A STUDY TO ASSESS THE EFFECTIVENESS OF HELFER SKIN TAP TECHNIQUE ON THE LEVEL OF PAIN REDUCTION DURING INTRA MUSCULAR INJECTION AMONG ORTHOPAEDIC PATIENT OF PANDIT DEEN DAYAL UPADHYAYA (CORONATION) GOVERNMENT HOSPITAL DEHRADUN UTTARAKHAND

Pain is an unpleasant sensory and emotional feeling accompanying existing or impending tissue damages or reference to such damage.According to WHO annual report more than 16 billion IM injections are administered throughout the word. Aim: This study is intended to determine the effectiveness of Helfer skin tap technique on the level of pain reduction during IM injection among orthopedic patient of PanditDeenDayalUpadhaya (Coronation)Government Hospital, Dehradun Uttarakhand. Methodology: An experimental approach with cross-over design was adopted for the study. The study samples were orthopedic patients who receiving IM diclofenac injection. There were 50 subjects that fulfill the inclusion and exclusion criteria are divided into two experimental groups (25 samples in each groups) by simple random sampling technique. The pain level was assessed by universal numerical pain rating scale .The pain level with the administration of intramuscular injection by Helfer skin tap technique was compared with a pain level with conventional Technique. Result:The result shows that in experimental group I majority of sample 52%perceived mild pain with Helfer skin tap technique whereas with majority of samples 64% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.88 was less than conventional technique 5.32.The obtained t value was 3.80 was significant at p<0.05 level of significance.Inexperimental group II majority of sample 64% perceived mild pain with Helfer skin tap technique whereas with majority of samples 68% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.52 was less than conventional technique 5.16.The obtained t value was 5.479 was significant at p<0.05 level of significance In period I the mean pain score using Helfer skin tap technique in experimental group I 3.88 was less than mean pain score of conventional technique in experimental group II 5.15.the obtained t value was found statistically significant at p<0.05 level. In period II the mean pain score using Helfer skin tap technique 3.52 was less than the mean pain scores of conventional technique 5.32.the obtained t value 4.5 was statistically significant at p<0.05 level of significance. There was no significant association found between level of pain during intramuscular injection with selected demographic variables. The overall result shows that Helfer skin tap technique was helpful in reducing the level of pain during intramuscular injection among orthopedic patients.

Single center, observational study to analyze correlation between vitamin D-3 deficiency and age in patients with orthopedic disorders

<p><strong>Background:</strong> Vitamin D deficiency has been strongly associated with various health outcomes, including all-cause mortality. Chronic vitamin D deficiency in adults and in old age results in osteomalacia, osteoporosis, muscle weakness, and increased risk of fall and long bone fractures. <strong></strong></p><p><strong>Methods:</strong> We examined records of 1029 such patients and to analyze association of vitamin d-3 levels and categories of age groups (1-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We categorized mild, moderate and severe cases age wise.</p><p><strong>Results: </strong>During the study period records for 1029 patients were evaluated, of which 347 (33.72%) male and 682 (66.27) were female the mean age with standard deviation for male was 38.25±15.64 years and for female was 41.43±15.23 years. Vitamin D deficiency (&lt;20 ng/ml) was present in 623 patients (61%), 189 patients (18%) had vitamin D level 20-30 ng/ml and 217 patients (21%) had sufficient levels of vitamin D.</p><p><strong>Conclusions:</strong> Our study concludes that although there is high prevalence of vitamin D-3 deficiency across all age groups among orthopedic patients, age group 31-40 years, was found to be more affected.</p><p><strong> </strong></p>

The benefits of computed tomography imaging in the diagnosis, prognosis and treatment planning of equine orthopedic patients illustrated by six cases

Radiography and/or ultrasonography are the first imaging modalities for diagnosing orthopedic pathology in equine patients. However, in some cases, cross-sectional imaging is necessary to reach a more accurate diagnosis. Six cases were retrospectively selected from the imaging database of the Faculty of Veterinary Medicine (Ghent University) to illustrate the benefits of computed tomography (CT) in orthopedic patients. In two cases, CT demonstrated osteomyelitis lesions in two young foals, which could not be detected with radiography and ultrasonography. In three cases, CT was performed for surgical planning of fracture repair, and in one case CT demonstrated multiple lesions at the soft tissues and ligamentous insertions in the stifle. In all cases, CT revealed additional findings, which were important for the treatment and prognosis of the patient.

Opioid use in Older Orthopedic Rehabilitation Inpatients: A Retrospective Study

Background: While there is much evidence about pain management for orthopedic patients in the immediate perioperative setting, little is known about how opioids are used during inpatient rehabilitation in the days and weeks that follow, particularly in older adults. A safe upper limit of 50 oral morphine equivalents (OME) is frequently cited in guidelines. This study’s objective is to characterize the use of opioids in an older adult population undergoing orthopedic rehabilitation. Methods: This is a retrospective observational study of adults aged ≥50 years old admitted for orthopedic rehabilitation between November 2019 and June 2021 at an academic rehabilitation hospital in Toronto, Canada. Acute care admissions preceding rehabilitation were for either a surgical or non-surgical orthopedic indication. Participants were divided into opioid-naïve individuals who received opioids, opioid-naïve individuals who did not receive opioids, and pre-existing chronic users of opioids. Demographic, clinical, and medication administration data were collected through the electronic health record and manual chart review. Average daily opioid dose for the first seven days of each stay was characterized using OME. Linear regression was used to assess for variables independently associated with opioid dose. Results: A total of 643 patients undergoing orthopedic rehabilitation were included: 125 (19.4%) involved chronic opioid users, 416 (64.7%) were opioid-naïve patients who received opioids, and 102 (15.9%) were opioid-naïve patients who did not receive opioids, with median age respectively of 72, 79, and 83. Median daily OME over the first week for chronic users was 30.3 and for opioid-naïve users was 6.9. Opioid dose was significantly positively associated with reported pain as defined by day 3 pain score and knee replacement; it was inversely associated with admission for a non-surgical indication and age. Conclusions: Opioids are frequently but heterogeneously used in older adults undergoing orthopedic rehabilitation. Median OME use in this cohort of older adults was substantially lower than the 50 OME threshold suggested in guidelines. Dedicated guidance for opioid use is warranted for this unique patient population.

Factors influencing online orthopedic doctor–patient consultations

Background Online doctor–patient consultation is a new option for orthopedic patients in China to obtain a diagnosis and treatment advice. This study explores the factors associated with online consultation to formulate operational guidelines for managing online consultations in an online medical community (OMC). Methods An empirical model was developed to identify the factors that influence online orthopedic doctor–patient consultations in an OMC while focusing on the perceived value of and perceived trust in online consultations. The moderating effects of different risk categories of orthopedic diseases were also considered. Data from 339 feedback surveys from orthopedic patients who used online consultation services and Stata software version 14.0 were used to estimate the model parameters and test the robustness of the empirical model. Results Of those who completed the feedback surveys, 53.42% were female patients, 82.27% were between 18 and 60 years old, and 61.98% sought consultations online more than 2 times per year. Model analysis demonstrated that the regression coefficients of the perceived value of and perceived trust in online consultations are 0.489 (p < 0.01) and 0.505 (p < 0.01), respectively. The interaction coefficient between disease risk and perceived value is 0.336 (p < 0.01), and the interaction coefficient between disease risk and perceived trust is − 0.389 (p < 0.01). Conclusions Orthopedic patients’ perceived value of and perceived trust in online consultations in an OMC can significantly influence their intention to seek online disease diagnosis and treatment consultations. The effects of perceived value and perceived trust on patients' intention to consult vary significantly across different disease risk categories. Therefore, enhancing the perceived value and perceived trust of orthopedic patients is an important component of OMC operation and management.

Music Intervention to Orthopedic Patients: A Possible Alternative Solution to Control Pain

Aims and Objective. Pain is a common problem associated with postoperative orthopedic patients; the current study is aimed at evaluating music intervention as an alternative method to control pain. Methodology. The experimental design of the current study was comparative, descriptive, and quasi-experimental. 38 postoperative orthopedic patients were equipped with pocket-size MP3 players with prerecorded music tracks (instrumental and lyrical) in Hindi, English, and Urdu. After that, pre-post-pain scores were recorded with the help of designed brief patient logs. Ultimately, a satisfactory survey was completed at discharge. Major Findings. It was found that during the intervention of music, the pain was significantly reduced from 5.40 to 2.98. There was a slight relationship between listening time and pain relief. It was also found that the feedback was extremely positive and each patient suggested the use of music to others with 96.6% recommendation. Conclusion. From the current study, it was found that music intervention can be beneficial to postoperative patient pain control. Further, it is hoped that the findings of the current experimental work will lead to improvements in the care of postoperative patients.

Systematic review and meta-analysis of opioid use at 3, 6 and 12 months post-operatively by opioid naïve orthopaedic surgery patients

Background and objective: There is evidence that opioid initiation post-surgery is contributing to the problem of chronic misuse and/or abuse of over the counter medications in the community, and that orthopedic patients may be particularly at risk. The aim of the systematic review with meta-analysis was to identify research that examined opioid use at 3, 6, and 12 months post-operatively by previously opioid naïve orthopedic surgery patients.Design, databases, and data treatment: A searched review with meta-analysis was undertaken. Eight databases were search. Meta-analyses conducted at all three time points (3 months, 6 months, and 12 months).Results: The search yielded 779 records, and after screening, 13 papers were included in meta-analysis. Results provide strong evidence that post-operative opioid use amongst the opioid naïve is a real effect (7 percent at 3 months, 4 percent at 6 months, and 2 percent at 12 months). A Z-test for overall effect revealed strong evidence that this proportion was nonzero for opioid use at 3, 6, and 12 months (p 0.001 for all time points). A small but significant proportion of opioid naïve patients who are prescribed opioids remain on these medications up to 12 months post-operatively.Conclusions: The nature of the studies included in the meta-analysis were varied, hence subanalyses regarding surgery type, characteristics of the patient group or other potential factors that might influence the progression to longer term opioid use after these surgeries could not be explored. Given this, further research in this area should explore such specific orthopedic subgroups.