Using routine referral data for patients with knee and hip pain to improve access to specialist care

Background Referral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain. The primary aim of this study was to evaluate the content of the referral letters to identify information that can independently predict an optimal care pathway. Methods Using a prospective longitudinal design, a convenience sample of patients with hip or knee pain were recruited from orthopaedic, specialist general practice and advanced physiotherapy practitioner clinics. Individuals completed a Knee or hip Osteoarthritis Outcome Score at initial consultation and after 6 months. Participant demographics, body mass index, medication and co-morbidity data were extracted from the referral letters. Free text of the referral letters was mapped automatically onto the Unified Medical Language System to identify relevant clinical variables. Treatment outcomes were extracted from the consultation letters. Each outcome was classified as being an optimal or sub-optimal pathway, where an optimal pathway was defined as the one that results in the right treatment at the right time. Logistic regression was used to identify variables that were independently associated with an optimal pathway. Results A total of 643 participants were recruited, 419 (66.7%) were classified as having an optimal pathway. Variables independently associated with having an optimal care pathway were lower body mass index (OR 1.0, 95% CI 0.9 to 1.0 p = 0.004), named disease or syndromes (OR 1.8, 95% CI 1.1 to 2.8, p = 0.02) and taking pharmacologic substances (OR 1.8, 95% CI 1.0 to 3.3, p = 0.02). Having a single diagnostic procedure was associated with a suboptimal pathway (OR 0.5, 95% CI 0.3 to 0.9 p < 0.001). Neither Knee nor Hip Osteoarthritis Outcome scores were associated with an optimal pathway. Body mass index was found to be a good predictor of patient rated function (coefficient − 0.8, 95% CI -1.1, − 0.4 p < 0.001). Conclusion Over 30% of patients followed sub-optimal care pathway, which represents potential inefficiency and wasted healthcare resource. A core data set including body mass index should be considered as this was a predictor of optimal care and patient rated pain and function

Managing small-acreage horse farms in central and eastern Oregon

Some good goals for a well-managed, small-acreage horse farm are: • A productive pasture with plenty of grass and few weeds • Less dust during the dry season and less mud during the wet season • Healthy horses free of problems associated with dust, manure, mud, and toxic plants • Manure managed as an important resource on the farm or recycled off the farm • Good stewardship of your property and the water that flows through, across, and below it • Satisfied owners who are able to conveniently care for their animals without dreading the chorePublished November 2007. Reviewed December 2013. Please look for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalo

Observation, experiment and hypothesis in modern physical science

These original contributions by philosophers and historians of science discuss a range of issues pertaining to the testing of hypotheses in modern physics by observation and experiment. Chapters by Lawrence Sklar, Dudley Shapere, Richard Boyd, R. C. Jeffrey, Peter Achinstein, and Ronald Laymon explore general philosophical themes with applications to modern physics and astrophysics. The themes include the nature of the hypothetico-deductive method, the concept of observation and the validity of the theoretical-observation distinction, the probabilistic basis of confirmation, and the testing of idealizations and approximations.The remaining four chapters focus on the history of particular twentieth-century experiments, the instruments and techniques utilized, and the hypotheses they were designed to test. Peter Galison reviews the development of the bubble chamber; Roger Stuewer recounts a sharp dispute between physicists in Cambridge and Vienna over the interpretation of artificial disintegration experiments; John Rigden provides a history of the magnetic resonance method; and Geoffrey Joseph suggests a statistical interpretation of quantum mechanics that can be used to interpret the Stern-Gerlach and double-slit experiments.This book inaugurates the series, Studies from the Johns Hopkins Center for the History and Philosophy of Science, directed by Peter Achinstein and Owen Hannaway