Factors Associated with Initial Interest and Treatment Selection in Patients with Femoroacetabular Impingement Syndrome.

BACKGROUND: Outcomes for operative and nonoperative management of femoroacetabular impingement syndrome (FAIS) are variable. Understanding factors that inform patients' treatment decisions may optimize their outcomes. OBJECTIVE: To identify factors that predict which patients with FAIS proceed to surgery within 90 days of their initial evaluation by an orthopedic surgeon. The study explored potential predictors of surgical intervention, including demographic factors, activity level, symptom duration, previous treatment, hip function, pain, presence of labral tear, and patient interest in surgical and physical therapy (PT) treatment. DESIGN: Prospective cohort. SETTING: Single-site academic medical center. PATIENTS: Seventy-seven individuals with FAIS. INTERVENTION: After evaluation in a hip preservation clinic, participants reported activity level, symptom duration, treatment history, hip function [Hip Outcome Score Activities of Daily Living(HOS-ADL)], pain severity and location, and treatment interests. These variables were evaluated based on univariate analysis for entry into a multiple binomial logistic regression to identify predictors of surgery within 90 days. Adjusted marginal prevalence ratios and 95% confidence interval estimates (PR [95% CI]) were reported (P ≤ .05). MAIN OUTCOME MEASURE(S): Ninety-day treatment (surgery or not). RESULTS: Participants indicated initial interest in surgery (n = 27), PT (n = 22), both (n = 18), or neither (n = 10). Those only interested in PT had lower prevalence of diagnosed labral tear (P < .001) and previous PT for the hip (P < .001). Prevalence of previous injection was higher for those only interested in surgery than for those with any interest in PT (P < .001). Thirty-six of 77 participants (46%) underwent surgery within 90 days. Surgical interest (3.56 [1.57, 5.46]), previous hip injection (3.06 [1.73, 3.89]), younger age (0.95 [0.92, 0.98]), and worse hip function (0.97 [0.95, 0.99]) were significant (P ≤ .02) predictors of surgery. CONCLUSIONS: Treatment interest and history, patient function, and age were significantly related to participants' decision to pursue surgical intervention within 90 days. Patient engagement in the decision-making process should include considerations of patient knowledge of, and experience with, the various treatment options.

Mechanical chest compressions.

The authors of this study state that there is a lack of evidence about the efficiency of mechanical devices in producing chest compressions as an adjunct to resuscitation during cardiorespiratory arrest.

Techniques for removing rings from injured fingers.

Staff in emergency departments or minor injury units are sometimes asked to remove rings from patients' fingers. This is often because their presence has become painful or is preventing treatment of injuries or illnesses. Practitioners must be able to identify the tourniquet effect of rings or bracelets, and understand why and how they should be removed. This article describes the procedures that can be used.

A patient with sepsis: an evaluation of care.

While undertaking an accident and emergency care course, the author was required to reflect critically on the care of a patient he had seen. This included the use of a Mind Map. The patient was diagnosed with sepsis but a delay in the recognition of the seriousness of his illness meant that gold standards for care were not met. Although the patient made a full recovery, it was clear that the team had to learn from the experience and change its practice. In particular, a full set of diagnostic tests should be followed where sepsis is suspected. To maintain patient confidentiality, any identifying features of this case have been removed or changed, in keeping with the Nursing and Midwifery Council (NMC) code of professional conduct and its guidance on standards for record keeping (NMC 2007, 2008).