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https://www.readbyqxmd.com/read/28527684/patient-perceptions-regarding-outpatient-hip-and-knee-arthroplasties
#1
R Michael Meneghini, Mary Ziemba-Davis
BACKGROUND: There has been increasing interest in outpatient total joint arthroplasty (TJA) in the orthopedic community, but how patients feel about outpatient TJA is unknown. The purpose of this study was to understand patient perspectives on hip and knee replacements performed in an outpatient setting. METHODS: We surveyed 110 consecutive patients scheduled for primary TJA in an academic suburban arthroplasty practice regarding their knowledge and perceptions of outpatient TJA...
April 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28390881/safe-selection-of-outpatient-joint-arthroplasty-patients-with-medical-risk-stratification-the-outpatient-arthroplasty-risk-assessment-score
#2
R Michael Meneghini, Mary Ziemba-Davis, Marshall K Ishmael, Alexander L Kuzma, Peter Caccavallo
BACKGROUND: Current patient selection criteria and medical risk stratification methods for outpatient primary total joint arthroplasty (TJA) surgery are unproven. This study assessed the predictive ability of a medically based risk assessment score in selecting patients for outpatient and short stay surgery. METHODS: A retrospective review of 1120 consecutive primary TJAs in an early discharge program was performed. An Outpatient Arthroplasty Risk Assessment ("OARA") score was developed by a high-volume arthroplasty surgeon and perioperative internal medicine specialist to stratify patients as "low-moderate risk (≤59)" and "not appropriate" (≥60) for early discharge...
March 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28377154/the-influence-of-activity-based-funding-on-treatment-intensity-and-length-of-stay-of-geriatric-rehabilitation-patients
#3
Hylco Bouwstra, Lizette M Wattel, Aafke J de Groot, Martin Smalbrugge, Cees M Hertogh
AIM: Little is known about the impact of activity-based funding (ABF) to increase treatment intensity and decrease length of stay (LOS) of inpatient geriatric patients. In January 2014, ABF was implemented in The Netherlands with the aim to increase treatment intensity and shorten LOS in geriatric rehabilitation (GR). OBJECTIVES: To describe the influence of ABF on treatment intensity and LOS of inpatient GR patients before and after ABF was implemented. DESIGN: Population-based, retrospective cohort study...
April 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28296768/difficult-clinical-management-of-antituberculosis-dress-syndrome-complicated-by-mrsa-infection-a-case-report
#4
Li Wang, Lin-Feng Li
RATIONALE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presentation. Prompt withdrawal of the culprit drug is the definitive treatment. DRESS syndrome induced by antituberculosis drugs has rarely been reported. PATIENT CONCERNS: A 50-year-old man admitted to our hospital with recurrent episodes of progressive rash, fever, eosinophilia, lymphadenopathy, hepatic, and pulmonary involvement were experienced after repeat trials of the same antituberculosis drugs...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28089186/predictors-of-same-day-discharge-in-primary-total-joint-arthroplasty-patients-and-risk-factors-for-post-discharge-complications
#5
Alex Sher, Aakash Keswani, Dong-Han Yao, Michael Anderson, Karl Koenig, Calin S Moucha
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population...
December 22, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28034481/complications-following-outpatient-total-joint-arthroplasty-an-analysis-of-a-national-database
#6
P Maxwell Courtney, Anthony J Boniello, Richard A Berger
BACKGROUND: As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols. METHODS: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014...
December 14, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28005122/opioid-sparing-pain-control-in-outpatient-total-joint-arthroplasty
#7
John W Barrington
Postoperative pain management is vital to promoting recovery and improving clinical outcomes. Although improved understanding of pain pathways has led to the development of varied approaches for controlling pain after surgery, some approaches are associated with potentially harmful side effects. Several lines of evidence have demonstrated that opioid analgesics can have unwanted adverse effects on patients having surgery. Similarly, risks associated with femoral nerve blocks have outweighed the benefits. Liposomal bupivacaine has shown efficacy in reducing the need for opioid analgesics and nerve blocks...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/27890310/same-day-total-hip-arthroplasty-performed-at-an-ambulatory-surgical-center-90-day-complication-rate-on-549-patients
#8
Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
April 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27385689/global-forum-an-international-perspective-on-outpatient-surgical-procedures-for-adult-hip-and-knee-reconstruction
#9
REVIEW
Jean-Noël A Argenson, Henrik Husted, Adolph Lombardi, Robert E Booth, Emmanuel Thienpont
Outpatient surgical procedures for adult hip and knee reconstruction are gaining interest on a worldwide basis and have been progressively increasing over the last few years. Preoperative screening needs to concentrate on both the patient's comorbidities and home environment to provide a proper alignment of expectations of the surgeon, the patient, and the patient's family. Preoperative multidisciplinary patient information covering all aspects of the upcoming treatment course is a mandatory step, focusing on pain management and early mobilization...
July 6, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27349628/liposomal-bupivacaine-incisional-injection-in-single-level-lumbar-spine-surgery
#10
Ross C Puffer, Kevin Tou, Rose E Winkel, Mohamad Bydon, Bradford Currier, Brett A Freedman
BACKGROUND CONTEXT: Postsurgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine, providing prolonged local anesthesia, up to 72 hours postinjection. Although, LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiskectomy has hitherto not been reported...
June 24, 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/27298819/a-novel-way-of-treating-multidrug-resistant-enterococci
#11
Hem Desai, Ryan Wong, Ahmed Khurshid Pasha
CONTEXT: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (β)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding...
May 2016: North American Journal of Medical Sciences
https://www.readbyqxmd.com/read/27147642/discharge-planning-and-hospital-readmissions
#12
Rachel Mosher Henke, Zeynal Karaca, Paige Jackson, William D Marder, Herbert S Wong
This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions...
May 4, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27111079/total-joint-arthroplasty-in-a-stand-alone-ambulatory-surgical-center-short-term-outcomes
#13
Bertrand W Parcells, Dean Giacobbe, David Macknet, Amy Smith, Mark Schottenfeld, David A Harwood, Stephen Kayiaros
For decades, the average hospital stay following total joint arthroplasty (TJA) has been getting shorter. The historical standard was several weeks of hospitalization, yet improvements in perioperative care have reduced the average length of stay to a few days. Medicare recognizes a 3-day inpatient stay as the standard of care following hip or knee replacement. Yet continued advances in minimally invasive surgical techniques, short-acting general anesthetics, long-acting local anesthetics, and blood loss management have further improved the safety and recovery for TJA procedures...
July 1, 2016: Orthopedics
https://www.readbyqxmd.com/read/27111073/adult-native-septic-arthritis-in-an-inner-city-hospital-effects-on-length-of-stay
#14
Jacob Daynes, Matthew F Roth, Mark Zekaj, Ian Hudson, Claire Pearson, Rahul Vaidya
The objective of this retrospective study was to assess what factors affected length of stay (LOS) in 183 adult patients with native septic arthritis. Diagnosis was based on a representative physical examination, fluid cell count/Gram stain, and organisms isolated from joint fluid culture. Data included demographics, comorbidities, laboratory results, treatment, and discharge times. Joint fluid cultures were positive in 55% (100 of 183) of the patients, and these patients were the subjects of this study. Blood cultures were taken for 65 patients and were positive in 54%; when positive, they were found to be the same as isolates from joint fluid analysis 91% of the time...
July 1, 2016: Orthopedics
https://www.readbyqxmd.com/read/26447429/fast-track-recovery-and-outpatient-joint-arthroplasty
#15
John W Barrington
There is a growing interest in performing joint arthroplasty on an outpatient or short-stay basis. Several factors make the hospital environment itself less than ideal for providing optimal health care, and follow-up of hospitalized patients represents a substantial time burden for the orthopedic surgeon. Essential components of a successful outpatient arthroplasty program include: robust screening of patients to ensure selection of appropriate candidates; preoperative patient preparation, including setting appropriate expectations; modification of surgical approaches where appropriate; and proactive, multimodal pain management to enable patients to walk earlier after surgery, so that they can be discharged home the same day...
October 2015: American Journal of Orthopedics
https://www.readbyqxmd.com/read/26295663/acute-appendicitis-use-of-clinical-and-ct-findings-for-modeling-hospital-resource-utilization
#16
Neal K Viradia, Byron Gaing, Stella K Kang, Andrew B Rosenkrantz
OBJECTIVE: The purpose of this study was to retrospectively investigate associations between baseline CT findings in suspected acute appendicitis and subsequent hospital resource utilization. MATERIALS AND METHODS: One hundred thirty-eight patients (76 male and 62 female patients; mean [± SD] age, 40 ± 21 years) who were admitted for suspected acute appendicitis and underwent baseline CT were included. A single radiologist reviewed CT examinations for appendiceal-related findings...
September 2015: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/26114559/-hemi-prosthesis-in-femoral-neck-fracture-in-the-elderly-op-video-and-our-results
#17
A Prokop, R Dolezych, M Chmielnicki
BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the therapy of choice. We want to demonstrate the operation technique of implantation of a hemiprosthesis (dual head prosthesis) by video in an 87-year-old female patient. In addition, we analyse the long-term results after surgery more than one year after endoprosthesis in patients with femoral neck fractures. METHOD: From 2007 to 2010, 219 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital...
June 2015: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/25991594/impact-of-pharmacist-intervention-in-conjunction-with-outpatient-physician-follow-up-visits-after-hospital-discharge-on-readmission-rate
#18
Matthew E Arnold, Lucinda Buys, Fekadu Fullas
OBJECTIVE: The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate...
June 1, 2015: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/25848596/patient-report-improves-posthospital-discharge-event-capture-in-total-joint-replacement-a-novel-approach-to-capturing-all-posthospital-event-data
#19
Leslie Harrold, Scott Pascal, Courtland Lewis, Regis O'Keefe, Vincent Pellegrini, Jeroan Allison, David Ayers, Patricia Franklin
INTRODUCTION: Current approaches to quantifying total posthospital complications and readmissions following surgical procedures are limited because the United States does not have a single health care payer. Patients seek posthospital care in varied locations, yet hospitals can only quantify those returning to the same facility. Seeking information directly from patients about health care utilization following hospital discharge holds promise to provide data that is missing for surgeons and health care systems...
2014: EGEMS
https://www.readbyqxmd.com/read/25365884/use-of-drop-and-dangle-rehabilitation-protocol-to-increase-knee-flexion-following-total-knee-arthroplasty-a-comparison-with-continuous-passive-motion-machine
#20
COMPARATIVE STUDY
Anuwat Pongkunakorn, Duangrak Sawatphap
BACKGROUND: There are variations in the type of rehabilitation program and duration of using the continuous passive motion (CPM) machine to increase range of motion (ROM) following total knee arthroplasty (TKA). OBJECTIVE: To compare the outcomes of the 'drop and dangle' (D&D) protocol vs. a 3-hour daily CPM for the purpose of increasing flexion following TKA. MATERIAL AND METHOD: A prospective non-concurrent controlled intervention study was conducted on patients who underwent primary TKA atLampang Hospital from December 2009 to August 2011 (D&D group, n = 36) andfrom September 2011 to December 2012 (CPM group, n = 33)...
September 2014: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
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