive to at least one test, and 9 per centwere positive in more than one test. Of the one hundred patients, 6 per cent had a positive test in spite of denying having a disease or any risk factors. None of the patients with HBV and/or HCV knew they were positive and three (43 per cent) of the seven with HIV were also unaware of their condition. CONCLUSIONS: This study suggests that a worrisome number of patients are seropositive for a blood borne transmissible disease, even though they had no knowledge of such disease and claimed they had no risk factors. In order to protect orthopaedic surgeons from the unreliability of some patients' histories, all trauma orthopaedic surgical patients should be managed with universal precautions.

Puerto Rico orthopaedic manpower study

Data regarding orthopaedic work-force is presented. Data is based on information obtained from the Puerto Rico Board of Medical Examiners, the Puerto Rico Department of Health and orthopaedic surgeon's pctice. The purpose of this study is to compare the local orthopaedic manpower with the American Academy of Orthopaedic Surgeons most recent national manpower survey and to provide a database of the local orthopaedic work-force.

The use of intraoperative autotransfusion as a second stage of autologous blood use in pediatric orthopaedic surgery

The purpose of this study is to evaluate the use of Intraoperative Autotransfusion (IAT) as a second stage in the use of autologous blood to reduce the need of allogeneic transfusions. We reviewed the medical records of 41 pediatric patients who underwent spinal fusion procedures from September 1991, to August 1993. Our experience with IAT started in August 1992. The group of patients was divided into those who only received preoperative donation autologous blood (53.6 percent) and those who received preoperative donation autologous blood and IAT(46.4 percent). The use of preoperative autologous blood donation in combination with IAT has proven to be a safe method of operative blood loss replacement in pediatric age patients. Exclusive use of autologous blood can reduce or eliminate transfusion reactions and exposure to transfusion transmitted agents and helps to increase the blood reserve at blood banks

The use of autologous blood transfusions in pediatric orthopaedic surgery

En este estudio se revisó los expedientes médicos de 29 pacientes que fueron sometidos a procedimientos de fusión espinal con el propósito de evaluar la efectividad de usar sangre antóloga e depositada previo a la cirugía para reemplazar la pérdida de sangrre operatoria. La edad de los pacientes fluctuó entre 8 y 25 años. Una vez se determinó la fecha de la cirugía, cada paciente comenzó en un suplemento de hierro oral. Las flebotomias fueron efectuadas por los Servicios de Sangre de la Cruz Roja Americana, Capítulo de Puerto Rico. La sangre fue removida 1 unidad cada 6 días si el hematocrito se mantuvo por encima de 34%. La última flebotomía fue efectuada por lo menos 7 días antes de la fecha establecida para la cirugía. La cantidad promedio de sangre donada fue 3.17 unidades (1,427 ml). La sangre fue almacenada utilizando la solución de adenina y salina como preservativo por un período no mayor de 35 días. El valor promedio de hematocrito preoperatorio fue 35%. En 89% de los casos estudiados, los pacientes fueron transfundidos utilizando sangre autóloga solamente. En el resto de los casos se requirió utilizar sangre homóloga donada por los familiares. El uso de sangre autóloga depositada de antemano para reemplazar la pérdida sanguínea intraoperatoria ha demostrado ser un método seguro, sencillo y bien aceptado para los pacientes de edad pediátrica. Esta técnica también reduce la demanda por sangre homóloga ayudando a mantener una reserva adecuada en los bancos de sangre

Anterior cervical osteophytes causing dysplagia

A review of the literature and four additional cases of surgical excision of anterior cervical osteophytes causing dysphagia is presented. Surgical excision of the osteiphytes is recommended only after a complete evalution to rule out other causes of dysphagia and after an adequate period of conservative therapy. The patients must be adivised that frequently symptoms will recur to some extent as time progresses. In patients who have findings consistent with diffuse idiopathic skeletal hyperostosis (DISH Syndrome) recurrence of the osteophyte appears to be more common