Two-year clinical and economic burden, risk and outcomes following application of software-assisted hexapod ring fixation systems

Abstract Background Multiplanar external fixation systems that employ software-assisted deformity correction consist of rings connected by angled struts, defined as hexapod ring fixators (HRF). Costs and outcomes associated with the application of HRFs are not well documented. This study was designed to provide a nationwide baseline understanding of the clinical presentation, risks, outcomes and payer costs, and healthcare resource utilization (HCU) of patients requiring application of an HRF, from the day of, and up to 2 years, post-application. Methods Patients with HRF application (“index”) between 2007 and 2019 within the IBM Marketscan® Commercial Claims database were identified and categorized based on diagnosis: acquired deformity, arthropathy, congenital deformity, deep infection, nonunion, fracture, and other post-operative fracture sequelae. Demographics, comorbidities at index, complications post-index, HCU, and payments were analyzed. Payments were estimated using a generalized linear model and were adjusted for inflation to the 2020 consumer price index. Rates of deep infection and amputation were estimated up to 2 years post-index using Poisson regressions, and risk factors for each were estimated using logistic regression models. Results Six hundred ninety-five patients were included in our study (including 219 fractures, 168 congenital deformities, 68 deep infections, 103 acquired deformities). Comorbidities at index were significantly different across groups: less than 2% pediatrics vs 18% adults had 3 or more comorbidities, < 1% pediatric vs 29% adults had diabetes. Index payments ranged from $39,250–$75,350, with 12-months post-index payments ranging from $14,350 to $43,108. The duration of the HRF application ranged from 96 days to 174 days. Amputation was observed in patients with deep infection (8.9, 95% confidence interval (CI): 3.2–23.9%), nonunion (5.0, 95%CI: 1.6–15.4%) or fracture (2.7, 95%CI: 0.9–7.6%) at index. Complicated diabetes was the main predictor for deep infection (odds ratio (OR): 5.14, 95%CI: 2.50–10.54) and amputation (OR: 5.26, 95%CI: 1.79–15.51). Conclusions Findings from this longitudinal analysis demonstrate the significant heterogeneity in patients treated with HRF, and the wide range in treatment intensity, payments, and outcomes. Risks for deep infection and amputation were primarily linked to the presence of complicated diabetes at the time of HRF application, suggesting a need for careful management of comorbid chronic conditions in patients requiring HRF for orthopedic care.

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Temporary hemiepiphysiodesis using an eight‐plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03915-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhen-Zhen Dai ◽

Zhen-Peng Liang ◽

Hao Li ◽

Jing Ding ◽

Zhen-Kai Wu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Deformity Correction ◽

Genu Valgum ◽

Angular Deformity ◽

Screw Loosening ◽

Logistic Regression Models ◽

The Mean ◽

Low Incidence ◽

Angular Deformities

Abstract Background Temporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population. Methods This retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models. Results The mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p < 0.001). After adjustment for other factors, younger children had higher correction velocities in the distal femur; however, genu valgum and idiopathic deformities were associated with higher correction velocities in the proximal tibia. In addition, we found three (3/101, 2.97%) knees with genu valgum that experienced rebound after removal of the eight-Plate, while five (5/101, 4.95%) knees with non-idiopathic genu angular deformity experienced screw loosening. No other complications were found, and non-idiopathic deformity was the only risk factor for complications (OR = 3.96). No risk factor was found for rebound in our study. Conclusions TH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.

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Comparative analysis of the quality of life of children with congenital scoliosis after surgical treatment: Extirpation of the hemivertebra from dorsal and combined access

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors60339 ◽

2021 ◽

Vol 9 (2) ◽

pp. 153-162

Author(s):

Dmitry N. Kokushin ◽

Michael A. Khardikov ◽

Sergey V. Vissarionov ◽

Vera V. Sokolova ◽

Nikita O. Khusainov ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Postoperative Period ◽

Deformity Correction ◽

Lumbar Vertebra ◽

Congenital Scoliosis ◽

Congenital Deformity ◽

Subsequent Increase ◽

Level Of Satisfaction

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the childs quality of life following surgical technique for congenital scoliosis have not been sufficiently studied. AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches. MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (minmax, 26196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used. RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p 0.05). CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.

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About the treatment of congenital clubfoot

Kazan medical journal ◽

10.17816/kazmj78876 ◽

1923 ◽

Vol 19 (3) ◽

pp. 37-49

Author(s):

M. O. Friedland

Keyword(s):

Doctor Who ◽

Congenital Clubfoot ◽

Congenital Deformities ◽

Orthopedic Care ◽

Rural Doctor ◽

Bed Capacity ◽

The Masses ◽

Orthopedic Patients ◽

Methods Of Treatment

The extremely low number of orthopedic care centers, given the enormous distances in our country, the poor transportation, and the lack of culture of the population, leads to the fact that our orthopedic institutions deal almost exclusively with neglected cases of deformities in general and congenital clubfoot in particular. In addition, if we take into consideration that the bed capacity of our orthopedic institutions is comparatively very small, and the number of orthopedic patients is enormous, and moreover each such patient requires long-term medical supervision, it becomes absolutely clear that orthopedic care should be taken outside of special institutions, bring it closer to the masses and include orthopedic methods of treatment in the practice of a rural doctor, who can start treatment of congenital deformities from the very first days of birth, with the help of a doctor who has the opportunity to provide treatment to children. This article is prompted by these very motives, in which I try to present, in a concise form, those of the modern methods of treating clubfoot which can be carried out in the conditions of a rural hospital.

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What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness (Preprint)

10.2196/preprints.14634 ◽

2019 ◽

Author(s):

Jing Liu ◽

Shengchao Hou ◽

Richard Evans ◽

Chenxi Xia ◽

Weidong Xia ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

A Priori ◽

Patient Experiences ◽

Study Patient ◽

Significant Heterogeneity ◽

Care Providers ◽

Patient Centeredness ◽

Patient Centered ◽

Wide Range

BACKGROUND Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. OBJECTIVE The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. METHODS First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. RESULTS In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. CONCLUSIONS Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

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Assessment of the impact of factors upon tourism revenue in Jordan

Теоретическая и прикладная экономика ◽

10.25136/2409-8647.2020.2.30039 ◽

2020 ◽

pp. 117-128

Author(s):

Moayyad Shakra ◽

Yuriy Davydovich Shmidt

Keyword(s):

Price Index ◽

Foreign Currency ◽

Consumer Price Index ◽

Negative Influence ◽

Positive Influence ◽

Distributed Lag ◽

Distributed Lag Model ◽

Wide Range ◽

The Impact ◽

Tourism Revenue

This article examines Jordan’s tourism revenue over the recent years. Tourism is a substantial source of national revenue and significantly contributes to the flow of foreign currency for the development of national economy. The economic theory claims that tourism revenue is affected by a wide range of factors. The article explores the impact of consumer price index and number of tourists upon Jordan’s tourism revenue. In the course of this study, the author used the statistical data of the World Bank and International Monetary Fund; applied Autoregressive Distributed Lag model (ARDL); and conducted necessary diagnostic tests in Eviews 9 software. The research demonstrated that high internal inflation ratios reduce the external demand for tourism services in Jordan, and thus significantly decrease the tourism revenue. Over a long-term, the author determines a negative influence of consumer price index upon tourism revenue in Jordan and the expected positive influence of the number of tourists thereof.  

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Does healthcare inequity reflect variations in peoples’ abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries

International Journal for Equity in Health ◽

10.1186/s12939-020-01281-6 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jeannie Haggerty ◽

Jean-Frederic Levesque ◽

Mark Harris ◽

Catherine Scott ◽

Simone Dahrouge ◽

...

Keyword(s):

Logistic Regression ◽

Primary Healthcare ◽

Social Vulnerability ◽

Regression Models ◽

Social Systems ◽

Social Characteristics ◽

Linear Regression Models ◽

Logistic Regression Models ◽

Wide Range ◽

Social Vulnerabilities

Abstract Background Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare. Methods This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access. Results The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability. Conclusions We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.

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Welfare Attitudes and Expressions of (Trans)national Solidarity

American Behavioral Scientist ◽

10.1177/0002764218823843 ◽

2019 ◽

Vol 63 (4) ◽

pp. 492-505

Author(s):

Anna Kurowska ◽

Olga Eisele ◽

Johannes M. Kiess

Keyword(s):

Welfare State ◽

The European Union ◽

Logistic Regression Models ◽

Explanatory Variables ◽

Eu Countries ◽

Wide Range ◽

Welfare Attitudes ◽

Eu Project ◽

National Solidarity ◽

The Welfare State

The article explores the extent to which Europeans’ welfare attitudes explain (trans)national solidarity behavior. We set our analyses against the backdrop of the broader debate of welfare state consequences: Does a strong welfare state that is considered to take care of those in need diminish or strengthen citizens’ motivations to become engaged in helping others? We distinguish individuals’ solidarity behavior toward others within the welfare state, that is, citizens within one’s country, and outside the welfare state community of the respondents’ particular country. We further distinguish different others outside the welfare state, that is, between refugees, taking the refugee crisis in the European Union (EU) as a prime example, and citizens living in other countries—in EU countries and non-EU countries. As far as the main explanatory variables are concerned, we derive from the concept of “multidimensional welfare attitudes” and focus on five crucial dimensions of these attitudes, that is, welfare goals, range, degree, redistribution, and outcome. We draw on data collected within the EU project TransSOL and calculate a set of multilevel logistic regression models controlling for a wide range of individual (sociodemographic, economic, and political) variables. Overall, we observe that a “crowding in” effect, that is, higher support of the welfare state, goes in line with solidarity activity toward others including both “outsiders” and “insiders” of the national community.

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The Eph-related tyrosine kinase ligand Ephrin-B1 marks germinal center and memory precursor B cells

Journal of Experimental Medicine ◽

10.1084/jem.20161461 ◽

2017 ◽

Vol 214 (3) ◽

pp. 639-649 ◽

Cited By ~ 39

Author(s):

Brian J. Laidlaw ◽

Timothy H. Schmidt ◽

Jesse A. Green ◽

Christopher D.C. Allen ◽

Takaharu Okada ◽

...

Keyword(s):

B Cells ◽

Germinal Center ◽

Tyrosine Kinases ◽

Memory B Cells ◽

Transcriptional Analysis ◽

Specific Marker ◽

Significant Heterogeneity ◽

Activation Markers ◽

Wide Range ◽

Precursor B Cells

Identification of germinal center (GC) B cells is typically reliant on the use of surface activation markers that exhibit a wide range of expression. Here, we identify Ephrin-B1, a ligand for Eph-related receptor tyrosine kinases, as a specific marker of mature GC B cells. The number of Ephrin-B1+ GC B cells increases during the course of an immune response with Ephrin-B1+ GC B cells displaying elevated levels of Bcl6, S1pr2, and Aicda relative to their Ephrin-B1– counterparts. We further identified a small proportion of recently dividing, somatically mutated Ephrin-B1+ GC B cells that have begun to down-regulate Bcl6 and S1pr2 and express markers associated with memory B cells, such as CD38 and EBI2. Transcriptional analysis indicates that these cells are developmentally related to memory B cells, and likely represent a population of GC memory precursor (PreMem) B cells. GC PreMem cells display enhanced survival relative to bulk GC B cells, localize near the edge of the GC, and are predominantly found within the light zone. These findings offer insight into the significant heterogeneity that exists within the GC B cell population and provide tools to further dissect signals regulating the differentiation of GC B cells.

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Why discontinue operations? Interrelated elements of the corporate focus hypothesis

International Journal of Managerial Finance ◽

10.1108/ijmf-11-2018-0341 ◽

2019 ◽

Vol 16 (2) ◽

pp. 182-202

Author(s):

Richard A. Lord ◽

Yoshie Saito

Keyword(s):

Risk Measures ◽

Cross Product ◽

Capital Expenditures ◽

Capital Investments ◽

Content Type ◽

Logistic Regression Models ◽

Wide Range ◽

Corporate Focus ◽

Exit Decisions ◽

Discontinued Operations

Purpose The purpose of this paper is to reexamine the corporate focus hypothesis to establish the characteristics of firms that discontinue operations. The authors concentrate on four interrelated elements of the hypothesis, diversification, performance, financial constraint and market-based risk measures. The authors also examine whether firms reporting positive- or negative-valued discontinued operations have different characteristics. Design/methodology/approach Analyzing discontinued operations provides a broad sample of strategically important exit decisions using a variety of different disposal methods. The authors use logistic regression models to explore whether the elements of the corporate focus hypotheses, and interactions between them, explain decisions to discontinue operations, and also the differences between firms making negative- and positive-valued announcements. Findings Firms that discontinue operations are more diverse, with weak operating performance, higher financial constraints and perform poorly in financial markets. Interrelationships between these factors strongly affect exit decisions. Companies reporting negative-valued discontinued operations are smaller, make lower capital investments and face greater cash constraints and market risk. Those announcing positive-valued discontinuations are larger and make higher payouts and capital expenditures. Their overall performance is weaker than for control firms, but clearly superior to companies discontinuing negative-valued operations. Originality/value Discounted operations represent a wide range of exit decisions. They provide a much larger sample than most previous studies of divestitures. The authors include β, the Sharpe ratio, cash holdings, payouts to shareholders, capital expenditures and also cross-product terms between the elements of the corporate focus hypothesis, all of which have received little attention in prior research. There are significant differences between firms announcing positive and negative-valued discontinued operations.

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Temporary Price Changes, Inflation Regimes, and the Propagation of Monetary Shocks

American Economic Journal Macroeconomics ◽

10.1257/mac.20180383 ◽

2020 ◽

Vol 12 (1) ◽

pp. 104-152

Author(s):

Fernando Alvarez ◽

Francesco Lippi

Keyword(s):

Price Index ◽

Price Level ◽

Consumer Price Index ◽

Monetary Shocks ◽

Scanner Data ◽

Optimal Plan ◽

Price Changes ◽

Inflation Rates ◽

Wide Range ◽

Menu Cost

We present a sticky price model that features the coexistence of many price changes, most of which are temporary, with a modest flexibility of the aggregate price level. Stickiness is introduced in the form of a price plan, namely a set of two prices: either price can be charged at any moment but changing the plan entails a menu cost. We analytically solve for the optimal plan and for the aggregate output response to a monetary shock. We present evidence consistent with the model implications using scanner data, as well as Consumer Price Index data across a wide range of inflation rates. (JEL D22, E31, E52, L11, O11, O23)

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