scholarly journals Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259242
Author(s):  
Brandon J. Kelly ◽  
Benjamin R. Williams ◽  
Amy A. Gravely ◽  
Kersten Schwanz ◽  
V. Franklin Sechriest
Keyword(s):  
Femoral Head ◽  
Practice Patterns ◽  
Treatment Guidelines ◽  
Corticosteroid Injection ◽  
Institutional Care ◽  
High Rate ◽  
Systematic Evaluation ◽  
Related Factors ◽  
Femoral Head Collapse ◽  
Before And After

Introduction Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinical data and institutional care practices followed by process improvement efforts; and (2) report our results. Methods Patients receiving hip IACSI during a 27-month period underwent retrospective review to determine the rate of FHC and to identify associated patient factors or practice shortfalls. Findings led to institution-wide interventions: (1) to improve patient/provider awareness of this association; and (2) to develop/implement practice guidelines. Rates of FHC after hip IACSI and practice patterns among providers before and after intervention were compared. Results Initial FHC rate after hip IACSI was 20.4%. Patient-related factors included body mass index (p = 0.025), history of cancer therapy (p = 0.012), Vitamin D level (p = 0.030), and multiple injections (p = 0.004). Volume/dose of injectate and post-injection surveillance methods varied widely. Quality improvement (QI) intervention resulted in fewer treatment referrals (from 851 to 436), fewer repeat injections (mean = 1.61 to 1.37; p = 0.0006), and a 5% lower FHC rate (p = 0.1292). Variation in practice patterns persisted, so a systems-based Clinical Pathway was established. Discussion When a high rate of FHC after hip IACSI was found to be associated with certain patient and practice factors, introduction of education materials and treatment guidelines decreased number of referrals, number of injections per patient, and FHC rate. In the absence of the systems-based Pathway, the type, dose, and volume of injectate and post-procedure follow-up remained variable.

619 HIGH DISCOVERY RATE OF GASTRODUODENAL EOSINOPHILIA BUT NOT EOSINOPHILIC ESOPHAGITIS IN PATIENTS WITH CHRONIC GASTROINTESTINAL SYMPTOMS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Nicholas Talley ◽  
Amol Kamboj ◽  
William Chey ◽  
Henrik Rasmussen ◽  
Brian Lacy ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Gastrointestinal Symptoms ◽  
High Rate ◽  
Systematic Evaluation ◽  
Tissue Eosinophilia ◽  
Severity Scores ◽  
Gi Symptoms ◽  
Multi Center Study ◽  
Loss Of Appetite ◽  
Duodenal Biopsies

Abstract   Although the prevalence of eosinophilic gastrointestinal disorders (EGIDs) is increasing, there is evidence that eosinophilic gastritis and/or duodenitis (EG/EoD) are underdiagnosed. Patients with EG/EoD often present with chronic, non-specific gastrointestinal (GI) symptoms, similar to patients with functional GI disorders. We hypothesized that systematic evaluation, including multiple esophageal, gastric and duodenal biopsies, of patients with chronic GI symptoms might reveal a high rate of gastroduodenal eosinophila, with or without eosinophilic esophagitis (EoE). Methods We performed a prospective multi-center study of patients with non-specific GI symptoms for ≥6 months, from 20 sites. Patients completed a questionnaire assessing abdominal pain, abdominal cramping, early satiety, bloating, nausea, vomiting, diarrhea, and loss of appetite. Those with daily average symptom severity scores ≥3/10 for any single symptom underwent esophagogastroduodenoscopy (EGD) with collection of 4 esophageal (EoE), 8 gastric, and 4 duodenal biopsies, analyzed by central pathologists. Histologic criteria for EoE was ≥15eos/hpf in ≥1 esophageal site and for EG/EoD was peak eosinophil counts ≥30/hpf in ≥5 gastric hpfs and/or 3 duodenal hpfs—criteria used in randomized trials. Results Of 556 patients screened, 405 (73%) met symptom criteria and underwent EGD; 181 patients (45%, mean age 45, 73% female) who underwent EGD met the histologic criteria for EG/EoD, and of these, 7% also had EoE diagnosed. Overall 2% met histologic criteria for EoE alone. Of patients who met the histologic criteria for EG/EoD, 93% were previously diagnosed with gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), or functional dyspepsia (FD) (Figure 1). The average duration of GI symptoms in the screened population as well as those that met histologic criteria for EG/EoD was 11 years. Conclusion Forty-five percent of patients with moderate-to-severe GI symptoms who underwent EGD met histologic criteria for EG/EoD. Over 90% of these patients had previously been diagnosed with GERD, IBS, and/or FD, and had minimal overlap with EoE. EGD with systematic gastroduodenal biopsies, and intentional evaluation for tissue eosinophilia, should be performed in patients with chronic GI symptoms. Accurate diagnosis of EG/EoD is required for appropriate, targeted treatment and improved outcomes of patients with moderate-to-severe GI symptoms.

scholarly journals National Imaging and Antibiotic Practice Patterns in Children Presenting With Urinary Tract Infection to Community Practices: Little Impact From the American Academy of Pediatrics Guidelines?

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1302-1308
Author(s):  
Brian M. Inouye ◽  
Zachary R. Dionise ◽  
Ruiyang Jiang ◽  
Steven Wolf ◽  
Leigh Nicholl ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Diagnostic Imaging ◽  
American Academy ◽  
Odds Ratio ◽  
Practice Patterns ◽  
American Academy Of Pediatrics ◽  
Antibiotic Utilization ◽  
Before And After

Our objective was to use community-based, national databases to evaluate diagnostic imaging and antibiotic prophylaxis practice patterns before and after the release of the 2011 American Academy of Pediatrics guidelines for acute febrile urinary tract infection. Using the National Ambulatory and Hospital Ambulatory Medical Care Surveys, urinary tract infection encounters were identified for patients aged 2 months to 18 years. Primary outcomes were utilization of antibiotics (as proxy for prophylaxis) and diagnostic imaging during encounters. Weighted multivariate logistic regression models were used to examine the association between time period (before and after 2011) and each of the primary outcomes. Among 8 588 035 weighted encounters, adjusting for covariates, there was insufficient evidence to suggest a difference between time periods for antibiotic utilization (odds ratio = 0.66, P = .12) or diagnostic imaging (odds ratio = 1.16, P = .56). Thus, we did not find evidence of changes in antibiotic utilization or diagnostic imaging practice patterns after the release of the 2011 American Academy of Pediatrics guidelines.

Use of computed tomography to compare two femoral head and neck excision ostectomy techniques as performed by two novice veterinarians

2015 ◽  
Vol 28 (05) ◽  
pp. 295-300 ◽  
Author(s):  
M. D. O’Donnell ◽  
G. Bobe ◽  
R. P. Scholz ◽  
J. E. Wiest ◽  
S. Nemanic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Head And Neck ◽  
Clinical Setting ◽  
Ex Vivo ◽  
Bone Volume ◽  
Bone Trauma ◽  
Before And After ◽  
Bone Fragments

Summary Objectives: To compare the results of femoral head and neck excision (FHNE) ostectomy performed by two novice veterinarians using an osteotome and mallet or microsagittal saw. Methods: In this ex vivo cadaveric study, hindlimbs of eight canine cadavers were randomized to FHNE with osteotome or micro sagittal saw as performed by two recently graduated veterinarians. The hindimbs were imaged by computed tomography (CT) before and after the osteotomy. Post FHNE CT images were evaluated by a board certified radiologist blinded to the ostectomy technique for assessment of the number of bone fragments, fissures, smoothness of osteotomy margination, and volume of residual fe-moral neck. Results: Femoral head and neck excision performed with the osteotome produced more peri-ostectomy bone fragments, cortical fissures, irregular margins, and residual femoral neck volume, compared with osteotomy using a saw. Clinical relevance: Compared to FHNE performed with a sagittal saw, osteotome FHNE resulted in a greater bone trauma and residual neck bone volume, which would require post-ostectomy modification in a clinical setting.

Prediction of Femoral Head Collapse in Osteonecrosis

2005 ◽  
Vol 128 (3) ◽  
pp. 467-470 ◽  
Author(s):  
K. Y. Volokh ◽  
H. Yoshida ◽  
A. Leali ◽  
J. F. Fetto ◽  
E. Y. S. Chao
Keyword(s):  
Femoral Head ◽  
Contact Problem ◽  
Contact Pressure ◽  
Cancellous Bone ◽  
Local Buckling ◽  
Young Modulus ◽  
Head Model ◽  
Element Mesh ◽  
Femoral Head Collapse ◽  
Cortical Shell

The femoral head deteriorates in osteonecrosis. As a consequence of that, the cortical shell of the femoral head can buckle into the cancellous bone supporting it. In order to examine the buckling scenario we performed numerical analysis of a realistic femoral head model. The analysis included a solution of the hip contact problem, which provided the contact pressure distribution, and subsequent buckling simulation based on the given contact pressure. The contact problem was solved iteratively by approximating the cartilage by a discrete set of unilateral linear springs. The buckling calculations were based on a finite element mesh with brick elements for the cancellous bone and shell elements for the cortical shell. Results of 144 simulations for a variety of geometrical, material, and loading parameters strengthen the buckling scenario. They, particularly, show that the normal cancellous bone serves as a strong supporting foundation for the cortical shell and prevents it from buckling. However, under the development of osteonecrosis the deteriorating cancellous bone is unable to prevent the cortical shell from buckling and the critical pressure decreases with the decreasing Young modulus of the cancellous bone. The local buckling of the cortical shell seems to be the driving force of the progressive fracturing of the femoral head leading to its entire collapse. The buckling analysis provides an additional criterion of the femoral head collapse, the critical contact pressure. The buckling scenario also suggests a new argument in speculating on the femoral head reinforcement. If the entire collapse of the femoral head starts with the buckling of the cortical shell then it is reasonable to place the reinforcement as close to the cortical shell as possible.

scholarly journals Glasgow coma scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents

2010 ◽  
Vol 138 (3-4) ◽  
pp. 210-213 ◽  
Author(s):  
Tonka Poplas-Susic ◽  
Zalika Klemenc-Ketis ◽  
Marija Komericki-Grzinic ◽  
Janko Kersnik
Keyword(s):  
Glasgow Coma Scale ◽  
Prescription Drugs ◽  
Drug Users ◽  
Acute Poisoning ◽  
Illegal Drug ◽  
High Rate ◽  
Illegal Drugs ◽  
Coma Scale ◽  
Before And After ◽  
History Of Use

Introduction. Data on emergency interventions in poisonings are scarce. Objective. To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. Methods. A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. Results. Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p<0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p=0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p=0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p<0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p<0.001). Conclusion. High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.

scholarly journals Assessing longitudinal and cross-sectional effects of age on adult obesity in an Iranian population: results from a large population-based cohort study

2021 ◽  
Author(s):  
Mahsa Rafiee Alhossaini ◽  
Anoshirvan Kazemnejad ◽  
Farid Zayeri ◽  
Masoumeh Sadeghi
Keyword(s):  
Odds Ratio ◽  
Large Population ◽  
Significant Risk ◽  
High Rate ◽  
Noncommunicable Diseases ◽  
Public Health Issue ◽  
Related Factors ◽  
Cross Sectional ◽  
Longitudinal Effects ◽  
Prevalence Of Obesity

Abstract Background Obesity is a significant risk factor for Noncommunicable diseases, and it is related to many adverse health consequences. The risk of obesity commonly changes with age, which is called a longitudinal or aging effect. Also, individuals born or enter to the study of the same age have similar living conditions that may influence their obesity risk in a particular way; this is a cross-sectional effect. In the current study, an advanced statistical model is used to distinguish between longitudinal and cross-sectional effects of age on the risk of obesity for men and women. Methods Participants are a group of 6504 Iranian adults over 35 years of age in 2001, who live in the central region of Iran. They were followed up for 12 years in a large community-based study. Various medical indexes, including Body Mass Index, were collected in 2001, 2007, and 2013. The Marginal Logistic Regression model, which includes linear and quadratic effects of the Baseline Age and its difference with current age, is used. Results Between 2001 and 2013, the prevalence of obesity raised from 13% to 18% in men and from 31% to 44% in women. The odds of obesity for women was approximately three times the odds of obesity for men on average adjusting for the age effects. Both cross-sectional and longitudinal effects of age were significantly associated with the odds ratio of obesity. There was a rise in the prevalence of obesity for individuals with Baseline Age 35 to 55 and a decline thereafter. Also, the odds ratio of obesity across one’s life course, had about 3% increase, on average, by each year aging, regardless of the age at baseline. Conclusions The high rate of obesity and its fast growth is a serious public health issue among Iranians, especially in adults age 35-55, and women. In the present study, Baseline Age was more strongly associated with the risk of obesity than aging. Considering both cross-sectional and longitudinal effects of age, helps us to understand the effect of age on obesity better and to identify the related factors.

scholarly journals Scientometrics analysis of recent trends in Global Corona virus Research

2020 ◽  
Author(s):  
Krishnamurthy M ◽  
Bhalachandra S Deshpande ◽  
Sajana C
Keyword(s):  
Web Of Science ◽  
Recent Literature ◽  
High Rate ◽  
Research Progress ◽  
Research Papers ◽  
Medical Virology ◽  
Before And After ◽  
Virus Research ◽  
Recent Trends ◽  
Prolific Authors

Abstract Background: The worldwide pandemic COVID-19 has produced a wealth of research more rapidly after the outbreak. In just a couple of months, there is a rise in several studies on Coronavirus, adding up to the scholarly literature.Method: The current study attempts to Scientometric analyze very recent literature on Coronaviruses just before and after the outbreak. Besides, the objective of this exploration was to assess the global research progress on Coronavirus in recent times. The current research is an analytical descriptive study using Scientometrics. The study sample includes research papers about the Coronavirus indexed in Web of Science (WoS) database from January 1, 2019 to May 14, 2020. The records with topic search (includes Title, Abstract, Keywords and Keywords Plus) “coronavirus” were extracted. These data were analyzed by MS Excel and the visualizations were created using TableauResult: The results showed that 2551 scientific literature about the Coronavirus was indexed in WoS. A considerable number of these articles were published in journals such as the Journal of Medical Virology, Viruses, Nature, and Lancet. Authors from China, USA and Italy were the most prolific authors. About 47.51% articles received total of 11435 citations with an average of 9 citations, which indicates that nearly half articles were cited in another publication. The highest and lowest citations for these articles were 737 and 1, respectively.Conclusion: These results show a high rate of research on Coronavirus.

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