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1.
Rev Med Liege ; 75(9): 593-597, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32909411

RESUMO

Rheumatoid arthritis (RA) is a heterogeneous disease in terms of presentation and evolution. In recent years, a change in the face of this disease has been noticed. RA appears to be less lethal than before, with a larger decline in cardiovascular mortality. Patient hospitalization and orthopedic surgery appear to be declining. Today's RA also seems less active and less destructive. These documented changes, especially over the last decade, are attributable not only to the emergence of biotherapies, but also to more rigorous management strategies by rheumatologists as well as increased patient awareness.


Assuntos
Artrite Reumatoide , Ortopedia , Humanos
2.
Arthroscopy ; 36(8): 2229-2230, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747064

RESUMO

As our vocabulary grows to include exotic terms promising treatment options for osteoarthritis and cartilage treatment, our adherence to the scientific method and quest for unbiased data remain critical. Only by following this path will biologics like exosomes remain more than theoretical comets of hope. Exosomes are extracellular vesicles that are released from all body cells. In orthopaedics, exosomes may be part of cell-to-cell communication systems mediating osteoarthritis, fracture healing, and cartilage repair. Recent research has combined mesenchymal stem cell exosomes and hyaluronic acid in a rabbit cartilage repair model. Currently, there are limitations in the translation of these methods into human trials.


Assuntos
Exossomos , Células-Tronco Mesenquimais , Ortopedia , Animais , Cartilagem , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Coelhos , Vocabulário
3.
J Orthop Trauma ; 34(9): e330-e335, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815847

RESUMO

Although elective surgeries and in-person office visits were greatly reduced during the COVID-19 crisis, orthopaedic surgeons continue to play a critical role in caring for both orthopaedic and nonorthopaedic problems during this pandemic. Orthopaedic departments provide the ability to off-load emergency departments of orthopaedic issues, redeploy staff to areas of need across the hospital system, and provide direct care to COVID-19 patients. The following will discuss the experience of a large academic orthopaedic surgery department within the epicenter of the COVID-19 pandemic with respect to redeployment of human capital and unique resources such as the United States Naval Ship Comfort as well as our recommended strategy for handling future disaster situations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Militares , Ortopedia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Navios , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
5.
Plast Reconstr Surg ; 146(2): 343-354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740587

RESUMO

Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.


Assuntos
Implementação de Plano de Saúde , Doenças Musculoesqueléticas/terapia , Sistemas On-Line , Ortopedia/organização & administração , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Estudos de Coortes , Coleta de Dados/métodos , Mãos/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Países Baixos , Ortopedia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor , Melhoria de Qualidade , Punho/fisiopatologia
6.
J Orthop Surg Res ; 15(1): 322, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787965

RESUMO

BACKGROUND: World Health Organization declared coronavirus disease-19 (COVID-19) a global pandemic on 11 March 2020, after the coronavirus claimed 4628 lives worldwide. Mental health challenges such as making impossible decisions and working under extreme pressures are expected to be faced by frontline healthcare workers who are directly involved in the care of COVID-19 patients. However, we question if significant stress levels might also be observed in a subspecialty musculoskeletal outpatient department, where staff are not first-line care providers of COVID-19 patients. We hypothesize that these healthcare workers also face significant psychological strain, and we aim to objectively determine the prevalence using a validated caregiver strain index. METHODS: A cross-sectional study was conducted in outpatient musculoskeletal clinics in a tertiary hospital in Singapore. We collected basic demographic data and used a 13-question tool adapted from the validated Caregiver Strain Index (CSI) to measure psychological strain in these healthcare workers. Participants were divided into 2 groups depending on the level of strain experienced. RESULTS: A total of 62 healthcare workers volunteered for this study. There were 32 participants (51.6%) who had 7 or more positive responses (group 1) and the remaining 30 participants (48.4%) were allocated to group 2. There were no significant differences between the two groups in terms of demographic data. "Work adjustments" (74.2%), "changes in personal plans" (72.6%), and finding it "confining" (72.6%) garnered the most positive responses in the questionnaire. On the other hand, "financial concerns" garnered the least positive responses (21.0%). CONCLUSION: The protracted duration of the COVID-19 outbreak and its resultant prolonged adjustments can have unintended consequences of wearing down healthcare resources otherwise allocated to chronic and elective conditions. Countries should ensure that measures are put in place to safeguard the mental well-being of our healthcare workers to avoid needing another reactive strategy in this battle against COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Ortopedia/tendências , Ambulatório Hospitalar/tendências , Pandemias , Pneumonia Viral/psicologia , Adulto , Idoso , Infecções por Coronavirus/terapia , Estudos Transversais , Feminino , Pessoal de Saúde/tendências , Humanos , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Doenças Musculoesqueléticas/terapia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Singapura/epidemiologia , Adulto Jovem
10.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2747-2755, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32803277

RESUMO

PURPOSE: To plan for the continuance of elective hip and knee arthroplasty during a resurgence or new wave of COVID-19 infections. METHOD: A systematic review was conducted using the terms "COVID-19" or "SARS-Cov-2" and "second wave". No relevant citations were found to inform on recommendations the plan. Therefore, an expert panel of the European Hip Society and the European Knee Associates was formed to provide the recommendations. RESULTS: Overall, the recommendations consider three phases; review of the first wave, preparation for the next wave, and during the next wave. International and national policies will drive most of the management. The recommendations focus on the preparation phase and, in particular, the actions that the individual surgeon needs to undertake to continue with, and practice, elective arthroplasty during the next wave, as well as planning their personal and their family's lives. The recommendations expect rigorous data collection during the next wave, so that a cycle of continuous improvement is created to take account of any future waves. CONCLUSIONS: The recommendations for planning to continue elective hip and knee arthroplasty during a new phase of the SARS-Cov-2 pandemic provide a framework to reduce the risk of a complete shutdown of elective surgery. This involves engaging with hospital managers and other specialities in the planning process. Individuals have responsibilities to themselves, their colleagues, and their families, beyond the actual delivery of elective arthroplasty.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Pneumonia Viral/epidemiologia , Betacoronavirus , Europa (Continente) , Humanos , Ortopedia , Pandemias , Sociedades Médicas , Cirurgiões
12.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2730-2746, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32844246

RESUMO

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Pneumonia Viral/epidemiologia , Antropologia Médica , Betacoronavirus , Consenso , Assistência à Saúde/métodos , Desinfecção/métodos , Desinfecção/normas , Europa (Continente) , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Humanos , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/normas , Procedimentos Ortopédicos , Ortopedia , Pandemias , Equipamento de Proteção Individual , Inquéritos e Questionários
15.
J Bone Joint Surg Am ; 102(15): e87, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32769593

RESUMO

Currently, the coronavirus disease 2019 (COVID-19) crisis has rapidly spread worldwide. As the earliest outbreak area of the pandemic, Wuhan, People's Republic of China, is gradually recovering to its normal state under the effective control of government authorities. Outpatient services in major hospitals are now being restored. An accumulation of asymptomatic infections is a potential risk for medical personnel, especially when there is crowding in hospitals. As the biggest center for orthopaedic patients in Wuhan, our orthopaedic outpatient department admits >300 patients per day. Optimal guidelines on how to handle this huge number of patients during the post-outbreak stage of the COVID-19 pandemic, particularly with regard to potential asymptomatic infection, are urgently needed for orthopaedic surgeons. We have developed and proposed applicable guidelines to fill this knowledge gap, including the necessary protective strategies for medical personnel in orthopaedic outpatient and inpatient wards as well as during surgery. We also have provided mental health recommendations for health-care workers. To the best of our knowledge, these guidelines are the first of their kind for orthopaedic surgeons who are slowly reestablishing medical activity following the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Ortopedia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , China , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto
17.
Orthopedics ; 43(4): 228-232, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32674173

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has had a global influence on health care. The authors examined the early effect of hospital- and state-mandated restrictions on an orthopedic surgery department and hypothesized that the volume of ambulatory clinic encounters, office and surgical procedures, and cases would dramatically decrease. A retrospective review was performed of all encounters in an orthopedic surgery department at a level I academic trauma center during a 4-week period, from March 16, 2020, to April 12, 2020. The results were compared with two control 4-week periods, February 17, 2020, to March 15, 2020, and March 16, 2019, to April 12, 2019. Weekly volume and work relative value units (RVUs) of clinic encounters, office and surgical procedures, and cases were assessed. The type of ambulatory visit also was recorded. Comparisons of mean weekly volume and RVUs between the study and control periods were performed with Student's t test. Surgical cases were categorized into fracture or dislocation, acute soft tissue or nerve injury, infection, oncology, and elective or nonurgent. After implementation of hospital- and state-mandated restrictions on elective health care, the volume of ambulatory orthopedic surgery clinic encounters decreased by 74% to 77%, the volume of clinic procedures decreased by 95%, and the volume of surgical cases decreased by 88%. The percentage of clinic visits performed via telemedicine increased from 0.3% to 81.2%. Elective surgical cases ceased, and the volume of nonelective surgical cases decreased by 51%. During the first 4 weeks after COVID-19-related restrictions were imposed, an immediate and dramatic effect was observed. Compared with the control periods, significant reductions were seen in the volume of ambulatory encounters, office-based procedures, and surgical cases. In addition, the volume of nonelective surgical cases decreased by 51%. [Orthopedics. 2020;43(4):228-232.].


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial , Betacoronavirus , Humanos , Massachusetts/epidemiologia , Pandemias , Estudos Retrospectivos , Centros de Traumatologia
18.
Orthopedics ; 43(4): 245, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32674175

RESUMO

The SARS-CoV-2 (COVID-19) crisis has strained hospitals and health systems across the world. In the United States, New York City has faced a surge of cases as the epicenter of the North American outbreak. Northwell Health, as the largest regional health system in New York City, has implemented various practices and policies to adapt to the evolving situation and prepare for future global events. [Orthopedics. 2020;43(4):245-249.].


Assuntos
Assistência Ambulatorial , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus , Infecções por Coronavirus/terapia , Hospitais , Humanos , Cidade de Nova Iorque/epidemiologia , Ortopedia/educação , Pandemias , Posicionamento do Paciente , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Decúbito Ventral , Quarentena , Estados Unidos/epidemiologia
19.
J Orthop Surg Res ; 15(1): 279, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703305

RESUMO

BACKGROUND: According to the required reorganization of all hospital activities, the recent COVID-19 pandemic had dramatic consequences on the orthopedic world. We think that informing the orthopedic community about the strategy that we adopted both in our hospital and in our Department of Orthopedics could be useful, particularly for those who are facing the pandemic later than Italy. METHODS: Changes were done in our hospital by medical direction to reallocate resources to COVID-19 patients. In the Orthopedic Department, a decrease in the number of beds and surgical activity was stabilized. Since March 13, it has been avoided to perform elective surgery, and since March 16, non-urgent outpatient consultations were abolished. This activity reduction was associated with careful evaluation of staff and patients: extensive periodical swab testing of all healthcare staff and swab testing of all surgical patients were applied. RESULTS: These restrictions determined an overall reduction of all our surgical activities of 30% compared to 2019. We also had a reduction in outpatient clinic activities and admissions to the orthopedic emergency unit. Extensive swab testing has proven successful: of more than 160 people tested in our building, only three COVID-19 positives were found, and of over more than 200 surgical procedures, only two positive patients were found. CONCLUSIONS: Extensive swab test of all people (even if asymptomatic) and proactive tracing and quarantining of potential COVID-19 positive patients may diminish the virus spread.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Emergências , Reforma dos Serviços de Saúde/organização & administração , Hospitalização , Humanos , Controle de Infecções/organização & administração , Itália/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Centro Cirúrgico Hospitalar/organização & administração
20.
Orthop Nurs ; 39(4): 215-217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32665477

RESUMO

The novel coronavirus (SARS-CoV-2) represents a rapidly evolving pandemic. Health systems are scrambling to mobilize and redeploy their medical staff in the fight against COVID-19. Orthopaedic nurse practitioners/physician assistants should be part of any redeployment strategy to address unmet needs during these unprecedented times. This article discusses redeployment considerations and strategies that utilize these providers appropriately while mitigating risks.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Profissionais de Enfermagem , Enfermagem Ortopédica , Assistentes Médicos , Estados Unidos/epidemiologia
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