Physician Leadership: As health care moves to value, more leaders going to PROMs

Physician Leadership: As health care moves to value, more leaders going to PROMs

by | Apr 17, 2019 | General News, Press Coverage

Patient-reported outcome measures (PROM), which are stored in the clinical record, help physicians optimize treatment. These surveys can shed light on important factors following treatment, such as how the patient feels about their quality of life after treatment and whether everyday activities have improved.

Henry B. Ellis, M.D., a pediatric orthopedic surgeon at Scottish Rite Hospital, recently spoke with the American Association for Physician Leadership about the use of PROMs and how they help him and his team.

“PROMs really help us quantify the results of our treatment,” Ellis says. “And it will quantify their activity level following their treatment as well.”

Read the full story here.

An Orthopedic Surgeon’s Perspective On Child Obesity

An Orthopedic Surgeon’s Perspective On Child Obesity

by | Apr 17, 2019 | Uncategorized

Originally presented by Corey S. Gill, M.D., at the Sports Medicine for Young Athlete: How Do We Keep Our Kids Safe Conference in Frisco.
Childhood obesity is a significant public health problem and significantly increases the risk of developing a number of debilitating medical conditions, such as diabetes and heart disease. The prevalence of childhood obesity nationwide is approximately 15%, but is often much higher in pediatric orthopedic patients. For example, more than one third of my patients who require surgery for orthopedic problems are obese. Obesity may play a causative role in disorders such as slipped capital femoral epiphysis (SCFE) and Blount’s disease, and often increases the severity and complexity of fractures and other orthopedic injuries.

Conditions Often Found in This Population
SCFE is a condition that can develop in the hips of obese children and adolescents. The excess body weight increases the stress across the cartilage growth plate of the femur near the hip joint and can lead to a stress fracture or complete fracture. This condition always requires surgical intervention and may lead to significant long-term damage to the hip joint that necessitates additional surgery or even hip replacements at a young age. This condition is often difficult to diagnose, as the hip pain can be vague or even manifest as knee pain. All obese adolescents with significant hip/knee pain, or a noticeable limp, should be evaluated by a pediatric orthopedic surgeon.

Blount’s disease is another condition correlated with obesity. In this condition, there is severe bowing of the knees that leads to pain, joint damage and a significant visible deformity. Surgical treatment for mild Blount’s disease is called growth modulation. This treatment involves tethering a growth plate near the knee with a metal plate and screws, so that the leg can gradually straighten over approximately one to two years. In more severe cases, larger surgeries are often required to cut and realign the tibia bone, often with an external metal frame attached to the leg for stability.

Fractures or broken bones are relatively common in growing children. Obese children are more likely to sustain arm and leg fractures after a fall compared to normal weight peers. In addition, these fractures are usually more severe and more complicated to fix in obese children. Finally, the excessive soft tissue present in obese limbs makes fractures more difficult to hold in position in a cast. Consequently, many fractures that can be treated nonsurgically in normal weight children require surgical intervention in obese children.

Peri-operative Risks in Obese Children
Overweight and obese children often have medical comorbidities that increase risk of complications during and after surgery, such as anesthesia-related complications, infection and wound problems.  A thorough preoperative evaluation is recommended in obese patients undergoing surgery in order to optimize perioperative care. For example, sleep apnea is found in 85% of patients with Blount’s disease and hypertension is present in 65% of Blount’s and SCFE patients. Oftentimes, these medical comorbidities are undiagnosed at the time of presentation, so orthopedic surgeons play an important role in the recognition and diagnosis of these diseases.

Now What?
Childhood obesity is a difficult problem, and there are no easy solutions to eliminate the epidemic. A multidisciplinary approach with frequent communication between surgeons, pediatricians, nutritionists and other health care providers is mandatory to optimize orthopedic care of the obese patient. The pediatric and orthopedic communities must continue to support initiatives to encourage kids to be active and to eat a healthy balanced diet. Regarding diet, healthy eating habits need to be established at a young age, as studies have shown that obese children as young as 11 are already consuming in excess of 1100 to 1300 extra calories per day. Regarding activity, children and adolescents should be encouraged to participate in at least 60 minutes of physical activity each day. Participation in team sport, or other activities such as walking, running or biking, may decrease obesity rates and promote a lifelong love of a healthy activity.

Learn more about injury prevention and pediatric sports medicine.

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WFAA Honors Scottish Rite Hospital’s Don Cummings

WFAA Honors Scottish Rite Hospital’s Don Cummings

by | Apr 15, 2019 | General News, Press Coverage

On April 5, 2019, several Scottish Rite Hospital staff members gathered before the break of dawn at the WFAA studio for a “Party on the Plaza” to celebrate a segment that was aired live that morning. The hospital’s Director of Prosthetics Don Cummings had no idea the story was actually about him.

Don, who has been at the hospital since 1987, was honored as WFAA Daybreak’s Rise and Shiner — an honor given to those dedicated to changing lives for the better through their work. Don was nominated by his peers and former patients at Scottish Rite Hospital, and the staff that showed up early Friday morning truly showed their support for Don and his family.

Watch the full segment here.

Doctors Travel to Israel for International Pediatric Orthopedic Conference

Doctors Travel to Israel for International Pediatric Orthopedic Conference

by | Apr 5, 2019 | Research & Innovation

Doctors from the hospital are attending the 38th annual European Paediatric Orthopaedic Society (EPOS) meeting in Tel Aviv, Israel. EPOS is an international association comprised of over 500 surgeons from across the world. This four-day conference allows members to discuss research and collaborate on latest treatment techniques to ultimately advance the quality of care for children with orthopedic conditions.

As active members of EPOS, hospital staff attend and participate throughout this international meeting each year. Several are in attendance, along with past fellows, presenting the hospital’s original research. Below are the projects being presented:

  • Can real time monitoring with a controlled advancement drill decrease plunge depth?
  • Metaphyseal fracture displacement is predictive of intra-articular diastasis in adolescent triplane ankle fractures
  • Gait analysis in children with proximal femoral focal deficiency

In addition to these research presentations, surgeons from Scottish Rite Hospital are directing the first ever web-based joint educational endeavor between EPOS and the Pediatric Orthopaedic Society of North America (POSNA). During this symposium, entitled “Across the Pond: International Differences in Pediatric Orthopaedic Trauma Management,” staff and former fellows from the hospital will discuss and debate current trauma treatment strategies with a panel of European trauma specialists. The debate will be recorded at the EPOS meeting and broadcast worldwide.

Pediatric orthopedic surgeon and director of resident education Anthony I. Riccio, M.D., is one of the hospital’s key representatives for EPOS. “As doctors and leaders within pediatric orthopedics, we have a responsibility to conduct research in order to better understand and find innovative techniques for treating complex conditions,” says Riccio. “It is an honor to travel the world to share our expertise and have the opportunity to both educate and learn from other specialists. Not only does this advance how we care for our patients here in Texas, but it evolves the treatment for pediatric orthopedic patients across the globe.”

Learn more about the hospital’s research.

Keeping Your Young Athlete Safe

Keeping Your Young Athlete Safe

by | Apr 4, 2019 | Sports Medicine

“Infectious diseases are not uncommon in athletes who participate in team sports, whether it be through school or club sport,” says Jane S. Chung, M.D., Scottish Rite for Children sports medicine physician. “Adolescents in particular are not the best when it comes down to personal hygiene. They like to share, and while ‘bonding’ with teammates is important, they need to be aware that infections can be spread.”

Children and adolescents are most familiar with sharing upper respiratory infections through coughing and sneezing. In youth sports and other settings, infections are also spread through sharing gym towels, water bottles, helmets, mouthpieces, and other equipment. Kids need to know that good personal hygiene goes beyond covering a cough. Parents and coaches should help them prepare for sports by providing individual water bottles or cups and other personal gear such as helmets, mouthpieces, and towels. Coaches and sports organizations must also maintain and clean gym equipment, like mats and weight machines, between workouts. Many teams have access to showers, and athletes should be encouraged to shower before going to the next activity or class.

Tips to teach your young athlete to help minimize the spread of infections:

  • Shower or at least wash your hands after practice and competition, especially before eating.
  • Don’t share water bottles or cups.
  • Be careful not to touch blood or body fluids when an athlete is injured or ill.
  • Tell your parents about symptoms you have or others have reported.
  • Don’t go to practice or a game when you have signs or symptoms of an infection.
  • Tell the coach if you have an open wound, infection, or illness that your doctor says may be contagious.

Shane M. Miller, M.D., Scottish Rite for Children sports medicine physician, works closely with several schools and takes infection control seriously. He says, “We work with our partners to ensure we are meeting the recommended guidelines. All schools and teams should take time to evaluate their current practices and identify areas for improvement to reduce the risk of spreading infections.”

Review the table of 25 organisms identified as a concern for young athletes in this American Academy of Pediatrics Clinical Report: Infectious Diseases Associated With Organized Sports and Outbreak Control.

Learn more about injury prevention and pediatric sports medicine.