The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · May 1997
Clinical Trial Controlled Clinical TrialEvaluation of a critical pathway for stroke.
The diagnosis of stroke, which is diagnosis-related group (DRG) 014, is the fourth most frequent discharge DRG at Macomb Hospital Center, Warren, Michigan. The length of stay for stroke was 7.52 days before intervention. ⋯ Quality of care was also improved in delivery time of carotid artery ultrasound examinations, as well as in timeliness of obtaining head computed tomography scans and reports. This article describes the development, implementation, and results of a stroke critical pathway that was implemented to address excessive length of stay.
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In the United States, approximately 1.5 million to 2 million persons practice the martial arts. It is the general belief that martial arts are safe, with little thought given to the physical forces involved. Some enthusiasts gravitate to the martial arts to learn self-defense, whereas others participate to improve cardiovascular fitness, flexibility, and self-esteem. ⋯ Occasionally fractures occur, most often involving the hands and digits. The neurosurgical literature indicates that wearing headgear increases the shearing injury to nerve fibers and neurons in the brain in proportion to the degree of acceleration to the head. Three case presentations illustrate death resulting from anterior chest trauma.
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J Am Osteopath Assoc · Aug 1996
Case ReportsInferior glenohumeral dislocation (luxatio erecta humeri).
A 67-year-old woman was seen in the emergency department because of severe pain and inability to move her left shoulder after falling on an abducted left arm. The fall was the result of a near-syncopal episode. On examination, the left arm was hyperabducted and elevated approximately 80 degrees from the horizontal plane. ⋯ It is important to obtain orthopedic consultation or follow-up (or both) for this injury, because of the high incidence of accompanying tears of the rotator cuff. Neurovascular compromise is also commonly associated with this dislocation. The neurologic injuries are more common than the vascular injuries but tend to resolve after reduction.
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The author provides practitioners with a summary of recent trends in the management of acute pain in children. This review encompasses pharmacologic techniques as they pertain to two common acutely painful conditions in children: postoperative and procedural pain. ⋯ In the area of procedural pain, current standards for safety guidelines and several recently introduced sedative and analgesic medications are discussed. The author emphasizes that the proper and safe alleviation of acute pain in the pediatric population is not only feasible but is currently the standard of care in the United States.