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Kara ÖS, Torgutalp SS, Turhan E, Dönmez G, Korkusuz F. Operative treatment in non-emergency sports injuries: a sports medicine clinic experience. PHYSICIAN SPORTSMED 2023; 51:596-602. [PMID: 36416053 DOI: 10.1080/00913847.2022.2151325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To elucidate referrals from sports medicine clinic (SMC) to orthopedics, consensus rates among physicians and surgeons on surgical need in these patients, and reasoning of the patients who refused to have surgery despite the recommendations by both groups in non-emergency sports injury patients. METHODS We conducted a retrospective cohort analysis by using the administrative and referral records of a sports medicine clinic for the 15 months between October 2017 and January 2019. Gender, age, diagnosis, and type of sport were compared between two groups (patients referred to orthopedics vs patients treated in SMC). Agreement between orthopedics and SMC on surgical need in those patients who were referred to orthopedics was evaluated. We additionally screened the hospital archive for surgery reports of patients recommended surgery, and, if a patient did not have a surgery record, we investigated the reasons by telephone interview and categorized these reasons. RESULTS Surgical evaluation needed for 4.7% (n = 155) of the patients. Patients referred to orthopedics were younger (median: 22.0 years), mostly male (n = 119, 76.8%), and involved in contact sports (n = 108, 69.7%) (p < 0.001 for all) compared to patients treated conservatively. Majority of the consultations were made owing to certain diagnoses such as cruciate/collateral ligament sprain (n = 70, 45.2%), meniscal tear (n = 21, 13.5%), and cartilage injuries (n = 15, 9.7%). Most of the patients diagnosed with Achilles tendon rupture (n = 2, 100%) and patellar instability (n = 13, 81.3%) were referred to surgery. Orthopedics agreed with the sports medicine physicians' opinions in most cases (n = 110, 71.0%). Thirty-four patients (30.9%) recommended surgery by the surgeon postponed/refused the treatment for various reasons or had surgery in another hospital. CONCLUSION Most non-emergency sports injuries can be treated conservatively. Young and male patients participating in contact sports are more likely to need surgical treatment. Non-surgeon musculoskeletal health-care providers may consider referring patients to orthopedics considering the data demonstrated in this study. Nevertheless, patient's motivation to undergo an operation should be considered before referring to orthopedics.
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Affiliation(s)
- Ömer Serkan Kara
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
- Department of Sports Medicine, Health Sciences, University Gülhane Medical Faculty, 06010, Ankara, Turkey
| | - Serife Seyma Torgutalp
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Egemen Turhan
- Department of Orthopedic and Traumatology, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Gürhan Dönmez
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06230, Ankara, Turkey
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Meyer R, Meller N, Mohr-Sasson A, Toussia-Cohen S, Machtinger R, Bart Y, Mashiach R, Levin G. Clinical features of isolated Fallopian tube torsion: evidence from a large series. HUM FERTIL 2023; 26:971-977. [PMID: 35114880 DOI: 10.1080/14647273.2022.2034056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98-33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70-0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96); (v) vomiting (aOR 95% CI 0.38, 0.19-0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Toussia-Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Ferreres AR. Unnecessary surgery. Cir Esp 2023; 101:813-815. [PMID: 37952717 DOI: 10.1016/j.cireng.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Alberto R Ferreres
- Universidad de Buenos Aires, Buenos Aires, Argentina; Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina; Universidad de Washington, Seattle, USA.
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AlAli KF. Unnecessary spine surgery: can we solve this ongoing conundrum? Front Surg 2023; 10:1270975. [PMID: 37693642 PMCID: PMC10491010 DOI: 10.3389/fsurg.2023.1270975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
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Palacios-Jaraquemada JM, Nieto-Calvache Á, Basanta NA. Anatomical basis for the uterine vascular control: implications in training, knowledge, and outcomes. Am J Obstet Gynecol MFM 2023; 5:100953. [PMID: 37031866 DOI: 10.1016/j.ajogmf.2023.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
The efficiency of uterine vascular control depends on the precise management of its arterial pedicles and anastomotic network. Although all specialists know the uterine and ovarian arteries, only a few are familiar with the anatomy of the inferior supply system and the connections of the pelvic vessels. For this reason, specific proven inefficient hemostatic procedures are still used worldwide. The pelvic arterial system is extensively interconnected with the aortic, internal iliac, external iliac, and femoral anastomotic components. Most uterine vascular control methods act on the blood supply to the uterus and ovary but rarely on the anastomotic network of the internal pudendal artery. Therefore, the effectiveness of vascular control procedures depends on the topographic area in which they are performed. In addition, the procedure's effectiveness depends on the skill and experience of the operator, among other factors. From a practical point of view, the uterine arterial supply is divided into 2 sectors, sector S1, which involves the uterine body, supplied by the uterine and ovarian arteries, and sector S2, which includes the uterine segment, the cervix, and the upper part of the vagina, provided by pelvis subperitoneal pedicles arising from the internal pudendal artery. As both sectors receive different arterial pedicles, the hemostatic procedures for one or the other are also different. The urgent nature of obstetrical hemorrhage, correct application of a specific technique, surgeon experience, time to provide accurate informed consent in a person under a life-threatening condition, lack of precise or possible harmful consequences of the proposed method, lack of randomized controlled trials or multiple phase II trials, epidemiologic data, qualitative data, and reports from the field from clinicians using an intervention multiple other aspects could be impossible to randomize all patients to obtain more precise information. Apart from actual effectiveness, there are no reliable morbidity data, as most complications are rarely published for various reasons. However, a simple and current presentation of pelvic and uterine blood supply and its anastomotic system allows readers to understand the value of different hemostatic procedures.
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Affiliation(s)
- José M Palacios-Jaraquemada
- Department of Anatomy, Centro de Educación Médica e Investigaciones Clínicas University Hospital, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina (Dr Palacios-Jaraquemada); Universitas Airlangga, Surabaya, Indonesia (Dr Palacios-Jaraquemada).
| | - Álbaro Nieto-Calvache
- Placental Accreta Spectrum Clinic, Fundación Valle del Lili, Cali, Colombia (Dr Nieto-Calvache)
| | - Nicolás A Basanta
- Department of Anatomy, Fernández Hospital, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina (Dr Basanta)
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Levin SB. Contributions of Hippocratic medicine and Plato to today's debate over health, social determinants and the authority of biomedicine. MEDICAL HUMANITIES 2022:medhum-2022-012486. [PMID: 36549860 DOI: 10.1136/medhum-2022-012486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 06/17/2023]
Abstract
By exploring a competition for authority on health and human nature between Plato and Hippocratic medicine, this paper offers a fresh perspective on an overarching debate today involving health and the role of healthcare in its safeguarding. Economically and politically, healthcare continues to dominate the USA's handling of health, construed biophysically as the absence of disease. Yet, notoriously, in major health outcomes, the USA fares worse than other countries in the Organisation for Economic Co-operation and Development (OECD). Clearly, in giving pre-eminence to healthcare, the USA is doing far less than it could to protect and improve health. Meanwhile, mounting evidence supports the view that health impacts of social determinants besides healthcare (eg, education) surpass healthcare in heft. Circumscribed shifts in the USA's current frame will not suffice: what's needed is a change in its overall template for addressing health. Unless this is widely seen, the sway of biomedicine will likely be reduced slowly, if at all. That biomedicine's role in relation to health is raised increasingly as a question is a sign that its ongoing supremacy is not a forgone conclusion. But making the most of this opportunity requires appreciating that 'How should health's relationship to medicine be conceptualised?' is not the most fundamental query that we need to pose. Through consideration of Hippocratic medicine and Plato, I argue that the most availing answer to this particular question can come only after exploration of three larger questions involving health's status as a human good and its relationship to human flourishing. Exploration of the Greeks is, thus, valuable methodologically. What's more, it supports today's advocacy of 'health promotion', a perspective tying health closely to well-being that has yet to achieve the overall prominence that it warrants.
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Affiliation(s)
- Susan B Levin
- Philosophy, Smith College, Northampton, Massachusetts, USA
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Veldman-Goossen PI, Deckers C, Dierselhuis EF, Schreuder HW, van der Geest IC. Shared decision making: Does a decision aid support patients with an atypical cartilaginous tumor in making a decision about treatment. PEC INNOVATION 2022; 1:100086. [PMID: 37213785 PMCID: PMC10194409 DOI: 10.1016/j.pecinn.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/19/2022] [Accepted: 09/19/2022] [Indexed: 05/23/2023]
Abstract
Objective Due to new insights, atypical cartilaginous tumors (ACTs) of the long bones are no longer considered malignant and treatment is shifting from surgery to active surveillance. We developed a decision aid in order to support in shared decision making on treatment.The aim of this study is to evaluate the treatment preferences of patients with an ACT in the long bones. Methods During thirty-four months, patients received a decision aid digitally with information about the disease, the treatment options, and the risks and benefits of active surveillance and surgical treatment. The given answers to patients' preference questions were evaluated qualitatively in relation to the final choice of treatment. Results Eighty-four patients were included. None of the patients who preferred active surveillance later underwent surgery. Only four patients underwent surgery based on patient preference. Conclusion In our experience the decision aid is useful for shared decision making as it provides the patient with information and the clinician with insight into patient's preferences. The preference for treatment generally corresponds to the eventual treatment. Innovation When treatment changes, due to new insights, a decision aid seems helpful for both patients and clinicians to discuss the treatment that best suits the patient's situation.
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Affiliation(s)
- Petra I. Veldman-Goossen
- Corresponding author at: Department of Orthopaedic surgery, Radboud university medical center, Postbus 9101, 6500 HB Nijmegen, the Netherlands.
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Rouf S, Malik A, Raina A, Irfan Ul Haq M, Naveed N, Zolfagharian A, Bodaghi M. Functionally graded additive manufacturing for orthopedic applications. J Orthop 2022; 33:70-80. [PMID: 35874041 PMCID: PMC9304666 DOI: 10.1016/j.jor.2022.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Additive Manufacturing due to its benefits in developing parts with complex geometries and shapes, has evolved as an alternate manufacturing process to develop implants with desired properties. The structure of human bones being anisotropic in nature is biologically functionally graded i,e. The structure possesses different properties in different directions. Therefore, various orthopedic implants such as knee, hip and other bone plates, if functionally graded can perform better. In this context, the development of functionally graded (FG) parts for orthopedic application with tailored anisotropic properties has become easier through the use of additive manufacturing (AM). Objectives and Rationale: The current paper aims to study the various aspects of additively manufactured FG parts for orthopedic applications. It presents the details of various orthopedic implants such as knee, hip and other bone plates in a structured manner. A systematic literature review is conducted to study the various material and functional aspects of functionally graded parts for orthopedic applications. A section is also dedicated to discuss the mechanical properties of functionally graded parts. Conclusion The literature revealed that additive manufacturing can provide lot of opportunities for development of functionally graded orthopedic implants with improved properties and durability. Further, the effect of various FG parameters on the mechanical behavior of these implants needs to be studied in detail. Also, with the advent of various AM technologies, the functional grading can be achieved by various means e.g. density, porosity, microstructure, composition, etc. By varying the AM parameters. However, the current limitations of cost and material biocompatibility prevent the widespread exploitation of AM technologies for various orthopedic applications.
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Affiliation(s)
- Saquib Rouf
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Abrar Malik
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Nida Naveed
- Faculty of Technology, University of Sunderland, UK
| | | | - Mahdi Bodaghi
- School of Science and Technology, Nottingham Trent University, UK
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Meyer R, Meller N, Mohr-Sasson A, Toussia-Cohen S, Komem DA, Mashiach R, Levin G. A clinical prediction model for adnexal torsion in pediatric and adolescent population. J Pediatr Surg 2022; 57:497-501. [PMID: 33902897 DOI: 10.1016/j.jpedsurg.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/27/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical characteristics of children and adolescents that underwent diagnostic laparoscopy for suspected adnexal torsion (AT), and to develop a prediction model for preoperative detection of AT among young women. METHODS A retrospective cohort study. We included all girls ≤18 years old with clinically suspected AT who underwent a diagnostic laparoscopy between 3/2011 and 6/2020. We compared patients with AT to those without AT and constructed a prediction model. RESULTS Overall, 120 children and adolescents with suspected AT were included in the study. Of those, AT was identified in 83 (69.2%). In a multivariate analysis, the following risk factors were independently associated with AT and included in the prediction model: absence of right lower quadrant tenderness upon examination [adjusted odds ratio (aOR) (95% Confidence interval (CI)) 3.23 (1.23-8.47), p = 0.017], platelets level >240 K [aOR (95% CI) 3.15 (1.19-8.36), p = 0.021], and neutrophils level >5.4 [aOR (95% CI) 2.71 (1.02-7.52), p = 0.046]. The rate of AT was 12.5% in cases without risk factors for AT, 56.7% with one, 68.8% with two, and 94.1% with three risk factors present, respectively. CONCLUSIONS We have identified preoperative indicators independently associated with surgically confirmed AT in a large cohort of young women. Level of evidence- III.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Toussia-Cohen
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
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Beresford L, Norwood T. Can Physical Therapy Deliver Clinically Meaningful Improvements in Pain and Function through a Mobile App?: An Observational Retrospective Study. Arch Rehabil Res Clin Transl 2022; 4:100186. [PMID: 35756979 PMCID: PMC9214340 DOI: 10.1016/j.arrct.2022.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To examine the effect of digital physical therapy (PT) delivered by mobile application (app) on reducing pain and improving function for people with a variety of musculoskeletal conditions. Design An observational, longitudinal, retrospective study using survey data collected pre- and postdigital PT to estimate multilevel models with random intercepts for patient episodes. Setting Privately insured employees participating in app-based PT as an employer health care benefit. Participants The study sample included 814 participants (N=814) 18 years or older who completed their digital PT program with reported final clinical outcomes between February 2019 (program launch) through December 2020. Mean age of the sample at baseline was 40.9±11.89 years, 47.5% were female, 21% sought care for lower back pain, 16% for shoulders, 15% for knees, and 13% for neck. Interventions Digital PT consisted of a synchronous video evaluation with a physical therapist followed by a course of PT delivered through a mobile app. Main Outcome Measures Pain was measured by the visual analog scale from 0 “no pain” to 10 “worst pain imaginable” and physical function by the Patient-Specific Functional Scale on a scale from 0 “completely unable to perform” to 10 “able to perform normally.” Results After controlling for significant demographics, comorbid conditions, adverse symptoms, chronicity, and severity, the results from multilevel random intercept models showed decreased pain (−2.69 points; 95% CI, −2.86 to −2.53; P<.001) and increased physical function (+2.67 points; 95% CI, 2.45-2.89; P<.001) after treatment. Conclusions Digital PT was associated with clinically meaningful improvements in pain and function among a diverse set of participants. These early data are an encouraging indicator of the clinical benefit of digital PT.
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Woroch R. The Referral Paradox. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chandra G, Pandey A. Design approaches and challenges for biodegradable bone implants: a review. Expert Rev Med Devices 2021; 18:629-647. [PMID: 34041994 DOI: 10.1080/17434440.2021.1935875] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Biodegradable materials have been at the forefront of cutting-edge research and offer a truly viable option in the designing and manufacturing of bone implants in biomedical engineering. Most research regarding these materials has focused on their biological characteristics and mechanical behavior vis-à-vis nonbiodegradable (NB) materials; but the design aspects and parametric configurations of biodegradable bone implant have somehow not received as much attention as they deserved.Area covered: This review aims to develop insight into the parametrically conceptualized design of biodegradable bone implant and takes into due consideration the characteristics of bone-biodegradable implant interface (BBII), design techniques employed for conventionally used bone implants to optimize parameters using standard test methods, traditional design, and finite element analysis approaches for implant and healing behavior, manufacturing techniques, real-time surgical simulations, and so on.Expert opinion: Some successful and conventionally used NB bone implants do not dissolve or degrade with time and require removal through a complicated surgery after fulfilling the intended objectives. These bone implants should be reconceptualized and designed with an appropriate biodegradable material while paying due attention to all factors/parameters involved and striking a balance between these factors with the ultimate objective of fulfilling all desired orthopedic requirements.
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Affiliation(s)
- Girish Chandra
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh, India
| | - Ajay Pandey
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh, India
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Chandra G, Pandey A. Design and analysis of biodegradable buttress threaded screws for fracture fixation in orthopedics: a finite element analysis. Biomed Phys Eng Express 2021; 7. [PMID: 34037541 DOI: 10.1088/2057-1976/ac00d1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Screws made up of non-biodegradable materials (Ti-alloy, etc.) have been used since long for temporary joining/fixation in applications involving skeleton damage or bone fracture. These screws need to be removed after complete healing as their sustained presence results in many complications, such as - micro-fracturing, stress shielding, etc. The removal of these screws is a little difficult too as it may result in the healed bone getting broken/damaged again. These problems can be overcome by employing metallic implants (plate, screws, etc.) made up of biodegradable metallic materials (Mg-alloy, etc.). Such implants exhibit optimal mechanical performance, are biocompatible, have adequate biodegradation rates, and rely on a unique design. Internal fracture fixation makes usage of screws with or without an accompanying plate. Buttress-threaded screws are the most frequently used ones. These screws must have the capacity to bear usually occurring loads and hold fractured segments of bone all through the process of healing. Finite element analysis (FEA) is an effective technique used for testing and validation of desired characteristics for Mg-based biodegradable buttress-threaded screw (BBTS). The characteristics of interest include maximum possible pullout resistance to tightly hold segments of bone, torsional ability for tightening or tapping, bending ability during providing plate support by screw head, and resistance to combined loading (tensile/compressive and bending) during the self-support stage using merely the screw(s). According to test results and subsequent validation through discretization error and convergence plot, BBTS made up of Mg-alloy are found safe for regular applications under usually encountered impact loads. Topological optimization and vibration analysis are also performed wherein it is observed that design of BBTS is good enough for possible usage in fracture fixation in orthopaedics.
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Affiliation(s)
- Girish Chandra
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal-462003, India
| | - Ajay Pandey
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal-462003, India
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Claes KEY, Hoeksema H, Robbens C, Verbelen J, Dhooghe NS, De Decker I, Monstrey S. The LDI Enigma, Part I: So much proof, so little use. Burns 2021; 47:1783-1792. [PMID: 33658147 DOI: 10.1016/j.burns.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laser Doppler imaging (LDI) is still not an ubiquitous part of burn care worldwide despite reported accuracy rates of more than 95%, which is significantly higher than clinical assessment alone (50-75%). The aims of Part I of this survey study are: to identify the most important barriers for the use of LDI and to provide useful recommendations for efficient implementation in routine burn care. The actual interpretation and use of LDI measurements is discussed in the Enigma Part II article. MATERIAL AND METHODS 1. Informative interviews with 15 representatives of burn centers without LDI. 2. A survey among 51 burn centers with LDI by means of an extensive questionnaire. 3. In-depth interviews with 21 of the participating centers. RESULTS 1. All 15 centers without LDI indicated that cost of purchase in combination with maintenance of the LDI device, as well as personnel costs were the reason for not buying, while 12 (80%) also rated the current scientific evidence as insufficient. 2. Twenty-seven burn centers with an LDI (53%) participated and filled in almost the entire questionnaire. In 5 centers, cost delayed the purchase of LDI. The hospital/department paid for the LDI device in 62% of the burn centers and in 88% also for maintenance and salaries. The LDI operators were mainly surgeons (47%) or nurses (42%). In more than half of the burn centers (52%), between 2 and 5 people were trained and certified to use an LDI. In 50% of burn centers, the interpretation of the LDI scan was done by the same person doing the actual measurements. Eighty-nine percent of the burn centers considered the accuracy of the LDI scan as mainly to almost completely accurate. In case of real discrepancy between clinical diagnosis and LDI, in 48% of the burn centers (13/27) the surgeon still relied more on the clinical diagnosis despite reporting this high or almost complete accuracy rate of the LDI. CONCLUSIONS Barriers for the routine implementation of LDI were: 1. cost of purchasing and using an LDI combined with health care systems that inadequately reimburse non-surgical management; 2. lack of awareness of or ongoing skepticism towards the scientific evidence supporting LDI use; and 3. organizational constraints combined with logistical limitations. Our recommendations for wider use of LDI technology include: 1. a cost-effective reimbursement of LDI use combined with a more appropriate valuation of expert conservative management compared to surgical therapy; 2. increased use of LDI for every mixed depth burn and; 3. specialized LDI teams to improve burn procedural flexibility and to enable embedding LDI use in the burn care routine. Implementing these measures would promote the highest standards for LDI measurements and interpretation resulting in optimal care with mutual benefits for the hospital, for burn care teams and, most importantly, for the patients.
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Affiliation(s)
- Karel E Y Claes
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Cedric Robbens
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Nicolas S Dhooghe
- Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Stan Monstrey
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
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15
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McPhail SM. Economic evaluations in 'non-inferiority' trials: can costs guide decisions between surgical and non-surgical interventions? Br J Sports Med 2019; 54:695-696. [PMID: 31857337 DOI: 10.1136/bjsports-2019-101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Steven M McPhail
- Australian Centre for Health Services Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia .,Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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16
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Zadro JR, Farey J, Harris IA, Maher CG. Do choosing wisely recommendations about low-value care target income-generating treatments provided by members? A content analysis of 1293 recommendations. BMC Health Serv Res 2019; 19:707. [PMID: 31707993 PMCID: PMC6844045 DOI: 10.1186/s12913-019-4576-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/30/2019] [Indexed: 11/21/2022] Open
Abstract
Background It is unknown to what extent Choosing Wisely recommendations about income-generating treatments apply to members of the society generating the recommendations. The primary aim of this study is to determine the proportion of Choosing Wisely recommendations targeting income-generating treatments, and whether recommendations from professional societies on income-generating treatments are more likely to target members or non-members. The secondary aim is to determine the prevalence of qualified statements, and whether qualified statements are more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members. Methods We performed a content analysis of all Choosing Wisely recommendations, with data extracted from Choosing Wisely websites. Two researchers coded recommendations as test or treatment-based, for or against a procedure, containing qualified statements, income-generating and applying to members. Disagreements were resolved by discussion or consultation with a third researcher. A Chi-squared test evaluated whether society recommendations on income-generating treatments were more likely to target members or non-members; and whether qualified statements were more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members. Results We found 1293 Choosing Wisely recommendations (48.3% tests and 48.6% treatments). Ninety-eight treatment recommendations targeted income-generating treatments (17.8%), and recommendations on income-generating treatments were less likely to target members compared to non-members (15.6% vs. 40.4%, p < 0.001). Nearly half of all recommendations were qualified (41.9%), with a similar proportion of recommendations targeting income-generating and non-income-generating treatments that apply to members containing qualified statements (49.4% vs. 42.0%, p = 0.23). Conclusions Many societies provide Choosing Wisely recommendations that minimise impact on their own members. Only 20% of treatment recommendations target income-generating treatments, and of these recommendations mostly target non-members. Many recommendations are also qualified. Increasing the number of recommendations from societies that are unqualified and target member clinicians responsible for de-implementation of low-value and costly treatments should be a priority.
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Affiliation(s)
- Joshua R Zadro
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
| | - John Farey
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ian A Harris
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christopher G Maher
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
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17
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Stahel PF, Wang P, Hutfless S, McCarty E, Mehler PS, Osgood GM, Makary MA. Surgeon Practice Patterns of Arthroscopic Partial Meniscectomy for Degenerative Disease in the United States: A Measure of Low-Value Care. JAMA Surg 2019; 153:494-496. [PMID: 29490362 DOI: 10.1001/jamasurg.2017.6235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, Rocky Vista University, College of Osteopathic Medicine, Parker, Colorado.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Peiqi Wang
- Gastrointestinal Epidemiology Research Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susan Hutfless
- Gastrointestinal Epidemiology Research Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Philip S Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Greg Michael Osgood
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Martin A Makary
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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19
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Jazrawi L, Gold HT, Zuckerman JD. Physical Therapy or Arthroscopic Surgery for Treatment of Meniscal Tears: Is Noninferiority Enough? JAMA 2018; 320:1326-1327. [PMID: 30285160 DOI: 10.1001/jama.2018.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Laith Jazrawi
- Department of Orthopedic Surgery, New York University School of Medicine, New York
| | - Heather T Gold
- Department of Orthopedic Surgery, New York University School of Medicine, New York
- Department of Population Health, New York University School of Medicine, New York
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, New York University School of Medicine, New York
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20
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Ghaly RF, Knezevic NN. What happened to "Patient first" and "Do no harm" medical principles? Surg Neurol Int 2018; 9:176. [PMID: 30221021 PMCID: PMC6130150 DOI: 10.4103/sni.sni_447_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 08/06/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ramsis F Ghaly
- Ghaly Neurosurgical Associates, Aurora, University of Illinois, Chicago, IL, USA.,Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.,Department of Surgery, University of Illinois, Chicago, IL, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.,Department of Surgery, University of Illinois, Chicago, IL, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL, USA
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21
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Stahel PF, Smith WR, Moore EE, Mehler PS, Weckbach S, Kim FJ, Butler N, Pape HC, Clarke TJ, Makary MA, Clavien PA. The 10 th anniversary of patient safety in surgery. Patient Saf Surg 2017; 11:27. [PMID: 29259657 PMCID: PMC5731067 DOI: 10.1186/s13037-017-0145-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Philip F Stahel
- Orthopaedics and Neurosurgery, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
| | - Wade R Smith
- Mountain Orthopedic Trauma Surgeons (MOTUS), Swedish Medical Center, Englewood, CO 80113 USA
| | - Ernest E Moore
- Department of Surgery, University of Colorado School of Medicine, Denver, CO 80045 USA
| | - Philip S Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | | | - Fernando J Kim
- Department of Surgery, University of Colorado School of Medicine, Denver, CO 80045 USA
| | - Nathan Butler
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 USA
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Ted J Clarke
- Colorado Physician Insurance Companies, Denver, CO 80320 USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091 Zurich, Switzerland
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