scholarly journals Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 428-434 ◽  
Author(s):  
Mark T. Garon ◽  
Patrick Massey ◽  
Andreas Chen ◽  
Trevor Carroll ◽  
Bradley G. Nelson ◽  
...  

Background: The purpose of this study was to compare closed reduction and percutaneous pinning of metacarpal and phalanx fractures performed in the operating room (OR) versus the procedure room of the emergency department with primary outcomes being infection rate, radiographic union, and monetary cost. Methods: From January 2006 to December 2010, all closed reduction and percutaneous pinnings of metacarpal and phalanx fractures (CPT codes: 26608; 26727) by a single board-certified hand surgeon (A.M.H.) were retrospectively reviewed. Patients were placed into 2 groups: Group 1 was patients treated in the OR, and group 2 was patients in an emergency department procedure room. Infection, malunion, and nonunion rates were compared using a chi-square test. Charges were compared using a t-test, and cost of supplies and labor was evaluated. Results: A total of 189 patients met final inclusion criteria for this study: 130 in group 1 and 59 in group 2. There was no statistically significant difference in infection rates ( P = .13), nonunion ( P = .40), malunion rates ( P = .89), and hardware failure with revision ( P = .94) between the 2 groups. The procedure room patients had an average hospital charge of $1358.55 compared with $3691.85 for OR-treated patients (P = .001). The total cost of supplies and nonphysician labor was $432.31 per OR case and $179.59 per procedure room case. Conclusions: Metacarpal and phalanx fractures of the hand amendable to closed reduction and percutaneous pinning can be treated in the procedure room with no increase in risk of infection, malunion, or nonunion rates. In addition, these surgeries can be performed in a procedure room with lower cost and less charges to patients than in the operating room.

Author(s):  
Mukesh Gohel ◽  
Jemil S. Makadia ◽  
Chandan Chakrabarti

Abstract Objective The aim of this study was to see the effect of hypoproteinemia on electrolyte measurement by two different techniques, that is, direct ion selective electrode (ISE) and indirect ISE. Material and Method It was an observational study in which 90 serum samples with normal protein content (Group-1) were subjected to sodium (Na+) and potassium (K+) measurements by direct and indirect ISE methods. In the same way, 90 serum samples with total protein < 5 g/dL (Group-2) were subjected to Na+ and K+ measurements by direct and indirect ISE methods. Result In samples from Group-1 patients, average Na+ was 138.1 ± 4.764 mmol/L by direct ISE method and 139.3 ± 3.887 mmol/L by indirect ISE method while average K+ was 4.41 ± 0.644 mmol/L by direct ISE method and 4.40 ± 0.592 mmol/L by indirect ISE method. There was no statistically significant difference in Na+ and K+ values measured by different methods. In samples from Group-2 patients, measured value of Na+ by direct ISE and indirect ISE was 134.57 ± 5.520 mmol/L and 138.64 ± 5.401 mmol/L, respectively. Difference between these two values was statistically significant with p-value of < 0.0001, but direct ISE and indirect ISE measured values of K+ was 4.146 ± 0.9639 mmol/L and 4.186 ± 0.8989, respectively, with no significant difference. Conclusion Direct and indirect ISE methods are not comparable and showing significantly different results for Na+ in case of hypoproteinemia. So, it is recommended that setups like intensive care unit or emergency department, where electrolyte values have significant treatment outcome, should follow direct ISE method and should compare its previous result with the same method. Both the methods should not be used interchangeably.


2017 ◽  
Vol 13 (1) ◽  
pp. 40-48
Author(s):  
Saroj Giri ◽  
S Chaudhuri ◽  
S Jirel ◽  
BD Aryal ◽  
DR Kumar ◽  
...  

Background: Acute appendicitis is one of the most common causes of acute abdominal pain presenting in emergency department. Preoperative use of adequate analgesia markedly reduces pain without affecting diagnosis accuracy and furthermore no single analgesia has been used for this purpose.Objective: To determine and compare the efficacy of injection diclofenac and injection tramadol for rapid pain management of acute appendicitis in emergency department.Methods: An experimental clinical trial was done including 50 patients aged _8 years who were clinically diagnosed as acute appendicitis and had not received analgesia prior to examination by the researcher. They were randomly divided into 2 groups: 25 patients (group 1) were given injection diclofenac intramuscularly and 25 patients (group 2) were given injection tramadol intravenously. Comparative analysis was carried out regarding the decrease in pain intensity using visual analogue scale (VAS) score for pain at presentation, at half an hour and at one hour of drug administration.Results: All the patients had VAS score of _5 at presentation without significant difference in the two groups. Half an hour after drug administration, 64% of subjects still had a VAS score of _6 in the first group while only 12% in the second group (p=0.005). At one hour of drug administration, 64% of subjects had a VAS score between 4 and 7 and 36% had score between 0 and 3 in group 1. In contrast to this score, in group 2 only 16% of the subjects scored between 4 and 7 and 84% between 0 and 3 (p=0.001).Conclusion: There was rapid and marked decrease of VAS score or pain in tramadol group as compared to diclofenac group. Hence, we can recommend that injection tramadol intravenous be considered for preoperative use for pain management of acute appendicitis in emergency department. Health Renaissance 2015;13 (1): 


Acta Medica ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 1
Author(s):  
Filiz Banu Ethemoglu ◽  
Hidir Yilmaz ◽  
Gulsum Kavalci ◽  
Cem Akman ◽  
Nurkan Terzioglu ◽  
...  

Objective: Thiol/disulphide homeostasis has a crucial role for life. The aim of this study was to compare thiol/disulphide homeostasis in healthcare professionals working in the operating room (Group 1) and healthcare professionals working in the emergency department (Group 2). Materials-Methods: This was a descriptive study. Fortynine operating room volunteers (Group 1) and 49 emergency department volunteers (Group 2) were included in this study. Thiol and disulphide concentrations were measured using the novel automated measurement method developed by Erel & Neşelioğlu in 2014. Result: The thiol/disulphide levels were compared in both groups; Native thiol in group 1 was 353,57 ± 49,86 μmol.L-1, and it was  333,73 ± 37,38 μmol.L-1 (p = 0.028) in group 2. total thiol values were 384,71 ± 52,36 μmol.L⁻¹ and 370,94 15,56 ± 5,36 μmol.L-1(P =0,133), respectively in group 1 and 2. In group 1,disulphide levels were  15,56±5,36 μmol.L-1,  in  group 2 it was  18,61 ± 7,71 μmol.L-1 (p = 0,025), disulphide/native thiol in  group 1 was 4,47 ± 1 %, and in  group 2 it was measured %, 5,73 ± 2,95% (p = 0.009). Disulphide/total thiol in the group 1 was 4,06 ± 1,32% and 5,03 ± 2,13% (p = 0,008) in group 2. Native thiol / total thiol levels were 90,23 ± 12,16% in group 1  and 89,93 ± 4,26% in  group 2 (p = 0,871). Native thiol level in group 1 and high level of disulphide in group 2 indicate that the exposure to oxidative stress in the emergency department is higher than in the operating room. Conclusion: Our results show that participants of emergency room group have statistically higher levels of disulphide than participants working in operating room which may suggest presence of oxidative stress related with workplace exposures.   Key Words: Health personnel, oxidative stress, thiol/disulphide homeostasis.    


VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.


MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 14-24

The clinic and diagnostics of tuberculosis meningitis (TM) in 926 patients treated in St. Petersburg hospitals in 1965–1994 (group 1) and in 1995–2018 (group 2) is presented. The TM clinic is demonstrated to be determined by the form of tuberculosis and its characteristic generalization nature in the presence of repeated waves of bacteremia and allergic vasculitis of greater or lesser severity. There is clinical peculiarity of TM in primary pulmonary tuberculosis and its early large-focal and late miliar generalization, as well as in hematogenous tuberculosis. In patients of the 1st and 2nd groups the TM clinic shows in some respects a noticeable similarity, in others — a significant difference. Despite the typical symptoms, early diagnosis of TM took place in less than 20% of patients. Clinical examples illustrating the unusual development of TM, contrasting with its usual course, are given. A number of objective and subjective factors contributing to the adverse evolution of TM and its lethal outcome are discussed. These include the peculiarity of modern tuberculosis, especially when associated with HIV infection, as well as medical errors associated with ignorance of the pathogenesis of tuberculosis and failure to comply with the minimum examination for tuberculosis.


2019 ◽  
Vol 70 (7) ◽  
pp. 2608-2613
Author(s):  
Larisa Simona Deac ◽  
Kamel Earar ◽  
Adela Loredana Colceriu Burtea ◽  
Alexandra Stefania Berghe ◽  
Aurora Antoniac ◽  
...  

This study evaluates and compares by dye penetration method and SEM photomicrographs the sealing obtained using two different classes of adhesive systems (etch-and-rinse and self-etch with selective etching) with SDR (Dentsply) bulk fill composite. 84 class V cavities were prepared on oral and vestibular face of 42 intact, freshly extracted wisdom teeth. The cavities were randomly divided in two groups and restored: Group 1 with prime &bond one select (Dentsply) and SDR (Dentsply) and Group 2 with prime&bond one Etch&Rinse (Dentsply) and SDR (Dentsply). Prime&bond one Select (Dentsply) is a single component adhesive and can be used in self etch mode, in selective enamel etch mode, or in etch-and-rinse mode. We chosen for this study the selective etch of the enamel mode. Prime&bond one Etch Rinse (Dentsply) is a universal etch-and-rinse one-bottle dental adhesive, designed to be used in two steps. The bulk fill composites are commonly used in modern dentistry due to their properties of low polymerization shrinkage and curing in layer of 4 mm depth, offering the practitioner a fast clinical procedure with good results. The results showed a good sealing at enamel and dentin margins with no statistically significant difference between adhesives, even though the mean of enamel infiltration was smaller for Group1. Furthermore the results show that there were differences between the two groups, for the infiltrations at the enamel, the values of microleakage being arithmetically higher for Group 1, but with no statistically difference between the two groups.SEM images showed for both groups a good adhesion surface with the tooth, but the hybrid layer of the total-etch adhesives is different from the hybrid layer formed by self etch adhesives, in terms of thickness, uniformity. In conclusion both adhesive systems have equivalent sealing qualities and can be successfully used with SDR.


2020 ◽  
Author(s):  
Guy Tobias ◽  
Assaf B Spanier

BACKGROUND Gingivitis is a non-painful, inflammatory condition that can be treated with home remedies. Left untreated gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. In order to contain the spread of the corona virus, governments, including in Israel, have restricted movements of their citizens which has caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of an mHealth app- iGAM to reduce gingivitis. METHODS A prospective observational cohort study was performed, 160 unpaid participants were divided into 2 equal groups and downloaded the iGAM app. Group 1 photographed their gums weekly for eight weeks. Group 2 photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the message "It is recommended to read the information contained within the app regarding maintaining oral hygiene habits". A single blinded researcher examined the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of group 1 was 26.77 (S.D. ± 7.43), and 28.53 (S.D. ± 10.44) for group 2. The majority were male (74.7% in group 1 vs. 66.7% in group 2), most participants described themselves as "secular", most were "single", non-smokers (74.7% vs. 78.4%) and did not take medications (85.3% vs. 78.4%). 126 subjects completed the study. A statistically significant difference (P <.001) was found in the dependent variable (MGI) in a linearly negative manner. As time passed, the gum condition improved, there were significantly lower gingivitis scores in group 1 (M = 1.16, S.D. ± 1.18) compared to group 2 (M = 2.16, S.D. ± 1.49), after eight weeks. Those with more recent dental visits had a lower MGI (p = .037). No association was found between knowledge and behavior, most participants were familiar with the recommendations for maintaining oral health, yet they only performed some. CONCLUSIONS A dental selfie taken once a week using an mHealth app (iGAM) reduced the signs of gingivitis and promoted oral health. During the current pandemic where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. CLINICALTRIAL The protocol was approved by Hadassah research ethics committee (IRB, 0212-18-HMO)


2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daniele Tognetto ◽  
Chiara De Giacinto ◽  
Alberto Armando Perrotta ◽  
Tommaso Candian ◽  
Alessandro Bova ◽  
...  

Purpose. To compare the capsule edges ultrastructure obtained by two femtosecond laser-assisted cataract surgery (FLACS) platforms and manual continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting. Eye Clinic, University of Trieste, Italy. Design. Experimental comparative study. Methods. 150 anterior capsules were collected and divided into three groups as follows: Group 1 (50 capsules) obtained with manual CCC, Groups 2 and 3 (each with 50 capsules) obtained with the Catalys Laser and the LenSx Laser, respectively. All samples were imaged by means of SEM and regularity of the cut surface, and thickness of the capsule edge were evaluated and compared. Results. All femtosecond laser (FSL) capsules were perfectly circular, whereas some alteration of the circular shape was observed in the manual ones. Group 1 showed a smooth and regular capsule edge without any surface irregularity, conversely Groups 2 and 3 showed postage-stamp perforations on the capsule edge. The cut surface irregularity value in Group 2 was 1.4 ± 0.63, while it was 0.7 ± 0.49 in Group 3 (p<0.05). Group 1 had a significantly lower thickness of the capsule edge than the FSL groups (p<0.05). No statistically significant difference in the capsule edge thickness between the FSL groups was found (p=0.244). Conclusions. Despite the presence of slight cut surface irregularities, both FSL capsulotomies showed a better geometry and circularity than the manual ones. Capsulotomy specimens obtained using both FSL capsulotomies showed laser-induced alterations of the capsule edge when compared with smooth and regular edges obtained using manual CCC.


2021 ◽  
Vol 28 (3) ◽  
pp. 328-338
Author(s):  
Ogbutor Udoji Godsday ◽  
Nwangwa Eze Kingsley ◽  
Nwogueze Bartholomew Chukwuebuka ◽  
Chukwuemeka Ephraim ◽  
Ezunu Emmanuel ◽  
...  

Decline in normal physiological pulmonary function has been attributed to premorbid conditions such as prehypertension. Research evidence suggests that physical activity reduces age-related decline in pulmonary function and improves the efficiency of the lungs in prehypertensive patients. However, there is a scarcity of data evidence relating to isometric exercise and pulmonary function. Furthermore, the interrelationship between the intensity and duration of isometric exercise and pulmonary function in these patients is still uncertain. Therefore, this study was undertaken to investigate the effect of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. To determine the effectiveness of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. A quasi experiment using a pre- and post-exercise method was carried out in two out-patients hospital settings. The sample comprised 192 sedentary pre-hypertensive subjects, aged between 30–50 years, that were randomly distributed into three groups of 64 participants each. The subjects performed, for 24 consecutive days, an isometric handgrip exercise at 30% Maximum Voluntary Contraction (M.V.C.). At the end of the 24 days, group one (GP1) discontinued, while group two (GP2) continued the exercise protocol for another 24 consecutive days and group three (GP3) continued with the exercise protocol for another 24 consecutive days but at 50% M.V.C. Determinants of lung function (outcomes) were Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC Ratio and Peak Expiratory Flow Rate (PEFR). The study shows that there was no statistically significant difference in the pre- and post-exercise outcomes for FEV1, FVC, FEV1/FVC Ratio and PEFR after 24 days for group 1. In group 2, there was a statistically significant difference in the FVC [(mean = 0.12 ± 0.12), (p = 0.002)], FEV1 [(mean = 0.15 ± 0.17), (p = 0.003)] and PEF [(mean = 0.85 ± 0.35), (p = 0.001)] after 48 days. In group 3, there was a statistically significant difference (p = 0.001) in all the outcomes assessed after 48 days. There was a between groups difference in favour of group 2 compared with group 1 for outcomes of FEV1 [(mean = 0.142 ± 0.68), (p = 0.005)] and PEF [(mean = 0.83 ± 0.19), (p = 0.0031)]. There was statistically significant difference in favour of group 3 compared to group 2, by increasing the exercise intensity from 30% to 50% M.V.C., for outcomes of FVC [mean change = 0.10 ± 0.052), (p = 0.005)], FEV1/FVC [mean change = 3.18 ± 0.75), (p = 0.017)] and PEF [(mean change = 0.86 ± 0.35), (p = 0.001)] after 48 days. Isometric handgrip exercise (after 48 days at 30% to 50% M.V.C.) improves outcomes of pulmonary function capacity in adults with prehypertension. Meanwhile, duration and/or increase in intensity of the isometric effort significantly contributed to the affects attained.


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Cabral ◽  
R Santos ◽  
F Januario ◽  
A Antunes ◽  
R Fonseca-Pinto

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant.  We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p &lt; 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.


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