Medical services during the 24th summer universiade.

Background: International sports competitions are one of the mass gathering events which require a well-planned medical care system for large numbers of participants. The Universiade, the World University Games, is organized for university athletes every two years. Methods: The medical service organization was presented and the medical care for injuries and illnesses provided during the 24th Summer Universiade were described. Results: During 1 to 23 August 2007, a total of 5,641 patients aged 12-89 years (including 1,700 athletes) received medical care. There were 2,535 cases (44.9%) using the Athletes’ Village Polyclinic, 2,755 cases (48.8%) using the on-site medical units, and 351 cases (6.2%) using Thammasat Hospital. For the patients presented at the Athletes’ Village Polyclinic, muscle strain was the most common injury (n=287, 34.1%), and musculoskeletal system problems were the most common illnesses (n= 484, 27.33%). Nineteen patients required hospital admission at Thammasat Hospital. Conclusion: This information might be useful for planning medical services in international multi-sport competitions in the future.

Validity and reliability of Thai version of the International Knee Documentation Committee Subjective Knee Form.

BACKGROUND: Self-administered questionnaires have become an important aspect for clinical outcome assessment of knee-related surgery. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a knee-specific questionnaire that is widely used and translated to many languages. The purposes of the present study were: (1) to translate the questionnaire into Thai; and (2) to assess the validity and reliability of the Thai version of the International Knee Documentation Committee (IKDC) Subjective Knee Form. MATERIAL AND METHOD: The IKDC Subjective Knee Form was translated into Thai using forward-backward translation protocol. Afterward, reliability and validity were tested The responses of 55 consecutive patients on two questionnaires, the Thai IKDC Subjective Knee Form and the Short Form-36, were used. The validity was tested by correlating the scores from both questionnaires. The reliability was adopted by measuring the test-retest reliability and internal consistency. RESULTS: The Thai IKDC Subjective Knee Form showed good correlations with the physical functioning and bodily pain domains of the SF-36 (Pearson's correlation coefficient = 0.75 and 0.76 respectively). The reliability proved excellent with an intra-class correlation coefficient of 0.92 for test-retest. The internal consistency was strong (Cronbach alpha = 0.92). CONCLUSION: The Thai version of IKDC Subjective Knee Form showed good value to retain the characteristic of the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.

The cost analysis using the clinical practice guideline and cost minimization analysis in orthopaedic inpatients under universal coverage policy admitted to Siriraj Hospital.

Objective: The hospital revenues are decreasing from the government policy in the universal coverage while increasing the hospital expenses . The cost analysis is a very important tool for the strategic plan in the hospital expenses reduction with standard quality. This study wanted to investigate the cost of 12 orthopaedic diseases using the clinical practice guideline (CPG) at maximum length of stay (LOS) and to compare the cost before and after utilization management in cost minimization analysis in orthopaedic inpatients under the universal coverage policy. Methods: Part 1, The CPG with maximum LOS was studied in detail and the cost analysis was performed using the formula C = S+I+X+P+O+L+A+R while C = unit service cost/case, S = service cost, I = instrument cost, X= X-ray cost, P = prosthetic cost, O = operating cost, L = laboratory cost, A = anesthetic cost, R = recovery room cost. Part 2, the cost minimization analysis (CMA) before and after utilization management was studied in 2 groups. Group A consisted of 236 cases which were studied after utilization management from June 1, 2003 to February 24, 2005. Group B consisted of 89 cases from June 1, 2002 to May 31, 2003 which were studied before utilization management was introduced in the department. The cost of both groups were compared. Results: The cost of the 12 orthopaedic diseases ranged from 13,036.10 baht/case for 3 days LOS in club foot surgery to 99,532.73 baht/case for 21 days LOS in total hip replacement surgery. The reduction of 1 day LOS reduces the service cost by an average 1,844.26 baht. The CMA found that after utilization management in group A, the CMA in the average cost reduction was 3,274.45 baht/case with an average 2.07 days reduction in length of stay. Both groups had the same outcomes. Conclusion: The cost analysis was done in 12 orthopaedic diseases using CPG. The usefulness with cost reduction was found after implementation of utilization management.

Difference in isokinetic strength of the muscles around dominant and nondominant shoulders.

BACKGROUND: Muscle training usually plays an important role in the treatment of shoulder disorders. Clinicians traditionally predict the pre-injury strength of an injured shoulder by using the contralateral uninjured side as the baseline data. OBJECTIVE: The primary purpose of the present study was to determine the difference in isokinetic peak torque of dominant and nondominant shoulders. MATERIAL AND METHOD: Both shoulders of 39 healthy subjects (24 men, 15 women) were tested isokinetically by using the CON-TREX MJ dynamometer at two angular velocities (60 and 180 degrees/sec) during abduction, adduction, flexion, extension, internal rotation and external rotation. RESULT: There were statistical differences of contralateral peak torque in almost all directions of shoulder muscle contractions except in shoulder flexion at both speeds. Peak torque of shoulder adduction, extension, and internal rotation were greater in the dominant side. Shoulder abduction and external rotation peak torque were greater in the nondominant side. CONCLUSION: Therefore, clinicians should not directly use the isokinetic strength of the contralateral shoulder as normal baseline data for an injured side without consideration.

Medical utilization review by indicators “ORTHOPAEDICS” in orthopaedic inpatients under universal coverage policy admitted to Siriraj Hospital.

Objective: Utilization review is very important especially in universal coverage policy. In Siriraj Hospital the utilization review began in 2002, and the Department of Orthopaedic Surgery developed the indicators “ORTHOPAEDICS” to assess the appropriateness of medical utilization. This study is designed to study the effectiveness of medical utilization review by using indicators “ORTHOPAEDICS” in orthopaedics, public inpatients under universal coverage policy in terms of expenses, the appropriateness, length of hospital stay and the satisfaction of the patients. Methods: 301 orthopaedic inpatients were divided in 2 groups: Group A included 149 patients, 100 men and 49 women. Their average age was 32.7 years old. From June 1, 2003 – May 31, 2004, each patient was prospectively reviewed regarding their daily utilization in terms of expenses, appropriateness of medical utilization by using indicators “ORTHOPAEDICS”. Their length of hospitalization was measured, as well as and their satisfaction evaluated. Group B was the control which included 152 patients, 98 men and 54 women. Their average age was 34.8 years old. No intervention was performed and the data was collected only in expenses and the length of hospital stay for each patient retrospectively from June 1, 2002– May 31, 2003. The expenses and the length of hospital stay of both groups were compared and analyzed. The appropriateness in Group A was studied by using indicators “ORTHOPAEDICS” which were: O = Operation; R = Relative weight rate; T = Type of treatment; H = Hospital stay; O = Occurrence of complication; P = procedures; A = admission; E = expenses; D = drugs; I = Investigation; C = Care map according to CPG of 12 diseases; S = Satisfactions score from 0-10 minimum to maximum, by asking the patients about the satisfaction in term of results of treatment. Results: The total expenses per patient in group A was 24,566.74 baht but in group B was 30,484.53 baht. The expense in group A was 5,917.79 baht reduction which was statistically significant difference (P<0.05). The average length of hospital stay in group A was 8.24 days, whereas in group B was 10.93 days. It reduced 2.69 days after utilization review was implemented. The appropriateness of utilization was found in the procedures, drugs and investigation without inappropriateness (0%). The inappropriateness in admission was 26.9% because the physician forgot to take blood examination and laboratory investigation before admission and it was done in the ward without any effect the treatment. And the average satisfaction score in group A was 9.6. Conclusion: “ORTHOPAEDICS” was useful and helpful indicator to significantly reduce the expense per patient and the length of hospitalization without reducing patient satisfaction and quality of treatment.

A study of footprints in athletes and non-athletic people.

Footprint analysis is a simple, cost-effective and readily available method for evaluation of flat feet, to identify a person in forensic content and for shoe manufacturing. OBJECTIVE: To examine the footprints in athletes and non-athletes and to compare their foot print measurements. MATERIAL AND METHOD: Four hundred and ninety-two athletes and four hundred and thirty-one non-athletes were recruited. Their age range was eighteen to thirty five years. The athletes were classified by sport level : national and non-national athletes. Footprint devices, foot impression system, produced by Berkemann Company was used. The right and left foot of each subject were measured separately in a standing position. Descriptive Statistics, ANOVA, chi-square test and simple correlation were used in this study. RESULT: The length between the heel to the first toe was shorter than that of to the second toe in national athletes. This finding was opposite to the non-athletes. The metatarsal distance in national atheletes were significantly wider than the others. The ratio of the length of footprint and body height showed significant difference between athletes and non-athletes. The Flat Index of national athletes was longer than the others. In males, the percentage of the state of contacting the ground of the fifth toe was significantly higher among athletes than non-athletes. CONCLUSION: The footprint parameters were somewhat different between persons who had experience in sport level and general non-athletic people.

Physical fitness and physical activities profiles of second-year medical student: Faculty of medicine Siriraj Hospital, Mahidol University.

To study the level of physical fitness and the physical activities of second-year medical students. There were obtained during the first semester of school year 2000. The subjects in this study were the 227 students from the second-year classes; 120 male and 107 female students. Fitness testing was performed by staff members of the Sports Medicine Unit. The test procedures took approximately 20-30 minutes for each student. A questionnaire concerning of their health, current disease, exercise habits and vital signs was administered at the beginning of the test. The physical fitness-related variables were 1) maximal oxygen consumption; Vo2max (Astrand-Ryhming test protocol) 2) strength and muscular endurance assessment to measure static strength of grip squeezing muscles and leg and back muscles (using isometric dynamometers) 3) flexibility assessment (traditional Sit-and-Reach test protocol) 4) lung function measurement: forced vital capacity (FVC). This study showed that only 8.8% of medical students performed regular exercise. Academic work load and little spare time were substantial obstacles to exercise. Neither males nor females exhibited high levels of cardiorespiratory fitness, however, the females in the study showed relatively higher levels than male counterparts; Vo2max 37.25 ฑ 6.06 ml/kg/min, strength of grip squeezing muscles 0.45 ฑ 0.07 kg/body weight, leg muscle strength 1.57 ฑ 0.41 kg/body weight, flexibility 4.34 ฑ 9.04 c.m. and force vital capacity (FVC) 53.13 ฑ 9.01 ml/ body weight for female and Vo2max 35.74 ฑ 6.58 ml/kg/min, strength of grip squeezing muscles 0.64 ฑ 0.11 kg/body weight, leg muscles strength 2.35 ฑ 0.55 kg/body weight, flexibility 5.70 ฑ 8.41 c.m. and force vital capacity (FVC) 66.99 ฑ 9.72 ml/body weight for male. Both groups (male and female) showed excellent levels of FVC compared with normative Thais standards. However, other fitness-related variables achieved considerably below average values for Thai people of the same age. The finding of relatively low levels of physical fitness among medical students, except for forced vital capacity (FVC), seem to be a reflection of lack of regular physical exercise.

Meniscal injuries and related sports.

The studies in sports-related meniscal injuries depend on the popularity of specific sports. 276 meniscectomies from 405 arthroscopic and arthrotomied knee injuries perfourmed in Siriraj Hospital, Bangkok, from 1985 to 1990 were studies. Sports-related meniscal injuries were tabulated and compared with all other causes. The results indicated that 76% were sport-related injuries, 58.6% were medial meniscal tears while 57.1% involved right knees. Football had a 60.9% predominance of medial meniscectomy, athletics 55.6%, volleyball 42.9%, badminton 33.3% and sepak takraw 60%. Our data indicated that there were no difference in the medial versus lateral meniscal injuries associated with sports activities but there is a difference in position in athletics versus individual sports and all sports taken together. The ratio of torn menisci (peripheral : body = 2:1) and the ratio of body types (longitudinal or bucket handle : transverse or oblique = 4.6:1) in all sports taken together were significantly different compared to non-athletes.

Badminton injuries.

In a five-year period, 6,046 patients with sports-related injuries were treated at the sports Science Centre, Sports Authority of Thailand and Siriraj Hospital, Mahidol University. Six hundred and seventy-three injuries, which were incurred as a result of playing badminton, were recorded among 441 males and 232 females, constituting 11.1 percent of the patients, with injured athletes seen at the Sports Science Centre. Joints and ligaments were injured in 39.8 percent of the patients, with the most frequent location being the lower limbs (46.1%), often the kness (22.8%). Muscle injuries occurred in 27.8 percent of the patients, frequently location in the back region (48.6%). Most injuries were minor, such as inflammation (37.6%), strain (26.4%) and sprain (25.7%) ; however, the most common badminton injuries in respect to diagnosis was lower back strain (21.1%). This clinical research work could provide guidelines for the prevention of and protection against possible injuries. Attempts should be made to plan training individually and to institute prophylactic measures.