Is hallway care dangerous? An observational study.

OBJECTIVES: In response to crowding the use of hallway beds has become an increasingly prevalent practice in Emergency Departments (EDs). There is limited research on whether caring for patients in hallways (HP) is associated with adverse outcomes. The goal of this study was to examine the effects of HP triage on 30 day outcomes for ED return, readmission, and mortality. METHODS: We performed a retrospective cohort study at an urban, academic ED comparing HPs (defined as HP for ≥30 min) to matched controls triaged to standard ED beds from 9/30/14 to 10/1/15. We analyzed data from the hospital's clinical data warehouse. Matched controls were selected by gender, age, ethnicity, and language. We used McNemar's test to assess the association between triage location and 30 day study outcomes. We also examined adverse outcomes by triage severity using McNemar's test. RESULTS: A total of 10,608 HPs were matched to control patients. Compared to controls, HPs had 2.0 times the odds of returning to the ED in 30 days (95% CI: 1.8-2.1), 1.6 times the odds of inpatient readmission (95% CI: 1.4-1.9), and 1.7 times the odds of readmission to observation (95% CI: 1.4-2.0). The odds ratio for mortality in HPs versus controls was 0.80, (95% CI: 0.50-1.3). CONCLUSIONS: Patients initially triaged to the hallway have an increased odds of 30 day return to the ED, observation and inpatient admission. After adjusting for ESI, the increased odds for return remained similar. The small sample size precluded testing effects of HP status on mortality.

A review of the management of patellofemoral pain syndrome.

OBJECTIVE: Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. METHODS: Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ≥ 10 participants, with trial data that were published within the last 5 years. RESULTS: Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. CONCLUSION: A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.

The barefoot debate: can minimalist shoes reduce running-related injuries?

Running has evolved throughout history from a necessary form of locomotion to an athletic and recreational pursuit. During this transition, our barefoot ancestors developed footwear. By the late 1970s, running popularity surged, and footwear manufacturers developed the running shoe. Despite new shoe technology and expert advice, runners still face high injury rates, which have yet to decline. Recently, "minimalist" running, marked by a soft forefoot strike and shorter, quicker strides, has become increasingly popular within the running community. Biomechanical studies have suggested that these features of barefoot-style running may lead to a reduction in injury rates. After conducting more outcomes-based research, minimalist footwear and gait retraining may serve as new methods to reduce injuries within the running population.