BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.
Aged ; Aged, 80 and over ; Female ; Hip Fractures/*epidemiology/mortality/*therapy ; Humans ; Length of Stay/*statistics & numerical data ; Los Angeles/epidemiology ; Male ; Managed Care Programs/*statistics & numerical data ; Middle Aged ; Patient Readmission ; Postoperative Complications ; Prospective Studies ; Quality of Health Care

Acupuncture ; education ; Acupuncture Therapy ; methods ; Humans ; Los Angeles ; Tai Ji ; United States

PURPOSE: The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures. MATERIALS AND METHODS: From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function. RESULTS: Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation. CONCLUSION: Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.
Anesthesia, Local ; California ; Clavicle ; Humans ; Los Angeles ; Range of Motion, Articular ; Shoulder ; Shoulder Joint

BACKGROUND/AIMS: Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. METHODS: A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. RESULTS: The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (> or = 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride > or = 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level > or = 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. CONCLUSIONS: The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.
Body Mass Index ; Delivery of Health Care ; Endoscopy ; Esophagitis ; Esophagitis, Peptic ; Fasting ; Glucose ; Helicobacter pylori ; Hernia, Hiatal ; Internship and Residency ; Korea ; Los Angeles ; Multivariate Analysis ; Obesity ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Risk Factors

BACKGROUND/AIMS: Esophagogastric junctional lesions, such as mucosal breaks with Los Angeles grade A or B reflux esophagitis, lacerations in Mallory Weiss syndrome, and short segment Barrett's esophagus, are mainly found in the right anterior wall of the distal esophagus. Asymmetrical lower esophageal sphincter pressure and resting radial asymmetrical acid reflux may be causes of this asymmetrical distribution of reflux esophagitis and short segment Barrett's esophagus. We developed a novel pH and pressure catheter to investigate the asymmetrical distributions of pH and intra-esophageal pressure in the distal esophagus. METHODS: One healthy male volunteer was enrolled in this study. Acid reflux and motor function in distal esophagus was investigated using simultaneous measurements of intra-esophageal pH and pressure in 8 directions with novel sensor catheter. RESULTS: Thirty-six acid and weak acid reflux events were observed, of which 22 were circumferential refluxes with pH drops in all channels and 14 were partial refluxes with pH drops in some channels. Increase in transient circumferential intraesophageal pressure was observed just after 72.7% of the circumferential reflux and 42.9% of the partial reflux events. CONCLUSIONS: Using a novel sensor catheter, 2 different types of acid reflux events were identified in the present study.
Barrett Esophagus ; Catheters ; Esophageal Sphincter, Lower ; Esophagitis, Peptic ; Esophagus ; Feasibility Studies ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Lacerations ; Los Angeles ; Male ; Mallory-Weiss Syndrome

BACKGROUND/AIMS: Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence > or =2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs). METHODS: Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with > or =25% Asian patients in their practice were eligible. RESULTS: Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed > or =200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that < or =25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that < or =50% of their adult Asian patients had received the HBV vaccine. CONCLUSIONS: Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed.
Adult ; Asian Americans ; Asian Continental Ancestry Group ; Chicago ; Data Collection ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Liver Neoplasms ; Los Angeles ; Mass Screening ; New York ; Prevalence ; Primary Health Care ; San Francisco ; Vaccination

PURPOSE: The purpose of this study was to investigate when the quality of life improve after rotator cuff repair. MATERIALS AND METHODS: Eighty-five consecutive cases with rotator cuff repair were studied. Patients completed the visual analogue scale (VAS), University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeon's scale (ASES), Korean Shoulder scale (KSS), and the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) preoperatively and at postoperative 3, 6, and 12 months. For evaluation of serial recovery pattern, section I (preoperatively-postoperative 3 months), section II (postoperative 3 months-postoperative 6 months), and section III (postoperative 6 months-postoperative 12 months) were divided. RESULTS: The mean WHOQOL-BREF score was significantly improved from 58.8 preoperatively to 66.4 at postoperative 12 months, with improvement of VAS, ULCA, ASES, and KSS scores. On serial recovery pattern, all measurements in section I, VAS, UCLA, and KSS scores in section II, and UCLA score in section III, were significantly improved. Female sex had a negative effect on all outcome measurements at postoperative 12 months. CONCLUSION: Our results showed improvement of quality of life as well as reduced pain and increased function at 3 months after rotator cuff repair. Further recovery of clinical outcomes showed gradual progress until postoperative 12 months.
California ; Elbow ; Female ; Humans ; Los Angeles ; Quality of Life ; Rotator Cuff ; Shoulder ; World Health Organization

BACKGROUND/AIMS: The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis. METHODS: We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model. RESULTS: Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001). CONCLUSIONS: In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.
Body Mass Index ; Case-Control Studies ; Electrolytes ; Endoscopy ; Esophagitis ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Helicobacter ; Helicobacter pylori ; Los Angeles ; Prevalence ; Risk Factors ; Smoke ; Smoking

BACKGROUND/AIMS: Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the population with high prevalence. Carlsson-Dent questionnaire (CDQ) is a standardized symptom-based diagnosis tool for GERD. The value of this tool in the population with low prevalence is unknown. The aim of this study was to determine CDQ performance for diagnosis of GERD in Thai population with low prevalence versus endoscopy or 24 hour pH monitoring. METHODS: Patients with dyspepsia by Rome II criteria were recruited. All patients completed a Thai version of CDQ and underwent endoscopic examination. Those without esophagitis or peptic ulcer and positive CDQ score took pH monitoring. RESULTS: One hundred patients (68 female) with mean age +/- SD of 45.6 +/- 12.4 years were recruited. Six with Los Angeles grade A esophagitis had negative CDQ score. In 44 with positive CDQ score, 3 had Los Angeles grade B esophagitis and 41 had pH monitoring done with 8 having positive test. The GERD diagnosis by CDQ was confirmed in 11 of 44 patients (25%). CDQ detected 11 out of 17 GERD detected by endoscopy and pH monitoring and the sensitivity of CDQ was 64%. CONCLUSIONS: CDQ diagnosed more GERD in Thai population with low prevalence compared with endoscopy and pH monitoring. This may be due to some patients with functional heartburn were picked up by CDQ and some patients with GERD were not detected by endoscopy and pH monitoring.
Asian Continental Ancestry Group ; Dyspepsia ; Endoscopy ; Esophagitis ; Gastroesophageal Reflux ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Los Angeles ; Peptic Ulcer ; Prevalence ; Surveys and Questionnaires ; Rome

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.
California ; Follow-Up Studies ; Humans ; Los Angeles ; Magnetic Resonance Imaging ; Rotator Cuff ; Shoulder ; Sutures ; Tendons