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Ottawa Knee Rules
The Ottawa knee rules are a set of rules used to help physicians determine whether an x-ray of the knee is needed. They state that an X-ray is required only in patients who have an acute knee injury with one or more of the following: * Age 55 years or older * Tenderness at head of fibula * Isolated tenderness of patella * Inability to flex the knee greater than 90° * Inability to bear weight both immediately and in the emergency department (4 steps) The Ottawa knee rules were derived to aid in the efficient use of radiography in acute knee injuries and have since been prospectively validated on multiple occasions in different populations and in both children and adults. Some studies found the sensitivity of the Ottawa knee rules is 98-100% for clinically significant knee fractures, meaning that 98-100% of all patients with a fracture will meet the criteria for X-ray. However, specificity for the Ottawa knee rules is typically poor, meaning that a significant proportion of those ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Knee
In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis. It is often termed a ''compound joint'' having tibiofemoral and patellofemoral components. (The fibular collateral ligament is often considered with tibiofemoral components.) Structure The knee is a modified hinge joint, a type of synovial joint, which is composed of three functional compartments: the patellofemoral articulation, consisting of the patella, or "kneecap", and the patellar groove on the front of the femur through which it slides; and the medial and lateral tibiofemoral articulations linking the femur, or thigh bone ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Fibula
The fibula or calf bone is a leg bone on the lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long bones. Its upper extremity is small, placed toward the back of the head of the tibia, below the knee joint and excluded from the formation of this joint. Its lower extremity inclines a little forward, so as to be on a plane anterior to that of the upper end; it projects below the tibia and forms the lateral part of the ankle joint. Structure The bone has the following components: * Lateral malleolus * Interosseous membrane connecting the fibula to the tibia, forming a syndesmosis joint * The superior tibiofibular articulation is an arthrodial joint between the lateral condyle of the tibia and the head of the fibula. * The inferior tibiofibular articulation (tibiofibular syndesmosis) is formed by the rough, convex surface of the medial side of the lower end of the f ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Patella
The patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. The patella is found in many tetrapods, such as mice, cats, birds and dogs, but not in whales, or most reptiles. In humans, the patella is the largest sesamoid bone (i.e., embedded within a tendon or a muscle) in the body. Babies are born with a patella of soft cartilage which begins to ossify into bone at about four years of age. Structure The patella is a sesamoid bone roughly triangular in shape, with the apex of the patella facing downwards. The apex is the most inferior (lowest) part of the patella. It is pointed in shape, and gives attachment to the patellar ligament. The front and back surfaces are joined by a thin margin and towards centre by a thicker margin. The tendon of the quadriceps femoris muscle attaches to the base of the patella., with the vastus intermedius muscle ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Sensitivity And Specificity
''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are considered "negative". *Sensitivity (true positive rate) refers to the probability of a positive test, conditioned on truly being positive. *Specificity (true negative rate) refers to the probability of a negative test, conditioned on truly being negative. If the true condition can not be known, a " gold standard test" is assumed to be correct. In a diagnostic test, sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives. For all testing, both diagnostic and screening, there is usually a trade-off between sensitivity and specificity, such that higher sensitivities will mean lower specificities and vice versa. If the goal is to return the ratio at w ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Specificity (statistics)
''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are considered "negative". *Sensitivity (true positive rate) refers to the probability of a positive test, conditioned on truly being positive. *Specificity (true negative rate) refers to the probability of a negative test, conditioned on truly being negative. If the true condition can not be known, a " gold standard test" is assumed to be correct. In a diagnostic test, sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives. For all testing, both diagnostic and screening, there is usually a trade-off between sensitivity and specificity, such that higher sensitivities will mean lower specificities and vice versa. If the goal is to return the ratio at w ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Pittsburgh Knee Rules
The Pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires the use of X-ray to assess a fracture. Criteria * Blunt trauma or a fall as mechanism of injury AND either of the following: ** Age younger than 12 years or older than 50 years. ** Inability to walk four weight-bearing steps in the emergency department. If the patient satisfies the above criteria, they should receive an X-ray to assess for a possible fracture. Accuracy The sensitivity of using the Pittsburgh knee rules is 99% with a specificity of 60%. That means the use of the above rules has a false negative result of 1% and a false positive result of 40%. From a medical point of view, the false positive result is less important as if the patient is positive, they should receive an X-ray to assess for a possible fracture, which has a much higher specificity. However, from a practical point of view, false positives that lead to negative X-ray tests were the very thing that the ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Unnecessary Health Care
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overuse was the predominant factor in its expense, accounting for about a third of its health care spending ($750 billion out of $2.6 trillion) in 2012. Factors that drive overuse include paying health professionals more to do more ( fee-for-service), defensive medicine to protect against litigiousness, and insulation from price sensitivity in instances where the consumer is not the payer—the patient receives goods and services but insurance pays for them (whether public insurance, private, or both). Such factors leave many actors in the system (doctors, patients, pharmaceutical companies, device manufacturers) with inadequate incentive to restrain health care prices or overuse. This drives payers, such as national health insurance systems or the U. ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
ALARP
ALARP ("as low as reasonably practicable"), or ALARA ("as low as reasonably achievable"), is a principle in the regulation and management of safety-critical and safety-involved systems. The principle is that the residual risk shall be reduced as far as reasonably practicable. In UK and NZ Health and Safety law, it is equivalent to SFAIRP ("so far as is reasonably practicable"). In the US, ALARA is used in the regulation of radiation risks. For a risk to be ALARP, it must be possible to demonstrate that the cost involved in reducing the risk further would be grossly disproportionate to the benefit gained. The ALARP principle arises from the fact that infinite time, effort and money could be spent in the attempt of reducing a risk to zero; not the fact that reducing the risk in half would require a finite time, effort and money. It should not be understood as simply a quantitative measure of benefit against detriment. It is more a best common practice of judgement of the balance of r ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Ottawa Ankle Rules
In medicine, the Ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been imaged. However the vast majority of patients with unclear ankle injuries do not have bone fractures. As a result, many unnecessary X-rays were taken, which was costly, time-consuming and a slight health risk due to radiation exposure. The Ottawa ankle rules Ankle X-ray Ankle X-ray is only required if: * There is any pain in the malleolar zone; and, * Any one of the following: ** Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR ** Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR ** An inability to bear weight both immediately and in the emergency department for four steps. Foot X- ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Emergency Medicine
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with Emergency Medical Services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency physicians generally practise in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include; disaster medicine, medical toxicology, point-of-care ultrasonography, critical care medicine, emergency medical services, hy ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Orthopedic Clinical Prediction Rules
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Etymology Nicholas Andry coined the word in French as ', derived from the Ancient Greek words ὀρθός ''orthos'' ("correct", "straight") and παιδίον ''paidion'' ("child"), and published ''Orthopedie'' (translated as ''Orthopædia: Or the Art of Correcting and Preventing Deformities in Children'') in 1741. The word was assimilated into English as ''orthopædics''; the ligature ''æ'' was common in that era for ''ae'' in Greek- and Latin-based words. As the name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventuall ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
