Characteristics of pediatric patients seen in medical school-based osteopathic manipulative medicine clinics.

CONTEXT: Manual medicine--specifically osteopathic manipulative treatment (OMT)--is commonly used in treating patients aged 18 years or younger. However, no published reports have described characteristics of this patient population or the conditions for which OMT is used with these patients. To better counsel parents, train physicians and other healthcare providers, and prioritize research, an improved understanding of the use of OMT in children is needed. OBJECTIVE: To characterize pediatric patients and their conditions as seen in a medical school-based osteopathic manipulative medicine clinic. STUDY DESIGN: Retrospective analysis of administrative data on the use of OMT. SETTING: Faculty osteopathic manipulative medicine specialty clinics associated with the University of New England College of Osteopathic Medicine. PATIENTS: Data were analyzed from patients seen in the clinics from January 1, 2007, through December 31, 2007, if they were younger than 19 years at their first visit during that period. OUTCOMES MEASURES: Factors included in the data analysis were patient age at first visit, age at time of visit, number of visits during the study period, types of clinical diagnoses, and visits with nonmusculoskeletal diagnoses. RESULTS: A total of 407 patients generated 1500 clinic visits. Data showed a mean of 3.7 visits per patient (25th-75th percentiles = 2-5 visits) during the 1-year study period. The mean age at the first clinic visit was 7 years, 3 months, with the 25th-to-75th percentile being 1 year, 9 months, to 12 years, 3 months. Clinic visits by age group (ie, age at time of visit) as percentages of total visits were as follows: 0 to 11 months, 13.7%; 1 to 4 years, 33.3%; 5 to 12 years, 28.9%, older than 12 years, 24.2%. Diagnoses provided in visits covered a wide variety of common pediatric conditions. For the entire study population, 43.5% of visits included nonmusculoskeletal diagnoses. The percentages of visits with nonmusculoskeletal diagnoses for each age group were as follows: 0 to 11 months, 33.7%; 1 to 4 years, 64.0%; 5 to 12 years, 48.8%; older than 12 years, 17.7%. CONCLUSION: Pediatric patients seen in the faculty osteopathic manipulative medicine specialty clinic included the entire pediatric age range and a wide range of common pediatric conditions. A substantial number of visits involved treatment for nonmusculoskeletal conditions. Further investigation is needed to determine if the patient sample of the present study is representative of other clinical settings or geographic regions.

Total hip arthroplasty: comparison of two-incision and standard techniques at an AOA-accredited community hospital.

CONTEXT: The two-incision approach to total hip arthroplasty (THA) has received increasing attention in recent years. However, the benefits of this procedure have been debated. OBJECTIVES: To evaluate the two-incision THA technique compared to the standard anterolateral THA approach in a community hospital setting. METHODS: A retrospective review of records from patients who had THA at Memorial Hospital of York in Pennsylvania. Outcomes for patients who received the two-incision THA technique were compared to those who had a standard anterolateral THA approach. Perioperative parameters included operation duration and complication rates. Early function was evaluated by hospital length of stay and whether patients were discharged home or to a rehabilitation center. RESULTS: Twenty-eight patients had 30 THAs with a two-incision technique, and 30 patients had a standard anterolateral THA. Demographic parameters were similar among both groups. The two-incision THA group had a longer mean operation time by 34 minutes but shorter hospital stay by 0.8 days. Patients in the two-incision THA group were discharged to home 87% of the time compared to 43% in the anterolateral group. In addition, 4 patients (13%) in the two-incision group had an orthopedic complication compared to no complications in the anterolateral group. CONCLUSION: There were longer operative times, shorter hospital stays, and higher complication rates among patients who received the two-incision THA. Patients who receive the two-incision THA should be selected carefully and advised about the potential for increased complications.

Adecuación del uso de ketorolaco en un hospital de traumatología / Appropriateness of ketorolac use in a trauma hospital

Objetivo: Adecuar la prescripción y el uso de ketorolaco, así como los demás antiinflamatorios no esteroideos (AINE) y analgésicos disponibles en la "Guía farmacoterapéutica" del hospital (GFT). Material y métodos: Este trabajo se estructuró siguiendo los pasos que integran un ciclo de mejora (PDCA). Se analizó el problema mediante un diagrama de Ishikawa. Se elaboraron tanto indicadores de calidad cualitativos, que medían la calidad de la prescripción, como cuantitativos (dosis diaria definida [DDD]/100E), que medían el consumo de medicamentos, y se marcaron los objetivos a alcanzar. Dichos indicadores se cuantificaron en el periodo previo y posterior a la implantación de las estrategias de mejora. La población estudiada fueron los pacientes ingresados en los servicios de traumatología y cirugía plástica con sistema de distribución de medicamentos en dosis unitaria. La estrategia de mejora consistió en el aporte de información mediante sesiones informativas y entrega de documentación a los médicos prescriptores en el periodo preintervención. Los resultados obtenidos se compararon con los objetivos iniciales para comprobar su cumplimiento. Resultados: Indicadores cualitativos: se incrementó el uso de ketorolaco intravenoso hasta2 días en el 25,5% (p < 0,001), y en pacientes de 65 años o más a dosis ≤ 60 mg/día un27,7% (p < 0,05). Indicadores cuantitativos: el consumo de ketorolaco descendió (cirugía plástica, 61,8 DDD/100E a 14,8), y el consumo de tramadol, ibuprofeno y metamizol aumentó (cirugía plástica, de 0 a 14,1; de 8,7 a 48,6 y de 50,1 a 71, respectivamente). Conclusiones: Se ha adecuado la prescripción y el uso de ketorolaco, AINE y tramadol, lo que proporciona mayor seguridad al paciente. Las estrategias utilizadas han sido efectivas (AU)

Objective: To evaluate the suitability of ketorolac and non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesic drugs currently used in the hospital. Material and method: We have followed the steps to develop a PDCA cycle (plan, do, check, act) or quality improvement cycle. The quality problem was analysed using anIshikawa diagram. We defined both qualitative quality indicators, those that measure prescription quality, and quantitative ones (defined daily dose, DDD/100BDs), which measure drug consumption, being the objectives to achieve. The study was conducted in all patients admitted to the hospital and who were admitted to orthopaedic and trauma surgery and plastic surgery departments with unit-dose dispensing systems. The strategy used was to give information to physicians through meetings and documentation. Finally, the results were analysed and compared with the initial objectives. Results: The study was performed on 260 patients in the first study period and 292 in the second. Qualitative indicators: intravenous ketorolac use ≤ 2 days, increased in 25.5% (p< 0.001); in patients ≥ 65 years old at dose ≤ 60 mg/day it increased 27.7% (p < 0.05). Quantitative indicators: in the second study period, ketorolac use decreased (plastic surgery department: 61.8 DDD/100BDs to 14.8), whereas tramadol, ibuprofen and metamizole increased (plastic surgery department: 0 to 14.1 in tramadol, 8.7 to 48.6 in ibuprofen and 50.1 to 71 in metamizole). Conclusions: Appropriateness of ketorolac, NSAIDs and tramadol use has been achieved, thus improving patient safety. Strategies have been effective (AU)

Osteopathic medicine in transition: postmortem of the Osteopathic Medical Center of Texas.

The stand-alone osteopathic hospital was a necessity to the osteopathic medical profession in an era when it was isolated from allopathic medicine. As osteopathic medicine has become increasingly integrated with allopathic medicine, however, an independent osteopathic hospital is no longer a necessity. Moreover, a stand-alone institution seems to be economically out of place in today's market. The Osteopathic Medical Center of Texas in Fort Worth is an example of a stand-alone hospital that was unable to capitalize on the benefits realized by integrated hospital systems. The author believes that this failure contributed to the institution's demise. The market power of a hospital system can be used for more favorable contracting with vendors and providers, as well as facilitating negotiations with payers. System affiliation provides economic efficiency, security, and protection in the highly uncertain, complex, and competitive healthcare market.

Prevalencia de desnutrición en pacientes ingresados en un hospital de rehabilitación y traumatología / Malnutrition prevalence in patients admitted to a rehabilitation and orthopedic surgery hospital

Objetivo: Diferentes estudios ponen de manifiesto la escasa atención concedida al estado nutricional en la historia y práctica clínica, lo que determina el desconocimiento del estado nutricional del paciente a su ingreso en el hospital y por tanto la imposibilidad de prevenir la malnutrición hospitalaria. El objetivo de nuestro estudio ha sido determinar la prevalencia de desnutrición de pacientes ingresados en un Hospital de Traumatología y Rehabilitación. Métodos: Estudio observacional analítico en 250 pacientes (60% hombres y 40% mujeres) seleccionados aleatoriamente, a los que se realizó una evaluación nutricional al ingreso hospitalario, mediante antropometría (Peso, talla, IMC, PB, PCT, PCSA y PCSE) y pruebas bioquímicas (Albúmina, Prealbúmina y Transferrina). Resultados: Según el IMC la prevalencia de desnutrición fue del 8%, el promedio de desnutrición de tipo calórico fue del 2,8% (según antropometría) y la prevalencia de desnutrición proteica se eleva al 54,8% (según marcadores bioquímicos). Conclusiones: La elevada prevalencia de malnutrición proteica o visceral (54,8%) demostrada en este estudio, pone de manifiesto la importancia de determinar el estado nutricional al ingreso hospitalario, particularmente en los pacientes de tipo quirúrgico, como es el caso de la mayoría de los que ingresan en los hospitales traumatológicos (AU)

Objective: Different studies show the scarce attention granted to the nutritional state in historical and clinical practice, what determines the ignorance of the patient's nutritional status to their entrance in the hospital and, therefore, the impossibility to prevent the hospital malnutrition. The objective of our study has been to determine the prevalence of patients' malnutrition entered in a Hospital of Orthopedic surgery and Rehabilitation. Methods: Observational and analytical study in 250 randomized patients (60% men and 40% women), who were nutritionally evaluated when entering, the hospital, by means of anthropometry (Weigh, height, BMI, skinfold, corporal circumferences) and biochemical tests (Albumin, Prealbumin and Transferrin). Results: According to the BMI the prevalence of malnutrition was of 8%, the average of caloric malnutrition was of 2,8% (according to anthropometry) and the prevalence of many-sided malnutrition rises to 54,8% (according to biochemical markers). Conclusions: The high prevalence of fundamental malnutrition (54,8%) demonstrated in this study, it shows the importance of determining the nutritional status when entering the hospital, particularly surgical type' patiens as is the case of most of those who enter the Orthopedic surgery hospitals (AU)

Los cuidadores familiares en el Hospital Universitario de Traumatología y Rehabilitación de Granada / Family caregivers in the University Hospital Traumatologia in Granada

Introducción: La hospitalización afecta a la dinámica de las relaciones familiares y obliga a cambios en la representación de los roles habituales. El papel de los cuidadores familiares adquiere toda su relevancia en la medida que satisfacen las necesidades del enfermo. Esta actividad en la mayoría de los casos es realizada por mujeres.Objetivos: Conocer el perfil y tipo de cuidados que prestan los cuidadores familiares en las unidades de Maxilofacial, Neurología, Neurocirugía y Traumatología del Hospital de Traumatología de Granada. Analizar las necesidades y problemas con los que se encuentran en el hospital. Conocer la opinión del personal de enfermería sobre el cuidador familiar.Diseño: Cualitativo, mediante Observación sistemática, grupos focales (uno con enfermeras y otro con auxiliares), encuestas y entrevistas en profundidad. El análisis de contenido ha sido realizado mediante el soporte informático Atlas/ti, 2.4.Resultados: correspondientes a la categoría de hábitat hospitalario, en relación con las actividades, nivel de información, demandas, etc, de los cuidadores familiares.Conclusiones: El ámbito hospitalario es hostil para el cuidador familiar; es necesario es¬tablecer un nuevo marco relacional entre los profesionales y los cuidadores y reconocer su presencia y actividad dentro de la institución sanitaria

Introduction: Generally hospitalization affects familiar relationships and it also obvies to take certain changes in families' routine. That is why family caregivers have acquired an important role, as they fulfil the needs of the patients. Most of the times, this activity is performed by women.Aims: The aims of this article are: to explain family care givers profile and the kind of care they provide in the following units: Maxilofacial, Neurology, Neurosurgery and Traumatology in the University Hospital Traumatología y Rehabilitación in Granada.This article will analyse different needs and problems family caregivers find within the hospital and inform about nurses opinion concerning the role of family caregivers.Design: A qualitative design has been used by means of systematic observation and focal group. Surveys and in-depth interviews have been carried out within 2 different groups:nurses and auxiliary nurses. The results obtained have been analysed by the programme Atlas/ti 2.4.Results: The results mentioned above were the appropriate for a hospital in relation with family caregivers as far as activities, level of information, and requests are concerned.Conclusión: On the whole atmosphere in hospitals is somehow hostile to family caregivers. For this reason it will be convenient to set up a different kind of professional relations between health staff and family caregivers. Moreover, it is necessary to recognize the importance of family caregivers role in the hospital

Cost structure of osteopathic hospitals and their local counterparts in the USA: are they any different?

Due to the emphasis on preventive care and less invasive solutions to medical problems, osteopathic hospitals may deliver cost efficient and cost effective care. This study examines the cost structure of osteopathic hospitals and compares their performance to a local control group selected from allopathic hospitals. Osteopathic hospitals are identified in the 1999 American Hospital Association (AHA) data and matched to local allopathic hospitals with respect to location, bed size, system, for-profit and teaching status. Cost functions are estimated for both groups of hospitals, and significant differences in input, output and costs are highlighted. Results show that osteopathic hospitals are more costly and less productive in comparison to their counterparts. Inefficient production of outpatient services and high cost of medical education are two reasons for the poor performance. The study has important policy implications on two fronts: first, osteopathic hospitals are more costly to operate than their counterparts, and subsequently this requires further analysis of the osteopathic treatments and techniques. In an environment where health care revenues are shrinking and costs are rising, this is probably much needed information for osteopathic hospitals. Secondly, there is an emerging concern among osteopathic medical schools and osteopathic physicians due to the declining number of osteopathic hospitals, which translates to a smaller number of residency positions for osteopathic medical school graduates. Analyzing cost, input and output variables reveal some of the contributing factors to the decline of osteopathic hospitals and help preserve this rich tradition.

Influencia del fútbol en la frecuentación de los servicios de urgencias traumatológicas / Influence of soccer on attendance to traumatological emergency services

No disponible

HFAP survey earns facility referral status.

Accreditation alternatives to the Joint Commission on Accreditation of Health Care Organizations (JCAHO) are not necessarily an either- or proposition. The American Osteopathic Association is seen as more document-driven, while JCAHO focuses on outcomes. Consultants prove invaluable in helping center prepare for Healthcare Facilities Accreditation Program survey.

Frequency of negative coronary arteriographic findings in patients with chest pain is related to community practice patterns.

OBJECTIVE: To determine factors contributing to the relatively high frequency and variability (10% to 30%) of finding no significant coronary disease by coronary angiography in patients with chest pain. STUDY DESIGN: Retrospective, comparative analysis of practice patterns at 3 southeastern Michigan hospitals and a composite sample from New York State. PATIENTS AND METHODS: Medical records for 7668 patients were reviewed to determine the frequency of negative coronary arteriographic findings in patients undergoing chest pain evaluation. A private practice allopathic community hospital with interventional cardiologists and a private practice osteopathic community hospital with diagnostic facilities (DiagCommunity) were compared with a university hospital with full-time salaried interventional cardiologists and a sample of 17 New York hospitals. RESULTS: Of the 7668 coronary angiograms at all centers, 39.7% were performed to assess patients with stable chest pain. There was no significant obstruction found in 16.5%, and the frequency was not different between the Michigan (17.8%+/-3.8%) and New York (14.2%) hospitals. The DiagCommunity had the highest proportion (22%; P < .001 vs others). On review of the negative coronary arteriographic findings, normal or near normal coronary arteriographic findings were infrequent (range, 2.4%-6.6%) but higher in the DiagCommunity (6.6% vs 2.9%+/-1.6%; P < .0001). CONCLUSIONS: The frequency of finding no significant coronary disease by arteriography in patients with chest pain is similar in southeastern Michigan hospitals and comparable to an established external database. Cardiology self-referral and personal gain does not seem to be a major factor in selection of patients for invasive studies.

Fracturas mandibulares: experiencia en un hospital de trauma / Mandibular fractures: experience of a trauma hospital

Background: Facial trauma has reached a peak in the last decades in the world; however, scanty epidemiological information is available in Chile. Aim: To report the experience in the treatment of mandibular fractures in the maxillofacial unit at Hospital del Trabajador, Santiago. Patients and methods: A retrospective study of patients with mandibular fractures treated in a seven years period (1990-1996). Demographic and clinical aspects of the patients are analyzed, with emphasis in causes of trauma, anatomic distribution of the fractures, treatment and complications. Results: One hundred and sixty patients (aged 14 to 65 years old) sustained 245 mandibular fractures. Road traffic accidents were the most common cause of fractures (46 percent). The most common mandibular fracture was subcondylar. Thirty eight patients (24 percent) presented with associated facial fractures, while 34 (21 percent) had also other non-facial fractures. Open reduction and internal fixation was performed in 88 subjects. Complications occurred in 60 patients (38 percent). Conclusions: Road traffic accidents are the main cause of mandibular fractures in this series of patients. The most common mandibular fracture is subcondylar, which can be linked to the high rate of occlusal complications observed

Engineering data exchange.

UNLABELLED: Mount Clemens General Hospsital, Mount Clemens, Mich. PROBLEM: performance anomalies due to multiple interfaces with separate systems. SOLUTION: implementation of an interface engine. RESULTS: improved management of data exchange among disparate systems. KEYS TO SUCCESS: up-front studies of vendor offerings, potential problems, and long-term needs.

Evaluación de cuatro años de la Fundación Ortopédica Infantil Cojedes: Hospital General San Carlos Servicio de Traumatología y Ortopedia, junio 1996 - junio 2000 / Evaluation of four years of the Fundación Ortopédica Infantil Cojedes

En este trabajo se presentan los resultados obtenidos durante cuatro años de funcionamiento de la Fundación Ortopédica Infantil de Cojedes con el objetivo de demostrar la necesidad de la creación de un servicio de Ortopedia Infantil en la ciudad de San Carlos para atender a pacientes con patologías ortopédicas pediátricas. Se hizo un estudio retrospectivo de 4 años evaluando la consulta médica ortopédica de 4.512 pacientes de los cuales fueron intervenidos quirúrgicamente 543. De las 543 intervenciones quirúrgicas; las patologías más frecuentes fueron: pie equino varo 104 (64 por ciento), 48 luxaciones por displasia de desarrollo de cadera (50 por ciento), enfermedad de Legg Calvé Perthes 32 (33 por ciento), coxa vara 11 (11,2 por ciento), coxa valga 6 (5,5 por ciento), sindactilia 10 (40,7 por ciento) Polidactilias 6 (22,2 por ciento), secuelas de parálisis cerebral 6 (22,2 por ciento), secuela de quemadura 3 (11,5 por ciento), mano zamba radial 2 (3,7 por ciento). En conclusión, este trabajo demuestra la necesidad de la creación de un Servicio de Ortopedia Infantil en la ciudad de San Carlos Estado Cojedes dedicado a la atención de pacientes con patologías ortopédicas pediátricas