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Factor S, Elbaz E, Kazum E, Pardo I, Morgan S, Ben-Tov T, Khoury A, Warschawski Y. Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications. Clin Orthop Surg 2024; 16:194-200. [PMID: 38562635 PMCID: PMC10973612 DOI: 10.4055/cios23204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 04/04/2024] Open
Abstract
Background Reverse oblique intertrochanteric fractures (ROFs) are unstable extracapsular hip fractures that present a mechanical challenge. These fractures are classified as AO/Orthopaedic Trauma Association (OTA) 31-A3 according to the Trauma Association classification system and can further be subclassified into 3 subtypes based on their specific characteristics. The study aimed to evaluate and compare the radiographic and clinical outcomes of the 3 subtypes of ROFs. Methods A retrospective study was conducted at a single high-volume, tertiary center, where data were collected from electronic medical records of consecutive patients who underwent surgical fixation of AO/OTA 31-A3 fractures. Patients with less than 1-year follow-up, pathological fractures, and revision surgery were excluded. The subtypes of fractures were classified as 31-A3.1 (simple oblique), 31-A3.2 (simple transverse), and 31-A3.3 (wedge or multi-fragmentary). The operation was done using 4 different fixation methods, and radiological evaluation was performed at routine intervals. Results The final population consisted of 265 patients (60.8% women) with a mean age of 77.4 years (range, 50-100 years) and the mean follow-up time was 35 months (range, 12-116 months). The incidence of medical complications was similar across the groups. However, there was a trend toward a higher incidence of orthopedic complications and revision rates in the 31-A3.2 group, although this was not statistically significant (p = 0.21 and p = 0.14, respectively). Conclusions Based on the findings of this study, no significant differences were observed between the groups, indicating that the subclassifications of AO/OTA 31-A3 fractures do not have a significant impact on surgical outcomes or the occurrence of postoperative complications.
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Affiliation(s)
- Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Itay Pardo
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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Kazum E, Maman E, Sharfman ZT, Wengier R, Sher O, Khoury A, Chechik O, Dolkart O. Development of a New Model of Humeral Hemiarthroplasty in Rats. J INVEST SURG 2023; 36:2162636. [PMID: 36592973 DOI: 10.1080/08941939.2022.2162636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE In vivo models are anatomically comparable to humans allowing to reproduce the patterns and progression of the disease and giving the opportunity to study the symptoms and responses to new treatments and materials. This study aimed to establish a valid and cost-effective in vivo rat model to assess the effects of implanted shoulder hemiarthroplasty materials on glenoid articular cartilage wear. METHODS Eight adult male Wistar rats underwent right shoulder hemi-arthroplasty. A stainless steel metal bearing was used as a shoulder joint prosthesis. X-rays were performed one week after surgery to verify correct implant position. Additional X-rays were performed 30 and 60 days post-implantation. Animals were sacrificed 24 weeks after implantation. All specimens were evaluated with micro-CT for cartilage and bone wear characteristics as well as histologically for signs of osteoarthritis. Samples were compared to the non-operated shoulders. RESULTS All animals recovered and resumed normal cage activity. All X-rays demonstrated correct implant positioning except for one in which the implant was displaced. Histologic evaluation demonstrated arthritic changes in the implanted shoulder. Decreased Trabecular thickness and Trabecular Spacing were documented among the implanted parties (p < .05). Bone Mineral Density and Tissue Mineral Density were reduced in the operated shoulder although not significantly (p = .07). CONCLUSIONS This study demonstrated significant glenoid cartilage wearing in the operated shoulder. Furthermore, the presence of an intra-articular hemiarthroplasty implant diminished underlying glenoid bone quality. This novel, in vivo-model will enable researchers to test implant materials and their effects on cartilage and bone tissue in a cost-effective reproducible rat model.
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Affiliation(s)
- Efi Kazum
- Division of Orthopaedic Surgery, Shoulder Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Division of Orthopaedic Surgery, Shoulder Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopaedic Surgery, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine, New York, USA
| | - Reut Wengier
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center and the Ben-Gurion University of the Negev, Ashdod, Israel
| | - Osnat Sher
- Pathology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Shoulder Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopaedic Surgery, Shoulder Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center and the Ben-Gurion University of the Negev, Ashdod, Israel
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Khoury A. Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment. Womens Health Issues 2023; 33:626-635. [PMID: 37580186 DOI: 10.1016/j.whi.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well. METHODS Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. RESULTS Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p < .001), with IUD use increasing from 4.3% to 5.2% (p < .001) and implant use increasing from 4.6% to 6.0% (p < .001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311-0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006-0.020) per month beyond expected values. CONCLUSIONS At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Bisakha Sen
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Beatty K, Smith MG, de Jong J, Weber A, Adelli R, Khoury A. Impact of the Choose Well Initiative on Contraceptive Access at Federally Qualified Health Centers in South Carolina: A Midline Evaluation. Am J Public Health 2023; 113:1167-1172. [PMID: 37651659 PMCID: PMC10568501 DOI: 10.2105/ajph.2023.307384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Choose Well (CW) is a statewide contraceptive access initiative to reduce unintended pregnancy among patients utilizing federally funded family planning services. We examined CW's impact on contraceptive access at South Carolina federally qualified health centers from 2016 to 2019, which reported significantly higher increases in providing the full range of contraceptive methods and training onsite. CW prioritized ensuring change sustainability through obtaining funding and institutionalizing changes. (Am J Public Health. 2023;113(11):1167-1172. https://doi.org/10.2105/AJPH.2023.307384).
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Affiliation(s)
- Kate Beatty
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Michael G Smith
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Jordan de Jong
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amy Weber
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Rakesh Adelli
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amal Khoury
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
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Onallah H, Hazan R, Nir-Paz R, Brownstein MJ, Fackler JR, Horne B, Hopkins R, Basu S, Yerushalmy O, Alkalay-Oren S, Braunstein R, Rimon A, Gelman D, Khalifa L, Adler K, Abdalrhman M, Gelman S, Katvan E, Coppenhagen-Glazer S, Moses A, Oster Y, Dekel M, Ben-Ami R, Khoury A, Kedar DJ, Meijer SE, Ashkenazi I, Bishouty N, Yahav D, Shostak E, Livni G, Paul M, Gross M, Ormianer M, Aslam S, Ritter M, Urish KL, La Hoz RM, Khatami A, Britton PN, Lin RCY, Iredell JR, Petrovic-Fabijan A, Lynch S, Tamma PD, Yamshchikov A, Lesho E, Morales M, Werzen A, Saharia K. Refractory Pseudomonas aeruginosa infections treated with phage PASA16: A compassionate use case series. Med 2023; 4:600-611.e4. [PMID: 37562400 DOI: 10.1016/j.medj.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND A growing number of compassionate phage therapy cases were reported in the last decade, with a limited number of clinical trials conducted and few unsuccessful clinical trials reported. There is only a little evidence on the role of phages in refractory infections. Our objective here was to present the largest compassionate-use single-organism/phage case series in 16 patients with non-resolving Pseudomonas aeruginosa infections. METHODS We summarized clinical phage microbiology susceptibility data, administration protocol, clinical data, and outcomes of all cases treated with PASA16 phage. In all intravenous phage administrations, PASA16 phage was manufactured and provided pro bono by Adaptive Phage Therapeutics. PASA16 was administered intravenously, locally to infection site, or by topical use to 16 patients, with data available for 15 patients, mainly with osteoarticular and foreign-device-associated infections. FINDINGS A few minor side effects were noted, including elevated liver function enzymes and a transient reduction in white blood cell count. Good clinical outcome was documented in 13 out of 15 patients (86.6%). Two clinical failures were reported. The minimum therapy duration was 8 days with a once- to twice-daily regimen. CONCLUSIONS PASA16 with antibiotics was found to be relatively successful in patients for whom traditional treatment approaches have failed previously. Such pre-phase-1 cohorts can outline potential clinical protocols and facilitate the design of future trials. FUNDING The study was funded in part by The Israeli Science Foundation IPMP (ISF_1349/20), Rosetrees Trust (A2232), United States-Israel Binational Science Foundation (2017123), and the Milgrom Family Support Program.
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Affiliation(s)
- Hadil Onallah
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel
| | - Ronen Hazan
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel.
| | | | | | - Bri'Anna Horne
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Robert Hopkins
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Subhendu Basu
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Ortal Yerushalmy
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Sivan Alkalay-Oren
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ron Braunstein
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amit Rimon
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Daniel Gelman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Leron Khalifa
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Karen Adler
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Mohanad Abdalrhman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Shira Gelman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Eyal Katvan
- The Martin (Szusz) Department of Land of Israel Studies and Archaeology, Bar Ilan University, Ramat-Gan 52900, Israel; Peres Academic Center, Rehovot 7610202, Israel
| | - Shunit Coppenhagen-Glazer
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Allon Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Michal Dekel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amal Khoury
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Suzy E Meijer
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Nancy Bishouty
- Pharmacy Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Dafna Yahav
- Infectious Disease Unit, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Eran Shostak
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva 4920235, Israel
| | - Gilat Livni
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petah Tikva 4920235, Israel
| | - Mical Paul
- Rambam Health Care Campus and Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa 3109601, Israel
| | - Menachem Gross
- Department of Otolaryngology-Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112000, Israel
| | - Matityahou Ormianer
- Department of Otolaryngology-Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112000, Israel
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92093, USA; Center for Innovative Phage Applications and Therapeutics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Michele Ritter
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Kenneth L Urish
- Bone and Joint Center, Magee Hospital, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
| | - Ricardo M La Hoz
- Division of Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ameneh Khatami
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ruby C Y Lin
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Jonathan R Iredell
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Aleksandra Petrovic-Fabijan
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Stephanie Lynch
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Pranita D Tamma
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Alexandra Yamshchikov
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY 14617, USA; Infectious Diseases Unit, University of Rochester Medical Center, Rochester, NY 14617, USA
| | - Emil Lesho
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY 14617, USA
| | - Megan Morales
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Alissa Werzen
- Division of Infectious Diseases, Jefferson Medicine, Philadelphia, PA 19107, USA
| | - Kapil Saharia
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Elbaz E, Morgan S, Factor S, Shaked O, Graif N, Ben-Tov T, Khoury A, Warschawski Y. Reduced cutout for reverse oblique intertrochanteric hip fractures treated with trochanteric fixation advanced (TFN-A) nail compared to the short gamma-3 nail. SICOT J 2023; 9:16. [PMID: 37276028 DOI: 10.1051/sicotj/2023013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Reverse oblique fractures (AO/OTA 31-A3) account for 5-23% of all intertrochanteric fractures and are challenging to manage. The Gamma 3-Proximal Femoral Nail (GPFN) and the Trochanteric Fixation Nail Advanced (TFNA) are two common cephalomedullary systems used to treat this fracture. No study has reported on outcomes with the TFN-A for reverse oblique fractures. This study aimed to compare outcomes and complication rates in patients with reverse oblique fractures, treated with either TFNA or GPFN. PATIENTS AND METHODS A total of 203 patients with reverse oblique fractures (137 in the GPFN group and 66 in the TFNA group), were treated in our institution between June 2010 and May 2019. Data was collected on postoperative radiological variables including screw or blade location, and tip-apex distance (TAD). Data were also collected for non-orthopaedic complication rates and orthopaedic complications. A sub-group analysis was additionally performed for different nail lengths. RESULTS We found no significant difference in the overall rate of complications and revisions between the two groups. Patients treated with the 235 mm TFN-A nail sustained lower rates of cutout, compared to 180 mm GPFN (GPFN: 6% TFN-A: 0%, p = 0.043). The frequency of revision surgeries and malunions/non-unions did not differ significantly between the two groups and additionally showed no difference in the subgroup analysis. CONCLUSION The 235 mm TFN-A was associated with lower rates of cut-out compared to the short GPFN for reverse oblique intertrochanteric fractures. Future well-designed prospective studies are warranted to investigate the role of the TFN-A in improving outcomes for such fractures.
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Affiliation(s)
- Etay Elbaz
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Or Shaked
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
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Chua M, Yadav P, Bobrowski A, Kim J, Silangcruz J, Ming J, Rickard M, Lorenzo A, Bagli D, Khoury A. Dorsal shortening versus ventral lengthening procedure for correction of congenital ventral curvature in patients with and without severe hypospadias: A meta-analysis of comparative studies. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Shichman I, Shaked O, Factor S, Ashkenazi I, Elbaz E, Aviv Mordechai R, Khoury A. The association between electric scooter riding position and injury characteristics. J Safety Res 2023; 84:347-352. [PMID: 36868663 DOI: 10.1016/j.jsr.2022.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The popularity of electric scooters (e-scooters) and the shared e-scooter services as new means of transportation worldwide led to high numbers of injuries requiring emergency department (ED) visits. Private and rental e-scooters have different sizes and capabilities, offering several possible riding positions. While the rising use of e-scooters and their associated injuries have been reported, little is known about the influence of riding position on injury characteristics. The purpose of this study was to characterize e-scooter riding positions and their related injuries. METHODS E-scooters related ED admissions were retrospectively collected between June 2020 and October 2020, in a level-I trauma center. Demographics, ED presentation data, injury information, e-scooter design, and clinical course were collected and compared according to e-scooter riding position ("foot-behind-foot" vs "side-by-side"). RESULTS During the study period, 158 patients were admitted to the ED with e-scooter related injuries. The majority of riders used the foot-behind-foot position (n = 112, 71.3 %) compared to the side-by-side position (n = 45, 28.7 %). Orthopedic fractures were the most common injuries (n = 78, 49.7 %). "Foot-behind-foot" group had a significantly higher fracture rate compared to "side-by-side" group (54.4 % vs 37.8 % within group, respectively; p = 0.03). CONCLUSIONS Riding position is associated with different injury types, with orthopedic fracture rates significantly higher in the more commonly used "foot-behind-foot" riding position. PRACTICAL APPLICATION These study findings suggest that the common e-scooter narrow-based design is considerably more dangerous, calling for further research to introduce safer e-scooter designs and update recommendations for safer riding positions.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Or Shaked
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Etay Elbaz
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Reut Aviv Mordechai
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
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9
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Ashkenazi I, Morgan S, Shaked O, Snir N, Gold A, Khoury A, Shemesh S, Warschawski Y. The effect of patient body mass index and sex on the magnification factor during pre-operative templating for total hip arthroplasty. SICOT J 2023; 9:13. [PMID: 37195151 DOI: 10.1051/sicotj/2023009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Pre-operative templating prior to hip arthroplasty has traditionally used implant-company-provided acetates, which assumed a magnification factor between 115% and 120%. In recent years, pre-operative planning has been performed with digital calibration devices, in order to calculate the magnification factor. However, these devices are not without their limitations and are not readily available at many institutions. As previous reports suggest a wide range of magnification factors, the determination of an optimal magnification factor is currently unclear. We investigated the relationship between obesity and gender on the magnification factor in order to improve the accuracy of pre-operative templating. PATIENTS AND METHODS Ninety-seven consecutive pre-operative calibrated pelvic radiographs using the KingMark calibration were analyzed using the TraumaCad templating software. The magnification factor calculated by the software was considered the true magnification factor and analysis was made in order to assess the effect of sex and body mass index (BMI) on the magnification factor. A linear regression analysis was utilized to create a predictive model for optimal magnification factor value. RESULTS Magnification factor was significantly affected by sex (male, 120.0% vs. female 121.2%, p < 0.01) and by categorized BMI (obese 121.8% vs. non-obese 119.9%, p < 0.001). A positive linear association was found between BMI and the magnification factor (r = 0.544). The magnification factor was significantly different between the following sub-groups: obese female, non-obese female, obese male, and non-obese male (p < 0.001). When applying the model formulated by the linear regression analysis, the calculated magnification factor was within 2% of the true magnification factor for the majority of patients (n = 83, 85.6%). CONCLUSIONS BMI and gender have a significant effect on the magnification factor. Future determination of the magnification factor should consider the influence of these variables in order to improve the accuracy of pre-operative templating in THA.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
| | - Or Shaked
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
| | - Shai Shemesh
- Department of Orthopedics, Assuta Ashdod Medical Center, Ashdod, Affiliated with the Ben Gurion Faculty of Medicine, 7747629 Beer Sheva, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel
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10
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Portnoy Y, Koren J, Khoury A, Factor S, Dadia S, Ran Y, Benady A. Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives. Int J Surg 2023; 109:3-10. [PMID: 36799780 PMCID: PMC10389328 DOI: 10.1097/js9.0000000000000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. METHODS The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. RESULTS Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. CONCLUSIONS Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.
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Affiliation(s)
- Yotam Portnoy
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Jonathan Koren
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Amal Khoury
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Shai Factor
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Solomon Dadia
- Sackler School of Medicine, Tel Aviv University
- Levin Center of 3D Printing and Surgical Innovation
- National Unit of Orthopedic Oncology
| | - Yuval Ran
- Sackler School of Medicine, Tel Aviv University
- Office of the Deputy Medical Manager, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amit Benady
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
- Levin Center of 3D Printing and Surgical Innovation
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11
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Sharma P, Sen B, Hale N, Manalew WS, Leinaar E, Khoury A. Contraception Use and Pregnancy Outcomes for Alabama Medicaid Enrollees: A Baseline Analysis Using 2012–2017 Data. South Med J 2022; 115:899-906. [DOI: 10.14423/smj.0000000000001482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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12
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Krasin E, Warschawski Y, Khoury A. The Clinician's Guide to Differential Diagnosis of Non-Localized Musculoskeletal Pain A Primer on Musculoskeletal Medicine. Bull Hosp Jt Dis (2013) 2022; 80:236-245. [PMID: 36403952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Orthopedic surgeons may encounter patients with musculo- skeletal complaints that are not localized to a specific joint or anatomical area. The list of diagnoses that may cause generalized pain originating from bones, muscles, fasciae, and joints, including surrounding tissues like tendons, ligaments, and bursae, is vast; starting with influenza or fibromyalgia and ending with mycetism and ultra-rare he- reditary disorders. A systematic multidisciplinary approach is required. Many of these patients require referral to rheu- matology, endocrinology, or other specialties but at least a basic understanding of differential diagnosis is needed. The purpose of this review is to comprehensively examine the clinical presentation of various causes of generalized musculoskeletal pain and create a mental framework to aid the diagnostician in achieving the correct diagnosis in an orderly and efficient manner.
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13
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abhilash Jain
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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Schermann H, Ashkenazi I, Graif N, Ogawa T, Morgan S, Ben Tov T, Khoury A, Warschawski Y. Would giving priority in surgery timing to the oldest patients result in lower mortality? Int Orthop 2022; 46:1701-1706. [PMID: 35678841 DOI: 10.1007/s00264-022-05466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Early hip fracture surgery in elderly patients is recognized as a positive prognostic factor. When applied as an intervention, it does not always reduce overall patient mortality. A plausible explanation for this is that not all patients equally benefit from early surgery. The purpose of the study is to investigate the effect of early surgery on mortality in patients ages 80 and older. METHODS This is a retrospective cohort of 3463 patients with hip fractures, operated upon within seven days of admission in a tertiary medical center between 2010 and 2018. Patients were divided into five groups: ages 80-84, 85-89, 90-94, 95-99, and 100 or above. Baseline characteristics were compared between groups. Mortality at one year post-operatively as a function of surgery delay was visualized for each group, using restricted spline curve analysis. RESULTS Patients with increasing age were operated on earlier, had increased co-morbidities with a higher ASA score and experienced higher mortality. Spline curve analysis in younger patients, ages 80 to 94, demonstrated an inflection point at 48 hours after admission, prior to which mortality was rising rapidly and after which it continued rising slowly. In the two oldest age cohorts, there was no increased mortality with an increasing surgical delay. CONCLUSIONS In patients ages 80-94 surgery on day one may be preferable to surgery on day two. In patients ages 95 and older, surgery time did not influence mortality. Pursuit of better patient outcomes may include prioritizing early surgery in younger patients.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomer Ben Tov
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
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15
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Ashkenazi I, Morgan S, Graif N, Shaked O, Shohat N, Khoury A, Snir N, Warschawski Y. Increased postoperative glycemic variability is associated with increased mortality in diabetic patients undergoing hip arthroplasty for hip fracture. Arch Orthop Trauma Surg 2022; 143:2773-2779. [PMID: 35900587 DOI: 10.1007/s00402-022-04558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Increased glycemic variability (GV) during hospitalization has been associated with increased rates of surgical site and periprosthetic joint infections (PJI) following elective total joint arthroplasty. Uncertainty exists surrounding GV as a predictor for complications in urgent arthroplasty cases following hip fractures. In this study, we evaluated the association between GV and postoperative complications in diabetic patients undergoing total hip arthroplasty (THA) and hemiarthroplasty (HA) for hip fractures. METHODS We analyzed data on 2421 consecutive patients who underwent THA or HA at our institution from 2011 to 2020. Patients with a known diagnosis of diabetes mellitus who had a minimum of three postoperative glucose values taken within the first week after surgery were included. GV was assessed using a coefficient of variation. Outcomes included short- and long-term mortality, reoperations, prosthetic joint infection (PJI) requiring revision and readmissions for any cause. RESULTS The final cohort consisted of 482 patients (294 females, 188 males). Higher GV was associated with an increased 90-day mortality (p = 0.017). GV was not associated with 30-day mortality (p = 0.45), readmissions of any cause at 30 or 90 days (p = 0.99, p = 0.91, respectively), reoperation of any cause (p = 0.91) or PJI requiring revision surgery (p = 0.42). CONCLUSIONS Higher GV in the postoperative period is associated with increased rates of mortality in diabetic patients following THA and HA for hip fractures. Efforts should be made to monitor and control glucose variability in the postoperative period.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Or Shaked
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopedics, Shamir Medical Center, Beer-Yaakov, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Manalew W, Hale N, Leinaar E, Sen B, Smith M, Khoury A. Medicaid Cost Savings from Provision of Contraception to Beneficiaries in South Carolina, 2012–2018. Popul Health Manag 2022; 25:542-550. [DOI: 10.1089/pop.2021.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W.Samuel Manalew
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Edward Leinaar
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Michael Smith
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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17
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Mann AK, Khoury A, McCartt P, Smith MG, Hale N, Beatty K, Johnson L. Multilevel Influences on Providers' Delivery of Contraceptive Services: A Qualitative Thematic Analysis. Women's Health Reports 2022; 3:491-499. [PMID: 35651999 PMCID: PMC9148650 DOI: 10.1089/whr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
Introduction: Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settings is critical for advancing quality care. This study offers an in-depth examination of influences on providers' delivery of contraceptive services across multiple primary care specialties and practice settings to identify issues and strategies to improve care. Materials and Methods: Twenty-four in-depth face-to-face interviews were conducted in 2017 with primary care providers, including family physicians, gynecologists, pediatricians, and nurse practitioners from academic settings, private practices, and health centers. Interviews were transcribed and analyzed thematically. Results: Providers described a complex set of influences on their provision of contraception across multiple ecological contexts. Seven major themes emerged from the qualitative analysis, including six types of influence on provision of contraception: organizational, individual provider-related, structural and policy, individual patient-related, community, and the lack of influences or barriers. Providers also discussed the sources they access for information about evidence-based contraception counseling. Conclusions: A diverse set of providers described a complex system in which multiple concentric ecological contexts both positively and negatively influence the ways in which they provide contraceptive services to their patients. To close the gaps in contraceptive service delivery, it is important to recognize that both barriers and facilitators to patient-centered contraceptive counseling exist simultaneously across multiple ecological contexts.
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Affiliation(s)
- Abbey K. Mann
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Paezha McCartt
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G. Smith
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Leigh Johnson
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Khoury A, Merlo A, Tessmann P. Is the Patient Full of It? A Case of Extreme Constipation Causing Left Ventricular Assist Device-Associated Chest Pain. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Khoury A, Bucknor A, King I, Kerstein R, Nduka C. 371 Use of Trello as a Project Management Tool for Collaborative Surgical Research and Audit. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Managing surgical research projects alongside clinical commitments requires organisation, prioritisation, and communication. Our unit is a tertiary plastic surgery centre with a large workforce, high volume case load and abundant research opportunity. In a busy department, co-ordination and communication is imperative for timely high-quality research and audit output and maximum productivity. Tools can be used to support this output; we trialled use of Trello project management software to increase productivity in this context.
Method
We set up a Trello account for our unit’s plastic surgery department. All consultants and trainees have access, and each project has a timeline and standardised progress checklist to support completion of projects to a uniform high standard.
Results
Our Trello for Surgical Research pilot has promoted organised collaborative working and reduced duplication and partial completion of audit and research projects within our department. It has encouraged engagement between smaller subgroups within the unit, and a platform to monitor progression through key stages of project development with oversight of an appointed Research Lead, resulting in an increase in completion of closed loop audits and research projects.
Conclusions
Similar experiences have been described in mathematics and engineering research groups, and delivery of educational material for English Literature study, but we have not identified description of Trello as a tool for medical research. Use of such platforms increases productivity and likelihood of completion of projects, as well as providing a clear outline of a departments’ research priorities and accessible opportunities for rotating juniors.
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Affiliation(s)
- A. Khoury
- Queen Victoria Hospital, East Grinstead, United Kingdom
- St John's Hospital, Edinburgh, United Kingdom
| | - A. Bucknor
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - I. King
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - R. Kerstein
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - C. Nduka
- Queen Victoria Hospital, East Grinstead, United Kingdom
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20
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Hale N, Tatro K, Orimaye SO, Smith M, Meit M, Beatty KE, Khoury A. Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012-2018. J Appalach Health 2022; 4:31-50. [PMID: 35769510 PMCID: PMC9200451 DOI: 10.13023/jah.0401.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist, and little is known about the extent to which broader declines are seen within Appalachia. Purpose The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia. Methods We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance. Results About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= -5.78, CI: -9.58, -1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable. Implications This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably.
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21
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Shichman I, Shaked O, Factor S, Weiss-Meilik A, Khoury A. Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases. World J Emerg Med 2022; 13:5-10. [PMID: 35003408 DOI: 10.5847/wjem.j.1920-8642.2022.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/16/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To determine the frequency, characteristics, and use of resources related to electric scooter (e-scooter) injuries in the emergency department (ED) of a major metropolitan area hospital. METHODS We performed a retrospective review of all ED presentations related to e-scooter injuries at a level I trauma center between May 2017 and February 2020. We identified ED presentation data, injury-related data, patients' clinical course after evaluation, injury diagnosis, surgical procedures, and ED readmissions. RESULTS A total of 3,331 patients with e-scooter injuries presented to the ED over a 34-month period. There was a 6-fold increase in e-scooter-related injuries presenting to the ED, from an average of 26.9 injuries per month before the introduction of shared e-scooter services in August 2018 to an average of 152.6 injuries per month after its introduction. The average injury rate during weekdays was 3.27 per day, with the majority of injuries occurring in the afternoon. The most common mechanism of injury was rider fall (79.1%). There were a total of 2,637 orthopedic injuries, of which 599 (22.7%) were fractures. A total of 296 (8.9%) patients were hospitalized following the initial ED admission, and 462 surgeries were performed within 7 days of ED arrival. CONCLUSIONS The introduction of the shared e-scooter services is associated with a dramatic increase in e-scooter injuries presenting to the ED. E-scooter use carries considerably underestimated injury risks of high-energy trauma and misunderstood mechanisms of injuries. These injuries challenge the healthcare system, with a major impact on both EDs and surgical departments.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Or Shaked
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Shai Factor
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Ahuva Weiss-Meilik
- Head of I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
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22
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Sharma P, Khoury A. Contraceptive Use and Pregnancy Outcomes Among Women Enrolled in South Carolina Medicaid Programs. Matern Child Health J 2021; 25:1960-1971. [PMID: 34637063 DOI: 10.1007/s10995-021-03260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. METHODS A retrospective cohort of women aged 15-45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. RESULTS Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41-0.49 and APR = 0.13, 95% CI 0.10-0.17; Low income families APR = 0.82; 95% CI 0.77-0.88 and APR = 0.33, 95% CI 0.28-0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68-0.77 and APR = 0.35, 95% CI 0.30-0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. CONCLUSIONS FOR PRACTICE The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, The University of Alabama at Birmingham School of Public Health, 1665 University Blvd, RPHB 330F, Birmingham, AL, 35294, USA
| | - Pradeep Sharma
- Department of Health Care Organization and Policy, The University of Alabama at Birmingham School of Public Health, 1665 University Blvd, RPHB 320C, Birmingham, AL, 35294, USA
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
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23
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Khoury A, Thomson D, Jones M. 1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic.
Method
Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology.
Results
2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia.
Conclusions
Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.
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Affiliation(s)
- A Khoury
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - D Thomson
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - M Jones
- Queen Victoria Hospital, East Grinstead, United Kingdom
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24
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Okwori G, Smith MG, Beatty K, Khoury A, Ventura L, Hale N. Geographic differences in contraception provision and utilization among federally funded family planning clinics in South Carolina and Alabama. J Rural Health 2021; 38:639-649. [PMID: 34355426 DOI: 10.1111/jrh.12612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contraceptive care, especially in rural areas. This study examines contraceptive provision, factors supporting contraceptive provision, and contraceptive utilization among federally funded family planning clinics in 2 Southern states. METHODS All health department and Federally Qualified Health Center clinics in Alabama and South Carolina that offer contraceptive services were surveyed in 2017-2018. Based on these surveys, we examined differences between rural and urban clinics in the following areas: clinic characteristics, services offered, staffing, staff training, policies, patient characteristics, contraceptive provision, and contraceptive utilization. Differences were assessed using Chi-square tests of independence for categorical variables and independent t-tests for continuous variables. FINDINGS Urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives (LARCs) overall, a greater proportion of patients in urban clinics utilized LARCs. CONCLUSIONS While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose LARC methods.
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Affiliation(s)
- Glory Okwori
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G Smith
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Liane Ventura
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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25
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Amzallag N, Factor S, Shichman I, Ben-Tov T, Khoury A. Hip Fractures during the COVID-19 Pandemic: Demographics, Treatment Pathway, and Outcomes. Isr Med Assoc J 2021; 23:484-489. [PMID: 34392622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Surgery for hip fractures within 48 hours of admission is considered standard. During the lockdown period due to the coronavirus disease-2019 (COVID-19) epidemic, our medical staff was reduced. OBJECTIVES To compare the demographics, treatment pathways, and outcomes of patients with hip fractures during the COVID-19 epidemic and lockdown with the standard at routine times. METHODS A retrospective study was conducted of all patients who were treated surgically for hip fracture in a tertiary center during the COVID-19 lockdown period between 01 March and 01 June 2020 and the equivalent period in 2019. Demographic characteristics, time to surgery, surgery type, hospitalization time, discharge destination, postoperative complications, and 30- and 90-day mortality rates were collected for all patients. RESULTS During the COVID-19 period, 105 patients were operated due to hip fractures compared to 136 in the equivalent period with no statistical difference in demographics. The rate of surgeries within 48 hours of admission was significantly higher in the COVID-19 period (92% vs. 76%, respectively; P = 0.0006). Mean hospitalization time was significantly shorter (10 vs. 12 days, P = 0.037) with diversion of patient discharge destinations from institutional to home rehabilitation (P < 0.001). There was a significant correlation between the COVID-19 period and lower 90-day mortality rates (P = 0.034). No statistically significant differences in postoperative complications or 30-day mortality rates were noted. CONCLUSIONS During the COVID-19 epidemic, despite the limited staff and the lack of therapeutic sequence, there was no impairment in the quality of treatment and a decrease in 90-day mortality was noted.
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Affiliation(s)
- Nissan Amzallag
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Ittai Shichman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ben-Tov
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
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26
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Shichman I, Shaked O, Factor S, Elbaz E, Khoury A. Epidemiology of Fractures Sustained During Electric Scooter Accidents: A Retrospective Review of 563 Cases. J Bone Joint Surg Am 2021; 103:1125-1131. [PMID: 34109939 DOI: 10.2106/jbjs.20.01746] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of electric scooters (e-scooters) has dramatically increased as they become an attractive alternative for public transportation in busy metropolitan areas worldwide. Despite their benefits, e-scooters challenge the health-care system with poorly understood forms of injuries, mainly orthopaedic fractures. To our knowledge, this study is the first to investigate e-scooter-related orthopaedic fracture patterns, mechanisms of injury, and management. METHODS Data on 3,331 e-scooter-related admissions were retrospectively collected between May 2017 and February 2020 in a level-I trauma center. These admissions were analyzed for demographic variables, orthopaedic fracture diagnosis (using the AO/OTA classification), associated injuries, and surgical treatment. RESULTS During the study period, a total of 716 fractures were diagnosed in 563 patients, with 46.4% of the patients requiring hospitalization. Of 492 upper-limb fractures, 89.2% occurred in a rider fall mechanism; and of 210 lower-limb fractures, 15.7% occurred in rider-vehicle collisions. Fifty-nine percent of long bone fractures were complex fragmentary and/or intra-articular fractures. Orthopaedic surgeons recommended that 225 fractures undergo surgical treatment. The most common upper-limb fracture was AO/OTA class 2R1A, with open reduction and internal fixation of the distal part of the radius being the most common upper-limb procedure (n = 58). The most common lower-limb fracture was AO/OTA class 41C, with open reduction and internal fixation of the proximal part of the tibia being the most common procedure (n = 28). A total of 22 patients (3.9%) required reoperation within 1 year. CONCLUSIONS This investigation provides unique information on demographic characteristics, patterns, and treatment of orthopaedic fractures secondary to the high-energy mechanism of e-scooter injuries. These new in-depth data are important, first, for health-care system preparedness with regard to management and resource allocation to treat these challenging injuries and, second, for legislators promoting safety and injury prevention strategies.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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27
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Factor S, Khoury A, Atzmon R, Vidra M, Amar E, Rath E. Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes. J Hip Preserv Surg 2021; 7:721-727. [PMID: 34377515 PMCID: PMC8349587 DOI: 10.1093/jhps/hnab006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20-61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2-43 months). At a mean follow-up of 28 months (range 12-55 months), the average PHAT score was 73 (range 70-80). The mean subjective activity level percentage improved from 34 (range 20-50) pre-surgery to 81 (range 75-90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Amal Khoury
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Ran Atzmon
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Matias Vidra
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Eyal Amar
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Ehud Rath
- Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
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28
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Efrima B, Ovadia J, Drukman I, Khoury A, Rath E, Dadia S, Gortzak Y, Albagli A, Sternheim A, Segal O. Cryo-surgery for symptomatic extra-abdominal desmoids. A proof of concept study. J Surg Oncol 2021; 124:627-634. [PMID: 34043245 DOI: 10.1002/jso.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Extra abdominal desmoid tumors are rare, highly aggressive, and invasive benign soft tissue tumors. Current treatment modalities show high levels of recurrence and comorbidities. Cryo-surgery as an alternative was subsequently investigated. METHODS In this retrospective, single center study 11 patients showing symptomatic tumors were treated with individualized cryo-surgery. Treatment protocol included preoperative planning using computer rendered 3D models, intraoperative navigation and execution using cone beam guidance, and postoperative magnetic resonance imaging image analysis using a gaussian mixture model software. Subjective outcomes were reported using Short Form Health Survey (SF-36) questionnaires. RESULTS Sixteen ablations were performed, each demonstrating a complete match with the determined preoperative plan and model. A total of 9/11 (82%) of patients showed improvements in symptoms and a reduction in tumor volume while 2/11 (18%) did not. Average reduction in tumor volume and viable segments were 36.7% (p = 0.0397) and 63.3% (p = 0.0477), respectively. Mild complications according to the SIR Adverse Event Classification Guidelines were experienced in 3/16 (19%) ablations. SF-36 scores showed a statistically significant improvement (p = 0.0194) in the mental health category and a nonsignificant (p = 0.8071) improvement in the physical health category. CONCLUSION Cryo-surgery using the three-phase protocol as described may improve the overall outcome of future ablation procedures.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Drukman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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29
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Johnson M, Khoury A, Dheansa B. Dilemmas in the management of rhinophyma in pigmented individuals. Ann R Coll Surg Engl 2021; 103:e165-e168. [PMID: 33930281 DOI: 10.1308/rcsann.2020.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rhinophyma affects predominantly the Caucasian population and is rare in those with Fitzpatrick skin type IV-VI. Diagnosis is based on clinical evaluation. Prominent features include abnormal coloration and texture of skin, impaired vascularity, irregular nodular exophytic growth and telangiectasia. Management can be surgical or dermatological. Surgery remains the mainstay of treatment but achieving an acceptable aesthetic result can be challenging, particularly in those with pigmented skin. Postsurgical hyper- and hypopigmentation make for unpredictable outcomes requiring appropriate preoperative counselling. We present a case that exemplifies this issue and discuss our recommended approach to counselling, consenting and managing such dilemmas in these patients, and a proposal for further investigation into the role of autologous melanocyte transplantation in reducing the effect particularly of hypopigmentation on aesthetic outcomes in this group.
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Affiliation(s)
- M Johnson
- Queen Victoria Hospital NHS Trust, East Grinstead, UK.,University of the West Indies, Mona Kingston, Jamaica
| | - A Khoury
- Queen Victoria Hospital NHS Trust, East Grinstead, UK
| | - B Dheansa
- Queen Victoria Hospital NHS Trust, East Grinstead, UK
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Ugarte S, Tang A, Harper Z, John RE, Mehta K, Khoury A, Knopf K. HSR21-072: Neoadjuvant Chemotherapy in Breast Cancer Care: Does Equal Access Mitigate Racial Disparities? J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tang A, Mooney C, Ugarte S, Knopf K, Khoury A. Abstract PS9-56: High compliance with choosing wisely breast procedures at a safety net hospital. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps9-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The Choosing Wisely campaign has emerged recently in setting guidelines for surgical procedures of low utility and cost-ineffectiveness. Hospitals caring for underserved medical populations represent a unique opportunity to assess for quality of care and adherence to these guidelines. The Choosing Wisely campaign for breast surgery has highlighted: avoiding surgical re-excision for invasive cancer close to margins of excised breast tissue, avoiding double mastectomy in patients who have a single breast with cancer, avoidance of axillary lymph node dissection in women undergoing lumpectomy with limited nodal disease, and avoiding sentinel lymph node biopsy in patients ≥ 70 years of age with early stage breast cancer. Recent studies have shown variable adherence to these recommendations. In order to evaluate cost-effective surgery at our hospital serving a poorer patient population, we retrospectively analyzed patients who underwent surgery for breast cancer from 2015-2020. A total of 231 patients were identified. There were no patients who underwent re-excision for close margins of invasive cancer. Only 0.9% of patients (2/231) received contralateral mastectomy and only 1.6% of eligible patients (3/191) received axillary lymph node dissection instead of sentinel lymph node biopsy. Although 77.7% of patients ≥ 70 years of age with stage 1 hormone positive breast cancer (14/18) received sentinel lymph node biopsy, there was a downward trend during 2015 to 2020 from 100% to 50% of eligible patients receiving sentinel lymph node biopsy. De-implementation of traditional surgical practices, deemed as low-value care, towards newer cost-effective guidelines are achievable even at community hospitals serving a low socioeconomic community while preserving patient outcome and avoiding overtreatment. By avoiding overtreatment, cost savings can be achieved which allow for social distributive justice amongst breast cancer patients by ensuring careful utilization of scarce health economic resources.
Citation Format: Annie Tang, Colin Mooney, Shannon Ugarte, Kevin Knopf, Amal Khoury. High compliance with choosing wisely breast procedures at a safety net hospital [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-56.
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Affiliation(s)
- Annie Tang
- 1University of California San Francisco, East Bay, Oakland, CA
| | - Colin Mooney
- 1University of California San Francisco, East Bay, Oakland, CA
| | | | | | - Amal Khoury
- 1University of California San Francisco, East Bay, Oakland, CA
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Orimaye SO, Hale N, Leinaar E, Smith MG, Khoury A. Adolescent Birth Rates and Rural-Urban Differences by Levels of Deprivation and Health Professional Shortage Areas in the United States, 2017-2018. Am J Public Health 2021; 111:136-144. [PMID: 33211579 PMCID: PMC7750627 DOI: 10.2105/ajph.2020.305957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. To examine the differences in adolescent birth rates by deprivation and Health Professional Shortage Areas (HPSAs) in rural and urban counties of the United States in 2017 and 2018.Methods. We analyzed available data on birth rates for females aged 15 to 19 years in the United States using the restricted-use natality files from the National Center for Health Statistics, American Community Survey 5-year population estimates, and the Area Health Resources Files.Results. Rural counties had an additional 7.8 births per 1000 females aged 15 to 19 years (b = 7.84; 95% confidence interval [CI] = 7.13, 8.55) compared with urban counties. Counties with the highest deprivation had an additional 23.1 births per 1000 females aged 15 to 19 years (b = 23.12; 95% CI = 22.30, 23.93), compared with less deprived counties. Rural counties with whole shortage designation had an additional 8.3 births per 1000 females aged 15 to 19 years (b = 8.27; 95% CI = 6.86, 9.67) compared with their urban counterparts.Conclusions. Rural communities across deprivation and HPSA categories showed disproportionately high adolescent birth rates. Future research should examine the extent to which contraceptive access differs among deprived and HPSA-designated rural communities and the impact of policies that may create barriers for rural communities.
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Affiliation(s)
- Sylvester O Orimaye
- All authors are with the Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City
| | - Nathan Hale
- All authors are with the Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City
| | - Edward Leinaar
- All authors are with the Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City
| | - Michael G Smith
- All authors are with the Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City
| | - Amal Khoury
- All authors are with the Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City
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Abstract
Obturator internus muscle (OIM) and adductor brevis (AB) abscess occurs rarely in adults. This condition mainly affects children experiencing trauma. This paper presents and discusses a unique case of OIM and AB abscess in an adult male that was treated operatively with a combined surgical approach (modified Stoppa and Smith-Peterson) after multiple failed drainage procedures. Case A 23-year-old male underwent reduction and fixation of his right tibiae shaft fracture with an intramedullary nail. After several referrals to the emergency room due to recurrent symptoms of fever and groin pain, he was finally admitted and diagnosed with OIM and AB abscess and fulminant MRSA sepsis. The operative treatment was performed by addressing the abscess with an unusual combined surgical approach (Smith-Peterson and modified Stoppa) for abscess drainage. Methods Using PubMed, Google scholar and Hadassah Hebrew University search engines, we conducted a literature search using the following keywords: ‘pyomyositis’, ‘obturator abscess’, ‘pelvic abscess’, and ‘pelvic osteomyelitis among children and adults’. Twenty case studies were found (14 children and 6 adults). No cases of combined OIM and AB abscess were found and only one OIM case was reported with methicillin-resistant Staphylococcus (MRSA).
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Affiliation(s)
- Ayman Khoury
- Orthopedic Department, Hadassah Hospital, Jerusalem, Israel
| | - Rami Mosheiff
- Orthopedic Department, Hadassah Hospital, Jerusalem, Israel
| | | | - Amal Khoury
- Orthopedic Department, Tel-Aviv Sourasky Medical Center, Israel
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Lee R, Frick M, Kaplan C, Joseph G, Tsoh J, Flores S, Dixit N, Cedermaz H, Wang L, Khoury A, Campbell B, Pasick R, Guerra CS, Stewart SL. Abstract PO-012: Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction While still low, diversity among clinical trial participants has improved in recent years due to efforts to eliminate health disparities. Here we present and endeavor to explain participation rates in our multicenter partially randomized preference noninferiority trial comparing the effectiveness of phone, video, and in person genetic counseling among high-risk English-, Spanish-, and Chinese-speaking patients. Methods High-risk patients were identified using a family history screener in clinics and via physician referrals. After reviewing forms received, bilingual/bicultural clinical research coordinators (CRC) called patients considered eligible in their preferred language (English, Spanish or Cantonese, Mandarin or Toisanese). Patients were informed that their hospital was conducting the study in conjunction with an academic institution. The CRC went over each patient’s family history of cancer to confirm eligibility and to explain the study components, including free genetic counseling. Because previous research had significant refusals due to patients’ preferences for a single mode, our consented patients were asked if they would accept random assignment to phone, video, or in person counseling or if they had a strong preference. Patients who declined were asked their reasons. Results Out of 1,403 patients reached (70% English-, 26% Spanish-, and 3% Chinese- speaking), 86% agreed to participate. The highest acceptance rate was among Spanish-speakers (94%), followed by English-speakers (83%) and Chinese-speakers (67%). Among the 201 patients who declined, 49% did so upon contact, while 51% declined after eligibility was confirmed. Reasons for declining are available for 71% of decliners as follows: 22% not interested; 19% no time; 10% cited no benefit them or family members; 7% did not want to talk about cancer; 7% had too many other medical issues; and 6% provided a range of other reasons. Discussion and Conclusions We believe that our study’s high initial participation rate for patients contacted was due to the purpose which was particularly meaningful to those with a family history of cancer. Also, patients trusted their own hospitals which co- sponsored the study. It was helpful that providers in the 3 public hospitals strongly supported the research which provided much needed genetic counseling and pursued questions important to access to genetic services. Importantly, our study design addressed significant known barriers to minority and low SES participation in clinical trials through the use of bilingual/bicultural investigators, multi-language study materials, and strong, positive working relationships with gatekeeper medical and clinic support staff. Reasons given for declining may indicate the existence of a socio-economic structural ceiling for participation due to patient vulnerabilities and societal burdens, causes outside the investigative scope of our study that are likely to continue to hamper efforts to improve participation if not addressed.
Citation Format: Robin Lee, Miya Frick, Celia Kaplan, Galen Joseph, Janice Tsoh, Selina Flores, Niharika Dixit, Heather Cedermaz, Lly Wang, Amal Khoury, Brittany Campbell, Rena Pasick, Claudia S. Guerra, Susan L. Stewart. Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-012.
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Affiliation(s)
- Robin Lee
- 1University of California, San Francisco, San Francisco, CA,
| | - Miya Frick
- 1University of California, San Francisco, San Francisco, CA,
| | - Celia Kaplan
- 1University of California, San Francisco, San Francisco, CA,
| | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
| | - Janice Tsoh
- 1University of California, San Francisco, San Francisco, CA,
| | - Selina Flores
- 1University of California, San Francisco, San Francisco, CA,
| | - Niharika Dixit
- 1University of California, San Francisco, San Francisco, CA,
| | - Heather Cedermaz
- 2Hematology/Oncology, Contra Costa Heath Services, Martinez, CA,
| | - Lly Wang
- 2Hematology/Oncology, Contra Costa Heath Services, Martinez, CA,
| | - Amal Khoury
- 3Highland Hospital, Alameda Health System, Oakland, CA,
| | | | - Rena Pasick
- 1University of California, San Francisco, San Francisco, CA,
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Pasick RJ, Stewart SL, Lee R, Guerra C, Kaplan C, Joseph G, Flores S, Tsoh J, Dixit N, Frick M, Cedermaz H, Wong L, Khoury A, Campbell B. Abstract PO-051: Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
In public health settings, where availability of genetic counseling (GC) and testing for hereditary breast and ovarian cancer is limited, telehealth could expand access to academic centers where these services are concentrated. However, little is known about the effectiveness of remote modes for ethnically diverse and low health literacy patients. Methods. From 2017-20 UCSF researchers partnered with 3 public hospitals to conduct a partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients with strong personal and/or family history of cancer. Participants received GC in person, by phone, or via video. Pre- and post-GC telephone surveys measured study outcomes: knowledge, cancer- specific distress, decisional conflict, risk perception, and satisfaction. A subset of 23 participants was recruited for case studies (CS) to elucidate quantitative findings. CS integrated patient and counselor in-depth interviews, GC session transcripts, and survey and tracking data for a multi-dimensional understanding of each individual’s GC experience. Results. Among 23,633 family history forms collected, 1,574 patients were eligible; 1404 were reached and 708 consented. Of 394 randomized, 322 attended GC and 312 completed the final survey. After GC, mean knowledge scores increased, and cancer-specific distress and decisional conflict decreased overall.
Counseling attendance varied significantly by assigned mode (75% via video at a clinic, 77% in person, and 92% by phone), but the modes yielded noninferior outcomes. Respondents overwhelmingly rated all modes as “very convenient” and satisfaction with counseling as “very high.” Compared with baseline, knowledge increased significantly regardless of mode. However, this increase was significantly less for African Americans and for those with less education (with each adjusted for the other) across all modes. Completion of genetic testing (GT) was the inverse of counseling attendance: 94% in person, 93% video, and 65% by phone. Case studies (CS) revealed the complexities of counseling public hospital patients. Phone patients valued the access despite connection issues, but phone appointments tended to be briefer, and qualitative interviews suggested that communication was less effective by phone. While many phone patients said they would not be able to access GC any other way, several felt they would get more out it in person. Importantly, GT was offered on the spot to in-person patients while some counseled by phone had second thoughts and other barriers. CS of video counseling found benefits similar to in-person GC such as use of visual cues and formation of meaningful connections. Conclusion. Our findings indicate that GC can be delivered to high-risk public hospital patients remotely by phone, video, or in-person in order to fill a gap in access to critical genetic services. Further research is needed to achieve optimal outcomes for all patients and to increase the rate of testing for those counseled by phone.
Citation Format: Rena J Pasick, Susan L. Stewart, Robin Lee, Claudia Guerra, Celia Kaplan, Galen Joseph, Selina Flores, Janice Tsoh, Niharika Dixit, Miya Frick, Heather Cedermaz, Lily Wong, Amal Khoury, Brittany Campbell. Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-051.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lily Wong
- 3Contra Costa Health Care System, Martinez, CA,
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Nasrallah K, Jammal M, Khoury A, Liebergall M. Adult female patient with osteitis pubis and pelvic instability requiring surgery: A case report. Trauma Case Rep 2020; 30:100357. [PMID: 33163608 PMCID: PMC7610045 DOI: 10.1016/j.tcr.2020.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Osteitis pubis (OP) is an inflammatory condition of the symphysis pubis (SP) characterized by focal pain and local tenderness. Pelvic instability (PI) is commonly associated with this condition. It is still not clear if OP leads to PI or it is PI that leads to OP. The exact cause of osteitis pubis is not yet known, although several predisposing factors have been suggested to contribute to this condition. In most cases, it is self-remitting and rarely needs surgical intervention. Case presentation A 63-year old woman presented with a 12-month history of persistent pain at the symphysis pubis and non-responsive to analgesics. The pain was aggravated by physical activity such as standing and walking. Physical examination showed focal tenderness at the symphysis pubis with no tenderness over the sacroiliac joints or lumbar region. The diagnosis was confirmed by characteristic findings on radiographs, CT and MRI. Surgery was considered after all conservative measures failed. The patient underwent a wedge-shaped resection of the symphysis pubis; the bone defect was filled autologous tri-cortical bone and fixed with dual plating. The outcome was satisfactory with radiologic union and symptom resolution postoperatively. Conclusions Osteitis pubis due to pelvic instability can cause chronic and persistent pain. In cases where conservative treatment fails, surgery should be considered. We recommend wide surgical resection of all non-viable bone at the symphysis pubis with the addition of tri-cortical iliac bone graft. Double plating should be considered in order to maximize the rate of fusion and further stabilize the fixation.
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Affiliation(s)
- Khalil Nasrallah
- Western Galilee Medical Center, 9 Nahariya-Cabri, Nahariya 22100, Israel
| | - Mahmoud Jammal
- Hadassah Medical Center of the Hebrew University, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
- Corresponding author.
| | - Amal Khoury
- Hadassah Medical Center of the Hebrew University, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Meir Liebergall
- Hadassah Medical Center of the Hebrew University, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
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Hale N, Smith M, Baker K, Khoury A. Contraceptive Use Patterns among Women of Reproductive Age in Two Southeastern States. Womens Health Issues 2020; 30:436-445. [PMID: 32958369 DOI: 10.1016/j.whi.2020.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Unintended pregnancies remain an important public health issue. Modern contraception is an important clinical service for reducing unintended pregnancy. This study examines contraception use among a representative sample of women residing in two southeastern U.S. states. METHODS A cross-sectional statewide survey assessing women's contraceptive use and reproductive health experiences was conducted in Alabama and South Carolina. Characteristics of the study population were compared across contraceptive use categories and multivariable regression analysis was performed examining relationships between covariates of interest and contraceptive use outcomes. RESULTS Approximately 3,775 women were included in the study population. Overall, 26.5% of women reported not using any contraception. Short-acting hormonal methods were the most commonly reported (26.3%), followed by permanent methods (24.4%), long-acting reversible contraception (LARC; 14.3%), and barrier/other methods (8.5%). Nonuse was more prevalent among women with some college or an associate's degree, incomes between $25,000 and $50,000, no health insurance, and longer gaps in care. LARC use among women with Medicaid as a pay source was higher than use among privately insured women and higher in South Carolina than Alabama. Both nonuse and LARC use were higher among women with no insurance. CONCLUSIONS Study findings are largely consistent with previous research using similar population-based surveys. LARC use was higher among the study population relative to what is observed nationally. Factors enabling access to contraceptive services, particularly for lower income women, were associated with contraception use patterns. These findings provide important context for understanding individuals' access to resources and are important for fostering increased access to contraceptive services among women in these two states.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, East Tennessee State University, College of Public Health, Johnson City, Tennessee.
| | - Michael Smith
- Department of Health Services Management & Policy, East Tennessee State University, College of Public Health, Johnson City, Tennessee
| | - Katie Baker
- Department of Community & Behavioral Health, East Tennessee State University, College of Public Health, Johnson City, Tennessee
| | - Amal Khoury
- Department of Health Services Management & Policy, East Tennessee State University, College of Public Health, Johnson City, Tennessee
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Guerra C, Lee R, Stewart SL, Kaplan C, Joseph G, Tsoh J, Dixit N, Cedermaz H, Kim J, Campbell J, Wang LX, Khoury A, Hellman-Wylie C, Pasick RJ. Abstract A034: Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-a034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Genetic counseling (GC) for hereditary breast and ovarian cancer is available mainly in academic settings. Despite equal risk, most low income public hospital patients remain unaware and untested. Remote counseling may be a solution, but research has been limited to phone counseling for insured patients. Our study compares in-person, phone, and video conference GC among high-risk patients in 3 public hospitals to determine the comparative effectiveness of GC delivered across modes with regard to patients’ knowledge, cancer distress, decisional conflict, perceived stress, risk perception, satisfaction, and recall. We also assessed whether patients have a preference for counseling mode and how that affects outcomes. This report describes the study design and lessons learned regarding recruitment. We conducted a multicenter partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients assigned by randomization or patients´ preference to one of the three GC modes. High-risk patients were identified using a family history screener in clinics or by physician referral. Study staff verified risk by phone, invited participation, conducted informed consent, and administered a baseline survey. Enrollees were asked whether they could be randomized or if they preferred one GC mode. They were then given a GC appointment and called again within 2 weeks of counseling for a follow-up survey. Power calculations required 270 randomized patients. A total of 23,401 screener forms yielded 824 likely to be high-risk; 656 completed baseline surveys. Race/ethnic composition was 40% Latinx, 25% white, 19% African American, and 8% Asian. Of these, 531 were counseled, and 505 completed final surveys (283 from randomized patients). The majority (64%) of non-randomized patients chose counseling by phone, 33% chose in person, 3% chose video. • At every step, participation exceeded our projections, showing that diverse low-income patients were interested in participating in research that they deemed relevant. • Our greatest recruitment challenges were due more to settings than to patients. Collection of screeners varied greatly by month and/or clinic. Oncologists valued the risk services offered by the study, but intensive engagement was necessary with front-line staff/supervisors because of their job demands. • Partial randomization functioned well. Prior studies showed that many high-risk women refuse randomization for GC. Adding a preference arm necessitated a larger sample, but greater inclusiveness yields more generalizable findings. • Recruitment of Chinese-speaking patients was low (2.5%) due largely to structural barriers which we continue to explore. Practice-based safety net research presents numerous challenges that require close partnerships, extensive planning, and highly skilled staff capable of sensitive personnel engagement. The work is rewarded by real-world findings, the sine qua non in efforts to eliminate cancer disparities.
Citation Format: Claudia Guerra, Robin Lee, Susan L Stewart, Celia Kaplan, Galen Joseph, Janice Tsoh, Niharika Dixit, Heather Cedermaz, Jin Kim, Jane Campbell, Lily X Wang, Amal Khoury, Cindy Hellman-Wylie, Rena J Pasick. Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A034.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jin Kim
- 4Alameda County Medical Center, Oakland, CA, USA,
| | - Jane Campbell
- 3Contra Costa Regional Medical Ctr, Martinez, CA, USA,
| | - Lily X Wang
- 3Contra Costa Regional Medical Ctr, Martinez, CA, USA,
| | - Amal Khoury
- 5Alameda County Medical Center, Oakland, CA, USA
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Tang A, Ugarte S, John R, Khoury A, Knopf K. Abstract P6-13-07: Cost-effective care for newly diagnosed breast cancer patients: Think globally, act locally. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Conscientious use of scarce health economic resources allows for social distributive justice by avoiding over-treatment of patients to allow for appropriate treatment for a broader patient population. Lower socioeconomic status patients with breast cancer have a worse outcome compared to higher socioeconomic status patients in the United States. In part, this is due to poor access to medical care and a failure of logistical care. We implemented a community based breast cancer multidisciplinary program with weekly meetings to discuss patients, coordinate care, and provide cost-effective care to a medically under-served and vulnerable patient population. Breast surgery and medical oncology providers saw patients together in a co-located space and expedited timely initiation of neoadjuvant and adjuvant chemotherapy / hormone therapy for appropriate patients. The conjoint clinic allowed for rapid temporal integration of care in our safety net hospital / community. A single breast cancer navigator provided rapid identification of patients, coordination through clinics, and assistance with social work and other needs. Weekly 30 minute discussion sessions reviewing all new and relevant follow up patient issues were implemented in lieu of a breast cancer tumor board for efficiency. The relevant published clinical literature was reviewed on an ongoing basis. Cost-effective care was obtained by implementing: 1) avoidance of post lumpectomy radiation for selected patients based on PRIME2 trial results, 2) judicious use of post-mastectomy radiation based on a careful re-analysis of the data, 3) avoidance of adjuvant/neoadjuvant Perjeta in HER2+ patients based on a lack of overall survival, 4) adoption of 6 month schedule of adjuvant Herceptin, 5) avoidance of excessive imaging by following NCCN guidelines and clinical judgment, 6) limiting dose dense chemotherapy to appropriate patients (ER- high risk node negative or node positive), and 7) No Nernyx. Using a cost-effectiveness analysis methodology, we are reviewing costs, effectiveness of interventions, and risks with outcomes measured from side effects, complications, recurrence, and mortality. The improvement in temporal parameters and economic endpoints are being currently monitored retrospectively and prospectively and will be presented.
Citation Format: Annie Tang, Shannon Ugarte, Rohan John, Amal Khoury, Kevin Knopf. Cost-effective care for newly diagnosed breast cancer patients: Think globally, act locally [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-13-07.
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Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar nailing of fractures of the tibia. Oper Orthop Traumatol 2020; 32:440-454. [PMID: 31996965 DOI: 10.1007/s00064-020-00649-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures. INDICATIONS Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. CONTRAINDICATIONS Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. SURGICAL TECHNIQUE Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. RESULTS In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.
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Affiliation(s)
- Martin H Hessmann
- Academic Teaching Hospital Fulda, Pacelliallee 4, 36043, Fulda, Germany.
| | - Michael Buhl
- Academic Teaching Hospital Fulda, Pacelliallee 4, 36043, Fulda, Germany
| | - Chris Finkemeier
- Sutter Roseville Medical Center, PO Box 2070, 95746, Granite Bay, CA, USA
| | - Amal Khoury
- Orthopedic Trauma Unit, Hadassah Ein Kerem Hospital, Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Rami Mosheiff
- Orthopedic Surgery Department, Hadassah Ein Kerem Hospital, Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Michael Blauth
- Department for Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Trauma, CMF, Biomaterials, DePuy Synthes, Synthes GmbH, Luzernstr. 21, 4528, Zuchwil, Switzerland
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Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W, Dadan S, Higuera M, Sifontes L, Harris P, Gana J, Rodríguez M, Vasquez M, González M, Rivera J, Gonzales J, Angulo D, Cetraro M, Del Compare M, López K, Navarro D, Calva R, Wagener M, Zablah R, Carias A, Calderón O, Vera-Chamorro J, Toca M, Dewaele M, Iglesias C, Delgado L, León K, Hassan I, Ussher F, Follett F, Bernedo V, Grinblat V, Agüero N, Oviedo C, García A, Salazar A, Coello P, Furnes R, Menchaca M, Fernández M, Khoury A, Rojo C, Fernández S, Morao C. Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Revista de Gastroenterología de México (English Edition) 2019. [DOI: 10.1016/j.rgmxen.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W, Dadan S, Higuera M, Sifontes L, Harris P, Gana JC, Rodríguez M, Vasquez M, González M, Rivera J, Gonzales J, Angulo D, Cetraro MD, Del Compare M, López K, Navarro D, Calva R, Wagener M, Zablah R, Carias A, Calderón O, Vera-Chamorro JF, Toca MC, Dewaele MR, Iglesias C, Delgado L, León K, Hassan I, Ussher F, Follett F, Bernedo V, Grinblat V, Agüero N, Oviedo C, García AG, Salazar A, Coello P, Furnes R, Menchaca M, Fernández M, Khoury A, Rojo C, Fernández S, Morao C. Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex (Engl Ed) 2019; 84:427-433. [PMID: 30292584 DOI: 10.1016/j.rgmx.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVE Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.
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Affiliation(s)
- R Pierre
- Clínica Razetti, Barquisimeto, Venezuela.
| | - M Vieira
- Hospital Pequeño Príncipe, Curitiba, Brasil
| | - R Vázquez
- Hospital Infantil de México Federico Gómez, México DF, México
| | - I Ninomiya
- Hospital Italiano, Buenos Aires, Argentina
| | - G Messere
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - W Daza
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - S Dadan
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - M Higuera
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - L Sifontes
- Centro Médico El Valle, Porlamar, Venezuela
| | - P Harris
- Pontificia Universidad Católica, Santiago, Chile
| | - J C Gana
- Pontificia Universidad Católica, Santiago, Chile
| | - M Rodríguez
- Hospital de Niños Dr. J.M. de Los Ríos, Caracas, Venezuela
| | - M Vasquez
- Hospital Universitario de Pediatría Dr. Agustín Zubillaga, Barquisimeto, Venezuela
| | - M González
- Hospital Dr. Roberto del Río, Santiago, Chile
| | - J Rivera
- Instituto Nacional de Salud del Niño, Lima, Perú; Clínica Ricardo Palma, Lima, Perú
| | - J Gonzales
- Instituto Nacional de Salud del Niño, Lima, Perú; Clínica Ricardo Palma, Lima, Perú
| | - D Angulo
- Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú
| | - M D Cetraro
- Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú
| | | | - K López
- Hospital Dr. Miguel Pérez Carreño, Caracas, Venezuela
| | - D Navarro
- Hospital Dr. Miguel Pérez Carreño, Caracas, Venezuela
| | - R Calva
- Facultad de Medicina BUAP, Puebla, México
| | - M Wagener
- Hospital de Niños Dr. O. Alassia, Santa Fe, Argentina
| | - R Zablah
- Clínica de Gastroenterología, Endoscopia y Nutrición Pediátrica Multipediátrica, San Salvador, El Salvador
| | - A Carias
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - O Calderón
- Clínica Farallones-Gastroped, Cali, Colombia
| | | | - M C Toca
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - M R Dewaele
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - C Iglesias
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - L Delgado
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - K León
- Policlínica Metropolitana, Caracas, Venezuela
| | - I Hassan
- Policlínica Metropolitana, Caracas, Venezuela
| | - F Ussher
- Hospital Universitario Austral, Buenos Aires, Argentina
| | - F Follett
- Hospital Universitario Austral, Buenos Aires, Argentina
| | - V Bernedo
- Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - V Grinblat
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - N Agüero
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - C Oviedo
- Hospital Vozandes, Quito, Ecuador
| | - A G García
- Gastroclínica, San Salvador, El Salvador
| | - A Salazar
- Hospital Central Ignacio Morones Prieto, San Luis Potosí, México
| | - P Coello
- Hospital Civil Juan I. Menchaca, Guadalajara, México
| | - R Furnes
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - M Menchaca
- Hospital Universitario UANL, Monterrey, México
| | - M Fernández
- Hospital Dr. Manuel Antonio Narváez, Porlamar, Venezuela
| | - A Khoury
- Centro Policlínico Valencia, Valencia, Venezuela
| | - C Rojo
- Hospital Regional Leonardo Guzmán, Antofagasta, Chile
| | | | - C Morao
- Hospital de Niños Dr. J.M. de Los Ríos, Caracas, Venezuela
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Abstract
Medical education is an arduous process with widespread study of very complex information across diverse subjects. The use of medical illustrations in schematic or cartoon-like appearances is an old method of conveying intricate information. They are relatively absent in medical classrooms today. The purpose of this study was to survey members of a medical university, students and teachers regarding their opinions of medical cartoons. Most respondents had favourable opinions of cartoons in medical education. More research is required to conclude what parameters make cartoons effective teaching aids. Moreover, many teachers may lack formal training in applying cartoons within their curriculum.
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Affiliation(s)
- Mohamed Mediouni
- a Independent researcher , 1420 Rue Laterriere. Sherbrooke, Quebec, J1K 2R2 , Canada
| | - Daniel R Schlatterer
- b Orthopaedic Trauma, division , Wellstar at Atlanta Medical Center , Atlanta , GA , USA
| | - Amal Khoury
- c Department of Orthopaedics , Hadassah Hebrew University Medical Center , Jerusalem , Israel
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Abstract
Introduction: Acute hematogenous osteomyelitis (AHO) has been noted mainly in open fractures injuring soft tissue immunological defenses and in immuneincompetent patients. Osteomyelitis complicating closed fractures in immunocompetent adult patients is, therefore, a rare clinical entity with scarce literature. Case Report: We report a case of primary Staphylococcus aureus bacterial infection of a closed, humeral shaft fracture occurring in a previously healthy 28-year-old male patient. The patient was involved in a motorcycle accident and was admitted to the surgical ward with a chest drain. While hospitalized, a peak of fever was noted, but no source was found. Diagnosis of the closed fracture infection was noted on primary open reduction and internal fixation (ORIF), and although the patient was treated with antibiotics, local osteomyelitis developed. Treatment including serial debridements utilizing gentamycin beads and an additional ORIF procedure until the full union was achieved. The patient regained full, painless, motion of the arm and shoulder. Conclusion: Although AHO complicating a closed fracture in immunocompetent adults is very rare, it should not be overlooked, and special attention should be sought in such cases. Meticulous debridement and rigid fixation are utmost for the eradication of infection and fracture union. Patients presenting with such infections should, therefore, be followed closely and treated promptly.
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Affiliation(s)
- Yechiel N Gellman
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Madi El-Haj
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Amal Khoury
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Yoram A Weil
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
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Khoury A, Humm G, Shaw A, Lloyd H. Fishbone perforation of the ileum: Case report and literature review. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hale N, Khoury A, Smith M. Use of Highly Effective Reversible Contraception in Title X Clinics: Variation by Selected State Characteristics. Womens Health Issues 2018; 28:289-296. [DOI: 10.1016/j.whi.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
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Hakimian D, Khoury A, Mosheiff R, Liebergall M, Weil YA. Radiographic markers for measuring tibial rotation based on CT-reconstructed radiographs: an accuracy and feasibility study. Skeletal Radiol 2018; 47:483-490. [PMID: 29128913 DOI: 10.1007/s00256-017-2810-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 08/24/2017] [Accepted: 10/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Malreduction in the axial plane (malrotation) following tibial fracture surgery is often undiagnosed. A few clinical and radiographic methods have been proposed for measuring tibial rotation intraoperatively, yet have failed to match the accuracy of computed tomography (CT). The aim of this study was to develop radiographic tools for future intraoperative assessment of the tibial shaft rotation profile. METHODS The setting was a laboratory computerized analysis. Twenty lower limb CT scans were used to construct a three-dimensional (3D) model using AMIRA© software. A virtual 3D cylinder was implanted in the posterior condylar line and in the transmalleolar axis. The 3D models were used to simulate four standard knee and ankle plain radiographs. On each radiograph, four landmarks were depicted by two observers and their relation with the cylinder was measured and analyzed for accuracy and reproducibility. A cadaveric lower leg was implanted with two Kirschner wires. A CT scan was performed in addition to 2D fluoroscopy. The simulated radiographs and the fluoroscopy were compared for accuracy. RESULTS Measurement of the landmarks showed reliability in most of the knee anteroposterior and ankle mortise radiographs (coefficients of variation < 0.01 and = 0.01) respectively. Cadaveric measurement of the landmarks using real fluoroscopy and simulated radiographs were similar. CONCLUSIONS To date, no reliable and common methods have been reported for the evaluation of tibial axial rotation. We propose a model in which simple radiographic landmarks can be used to calculate a 3D coordinate system that accurately assesses the axial rotation angle of the tibial shaft.
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Affiliation(s)
- David Hakimian
- Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel
| | - Amal Khoury
- Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel
| | - Rami Mosheiff
- Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel
| | - Yoram A Weil
- Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel.
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Weil YA, Liebergall M, Mosheiff R, Khoury A. [FLUOROSCOPIC BASED NAVIGATION IN ORTHOPAEDIC TRAUMA - A REVIEW OF A LARGE CENTER'S EXPERIENCE]. Harefuah 2018; 157:145-148. [PMID: 29582942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Computer Assisted Orthopaedic Surgery (CAOS) was introduced in the late 1990's and early 2000's. Since then its application in orthopaedic trauma has been utilized mainly as augmented fluoroscopy for intraoperative navigation. From 2010 our center implemented an advanced system allowing further expansion of this technology. AIMS The aim of this study was to describe the experience with an advanced fluoroscopic based CAOS system in our center. METHODS The BrainLabTM Trauma 3.0 utilizes a handheld fluoroscope tracker, enables tracking of two anatomical objects and intraoperative planning. We implemented this system for the performance of 126 navigated procedures between the years 2011-2014. The procedures included 58 cases of navigated hip fracture pinning, 9 plate navigation for distal femoral fractures, 19 iliosacral screw insertions, 20 femoral fracture reductions, and 12 other procedures (acetabular screws, osteotomies etc). RESULTS The mean age of patients was 52 years (range 16-82 years); 46 male and 80 female patients. The mean operating room time was 157 minutes (range 70 to 470 minutes). The average radiation required was 550 rad cm2 (~30 sec fluoroscopic time). Overall estimated additional OR time was estimated as 10-15 minutes for hip pinning, 15-20 minutes for pelvic iliosacral screws and 30-45 minutes of additional OR time for femur fracture reduction for length and rotation. In 5% of cases (6 patients), navigation was aborted due to technical reasons. No misplaced hardware due to the use of navigation was documented. CONCLUSIONS CAOS is a powerful tool in trauma surgery with 95% success rate, with a reasonable added burden time. Although 3D navigation may be more useful in the pelvis, even two-dimensional navigation increases precision and implant placement. Femoral fracture reduction for accurate length and rotation control is solely enabled by CAOS. In the future, more time efficient and user-friendly systems will enable widespread use of these technologies in orthopaedic trauma.
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Affiliation(s)
- Yoram A Weil
- Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rami Mosheiff
- Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amal Khoury
- Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Mediouni M, Schlatterer DR, Khoury A, Von Bergen T, Shetty SH, Arora M, Dhond A, Vaughan N, Volosnikov A. Optimal parameters to avoid thermal necrosis during bone drilling: A finite element analysis. J Orthop Res 2017; 35:2386-2391. [PMID: 28181707 DOI: 10.1002/jor.23542] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/23/2017] [Indexed: 02/04/2023]
Abstract
The drilling bone may potentially cause excessive frictional heat, which can lead to local bone necrosis. This heat generation and local necrosis has been suggested to contribute to the resorption of bone around the placed screws, ending in loss of screw purchase in the bone and inadvertent loosening and/or the bone-implant construct. In vivo studies on this subject have inherent obstacles not the least of which is controlling the variables and real time bone temperature data acquisition. Theoretical models can be generated using computer software and the inclusion of known constants for the mechanical properties of metal and bone. These known Data points for the variables (drill bit and bone) enables finite element analysis of various bone drilling scenarios. An elastic-plastic three-dimensional (3D) acetabular bone mode was developed and finite element model analysis (FEA) was applied to various simulated drilling procedures. The FEA results clearly indicate that the depth of drilling and the drill speed both have a significant effect on the temperature during drilling procedures. The reduction of the feeding speed leads to a reduction in bone temperature. Our data suggests that reducing the feeding speed regardless of RPMs and pressure applied could be a simple useful and effective way to reduce drilling temperatures. This study is the first step in helping any surgeon who drills bone and places screws to better understand the ideal pressure to apply and drill speed to employ and advance rate to avoid osteonecrosis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2386-2391, 2017.
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Affiliation(s)
| | - Daniel R Schlatterer
- Orthopaedic Trauma, Division, Wellstar at Atlanta Medical Center, 303 Parkway Drive NE, Atlanta, Georgia 30312
| | - Amal Khoury
- Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tobias Von Bergen
- Orthopaedic Trauma, Division, Wellstar at Atlanta Medical Center, 303 Parkway Drive NE, Atlanta, Georgia 30312
| | - Sunil H Shetty
- Department of Orthopaedics, DY Patil Hospital, Navi Mumbai 400706, India
| | - Manit Arora
- Department of Orthopaedics, DY Patil Hospital, Navi Mumbai 400706, India
| | - Amit Dhond
- Department of Orthopaedics, DY Patil Hospital, Navi Mumbai 400706, India
| | - Neil Vaughan
- Department of Computing and Informatics, Bournemouth University, Poole, Dorset, United Kingdom
| | - Alexander Volosnikov
- Federal State Budgetary Institution, Russian Ilizarov Scientific Center, Restorative Traumatology and Orthopaedics of Ministry of Healthcare, Kurgan, Kurgan Region, Russian Federation
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Zee RS, Herndon CDA, Cooper CS, Kim C, McKenna PH, Khoury A, Herbst KW. Time to resolution: A prospective evaluation from the Society for Fetal Urology hydronephrosis registry. J Pediatr Urol 2017; 13:316.e1-316.e5. [PMID: 28215834 DOI: 10.1016/j.jpurol.2016.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/09/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The resolution rate of prenatal urinary tract dilation (UTD) has been documented in several retrospective studies. The present study analyzed prospective observational registry data, with the aim of determining time to resolution among patients prenatally identified with mild postnatal UTD. MATERIALS AND METHODS A total of 248 subjects, from four centers, were prospectively enrolled from 2008 to 2015. Exclusion criteria included other anomalies (n = 69), fewer than two ultrasounds, and/or <3 months follow-up (n = 26). Resolution was defined as Outcome A (SFU 0) and Outcome B (SFU 0/1). Fisher's exact test, Mann-Whitney U or Kruskal-Wallis test and Kaplan-Meier were used for analysis. RESULTS/DISCUSSION The median follow-up for 179 (n = 137 males) subjects was 15 months (IQR 7-24), range 0-56 months. VCUG was performed in 100 (57%) and VUR identified in 15 (15%). There was no association with reflux and resolution (P = 0.72). For resolution assessment (n = 153), lower grades were likely to resolve and demonstrated a higher rate in the Outcome B classification. Time to resolution also favored lower grades, with the majority resolving within 2 years (Figure). Surgical intervention was performed in 14 (8%). It is interesting to note that regardless of grade of UTD, there was no difference in frequency of US or the time that RUS was first performed. Practitioners performed the first RUS of life within a narrow window ranging from 0.27 RUS/month for Grade 1 UTD to 0.30 RUS/month for Grade 4 UTD. It was speculated that this practice pattern occurrence likely reflected the deficiency in knowledge by primary care providers, and identified a potential opportunity for education. The SFU registry substantiates that the vast majority of patients will demonstrate transient UTD and most cases that do not resolve will improve within 2 years of life. This data could be used to further an evidenced-based approach towards the evaluation and management of prenatal UTD, as outlined in the multidisciplinary consensus statement for prenatal urinary tract dilation. CONCLUSIONS This prospective registry confirms that the majority of prenatal UTD is transient, resolution occurs within the first 3 years of life, and most patients will not need intervention. Redefining SFU 1 as normal increased the resolution rate. A large proportion of patients were not evaluated with a VCUG, therefore impact of VUR could not be determined.
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Affiliation(s)
- R S Zee
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - C D Anthony Herndon
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - C S Cooper
- Department of Urology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - C Kim
- 100 Simsbury Road, Suite 208, Avon, CT 06001, USA
| | - P H McKenna
- Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - A Khoury
- Department of Urology, UC Irvine School of Medicine, Irvine, CA, USA
| | - K W Herbst
- Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA
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