Amputee Care Research Articles

Primary survival and prosthetic fitting of lower limb amputees

During the period 1984-1985 amputation of the lower limb at a level potentially requiring a prosthesis was performed on 577 patients in 16 operative units. The mean age was 75.7 years for females and 68.1 for males. The most common site of the amputation was above the knee (49.9%). The majority of amputations (93.8%) were performed for vascular diseases and diabetes. Survival figures showed that 25.5% of amputees died within 2 months of amputation, 60.7% were alive after one year and 43.2% after two years. Out of a total of 577 patients, 26.9% were fitted with a prosthesis. Out of below-knee and above-knee amputees surviving over 2 months, 61.5% and 27.2% respectively were fitted with a prosthesis. There were markedly fewer prosthetic fittings in the over-60 age group. Diabetic patients of both sexes were fitted with a prosthesis more often than arterio-sclerotic patients. Among tumour patients 82.4% received a prosthesis. In the study area more emphasis must be put on the concept of preserving the knee joint and preoperative assessment of vascular patients for selection of amputation level. Every effort must be made to avoid delay in the postoperative mobilization and rehabilitation. Prosthetic fitting of amputees could be improved by better liaison between surgical unit and specialized rehabilitation unit and by closer team approach of amputee care.

Africa — Latin America — Asia and Pacific — Middle East

Dr. Athos Gallino, member of the ICRC, accompanied by Dr. Rémi Russbach, chief medical officer of the ICRC, went on mission from 20 January to 3 February, first to Mozambique and then to Zimbabwe, Ethiopia and Sudan. As head of the “Special Fund for the Disabled”, created by the ICRC in 1983, — Dr. Gallino visited the centres for care of war amputees and paraplegics which have been set up in these countries by the ICRC with the support of local authorities and National Red Cross and Red Crescent Societies. The ICRC representatives went to Maputo (Mozambique), Bulawayo (Zimbabwe), Debre Zeit and Asmara (Ethiopia) and Kassala (Sudan).Dr. Gallino and Dr. Russbach also visited the ICRC feeding centres in Axum and Mekele (Ethiopia).

Medicaid in New York City. A discussion of three papers.

BOSTON having often been accused of robbing New York City of its medical talent, it is good to note that municipal health services are in such capable hands as those of Drs. Bellin and Kavaler and Mr. Alexander. Considered as a whole, the three papers are a tribute to their dedication and resourcefulness. At the same time, the three papers constitute a forceful indictment of Medicaid as a mechanism to solve the problem of delivering health services to indigent and medically indigent persons. It is well to recall that New York City has had almost 300 years of providing public medical care to the poor; for the last 130 years, the city has made continuous payment for services rendered to city charges by voluntary hospitals as well. Medicaid in New York City is not, then, a new development. Mr. Alexander's excellent paper contains a few minor errors of fact. For example, he states that at the inception of the Medicaid program the New York City Health Department had no structure for standard setting or evaluation, and that these were under welfare jurisdiction. The Health Department's Bureau of Handicapped Children has been engaged in standard setting for many years. Moreover, the Inter-Departmental Health Council has developed a mechanism for the establishment of standards of care for all persons receiving services at city expense in such fields as: the care of amputees, and cardiac, thoracic, and neurological surgery. Hospitals, unable or unwilling to comply with the standards, were not reimbursed for care in these specialty areas. In addition, the Medical Welfare Administrator established general standards for hospital outpatient departments and authorized higher per visit payments for those hospitals that met them. In respect to evaluation, the Department of Health established a unit under Dr. Paul Densen which carried out evaluation studies in the Departments of Health, Hospitals, and Welfare. Mr. Alexander states that both public and professionals unfortunately thought of Medicaid as welfare. However, the public and professionals are right. Title XIX of P.L. 89-97 provides for the consolidation and expansion of welfare medical care by making medical assistance available to all individuals receiving aid or assistance under . . . Titles I, IV, X, XIV, and XVI, the public assistance title of the Social Security Act (Section 1902 (a) (10) Title XIX, P.L. 89-97). Moreover, Section 1902 (a) (5) requires that the determination of eligibility for medical assistance be made by the state or local public welfare agency. Medicaid is medical welfare. Mr. Alexander's generally unfavorable comparisons of Welfare Department Administration to Health Department Administration fail to mention the less than inspired direction given to Medicaid by the New York State Department of Health. Dr. Bellin's paper contains an excel-

Problems in the care of arm amputees

Problems in the care of arm amputees

Human Limbs and Their Substitutes. Presenting Results of Engineering and Medical Studies of the Human Extremities and the Application of the Data to the Design and Fitting of Artificial Limbs and to the Care and Training of Amputees. Paul E. Klopsteg, Ph.D., Sc.D., Philip D. Wilson, M.D. et al. Prepared under the sponsorship of the Advisory Committee on Artificial Limbs,

Human Limbs and Their Substitutes. Presenting Results of Engineering and Medical Studies of the Human Extremities and the Application of the Data to the Design and Fitting of Artificial Limbs and to the Care and Training of Amputees. Paul E. Klopsteg, Ph.D., Sc.D., Philip D. Wilson, M.D. et al. Prepared under the sponsorship of the Advisory Committee on Artificial Limbs,