To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture.
Prospective cohort study.
A secondary teaching hospital.
We enrolled 183 hips operated with hemiarthroplasty for displaced femoral neck fracture using the DL or PL approach.
Preoperatively, we evaluated the Harris hip score (HHS) and European Quality of Life-5 Dimensions (EQ-5D). At 1 year postoperatively, lucid patients were clinically examined to evaluate the Trendelenburg sign, abductor muscle strength with a dynamometer, and trochanteric tenderness with an electronic algometer. The 1-year HHS and EQ-5D were documented.
The primary outcome was the incidence of postoperative Trendelenburg sign, whereas the secondary outcomes included patients' reported limp, abductor muscle strength, trochanteric tenderness, HHS, and EQ-5D.
There were 48 patients (24 in the DL group and 24 in the PL group) who attended the 1-year clinical follow-up. The 2 groups were comparable (P > 0.05). The DL group showed a higher incidence of the Trendelenburg sign (9/24 vs. 1/24, P = 0.02) and limp (12/24 vs. 2/24, P = 0.004). Further analysis with logistic regression showed the surgical approach to be the only factor that resulted in the increment. No differences regarding HHS, EQ-5D, abductor muscle strength, algometer pressure pain threshold, and radiologic measurements were found (P > 0.05).
The incidence of the Trendelenburg sign and limp were significantly higher in the DL approach although this seemed not to influence abductor muscle strength or the incidence of trochanteric tenderness or compromise the clinical outcome.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Transmisssion of infection within healthcare institutions is a significant threat to patients and staff. One of the most effective means of prevention is good hand hygiene. A research team at Toronto Rehabilitation Institute, Ontario, Canada, developed a wearable hand disinfection system with monitoring capabilities to enhance hand wash frequency. We present the findingsof the first phase of a larger study addressing the hypothesis that an electronic hand hygiene system with monitoring and reminding propertieswill increase hand hygiene compliance. This first phase focused on the acceptability and usability of the wearable electronic hand wash device ina clinical environment. The feedback from healthcare staff to the first prototype has provided evidence for the research team to continue with the development of this technology.
Using action-research methods and the principles of community development, a small working group initiated an organization-wide process to sensitize the Sunnybrook and Women's College hospital community to the relationship between violence and women's health. In this article, we explore the process by which the initiative was successfully introduced into the newly merged hospital. We describe critical factors for the initiative's success and offer some suggestions on how to maximize opportunities for organizational change.
Telecom-Bretagne, Ecole Supérieure des Télécommunications de Bretagne, (LUSSI)/MARSOUIN/CREM, Département LUSSI, Logiques des Usages, Sciences Sociales et Sciences de l'Information, GET/ENST-Bretagne, Technopôle de Brest Iroise, CS 83818, 29238, Brest Cedex 3, France. email@example.com
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.
Postdischarge safety is an area that has long been neglected. Recent studies from the United States and Canada found that about one in five patients discharged home from the general internal medicine services of major teaching hospitals suffered an adverse event.
MEDLINE, Cochrane databases, and reference lists of retrieved articles were used in a literature search of articles published from 1966 through May 2007.
Patient safety research has focused mostly on adverse events in hospitalized patients. Although some data are available about the ambulatory setting, even fewer studies have been done focusing on adverse events following hospital discharge. Only two studies conducted in North America have examined the incidence rate of all types of postdischarge adverse events. On the basis of the available evidence, key areas of opportunity to improve postdischarge care are as follows: (1) improving transitional care, (2) improving information transfer through strategic use of electronic health records, (3) medication reconciliation, (4) improving follow-up of test results, and (5) using screening methods to identify patients with adverse events.
Limited evidence suggests that about one in five internal medicine patients suffers an adverse event after discharge from a North American hospital. The risk of postdischarge adverse events should be recognized by patient safety experts as an important area of concern.
Wait times for cancer surgery in Ontario have increased over the last decade. We reviewed trends in wait times for endometrial cancer surgery from 1996 to 2000 and identified determinants that may need to be addressed in order to reduce these wait times.
The study population included women diagnosed with endometrial cancer (ICD-9 codes 179 or 182) prior to surgery. Surgical wait time was defined as the interval between date of diagnosis and hospital admission for surgery. Univariate analyses assessed demographic, treatment, and hospital factors associated with wait times. A multilevel linear regression model was created to account for clustering of patients at the hospital level and regional level defined by local health integration networks (LHINs). Effects of covariates were expressed as estimates of the median proportional change in wait time.
There were 2042 cases in this analysis. Mean wait time increased from 32 to 40 days (P = 0.0012). Prolonged wait times were associated with age > 70 years, presence of comorbidities, and surgery performed at a teaching hospital and by a gynaecologic oncologist. Wait times were not associated with income level or region of residence defined by LHIN.
Wait times for endometrial cancer surgery have increased significantly in Ontario. Determinants of these prolonged wait times need to be addressed, and criteria for referral to a teaching hospital and gynaecologic oncologist should be developed to ensure that local health integration networks provide equal and timely access to care.