Seventy-eight diaphyseal femur fractures in 77 children were stabilized with flexible intramedullary nails. The patients ranged in age from 2 + 9 to 18 years. All patients had open femoral growth plates at the time of fixation. Eleven percent of the fractures had an average varus or valgus malalignment of 6 degrees. Eight percent of the fractures had an average anterior or posterior malalignment of 8 degrees. Eight percent of the patients had a rotational malalignment that averaged 8 degrees. Sixty-eight percent of the children had equal leg lengths at follow-up. There were four unscheduled reoperations, but no major complications; all fractures united. The results obtained using flexible intramedullary nails for the stabilization of select pediatric diaphyseal femur fractures are comparable to nonoperative methods of treatment, but with less disruption to family life and a shorter hospitalization.

Adolescent↗

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An integrated model for continuous quality improvement and productivity improvement in health services organizations.

The health services paradigm with respect to quality has shifted to that of conformance to requirements (the absence of defects) and fitness for use (meeting customer expectations and needs). This article presents an integrated model of continuous quality improvement (CQI) (often referred to as total quality management) and productivity improvement for health services organizations. It incorporates input-output theory and focuses on the CQI challenge--"How can we be certain that we do the right things right the first time, every time?" The twin pillars of CQI are presented. Achievement of both will result in productivity improvement and enhancement of the health services organization's competitive position.

Efficiency↗

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Administrative ethics and the health services manager.

Explore the source record for details and available documents.

Analysis of Variance↗

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The ethical imperative in health services governance and management.

Increasingly, administrative and biomedical ethical issues affect decision making in health services organizations. Although the ethics of biomedical decision making affect governance and management, this article is limited to administrative ethics: fiduciary duty, conflicts of interest, confidential information, resource allocation, and consent. Those who govern and manage health services organizations face an ethical imperative: They are moral agents with an independent duty to protect patients and further their interests. This duty is separate from any existing between care givers--such as physicians--and patients. It may complement other relationships, but it is always present. This imperative will become more difficult to attain. The potential conflict between economic and patient interests lies close to the surface in the patient care relationship, and maintaining it undoubtedly will be exacerbated by competitive pressures. The ethical implications of this conflict for those who govern and manage health services organizations are enormous.

Confidentiality↗