Home Management Versus Primary Care Physician Follow-up of Patients With Distal Radius Buckle Fractures: A Randomized Controlled Trial.

STUDY OBJECTIVE: In patients with a distal radius buckle fracture, we determine whether home removal of a splint and physician follow-up as needed (home management) is noninferior to primary care physician follow-up in 1 to 2 weeks with respect to functional recovery. We also compare groups with respect to health care and patient-level costs. METHODS: This was a noninferiority randomized controlled trial conducted at a tertiary care children's hospital. Eligible patients were randomized to home management versus primary care physician follow-up and received telephone contact at 3 and 6 weeks after the index ED visit. Functional recovery was measured with the Activities Scale for Kids-performance, and participants reported wrist-injury-related health care interventions and expenses. The primary outcome was a comparison of the performance score between groups at 3 weeks. RESULTS: We enrolled 149 patients with mean age 9.5 years (SD 2.7 years), and 81 (54.4%) were male patients. Of the 133 patients (89.3%) with completed 3-week follow-up, the mean Activities Scale for Kids-performance score was 95.4% in the home management group (n=66) and 95.9% in the primary care physician follow-up group (n=67) (mean difference -0.4%; lower bound of the 95% confidence interval -2.4%). There was a mean costs savings of -$100.10 (95% confidence interval -$130.0 to -$70.20) in health care and -$28.2 (95% confidence interval -$49.6 to -$7.0) in patient costs in the home management versus primary care physician follow-up group. CONCLUSION: In patients with distal radius buckle fractures, home management is at least as good as primary care physician follow-up with respect to functional recovery. Implementation of the home management strategy also demonstrated significant cost savings.

Imagem do enfermeiro sob a ótica do acadêmico de enfermagem / Image of nurse under the perspective of the nursing academic

Objetivo: conhecer a imagem do enfermeiro frente ao acadêmico de enfermagem. Metodologia: estudo de caso qualitativo fundamentado na Sociologia Compreensiva do Cotidiano, realizado com 26 participantes do 9º período de uma instituição de ensino superior. Os dados foram coletados por meio da entrevista individual e analisados segundo Análise de Conteúdo Temática. Resultados: a imagem se postula em um profissional essencial na área da saúde, que organiza o setor, gerencia ações, lidera a equipe, presta assistência aos pacientes e é referência para outros profissionais. Conclusão: a (des)valorização do profissional foi um dos aspectos na construção dessa imagem e na percepção positiva/negativa do acadêmico frente ao futuro na profissão.

Objective: to know the image of the nurse in front of the nursing academic. Methodology: a qualitative case study based on the Comprehensive Sociology of Daily Life, carried out with 26 participants from the 9th period of an institution of higher education. The datas were collected through the individual interview and analyzed according to the Thematic Content Analysis. Results: The image postulates itself in a essencial professional in the health area, which organizes the sector, manages actions, leads the team, provides assistance to patients and is a reference for other professionals. Conclusion: The (de) valuation of the professional was one of the aspects in the construction of this image and in the positive / negative perception of the academic towards the future in the profession.

Objetivo: conocer la imagen de la enfermera en el estudiante de enfermería. Metodología: estudio de caso cualitativo basado en la sociología comprensiva de la vida cotidiana, que se celebró con 26 participantes del noveno período de una institución de educación superior. Los datos fueron recolectados a través de entrevistas individuales y se analizaron mediante análisis de contenido temático. Resultados: La imagen se postula un profesional esencial en el campo de la salud, que organiza el sector, gestiona las acciones, dirige el equipo, ayuda a los pacientes y es un punto de referencia para otros profesionales. Conclusión: La (des) valoración profesional fue uno de los aspectos de la construcción de la imagen y la percepción positiva / negativa frente académico del futuro en la profesión.

Primary Care Physician Follow-up of Distal Radius Buckle Fractures.

OBJECTIVES: Our main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy. METHODS: This prospective cohort study was conducted at a tertiary care pediatric emergency department (ED). Eligible children were aged 2 to 17 years with a distal radius buckle fracture treated with a removable splint and referred to the PCP for reassessment. We telephoned families 28 days after their ED visit. The primary outcome was the proportion who received PCP follow-up exclusively. We also measured the proportion who received PCP anticipatory guidance and those children who reported returning to usual activities "always" by 4 weeks. RESULTS: We enrolled 200 children, and 180 (90.0%) received telephone follow-up. Of these, 157 (87.2% [95% confidence interval: 82.3 to 92.1]) received PCP follow-up exclusively. Specifically, 11 (6.1%) families opted out of physician follow-up, 5 (2.8%) self-referred to an ED, and the PCP requested specialty consultation in 7 (3.9%) cases. Of the 164 with a PCP visit, 77 (47.0%) parents received anticipatory guidance on return to activities for their child, and 162 (98.8%) reported return to usual activities within 4 weeks. CONCLUSIONS: The vast majority of children with distal radius buckle fractures presented to the PCP for follow-up and did not receive additional orthopedic surgeon or ED consultations. Despite a suboptimal rate of PCP advice on return to activities, almost all parents reported full return to usual activities within 4 weeks.

Bone fractures in children: is there an association with obesity?

OBJECTIVE: To determine the relationship between body mass index (BMI) and odds of extremity bone fractures in children. STUDY DESIGN: This was a prospective cross-sectional study conducted at 2 tertiary care pediatric emergency departments. A convenience sample of children 2-17 years of age with a nonpenetrating extremity injury was enrolled. Demographics, activity level, mechanism of injury, participant BMI, and presence of a fracture were recorded. The main outcome was the odds of an extremity bone fracture based on BMI category; logistic regression was used to estimate the odds of fracture by BMI category. RESULTS: We enrolled 2213 children, of whom 1078 (48.7%) sustained a fracture and 316 (14.3%) were classified as obese. The mean (SD) age was 9.5 (4.2) years, and percentage of male children was 56.8%. Compared with children with a normal BMI, the adjusted odds of fracture among obese, overweight, and underweight children were 0.75 (0.58, 0.97), 1.15 (0.89, 1.48), and 1.44 (1.00, 2.07) respectively. CONCLUSIONS: Obese children had a minor but statistically significant decreased odds of fracture relative to children with a normal BMI, but no association was observed in overweight children. However, underweight children were found to be at an increased odds of fracture. This study suggests that overweight and obese children do not have increased odds of extremity fracture.

Variables posiblemente asociadas a depresión posparto, según escala Edimburgo / Variables probably associated to postpartum depression, according to the Edimburg scale

Analizar algunas variables sociodemográficas, obstétricas y perinatales asociadas al riesgo de depresión posparto, según escala de Edimburgo. Departamento de Obstetricia y Puericultura. Facultad de Medicina, Universidad de Concepción y Hospital de Coronel, Chile. Estudio analítico, observacional en 50 puérperas que asistieron a control a la 6° semanas posparto en el 2006. Se les aplicó la escala de Edimburgo, escala de Graffar y un instrumento de variables obstétricas y perinatales. Para el análisis estadístico se aplicó las pruebas Fisher y Chicuadrado. La frecuencia de test positivo según escala de Edimburgo, fue de 22 por ciento. La edad, escolaridad, estado civil, nivel socioeconómico, paridad, patologías del embarazo, tipo de parto, hospitalización del recién nacido, no resultaron estadísticamente diferentes para riesgo de depresión posparto. Es necesario realizar un tamizaje universal para la pesquisa precoz de depresión posparto y realizar nuevos estudios considerando otros factores asociados.

To analyze some socio-demographic, obstetrical and perinatal factors associated to postpartum depression risk in women, according to the Edinburgh Postnatal Depression Scale. Setting: Department of Obstetrics and Puericulture. Faculty of Medicine, University of Concepcion and Hospital of Coronel, Chile. Analytical and observational study in 50 postnatal women that attended control to six weeks pospartum in 2006. It was applied the Edinburgh Postnatal Depression Scale, Graffar scale and an instrument of obstetrical and perinatal variables. For the statistical analysis, the Fisher and Chisquare tests were applied. The frequency of positive test accordong to the Edinburg scale was 22 percent. The age, marital status, socioeconomic level, parity, pregnancy pathologies, type of delivery, and hospitalization of newborn, were not statistically different for postpartum depression risk. It is necessary to make a universal screening for the precocious detection of postpartum depression and to performe studies considering other associated factors.