scholarly journals Lateral versus Anterior TAR: A Prospective Cohort Pilot Study of PROs and Re-Operation Rates

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Oliver Gagné ◽  
Andrea Veljkovic ◽  
Kevin Wing ◽  
Murray J. Penner ◽  
S.E. Younger Alastair
Keyword(s):  
Pilot Study ◽  
Wound Complication ◽  
Deep Infection ◽  
Foot And Ankle ◽  
Early Results ◽  
Lateral Group ◽  
Sf 36 ◽  
One Year ◽  
The One ◽  
Anterior Group

Category: Ankle, Ankle Arthritis Introduction/Purpose: Recent advances in arthroplasty for the hip and the knee have motivated modern foot and ankle research to perfect the implant and technique for the optimal total ankle replacement. Unlike in the hip where different approaches can be done with the same implants, the approach of a total ankle is intimately associated to the prosthetic design. The anterior and lateral approaches have pros and cons regarding their respective soft tissue complications, osteotomy necessity, orientation of the bone cut and gutter visualization. While both have been studied independently, very few reports have compared both in the same setting. We set out to quantify the PROs and re-operations of both groups. Methods: A prospective study was conducted from a single center between 2014 and 2018 including a total of 64 total ankles performed by one of four fellowship-trained foot and ankle surgeon. A baseline dataset of their demographic as well as baseline scores (AOS, AAS & SF-36) was documented as well as at the 6 months and yearly mark post-operatively. Re-operations were also reported and coded in the local database. The approach was determined by the surgeon’s practice preference and patients were referred to surgeons as part of a central intake. Patients were included when they had a primary TAR in the timeframe noted and had a complete dataset up to at least the one year outcome. This cohort comprised 27 anterior and 37 lateral with balanced demographic for age (95%CI 63-67 yo) and gender (47% F). The lateral group had higher COFAS type arthritis, longer intraoperative time and adjunct procedures. Results: Comparing the two groups, it was noted that the anterior group had superior SF-36 scores at the one-year post- operative mark on both the physical and mental components. The difference was statistically significant and greater than the MCID. Otherwise, the two groups had similar AOS and AAS post-operative scores that were not statistically different. A total of 8 patients had a reoperation, 7 were from the lateral cohort and 1 from the anterior approach group. The lateral group had 3 surgical debridement for deep infection/wound complication, 2 ankle gutter/HO debridement and 2 lateral hardware removal. The anterior group had one ankle gutter/ HO debridement. Two of the above patients had two re-operations and one had three. Conclusion: This prospective pilot study outlines the early results of lateral versus anterior total ankle replacements. The risk of deep infection requiring reoperation was higher in the lateral group and the SF-36 scores one year after surgery were inferior to the anterior group. The lateral cohort had however significantly more pre-operative peritalar disease which was not balanced and likely affected those results. Patient experience based on PROs (AAS, AOS) otherwise is comparable. Future studies with longer prospective data need to be considered to have the power to draw significant conclusions.

scholarly journals O42 SURGICAL REPAIR OF DIASTASIS RECTI ABDOMINIS (DRA) PROVIDES LONG-TERM IMPROVEMENT OF ABDOMINAL CORE FUNCTION AND QUALITY OF LIFE: A THREE-YEAR FOLLOW-UP

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Anders Olsson ◽  
Olivia Kiwanuka ◽  
Sofia Wilhelmsson ◽  
Gabriel Sandblom ◽  
Otto Stackelberg
Keyword(s):  
Quality Of Life ◽  
Surgical Repair ◽  
Post Partum ◽  
Diastasis Recti ◽  
Sf 36 ◽  
Core Function ◽  
One Year ◽  
The One

Abstract Aim Diastasis Recti Abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women. Material and Methods Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the Abdominal Trunk Function Protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and Quality of Life was evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at one year and three years’ post-operatively. Results Response rate at the three-year follow-up was 86.7 % for the DRI questionnaire; and 71.7% for ATFP, the UDI-6, IIQ-7, and SF-36 questionnaires. All DRI-parameters were improved (p < 0,05) after three-years of follow-up compared to preoperative values. The functional tests in the ATFP showed an improvement (p < 0.05) in core muscle strength and stability, persisting back and abdominal muscle strength compared to preoperative values as well as an improvement compared to the one-year follow-up values (p < 0.05). UDI-6 and IIQ-7 results were improved (p < 0.05) compared to preoperative values and showed consistent values compared to the one-year follow-up. Quality of life measured with SF-36 were improved compared to preoperative values and showed consistent values compared to the one-year follow-up (p < 0.05). Conclusions The functional improvement of surgical reconstruction of the DRA persisted for three years in this series of post-partum women with DRA.

Developing a cancer-specific trigger tool to identify adverse events using administrative data.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 238-238
Author(s):  
Saul N. Weingart ◽  
Benjamin Koethe ◽  
Jason Nelson ◽  
Omar Yaghi ◽  
David M. Kent ◽  
...  
Keyword(s):  
Patient Safety ◽  
Pilot Study ◽  
Metastatic Disease ◽  
Cancer Center ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
One Year ◽  
The One ◽  
Specific Trigger

238 Background: “Trigger tools” identify complications of care and potential patient safety hazards. However, attempts to create triggers that flag treatment-related complications in oncology have been largely unsuccessful. To address this problem, the authors built a set of claims-based oncology-specific triggers based on a promising pilot study conducted at Memorial Sloan-Kettering Cancer Center. Methods: We selected subjects from the OptumLabs data warehouse, a repository of > 160 million de-identified patients drawn from commercial claims. The cohort included patients with breast, colorectal, lung, and prostate cancer undergoing an initial course of cancer-directed therapy from 2008-14. Using ICD and CPT codes, we defined 16 oncology-specific triggers drawn from the pilot study, all with PPVs ≥50%. Triggers included events such as neutropenic fever, abnormal serum potassium or bicarbonate, and initiation of therapeutic anticoagulation. To distinguish treatment-related complications from other comorbidities, we required a logical and temporal relationship between a treatment and the associated trigger. We tabulated the prevalence of cancer triggers by cancer type and metastatic status during a one-year follow up period and created multivariate logistic regression models to examine the association of triggered cases with one-year mortality. Results: The cohort comprised 369,354 unique subjects including 29% with metastatic disease. The prevalence of triggered events was greatest among non-metastatic patients with lung (33%) and colorectal (21%) cancers, and among those with metastatic disease. The most common triggers included abnormal chemistry tests, blood transfusions, hypoxemia, and chest CT following radiation therapy. The mortality rate was substantially higher among patients with at least one trigger compared to patients with none. Experiencing at least one cancer-specific trigger increased the one-year risk of death by 1.69 (95% CI 1.28-2.24). Conclusions: Oncology-specific triggers provide researchers a promising method for studying patient safety in cancer care.

scholarly journals The Effect of Different Lower Third Molar Conditions on the Re-Crowding of Lower Anterior Teeth in the Absence of Tight Interproximal Contacts One-Year Post Orthodontic Treatment: A Pilot Study

2004 ◽  
Vol 5 (3) ◽  
pp. 66-73 ◽  
Author(s):  
Khalid M. Al-Balkhi
Keyword(s):  
Pilot Study ◽  
Orthodontic Treatment ◽  
Third Molar ◽  
Dental Arch ◽  
Third Molars ◽  
Lower Incisor ◽  
Exact Test ◽  
Anterior Teeth ◽  
One Year ◽  
The One

Abstract The role of lower third molars in lower incisor crowding is a debatable topic. Some believe the presence or eruption of lower third molars is associated with the crowding of mandibular incisors, others negate such association. Thirty-two newly debonded orthodontic patients, with ages ranging from 14-19 years, were randomly selected. No retainers were used for the lower dental arch. Removal of tight interproximal contacts of the lower anterior teeth was created and maintained by periodic abrasive stripping every 2-3 months, if needed. The cases were followed up for one year. Orthopantomographs (OPGs) and study casts were taken at debonding (post-treatment) and at the end of the one year follow up (post retention). Statistical analysis of the lower third molar conditions – erupted, unerupted, or missing with or without sufficient space for their eruption – versus re-crowding of lower incisors was evaluated using Fisher's Exact Test. The results of this pilot study revealed there was no significant correlation between the different conditions of the lower third molars versus lower anterior re-crowding in the absence of tight interproximal incisal contacts; however, a larger sample size is needed to verify such findings. Citation Al-Balkhi KM . The Effect of Different Lower Third Molar Conditions on the Re-Crowding of Lower Anterior Teeth in the Absence of Tight Interproximal Contacts One-Year Post Orthodontic Treatment: A Pilot Study. J Contemp Dent Pract 2004 August;(5)3:066-073.

scholarly journals IMPROVEMENT OF ODI AND SF-36 QUESTIONNAIRES SCORE AFTER ONE YEAR OF PLIF OR TLIF

2019 ◽  
Vol 18 (4) ◽  
pp. 318-321
Author(s):  
Fabiano Caumo ◽  
Carlos Henrique Maçaneiro ◽  
Ricardo Kiyoshi Miyamoto ◽  
Rodrigo Fetter Lauffer ◽  
Ricardo André Acácio dos Santos
Keyword(s):  
Hospital Stay ◽  
Randomized Study ◽  
Health State ◽  
Single Center ◽  
Level Of Evidence ◽  
Sf 36 ◽  
The Mean ◽  
Group 2 ◽  
One Year ◽  
The One

ABSTRACT Objective: Determine if patients undergoing PLIF or TLIF surgery achieved improvement in the score of ODI and SF-36 questionnaires one year after surgery. Methods: Retrospective, single-center and non-randomized study. Patients submitted to spinal surgery using the PLIF or TLIF technique were included who completed the ODI and SF-36 questionnaires at least at the preoperative visit, and one year after surgery. Patients were divided into two groups, Group 1 (1 surgery level) and Group 2 (> 1 surgery level) and the ODI and SF-36 scores were compared for improvement. Results: The mean age was 47 years, with 52% of males (13/25) and mean of 5 days of hospital stay. Patients presented a significant improvement of ODI questionnaire (p<0.001) and in all SF-36 domains except in General Health State (p=0.58). In each group, it was observed that patients submitted to more than one level of surgery had greater blood loss and shorter hospital stay; however, the improvement obtained in ODI and SF-36 compared to the one-level surgery group was similar. Conclusions: PLIF and TLIF techniques are effective and lead to improved scores in ODI and SF-36 questionnaires one year after surgery. Patients undergoing two or more levels of instrumentation showed significant and similar improvement in ODI and SF-36. Level of evidence II, Single-Center Retrospective Study.

scholarly journals The iDuo Bi-compartmental Knee Replacement: Our Early Experience.

2016 ◽  
Vol 6 (4) ◽  
Author(s):  
Peter Jemmett ◽  
Stuart Roy
Keyword(s):  
Knee Replacement ◽  
Case Series ◽  
Lateral Compartment ◽  
Physiological Age ◽  
Unaffected Side ◽  
Early Results ◽  
Total Knee ◽  
One Year ◽  
The One

We present the first UK single surgeon case series for the iDuo knee. This is a CT based custom fit monolithic bi-compartmental design that resurfaces both trochlea and condyle. Perceived benefits include maintenance of normal kinematics and preservation of bone stock on the unaffected side. The femoral component is tailored to the patient with no compromise of either the trochlea or femoral geometry.MethodPatients were selected based on functional ability and physiological age who had an intact symptom free lateral compartment. Knee Society scoring (KSS) was performed pre-operatively and at regular intervals. Patients were asked whether they would undergo the same operation at the one-year mark.ResultsSeven patients have undergone this procedure from 2013 until present. Average age is 60 (Range 55- 82).  Average pre-op KSS was 108. All patients consistently scored higher at each interval follow up with excellent results at one year (Av KSS 194). This benefit was seen past two years in all but one in those reaching this point.ConclusionOur early results suggest that the iDuo knee is a good option for those with isolated bi-compartmental disease and outcome scores are comparable with those reported for the BKA. This bi-compartmental design may bridge the gap between the uni-compartmental and total knee replacement. The choice between monolithic or modular designs remains in debate. We will continue to use this prosthesis for a carefully selected group of patients.

Reoperation Profile of Lateral vs Anterior Approach Ankle Arthroplasty

2020 ◽  
Vol 41 (7) ◽  
pp. 834-838
Author(s):  
Oliver J. Gagné ◽  
Murray Penner ◽  
Kevin Wing ◽  
Andrea Veljkovic ◽  
Alastair S. Younger
Keyword(s):  
Soft Tissue ◽  
Anterior Approach ◽  
Lateral Approach ◽  
Wound Complications ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Data Set ◽  
Ankle Arthroplasty ◽  
Lateral Group ◽  
Anterior Group

Background: The operative procedure for a total ankle replacement (TAR) is intimately associated with the prosthetic design. The anterior and lateral approaches both have pros and cons regarding their respective soft tissue complications, osteotomy requirements, orientation of the bone cut, and gutter visualization. Although both have been studied independently, few reports have compared both in the same setting. The purpose of this retrospective study was to investigate the difference in reoperation rate after lateral or anterior approach ankle arthroplasty. We hypothesized that the anterior approach had a higher rate of wound complications. Methods: We evaluated data from a single center collected between 2014 and 2017, comprising a total of 115 total ankle replacements performed by 1 of 4 fellowship-trained foot and ankle surgeons. Reoperations were recorded as an operative report with classification by Canadian Orthopaedic Foot and Ankle Society (COFAS) Reoperations Coding System (CROCS). The index approach used was determined by the surgeon’s practice preference. Patients were included when they had a primary TAR in the time frame noted and had a complete data set up to at least 2 years after surgery. The cohort comprised 67 anterior and 48 lateral operations with balanced demographics for age (95% CI: 63-67 years) and gender (47% F). The lateral group had more complex cases with higher COFAS type arthritis (more periarticular arthritis and surrounding deformity). Results: Comparing the 2 groups, a total of 40 reoperations (7 anterior [A], 33 lateral [L]) occurred in 27 patients (5 A, 22 L). One patient had 4 related reoperations. The only revision was in the anterior group. The only soft tissue reconstruction was a split-thickness skin graft in the lateral group. Nine reoperations were irrigation debridement related to an infection or wound complication (3 A, 6 L). The majority (19/33) of reoperations in the lateral group were gutter debridement (8) or lateral hardware removal (11). Operative time was statistically different at 145 minutes (95% CI: 127-164 minutes) in anterior TAR and 178 minutes (95% CI: 154-202 minutes) for lateral TAR ( P = .0058). The odds ratio of having any reoperation with a lateral approach TAR was 6.19 compared to the anterior group. Conclusion: The results at the 2-year time point demonstrated that there were more reoperations after a lateral approach TAR than an anterior TAR, recognizing the significant case complexity imbalance between the groups and a corresponding relative increase in resource utilization of lateral TAR patients. The 2 implant designs were associated with different reoperation rates, favoring the anterior group. Change in the lateral fixation may have reduced the risk of repeat surgery. Level of Evidence: Level III, retrospective comparative series.

scholarly journals A Pilot and Feasibility Study to Evaluate Small and Large Bite Fascial Closure Techniques

2021 ◽  
Vol 14 ◽  
pp. 163-169
Author(s):  
Clint Gates ◽  
Gina M Berg ◽  
Kyle Vincent ◽  
David Acuna ◽  
Kamran Ali
Keyword(s):  
Pilot Study ◽  
Large Scale ◽  
Clinical Results ◽  
Fascial Closure ◽  
Surgical Closure ◽  
Feasibility Assessment ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
One Year ◽  
The One

Introduction. Few randomized controlled studies have been conducted comparing a small to large fascial bite technique, yet recommendations have been made to standardize small bite closures.  However, large scale randomized controlled trials require considerable effort and may benefit from a pilot study. Methods. This multi-center randomized controlled pilot study of adult patients undergoing median laparotomy incision investigated the feasibility of studying the outcomes between small and large surgical closure techniques. Results. Fifty of 100 planned patients consented, 32 patients completed surgery and 19 patients completed the one-year ultrasound.  Enrollment was 2.7 versus 8 patients per month pre/post addition of study coordinator.  Clinical results are summarized for feasibility demonstration purposes, but not analyzed for hypothesis testing.  The total cost of the pilot study was $19,152.50 and took 22 months from first surgery to final one-year ultrasound.  Conclusions. This feasibility assessment demonstrates the complexity of planning a large scale randomized trial evaluating small and large bite surgical closure technique.  To expand this pilot study to a full scaled sample size study would require dedicated personnel and large grant funding. 

Resources: Internet Resources for the Independent Medical Evaluator – 2007

2007 ◽  
Vol 12 (4) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham ◽  
Jenny Walker
Keyword(s):  
Head Trauma ◽  
Clonic Seizure ◽  
Acute Subdural Hematoma ◽  
Orbital Fracture ◽  
Orbital Wall ◽  
First Occurrence ◽  
One Year ◽  
The One ◽  
Neurological Injuries ◽  
Medial Orbital Wall

Abstract Rating patients with head trauma and multiple neurological injuries can be challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 13.2, Criteria for Rating Impairment Due to Central Nervous System Disorders, outlines the process to rate impairment due to head trauma. This article summarizes the case of a 57-year-old male security guard who presents with headache, decreased sensation on the left cheek, loss of sense of smell, and problems with memory, among other symptoms. One year ago the patient was assaulted while on the job: his Glasgow Coma Score was 14; he had left periorbital ecchymosis and a 2.5 cm laceration over the left eyelid; a small right temporoparietal acute subdural hematoma; left inferior and medial orbital wall fractures; and, four hours after admission to the hospital, he experienced a generalized tonic-clonic seizure. This patient's impairment must include the following components: single seizure, orbital fracture, infraorbital neuropathy, anosmia, headache, and memory complaints. The article shows how the ratable impairments are combined using the Combining Impairment Ratings section. Because this patient has not experienced any seizures since the first occurrence, according to the AMA Guides he is not experiencing the “episodic neurological impairments” required for disability. Complex cases such as the one presented here highlight the need to use the criteria and estimates that are located in several sections of the AMA Guides.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad
Keyword(s):  
Saphenous Vein ◽  
Short Term ◽  
Foam Sclerotherapy ◽  
Results Of Treatment ◽  
Ulcer Healing Rate ◽  
Complete Obliteration ◽  
Ceap Classification ◽  
One Year ◽  
The One

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.

Regional household poverty and mobility analysis – a transition probability approach

2020 ◽  
Vol 63 (3) ◽  
pp. 286-302
Author(s):  
Damian Mowczan ◽  
Keyword(s):  
Transition Probability ◽  
General Level ◽  
Transition Matrices ◽  
Equivalent Unit ◽  
Central Statistical ◽  
Per Capita ◽  
Probability Matrices ◽  
General Mobility ◽  
One Year ◽  
The One

The main objective of this paper was to estimate and analyse transition-probability matrices for all 16 of Poland’s NUTS-2 level regions (voivodeship level). The analysis is conducted in terms of the transitions among six expenditure classes (per capita and per equivalent unit), focusing on poverty classes. The period of analysis was two years: 2015 and 2016. The basic aim was to identify both those regions in which the probability of staying in poverty was the highest and the general level of mobility among expenditure classes. The study uses a two-year panel sub-sample of unidentified unit data from the Central Statistical Office (CSO), specifically the data concerning household budget surveys. To account for differences in household size and demographic structure, the study used expenditures per capita and expenditures per equivalent unit simultaneously. To estimate the elements of the transition matrices, a classic maximum-likelihood estimator was used. The analysis used Shorrocks’ and Bartholomew’s mobility indices to assess the general mobility level and the Gini index to assess the inequality level. The results show that the one-year probability of staying in the same poverty class varies among regions and is lower for expenditures per equivalent units. The highest probabilities were identified in Podkarpackie (expenditures per capita) and Opolskie (expenditures per equivalent unit), and the lowest probabilities in Kujawsko-Pomorskie (expenditures per capita) and Małopolskie (expenditures per equivalent unit). The highest level of general mobility was noted in Małopolskie, for both categories of expenditures.

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