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1.
J Arthroplasty ; 33(7S): S239-S243, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29500089

RESUMO

BACKGROUND: Venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolism) is a known complication following total knee arthroplasty (TKA). Recent literature has identified differences in VTE risk based on race with African Americans having higher risk of VTE. This study evaluated the impact of race on VTE following TKA using a large multicenter database. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program to identify patients who underwent primary TKA in 2010-2014. Patients were stratified based on race: Asian, Black/African American, White, and Other. Demographics were compared to determine the impact on 30-day postoperative complications. Multivariate logistic regression analysis was performed to control for confounding demographics and comorbidities between races. Primary outcomes included overall complications and VTE. RESULTS: In total, 96,230 patients were included. Univariate analysis demonstrated that Blacks had a significantly higher rate of any complication (5.5%), deep venous thrombosis (1.3%), and pulmonary embolism (1.1%) than other races (P = .007, P < .001, and P < .001, respectively). Overall mortality rate did not differ between races (P = .26). Multivariate regression analysis identified that Blacks were significantly more likely to have a VTE than Whites (odds ratio 1.7, 95% confidence interval 1.4-2.0). Overall complications were significantly higher for Blacks than Whites (odds ratio 1.1, 95% confidence interval 1.02-1.3). There were no differences in the rates of VTE or overall complications between Asians/Other races and Whites. CONCLUSION: Blacks have a significantly higher risk of VTE following primary TKA than other races. Future studies should investigate causes for this disparity.


Assuntos
Artroplastia do Joelho/efeitos adversos , Complicações Pós-Operatórias/etnologia , Tromboembolia Venosa/etnologia , Idoso , Povo Asiático , População Negra , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Fatores de Risco , Estados Unidos/epidemiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , População Branca
2.
J Arthroplasty ; 32(9S): S8-S10.e1, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28209276

RESUMO

BACKGROUND: Despite American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPGs) related to the non-arthroplasty management of osteoarthritis (OA) of the knee, non-recommended treatments remain in common use. We sought to determine the costs associated with non-arthroplasty management of knee OA in the year prior to total knee arthroplasty (TKA) and stratify them by CPG recommendation status. METHODS: The Humana database was reviewed from 2007 to 2015 for primary TKA patients. Costs for hyaluronic acid (HA) and corticosteroid injections, physical therapy, braces, wedge insoles, opioids, non-steroidal anti-inflammatories, and tramadol in the year prior to TKA were calculated. Cost was defined as reimbursement paid by the insurance provider. Costs were analyzed relative to the overall non-inpatient costs for knee OA and categorized based on CPG recommendations. RESULTS: In total 86,081 primary TKA patients were analyzed and 65.8% had at least one treatment in the year prior to TKA. Treatments analyzed made up 57.6% of the total non-inpatient cost of knee OA in the year prior to TKA. Only 3 of the 8 treatments studied have a strong recommendation for their use (physical therapy, non-steroidal anti-inflammatories, tramadol) and costs for these interventions represented 12.2% of non-inpatient knee OA cost. In contrast, 29.3% of the costs are due to HA injections alone, which are not supported by CPGs. CONCLUSION: In the year prior to TKA, over half of the non-inpatient costs associated with knee OA are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this is due to HA injections alone. If only interventions recommend by the CPG are utilized then costs associated with knee OA could be decreased by 45%.


Assuntos
Artroplastia do Joelho/economia , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/cirurgia , Idoso , Anti-Inflamatórios não Esteroides/economia , Anti-Inflamatórios não Esteroides/uso terapêutico , Distinções e Prêmios , Feminino , Custos de Cuidados de Saúde , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/economia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ortopedia/economia , Modalidades de Fisioterapia/economia , Resultado do Tratamento
3.
J Telemed Telecare ; 26(4): 223-231, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30428766

RESUMO

INTRODUCTION: This study explores a novel smartphone application for postoperative care following carpal tunnel release (CTR). We hypothesized that a software-based 'virtual visit' for CTR could be safe, effective and convenient for the patient. METHODS: Our group developed the software application utilized in this study. Interactive steps with video instructions enabled patients to complete dressing and suture removal, capture a wound photo, answer a question about median nerve symptoms and capture a video of finger range of motion. Adult patients undergoing endoscopic or open CTR were enrolled. Prior to their scheduled postoperative visit, patients received and completed the module using their smartphone. Agreement between findings of the virtual visit and the corresponding in-person clinical visit was assessed using kappa values. RESULTS: Twenty-two patients were contacted regarding study enrolment and 17 patients were enrolled (ages 23-63, mean 48.2, 6M, 11F). Of 16 patients who participated, all completed dressing removal. Ten of 16 patients removed their sutures successfully. Fourteen patients captured a clinically adequate wound photo and 15 patients answered a question about median nerve symptoms. Fourteen patients captured a range of motion video. Software assessments of surgical wounds, nerve symptoms and physical exams agreed strongly with clinical assessments. DISCUSSION: Most patients were able to respond to a question about their symptoms, provide clinical assessment of their wound via a photo and record a video of their range of motion. Suture removal was the most difficult task. More investigation is needed to determine which patients can reliably remove their sutures.


Assuntos
Síndrome do Túnel Carpal/reabilitação , Cuidados Pós-Operatórios/métodos , Treinamento por Simulação/métodos , Smartphone/estatística & dados numéricos , Adulto , Idoso , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Adulto Jovem
4.
Comp Med ; 62(2): 116-23, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22546917

RESUMO

To understand the structure-function relationship in the postinfarcted myocardium in rabbits, we induced cardiac ischemia by ligating the left circumflex coronary artery. Sham controls underwent thoracotomy only. At 7 and 30 d after ligation, cardiac MRI was conducted by using pulse-oxymetry-gated cine acquisition to provide complete phases of the heartbeat. The rabbits were anesthetized under 1.5% isoflurane ventilation, and ultrafast techniques made breath-hold 3D coverage in different cardiac axes feasible. Viability imaging was performed after intravenous injection of 0.15 mmol/kg gadolinium to assess the extent of infarction. Data (n ≥ 6) are presented as mean ± SEM and analyzed by ANOVA and ANCOVA. In postligation rabbits, end-systolic (mean ± SEM, 2.3 ± 0.3 mL) and end-diastolic (4.2 ± 0.4 mL) volumes were increased compared with preligation values (end-systolic, 1.1 ± 0.1 mL; end-diastolic, 2.98 ± 0.2 mL). Ejection fraction was influenced adversely by the presence of scar tissue at both 7 and 30 d after ligation and apparently nonlinear with the heart rate. Cardiac force was increased in the basal region in both end-systole and end-diastole in postligation hearts but progressively decreased toward the apex. Late gadolinium enhancement delineated 15.2 ± 5.8% myocardial infarction at 7 d after ligation and 14.5 ± 5.8% at 30 d, with limited wall motion and wall thinness. Compensatory wall thickening was present in the basal region when compared with that in preligation hearts. MRI offers detailed spatial resolution and tissue characterization after myocardial infarction.


Assuntos
Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/patologia , Miocárdio/patologia , Remodelação Ventricular , Análise de Variância , Animais , Meios de Contraste , Modelos Animais de Doenças , Frequência Cardíaca , Masculino , Meglumina/análogos & derivados , Contração Miocárdica , Infarto do Miocárdio/fisiopatologia , Compostos Organometálicos , Oximetria , Valor Preditivo dos Testes , Coelhos , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
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