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elective Knee replacement

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https://www.readbyqxmd.com/read/27893033/effect-of-a-decision-aid-on-access-to-total-knee-replacement-for-black-patients-with-osteoarthritis-of-the-knee-a-randomized-clinical-trial
#1
Said A Ibrahim, Marissa Blum, Gwo-Chin Lee, Pekka Mooar, Elina Medvedeva, Aliya Collier, Diane Richardson
Importance: Black patients with advanced osteoarthritis (OA) of the knee are significantly less likely than white patients to undergo surgery. No strategies have been proved to improve access to surgery for black patients with end-stage OA of the knee. Objective: To assess whether a decision aid improves access to total knee replacement (TKR) surgery for black patients with OA of the knee. Design, Setting, and Participants: In a randomized clinical trial, 336 eligible participants who self-identified as black and 50 years or older with chronic and frequent knee pain, a Western Ontario McMaster Universities Osteoarthritis Index score of at least 39, and radiographic evidence of OA of the knee were recruited from December 1, 2010, to May 31, 2014, at 3 medical centers...
November 23, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27872771/tranexamic-acid-an-exceedingly-rare-cause-of-anaphylaxis-during-anaesthesia
#2
R A Bansal, A Nicholas, A S Bansal
Tranexamic acid (TXA) allergy is extremely rare. An 80-year-old woman without prior exposure to TXA underwent elective knee replacement. Shortly after induction of anaesthesia and intravenous TXA, she developed hypotension, tachycardia, and facial erythema accompanied by a raised serum tryptase. Later, skin prick and intradermal testing confirmed positive responses to TXA in high dilution and with negative results to the other drugs used. While neuromuscular blocking agents, opiates, and antibiotics remain the most frequent cause of anaphylaxis during anaesthesia, allergy to TXA should always be borne in mind and requires skin testing for confirmation as there are presently no blood tests available...
2016: Case Reports in Immunology
https://www.readbyqxmd.com/read/27871190/the-significance-of-social-rules-in-group-training-sessions
#3
Line Blixt, Kari Nyheim Solbrække
PURPOSE: To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery. METHODS: Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients...
November 21, 2016: Disability and Rehabilitation
https://www.readbyqxmd.com/read/27861701/preparing-family-caregivers-to-recognize-delirium-symptoms-in-older-adults-after-elective-hip-or-knee-arthroplasty
#4
Margaret J Bull, Lesley Boaz, Mehdi Maadooliat, Mary E Hagle, Lynn Gettrust, Maureen T Greene, Sue Baird Holmes, Jane S Saczynski
OBJECTIVES: To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN: Mixed-method, pre-post quasi-experimental design. SETTING: A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS: Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention...
November 11, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27797404/pentasaccharides-for-the-prevention-of-venous-thromboembolism
#5
REVIEW
Kezhou Dong, Yanzhi Song, Xiaodong Li, Jie Ding, Zhiyong Gao, Daopei Lu, Yimin Zhu
BACKGROUND: Venous thromboembolism (VTE) is a common condition with potentially serious and life-threatening consequences. The standard method of thromboprophylaxis uses an anticoagulant such as low molecular weight heparin (LMWH) or warfarin. In recent years, another type of anticoagulant, pentasaccharide, an indirect factor Xa inhibitor, has shown good anticoagulative effect in clinical trials. Three types of pentasaccharides are available: short-acting fondaparinux, long-acting idraparinux and idrabiotaparinux...
October 31, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27787880/reducing-hospital-readmission-disparities-of-older-black-and-white-adults-after-elective-joint-replacement-the-role-of-nurse-staffing
#6
Karen B Lasater, Matthew D McHugh
OBJECTIVES: To examine racial differences in readmissions of older adults undergoing elective total hip and knee replacement, to determine the relationship between nurse staffing and readmission, and to study whether the relationship between staffing and readmission differs for older black and white adults. DESIGN: Cross-sectional analysis of multiple linked secondary data sources. SETTING: Nonfederal acute care hospitals in California, Florida, New Jersey, and Pennsylvania (n = 483)...
October 27, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27637304/postorthopedic-surgery-joint-replacement-surgery-venous-thromboembolism-prophylaxis
#7
REVIEW
Louis M Kwong, Jon A Kimball
Elective total hip or knee arthroplasty places patients at risk for venous thromboembolism (VTE). As our understanding of the pathophysiology of VTE after joint arthroplasty has increased, pharmacologic strategies have been developed to target different aspects of the coagulation cascade. Various approaches have been used as risk reduction strategies. In 2011 and 2014 the Food and Drug Administration approved rivaroxaban and apixaban as new oral antithrombotic agents. Although controversies remain with regard to the ideal VTE pharmacoprophylactic agent, this class of novel oral anticoagulants has been demonstrated to be safe and to be more effective than enoxaparin...
October 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27623680/exploring-unmet-needs-in-venous-and-arterial-thromboembolism-with-rivaroxaban
#8
Riccardo Cappato, Robert Welsh
The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thromboembolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation...
September 28, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27611713/emergency-department-visits-following-joint-replacement-surgery-in-an-era-of-mandatory-bundled-payments
#9
Susan Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day post-discharge Emergency Department (ED) visits of Medicare beneficiaries following total joint replacement (TJR) surgery meeting eligibility for a CMS bundled payment program. METHODS: The CMS research identifiable file for the State of Texas for 2011-2012 was used to identify patients who underwent TJR...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27601761/orthopaedic-enhanced-recovery-programme-for-elective-hip-and-knee-arthroplasty-could-a-regional-programme-be-beneficial
#10
Adam Tucker, Darren McCusker, Nidhi Gupta, Jonathon Bunn, Mark Murnaghan
INTRODUCTION: Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. OBJECTIVES: The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. METHODS: A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit...
May 2016: Ulster Medical Journal
https://www.readbyqxmd.com/read/27594378/safety-and-efficacy-of-new-oral-anticoagulants-and-low-molecular-weight-heparins-compared-with-aspirin-in-patients-undergoing-total-knee-and-hip-replacements
#11
Johannes T H Nielen, Pieter C Dagnelie, Pieter J Emans, Nicole Veldhorst-Janssen, Arief Lalmohamed, Tjeerd-Pieter van Staa, Annelies E R C H Boonen, Bart J F van den Bemt, Frank de Vries
BACKGROUND: There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery. OBJECTIVE: This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement. METHODS: A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink...
September 4, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/27581506/the-prophylaxis-of-venous-thromboembolism
#12
Albrecht Encke, Sylvia Haas, Ina Kopp
BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008...
August 8, 2016: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/27575874/spouse-related-factors-associated-with-quality-of-recovery-of-patients-after-hip-or-knee-replacement-a-nordic-perspective
#13
Åsa Johansson Stark, Sanna Salanterä, Arun K Sigurdardottir, Kirsi Valkeapää, Margareta Bachrach-Lindström
BACKGROUND: Today's shorter hospital stays mean that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the healthcare staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be the primary caregivers as their relationship with the patient is more interdependent than that of other family members or caregivers. OBJECTIVES: The aim was to describe spouse-related factors that were associated with patients' quality of recovery on discharge from hospital after elective hip or knee replacement...
March 17, 2016: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/27544495/inpatient-mortality-after-elective-primary-total-hip-and-knee-joint-arthroplasty-in-botswana
#14
Laughter Lisenda, Lipalo Mokete, Joseph Mkubwa, Mkhululi Lukhele
PURPOSE: Total hip and knee joint arthroplasty (TJA) rank among the most successful orthopaedic operations. Several developing countries in Africa have started to perform these procedures that are routine in developed countries. The aims of this study were to measure the incidence and assess the determinants of in-hospital mortality after elective primary TJA in our unit and compare it with published data. METHODS: This was a retrospective study of the first consecutive cohort of patients who underwent elective primary TJA in Princess Marina Hospital, Botswana between March 2009 and October 2015 (6...
August 21, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27466030/anesthesia-technique-and-mortality-after-total-hip-or-knee-arthroplasty-a-retrospective-propensity-score-matched-cohort-study
#15
Anahi Perlas, Vincent W S Chan, Scott Beattie
BACKGROUND: This propensity score-matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty. METHODS: All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time...
October 2016: Anesthesiology
https://www.readbyqxmd.com/read/27455072/does-anticoagulant-medication-alter-fracture-healing-a-morphological-and-biomechanical-evaluation-of-the-possible-effects-of-rivaroxaban-and-enoxaparin-using-a-rat-closed-fracture-model
#16
Peter Michael Prodinger, Rainer Burgkart, Kilian Kreutzer, Franz Liska, Hakan Pilge, Andreas Schmitt, Martina Knödler, Boris Michael Holzapfel, Alexander Hapfelmeier, Thomas Tischer, Oliver Bissinger
Low molecular weight heparin (LMWH) is routinely used to prevent thromboembolism in orthopaedic surgery, especially in the treatment of fractures or after joint-replacement. Impairment of fracture-healing due to increased bone-desorption, delayed remodelling and lower calcification caused by direct osteoclast stimulation is a well-known side effect of unfractioned heparin. However, the effect of LMWH is unclear and controversial. Recent studies strongly suggest impairment of bone-healing in-vitro and in animal models, characterized by a significant decrease in volume and quality of new-formed callus...
2016: PloS One
https://www.readbyqxmd.com/read/27425041/variable-surgical-outcomes-after-hospital-consolidation-implications-for-local-health-care-delivery
#17
Victor Chang, Robert H Blackwell, Ryan M Yau, Stephanie Besser, Joslyn M Albright, Gopal N Gupta, Paul C Kuo, Anai N Kothari
BACKGROUND: With more hospital consolidations as an inevitable part of our future health care ecosystem, we investigated the relationship between hospital consolidations and operative outcomes. METHODS: Using the Health Care Cost and Utilization Project State Inpatient Database (Florida and California), the American Hospital Association Annual Survey Database, and Medicare's Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and 2013 and propensity matched them with 19 independent hospitals, using patient and hospital characteristics...
November 2016: Surgery
https://www.readbyqxmd.com/read/27412102/incidence-risk-factors-and-the-healthcare-cost-of-falls-postdischarge-after-elective-total-hip-and-total-knee-replacement-surgery-protocol-for-a-prospective-observational-cohort-study
#18
Anne-Marie Hill, Gail Ross-Adjie, Steven M McPhail, Leanne Monterosso, Max Bulsara, Christopher Etherton-Beer, Sarah-Jayne Powell, Gerard Hardisty
INTRODUCTION: The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. METHODS AND ANALYSES: A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community...
2016: BMJ Open
https://www.readbyqxmd.com/read/27356253/rationing-of-hip-and-knee-replacement-effect-on-the-severity-of-patient-reported-symptoms-and-the-demand-for-surgery-in-otago
#19
David Gwynne-Jones, Ella Iosua
AIM: A key Government health target has been to increase access to elective surgery. Despite this, there is a growing concern about unmet demand and increasing numbers of patients are being declined elective surgery. This study aims to determine whether there has been an increase in the severity of osteoarthritis of the hip and knee in patients undergoing publicly-funded elective total joint replacement (TJR) and any increase in demand for TJR in Otago. METHOD: Demographic details and preoperative patient reported outcome scores (Oxford hip or knee score (OHS,OKS) and a reduced Western Ontario and McMaster Osteoarthritis Index (WOMAC) score (RWS) were collected prospectively in an historical cohort of patients undergoing total hip and knee replacement (THR, TKR) between 2006-2010...
2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27356250/perioperative-mortality-in-new-zealand-related-to-hip-and-knee-replacement-surgery-comparing-administrative-and-registry-data
#20
P Hider, C Frampton, J-C Theis, L Wilson, A Rothwell
INTRODUCTION: Perioperative mortality is of considerable importance, but few national assessments are available. New Zealand has a clinical registry and an administrative dataset that both capture national information about hip and knee arthroplasties. National perioperative mortality rates were compared between the two data sources. METHOD: Data related to all patients undergoing an elective hip or knee replacement procedure (primary or revision) between 1 January 2007 and 31 December 2011 were separately extracted from the New Zealand Joint Registry and the National Minimum Dataset...
2016: New Zealand Medical Journal
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