Five patients severely affected by haemophilia, in whom six knees showed advanced haemophilic arthropathy, have been studied. The patients presented with painful limitation of movement and increasingly frequent episodes of spontaneous bleeding in the affected knees. These all showed secondary degenerative changes and varus deformity. A Corrective osteotomy of the proximal tibia was performed under full haematological cover without complications. Follow-up ranged from 6 to 36 months, with a mean of 18 months. At follow-up all patients were free of pain and had retained their range of movement. In the three patients with a longer follow-up there was radiological improvement. The most significant feature was that there was almost complete cessation of bleeding episodes into the knee in all patients and no progression of the arthropathy. The cost benefit implications of this corrective procedure are discussed.
Objective
To investigate musculoskeletal disorders, psychological comorbidity, and general physical and mental health and wellbeing in Gulf War veterans and a military comparison group.
Methods
Cross-sectional study of 1456 male Australian 1990–1991 Gulf War veterans (veterans) and a non-Gulf comparison group (n = 1588). At a medical assessment in 2000–2002, reported doctor diagnosed arthritis or rheumatism, back or neck problems, joint problems, soft tissue disorders were rated by medical practitioners as non-medical, unlikely, possible, or probable diagnoses. Only musculoskeletal disorders rated as probable diagnoses were included in analyses. DSM-IV psychological disorders were measured using the Composite International Diagnostic Interview. Physical and mental health and wellbeing was assessed using the 12-item Short-Form Health Survey (SF-12).
Results
Almost one-quarter of veterans (24.5%) and comparison group (22.4%) reported a musculoskeletal disorder (odds ratio OR 1.19; 95% CI 1.00–1.43). Having any or a specific musculoskeletal disorder was associated with depression and posttraumatic stress disorder (PTSD) but not alcohol use disorders. Physical health and wellbeing was poorer in those with a musculoskeletal disorder compared to those without (e.g., for veterans, difference in SF-12 PCS medians = -10.49: 95% CI -12.40, -8.57). Mental health and wellbeing was poorer in those with comorbid depression or PTSD compared to those with musculoskeletal disorders alone (e.g., for veterans, difference in SF-12 MCS medians = -20.74: 95% CI -24.3, -17.18). Similar patterns were found for the comparison group.
Conclusions
Musculoskeletal disorders in the military were associated with depression and PTSD and poorer physical and mental health and wellbeing. Comorbidity of these conditions has implications for treatment and management and should be considered during assessment.
The application of the Clinical Decision Support Systems (CDSS) in the process of facilitating the activity of the evidence-centred treatment project effect enhances the quality of the healthcare services. The main purpose of this article is to define and illustrate the basis of the processes of the evidence-centred decision support tracking at the two thousand AMIA symposium spring. The analysis has been done on the basis of protocol issues when capturing the evidence-centred practices in machine interpretation and repositories for supporting and developing the CDSS for evidence-centred treatment. As a result, the research recommendations are based on five areas: capturing literature-centred and practice-centred evidence in the interpretation of machine knowledge and bases; creating maintainable methodological and technical elements for computer-centred decision support CDSS; assessing the medical costs and effects for clinical decision support system and the manner in which the systems affect the organizational best practices; disseminating and identifying the works based on work-flow sensitivity approach for the system and creating the public policy which will effectively provide the incentives meant to implement CDSS to enhance the quality of healthcare services. The paper is concluded with an assumption of evidence-based medicine aspect being strong. However, future research is still recommended in CDSS to potentially realize more defined benefits of the systems.
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