A Remote Physical Therapy Program Demonstrates Similar Outcomes Compared to In-Person, Supervised Physical Therapy After Same-Day Discharge Total Knee Arthroplasty: A Randomized Clinical Trial.

BACKGROUND: A growing number of total knee arthroplasty (TKA) patients are candidates for same-day discharge (SDD). Previous research has shown that internet-based remote physical therapy (RPT) can produce equivalent outcomes to supervised outpatient physical therapy (OPT) after TKA. We sought to compare outcomes between RPT and OPT in patients undergoing SDD TKA using an electronic remote perioperative management (ERPM) program. METHODS: Patients undergoing SDD TKA were enrolled in an ERPM program and randomized to ERPM + RPT or ERPM + OPT. Preoperative and 6-week functional assessments included knee range of motion, timed up and go, and 4-meter gait speed. Numerical Rating Scale pain scores were evaluated preoperatively, at 6 and 12 weeks, and satisfaction was assessed at 6, 12, and 52 weeks postoperatively. Participants completed the Veterans Rand 12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score preoperatively and at 6, 12, and 52 weeks postoperatively. OPT utilization was collected 90 days postoperatively. RESULTS: Of 197 initially randomized patients, 76 remained in the ERPM + RPT group and 95 in the ERPM + OPT group after withdrawals and crossovers. Baseline characteristics showed no differences between the 2 groups. No clinically relevant differences were observed in knee range of motion, Numerical Rating Scale pain, patient-reported outcomes, functional assessments, or satisfaction at any follow-up time. Participants in the ERPM + OPT group attended an average of 11.57 physical therapy sessions, incurring a total cost of $462.8 and 133 minutes of travel. Conversely, the ERPM + RPT group experienced no expenses or travel time. CONCLUSIONS: Patients in the ERPM + RPT group had similar outcomes, lower costs, and saved time compared to patients in the ERPM + OPT group after SDD TKA. Further analysis is needed to determine predictive indicators for crossovers.

Evaluating Knee Recovery Beyond Patient Reports: A Comparative Study of Smart Implantable Device-Derived Gait Metrics Versus Patient-Reported Outcome Measures in Total Knee Arthroplasty.

BACKGROUND: Total Knee Arthroplasty (TKA) is frequently performed for advanced osteoarthritis, with patient-reported outcome measures (PROMs) traditionally reporting on efficacy. These subjective evaluations, although useful, may inaccurately reflect post-TKA activity levels. With technological advancements, smart implantable devices (SIDs) offer objective, real-time gait metrics, potentially providing a more accurate postoperative recovery assessment. This study compares these objective metrics with PROMs to evaluate TKA success more effectively. METHODS: We conducted a retrospective cohort study with 88 participants undergoing TKA using a SID. Eligible patients were aged 18 years or older and had advanced osteoarthritis. We excluded those who had bilateral TKAs, joint infections, or neuromuscular disease. The SID system collected daily gait metrics, including step count, distance traveled, walking speed, stride length, cadence, and functional knee range of motion. The PROMs, including Knee Injury and Osteoarthritis Outcome Score-Joint Replacement, Veterans Rand 12 Physical Component Summary, and Veterans Rand 12 Mental Component Summary, were analyzed against SID gait metrics. Among the 88 patients, 80 provided continuous data over 12 weeks. RESULTS: All gait metrics, except stride length, significantly increased at the 12-week point (P < .05). The PROMs also significantly improved postoperatively (P < .05). Initial low positive correlations between 12-week PROMs and SID metrics decreased after adjusting for demographic variables, leaving only weak correlations between the Veterans Rand 12 Physical Component Summary and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement with functional knee range of motion (r = 0.389, P = .002; r = 0.311, P = .014, respectively), and Veterans Rand 12 Mental Component Summary with step count (r = 0.406, P = .001) and distance traveled (r = 0.376, P = .003). CONCLUSIONS: This study indicates that both PROMs and SID gait metrics show significant improvements post-TKA, though they correlate weakly with each other, suggesting a possible discrepancy between perceived recovery and actual functional improvement. The SID gait metrics might provide a valuable addition to traditional PROMs by offering an objective representation of physical capabilities unaffected by patient compliance or subjective perceptions of recovery. Further research is needed to validate these findings in larger populations and to explore whether integrating SID metrics can enhance long-term functional outcomes.

Dialysis Water Supply Faucet as Reservoir for Carbapenemase-Producing Pseudomonas aeruginosa.

During June 2017-November 2019, a total 36 patients with carbapenem-resistant Pseudomonas aeruginosa harboring Verona-integron-encoded metallo-ß-lactamase were identified in a city in western Texas, USA. A faucet contaminated with the organism, identified through environmental sampling, in a specialty care room was the likely source for infection in a subset of patients.

Creating an innovative educational structure to support best practice among novice nurses.

In today's complex health care environment, staff nurses are responsible for having the skills to analyze complicated patient situations, develop complex plans of care, and skillfully communicate with the health care team. The establishment of a new progressive care unit presented a unique opportunity to create innovative educational structures. Expert nurses developed successful strategies that can be incorporated on any unit to facilitate learning for all nurses. The "Teach Me Tuesday" structure was created to enhance patient safety and information sharing. A more formal class, Cardiac Construction 101, was developed to help novice nurses fill their figurative tool box with skills to care for complex patients. Distinct courses of treatment for patients on the unit were selected for "Third Thursday" case studies.

Posterior Cruciate Ligament Preservation versus Posterior Cruciate Ligament Sacrifice: Comparing Patient Outcomes in Medial Congruent Total Knee Arthroplasty.

This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n = 9) with either PCL preservation (n = 264) or sacrifice (n = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Comparison of different methods for achieving hemostasis after arterial sheath removal.

BACKGROUND AND RESEARCH OBJECTIVE: Randomized studies are limited on whether the use of procoagulant pads improve outcomes after arterial sheath removal in interventional cardiology patients. The purpose of this study was to determine if the use of a procoagulant pad in combination with manual compression would decrease time to hemostasis compared with our institution's manual compression alone procedure after arterial sheath removal associated with a percutaneous coronary intervention (PCI). PARTICIPANTS AND METHODS: A convenience sample of PCI patients were randomly assigned to 3 methods for achieving hemostasis at the femoral artery site after sheath removal (manual compression alone, SyvekPatch NT plus manual compression, and D-Stat Dry plus manual compression). Outcome variables included time to hemostasis, number of pressure applications, and development of complications. Analysis of variance and χ analysis were used to test differences among the 3 groups, with P < .05 considered significant. RESULTS AND CONCLUSIONS: A total of 80 PCI patients were studied (n = 26 manual compression only; n = 26 SyvekPatch NT; n = 28 D-Stat Dry). Significant differences were found among the 3 methods for time to hemostasis (F2,77 = 4.12, P = .020), with the manual compression alone method significantly longer than either of the 2 procoagulant pad groups. Complications were rare and were not significantly different with the 3 methods.

Preparation of positive control platelets for detection of canine platelet surface-associated IgG, IgM and complement (C3) by flow cytometry.

An assay for detection of platelet surface-associated (PSA-) IgG, IgM and/or complement (C3) in dogs was modified by preparation of artificial positive control platelets. Flow cytometry of fluorescein isothiocyanate (FITC)-conjugated anti-dog IgG, anti-dog IgM and anti-dog C3 antibodies was used to detect the PSA proteins. IgM single, IgM/C3 double and IgG/IgM/C3 triple positive platelets were prepared. FITC-conjugated anti-IgG antibody bound strongly only to the triple positive platelets. Binding of FITC-conjugated anti-IgM or anti-C3 antibody to the double and triple positive platelets was specifically blocked by preincubation with the respective non-FITC-conjugated same-origin antibodies. These results confirm that FITC-conjugated antibodies specifically detect PSA proteins and that the control platelets prepared in this study are appropriate positive controls for detection of PSA proteins by flow cytometry.

Hematologic and Serum Biochemical Reference Intervals for the Bilby (Macrotis lagotis).

Hematologic and serum biochemistry blood reference intervals were established for the endangered marsupial, the bilby (Macrotis lagotis). Blood samples were collected from 135 bilbies that were housed in a captive breeding colony or were free ranging in a 10-ha exclosure. Statistical analyses were undertaken, and significant differences in parameters were found depending on age, sex, and captive or free-ranging status of animals. These reference intervals will assist ongoing health and conservation management of this endangered marsupial species.

Teaching dental students how to deliver bad news: S-P-I-K-E-S model.

Delivering bad news has traditionally been associated with life-threatening illness, the imminence of death, or communicating about the death of a loved one to a family member. The delivery of bad news in dentistry is rarely about life-threatening circumstances. However, the impact of the bad news such as the loss of an anterior tooth can be devastating for the patient. This article outlines the S-P-I-K-E-S protocol and discusses the teaching aims and methodology in applying the model in an undergraduate dental program in Ireland.