Whittakerpearson8574

This study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB).

Thirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed.

The mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment.

Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.Health plans develop predictive models to predict key clinical events (eg, admissions, readmissions, emergency department visits). The authors developed predictive models of admissions and readmissions for a quality improvement organization with many large government and private health plan clients. Its membership and authorization data were used to develop models predicting 2019 inpatient stays, and 2019 readmissions following 2019 admissions, based on patients' age and sex, diagnoses identified and procedures requested in 2018 authorizations, and 2018 admission authorizations. In addition to testing multivariate models, risk scores were calculated for admission and readmission for all patients in the model. The admissions model (C = 0.8491) is much more accurate than the readmissions model (C = 0.6237). Measures of risk score central tendency and skewness indicate that the vast majority of members had little risk of hospitalization in 2019; the mean (standard deviation) was 0.042 (0.074), and the median was 0.018. These risk scores can be used to identify members at risk of admission and to support proactive risk management (eg, design of health management programs). check details Different risk thresholds can be used to identify different subsets of members for follow-up, depending on overall strategy and available resources. This model development project was novel in employing authorization data rather than utilization data. Advantages of authorization data are their timeliness, and the fact that they are sometimes the only data available, but disadvantages of authorization data are that authorized services are not always actually performed, and diagnoses are often "rule out" rather than final diagnoses.Background Physician satisfaction with telehealth during the coronavirus disease 2019 pandemic is a strong indicator for future use. Validated surveys can guide improvement and future expansion of telehealth programs. Introduction This study examines physician and advanced practice provider perspectives and satisfaction using telehealth at UPMC Pinnacle and to assess key predictors of future use in ambulatory care. Methods A web-based Likert scale survey of UPMC Pinnacle physicians and advanced practice providers was conducted in May-June 2020. Cronbach's alpha was used to measure the survey's internal consistency. Crosstab analysis and multivariate regression were used to analyze the interrelationships between variables. Results A significant majority (64%) of physicians responded positively that they enjoyed telehealth video visits. A majority (65%) felt that the physician-patient relationship was unimpaired during telehealth visits, but only 29% of the respondents felt they were able to examine the patients properly. Providers who experienced good video and audio quality were 3.68 times more likely to enjoy telehealth visits (p less then 0.001, 95% confidence interval 2.05-6.61) than those with less-than-optimal video and audio quality. Logistic regression shows a strong correlation between the audio and image quality and respondents' satisfaction with telehealth. Discussion The key barriers for patients when using telehealth are perceived to be the ability to use a smartphone app, password management, or video/microphone features. For clinicians, barriers include problems with seeing and hearing on the platform. Conclusions Patient education and improvement of audio and image quality are essential for improving telehealth usage and satisfaction.Background This study aims to describe one center's experience in expanding a fetal telecardiology program through collaborative work with maternal fetal medicine (MFM) clinics with the goal of safely reaching mothers during the COVID-19 pandemic. We sought to define the extent of fetal telehealth conversion at a large fetal cardiac care center and evaluate the diagnostic accuracy for studies performed. Methods At our center, fetal telemedicine expanded from one MFM site before the pandemic to four additional sites by May 2020. A retrospective review of fetal telecardiology visits between March 15 and July 15, 2020, was performed. The chart was reviewed for confirmation of diagnosis postnatally. Results With pandemic onset, there was a large increase in the number of telemedicine visits with a total of 122 mothers seen between five MFM clinics. Fourteen mothers (11.5%) had abnormal fetal echocardiograms requiring additional follow-up, and seven mothers (5.8%) had a fetal echocardiogram suspicious for a critical congenital heart disease (CCHD). All the fetal echocardiograms suspicious for CCHD were confirmed on postnatal echocardiogram. To our knowledge, none of the normal fetal echocardiograms were found to have congenital heart disease postnatally. Conclusions In response to the COVID-19 pandemic, we rapidly transitioned to fetal telecardiology using a variety of formats. This has reduced potential infectious exposure for pregnant mothers and minimized contact between physicians without compromising diagnostic accuracy. In our experience, the expansion of a telemedicine program requires strong initial infrastructure, prior relationships with MFM providers, and appropriate training among obstetric sonographers.