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1.
Bone Joint J ; 103-B(7 Supple B): 103-110, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34192916

RESUMEN

AIMS: Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. METHODS: We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model. RESULTS: A discharge prescription of < 400 MMEs was not a risk factor for opioid represcribing in the entire population (p = 0.772) or in opioid-naïve patients alone (p = 0.272). Procedure type was the most significant risk factor for narcotic represcribing, with unilateral TKA (hazard ratio (HR) = 5.62), bilateral TKA (HR = 6.32), and bilateral unicompartmental knee arthroplasty (UKA) (HR = 5.29) (all p < 0.001) being the highest risk for refills. For these three procedures, there was approximately a 5% to 6% increase in refills from P1 to P3 (p < 0.001); however, there was no significant increase in refill rates after any hip arthroplasty procedures. Total MMEs prescribed were significantly reduced from P1 to P3 (p < 0.001), leading to the equivalent of nearly 500,000 fewer oxycodone 5 mg tablets prescribed. CONCLUSION: Decreasing opioids prescribed at discharge led to a statistically significant reduction in total MMEs prescribed. While the represcribing rate did not increase for any hip arthroplasty procedure, the overall refill rates increased by about 5% for most knee arthroplasty procedures. As such, we are now probably prescribing an appropriate amount of opioids at discharge for knee arthroplasty procedure, but further reductions may be possible for hip arthroplasty procedures. Cite this article: Bone Joint J 2021;103-B(7 Supple B):103-110.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Alta del Paciente , Estudios Retrospectivos
2.
N Engl J Med ; 385(4): 342-351, 2021 07 22.
Artículo en Inglés | MEDLINE | ID: mdl-34289277

RESUMEN

BACKGROUND: Historically, the receipt of prescription opioids has differed among racial groups in the United States. Research has not sufficiently explored the contribution of individual health systems to these differences by examining within-system prescription opioid receipt according to race. METHODS: We used 2016 and 2017 Medicare claims data from a random 40% national sample of fee-for-service, Black and White beneficiaries 18 to 64 years of age who were attributed to health systems. We identified 310 racially diverse systems (defined as systems with ≥200 person-years each for Black and White patients). To test representativeness, we compared patient characteristics and opioid receipt among the patients in these 310 systems with those in the national sample. Within the 310 systems, regression models were used to explore the difference between Black and White patients in the following annual opioid measures: any prescription filled, short-term receipt of opioids, long-term receipt of opioids (one or more filled opioid prescriptions in all four calendar quarters of a year), and the opioid dose in morphine milligram equivalents (MME); models controlled for patient characteristics, state, and system. RESULTS: The national sample included 2,197,153 person-years, and the sample served by 310 racially diverse systems included 896,807 person-years (representing 47.4% of all patients and 56.1% of Black patients in the national sample). The national sample and 310-systems sample differed meaningfully only in the percent of person-years contributed by Black patients (21.3% vs. 25.9%). In the 310-systems sample, the crude annual prevalence of any opioid receipt differed slightly between Black and White patients (50.2% vs. 52.2%), whereas the mean annual dose was 36% lower among Black patients than among White patients (5190 MME vs. 8082 MME). Within systems, the adjusted race differences in measures paralleled the population trends: the annual prevalence of opioid receipt differed little, but the mean annual dose was higher among White patients than among Black patients in 91% of the systems, and at least 15% higher in 75% of the systems. CONCLUSIONS: Within individual health systems, Black and White patients received markedly different opioid doses. These system-specific findings could facilitate exploration of the causes and consequences of these differences. (Funded by the National Institute on Aging and the Agency for Healthcare Research and Quality.).


Asunto(s)
Analgésicos Opioides/uso terapéutico , Disparidades en Atención de Salud/etnología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos , Personas con Discapacidad , Grupo de Ascendencia Continental Europea , Femenino , Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Medicare , Persona de Mediana Edad , Manejo del Dolor , Medicamentos bajo Prescripción/uso terapéutico , Estados Unidos , Adulto Joven
4.
West J Emerg Med ; 22(3): 756-762, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-34125057

RESUMEN

INTRODUCTION: Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities. METHODS: We conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state's implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic. RESULTS: The overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%-52.2%) to 47.9% (95% Cl, 47.0%-48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001). CONCLUSION: We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Programas de Monitoreo de Medicamentos Recetados/organización & administración , Adulto , Femenino , Humanos , Análisis de Series de Tiempo Interrumpido , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Estudios Retrospectivos
5.
J Manipulative Physiol Ther ; 44(4): 280-288, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34090548

RESUMEN

OBJECTIVES: The purpose of this study was to assess the status, supply, demographics, and characteristics of chiropractic practice in the continent of Africa. METHODS: A survey consisting of questions on demographics, clinical practice, and patient profile was administered to 608 chiropractors practicing in the different countries of the African continent. Chiropractic association officers of each country were contacted via e-mail for assistance in the distribution of the survey link to chiropractors in their country. The initial questionnaire was pretested with a small group of chiropractors from 2 African countries-4 from Ethiopia and 6 from Botswana-to assess the validity of the questions. The legal status of the chiropractic practice was obtained from online resources. Descriptive statistics were conducted in Microsoft Excel. RESULTS: Of the 54 countries in the continent of Africa, 23 countries were identified to have chiropractors. One hundred twenty-four surveys were returned from 15 countries with an overall response rate of 20.3% by clinicians with varying years in clinical practice. Nearly 84% of the chiropractors were between ages 26 and 50. More than 69% reported being a graduate of 1 of the 2 academic institutions located in Africa. Most chiropractors practice in South Africa. Most chiropractors practice in privately owned clinics, and 38% practice in multidisciplinary clinics. Nearly 92% reported using diversified technique and 27% used McKenzie exercises for treatment. Patients presented with a variety of conditions, predominantly chronic pain (59%). CONCLUSIONS: This study provides a general overview on the status, supply, demographics, and characteristics of chiropractic practice in the continent of Africa. The supply of chiropractors in Africa is scarce and unevenly distributed. Although in the early stages of recognition, chiropractors in Africa are contributing to the care of people with musculoskeletal and spine-related disorders. Considering the high burden of spine pain, there appears to be potential for growth for chiropractic in the continent of Africa.


Asunto(s)
Actitud del Personal de Salud , Quiropráctica/estadística & datos numéricos , Manipulación Quiropráctica/estadística & datos numéricos , Enfermedades Musculoesqueléticas/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Personal de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Sudáfrica , Encuestas y Cuestionarios
6.
Br J Surg ; 108(6): 717-726, 2021 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-34157090

RESUMEN

BACKGROUND: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. METHODS: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. RESULTS: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. CONCLUSION: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.


Asunto(s)
Apendicitis/terapia , Actitud del Personal de Salud , COVID-19 , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos , Antibacterianos/uso terapéutico , Apendicectomía/métodos , Apendicectomía/estadística & datos numéricos , Prueba de COVID-19/estadística & datos numéricos , Administración Hospitalaria , Humanos , Pandemias , Equipo de Protección Personal/estadística & datos numéricos , Encuestas y Cuestionarios
7.
Eur J Endocrinol ; 185(2): 265-278, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34061767

RESUMEN

Objective: Metabolic syndrome is a cluster of cardio-metabolic risk factors associated with an increased risk of cardiovascular disease and type 2 diabetes. In the last two decades, several definitions of metabolic syndrome have been proposed for the pediatric population; all of them agree on the defining components but differ in the suggested criteria for diagnosis. This review aims to analyze the current diagnostic criteria of metabolic syndrome in pediatrics with reference to their feasibility and reliability in clinical practice. Methods: The systematic research was conducted from January 2003 to June 2020 through MEDLINE via PubMed, Cochrane Library and EMBASE databases. Results: After the selection phase, a total of 15 studies (182 screened) met the inclusion criteria and are reported in the present review. Twelve studies were cross-sectional, two were longitudinal and one was a consensus report. The sample population consisted of multiethnic group or single ethnic group, including Turkish, European, Asian and Hispanic subjects. Conclusions: To date, there is not a univocal, internationally accepted pediatric definition of metabolic syndrome, which guarantees a high sensitivity and stability of the diagnosis. The definition proposed by IDF results the most straightforward and easy to use in clinical practice, having the unquestionable advantage of requiring measurements quickly accessible in clinical practice, without the adoption of multiple reference tables. Further research is needed to validate a new version of such definition which includes the diagnostic cut-off points recently suggested by published guidelines.


Asunto(s)
Técnicas de Diagnóstico Endocrino , Síndrome Metabólico/diagnóstico , Pediatría , Adolescente , Edad de Inicio , Niño , Preescolar , Técnicas de Diagnóstico Endocrino/normas , Técnicas de Diagnóstico Endocrino/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Síndrome Metabólico/epidemiología , Pediatría/métodos , Pediatría/normas , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Reproducibilidad de los Resultados
8.
Medicine (Baltimore) ; 100(24): e26195, 2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34128851

RESUMEN

ABSTRACT: To approximate the breakdown of narrow anterior chamber angle conditions, on general ophthalmology clinics, in the predominantly white population of the South East Kent region in the United Kingdom.A review was done of all patients attending a secondary care ophthalmology general clinic over a 3-year period. Patients were assessed with: slitlamp biomicroscopy with indentation gonioscopy; SD optical coherence tomography, Humphrey visual field analyzer, and high frequency ultrasound and categorized into various narrow angle conditions. These were: narrow Van Herrick but open angle; primary narrow angle but nonoccludable; primary angle closure suspect; primary angle closure; chronic narrow angle glaucoma; plateau iris configuration; plateau iris syndrome, and phacomorphic narrow angle.A total of 14,520 patients were referred to the clinic, of those 10,491 attended and were analyzed. Six hundred seventy four (6.4%) of the patients had some form of narrow angle condition in at least 1 eye. The majority of these patients were at relative low risk of pathology such as nonoccludable narrow angles (359/53.3%) and narrow Van Herrick but open angles (93/13.8%). 8.8% of all the narrow angle patients had primary angle closure suspect or primary angle closure. Plateau iris pathology was seen in 68 (10.1%) of patients with 18 (26%) having confirmed plateau iris syndrome after peripheral iridotomy. Phacomorphic pathology was confirmed in 75 (11.1%) patients.Narrow angle patients form a significant proportion (6.4%) of those attending general ophthalmology clinic in the predominantly white population in the South East Kent Region of the United Kingdom. The majority of these (67.1%) are at a relatively low risk of developing acute or chronic angle closure glaucoma. Of the remaining patients 8.8% have primary angle closure suspect or primary angle closure and 2.9% have already progressed to chronic narrow angle closure glaucoma. Plateau iris pathology and phacomorphic glaucoma account for the remainder of the presentations.


Asunto(s)
Glaucoma de Ángulo Cerrado/epidemiología , Enfermedades del Iris/epidemiología , Oftalmología/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Cámara Anterior/patología , Estudios Transversales , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico , Gonioscopía , Humanos , Iris/patología , Enfermedades del Iris/diagnóstico , Masculino , Persona de Mediana Edad , Prevalencia , Tomografía de Coherencia Óptica , Ultrasonografía , Reino Unido/epidemiología , Pruebas del Campo Visual
11.
Med Clin North Am ; 105(4): 783-797, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34059250

RESUMEN

This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.


Asunto(s)
Infecciones Bacterianas/patología , Infecciones por Herpesviridae/patología , Micosis/patología , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/patología , Adolescente , Adulto , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Niño , Preescolar , Ectima/diagnóstico , Ectima/tratamiento farmacológico , Erisipela/diagnóstico , Erisipela/tratamiento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamiento farmacológico , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/tratamiento farmacológico , Foliculitis/diagnóstico , Foliculitis/tratamiento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Herpes Labial/diagnóstico , Herpes Labial/tratamiento farmacológico , Infecciones por Herpesviridae/complicaciones , Infecciones por Herpesviridae/virología , Humanos , Impétigo/diagnóstico , Impétigo/tratamiento farmacológico , Erupción Variceliforme de Kaposi/diagnóstico , Erupción Variceliforme de Kaposi/tratamiento farmacológico , Persona de Mediana Edad , Micosis/complicaciones , Micosis/microbiología , Onicomicosis/diagnóstico , Onicomicosis/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedades Cutáneas Infecciosas/microbiología , Enfermedades Cutáneas Infecciosas/virología , Tiña del Cuero Cabelludo/diagnóstico , Tiña del Cuero Cabelludo/tratamiento farmacológico , Adulto Joven
12.
Diabetes Res Clin Pract ; 176: 108852, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33957143

RESUMEN

Diabetes is a very important comorbidity in patients with heart failure. When both diseases coexist cardiovascular morbidity and mortality is greatly increased. Therefore, it is of clinical importance to treat both diseases as early as possible with an optimal therapy. Hitherto, heart failure therapy did not differ if a patient had concomitant diabetes. However, with SGLT-2 inhibitors having demonstrated to reduce hospitalization of heart failure independent of diabetes state and expected to be included into the ESC heart failure treatment guidelines in 2021 coexisting diabetes potentially will make a difference when to start therapy. In this article we provide an overview of current recommendations and also provide clinical considerations for the therapy of heart failure with concomitant diabetes.


Asunto(s)
Cardiólogos , Angiopatías Diabéticas/terapia , Insuficiencia Cardíaca/terapia , Pautas de la Práctica en Medicina , Cardiólogos/normas , Cardiólogos/estadística & datos numéricos , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/epidemiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Hospitalización/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pronóstico , Volumen Sistólico
13.
Am J Gastroenterol ; 116(4): 796-807, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33982950

RESUMEN

INTRODUCTION: Pain control is an important management approach for many gastrointestinal conditions. Because of the ongoing opioid crisis, public health efforts have focused on limiting opioid prescriptions. This study examines national opioid prescribing patterns and factors associated with opioid prescriptions for gastrointestinal conditions. METHODS: We conducted a repeated cross-sectional study using the National Ambulatory Medical Care Survey data from 2006 to 2016. The International Classification of Diseases codes were used to identify ambulatory visits with a primary gastrointestinal diagnosis. Data were weighted to calculate national estimates for opioid prescriptions for gastrointestinal disease. Joinpoint regression was used to analyze temporal trends. Multivariable logistic regression was used to examine factors associated with opioid prescriptions. RESULTS: We analyzed 12,170 visits with a primary gastrointestinal diagnosis, representing 351 million visits. The opioid prescription rate for gastrointestinal visits was 10.1% (95% confidence interval [CI] 9.0%-11.2%). Opioid prescription rates for gastrointestinal disease increased by 0.5% per year from 2006 to 2016 (P = 0.04). Prescription rates were highest for chronic pancreatitis (25.1%) and chronic liver disease (13.9%) visits. Seventy-one percent of opioid prescriptions were continuations of an existing prescription. Patient characteristics associated with continued opioid prescriptions included rural location (adjusted odds ratio [aOR] 1.46; 95% CI 1.11-1.93), depression (aOR 1.83; 95% CI 1.33-2.53), and Medicaid insurance (aOR 1.57; 95% CI 1.15-2.13). DISCUSSION: Opioid prescription rates for gastrointestinal disease visits increased from 2006 to 2016. Our findings suggest an inadequate response to the opioid epidemic by providers managing gastrointestinal conditions. Further clinical interventions are needed to limit opioid use for gastrointestinal disease.(Equation is included in full-text article.).


Asunto(s)
Analgésicos Opioides/farmacología , Prescripciones de Medicamentos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Enfermedades Gastrointestinales/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , Población Rural , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/etiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos/epidemiología
14.
Lancet Diabetes Endocrinol ; 9(6): 393-405, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34022157

RESUMEN

China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.


Asunto(s)
Obesidad/terapia , China/epidemiología , Atención a la Salud/normas , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Humanos , Obesidad/epidemiología , Sobrepeso/epidemiología , Sobrepeso/terapia , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Programas de Reducción de Peso/métodos , Programas de Reducción de Peso/estadística & datos numéricos , Programas de Reducción de Peso/provisión & distribución
15.
Bone Joint J ; 103-B(5): 809-812, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934656

RESUMEN

The use of tourniquets in lower limb trauma surgery to control bleeding and improve the surgical field is a long established practice. In this article, we review the evidence relating to harms and benefits of tourniquet use in lower limb fracture fixation surgery and report the results of a survey on current tourniquet practice among trauma surgeons in the UK.


Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Fijación Interna de Fracturas/métodos , Traumatismos de la Pierna/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Torniquetes , Medicina Basada en la Evidencia , Humanos , Dimensión del Dolor , Complicaciones Posoperatorias , Encuestas y Cuestionarios , Reino Unido
16.
Medicine (Baltimore) ; 100(20): e25939, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011070

RESUMEN

ABSTRACT: Although collaborative treatment by traditional Korean medicine doctors (KMDs) and medical doctors occurs, it is mainly done by referral. As no survey of the general public's preference for the type of collaboration has ever been conducted, we aimed to investigate Koreans' preferences for a collaborative treatment type.The responders were extracted by random digit dialing and then reextracted using the proportional quota sampling method by sex and age. From July to October 2017, telephone interviews were conducted and the participant responses regarding treatment history for spinal or joint diseases, experiences with collaborative treatment, and preferred type of collaborative treatment were recorded.Of the 1008 respondents, 44.64% reported a history of treatment for spinal or joint diseases at a medical institution. The concurrent collaborative treatment system, in which both KMDs and medical doctors are present in one location participating in the treatment concurrently, was the most preferred system among the respondents. Respondents who reported experience with traditional Korean medicine hospitals were more likely to prefer a one-stop treatment approach than those who did not have experience with traditional Korean medicine hospitals (adjusted odds ratio: 1.73; 95% confidence interval: 1.12-2.68). Respondents who were familiar with collaborative treatment but did not report any personal experience with it were more likely to prefer a one-stop treatment approach than those who were not familiar with collaborative treatment (adjusted odds ratio: 1.82; 95% confidence interval: 1.37-2.44).Koreans prefer a concurrent type of collaborative treatment system by KMDs and medical doctors. Therefore, efforts and support are needed to increase the application of the concurrent type of collaborative system.


Asunto(s)
Colaboración Intersectorial , Artropatías/terapia , Prioridad del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/organización & administración , Enfermedades de la Columna Vertebral/terapia , Adulto , Anciano , Terapia Combinada/métodos , Terapia Combinada/estadística & datos numéricos , Femenino , Salud Holística/estadística & datos numéricos , Humanos , Masculino , Medicina Tradicional Coreana/métodos , Medicina Tradicional Coreana/estadística & datos numéricos , Persona de Mediana Edad , Ortopedia/organización & administración , Ortopedia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , República de Corea , Encuestas y Cuestionarios/estadística & datos numéricos
17.
Bone Joint J ; 103-B(6 Supple A): 38-44, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34053298

RESUMEN

AIMS: The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred. METHODS: Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m2 and ≥ 40 kg/m2 and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses. RESULTS: In total, 314,695 patients underwent TKA and 46,362 (15%) had BMI ≥ 40 kg/m2. The prevalence of morbid obesity among TKA patients did not change greatly, ranging between 14% and 16%. Reoperation rate decreased from 1.16% to 0.96% (odds ratio (OR) 0.81 (95% confidence interval (CI) 0.66 to 0.99)) for patients with BMI < 40 kg/m2, as did rates of readmission (4.46% to 2.87%; OR 0.61 (0.55 to 0.69)). Patients with BMI ≥ 40 kg/m2 also had fewer readmissions over the study period (4.87% to 3.34%; OR 0.64 (0.49 to 0.83)); however, the rate of reoperation did not change (1.37% to 1.41%; OR 0.99 (0.62 to 1.56)). Significant improvements were not observed for infective complications over time for either group; patients with BMI ≥ 40 kg/m2 had increased risk of both deep infection and wound complications compared to non-morbidly obese patients. Rate of any complication decreased for all patients. CONCLUSION: The proportion of TKAs in morbidly obese patients has not significantly changed over the past decade. Although readmission rates improved for all patients, reductions in reoperation in non-morbidly obese patients were not experienced by the morbidly obese, resulting in a widening of the complication gap between these cohorts. Care improvements have not lowered the differential risk of infective complications in the morbidly obese. Cite this article: Bone Joint J 2021;103-B(6 Supple A):38-44.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Obesidad Mórbida/complicaciones , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Reoperación/estadística & datos numéricos , Estados Unidos/epidemiología
18.
Medicine (Baltimore) ; 100(18): e25794, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33950976

RESUMEN

ABSTRACT: The physiological benefits of applying blood flow restriction (BFR) in isolation or in the presence of physical exercise have been widely documented in the scientific literature. Most investigations carried out under controlled laboratory conditions have found the technique to be safe. However, few studies have analyzed the use of the technique in clinical settings.To analyze how the BFR technique has been applied by professionals working in the clinical area and the prevalence of side effects (SEs) resulting from the use of this technique.This is a cross-sectional study. A total of 136 Brazilian professionals who perform some function related to physical rehabilitation, sports science, or physical conditioning participated in this study. Participants answered a self-administered online questionnaire consisting of 21 questions related to the professional profile and methodological aspects and SEs of the BFR technique.Professionals reported applying the BFR technique on individuals from different age groups from youth (≤18 years; 3.5%) to older adults (60-80 years; 30.7%), but mainly on people within the age group of 20 to 29 years (74.6%). A total of 99.1% of the professionals coupled the BFR technique with resistance exercise. Their main goals were muscle hypertrophy and physical rehabilitation. The majority (60.9%) of interviewees reported using BFR in durations of less than 5 minutes and the pressure used was mainly determined through the values of brachial blood pressure and arterial occlusion. Moreover, 92% of professionals declared observing at least 1 SE resulting from the BFR technique. Most professionals observed tingling (71.2%) and delayed onset of muscle soreness (55.8%). Rhabdomyolysis, fainting, and subcutaneous hemorrhaging were reported less frequently (1.9%, 3.8%, and 4.8%, respectively).Our findings indicate that the prescription of blood flow restriction technique results in minimal serious side effects when it is done in a proper clinical environment and follows the proposed recommendations found in relevant scientific literature.


Asunto(s)
Músculo Esquelético/patología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Flujo Sanguíneo Regional/fisiología , Entrenamiento de Fuerza/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Personal de Salud/estadística & datos numéricos , Hematoma/epidemiología , Hematoma/etiología , Humanos , Hipertrofia/fisiopatología , Hipertrofia/terapia , Masculino , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Presión , Entrenamiento de Fuerza/efectos adversos , Entrenamiento de Fuerza/estadística & datos numéricos , Rabdomiólisis/epidemiología , Rabdomiólisis/etiología , Encuestas y Cuestionarios/estadística & datos numéricos , Síncope/epidemiología , Síncope/etiología , Factores de Tiempo , Adulto Joven
19.
Medicine (Baltimore) ; 100(18): e25810, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33950984

RESUMEN

ABSTRACT: Research that focuses on transfers to and from the intensive care unit (ICU) could highlight important patients' safety issues. This study aims to describe healthcare workers' (HCWs) practices involved in patient transfers to or from the ICU.This cross-sectional study was conducted among HCWs during the Saudi Critical Care Society's annual International Conference, April 2017. Responses were assessed using Likert scales and frequencies. Bivariate analysis was used to evaluate the significance of different indicators.Overall, 312 HCWs participated in this study. Regarding transfer to ICUs, the most frequently reported complications were deterioration in respiratory status (51.4%), followed by deterioration in hemodynamic status (46.5%), and missing clinical information (35.5%). Regarding transfers from ICUs to the general ward, the most commonly reported complications were changes in respiratory status (55.6%), followed by incomplete clinical information (37.9%), and change in hemodynamic conditions (29%). The most-used models for communicating transfers were written documents in electronic health records (69.3%) and verbal communication (62.8%). One-fourth of the respondents were not aware of the Situation, Background, Assessment, Recommendation (SBAR) method of patients' handover. Pearson's test of correlation showed that the HCW's perceived satisfaction with their hospital transfer guidelines showed significant negative correlation with their reported transfer-related complications (r = -0.27, P < .010).Hemodynamic and respiratory status deterioration is representing significant adverse events among patients transferred to or from the ICU. Factors controlling the perceived satisfaction of HCWs involved in patients, transfer to and from the ICU need to be addressed, focusing on their compliance to the hospital-wide transfer and handover policies. Quality improvement initiatives could improve patient safety to transfer patients to and from the ICU and minimize the associated adverse events.


Asunto(s)
Deterioro Clínico , Cuidados Críticos/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cuidados Críticos/normas , Enfermedad Crítica/terapia , Estudios Transversales , Femenino , Adhesión a Directriz/estadística & datos numéricos , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/normas , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Pase de Guardia/normas , Pase de Guardia/estadística & datos numéricos , Transferencia de Pacientes/normas , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Arabia Saudita , Encuestas y Cuestionarios/estadística & datos numéricos
20.
Pan Afr Med J ; 38: 193, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33995799

RESUMEN

Introduction: in Oman, there is a need to understand the profile of primary care physicians' (PCP) knowledge, attitude, and practice, and barriers (KAPB) towards tobacco dependence treatment (TDT). Their profile will directly affect their consultation and contribution to health care educators to develop an appropriate educational program for the PCPs. The aim of this study is to determine profiles in a cohort of PCP with regards to factors associated with physicians' perceived KAPB of providing TDT. Methods: a cross-sectional survey was conducted for four months from September to December 2019. A sample of 226 (response rate is 71.2%) PCPs working for Muscat's health centers, the capital of Oman, was collected. A 2-step cluster method was used to separate the sample into sub-groups according to their demographic and KAPB scores. Results: cluster analysis revealed two groups of PCPs who are different in demographics and KAPB scores. The PCPs in cluster B (27.4%) have higher educational levels, senior ranking, more males and older. They labeled as the "good knowledge, positive attitudes, and highly practices" group. The PCPs in cluster A comprised 72.6% of our samples. There are more females, younger, and with a junior ranking. This cluster was identified as the "lack of knowledge, moderate attitudes, and rarely practices" group. Conclusion: findings might help primary health care authorities to address this preventable issue and plan interventions to establish well-structured TDT clinics in the future.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Tabaquismo/rehabilitación , Adulto , Factores de Edad , Actitud del Personal de Salud , Análisis por Conglomerados , Estudios Transversales , Femenino , Humanos , Masculino , Omán , Atención Primaria de Salud/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios
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