Correlation between health outcome and length of hospital stay in lumbar microdiscectomy.

STUDY DESIGN: Prospective observational trial in a community hospital setting. OBJECTIVES: To examine the effect on patient-reported outcome of a clinical practice, namely, decrease in hospital length of stay for single-level lumbar microdiscectomy. SUMMARY OF BACKGROUND DATA: Health care reform and the economic demands of managed care have created increasing pressure to manage health care resources more effectively. Spine surgery is one of the most common surgeries. METHODS: Starting in October 1993, length of stay for patients undergoing lumbar microdiscectomy was decreased at the study institution. Patients completed questionnaires (SF-36) before surgery and 3 months after surgery that assessed health status, back-related functional status, and treatment satisfaction. Comparisons were made between the intervention group and a historical control group and between 1-day and 2-day patients. RESULTS: SF-36 scores 3 months after surgery approximated age and sex norms of five of the eight SF-36 scales and improved significantly on the remaining three scales. The physical functioning and general health scores were significantly better for the 1-day than the 2-day patients. Patient satisfaction was similar in all groups. Hospital charges for the 1-day patients were $781 less per patient than for the 2-day patients. CONCLUSIONS: Hospital length of stay for lumbar microdiscectomy can be decreased without adverse effect on short-term patient self-reported health status or satisfaction and with lower hospital charges. This model assesses the effect of efficient management of health care resources on patient-perceived quality and satisfaction.

Stroke rehabilitation. 3. Rehabilitation evaluation and management.

This self-directed learning module highlights rehabilitation evaluation and management. Part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on determining the level of rehabilitation needed after stroke, the common disabilities seen after a stroke and their evaluation and management, neurofacilitative approaches in stroke recovery, and the management of dysphagia and bladder and bowel dysfunction in the stroke patient.

Stroke rehabilitation. 5. Stroke outcome.

This self-directed learning module highlights outcome after stroke rehabilitation. Part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on predictors of stroke outcome; the ability of stroke rehabilitation to achieve functional improvement, maintain functional gains, and reduce costs; and the efficacy of varying levels of rehabilitation services.

Stroke rehabilitation.

It is clear from this article that additional studies examining what factors can be used to predict the outcome of stroke and what process achieves the best outcome most effectively need to be developed. The available data support the usefulness of a coordinated rehabilitation program in the treatment of the functional impairment that occurs after the stroke. The process of rehabilitation is a vibrant and exciting one for all individuals involved. It is a unique process in medicine in which the physician does not "do" anything to the patient, but rather he or she leads a multidisciplinary team in providing a milieu in which the patient can improve and better his or her functional abilities. The process of seeing patients improve and overcome the often overwhelming sequelae of stroke to return home in an independent fashion is gratifying not only for the patient but also for the members of the rehabilitation team. In rehabilitation there is a focus on not only the health of the patient but also a strong focus on the quality of life and functional independence once the patient returns home.

Injuries in adolescent and preadolescent boys at two large wrestling tournaments.

We evaluated injury patterns at two wrestling tournaments involving 1742 participants, aged 6 to 16 years. The overall injury rate was 12.7%. Injuries requiring withdrawal from the tournament occurred in 4.6% of the participants. Of all participants, 3% sustained an injury in their first match, and 1.1% sustained an injury during their first match that required withdrawal from the tournament. Primary areas of injury were the upper extremity (33%) and the neck and back (24%). Wilcoxon rank-sum tests revealed that increasing age and increasing weight were correlated with injury, whereas multiple logistic regression analysis revealed that only increasing age was correlated with injury. These findings suggest the need for medical supervision at large wrestling tournaments, where it is likely that severe injuries will occur. In addition, older wrestlers and perhaps heavier wrestlers are at an increased risk for injury.

Stiff-man syndrome updated.

Stiff-man syndrome, a rare disorder characterized by intermittent spasms and stiffness of the axial muscles, is associated with an electromyographic pattern of continuous motor unit activity in affected muscles. Since the initial description in 1956, the stiff-man syndrome has been reported to occur in various clinical and neurologic settings. In this study, we reviewed the current state of knowledge about this syndrome, defined diagnostic criteria, provided a long-term follow-up of the disorder, and assessed rehabilitative attempts in affected patients. Use of rigorous criteria that identify patients who have the stiff-man syndrome is important because the initial clinical manifestations are similar to those of other neuromuscular diseases. Analysis of 13 patients with stiff-man syndrome examined at the Mayo Clinic during the past 30 years revealed that treatment with diazepam decreased the muscle spasms. Because some muscle spasms usually persist, rehabilitation is an important adjunct that may further improve function when it is centered on the treatment of low-back pain and hyperlordosis, mobility problems, gait abnormalities, and muscular stiffness.