Background The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well. Questions/purposes (1) What changes in patient-reported outcomes scores occur in patients treated with PAO for hip dysplasia in the setting of a single-surgeon practice? (2) What are the predictors of clinical function and survivorship? Methods All 67 patients presenting to a single surgeon's clinic with hip dysplasia treated with PAO between October 2005 and January 2013 were prospectively followed. Baseline demographic data as well as pre-and postoperative radiographic and functional measurements were obtained with a minimum of 1-year followup. Radiographic criteria included Tönnis grade, Tönnis angle, minimum joint space width, center-edge angle, presence of crossover sign, medial translation of the hip center, and alpha angle. We also used validated outcome measures including the WOMAC, the UCLA Activity Scale, and the SF-12. Multiple regression analysis was used to determine predictors of functional outcome scores. Results There were increases in WOMAC, UCLA, and SF-12 Physical scores. Higher preoperative alpha angle was associated with a lower postoperative WOMAC score (b = À0.47; 95% confidence interval [CI], À0.92 to À0.02; R 2 = 0.08; p = 0.04). The 5-year Kaplan-Meier survivorship was 94.1% (95% CI, 90.7-97.5) with reoperation (ie, hip arthroscopy and/or total hip arthroplasty) used as the endpoint for failure. With the limited numbers available, we could not identify any demographic or radiographic factors associated with reoperation. Conclusions Overall survivorship for the PAO at our center at 5 years is comparable to other clinical series with overall functional scores improving. A greater alpha angle preoperatively was associated with poorer patient-reported outcome scores. Further research is needed to determine how and when intraarticular cartilage damage associated with dysplasia needs to be addressed. Level of Evidence Level IV, therapeutic study.
This paper describes the initiatives that led to a study day for Health Care Assistants in the UK, focusing on the principles and practice of palliative care for practitioners. Topics covered were 'What is palliative care?', 'How can you help patients with pain', 'Needs of the dying patient', 'I don't know what to say', 'Answering awkward questions', and 'Ways of relieving distressing symptoms'. Participants valued the study day and feedback showed that the Health Care Assistants, essentially assistants to qualified nursing staff with minimal or no training themselves, had many vocational and emotional needs that were not being met.
This article describes a study that sought to assess how patients, relatives, doctors and nurses in a palliative care unit viewed pain and pain management, and how standards and expectations for pain relief can be raised by upholding statements of care and agreed partnership values. The results showed that research-based pain management enables the provision of pain control that is acceptable to patients, relatives, doctors and nurses. By valuing patient-centred care, where assessment tools assist communication and information sharing, a partnership of care is established in which patient and professional autonomy are recognized and respected, international recommendations for pain relief are practised and professional codes of conduct upheld. Good pain management requires accurate assessment that is best achieved by open and honest discussion in a supportive environment. Hospices provide specialist symptom control aimed at improving quality of life for patients with advanced disease. They are not only an ideal setting to provide evidence for practice, but also a learning environment for specialist understanding of symptom control and a resource base for other professionals.
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