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early ambulation

Matthew J Grosso, David P Trofa, Jonathan R Danoff, Thomas R Hickernell, Taylor Murtaugh, Akshay Lakra, Jeffrey A Geller
Background: The purpose of this study was to investigate the influence of tranexamic acid (TXA) on functional outcomes in the immediate postoperative period after total knee arthroplasty (TKA). We hypothesized that the known benefits of TXA would confer measurable clinical improvements in physical therapy (PT) performance, decrease pain, and decrease hospital length of stay (LOS). Methods: We retrospectively analyzed 560 TKA patients, including 280 consecutive patients whose surgery was performed before the initiation of a standardized TXA protocol and the first 280 patients who received TXA after protocol initiation...
March 2018: Arthroplasty Today
Ali H Hakim, Usman Ahmad, Kenneth R McCurry, Douglas R Johnston, Gosta B Pettersson, Marie Budev, Sudish Murthy, Eugene H Blackstone, Michael Z Tong
BACKGROUND: Extracorporeal membrane oxygenation (ECMO), when used as bridge to lung transplantation (BTT) identifies high-risk candidates. Recent advances in cannula design and patient selection fosters "awake ambulatory ECMO" as a viable option for critically ill candidates in an attempt to retard deconditioning while awaiting allografts. METHODS: From 2012 to 2015, 30 patients underwent ECMO as BTT. Candidacy for ECMO was determined prior to listing for transplant...
March 17, 2018: Annals of Thoracic Surgery
Hirotaka Iijima, Kanako Shimoura, Tomoki Aoyama, Masaki Takahashi
BACKGROUND: Stair climbing was suggested to be the first affected task in individuals with knee osteoarthritis (OA). RESEARCH QUESTION: This review aimed to identify consistent kinematic, kinetic, and spatiotemporal alterations of stair climbing exhibited by individuals with knee OA. METHODS: A literature search published until September 2017 was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL. Reviewer extracted data in accordance with the Cochrane Handbook...
March 8, 2018: Gait & Posture
Cheisson Gaëlle, Jacqueminet Sophie, Cosson Emmanuel, Ichai Carole, Leguerrier Anne-Marie, Nicolescu-Catargi Bogdan, Ouattara Alexandre, Tauveron Igor, Valensi Paul, Benhamou Dan
Perioperative hyperglycaemia (>1.80g/L or 10 mmol/L) increases morbidity (particularly due to infection) and mortality. Hypoglycaemia can be managed in the perioperative period by decreasing blood sugar levels with insulin between 0.90 and 1.80g/l but it may occur more frequently when the goal is strict normoglycaemia. We propose continuous administration of insulin therapy via an electronic syringe (IVES) in type-1 diabetes (T1D) and type-2 diabetes (T2D) patients if required or in cases of stress hyperglycaemia...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
Marcus Eng Hock Ong, Gavin D Perkins, Alain Cariou
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff...
March 10, 2018: Lancet
Justin Ralph Abbatemarco, Mary Alissa Willis, Robert G Wilson, Sean J Nagel, Andre G Machado, Francois A Bethoux
OBJECTIVES: Stiff-person syndrome (SPS) is associated with axial rigidity superimposed on sustained muscle spasms. These symptoms commonly interfere with the performance of activities of daily living including ambulation. This retrospective case series evaluates the outcomes of screening tests and chronic infusion of intrathecal baclofen (ITB) in patients diagnosed with SPS treated in our spasticity clinic. MATERIALS AND METHODS: Patients were identified from an institutional review board-approved clinical registry of ITB therapy...
March 13, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Robert M Van Haren, Reza J Mehran, Arlene M Correa, Mara B Antonoff, Carla M Baker, Ta Charra Woodard, Wayne L Hofstetter, Gabriel E Mena, Jack A Roth, Boris Sepesi, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, David C Rice
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways aim to improve postoperative recovery through evidence-based practices including early ambulation, multimodal opioid-sparing analgesia, and reduction of surgical stress. The purpose of this study was to evaluate outcomes following implementation of ERAS in patients undergoing resection for pulmonary malignancy. METHODS: A retrospective review compared outcomes for patients undergoing pulmonary resection for primary lung cancer...
March 9, 2018: Annals of Thoracic Surgery
Bin Mei, Gaige Meng, Guanghong Xu, Xinqi Cheng, Shishou Chen, Ye Zhang, Ming Zhang, Xuesheng Liu, Erwei Gu
BACKGROUND: Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium. The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of postoperative delirium. METHODS: A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017...
March 9, 2018: Clinical Journal of Pain
Yingying Hu, Jun Xu, Huadong Zhu, Guoxiu Zhang, Feng Sun, Yazhi Zhang, Xuezhong Yu
OBJECTIVE: To investigate the status of cardiopulmonary resuscitation (CPR) in patients with sudden cardiac arrest (CA) in the emergency department. METHODS: A multicenter prospective observational study was conducted. The patients with CA admitted to 13 hospitals from 6 provinces in four different regions, including North China, Southern China, East China, Southwest China, from July 1st, 2015 to July 31st, 2017 were enrolled. A modified Utstein template was applied to collect clinical data, including general data, CA related data and prognosis, and primary outcome indicator was the return of spontaneous circulation (ROSC) rate, and the secondary outcome indicator was 28-day survival rate...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Judith Brenner, Jeffrey Bird, Samara B Ginzburg, Thomas Kwiatkowski, Vincent Papasodero, William Rennie, Elisabeth Schlegel, Olle Ten Cate, Joanne M Willey
BACKGROUND: Two dominant themes face medical education: developing integrated curricula and improving the undergraduate medical education (UME) to graduate medical education (GME) transition. An innovative solution to both of these challenges at the Zucker School of Medicine has been the application of the cognitive apprenticeship framework in requiring emergency medical technician (EMT) certification during the first course in medical school as the core on which to build an integrated curriculum and provide entrustable clinical skills...
March 8, 2018: Medical Teacher
Michael X Ma, Yi Huang, Leon A Adams, Robert Gilpin, George Garas, Gerry MacQuillan, Gary P Jeffrey, Ross Mac Nicholas
A cross-sectional survey of 188 ambulant patients with chronic liver disease was performed to determine the prevalence of restless legs syndrome (RLS) using a validated patient completed questionnaire. Patient responses were verified by standardised telephone interview. RLS was identified in 64 (34%) patients. Significantly, more patients with cirrhosis had RLS than patients without RLS (43.9 vs 23.3%, P = 0.003, respectively). Cirrhotic patients with a history of hepatic encephalopathy were also more likely to have RLS than patients without hepatic encephalopathy (odds ratio = 4...
March 2018: Internal Medicine Journal
Tom E F Abbott, Nicholas Cron, Nidhi Vaid, Dorothy Ip, Hew D T Torrance, Julian Emmanuel
Background: National Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay. Methods: Planned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study...
March 2018: Annals of Medicine and Surgery
Hyun-Mi Oh, Geun-Young Park, Young Min Choi, Hyung Jung Koo, Yongjun Jang, Sun Im
BACKGROUND: There are no guidelines on the ideal time to inject botulinum toxin (BT-A) for lower leg spasticity in stroke patients. An early injection may produce unwanted weakness, interfering with gait recovery. OBJECTIVE: To evaluate whether the outcomes after BT-A injection for plantarflexion spasticity can be different according to stroke chronicity. DESIGN: A secondary analysis study from a double- blinded, randomized trial with group reclassification according to stroke chronicity SETTING: Two rehabilitation centres...
March 3, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
Linda Martin, Bethany Sarosiek, Meredith Harrison, Traci Hedrick, James Isbell, Alexander Krupnick, Christine Lau, Hunter Mehaffey, Robert Thiele, Dustin Walters, Randal Blank
BACKGROUND: To minimize the stress of surgery, improve the patient experience, reduce variability and optimize resource utilization, we implemented a thoracic Enhanced Recovery After Surgery (ERAS) protocol and evaluated progress after one year. METHODS: Two protocols were developed: video assisted thoracic surgery (ERAS-VATS) and thoracotomy (ERAS-T). Each incorporated preoperative patient education, carbohydrate loading, opioid-sparing analgesia, conservative fluid management, and early ambulation...
March 3, 2018: Annals of Thoracic Surgery
Zhiwei Xu, Jian Cheng, Wenbiao Hu, Shilu Tong
OBJECTIVES: Temperature observation time and type influenced the assessment of heat impact on mortality, and different health events may have different temperature thresholds beyond which these health events increase substantially. This study aimed to investigate whether temperature observation time and type influenced the assessment of heatwave impact on morbidity, to assess how heatwave duration modified heatwave impact on morbidity, and to examine whether there was a consistent temperature threshold beyond which five different types of health events increased sharply...
February 26, 2018: Science of the Total Environment
Łukasz Szelerski, Radosław Górski, Sławomir Żarek, Karol Mochocki, Paweł Małdyk
BACKGROUND: Distal femoral fractures constitute a type of lower limb injuries that is rare and difficult to treat. Despite advances in surgical technique and development of implants used for internal fixation of fracture fragments, the treatment continues to result in numerous complications. The Ilizarov External Fixator reduces the risk of complications and allows for bone union. MATERIAL AND METHODS: Six men with distal femoral fractures resulting from multisite and multiorgan injuries were treated at the Department of Orthopaedics and Musculoskeletal Traumatology of the Medical Uni-versity of Warsaw between 2008 and 2016...
December 30, 2017: Ortopedia, Traumatologia, Rehabilitacja
Aimee Marie Charnell, Emma Ferriman, Rozalia Dimitriou, Michalis Panteli, Peter V Giannoudis
In this case, we opted for dual surgery combining caesarean section and internal fixation of acetabular fracture in late pregnancy, which allowed safe foetal delivery, fracture repair and early ambulation of the mother. In similar cases, this method could be potentially considered in the armamentarium of treatment options, aiming to facilitating prompt motherhood input and early hospital discharge, as well as minimising the risk of post-traumatic arthritis of the hip.
February 2018: JRSM Open
Keibun Liu, Takayuki Ogura, Kunihiko Takahashi, Mitsunobu Nakamura, Hiroaki Ohtake, Kenji Fujiduka, Emi Abe, Hitoshi Oosaki, Dai Miyazaki, Hiroyuki Suzuki, Mitsuaki Nishikimi, Alan Kawarai Lefor, Takashi Mato
Background: There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. Methods: This was a single-center prospective observational study...
2018: Journal of Intensive Care
Ae Ryoung Kim, Dae Hyun Kim, So Young Park, Sunghyon Kyeong, Yong Wook Kim, Seung Koo Lee, Deog Young Kim
This study aimed to investigate the long-term motor outcome according to early diffusion tensor tractography findings for the affected corticospinal tract (CST) in poststroke hemiplegic patients. A total of 48 supratentorial subacute patients after stroke were enrolled, who had a brain MRI scan within 6 weeks from onset, and no stroke recurrence reported within the 2-year follow-up period. Diffusion tensor images were obtained and CSTs were reconstructed. The participants were classified into three groups: type A, the CST originating from the primary motor cortex was preserved around the lesion area; type B, the CST was similar to type A, except that the fiber originated from the area adjacent to the primary motor cortex; and type C, the CST was interrupted or not shown...
February 23, 2018: Neuroreport
W S El Masri Y
The controversy about surgical vs conservative treatment of the injured spine with cord damage is centuries old. Until the end of the Second World War the majority of patients died or lived a short miserable life. Subsequently, Guttmann, an experienced neurosurgeon, realised surgery was not beneficial and sometimes detrimental to the person with spinal cord injury. Guttman, Frankel and others demonstrated with expert conservative management of the spine and the multi-system consequences of cord damage most patients made some neurological recovery and most with incomplete cord injury recovered ambulation regardless of X-ray findings...
2018: Spinal Cord Series and Cases
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