International Journal of Health Management Review

Agreement in the neer classification of proximal humerus fracture

Francielly Teles Silva — 2022-09-19

Background: Proximal humerus fractures account for approximately 4 to 5% of all fractures, affecting more elderly females. As a treatment method, whether surgical or conservative, it is necessary to classify it to know the prognosis of the fracture. Despite being widely used, there are dissociations of evaluation and radiographic reproducibility among examiners.

Aim: To assess the inter- and intra-observational agreement of Neer's classification for fractures of the proximal humerus in adults.

Method: Radiographs of 20 cases of proximal humerus fracture were selected and made available to 35 examiners (Orthopedists, including specialists in shoulder and elbow surgery), who classified them according to Neer's classification, over a period of 60 days. Results: Initially evaluating the 35 evaluators with different levels of experience, at two different times, with a common interval of 60 days between one evaluation and another, the intra-evaluator reliability, considering the median, was excellent 0.923 (95% CI [0.610 - 1.237]), as well as the mode 0.925 (95% CI [0.626 – 1.224]). In the evaluation of the 20 evaluators with the highest intra-evaluator reliability (k>0.5), the intra-evaluator reliability, considering the median among the 20 evaluators, was excellent 0.923 (95% CI [0.610 - 1.237]), as well as considering the mode 0.855 (95% CI [0.569 - 1.141]). Finally, considering the 20 evaluators with the highest individual intra-evaluator reliability, the inter-evaluator reliability in the first evaluation (test) was light 0.259 (95% CI [0.239 - 0.280]), as well as in the second evaluation (retest) 0.289 (95% CI [ 0.269 - 0.310]).

Conclusion: This study evidences that the classification system proposed by Neer, following the Kappa index, presents as a final result a poor categorization of agreement, both intraobservational and interobservational, of fractures of the proximal humerus extremity. A lower reliability (mild to negligible) was also observed in the interobserver analysis. Thus, it is evident the importance of using other classification systems and complementary diagnostic methods, such as computed tomography, for better assessment and management of patients with fractures of the proximal humerus, aiming at optimizing the treatment and rehabilitation of these cases.

Proximal femur fractures: incidence before and during the COVID-19 pandemic

Thiago Henrique Abrão Bertholini — 2022-09-19

Background: Fracture of the proximal femur is a common and important cause of mortality and functional loss. The incidence of this type of fracture increases with age, mainly due to the increase in the number of falls associated with a higher prevalence of osteoporosis. It is more commonly related to elderly people living in urban areas, female and institutionalized. Fracture of the proximal femur can be intracapsular or extracapsular. In the first type are femoral neck fractures, and in the second, transtrochanteric fractures, both of which result from low-energy trauma, such as falls. The treatment of most of these fractures is surgical, aiming at the reduction and stable fixation of the fracture, using the most varied methods of osteosynthesis or arthroplasty, especially in the case of fractures of the femoral neck with displacement.

Aim: To assess the incidence of proximal femur fractures before and during the COVID-19 pandemic.

Method: This is a retrospective study, with a systematic review of data regarding the number of surgical procedures for proximal femur fractures in the years 2019 to 2021, corresponding to the period before and during the COVID19 pandemic, and to demonstrate its incidence and need of care, in a private hospital in the interior of the state of São Paulo.

Results: During the study period, 1,203 procedures were performed. It was possible to notice the gradual increase in cases during the pandemic years, and a high rate of proximal femur fractures in women, reaching a difference of 62% in relation to men in 2022. The mortality rate during hospitalization was 2.39% in 2019, 2.78% in 2021, and 2.83% in 2022. The factors positively correlated with mortality, most frequently indicated, were advanced age, presence of associated diseases, significant cognitive impairment and female gender.

Conclusion: Recent literature, even within the context of a pandemic and its restrictions, has identified four major factors directly related to mortality in proximal femur fractures in the elderly, namely the patient's advanced age, the presence of associated diseases, the female sex and the existence of cognitive deficiencies.

Patients' perception of the percutaneous coronary intervention benefits in stable coronary artery disease

Stefany Casarin Moura — 2022-09-19

Background: Percutaneous coronary intervention (PCI) is a common procedure to relieve obstruction of a stenotic coronary artery. Patients' beliefs about the need for the procedure and its effectiveness are shaped by interaction with attending physicians. Therefore, every decision involving the procedure must be taken jointly between the patient and the physician, and the physician must help the subject to understand the probability of the expected benefits and the risks to be faced in the intervention, acting as an experienced partner.

Aim: To assess patients' perception of the benefits and risks of PCI based on information provided by the attending physician. Method: Through a descriptive longitudinal study carried out with patients diagnosed with coronary insufficiency admitted to the HUSF.

Results: When analyzing the expected benefits, in a fraction of the sample, through the performance of PCI, 26% of patients would like to avoid acute myocardial infarction, 26% wanted to reduce their possibility of dying, 10% sought to live longer, 40% wanted to reduce chest pain, 5% would like to take less medication, 25% wanted to decrease dyspnea and 15% did not know how to respond. All patients said that the risks of the procedure were not addressed in the conversation, and only one patient was able to inform possible risks due to prior knowledge.

Conclusion: It was noted the existence of failures in communication between the doctor and the patient, evidenced by the overestimation of benefits and underestimation of risks in performing PCI.

Academic League of Urgency and Emergency, Pre-Hospital and Emergency Care (LUEPPA) – Medical School of São Bernardo do Campo, SP - Brazil: 2022-2023 management experience report

Giulia Veneziani Zogaib — 2022-09-19

The aim of the present study was to report the experience of the Academic League of Urgency and Pre-Hospital Emergency and Emergency Care (LUEPPA) of the Faculdade de Medicina Nove de Julho - São Bernardo do Campo, SP, Brazil. The classes took place during the first semester of the year 2022, and were taught by experienced professionals, mostly doctors, who work in specific areas related to each of the lectures. Most of the meetings took place weekly, via Google meet, at night. The assembly of the classes was at the discretion of each speaker, as well as the conduction of the presentation, which ranged from the lecture to the dialogued lecture, encouraging the participation of those present. At the end of the presentations, doubts were resolved, creating an environment of interaction between the speaker and those present. In conclusion, it is understood that the work of Academic Leagues should be encouraged by Faculties and Universities, since it is a learning environment of enormous contribution, especially for medical students.

Perineal reconstruction after Fournier's syndrome: three-year experience at the Hospital do Servidor Público Municipal (São Paulo city)

Sheila Cover — 2022-10-10

Fournier's syndrome is a multi bacterial infectious disease with an insidious onset and rapid progression in the perineal region. Its treatment includes debridement and broad-spectrum antibiotic therapy. Debridement results in loss of skin coverage in the perineal region. There are several possible techniques for reconstruction of the open area, such as skin grafts, myofasciocutaneous and fasciocutaneous flaps, in addition to primary closure of the lesion.

The study analyzed six patients who underwent coverage of the open areas with reconstructive procedures, which ranged from the approximation of the edges with simple suture to the use of flaps and grafts in larger lesions. Cutaneous repair techniques presented good evolution with resolution of the raw area, obtaining satisfactory results.