Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis

2018 ◽  
Vol 111 ◽  
pp. e845-e849 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Amanda R. Sergesketter ◽  
Michael Ongele ◽  
Victoria Vuong ◽  
...  
Keyword(s):  
Critical Care ◽  
Interdisciplinary Care ◽  
Corrective Surgery ◽  
Care Model ◽  
Degenerative Scoliosis ◽  
Care Services ◽  
Adult Degenerative Scoliosis

Robotic Sacroiliac Fixation Technique for Triangular Titanium Implant in Adult Degenerative Scoliosis Surgery: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Connor Berlin ◽  
Parantap Patel ◽  
Isador Lieberman ◽  
Mark Shaffrey ◽  
Avery Buchholz
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Titanium Implants ◽  
Leg Pain ◽  
Definitive Treatment ◽  
Scoliosis Surgery ◽  
Corrective Surgery ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
K Wires

Abstract Corrective surgery remains a definitive treatment for adult spinal deformity, improving pain and disability. With these cases, instrumentation to the pelvis with iliac fixation is recommended. Whether iliac or S2-Alar-Iliac (S2AI) trajectories are used, sacroiliac joint pain and long-term sacroilitis can be common after long-fusion constructs.1-3 Sacroiliac fusion with triangular titanium implants during fusion can reduce back pain associated with sacroiliac joint degeneration,3 provides reduction in sacroiliac joint motion and stress when added to S2AI screws, and potentially enhances mechanical stability of fusion constructs.4 Here, we present a technique for placing triangular titanium sacroiliac implants (iFuse BedrockTM; SI-BONE Inc, Santa Clara, California) alongside S2AI screws using a robotic platform (Mazor X; Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Navigated robotics allows reduction in human error with implant placement, and potentially decreased operative time/fluoroscopy.5-7 Key surgical steps include placement of K wires for S2AI and bilateral SI-implants, tapping, replacing SI-implant K wires with guide pins, placing S2AI screws, and finally placing the SI-implant. Final placement is verified with intraoperative fluoroscopy. The patient described is a 61-yr-old woman with worsening adult degenerative scoliosis, lower back pain, left leg radicular pain, and mild right leg pain who failed conservative treatment. Examination revealed diminished strength in both legs. Imaging was significant for moderate sigmoid scoliosis, discogenic disease, and osteoarthritis at all levels. She consented to undergo corrective surgery. Postoperatively, the patient experienced resolution of her leg weakness and pain. Imaging demonstrated appropriate positioning of hardware. Prospective studies on the efficacy of the SI-implant are underway.

scholarly journals Second sacral sacralalar‐iliac (S2AI) screw placement in adult degenerative scoliosis (ADS) patients: an imaging study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bing Wu ◽  
Kai Song ◽  
Junyao Cheng ◽  
Pengfei Chi ◽  
Zhaohan Wang ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Imaging Study ◽  
Outer Diameter ◽  
Degenerative Scoliosis ◽  
Female Patients ◽  
Lateral Angle ◽  
Adult Degenerative Scoliosis ◽  
Imaging Characteristics ◽  
Starting Point ◽  
Trajectory Length

Abstract Background The imaging characteristics of sacral sacralalar-iliac (S2AI) screw trajectory in adult degenerative scoliosis (ADS) patients will be determined. Methods S2AI screw trajectories were mapped on three-dimensional computed tomography (3DCT) reconstructions of 40 ADS patients. The starting point, placement plane, screw template, and a circle centered at the lowest point of the ilium inner cortex were set on these images. A tangent line from the starting point to the outer diameter of the circle was selected as the axis of the screw trajectory. The related parameters in different populations were analyzed and compared. Results The trajectory length of S2AI screws in ADS patients was 12.00 ± 0.99 cm, the lateral angle was 41.24 ± 3.92°, the caudal angle was 27.73 ± 6.45°, the distance from the axis of the screw trajectory to the iliosciatic notch was 1.05 ± 0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12 ± 1.65 cm. Compared with females, the lateral angle of male ADS patients was decreased, but the trajectory length was increased (P < 0.05). Compared to patients without ADS in previous studies, the lateral angle of male patients was larger, the lateral angle of female patients was increased, and the caudal angle was decreased (P < 0.05). Conclusions There is an ideal trajectory of S2AI screws in ADS patients. A different direction should be noticed in the placement of S2AI screws, especially in female patients.

scholarly journals Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bin Li ◽  
Xianglong Meng ◽  
Xinuo Zhang ◽  
Yong Hai
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Posterior Approach ◽  
Frailty Index ◽  
Cardiac Complications ◽  
Corrective Surgery ◽  
Degenerative Scoliosis ◽  
Acute Renal Dysfunction ◽  
Radiographic Measurements ◽  
Single Approach

Abstract Background With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined. Methods ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years. Results A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences. Conclusions Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

scholarly journals Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alayne M. Adams ◽  
Rushdia Ahmed ◽  
Shakil Ahmed ◽  
Sifat Shahana Yusuf ◽  
Rubana Islam ◽  
...  
Keyword(s):  
Critical Care ◽  
Urban Poor ◽  
Emergency Services ◽  
Census Data ◽  
Service Providers ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Care Services ◽  
Referral Systems ◽  
Alternative Scenarios

Abstract Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

scholarly journals Geographical access to critical care services in Scotland

2017 ◽  
Vol 19 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Philip Emerson ◽  
Naomi Dodds ◽  
David R Green ◽  
Jan O Jansen
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Rural Areas ◽  
Care Facility ◽  
Population Data ◽  
Small Towns ◽  
Health Board ◽  
Care Services ◽  
Geographical Access ◽  
Scottish Population

Background Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods This was a descriptive, geographical analysis of population access to ‘intermediate’ and ‘definitive’ critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter. Access was analysed by health board, rurality and as a country using freely available geographically referenced population data. Results Ninety-six percent of the population reside within a 45-min drive of the nearest intermediate critical care facility, and 94% of the population live within a 45-min ambulance drive time to the nearest intensive care unit. By helicopter, these figures were 95% and 91%, respectively. Some health boards had no access to definitive critical care services within 45 min via helicopter or road. Very remote small towns and very remote rural areas had poorer access than less remote and rural regions.

scholarly journals Outcomes of Short Fusion versus Long Fusion for Adult Degenerative Scoliosis: A Systematic Review and Meta-analysis

2017 ◽  
Vol 9 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Kevin Phan ◽  
Joshua Xu ◽  
Monish M Maharaj ◽  
Julian Li ◽  
Jun S Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis

scholarly journals Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

2016 ◽  
Vol 50 (2) ◽  
pp. 239-246 ◽  
Author(s):  
Daiane Medeiros da Silva ◽  
Hérika Brito Gomes de Farias ◽  
Tereza Cristina Scatena Villa ◽  
Lenilde Duarte de Sá ◽  
Maria Eugênia Firmino Brunello ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Chronic Care Model ◽  
Health Care Services ◽  
Chronic Care ◽  
Capital City ◽  
Care Model ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services

Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. RESULTS: The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. CONCLUSION: The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge.

Critical care services: Is regionalization the answer?*

2008 ◽  
Vol 36 (11) ◽  
pp. 3114-3116 ◽  
Author(s):  
Sydney Vail ◽  
Tyler Putnam ◽  
Anthony D. Slonim
Keyword(s):  
Critical Care ◽  
Care Services
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