Assessment of internet use and effects among healthcare professionals: a cross sectional survey.

PURPOSE: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice. METHODS: Cross sectional survey conducted in the USA using questionnaires distributed randomly to healthcare professionals attending distinct continuing medical education programmes between 2003 and 2004. Multiple choice and yes/no questions related to the trends of internet use and its effects on clinical practice were extracted and responses analysed. The main outcome measures are self reported rates of internet use, perceived effects, and the role of medical web sites in clinical practice. RESULTS: The overall response rate was 60%. A total of 277 survey respondents (97%) had internet access. Some 7% in private practice and 1% of group practice physicians did not have internet access. Most (71%) used the internet regularly for medical or professional updating and 62% (n = 178) felt the need for sharing web sites designed for healthcare professionals with patients. Some 27% of the physicians currently own established personal practice web sites. Sixty three per cent have recommended a web site to a patient for more information, matching the positive trust (>70%) on the general quality of selected medical web sites. CONCLUSION: This cross sectional survey shows that internet use and web based medical information is widely popular among physicians and patients. About 23%-31% of the healthcare professionals report >80% interaction with web informed patients in their daily practice.

Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention.

Musculoskeletal pain is common, frequently under-reported, and inadequately treated in the older adult. The objective of this article is to review the management of musculoskeletal pain syndromes in older adults emphasising the potential role of opioid agents in carefully selected patients. Systematic analysis of the relevant literature was done. Even in cognitively impaired patients, assessment of musculoskeletal pain is mandatory. An algorithm for musculoskeletal pain is presented emphasising a stepwise pharmacological approach in combination with an array of non-pharmacological therapies. Comorbid conditions may limit therapeutic choices, particularly in the elderly. Repeated assessment of pain levels as well as functional status is critical for optimal pain management.

Evaluation of cold therapy in postoperative spine patients.

The use of cold therapy postoperatively in orthopaedics has been the topic of a long-standing discussion. How cold is applied, (i.e., ice vs. machine), the length of time of cold exposure, and frequency of appli- cation has been the subject of debate for years, and there is still no clear-cut answer or standard which isuniformly followed. The use of cold has been shown by both Cohn 1 and McCoy2to decrease the need for pain medication postoperatively. Masten3 used cold therapy in the laboratory to demonstrate that post-traumatic swelling was controlled with cold applications. McMaster and Liddle' showed a relationship with decreased edema and early application of ice.We attempted to look at the application of cold therapy in postoperative spine patients to see if there was significant benefit to our patients. In our study patients were randomly cho- sen to receive cold therapy postoperatively. Patient groups were normalized as to sex, age, and surgery. Both groups were homogenous when looked at overall. The Hot/Ice System™ (Incare Medical Products, Hollister Inc., Hollister, Calif.] was chosen as the method of cold delivery for three reasons: (1) ease of use, (2) limited need for nursing intervention, and (3) delivery of consistent cold temperatures (Fig. 1).

Seven-year follow-up of vertebral excision and reconstruction for malignant hemangioendothelioma of bone.

STUDY DESIGN: This study reports the 7-year follow-up of an L5 vertebral hemangioendothelioma treated with tumor excision and allograft reconstruction stabilized with transpedicular fixation. OBJECTIVES: A review of vertebral hemangioendotheliomas is provided to outline the rationale for surgical excision in such cases. SUMMARY OF BACKGROUND DATA: Radiation therapy has been the mainstay of therapy in surgically inaccessible lesions of the spine. The long-term follow-up of radical spinal tumor excision and reconstruction in previously surgically inaccessible areas has not been reported for vertebral hemangioendothelioma. METHODS: After embolizations, anterior L5 corpectomy and allograft femoral reconstruction was performed. Second-stage (same day) posterior element excision was followed by VSP stabilization of L4-S1 with artificial pedicles anchored into the femoral allograft at L5. Radiation therapy followed. RESULTS: Satisfactory long-term (7-year) segmental reconstruction using allograft and VSP was realized, even in the face of postoperative radiation therapy. CONCLUSION: Contemporary spinal reconstructive techniques have been developed that continue to limit the number of surgically inaccessible tumors in the spine. The present report shows these techniques to be durable and apparently effective in vertebral hemangioendothelioma.

Posterior transvertebral osteotomy for adult thoracolumbar kyphosis.

STUDY DESIGN: A retrospective case study was performed on the single-stage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. SUMMARY OF BACKGROUND DATA: Forty-one consecutive cases in 38 patients available for follow-up, averaging 33 months (range 4-87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had postlaminectomy failed back syndromes with kyphosis. A preoperative neurologic deficit was present in 34% of the cases including two with cauda equina syndrome. METHODS: Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. RESULTS: All cases had solid union at follow-up; 93% maintained correction averaging 35 degrees with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neurologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively; 26 additional surgeries were performed on 18 patients most commonly for pain (x 11) and additional trauma (x 4). The subjective questionnaire results indicated significant patient satisfaction, with 76% stating they would repeat the surgery and 90% recommending it to another. CONCLUSION: This technically demanding high-risk procedure provides an effective and mechanically superior correction for acute angle thoracolumbar kyphosis in selected adult patients, with high subjective satisfaction.

Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases.

Records of 41 patients were reviewed for early complications resulting from reduction of high-grade spondylolisthesis. Blood loss averaged 1,427 ml. There were no cases of infection, dural tears, or bladder or bowel dysfunction. Two cases of transient foot drop and one case of permanent foot drop developed. A lumbar plexus stretch palsy occurred in one patient. Long-term results were evaluated in 20 patients followed up 2 or more years after surgery. Three of the 20 did not have interbody fusions and lost their reductions. All 20 patients went on to fuse with no pseudoarthrosis. One case of broken plate and two cases of broken screws occurred. Patient satisfaction ranged from good to excellent. Results suggest that reduction of high-grade slips with interbody fusion is a safe and effective procedure.

Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine.

A new segmental spine plate fixation system, utilizing a posterior approach and screw fixation, has been developed for disorders of the lower thoracic or lumbar spine. The indications are significant instability and severe pain relieved by immobilization. This new system uses multiple segmental fixation points through the pedicle "force nucleus" of the vertebral body. The spine plates can be contoured for anatomic positioning, reduction, and rigid stabilization to enhance graft consolidation and fusion. The surgical fixation technique is demonstrated in five case presentations illustrating the application and versatility of the method.