Might hospital length of stay decrease in a normal healthcare setting following implementation of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty?

BMC Musculoskeletal Disorders

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Q and A for moderating that office thermostate …

“Q. Now that the air-conditioning is running in your office, you and some co-workers think it’s too cold. But others say they feel just fine. What’s going on?

A. The problem is that the way people experience temperature depends on a range of factors, including body type, clothing, activity level and proximity to other people and to vents, computers and windows — as well as individual preferences and expectations.

At the same time, most modern office buildings have a one-size-fits-all design that can’t possibly accommodate all these variables. “You’re almost set up to fail when you put a lot of people in a building and give them one temperature,” said Gail S. Brager, a building science professor in the architecture department at the University of California, Berkeley.

Think of how much more control you have over your comfort at home, she said. You can open windows, turn on fans, heaters or air-conditioners, change clothes or move to a different room. At most offices, you lose that control. “Somebody else is pushing the button,” said Professor Brager, who is also associate director of the Center for the Built Environment at Berkeley.

Rather than creating optimal working conditions for everyone, she added, the goal in many offices “is to minimize the number of people who might complain.”

Q. It seems as if women complain about feeling cold more than men do. Is there a gender disparity when it comes to temperature’s effects?

A. Women do tend to feel colder in air-conditioned offices — for reasons of physiology and fashion, said Alan Hedge, an ergonomics professor at Cornell University.

The muscles of the body generate about a third of its heat, he explained, and women tend to have less muscle mass than men. In addition, women are often freer to wear clothing that leaves their arms, legs and the neck area exposed. (The ankles, he said, are particularly vulnerable to cold.)

Traditionally, women in offices have held more sedentary positions than men, he added, and the less you move around, the less heat you generate.”    (Continued via NYTimes.com, Phyllis Korkki)    [Ergonomics Resources]

Cold Office

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Searching for the Open Door: A Woman’s Struggle for Survival after A Traumatic Brain Injury (Paperback)
By Cynthia, P Doroghazi

Buy new: $14.95
18 used and new from $11.98
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Customer tags: rehabilitation(2), cynthia p doroghazi(2), physical medicine(2), brain injury(2), inspirational, motivational

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New ergonomic goals in auto design …

“Whether suffering from arthritis, weakening eyesight or diminished mobility, Canadians will increasingly have the ability to match their ailments to their cars as the transportation industry prepares for one of the biggest shifts in driving demographics on record.

In the next three years, the oldest Baby Boomers will turn 65. By 2015, for the first time in Canadian history, seniors will outnumber children younger than 15. By 2031, the number of elderly people in Canada will more than double to 9.1 million from 4.3 million, with seniors accounting for roughly one in four drivers.

Ongoing and proposed changes in everything from intersection layouts to vehicle ergonomics and licensing systems are being designed to keep both these greying drivers — and those with whom they’ll share the road– safer.

“Generally, when you make things safer for older drivers, you make them safer for everybody,” says Paul Boase, co-investigator for the Canadian Driving Initiative for Vehicular Safety in the Elderly at Transport Canada.

“Ten years ago, agencies were only thinking in terms of whether or not a driver was fit to be on the road,” Boase says. “Now we’re seeing a much larger look at the whole transportation process.”

Automakers are literally putting their engineers in older people’s orthopedic shoes to meet the Boomers’ future driving needs. Both Ford and Nissan have their young designers don special ageing suits that simulate mobility and vision limitations through such contraptions as cataract goggles and flexibility-restricting body casts. However, manufacturers say their efforts aren’t just for the older set.

“Nissan has no intention of building an elderly car,” says Etushiro Watanabe, associate chief designer for the company. “The improved ergonomics benefit drivers of all age groups.”

Many of the latest innovations designed to either soothe or prevent irritation of certain health conditions have been documented by the University of Florida’s National Older Driver Research Center. In partnership with the American Automobile Association, it recently released a chart that matches drivers’ woes with specific cars and their on-board modifications. For example, someone with diminished mobility could benefit from wide-angle mirrors, heated seats with lumbar support or the likes of Nissan’s Around View mirror, which uses four wide-angle cameras to show the driver any obstructions during parking and minimize the need for head turning when backing up.

A senior with vision limitations might seek out larger audio and climate controls with contrasting text or infrared night-vision cameras such as the ones seen on luxury cars from Mercedes-Benz and BMW.”    (Continued via driving.ca)    [Ergonomics Resources]

Ergonomic Design

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Tips for setting-up your office with a slide show explaining each point …

“Office employees who sit at their computers for eight or more hours daily report frequent aches and pains, ranging from stiff necks to lower backaches to numb wrists. Add to that list “BlackBerry thumb,” the throbbing sensation many users feel in their digit from too much typing on the hand-held device.

The good news is a few small adjustments to your workstation and your daily routine should alleviate, or even prevent, the pain.

The most important thing office workers can do, according to those who study ergonomics, is to take short breaks every 30 minutes. That might seem frequent, but you don’t even need to leave your desk. Just stand up and roll your shoulders back a few times. Holding the same posture for hours and repeating the same activities–typing and clicking a mouse–puts strain on muscles over time. Taking breaks eases that tension.

“There’s a lot of social pressure to sit at your desk all day,” says Deborah Quilter, the author of two books on repetitive strain injury. “Managers worry that their employees lose productivity, but [they] will gain productivity in the long term. If your employees are healthy, there’s less downtime and fewer workers’-compensation costs.”    (Continued via Forbes.com, Tara Weiss)    [Ergonomics Resources]

Desk Set-up

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that’s the only way I know to describe the sentiments of PT’s and the entire medical community over the inability of the Senate to pass HR 6331 which would have avoided a 10.6% cut in fees for medical providers and for us PT’s it would have extended the exceptions process.
My observations:
-the method to avoid the fee reduction was actually well founded (and reported many times at this blog including here and here and here) in that it sought to reduce the premium paid to private insurers that is above the cost that CMS could administer the plan itself.  I believe Mr. Obvious would site that politics played a role in the Senate not passing this
-A system where the cap is in place for everybody but hospitals is just illogical as CMS’ data clearly shows that hospitals are losing significant market share in patients obtaining care in that outpatient setting. I challenge anybody in the profession to explain with any logic the reason that hospitals are exempt
-I am steadfastly against a cap for most of the traditional reasons that have been cited but also because it is unprecedented in the CMS system.  Can you imagine a cap on imaging or seeing a family physician?  Does CMS easily forget that PT is less than 2% of their budget?
-I am equally against the exception process. All it does is increase our cost (essentially decreasing reimbursement) thru an additional administration burden that while occurring infrequently casts a disruptive process to a PT clinic
I predict that somehow the 10% reduction will get dealt with because it is an election year.  I am not as confident on anything related to PT.
I highly commend APTA and groups like PTPN for their yeoman’s work in organizing the troops of PT’s to lobby for the passage of the legislation in both the Senate and the House.  What I cannot understand is why can’t we get the same sense of mobilization for the rules that CMS has put in place that profoundly impacts PT at much greater rates and financial implications than the Cap?  Why can’t we get PT’s on Capital Hill with the same rage to fight for the following:
-complete elimination of the stupid plan of care requirement that has gone from 30 days to 90 days without any clear implementation (now I know how Seniors felt about figuring out their new Medicare Part D drug benefit).
-elimination of all of the rules that are directly against practice acts and eliminate judgment by PT’s who are now in supposedly a “doctoring” profession including 8 minute rule, explicit providers of PT and PTA’s only, supervision requirements of PTA’s and students that are grossly inconsistent, the whole “group” therapy mess, and elimination of the requirement of physician referral
Why do we simply sit back and assume the position referred to in the 1978 film Animal House along with its phrase “thank you sir may I have another” ?
Perhaps the time has finally come when the PT’s around the US can lobby for all of these things together rather than a piecemeal approach that overemphasizes a cap that occurs at much less frequently than the practice superimposed rules that severely marginalize our profession and undermine the professional medical judgment of a PT.
Thoughts?
larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

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Long fingernails make it hard to type on the iPhone …

“Some women with long nails have a hard time typing on the iPhone’s touchscreen because the nail itself doesn’t have the right electrical properties. When Apple announced all the new iPhone 2.0 features on June 9th, there was nothing new that solved that problem.

Right after the WWDC Keynote on June 9th, when many new features for the iPhone 2.0 software were announced, Erica Watson-Currie of Newport Beach, Calif felt frustrated. She told the L.A. Times about her problems typing on her iPhone.

“Considering ergonomics and user studies indicating men and women use their fingers and nails differently, why does Apple persist in this misogyny?” Ms. Watson-Currie wrote.

Of course, one of the key design points of the iPhone is its ability to operate without real plastic keys and/or a stylus. While a stylus would really help for some, it’s just not something Apple wants to do.

The problem stems from the fact that the iPhone touchscreen responds to the electrical charge of the human fingertip — but not the finger nail itself. Some observers even predicted that might become a problem with teenage girls. So far, however, sales number suggest there hasn’t been a problem, and sales to women are growing faster than to men lately.

There is one solution. Ten One Design sells a iPhone stylus. Another idea from an ergonomic consultant that doesn’t yet exist: nail polish that has the desired electrical properties.

The tenor of the situation was summarized by another woman reader: “Why are they still discriminating against those of us with fingernails? … Guess it’s a Blackberry for me :(”    (Continued via The iPod Observer, John Martellaro)    [Ergonomics Resources]

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The AMA may be going bananas about the evolving world of healthcare and the evolving role of physicians.  Larry implored the AMA to forget their proposed movement to restrict the use of the terms "doctor," "resident," and "residency" to physicians and just go golfing instead.  Well, it seems that some must have hit the links, but not all.  Ultimately, the AMA chose to abandon that resolution and instead adopted a resolution which calls for legislation that requires health care professionals to
"clearly and accurately identify to patients their qualifications and
degree(s)" and make it a felony to "misrepresent one’s self as a
physician."

Insiders at the meeting feel this resolution could be used by some state chapters to move through legislative efforts to limit the use of those terms, perhaps making the "misrepresentation" a felony!  Illinois, watch out, as it was that state’s delegation that introduced the initial resolution. 

I found this letter from the American Society of Health-System Pharmacists
(pdf) commenting on the proposed resolution, which apparently played some role in the movement away from the restriction of the term "doctor".

This article contains a list of other actions taken by the AMA at their recent meeting which serve to protect a physicians right to control your healthcare.  Remember when the AMA acted to make it a felony for any physician to voluntarily associate with an osteopath?  You can read about the AMA history with Osteopathy at Wikipedia. 

When considered historically, how can we trust all these actions that serve to protect physicians’ scope of practice?  Is it possible there are cheaper, more efficient ways to obtain good health?

ERIC (Source: MyPhysicalTherapySpace.com)

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Recombinant human erythropoietin (rHuEpo) is a genetically engineered hormone sometimes misused by high-performance athletes such as cyclists and marathon runners to boost their endurance. The potential misuse of the drug is detected in urine collected from athletes. Since the test was introduced in 2000, 33 labs around the world have been accredited by the World Anti-Doping Agency (WADA) to administer the procedure.

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Theresa Byrne has helped thousands blossom through health and fitness at her Denver martial arts studio and as the fitness coach on the reality show Fitting In, on the ABC Family Channel. Now she’s bringing her motivational fitness program to a kid near you.

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