Epidemiology of recreational archery injuries: implications for archery ranges and injury prevention.

AIM: The aim of this paper was to assess the incidence of injuries in the general population caused by participation in the sport of target archery or bowhunting. METHODS: Descriptive analysis of a national probability sample of hospital based treatments for archery-related injuries, over a 10-year period. RESULTS: The leading injuries were lacerations (62±2%), which most often occurred through mishandling hunting arrows. Puncture wounds accounted for 8±1% and foreign bodies 6±1%, arising from feathers or vanes embedding in the hand, falling onto an arrow, or a rupturing arrow shaft. Contusions and abrasions, often caused by the bowstring hitting the arm, accounted for 6±1% of injuries. Nearly all (99±0.4%) of cases were treated and released. The overall injury rate is 4.4/10000 participants age 6 and over. CONCLUSION: Contrary to the prevailing perception that archery is inherently dangerous, the evidence shows that recreational archery is a very safe sport ­ safer than popular field sports where people risk collisions or falls, such as soccer, basketball or baseball. The injury rate from lacerations could be significantly reduced if bow hunter education courses emphasized safe handling of broadhead arrows. The data suggest that nearly all acute injuries in target archery can be prevented through participation in an accredited training program and the use of basic protective gear (arm guards and shooting gloves). All archery education programs should focus on proper archery stance and joint strengthening to minimize chronic shoulder and back injuries.

Clinical staffing in staff- and group-model HMOs.

Analysts frequently have used health maintenance organization (HMO) staffing patterns as a yardstick for estimating national clinical workforce requirements. Based on a nationwide survey of fifty-four staff- and group-model HMOs, the largest sample yet used in an analysis of this type, this DataWatch examines physician-to-member ratios, the use of nonphysician providers, and HMOs' methods of estimating clinical staffing needs. Overall physician staffing ratios and primary care physician staffing ratios closely resemble those reported in previous studies, but they exhibit wide variability and are strongly correlated with HMO size. Although caution should be exercised when using HMO staffing ratios in projections of physician workforce requirements, the ratios described here support projections of a specialty physician surplus.

Telerehabilitation: managed care's new opportunity.

Recent advances in telecommunications technology are leading to new developments in postacute and rehabilitative care. For about $400 per patient and a telephone hookup, physicians and therapists can provide ongoing, direct care to patients at remote clinics or in their homes. The lack of large-scale randomized controlled trials demonstrating clinical and cost effectiveness in rehabilitation and telemedicine has precluded many payers from reimbursing for services. Guidelines for best use do not currently exist, yet the benefits for payers, providers, and patients could be substantial. Telerehabilitation could become an important modality to MCOs seeking to extend the continuum of postacute care to nonclinical settings.