Konradsenkock3434
f knee skeletal maturity systems isolated 7 discrete radiographic knee parameters that theoretically outperform the GP bone age in estimating skeletal maturity.
We present a modified knee skeletal maturity system that can potentially preclude the need for additional imaging of the hand and wrist in reliably estimating skeletal maturity.
We present a modified knee skeletal maturity system that can potentially preclude the need for additional imaging of the hand and wrist in reliably estimating skeletal maturity.
The COVID-19 pandemic has rapidly affected all facets of everyday life including the practice of medicine. Hospital systems and medical practices have evolved to protect patients, physicians, and staff and conserve personal protective equipment and resources. Orthopaedic practices have been specifically affected by social distancing and stay at home guidelines, limiting in-office practice and elective surgery restrictions. This, in turn, has had an effect on resident education. Previous literature has been published regarding how academic programs have adjusted to these changes. However, the effects on smaller orthopaedic residencies with nonacademic faculty has not been discussed. The orthopaedic residency at Baylor University Medical Center of Dallas is a fifteen-resident program with a combination of hospital employed and private practice faculty. We adjusted our resident education in mid-March 2020 to keep residents safe while trying to maximize surgical and clinical education and outside research.
Ouso adapt to the changing environment while continuing to provide residents safe opportunities for patient care, didactic education, and research. We believe we have come up with a sustainable, adaptable model for resident education during this challenging time.
This study investigated the relationship between varying levels of preoperative anemia and postoperative complications within 30 days of total shoulder arthroplasty (TSA).
All patients who underwent TSA from 2015 to 2017 were queried from the American College of Surgeons National Surgical Quality Improvement database. Patients were categorized based on preoperative hematocrit levels normal (>39% for men and >36% for women), mild anemia (29% to 39% for men and 29% to 36% for women), and severe anemia (<29% for both men and women).
A total of 10,547 patients were included in the study. Of these patients, 1,923 patients were (18.2%) in the mild anemia cohort and 146 (1.4%) were in the severe anemia cohort. Mild anemia was identified as a significant predictor of any complication (odds ratio [OR] 2.74, P < 0.001), stroke/cerebrovascular accident (OR 6.79, P = 0.007), postoperative anemia requiring transfusion (OR 6.58, P < 0.001), nonhome discharge (OR 1.79, P < 0.001), readmission (OR 1.63, P < 0.001), and return to the surgical room (OR 1.60, P = 0.017). Severe anemia was identified as a significant predictor of any complication (OR 4.31, P < 0.001), renal complication (OR 13.78, P < 0.001), postoperative anemia requiring transfusion (OR 5.62, P < 0.001), and nonhome discharge (OR 2.34, P < 0.001).
Preoperative anemia status is a risk factor for complications within 30 days of TSA.
Preoperative anemia status is a risk factor for complications within 30 days of TSA.
Our goal was to assess the variability in the assigned duration of pediatric orthopaedic rotation among US allopathic orthopaedic residency programs to see how pediatrics is incorporated into surgical education.
Using publicly available information for US allopathic orthopaedic residency programs in 2019, we retrospectively collected data on the assigned duration of pediatric orthopaedic rotation and variables such as number and sex of residents, number of orthopaedic faculty, university- versus community-based programs, outsourcing residents to unaffiliated hospital for pediatric exposure, specialty of program leadership, and presence of pediatric orthopaedic fellowship in the home program.
One hundred thirty-eight of the 146 (95%) eligible allopathic orthopaedic residency programs provided sufficient information. The average time assigned to a pediatric rotation during residency was 6 months (range 2 to 11 months). Overall, 43/146 (29%) programs outsourced their pediatric training to another institution. A correlation was noted between the length of pediatric rotation and percentage of pediatric orthopaedic faculty (P = 0.0007, r = 0.3).
The impact of the variability in the duration of duration of pediatric orthopaedic rotation on the clinical knowledge and skills acquired by the resident during training needs further study.
The impact of the variability in the duration of duration of pediatric orthopaedic rotation on the clinical knowledge and skills acquired by the resident during training needs further study.
Most orthopaedic subinternships function as month-long interviews. These rotations remain relatively unstructured and lack standardization, and their overall educational value has been called into question. The goals of this educational initiative were to create a structured subinternship curriculum for orthopaedic applicants and to shift the focus of the subinternship from a month-long interview to an organized educational experience.
After review of knowledge and skills expected for early orthopaedic residency under the structure of the Accreditation Council for Graduate Medical Education Milestones, a curriculum dedicated to orthopaedic subinternships was created. Students who completed the curriculum filled out anonymous Likert scale evaluations (rating their comfort/knowledge from 0 to 10 before and after their rotation) and answered open-ended qualitative questions.
Forty-six subinterns participated in the program over 3 years. Four weekly learning modules were designed and taught by orthopaedic rontent of this subinternship curriculum can easily be adapted to regional and national teaching programs.
This educational initiative resulted in the successful design and implementation of a milestone-based orthopaedic surgery subinternship curriculum. The program was well received by students, contributed to learning and competency, and provided teaching opportunities for residents. The format and content of this subinternship curriculum can easily be adapted to regional and national teaching programs.The aim of this study was to evaluate discontinuation and hospitalization rates in patients with schizophrenia spectrum disorder who were treated with long-acting injectable (LAI) antipsychotics. We recorded clinical data about the period before the LAI treatment, when LAI treatment was initiated, and during the LAI treatment. Variables related to early ( less then 8 weeks) and other LAI discontinuations and hospitalization were analyzed. Out of 452 patients, 14.4% of them discontinued their LAI treatment before 8 weeks, another 24.8% of the patients stopped their LAI by themselves later. Early discontinuers were younger, had shorter duration of illness, and less educated. Sixty-two (27.2%) of the patients were hospitalized under LAI treatment and 40% of the hospitalizations occurred in initial 6 months. Rate of hospitalization was 36.1% in the group who discontinued LAI after 8 weeks. In logistic regression analysis, younger age, history of combined antipsychotic treatment, number of hospitalizations before LAI, use of LAI for less than 6 months and alcohol abuse under LAI treatment were found related to hospitalization. Our findings suggested that discontinuation and hospitalization are still common among the patients who were treated with LAI antipsychotics.
Hip fractures are common and severe conditions among older individuals, associated with high mortality, and the Nordic countries have the highest incidence rates globally. With this study, we aim to present a comprehensive picture of trends in hip fracture incidence and survival in the older Swedish population stratified by education, birth country, and comorbidity level.
This study is based on a linkage of several population registers and included the entire population over the age of 60 living in Sweden. We calculated age-standardized incidence rates for first and recurrent hip fractures as well as age-standardized proportions of patients surviving 30 and 365 days through the time period 1998 to 2017. Midostaurin molecular weight We calculated all outcomes for men and women in the total population and in each population stratum.
Altogether, we observed 289,603 first hip fractures during the study period. Age-standardized incidence rates of first and recurrent fractures declined among men and women in the total population and in each educational-, birth country-, and comorbidity group. Declines in incidence were more pronounced for recurrent than for first fractures. Approximately 20% of women and 30% of men died within 1 year of their first hip fracture. Overall, survival proportions remained constant throughout the study period but improved when taking into account comorbidity level.
Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.
Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.
Metaphyseal fracture healing in the distal femur requires a stable biomechanical environment. The presence of arthritis-induced coronal-plane knee deformities can cause deviation of the mechanical axis, which results in asymmetric loading and increased bending forces in fractures of the distal femur metaphysis. This predisposes patients to nonunions or loss of fixation. Concurrent TKA during revision osteosynthesis might facilitate fracture healing, owing to its ability to correct coronal alignment, thereby restoring normal loading patterns at the fracture site, but to our knowledge, this has not been studied.
(1) Does TKA with concurrent revision internal fixation achieve fracture union in patients with coronal-plane deformity from knee arthritis and nonunion or loss of fixation in distal metaphyseal femoral fractures? (2) What is the survivorship and what are the short-term functional outcomes after these reconstructions? (3) What complications occur after these reconstructions?
Between 2015 and 2018, distal metaphyseal femur nonunion and loss of fixation in the setting of coronal-plane deformity induced by knee arthritis. Short-term TKA survival and improvement in patient mobility are excellent, although 4 of 16 patients in this report experienced complications, as one might expect with a procedure of this magnitude. Based on our results, correction of arthritis-induced coronal-plane knee malalignment can be considered part of the surgical strategy when treating such distal metaphyseal femur nonunions. Better preoperative evaluation of the deformity and control-based comparative studies can further validate the utility of this technique.
Level II, therapeutic study.
Level II, therapeutic study.
