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Evidence for treatment of muscular vein thrombosis in orthopaedic patients

Evidence for treatment of muscular vein thrombosis in orthopaedic patients

heparin. An American study by Novicoff et al. [23] published in 2008 retrospectively examined over 1,000 orthopaedic cases undergoing total hip or knee arthroplasty over 3 years. According to local protocol introduced in 2005, all patients received warfarin starting on the day of surgery and low- molecular-weight heparin if they were at high risk of throm- botic disease to continue for 4–6 weeks after surgery. The implementation of this regimen saw a statistically significant increase in the rate of complications and length of hospital stay. Bleeding complications increased from 1.4 % in 2004 to 9.6 % in 2006 (P \ 0.0001). The rate of venous thromboembolism did not change in this period. The studies that look at com- plications of anticoagulation for orthopaedic patients focus largely on prophylaxis rather than treatment regimens. We speculate that the range and rate of complications may differ since the treatment dose is higher and for a longer period.
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Prevalence of Kidney Dysfunction among Orthopaedic Patients in Northwestern Nigeria

Prevalence of Kidney Dysfunction among Orthopaedic Patients in Northwestern Nigeria

Chronic kidney disease have been reported to affect about one in ten adults worldwide [7]. It was estimated that over 20 million Americans have chronic kidney disease [8]. The increased prevalence of ESRD among blacks in the United States (US) and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the US and other developed nations. The prevalence of chronic renal failure (CRF) has been shown in various parts of Nigeria to be between 1.6-10.0% [9]. These studies are hospital-based and fail to include orthopaedic patients. Furthermore, no studies have been carried out on orthopaedic patients in Kano which is the most populous state in Nigeria. Therefore, this study was aimed at determining the prevalence of kidney dysfunction in accordance to age and gender among patients attending National Othropeadic Hospital Dala, Kano by estimating serum urea, electrolytes, creatinine and eGFR as well as proteinuria of the studied subjects.
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Clopidogrel in Orthopaedic patients: a review of current practice in Scotland

Clopidogrel in Orthopaedic patients: a review of current practice in Scotland

We obtained recommendations from all four Scottish uni- versity teaching hospital haematology departments regarding the peri-operative management of orthopaedic patients taking clopidogrel (Table 3). All four haematol- ogy departments suggested that a cardiology opinion should be sought prior to altering medication, and that the decision whether or not to stop clopidogrel depends on the balance between risks of bleeding compared to the risk of an ischemic event. Most haematologists felt that clopidogrel should ideally be stopped before planned sur- gery and that if additional DVT prophylaxis was needed (high risk patients), low molecular weight heparin (LMWH) or fondaparinux should be used. Discontinuing clopidogrel, and commencing these patients on aspirin (as many orthopaedic units use low dose aspirin as their standard DVT prophylaxis) was not thought to be advisa- ble, as this does not allow platelet function to recover. For those taking aspirin and clopidogrel together, it was sug- gested that aspirin could be continued as DVT prophylaxis if indicated once clopidogrel was stopped. In the trauma setting, there was a difference of opinion as to what the best practice should be with suggestions that it may be possible to continue clopidogrel during the peri-operative period utilising its anti-platelet action for thrombo- prophylaxis.
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A Study to Evaluate the Effectiveness of Structured Teaching Programme regarding prevention of Selected Complications among immobilized orthopaedic patients in Government
Rajaji  Hospital, Madurai

A Study to Evaluate the Effectiveness of Structured Teaching Programme regarding prevention of Selected Complications among immobilized orthopaedic patients in Government Rajaji Hospital, Madurai

Lengthy periods of immobilization are emotionally stressful for patients. Immobility related problems include pressure ulcers, pneumonia, constipation, loss of appetite, urinary stasis, urinary track infections and venous stasis or deep vein thrombosis. When the complications due to immobilization are prevented it helps an individual to be physically, emotionally and psychologically sound. These complications can be prevented through simple basic patient care like skincare, active-passive exercises, changing position and deep breathing exercises. Nurses have a key role in prevention of these complications by educating the patients. Hence the study was conducted “To evaluate the effectiveness of structured teaching programme regarding prevention of selected complications among immobilized orthopeadic patients in Government Rajaji Hospital, Madurai.
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Analysis of kidney dysfunction in orthopaedic patients

Analysis of kidney dysfunction in orthopaedic patients

We retrospectively analyzed the medical records of 1025 admissions to our institution in a period of 13 months be- tween February 2008 and March 2009. The study protocol was approved by the Scientific Council and the Ethics Committee of Levadia General Hospital, Greece. Patients that underwent an elective or emergency orthopaedic pro- cedure were eligible for inclusion to the study. Patients that were admitted for conservative treatment were excluded. There were 586 male and 439 female with a mean age of 64 years (range: 27 to 98 years, SD: ± 10.2). Demographics, indications for admission, comorbidities and length of stay in hospital (hospitalization) were assessed and all collected data are presented in Table 1.
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Background: Orthopaedic patients are at risk of having irregular levels of vitamin D and calcium due to lack of motility and sun light exposure. Among entire population of patients, Juvenile members of society are considered high-risk groups for vitamin D inadequacy. By considering the high prevalence of this complaint according to domestic studies in Iran, this study aims to provide a report of vitamin D and related factors among orthopaedic patients in Iran.

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Advanced practice physiotherapy led triage in Irish orthopaedic and rheumatology services: national data audit

Advanced practice physiotherapy led triage in Irish orthopaedic and rheumatology services: national data audit

Results: In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. Conclusion: This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.
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A retrospective cohort study of adverse events in patients undergoing orthopaedic surgery

A retrospective cohort study of adverse events in patients undergoing orthopaedic surgery

The FCI was developed by Groll et al. [33] for use in general populations. They derived the FCI from self- reported diagnoses of 18 chronic conditions; the selected conditions predict the physical function subscale (10 items) of the medical outcomes study short form-36 (MOS SF-36). The FCI includes arthritis (osteoarthritis and rheumatoid), osteoporosis, asthma, angina, neuro- logical disease, depression, anxiety or panic disorders, visual impairment, hearing impairment, degenerative disc disease, obesity (body-mass index > 30), chronic ob- structive pulmonary disease, congestive heart failure, heart attack, stroke or transient ischemic attack, periph- eral vascular disease, diabetes (type I and II), and upper gastrointestinal disease (see Table 5 in Groll et al. [33]). We used one of the recommended methods for scoring the FCI—a simple count of the number of conditions re- ported by each subject [33]. The FCI includes an import- ant functional assessment that goes beyond the CCI and was developed in patients with musculoskeletal condi- tions and therefore is appropriate in our population.
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Complementary and alternative medicine use amongst Malaysian orthopaedic oncology patients

Complementary and alternative medicine use amongst Malaysian orthopaedic oncology patients

for patients and parents to move through the illness tra- jectory. Both biological therapies and mind-body tech- niques were most frequently used amongst our patients and its use may be explained by Lazarus and Folkmans’ problem-focused and emotion-focused coping strategies [31,32]. Problem-focused strategies include the use of various biological therapies in attempts to alleviate disease- related symptoms or adverse-effects of conventional treat- ment, while prayers and meditation techniques are examples of emotional-focused coping strategies as pa- tients venture into a spiritual and emotional journey [18]. Factors that drive patients and parents towards the uptake of CAM may also be viewed from a problem- focused verses emotion –focused perspective. Overall, when the factors motivating CAM usage were analysed, they were skewed towards problem-focused factors (>20% frequency each); these included enhancing physical well- being, accelerating wound-healing, controlling disease progression, boosting immune system and ameliorating symptoms resulting from disease and treatment. Parents of paediatric oncology patients also seemed lop-sided to- wards problem-focused factors. During conventional treatment, parents often play a passive role with little op- portunity for active involvement in the healing process of their children [33]. Coping strategies focusing on problem- solving are action-centred and enables more involvement in care activities of their child [33]. Other reasons such as improving psychological well-being and finding hope, tak- ing more control over own treatment, allowing to relax/ sleep may be described as emotion-focused factors and were less frequently mentioned (<20% frequency) in our study.
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“Publish or perish”—presentations at annual national orthopaedic meetings and their correlation with subsequent publication

“Publish or perish”—presentations at annual national orthopaedic meetings and their correlation with subsequent publication

All podium and poster presentations from the SOA ASM of six annual conferences, between 2007 and 2013 with the exception of 2008, were obtained. Abstract titles and author names were then entered into a database. For each abstract, the year of presentation was noted along with whether the work was presented as a podium or poster presentation and whether the work presented was from a local or international source. Orthopaedic subspecialties which were relevant to the abstract were also recorded. Author names were then typed into PubMed in order to identify potential corresponding publications. Abstract keywords were combined with au- thor names, using the Boolean term “AND”, in order to narrow our search down if an author had more than one publication. The process was repeated for all possible keywords until either a match was found or until all combinations were exhausted. The process was then re- peated using Google Scholar if a publication was not found. From the available data, Χ 2 testing was then used to explore whether publication rates were influenced by the mode of abstract presentation (podium vs. poster), the source of the research (local vs. international) and the type of research conducted (basic science vs. clinical research). Subspecialties were also explored as potential factors influencing likeliness of publication. Factors that were seen as potential predictors of publication were then entered together into a multivariate, binary logistic regression model to further confirm their predictive value with corrections made for potential confounding effects.
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Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years

Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years

The strengths of this study were that a sample of sixty digital shoulder MRI scans were used, which is larger than the sample size of many published studies on this topic; in addition, intra- and interobserver agreement was evaluated among orthopaedic shoulder surgeons, MSK radiologists, orthopaedic fellowship-trained shoul- der surgeons, and fellowship-trained orthopaedic sur- geons, allowing a comparison among four groups of evaluators with different levels of experience [3, 8, 9, 18]. The weaknesses of the study were that no other RCTs (infraspinatus and subscapularis tears) were evaluated, the grade of tendonosis and the grade of supraspinatus partial-thickness tear were not evaluated, and there were no comparisons performed between MRI arthrography or arthroscopy, which would provide more reliability to our study [1, 19].
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A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

means of DCO allowed fractures to be definitively ad- dressed later by more sufficiently staffed and supplied treatment teams or allowed patients to be transported to better-equipped facilities [22]. Awais et al. noted similar findings, advocating for the use of both external fixation and, when necessary, amputation, after the 2005 earth- quake in Pakistan, which claimed more than 73,000 lives [20, 23]. A retrospective study after that earthquake reported that in 295 of 1145 fractures (26%), reductions were achieved with external fixation [20]. We did not expect to find a discrepancy between open fracture rates (22%) and the rate of surgical debridement (33%). As irri- gation and debridement is key for the management of open fractures, an explanation for this difference might be that grossly contaminated open fracture wounds may require multiple debridement before definitive fixation and wound closure can be achieved.
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Situs Invertus Totalis in a Patient with Bilateral Papillary Serous Cystadenocarcinoma Ovary: Rare Association with Review of Literature

Situs Invertus Totalis in a Patient with Bilateral Papillary Serous Cystadenocarcinoma Ovary: Rare Association with Review of Literature

After taking all aseptic precautions, Brachial plexus block via supraclavicular technique was performed in the lying down position. Patients were asked to turn the head to different side with his arms pulled towards the knee. Identification of the EJV, midclavicular point, and subclavian artery pulsation was done. A 22 G, 1.5 inch needle have to be introduced approx 2 cm above the midclavicular point and just lateral to subclavian artery pulsation and directed caudad and medially until patient encountered the paraesthesia. 37 milliliters of LA with dexmedetomidine was injected in the perineural area. Intravenous inj of midazolam 1-1.5 mg was given to all the patients for sedation. Routine monitoring was done and any unexpected effects were also being noted.
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Developmental Dysplasia of the Hip Practice Guideline: Technical Report

Developmental Dysplasia of the Hip Practice Guideline: Technical Report

The decision model (reduced, based on available evi- dence) suggests that orthopaedic screening is optimal, but because orthopaedists in the published studies and in practice would differ, the supply of orthopaedists is relatively limited, and the difference between orthopae- dists and pediatricians is statistically insignificant, we conclude that pediatric screening is to be recommended. The place of ultrasonography in the screening process remains to be defined because there are too few data about postneonatal diagnosis by ultrasonographic screening to permit definitive recommendations. These data could be used by others to refine the conclusions based on costs, parental preferences, or physician style. Areas for research are well defined by our model-based approach. Pediatrics 2000;105(4). URL: http://www. pediatrics.org/cgi/content/full/105/4/e57; developmental dysplasia of the hip, avascular necrosis of the hip, newborn.
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<p>Emotional Effects on Factors Associated with Chronic Low Back Pain</p>

<p>Emotional Effects on Factors Associated with Chronic Low Back Pain</p>

The OR increased with an increase in the frequency of this new factor (Table 2). As mentioned earlier in the Methods section, Outshout, a psychological factor, affects CLBP. Both the expression of anger and attempts to inhibit this emotion are harmful to our health and are associated with coronary diseases. 51 Rather than having the expected cath- artic effect, the expression of anger is accompanied by elevated psychological stress and aggression. 52,53 Thus, the stress underlying Outshout might increase for anger, possibly causing circulatory insuf fi ciency and CLBP because of increase in the secretion of stress hormones such as adrenaline or cortisol. 54,55 Moreover, patients reporting frequent Outshout may be more affected by psychological stress than those reporting its occasional occurrence. This may explain why OR for patients in the former category was higher than that for those in the latter category. In this study, the presence of alexithymia in study subjects, which is a marked dysfunction in emo- tional awareness, was not con fi rmed. Although it is a rare case, further research on this topic is warranted.
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Optimization of MSTpPlaster rooms : a simulation Study

Optimization of MSTpPlaster rooms : a simulation Study

appointment unless there is no room left on the designated day to fit the appointment. We do this because we want to see how the current intervention could perform on number of overbooked appointments when they try. This number is therefore lower in the simulation than it was in Oldenzaal in the 2017 data. For the current situation that should show what performance could be obtained when they would always try to prevent overbooking. Unfortunately, since this is not done in reality, we cannot validate the accuracy of this value from Oldenzaal. Also notice that HBP is lower than O1+O2 and HCH is lower than CH1+CH2. This is caused by the fact that sometimes in reality they “cheat” by scheduling 20-minute appointments as 10-minute appointments to fit them in the schedule and we do not do that. This is because we want to know what performance is possible without cutting appointments short. Aside from that, it is also not possible to know how much of the 10-minute appointments are 20-minute appointments, since it is not documented. This makes it impossible for us to simulate the eventual “cheating” in such cases. Taking away these causes of deviation, these numbers seem well proportioned compared to each other in our opinion. Orthopaedic appointments in Oldenzaal have a very low number of overbooked appointments, surgical in Enschede has about 120 overbooked appointments, orthopaedic in Enschede about 180 (without cheating) and surgical in Oldenzaal 140 when always trying to prevent overbooked appointments. This will be our baseline for the other experiments to come. The most important aspect of our research is to find out how different interventions differ from this baseline simulation.
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Orthopaedic research in low income countries:
A bibliometric analysis of the current literature

Orthopaedic research in low income countries: A bibliometric analysis of the current literature

Another limitation is the fl uctuating nature of the classi fi ca- tion system utilised by the World Bank, with countries moving between categories each year. Given that this study assessed publications in orthopaedic journals over the last 10 years but used the World Bank Classi fi cation for the fi scal year 2018, it only allowed analysis of articles from a single point in time and did not take into account articles from countries that moved into or out of the low-income or lower middle-income categories. This study also only considered English language literature and more than 400 million Africans (over one third of the con- tinent ’ s population) live in French- and Portuguese-speaking countries. However, following the initial research of the present study, only one paper was excluded, owing to the fact it was not translated into English (German publication), but we acknowl- edge this as a limitation.
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How to perform a root cause analysis for workup and future prevention of medical errors: a review

How to perform a root cause analysis for workup and future prevention of medical errors: a review

The goal of performing an RCA is to protect patients by identifying and changing factors within the healthcare system that can potentially lead to harm. There are 9 steps (Table 1) which serve as a guide for performing an effective RCA. Before a RCA can begin, honest and open reporting of errors is required [9]. A Department should strongly encourage residents, midlevel providers, and faculty to report adverse events and close calls (or near misses). A risk based triaging system should be used to evaluate the report to determine if an RCA is required. At our institution, there is a patient care committee comprised of faculty and residents who review incident reports and decide if an event would benefit from an RCA. If an RCA is required, it would be assigned to a small team consisting of 4 to 6 individuals who have fundamental knowledge of the specific area involved [7]. Team members should consist of physicians, supervi- sors, ancillary staff and quality improvement experts. It is important that members of the RCA team are not in- volved in the case being reviewed to ensure objectivity [10, 11]. Time to completion of an RCA varies depend- ing complexity of the case, time required to conduct in- terviews and synthesize information, and barriers to implementation of corrective actions; however, a typical investigation should range between one to three months. The next step of the RCA process is to create an “ini- tial flow diagram” depicting the known sequence of events leading up to the adverse event being investi- gated. The purpose of the initial flow diagram is to present the known facts and serve as a springboard to investigate what contributed to each event [12]. Devel- opment of a basic flow diagram facilitates a mutual un- derstanding of the event and problem.
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Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture

Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture

Data from two hospital quality databases for hip fracture patients, Haraldsplass Deaconess Hospital (HDH) in Bergen, Norway and Diakonhjemmet Hospital (DH) in Oslo, Norway were used as the reference standard for the patients` cognitive function. Both hospitals had orthogeriatric units, staffed by orthopaedic surgeons and geriatric consultants. The databases contain data such as date of operation, comorbidity, chronic cognitive impair- ment, medical complications and length of stay. The da- tabases are managed by special trained nurses in cooperation with geriatricians and information is regis- tered during the patients’ hospital stay. The patients’ pre-fracture cognitive function was assessed by short form of the Informant Questionnaire on Cognitive De- cline in the Elderly (IQCODE) [21].
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Prophylactic Antibiotics in Orthopaedic Surgery: Guidelines and Practice

Prophylactic Antibiotics in Orthopaedic Surgery: Guidelines and Practice

Prophylactic Antibiotics in Orthopaedic Surgery Guidelines and Practice ORIGINAL ARTICLE Prophylactic Antibiotics in Orthopaedic Surgery Guidelines and Practice rrllll!ll!lllI!ll!lllllllllllill rIllll[.]

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