Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

2020 ◽  
pp. 193864002098092
Author(s):  
Cornelia Keyser ◽  
Abhiram Bhashyam ◽  
Abdurrahman Abdurrob ◽  
Jeremy T. Smith ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Control Group ◽  
Foot And Ankle ◽  
Opioid Medication ◽  
Ankle Surgery ◽  
Randomized Control ◽  
Level I ◽  
To Receive ◽  
Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

scholarly journals Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

2021 ◽  
Vol 18 (5) ◽  
pp. 2654
Author(s):  
Roxana Steliana Miclaus ◽  
Nadinne Roman ◽  
Ramona Henter ◽  
Silviu Caloian
Keyword(s):  
Virtual Reality ◽  
Muscle Strength ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Control Group ◽  
Mirror Therapy ◽  
Cohen’S D ◽  
Cohen's D ◽  
Experimental Group ◽  
Post Therapy

More innovative technologies are used worldwide in patient’s rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen’s d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen’s d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen’s d 0.693), muscle strength (p < 0.05, Cohen’s d 0.924), lower extremity functionality (p < 0.05, Cohen’s d 0.984) and postural balance (p < 0.05, Cohen’s d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.

scholarly journals Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

EFFECT OF ACCUPRESSURE PEN ON DISTANCE VARIABLE IN SCIATICA PATIENTS -A RANDOMIZED CONTROL TRIAL

2021 ◽  
pp. 28-31
Author(s):  
Urja S. Vaidya ◽  
Roshani S. Patel
Keyword(s):  
Randomized Control Trial ◽  
Stride Length ◽  
Step Length ◽  
Control Group ◽  
Exclusion Criteria ◽  
Parametric Test ◽  
Group A ◽  
Randomized Control ◽  
Experimental Group ◽  
Distance Variable

Background: Sciatica is a radiating pain which is treated with manual accupressure and after a time electro accupressure came into introduction. Aim And Objective: Aim: To nd out the effectiveness of accupressure pen to improve the distance variable To nd out the effect of Objective: accupressure pen on pain and distance variable in sciatica patient To compare the experimental group to the control group On the basis of Method: inclusion and exclusion criteria 30 participants were selected. They were treated with electro accupressure pen for 3 alternative days / week for 3 weeks, after that re-assessment was taken with NPRS, Slump and Distance variables. The data was analyzed using SPSS Version Results: 21.Parametric test was used .In Group A improvement was seen Accupressure Conclusions: pen is effective to reduce pain and improve step length and stride length in Sciatica Patients

A Randomized Trial of A.C.T. (Asthma Care Training) for Kids

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 478-486 ◽  
Author(s):  
Charles E. Lewis ◽  
Gary Rachelefsky ◽  
Mary Ann Lewis ◽  
Ann de la Sota ◽  
Michael Kaplan
Keyword(s):  
Los Angeles ◽  
Experimental Treatment ◽  
Control Group ◽  
Emergency Rooms ◽  
Asthma Care ◽  
Kaiser Permanente ◽  
Care Training ◽  
Randomized Control ◽  
Treatment Use ◽  
Experimental Group

A randomized control trial of a curriculum, A.C.T. (Asthma Care Training) for Kids, was conducted. Seventy-six children between the ages of 8 and 12 years, whose asthma required treatment with medications at least 25% of the days per month, were randomly assigned to control and experimental groups. The control group received 4½ hours of lecture presentations on asthma and its management. The experimental groups (consisting of four to seven children and their parents) received five 1-hour sessions comprising "the treatment." Children and their parents were interviewed before the sessions and 3, 6, and 12 months after the completion of the experimental treatment. Use of emergency rooms and hospitals was determined by reviewing the records of these patients (all members of the Los Angeles Kaiser Permanente health care system) for the period of 1 year before and 1 year after the treatment. Results include (1) equivalent increases in knowledge and changes in beliefs in both groups, (2) significant changes in the self-reported compliance behaviors of the experimental group only, and (3) significant reductions in emergency room visits and days of hospitalization among those receiving the experimental treatment, compared with the control group. These changes represent an estimated savings of approximately $180 per child per year for those in the experimental group.

scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

scholarly journals Meta-Analysis of Randomized Controlled Trials of Xueshuantong Injection in Prevention of Deep Venous Thrombosis of Lower Extremity after Orthopedic Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Shu-ting Yan ◽  
Feng Gao ◽  
Tai-wei Dong ◽  
Hao Fan ◽  
Miao-miao Xi ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Randomized Controlled Trials ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Experimental Group

Objective. To systematically evaluate the clinical efficacy of Xueshuantong injection (Panax notoginseng saponins) in preventing deep venous thrombosis (DVT) of lower extremity after orthopedic surgery. Methods. The randomized controlled trials (RCTs) of Xueshuantong injection in prevention of lower extremity DVT after orthopedic surgery were retrieved from CNKI, Wanfang database, VIP, PubMed, and Cochrane Library by August 2020. Revman5.2 was used to analyze the results. Results. A total of 20 articles including 2336 patients were included. The results of meta-analysis showed that the incidence of DVT in the experimental group was lower than that in the control group; after operation, the D-dimer (Ddimer), thrombin time (APTT), and prothrombin time (PT) in the experimental group were significantly improved compared with those in the control group, and the difference between the two groups was statistically significant. Conclusion. Xueshuantong injection can effectively prevent the formation of lower extremity DVT after orthopedic surgery and antagonize the postoperative hypercoagulable state of blood, which has high clinical value.

Quality of Research and Level of Evidence in Foot and Ankle Publications

2012 ◽  
Vol 33 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Heather L. Barske ◽  
Judith Baumhauer
Keyword(s):  
Clinical Research ◽  
Medical Profession ◽  
Research Articles ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Level I ◽  
Quality Of Research

Background: The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Methods: Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. Results: A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Conclusion: Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

THE IDENTIFICATION OF CHANGES OF SIGNIFICANT NECESSITIES, THAT ARE TYPICAL FOR THE PERSONALITY OF THE COMBATANT IN THE COURSE OF THE REHABILITATION PERIOD

2020 ◽  
pp. 11-15
Author(s):  
O. Karachynskyi
Keyword(s):  
Social Activity ◽  
Emotional Engagement ◽  
Control Group ◽  
Control Groups ◽  
Color Selection ◽  
Initial Stage ◽  
Rehabilitation Period ◽  
The One ◽  
To Receive ◽  
Experimental Group

The article is dedicated to the research of identifying the changes of significant necessities, that are typical for thepersonality of combatants in the course of the rehabilitation period. In order to identify significant necessities, that are typical forthe personality of combatants the method of color selection has been used. It is referred to the necessities that are determinedby main colors: the necessity of satisfaction and affection, the necessity of self-empowerment, the necessity of achievement,obtainment, power; the necessity of social activity and emotional engagement. When interpreting the results, the orientationwas aimed at the first, second and seventh and eight positions, though we had the intention to receive the information concerning the main way of action and its purpose, the one that the researcher is planning to reach as well as his suppressednecessities.At the initial stage of research within the experimental group (EG) the main necessities and tendencies were focused onactivity, the emotional engagement, and simultaneously the necessity to lose the actual reality. At the final stage of researchprominent remains the necessity to stay active, and emotionally engaged there’s no longer a necessity to lose the actual real ity.Prior becomes the need to fortify ones’ position.The main necessities of the control group were: the need to sense intense affiliation, the tendency to achieve externalprotection and emotional comfort; the need to be emotionally engaged, active, the tendency to be passive. When comparing thefixed stages of the experiment we could obviously claim that the prior necessities of control groups under research havepractically not changed. However, at the final stages of research there turned out to be features of harmonizing the personality.

Family-Based Intervention for Schizophrenic Patients in China

1994 ◽  
Vol 165 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Wei Xiong ◽  
M. R. Phillips ◽  
Xiong Hu ◽  
Ruiwen Wang ◽  
Qinqing Dai ◽  
...  
Keyword(s):  
Family Relationships ◽  
Medication Management ◽  
Urban Families ◽  
Family Intervention ◽  
Family Education ◽  
Control Group ◽  
Schizophrenic Patients ◽  
Family Based ◽  
To Receive ◽  
Experimental Group

Background.We developed and evaluated a comprehensive, ongoing intervention for families of schizophrenic patients appropriate for China's complex family relationships and unique social environment.Method.Sixty-three DSM–III–R schizophrenic patients living with family members were enrolled when admitted to hospital and randomly assigned to receive standard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems, medication management, family education, family group meetings, and crisis intervention.Results.At 6, 12, and 18-month follow-ups by blind evaluators, the proportion of subjects rehospitalised was lower, the duration of rehospitalisation was shorter, and the duration of employment was longer in the experimental group than in the control group; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance. Family intervention was associated with significantly lower levels of family burden.Conclusions.This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.

scholarly journals Effect of Balanced Diet Education with Media Comic on Modification of Eating Behavior in Adolescents at Middle School, Malang

2020 ◽  
Author(s):  
Rani Nurmayanti ◽  
◽  
I Nengah Tanu Komalyna ◽  
Sugeng Iwan Setyobudi Maryam Razak ◽  
◽  
...  
Keyword(s):  
Middle School ◽  
Eating Behavior ◽  
Control Group ◽  
Test Results ◽  
Contributing Factors ◽  
Balanced Diet ◽  
Dependent Variables ◽  
Independent Variable ◽  
Randomized Control ◽  
Experimental Group

Background: Obesity remains the main malnutritional problem globally. One of the contributing factors is the imbalance diet eating behavior. This study aimed to analyze the effect of balanced diet education with media comic on modification of eating behavior in adolescents at middle school, Malang, East Java. Subjects and Method: A randomized control trial study was conducted at Middle School, Malang, East Java, in November 2018. A sample of 64 students was randomized into two groups: (1) Experiment group that received diet education using media comic, and (2) Control group that received no intervention. The dependent variables were knowledge, attitude, and skill of eating behavior. The independent variable was diet education using media comic. The data were analyzed by independent t-test. Results: After the intervention, the experimental group had higher mean of knowledge (Mean= 92.72; SD= 10.78), attitude (Mean= 83.23; SD= 18.13), and skill (Mean= 78.79; SD= 16.94) than the control group, including knowledge (Mean= 88.68; SD= 11.47), attitude (Mean= 87.60; SD= 8.60), and skill (Mean= 79.94; SD= 14.31), and it was statistically insignificant in each outcomes, (p= 0.151), (p= 0.223), and (p= 0.770) respectively. Conclusion: Diet education with media comic is effective in improving knowledge, attitude, and skill of eating behavior in students, but it is not statistically significant. Keywords: diet education, media comic, eating behavior, balanced diet Correspondence: Rani Nurmayanti. School of Health Polytechnics, Ministry of Health. Jl Besar Ijen 77C Malang, East Java. Email: [email protected]. Mobile: +6285258334321. DOI: https://doi.org/10.26911/the7thicph.02.37

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