Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members.

PURPOSE: The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS). METHODS: A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed. RESULTS: A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS -members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible. CONCLUSION: There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.

Assessing the HIV prevention capacity building needs of community-based organizations.

Community-based organizations (CBOs) have been providing HIV prevention services to priority populations for many years. Recent research suggests that CBOs could benefit from capacity building to strengthen their public health prevention knowledge and skills, including ability to access and use behavioral science to guide prevention efforts. A cross-sectional survey of 316 CBOs was conducted to assess desire and preferences for training, support for training at the organizational level, motivation for training at the individual level, barriers to training, and factors associated with the perceived need for training. Results suggest the need for a national training initiative to increase CBO capacity.

Hospital pharmacy-based service for patient-controlled analgesia.

A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.

Interrupted noise as a tinnitus masker: an annoyance study.

Tinnitus can be masked by a simultaneous and/or nonsimultaneous stimuli. The usefulness of the masker depends on its power and its perceived annoyance. The purpose of the current study was to compare annoyance produced by interrupted and continuous noises. Data were gathered from six normal-hearing subjects without tinnitus and six subjects with tinnitus. Continuous white noise and interrupted white noise (2, 4, 10, 20, and 40 pulses per second) were presented at 20, 40, and 60 dB. Subjects adjusted the interrupted noise to be as annoying as the reference signal. The general findings were: (1) interrupted noises were more annoying than the continuous noises for both groups, and (2) the perception of annoyance in both groups was very similar at the highest level and significantly different at lower levels. For normal-hearing listeners, the differences between annoyance produced by continuous and interrupted noise were independent of the pulse rate for rates slower than 10 pulses per second, gradually decreasing for the higher rates. Despite the advantages of interrupted noise, it is not suitable as a tinnitus masker since it is more annoying than continuous noise.