The objective of this study was to determine if peer comparisons, an educational intervention, and positive physician feedback would decrease ordering of knee X-ray studies. We prospectively studied the ordering of knee X-ray studies for patients presenting with knee injuries before and after an educational program to encourage use of the Ottawa decision rule for knee radiography. Physicians were able to privately compare their individual baseline X-ray utilization data with that of their colleagues. Although acceptance of the rule was voluntary, both oral and written feedback encouraged consideration of the rule in clinical decision-making. The percentage of knee injury patients who received X-ray studies, as well as the Percentage Abnormal Results (PAR, defined as the percentage of X-ray studies demonstrating a fracture or effusion), were calculated before and after the educational meeting. Results of the study showed that the percentage of patients presenting with knee injuries who received X-ray studies decreased 23%. In addition, the PAR increased 58.4% between the two study periods. In conclusion, physician behavior can be altered positively with reinforcement. Peer comparisons, education, and positive physician feedback decreased test ordering by physicians even without mandating use of a protocol. PAR is a useful outcome measure to track physician utilization.

Education, Medical, Continuing↗

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Unique aspects of caring for dying children and their families.

Pediatric hospice has become an important service for children and their families in the past decade. In this article we present unique aspects of StarShine, the hospice of Children's Hospital Medical Center in Cincinnati, Ohio. Length-of-service data demonstrate the need to find innovative ways of encouraging earlier referral to hospice. Several specialized aspects of care, such as long-term bereavement, pet visitation and social services for the family are presented. The initiation of a novel in-home pain management program is described. StarShine has not followed an adult hospice model, and as such, we discuss those unique aspects of dying pediatric patients and suggest specific solutions and interventions designed for children.

Child↗

PubMedDate not supplied

Surgical treatment of venous insufficiency.

The incidence of venous insufficiency syndrome (VIS) is increasing. Although clinical findings will help for diagnosis of this condition, invasive and non invasive tests confirm the diagnosis. Thermodilution, a new and unique technique, appears to be the only test for diagnosis and decision making for treatment of this condition. Overloading and increase muscle work appear to be present in cases of VIS. Cases of failed medical treatment and findings of increased flow, with venography evidence of grade IV venous insufficiency are generally subjected to surgical treatment. Ninety-four cases of severe VIS have been operated on since July 1980 with 75% excellent results.

Atrophy↗

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Experimental prosthetic vein valve.

Medical and surgical management of venous insufficiency syndrome (VIS) has produced disappointing results despite the recent introduction of new surgical techniques. This has prompted the investigation of a sutureless prosthetic vein valve. Ten prosthetic sutureless vein valves have been tested to date. The valves are of two types, one constructed of platinum, the other of titanium. Fourteen to eighteen months post-insertion into the femoral vein or vena cava of mongrel dogs, five valves remain patent as shown be venography. The sutureless prosthetic vein valve is a promising development in the treatment of venous insufficiency.

Animals↗

PubMedDate not supplied

Indications and results of vein valve transplant.

Approximately 250,000 people are affected by postphlebitic syndrome each year in the U.S. Its pathogenesis is related to the incompetence of vein valves in the leg caused by thrombophlebitis and congenital redundancy. "Indications and results of vein valve transplant" discusses the correction of postphlebitic syndrome. Preliminary results of the vein valve transplant have been previously reported. This report updates the follow-up of 46 patients up to 3 years after the operation. The significance of muscle changes that occur with venous insufficiency is illustrated, and two new modalities of preoperative evaluation and postoperative follow-up are introduced.

Blood Pressure↗