Comparison of rates of emergency department procedures and critical diagnoses in metropolitan and rural hospitals.

Introduction: Emergency medicine (EM) workforce studies show low rates of board-certified/residency-trained emergency physicians practising in rural emergency departments (EDs) in the USA. Rural ED rotations for EM residents may lead to increased numbers of residency-trained EM providers in rural areas. There is concern that residents trained in rural environments will not get sufficient procedural experience or patient acuity.

Typed versus voice recognition for data entry in electronic health records: emergency physician time use and interruptions.

Introduction: Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition.

Comparison of procedural sedation for the reduction of dislocated total hip arthroplasty.

Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity.

Impact of an anesthesiology rotation on subsequent endotracheal intubation success.

Background: Endotracheal intubation (ETI) is an essential skill that emergency medicine residents learn throughout their training.

Objective: To evaluate the effect of implementing a postgraduate year (PGY)-1 anesthesiology rotation on ETI success in the emergency department during PGY-2.

Methods: Residents in the study group completed a 4-week PGY-1 anesthesiology rotation.

Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress.

Introduction: Congenital diaphragmatic hernia is an embryologic defect that creates a passage for herniation of abdominal structures into the thoracic cavity. This can lead to a variety of complications, including gastric volvulus that can present acutely with epigastric distention and vomiting. In cases of late-onset congenital diaphragmatic hernia, symptoms may be vague and often necessitate further investigation.

Application of statistical process control to physician-specific emergency department patient satisfaction scores: a novel use of the funnel plot.

Objectives: Emergency department (ED) patient satisfaction remains a high priority for many hospitals. Patient surveys are a common tool for measuring patient satisfaction, and process improvement efforts are aimed at improving patient satisfaction scores. In some institutions, patient satisfaction scores can be calculated for each emergency physician (EP).

Predictive measures of a resident's performance on written Orthopaedic Board scores.

Objective: Residency programs are continually attempting to predict the performance of both current and potential residents. Previous studies have supported the use of USMLE Steps 1 and 2 as predictors of Orthopaedic In-Training Examination (OITE) and eventual American Board of Orthopaedic Surgery success, while others show no significant correlation. A strong performance on OITE examinations does correlate with strong residency performance, and some believe OITE scores are good predictors of future written board success.

Surgical simulators and hip fractures: a role in residency training?

Background: Orthopedic surgery residency training requires intellectual and motor skill development. In this study, we utilized a computer-based haptic simulator to examine a potential model for evaluation of resident proficiency and efficiency in the placement of a center guide wire during fixation of an intertrochanteric proximal femur fracture. We hypothesize the junior residents will utilize more fluoroscopy and require more time to complete the task.

Radiographic evaluation of midterm failure rates following metal-on-metal hip resurfacing.

This prospective study examined patient characteristics and radiographic findings for 89 subjects undergoing total hip resurfacing. Thirteen (14.6%) of 89 hips have required revision.

Bilateral gluteal compartment syndrome following robotic-assisted prostatectomy.

Bilateral gluteal compartment syndrome is a rare condition. Only 6 previous cases have been reported in the literature. Two previous cases involved positioning for urological procedures, while the other cited causes of bilateral gluteal compartment syndrome include exercise-induced, trauma, and prolonged immobilization from substance abuse.

Trace metal analysis following locked volar plating for unstable fractures of the distal radius.

An increase in the utilization of metallic devices for orthopaedic interventions from joint replacement to fracture fixation has raised concern over local metal ion release and possible systemic sequelae due to dissemination of these ions. Our purpose was to determine whether serum titanium concentrations were elevated in patients who had previously received a locked volar distal radius plate. Our hypothesis was that the simple presence of titanium alone in a relatively fixed implant was not enough to raise serum titanium levels.

Torsional stiffness of an intramedullary nail versus blade plate fixation for tibiotalocalcaneal arthrodesis: a biomechanical study.

The purpose of this investigation is to compare the rotational stability of intramedullary rod fixation with blade plate and screw fixation in tibiotalocalcaneal arthrodesis. Five matched pairs of cadaver ankles were randomly fixated with a lateral blade plate and screws or a retrograde intramedullary nail. The bone mineral density (BMD) for each sample was ascertained.

Hospital outcome after emergent vs elective revision total hip arthroplasty.

This is a retrospective review of inpatient outcomes, based upon emergent or elective admission for revision total hip arthroplasty (THA) procedures performed between 2000 and 2006. Three hundred forty-two revision THA procedures (291 elective, 51 emergent) were identified. Emergent revisions were more likely to be older (69.

Effect of bone cement viscosity and set time on mantle area in total knee arthroplasty.

To assess the impact of bone cement viscosity on total knee arthroplasty, we compared 1 high-viscosity and 2 medium-viscosity cements with respect to mantle area and zone-specific intrusion depths into the tibial plateau. We analyzed postoperative radiographs to determine penetration area and depth in 72 consecutive patients (79 knees) in whom DePuy II (n = 11), Endurance (n = 34), or Simplex-P (n = 34) cement was used. Penetration into the tibial plateau (anteroposterior zones 1-4) was significantly reduced with use of the high-viscosity DePuy II cement but did not differ significantly between the 2 medium-viscosity cements, Endurance and Simplex-P.

Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty.

Background: Gun pressurization in total knee arthroplasty (TKA) may result in better cement penetration than hand packing, leading to fewer tibial plate failures. We compared cement intrusion characteristics between vacuum mixing and gun pressurization versus hand mixing and packing in the proximal tibia among patients undergoing TKA.

Methods: We analyzed 6-week radiographs from 77 consecutive patients for cement area and zone-specific intrusion using computer-assisted image analysis.

Acetabular cup malalignment after total hip resurfacing arthroplasty: a case for elective revision?

This article describes the clinical course of a patient with a resurfacing implant in a poor cup position in combination with elevated serum metal ions prior to implant failure. Following resurfacing, the patient had substantial improvement from baseline in pain and functional status. Postoperative radiographs indicated the acetabular cup in an abducted and excessively anteverted position.

Are honors received during surgery clerkships useful in the selection of incoming orthopaedic residents?

The purpose of this study was to review institutional statistics provided in dean's letters and determine the percentage of honors awarded by institution and clerkship specialty.Institutional and clerkship aggregate data were compiled from a review of dean's letters from 80 United States medical schools. The percentage of honors awarded during 3rd year clerkships during 2005 were collected for analysis.

Component version in modular total hip revision.

Morphologic changes of the proximal femur make revision total hip arthroplasty challenging. Metaphyseal retroversion and diaphyseal varus are common in this scenario. Twenty-one total hip revisions using a modular femoral prosthesis were examined by obtaining three radiographs (A/P, surgical lateral, and true lateral of the femur) to assemble CAD models for determining the range of modular component positioning.

Impact of the 80-hour workweek on surgical exposure and national in-training examination scores in an orthopedic residency program.

Objectives: This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period.

Methods: Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003.

Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty.

Traditional treatment of pain following total joint arthroplasty involves postoperative oral narcotic medications and intravenous patient-controlled analgesia, both of which can result in significant postoperative morbidity. Multi-modal analgesia involving >or=2 classes of drugs acting on different receptor types may be as effective as single-narcotic/patient-controlled analgesia with fewer analgesic-related side effects. In addition, administering analgesia prior to surgery (pre-emptive) may reduce postoperative pain intensity.

Serum titanium levels after instrumented spinal arthrodesis.

Study Design: A retrospective study measuring postoperative serum titanium levels in patients with titanium alloy spinal instrumentation.

Objective: To determine serum titanium levels in patients after instrumented spinal arthrodesis with implants composed of titanium alloy and to identify potential factors responsible for any increase in ion levels.

Summary Of Background Data: Previous studies have documented localized metal debris in the tissues surrounding spinal instrumentation.

Serum cobalt and chromium elevations following hip resurfacing with the Cormet 2000 device.

This study was designed to monitor serum cobalt (Co) and chromium (Cr) levels at multiple time points following hip resurfacing with the Cormet 2000 device. Serum samples were obtained preoperatively, at 6 months, 1, 2, and 3 years after surgery. Co/Cr levels (micro g/L) were determined by high-resolution inductively coupled plasma mass spectrometry.

Healing pressure ulcers with collagen or hydrocolloid: a randomized, controlled trial.

Objectives: To compare the effects of topical collagen and hydrocolloid on pressure ulcer healing.

Design: Randomized (allocation concealed), single-blind (outcome assessors), controlled trial with 8-week follow-up.

Setting: Eleven nursing homes in central Illinois.