RESUMEN
Pelvic and sacral dysfunctions resulting from sports-related injuries are unusual. A simple groin pull, however, can prohibit an athlete from participating in sports activities for an extended period of time. Pelvic floor dysfunctions can be particularly impairing for women athletes, and are rarely discussed in sports literature. This article reviews the anatomy, biomechanics, common injury patterns, and treatment options for athletic injuries related to the pelvis.
Asunto(s)
Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/rehabilitación , Pelvis/fisiopatología , Sacro/fisiopatología , Traumatismos en Atletas/complicaciones , Fenómenos Biomecánicos , Ingle/lesiones , Ingle/fisiopatología , Humanos , Diafragma Pélvico/lesiones , Diafragma Pélvico/fisiopatología , Pelvis/lesiones , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/fisiopatología , Sacro/lesiones , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Esfuerzo/fisiopatología , Incontinencia Urinaria de Esfuerzo/terapiaRESUMEN
STUDY DESIGN: Multicenter, prospective, observational study. OBJECTIVES: To document the incidence of and factors associated with intravascular uptake during lumbar spinal injection procedures. SUMMARY OF BACKGROUND DATA: In prior reports, the incidence of inadvertent intravascular needle placement during contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures has been incidentally noted to range from 6.4% to 9.2%. We present the first systematic prospective documentation of intravascular uptake of contrast dye during different types of lumbar injection procedures. METHODS: Fifteen interventional spine physicians in seven centers recorded data regarding intravascular uptake during 1219 contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures. RESULTS: The overall incidence of intravascular uptake during lumbar spinal injection procedures as determined by contrast enhanced fluoroscopic observation is 8.5%. Caudal and transforaminal routes have the highest rates at 10.9% and 10.8%, respectively, followed by zygapophyseal joint (6.1%), sacroiliac joint (5.3%), and translaminar (1.9%) injections. Intravascular uptake is twice as likely to occur in those patients over rather than under 50 years of age. Preinjection aspiration failed to produce a flashback of blood in 74% of cases that proved to be intravascular upon injection of contrast dye. CONCLUSION: The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.
Asunto(s)
Medios de Contraste/metabolismo , Inyecciones Espinales , Vértebras Lumbares/metabolismo , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Distribución por SexoRESUMEN
OBJECTIVE: To quantify physician knowledge of hospital charges and determine if computer fiscal feedback would improve physician awareness of hospital charges. DESIGN: Comparison of physicians' knowledge of hospital charges before and 6 months after the instigation of a computer feedback educational program. PARTICIPANTS AND SETTING: All physicians (attendings, residents, and fellows) at a large academic rehabilitation hospital. INTERVENTION: After surveying physicians' knowledge of hospital charges, the billing fees for some items were placed on the computer ordering menu so that these charges were viewed when orders were made by physicians. MAIN OUTCOME MEASURES: Error in physician charge estimates before and after computer education program, and physician confidence in charge estimates. RESULTS: The baseline survey found that physicians had poor awareness of hospital charges, regardless of ordering frequency, relative charge for the item, or physician experience. Physicians expressed little confidence in their knowledge of the charges and were twice as likely to underestimate than to overestimate charges. Six months after the implementation of a computer feedback educational program, improvement was seen in the awareness of hospital charges for all imaging studies and most laboratory tests. Fiscal awareness of items that had not been included in the computer feedback also showed some small improvement. Physicians' confidence in their knowledge of fees improved. Physicians indicated the program was beneficial and should be expanded to include fiscal information on more services. CONCLUSIONS: Immediate computer feedback of hospital charges improves physicians' fiscal awareness and may lead to their practice of more cost-efficient medicine.
Asunto(s)
Instrucción por Computador/métodos , Educación Médica Continua/métodos , Precios de Hospital , Cuerpo Médico de Hospitales/educación , Centros de Rehabilitación/economía , Evaluación Educacional , Retroalimentación , Conocimientos, Actitudes y Práctica en Salud , Sistemas de Información en Hospital , Humanos , Cuerpo Médico de Hospitales/psicologíaRESUMEN
Containment of health care costs is a pressing national issue. In this study, we examined physician knowledge of rehabilitation hospital costs by quantifying their awareness of hospital charges. All physicians at a free-standing rehabilitation hospital were surveyed. Approximately one-half of the physicians responded, including 19 attending and 17 resident physicians. The survey addressed three issues: physicians' estimate of the billing fee (hospital charge to the patient) for various items; how confident they were of the charge; and how frequently they ordered each item. The survey listed 65 items including diagnostic testing, drugs, therapies, and equipment. The average error in the charge estimates was quite large. For example, it was 52, 48, and 108% for hematologic tests, imaging studies, and pharmaceuticals, respectively. Charges were underestimated twice as often as they were overestimated. Physicians' confidence in their knowledge of these fees was quite low. They indicated that they were guessing 80 to 90% of the time, had an idea of the cost for 10 to 20% of the items, and were confident in their knowledge for less than 1% of the items. There were no significant correlations between accuracy of the charge estimates and ordering frequency, actual charge of the item, or experience level of the physicians.