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Outpatient joint

Charles A DeCook
The performance of joint arthroplasty in an outpatient setting is expected to rise significantly over the coming decade, with predictions that greater than half of all primary joint arthroplasties will be performed in an outpatient setting by the year 2026. Financial pressures, bundled payment models, and improved understanding of patient recovery have led to discharging patients home the same day as the index procedure. Arthroplasty surgeons are starting to utilize ambulatory surgery centers (ASCs) to perform these outpatient arthroplasty procedures...
January 15, 2019: Journal of Arthroplasty
Carolin Winkelmann, Thomas Neumann, Jan Zeidler, Anne Prenzler, Bodo Vogt, Frank K Wacker
BACKGROUND:  Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. METHOD:  This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors...
February 14, 2019: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Allen S Chen, Vincent F Miccio, Clark C Smith, George C Christolias, Adam R Blanchard
Objective: To determine if skin wheals reduce procedural pain associated with lumbar medial branch blocks (MBBs) performed with 25-gauge needles. Design: Prospective comparative observational study. Setting: Outpatient Physical Medicine & Rehabilitation and interventional pain practice within an academic tertiary care center. Subjects: Ninety-nine consecutive patients who underwent lumbar MBBs for facet pain were included...
February 12, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Linda Wennberg, Sarah Widgren, Rimma Axelsson, Kurt Gerok-Andersson, Börje Åkerlund
AIM: To investigate at a national level the multidisciplinary team (MDT) care of patients with diabetes mellitus and foot complications. METHODS: A questionnaire was sent to all 75 Swedish hospitals with emergency departments, which were grouped according to size. RESULTS: The response rate was 92 %, 58/69 of the hospitals have a foot team. Most teams have access to an internal medicine specialist/diabetologist, podiatrist and orthotist. Fewer teams reported access to an orthopaedic surgeon and infectious diseases specialist and only half to a vascular surgeon...
February 7, 2019: Diabetes Research and Clinical Practice
Mary Ziemba-Davis, Peter Caccavallo, R Michael Meneghini
BACKGROUND: The Outpatient Arthroplasty Risk Assessment (OARA) score was designed to identify patients medically appropriate for same- and next-day discharge after surgery. The purpose of this study was to update and confirm the greater predictive utility of the OARA score in relation to American Society of Anesthesiologists Physical Status (ASA-PS) classification for same-day discharge and to identify the optimal preoperative OARA score for safe patient selection for outpatient surgery...
January 15, 2019: Journal of Arthroplasty
Katsuhiko Maezawa, Masahiko Nozawa, Takahito Yuasa, Motosi Gomi, Hironobu Sato, Munehiko Sugimoto, Kazuo Kaneko
BACKGROUND: Motor disorders are caused by orthopedic problems that are mainly related to aging. These disorders can lead to a decline of physical activity and impairment of ADL. When evaluating a patient's motor function after treatment, it is necessary to determine whether or not the level of function is age-appropriate. To investigate the influence of hip joint dysfunction on motor disorders, we determined the JHEQ and GLFS-25 scores and performed muscle strength testing in female patients with hip osteoarthritis...
January 28, 2019: Archives of Gerontology and Geriatrics
Alexander Sah
Elements of a successful comprehensive joint replacement program include preoperative education, joint class or camps, office support, and follow-up staff and systems. To meet the demand for consistent and safe outpatient joint replacement discharges, these elements must be optimized and, in many cases, enhanced beyond standard procedures. The office and staff protocols that support the outpatient joint replacement patient before and after surgery are as important as the surgery itself. There are unique consequences, or "ripple effects", of speeding patient recovery after joint replacement surgery and proceeding to early discharges...
January 8, 2019: Journal of Arthroplasty
R Michael Meneghini
No abstract text is available yet for this article.
January 9, 2019: Journal of Arthroplasty
Bryant J Webber, Alan M Flower, Sonal R Pathak, Rachael P Burganowski, Mary T Pawlak, Ryan C Gottfredson, Brian K White, James A Young
Introduction: Many epidemiologic studies have been performed in military recruit populations, but little is known about the health of those who conduct the training. This study aims to characterize the physical and mental health of a military trainer cohort. Materials and Methods: All US Air Force military training instructors (MTIs) who served between 1 October 2011 and 30 September 2016 were included in this retrospective descriptive study. All International Classification of Diseases, Ninth or Tenth Revision codes received by MTIs as inpatients or outpatients in the TRICARE system were obtained and mapped to Clinical Classifications Software levels...
January 23, 2019: Military Medicine
Arzu Atici, Ilknur Aktas, Pinar Akpinar, Feyza Unlu Ozkan
OBJECTIVE: Joint hypermobility (JH) is a clinical condition in which the joints move beyond the expected physiological range of motion. JH can be accompanied by many musculoskeletal complaints. One of the common causes of musculoskeletal pain is shoulder pain. The aim of this study was to investigate the relationship between subacromial impingement syndrome (SAIS), shoulder adhesive capsulitis (AC), and JH in patients with shoulder pain. METHODS: Patients aged between 18 and 70 years who presented at the physical medicine and rehabilitation outpatient clinic and who were diagnosed with SAIS or AC in a clinical and physical examination were included in the study...
September 2018: Northern Clinics of Istanbul
Jason Fletcher, Ezekiel S L Tan, Michael Thomas, Fraser Taylor, Devlin Elliott, Randy Bindra
BACKGROUND: Dupuytren's disease causes a flexion contracture of the hand that limits hand function and reduces quality of life. Traditional management is surgical excision which is associated with potentially serious complications. A viable alternative is collagenase Clostridium histolyticum (CCH) (Xiaflex®; Pfizer Australia) which is an effective, safe, outpatient treatment that to date has no published data in the Australian public health setting. METHODS: A prospective cohort, single centre study, enrolling 54 patients to treat 81 joints with CCH...
January 26, 2019: ANZ Journal of Surgery
William G Hamilton
Converting from an inpatient to an outpatient total joint arthroplasty program is achievable, with a concerted effort from all members of the clinical team. This paper highlights key factors that allow for a successful implementation of an outpatient center. First, consistent messaging about patient safety is crucial in helping to assuage the patient's concerns of getting an outpatient procedure, and to eliminate inpatient mentality. Next, earlier handout of prescriptions for medications, assisted devices, or web-based educational materials during preoperative preparations can also allow for a rapid home discharge...
January 7, 2019: Journal of Arthroplasty
Antje Freytag, Markus Krause, Anna Bauer, Bianka Ditscheid, Maximiliane Jansky, Sabine Krauss, Thomas Lehmann, Ursula Marschall, Friedemann Nauck, Werner Schneider, Kathleen Stichling, Horst Christian Vollmar, Ulrich Wedding, Winfried Meißner
BACKGROUND: Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care...
January 26, 2019: BMC Palliative Care
Maria Sole Chimenti, Giulia Lavinia Fonti, Paola Conigliaro, Juna Hitaj, Paola Triggianese, Miriam Teoli, Marco Galluzzo, Marina Talamonti, Barbara Kroegler, Elisabetta Greco, Roberto Perricone
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic autoimmune diseases leading to joint damage, functional limitation, and disability and are typically associated with several comorbidities. Alexithymia is a personality trait characterized by a disregulation of emotion processing and regulation of emotions that involves a dissociation of emotional and physical responses to life events. A broad association between alexithymia and symptoms as depression, inflammation, and pain has been demonstrated...
January 2019: Medicine (Baltimore)
Mija Ververs, Jesse Wambugu Muriithi, Ann Burton, John Wagacha Burton, Allison Oman Lawi
Scurvy is a relatively rare micronutrient deficiency disease that can occur among refugees dependent on food aid (1). Inadequate access to fresh fruits and vegetables in refugee camps can result in scurvy (2,3). Kakuma Refugee Camp in Kenya's Turkana District is home to 148,000 refugees, mostly from Somalia and South Sudan, who receive food assistance. In August 2017, a number of South Sudanese adolescent and young adult male refugees were evaluated at a health clinic in the camp for calf pain, chest pain, and gingival swelling...
January 25, 2019: MMWR. Morbidity and Mortality Weekly Report
Nikolaj R Milandt, Per H Gundtoft, Søren Overgaard
BACKGROUND: The diagnostic and prognostic value of unexpected positive intraoperative cultures remains unclear in diagnosing prosthetic joint infection (PJI) in THA revisions. QUESTIONS/PURPOSES: Therefore, we asked: (1) What is the clinical importance of bacterial growth in intraoperative tissue cultures taken during first-time revision of a clinically aseptic THA in terms of all-cause rerevision and rerevision for PJI specifically? (2) Is there a difference in outpatient antibiotic treatment patterns that is dependent on the number of positive intraoperative cultures? METHODS: This register-based study included all procedures reported to the Danish Hip Arthroplasty Register (DHR) as first-time aseptic loosening revisions performed during January 2010 to May 2016...
January 7, 2019: Clinical Orthopaedics and related Research
Ryuji Kawaguchi, Koji Matsumoto, Shigeo Akira, Ken Ishitani, Kazuhiro Iwasaku, Yutaka Ueda, Ryugo Okagaki, Hiroya Okano, Toshimichi Oki, Kaori Koga, Michiko Kido, Takumi Kurabayashi, Yasushi Kuribayashi, Yuichi Sato, Kaori Shiina, Yasushi Takai, Satoshi Tanimura, Osamu Chaki, Masakazu Terauchi, Yukiharu Todo, Yasuyuki Noguchi, Sayaka Nose-Ogura, Tsukasa Baba, Akira Hirasawa, Takuma Fujii, Tsuneo Fujii, Tetsuo Maruyama, Etsuko Miyagi, Kaoru Yanagida, Osamu Yoshino, Mitsutoshi Iwashita, Tsugio Maeda, Takashi Minegishi, Hiroshi Kobayashi
Six years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the third revised edition was published in 2017. The 2017 Guidelines includes 10 additional clinical questions (CQ), which brings the total to 95 CQ (12 on infectious disease, 28 on oncology and benign tumors, 27 on endocrinology and infertility and 28 on healthcare for women). Currently a consensus has been reached on the Guidelines and therefore the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate...
January 24, 2019: Journal of Obstetrics and Gynaecology Research
Silke Jankowiak, Julia Dannenmaier, Sabrina Ritter, Rainer Kaluscha, Gert Krischak
OBJECTIVE: The aim of this study was to examine which factors predict rehabilitation setting (inpatient vs. outpatient) after hospitalization in order to indicate the meaning of severity for access to a certain kind of rehabilitation. METHODS: All patients with surgery for hip or knee (joint) endoprosthesis or disc surgery between 2005 and 2010 were selected for analysis from anonymized data from statutory health insurance (AOK Baden-Württemberg) and German Pension Fund (Bund as well as Baden-Württemberg)...
January 23, 2019: Die Rehabilitation
Pietro G di Summa, Gianluca Sapino, Mario Cherubino, Giorgio De Santis, Sebastien Durand, Patrice Zaugg, Olivier Bauquis, Wassim Raffoul
BACKGROUND: We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one-stage procedure. METHODS: We performed a retrospective investigation including 21 "functional" ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment...
January 22, 2019: Microsurgery
Tom D Wilsdon, Samuel L Whittle, Tilenka Rj Thynne, Arduino A Mangoni
BACKGROUND: Psoriatic arthritis is an inflammatory disease associated with joint damage, impaired function, pain, and reduced quality of life. Methotrexate is a disease-modifying anti-rheumatic drug (DMARD) commonly prescribed to alleviate symptoms, attenuate disease activity, and prevent progression of disease. OBJECTIVES: To assess the benefits and harms of methotrexate for psoriatic arthritis in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the WHO International Clinical Trials Registry Platform, and www...
January 18, 2019: Cochrane Database of Systematic Reviews
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