Orthopedics Research Today is a free monthly online journal that collates and summarizes the latest research about Orthopedics, including details on chronic injuries, muscoskeletal disorders, surgery, reconstruction.

Assessing Resident Knowledge of Acute Pain Management in Hospitalized Children: A Pilot Study.

Saroyan JM, Schechter WS, Tresgallo ME, Sun L, Naqvi Z, Graham MJ

Division of Pediatric Anesthesia, Department of Anesthesiology (J.M.S., W.S.S., M.E.T., L.S.), College of Physicians and Surgeons, Columbia University; and Center for Education Research and Evaluation (Z.N., M.J.G.), Columbia University Medical Center, New York, New York, USA.

This pilot study was undertaken to evaluate the hypotheses that there are differences in pediatric pain management (PPM) knowledge across resident specialties, that questions in the form of multiple-choice items could detect such differences, and that resident knowledge of analgesic-related adverse drug events (ADEs) would be greater than knowledge of PPM. Questions were based on two general categories of knowledge within acute pain management in hospitalized children: pediatric pain assessment and treatment, and identification of analgesic-related ADEs. As part of the pilot nature of this study, a convenience sample of 60 residents completed a 10-item PPM knowledge assessment prior to a PPM lecture. Twenty-six were pediatric residents (43%), 19 were orthopedic residents (32%), and 15 were anesthesiology residents (25%). All items had content validity. When controlling for resident year, performance by resident specialty was significantly different between anesthesia and orthopedics (P=0.006) and between anesthesia and pediatrics (P<0.001). Resident knowledge of analgesic-related ADEs was not greater than knowledge of PPM. The most difficult topics were opioid equianalgesia, assessment of the cognitively impaired child, and maximal acetaminophen doses. Repeated administration of the PPM knowledge assessment at multiple institutions will allow further evaluation of our initial findings, and with directed educational interventions, provide opportunity for measurement of improvement.

Published 10 April 2008 in J Pain Symptom Manage.
Full-text of this article is available online (may require subscription).

Articles on Orthopedics published 8 April 2008:

Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness.   Vet Surg, 37(3): 241-6.

OBJECTIVE: To evaluate the relationship between previously used subjective and objective measures of limb function in normal dogs that had an induced lameness. STUDY DESIGN: Prospective, blinded, and induced animal model trial. ANIMALS: Normal, adult, and mixed-breed dogs (n=24) weighing 25-35 kg. METHODS: Force platform gait analysis was collected in all dogs before and after induction of lameness. All gait trials were videotaped; 60 video trials were evaluated by 3 surgeons with practice ... [Abstract] [Full-text]

Articles on Orthopedics published 4 April 2008:

Application of Software Design Principles and Debugging Methods to an Analgesia Prescription Reduces Risk of Severe Injury From Medical Use of Opioids.   Clin Pharmacol Ther.

A prescription is a health-care program implemented by a physician or other qualified practitioner in the form of instructions that govern the plan of care for an individual patient. Although the algorithmic nature of prescriptions is axiomatic, this insight has not been applied systematically to medication safety. We used software design principles and debugging methods to create a "Patient-oriented Prescription for Analgesia" (POPA), assessed the rate and extent of adoption of POPA ... [Abstract] [Full-text]

Articles on Orthopedics published 28 March 2008:

On-call specialists and higher level of care transfers in California emergency departments.   Acad Emerg Med, 15(4): 329-36.

OBJECTIVES: To survey California emergency department (ED) medical directors' impressions of on-call specialist availability and higher level of care (HLOC) transfer needs and difficulties and changes since the passage of the Emergency Medicine Treatment and Active Labor Act (EMTALA) final rule in 2003. METHODS: The authors conducted a survey of all California ED medical directors from February to June 2006 with regard to the composition of the ED on-call panel and need for HLOC transfer. ED ... [Abstract] [Full-text]

Articles on Orthopedics published 27 March 2008:

Identification of the First Vancomycin Intermediate-Resistant Staphylococcus aureus (VISA) Isolate from a Hospital in Portugal.   Microb Drug Resist, 14(1): 1-6.

A clinical isolate of methicillin-resistant Staphylococcus aureus (MRSA) with intermediate resistance to vancomycin (minimal inhibitory concentration [MIC] of 4 mug/ml) was isolated in 2006 from a surgical wound of a patient hospitalized at the orthopedics ward of Hospital de São Marcos - Braga, in the town of Braga. A combination of molecular typing methods, including pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and staphylococcal chromosomal cassette mec ... [Abstract] [Full-text]

Articles on Orthopedics published 11 March 2008:

The effect of patients' sex on physicians' recommendations for total knee arthroplasty.   CMAJ, 178(6): 681-7.

BACKGROUND: The underuse of total joint arthroplasty in appropriate candidates is more than 3 times greater among women than among men. When surveyed, physicians report that the patient's sex has no effect on their decision-making; however, what occurs in clinical practice may be different. The purpose of our study was to determine whether patients' sex affects physicians' decisions to refer a patient for, or to perform, total knee arthroplasty. METHODS: Seventy-one physicians (38 family ... [Abstract] [Full-text]

Articles on Orthopedics published 6 March 2008:

Giant cell tumor of bone: treatment and outcome of 214 cases.   J Cancer Res Clin Oncol.

BACKGROUND: Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study. PATIENTS AND METHODS: The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage ... [Abstract] [Full-text]

Articles on Orthopedics published 5 March 2008:

Does The Presence Of Proximal Humerus Growth Plate Changes In Young Baseball Pitchers Happen Only In Symptomatic Athletes? A X-Ray Evaluation Of 21 Young Baseball Pitchers.   Br J Sports Med.

OBJECTIVE: To evaluate the prevalence of X-rays changes in the proximal humerus growth plate of 21 young pitchers. DESIGN: Case Series SETTING: This study was conducted at the Department of Orthopedics and Traumatology, ABC Faculty of Medicine, Santo Andre, SP -Brazil. Terciary institution. PATIENTS: We studied 21 male adolescent baseball pitchers with mean age 14.5 years selected from the Brazilian National Team. INTERVENTIONS: The patients were submited to X rays evaluations of the shoulders ... [Abstract] [Full-text]

Articles on Orthopedics published 3 March 2008:

Primary human osteoblasts grow into porous tantalum and maintain an osteoblastic phenotype.   J Biomed Mater Res A, 84(3): 691-701.

Porous tantalum (Ta) has found application in orthopedics, although the interaction of human osteoblasts (HOB) with this material has not been reported. The aim of this study was to investigate the interaction of primary HOB with porous tantalum, using 5-mm thick discs of porous tantalum. Comparison was made with discs of solid tantalum and tissue culture plastic. Confocal microscopy was used to investigate the attachment and growth of cells on porous Ta, and showed that HOB attached ... [Abstract] [Full-text]

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