scholarly journals Intra- and interobserver reliability for predicting hip preservation versus hip arthroplasty utilizing plain radiographs with comparison of surgeon specialization

2020 ◽  
Vol 7 (1) ◽  
pp. 70-76
Author(s):  
Kyle Schultz ◽  
Jeff Osborne ◽  
Karen Nelson ◽  
Vishnu Potini ◽  
Chaoyang Chen ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Interobserver Reliability ◽  
Clinical Information ◽  
Patient Characteristics ◽  
Care Pathways ◽  
Subspecialty Training ◽  
Substantial Impact ◽  
Foveal Region ◽  
Tönnis Grade ◽  
Anterior Posterior

Abstract Surgeon subspecialty training and practice landscape are formative in diagnostic evaluation and treatment recommendations. Varying recommendations can have substantial impact on patients’ care pathways and outcomes. We investigated intra- and interobserver reliability of treatment predictions for total hip arthroplasty (THA) between surgeons performing arthroplasty and/or arthroscopic hip preservation surgery. Anterior–posterior (AP) hip radiographs cropped to include the lateral sourcil, medial sourcil and foveal region of 53 patients with Tönnis Grade 0–3 were evaluated by five surgeons (two performing arthroplasty, two performing arthroscopic hip preservation and one performing both interventions). Surgeons predicted THA versus no THA as the treatment for each image. Predictions were repeated three times with image order randomized, and intra- and interobserver reliability were calculated. Surgeons were blinded to patient characteristics and clinical information. Interobserver reliability was 0.452 whereas intraobserver reliability ranged from 0.270 to 0.690. Arthroscopic hip preservation surgeons were more likely to predict THA (36.9%) than arthroplasty surgeons (32.7%), P = 0.041. Intra- and interobserver reliabilities of surgeons predicting THA versus no THA based on an AP hip radiograph were average at best. Arthroscopic hip preservation surgeons were more likely to predict THA than arthroplasty surgeons. Subjective surgeon interpretation can lead to variability in recommendations to patients; potentially complicating care pathways.

scholarly journals Data-driven approach to Early Warning Score-based alert management

2018 ◽  
Vol 7 (3) ◽  
pp. e000088 ◽  
Author(s):  
Muge Capan ◽  
Stephen Hoover ◽  
Kristen E Miller ◽  
Carmen Pal ◽  
Justin M Glasgow ◽  
...  
Keyword(s):  
Patient Safety ◽  
Early Warning ◽  
Early Recognition ◽  
Clinical Information ◽  
Patient Characteristics ◽  
The Elderly ◽  
Early Warning Score ◽  
The Right ◽  
The Impact ◽  
Alerting Systems

BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

scholarly journals Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

2018 ◽  
Vol 29 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Pascal C Haefeli ◽  
Moritz Tannast ◽  
Martin Beck ◽  
Klaus A Siebenrock ◽  
Lorenz Büchler
Keyword(s):  
Los Angeles ◽  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Control Group ◽  
Total Hip ◽  
Tönnis Grade

Introduction: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. Methods: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5–13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d’Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. Results: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group ( p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). Conclusion: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

Impact of rapid infliximab infusions on access at a large academic tertiary medical center

2021 ◽  
Author(s):  
Antoinette Pusateri ◽  
Ashley Hatcher ◽  
Nisha Patel ◽  
Joy Lehman ◽  
Alice Hinton ◽  
...  
Keyword(s):  
Medical Center ◽  
Private Insurance ◽  
Clinical Information ◽  
Patient Characteristics ◽  
Infusion Time ◽  
Rheumatologic Disease ◽  
Future Directions ◽  
Patient Surveys ◽  
Inflammatory Bowel ◽  
To Receive

Abstract Purpose Infliximab promotes remission in patients with inflammatory bowel disease (IBD) and rheumatologic disease (RD). Rapid infliximab infusions (RI) reduce infusion time from 2 hours to 1 hour and can enhance access to care, as defined by capacity, safety, and patient characteristics. Our hypothesis for the study described here was that use of RI can enhance access for patients. Methods Data on all patients receiving infliximab for IBD or RD at our outpatient infusion center from February 2016 to August 2017 were retrospectively analyzed. Demographic and clinical information were collected. Results Of 348 patients who received infliximab, 205 had IBD and 143 had RD. In terms of capacity, 40% of patients received RI, resulting in a 16.1% decrease in average daily infusion time and a 9.8% increase in average daily available scheduled infusion chair time (P = 0.720). In terms of safety, 4 patients switched back to standard infusions after RI, after 3 specifically had reactions to RI. In terms of patient characteristics, more patients with RD versus IBD received RI (P = 0.020). Among the patients with RD, a lower proportion receiving RI were female (P = 0.043). For the patients with IBD, a higher proportion receiving RI were white (P = 0.048). Among both patients with RD and patients with IBD, a higher proportion receiving RI had private insurance (P = 0.016 and P = 0.018, respectively). Conclusion RI were safe and increased available chair time. Females with RD, patients of non-White race with IBD, and patients with public insurance were less likely to receive RI. Future directions include patient surveys and evaluation of implicit bias against patient factors that may impact access to RI.

scholarly journals Clinical Considerations for Return to Driving a Car following a Total Knee or Hip Arthroplasty: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Annalisa Na ◽  
Kacy Richburg ◽  
Zbigniew Gugala
Keyword(s):  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Response Times ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Cochrane Library ◽  
Clinical Factors ◽  
Study Results ◽  
Meta Analyses

Aim. The purpose of this study is to systematically review patient characteristics and clinical determinants that may influence return to driving status and time frames following a primary TKA or THA and provide an update of the current literature. Methods. This review was completed per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Final electronic database searches were completed in October 2019 in Medline/PubMed, Medline/OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library using preselected search terms. Manuscripts of prospective and nonrandomized studies that examined the return to driving a car after a primary knee or hip arthroplasty patients were included. The Methodological Index for Non-Randomized Studies was used to measure study quality. Two authors selected studies and assessed their qualities. All disagreements were resolved through discussion and, as needed, a third reviewer. Data on study title, author(s), country, year, study design, sample size, inclusion and exclusion criteria, age, BMI, gender, statistical analyses, driving measure, follow-up time, surgical approach, laterality, and postoperative management were extracted from each study. Results. A total of 23 studies were eligible, including 12 TKA studies (n=654) with mean ages between 43 and 82 years, 9 THA studies (n=922) with mean ages between 34 and 85 years, and 2 combined TKA and THA (TKA, n=815; THA, n=685), yielded MINORS scores between 6 and 12. Most patients achieved or exceeded preoperative response times between 1 and 8 weeks following a TKA and 2 days to 8 weeks following a THA, and/or self-reported return to driving between 1 week and 6 months. Influences on return to driving time included laterality and pain, but gender was mixed. Discussion/Conclusions. Study results were consistent with previous systematic reviews in that return to driving a car after a primary TKA or THA is highly variable, and most commonly occurs around 4 weeks, but can range between 2 and 8 weeks. While various patient and clinical factors can influence return to driving for a TKA or THA, the most common contributing facts were pain and laterality. The heterogeneous nature of the studies prevented a meta-analysis for determining contributions of return to driving following a primary TKA or THA. Regardless, this study updates previous systematic reviews and presents insight on patient and clinical factors beyond generalized timeframes for return to driving a car. This information and results from future studies are essential to guide clinical recommendations and patient and clinician expectations for return to driving a car after a primary TKA or THA.

Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty

2020 ◽  
Vol 44 (10) ◽  
pp. 1951-1956
Author(s):  
Ittai Shichman ◽  
Shai Factor ◽  
Or Shaked ◽  
Samuel Morgan ◽  
Nissan Amzallag ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Characteristics ◽  
Total Hip ◽  
Surgeon Experience ◽  
Operative Planning

Time to ADT and chemotherapy initiation for treatment of metastatic prostate cancer (mPC).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 41-41 ◽  
Author(s):  
Daniella J. Perlroth ◽  
Stephen F. Thompson ◽  
Yesenia Luna ◽  
Dana P. Goldman ◽  
Essy Mozaffari ◽  
...  
Keyword(s):  
Regression Models ◽  
Clinical Information ◽  
Sociodemographic Factors ◽  
Summary Statistics ◽  
Community Practice ◽  
Substantial Impact ◽  
Medicare Claims ◽  
Time To Initiation ◽  
The Difference ◽  
Chemotherapy Initiation

41 Background: ADT and chemotherapy use in men with mPC may differ across regions in community practice. The extent of variation could indicate whether men with mPC have appropriate access to effective treatments. Methods: We identified 16,024 men diagnosed with mPC in the Surveillance, Epidemiology, and End Results (SEER) database from 2000-2005 linked to their Medicare claims. Patients were excluded if they had a second cancer or disenrolled from Medicare Parts A or B (n=6,155), or failed to initiate therapy with ADT (n=3,400). We identified demographic and clinical information from SEER and treatments and comorbidities from J-codes and ICD-9 codes in the Medicare claims. We used regression models to estimate the probability of advancement to chemotherapy, the time from diagnosis to first ADT use, and time from first ADT to chemotherapy. Then the patient-level predicted results from these models were used to generate summary statistics by hospital service area (HSA). Results: There were 6,469 patients remaining after exclusion who were treated with ADT, and 1,198 of those received chemotherapy (19%). The median age was 76 years old, most were white (77%), married (62%), and 50% had 1 other major comorbidity (most frequent was diabetes, 21%). Men who were younger, married, with fewer comorbidities, and higher Gleason scores were statistically more likely to both receive chemotherapy and use it earlier. After adjusting for clinical and sociodemographic factors, the average time to ADT by referral region was 2.7 months but varied from 1.3 to 5.6; probability of progression to chemotherapy averaged 19% but varied from 6% to 30%, and the time from first ADT to chemotherapy averaged 19.7 months but varied from 12.9 to 25.7 months. The difference in time to ADT between regions in the 10th and 90th percentiles of use was 2.6 months, whereas for chemotherapy initiation, it was 12.4 months. Conclusions: Our results suggest that living in different parts of the country has a substantial impact on how clinically similar patients are treated. There was substantial variation across regions in use of and time to initiation of chemotherapy for men with mPC, but not in ADT use.

scholarly journals Pure transanal total mesorectal excision for rectal cancer: experience with 55 cases

2019 ◽  
Vol 8 (1) ◽  
pp. 42-49
Author(s):  
Xiao-Ming Wang ◽  
Yan-Yan Xu ◽  
Gang Yu ◽  
Zhen Rong ◽  
Rui-Chao Geng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Surgical Procedure ◽  
Clinical Information ◽  
Patient Characteristics ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Estimated Blood Loss ◽  
Cancer Experience ◽  
Narrow Pelvis

Abstract Background Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision (h-taTME), a completely incisionless surgical procedure has not yet been developed. This study was performed to explore the efficacy of pure taTME (p-taTME) without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer. Methods We retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018. Relevant patient characteristics and clinical information including the surgical procedure, specimens, pathological characteristics, and patients’ post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed. Results Fifty-five patients who had undergone p-taTME were included in this study. They comprised 32 (58.2%) men and 23 (41.8%) women with a mean age of 65.6 ± 10.6 years and mean body mass index of 23.4 ± 3.3 kg/m2. The median surgical time was 180.0 (range, 130–360) min and estimated blood loss was 25.0 (range, 15–80) mL. The commonest post-operative complication was varying degrees of faecal incontinence (56.4%). However, such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients’ quality of life. Conclusions p-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer, especially in those with obesity or a narrow pelvis. However, further studies of the indications and long-term efficacy are needed to verify the suitability of this procedure.

scholarly journals Key performance and training parameters in primary total hip arthroplasty – an expert consensus using the Delphi technique

2021 ◽  
pp. 112070002110568
Author(s):  
Daniel Howgate ◽  
Patrick Garfjeld Roberts ◽  
Ben Kendrick ◽  
Jonathan Rees
Keyword(s):  
Patient Outcome ◽  
Total Hip Arthroplasty ◽  
Surgical Training ◽  
Hip Arthroplasty ◽  
Delphi Technique ◽  
Expert Consensus ◽  
Substantial Impact ◽  
Total Hip ◽  
Key Steps ◽  
Primary Total Hip Arthroplasty

Aims: Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome. Materials and methods: The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3. Results: 50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching. Conclusions: The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.

scholarly journals Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging

2021 ◽  
Vol 24 (2) ◽  
pp. 98-105
Author(s):  
Hassanin Alkaduhimi ◽  
Aïmane Saarig ◽  
Ihsan Amajjar ◽  
Just A. van der Linde ◽  
Marieke F. van Wier ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Interobserver Agreement ◽  
Interobserver Reliability ◽  
Patient Characteristics ◽  
Accurate Diagnosis ◽  
Bonferroni Correction ◽  
Resonance Imaging ◽  
Similar Appearance ◽  
Magnetic Resonance Imaging Mri

Background: Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement. Methods: Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss’ kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction. Results: The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion. Conclusions: Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.

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