Clubfoot is a bony deformity characterized by inversion, adduction, and equinus that often require surgical intervention. This study assessed the gait kinetics and kinematics of children with unilateral and those with bilateral clubfoot, comparing them with age-and gender-matched normal (control) children. Patient satisfaction also was examined using a questionnaire, and muscle strength was evaluated at the ankle and knee. In evaluating the kinematics, it was important to note that deviations occurred at the ankle of children with clubfoot. Differences in kinematics and kinetics at the hip and knee between normal children and those with clubfoot resulted from lack of motion at the ankle. Furthermore, the strength of ankle plantarflexors was weak, which reduced plantarflexion during push-off. This restricted motion may have been caused by residual bony deformities and muscle tightness resulting from the original condition that contributed to muscle stiffness during gait.

Adolescent↗

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Ankle and first metatarsophalangeal joint dorsiflexion in children with clubfoot.

It has been hypothesised that the stiffness of the plantar aponeurosis after clubfoot surgery affects push-off. Because the first metatarsophalangeal (MTP) joint motion relies on the plantar aponeurosis, it was important to determine whether there was a lack of first MTP joint motion in children with clubfoot that also affected push-off. By examining the motion of the first MTP joint using a motion analysis system and passive motion techniques, then correlating these with gait characteristics, the authors found that the first MTP joint was not affected in children with clubfoot. The authors found that a motion analysis system could be used to determine range of motion accurately.

Analysis of Variance↗

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Cost-effectiveness of office obstetrical ultrasound in family practice: preliminary considerations.

This study reports costs incurred over a nine-and-one-half-month period following the introduction of obstetrical ultrasound into a group family practice serving primarily prepaid health plan patients. During this introductory period, 248 examinations were performed by family physicians and refereed by a radiologist for accuracy. The estimated cost to the practice was $95 per examination. This figure includes physician training expenses, professional fees, personnel, equipment and maintenance costs, costs for exams repeated due to technical error, and costs for additional consultation by a radiologist. Previously, all exams were referred to other consultants, and the charge was $185 per exam. Thus, in-office ultrasound exams performed by family physicians can provide cost savings while maintaining high standards of obstetric care.

Cost-Benefit Analysis↗

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The academic role and scholarship.

Explore the source record for details and available documents.

Family Practice↗

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Financial and clinical relationships between family practice and the academic medical center.

The clinical relationship of academic family practice units to their parent tertiary care medical centers was studied. We surveyed the designated family practice contacts in all U.S. medical schools and achieved a response rate of 84%. We found wide variations in the degree to which academic family practice units provide patient care within the walls of the academic medical center. Those departments which perform greater than 50% of their patient care within the academic medical center are more involved in medical center-sponsored alternative health care delivery systems. Residents of these programs receive more than 50% of their training at the academic medical center. These departments are also more likely to teach a required first-year course in the medical school curriculum. Finally, we found a suggestion, not statistically significant, that these departments may be supporting a greater proportion of their total budgets through clinical revenues. We conclude that academic family medicine units may benefit from closer clinical and financial connections to parent academic medical centers.

Academic Medical Centers↗

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The doctor, the patient: a first-year course for personal and professional growth.

BACKGROUND AND OBJECTIVES: Medical education has tended to focus primarily on the biomedical aspects of care while neglecting the human side of patients and students. To help students become aware of student, patient, and family issues that may impact the doctor-patient relationship, a first-year course was developed. METHODS: This course consists of 12 didactic sessions and 10 small-group meetings led by family medicine faculty. Topics include self-assessments, analysis of videotaped doctor-patient interactions, genogram development, and family systems. Students have evaluated the course for content, strengths, weaknesses, and impact. RESULTS: This course was highly rated by the students. The students reported gaining insight into personal issues that might impact their interaction with patients. Students also became aware of the importance of family issues to their patients' health and well-being. CONCLUSIONS: Through courses like this, students may gain deeper insight into issues that impact them, their patients, and the doctor-patient relationship.

Evaluation Studies as Topic↗