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"Lewis, Courtland"
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Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
This trial compared a restrictive hemoglobin threshold with a liberal threshold for blood transfusion among hip-surgery patients with risk factors for CVD. The liberal strategy resulted in more transfusions and did not reduce death or inability to walk independently.
In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused.
1
Blood transfusions are frequently given to surgical patients and to the elderly.
2
,
3
Yet, the indications for postoperative transfusion have not been adequately evaluated and remain controversial. Most clinical trials have been small.
4
One adequately powered trial involving adults in intensive care units showed a nonsignificant decrease in 30-day mortality with a restrictive transfusion strategy, as compared with a liberal strategy (18.7% vs. 23.3%).
5
However, the effect of a restrictive approach on functional recovery or risk of myocardial infarction in patients . . .
Journal Article
The effects of patient age on human osteoblasts’ response to Ti–6Al–4V implants in vitro
Osseointegrated implants are a common therapy for the elderly population as lifespan increases. Understanding the effects of age and sex on osseointegration is important for successful implant therapy. Therefore, the response of primary human osteoblasts (HOB) to implant materials was studied. HOBs were obtained by outgrowth of cells from bone from orthopaedic procedures and categorized as Young (Y), <15; Middle (M), 30–50; and Old (O), >60 years old. Initially the HOB phenotype was determined on tissue culture plastic. Alkaline phosphatase (ALP) staining and activity were significantly increased in HOBs from older patients. Message levels of type I collagen (COL), bone sialoprotein (BSP) and ALP were significantly higher (from 2.3- to 3.8-fold) in Y subjects compared to M and O patients at 2 weeks. Studies of the response of HOBs to implant materials were undertaken using Ti–6Al–4V disks prepared in a manner similar to orthopaedic implants. A 1.4-fold (
p<0.05) increase in cell attachment was found in HOBs from Y compared with O in female subjects but not in male subjects. Cell proliferation at 24 h was not significantly different by age or sex, nor was DNA content different at 2 and 4 weeks. Mineralization in HOB-implant cultures was 2.3-fold higher in Y than in O, and 1.7-fold higher in Y compared to M HOBs from female but not male subjects at 4 weeks. Northern blot and RT-PCR analysis at 2 weeks of culture showed significantly higher levels (1.6–2.3-fold) of COL, BSP, and osteocalcin (OC) mRNAs in Y HOBs compared to M and O HOBs from female subjects. We conclude that human osteoblasts from older female patients have a decreased ability to form bone on implants.
Journal Article
Factors That Influence Provider Selection for Elective Total Joint Arthroplasty
Background
The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients’ choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood.
Questions/purposes
We evaluated the factors patients consider when selecting an orthopaedic surgeon and hospital for TJA.
Methods
Two hundred fifty-one patients who sought treatment from either an academic or community-based orthopaedic practice for primary TJA completed a 37-item survey using a 5-point Likert scale rating (“unimportant” to “very important”) regarding seven established clinical and nonclinical dimensions of care patients considered when selecting a provider and hospital.
Result
Patients rated physician manner (average Likert, 4.7) and physician quality (eg, outcomes) (average Likert, 4.6) as most important in their selection of surgeon and hospital for TJA. Despite the expressed importance of surgeon and hospital quality, only 46% of patients were able to find useful information to compare outcomes among surgeons, and 47% for hospitals that perform TJA.
Conclusions
Our findings suggest physician manner and surgical outcomes are the most important considerations for patients when choosing a provider for elective TJA. Cost sharing is the least important criterion patients considered. Patients expressed high motivation to seek out provider quality information but indicated accessible and actionable sources of information are lacking. Future efforts should be directed at developing clinically relevant, easily interpretable, objective, risk-adjusted measures of physician and hospital quality.
Journal Article
Functional Outcome of Arthrodesis for Failed Total Knee Arthroplasty
ABSTRACT To establish the ability of a salvage procedure to restore an independent lifestyle, the SF-36 functional outcome instrument and the pain, mobility, and physical activity subscales of the Arthritis Impact Measurement Scale (AIMS) was used to assess patient function. Nine patients (10 knees) who had undergone arthrodesis for failed total knee arthroplasty were compared with a control group of successful primary total knee arthroplasty patients. Average clinical follow-up was 42 months (minimum: 24 months). For six of the eight SF-36 categories, the average scores for the arthrodesis and arthroplasty groups were similar. The average global scores for the two groups were nearly identical. The arthroplasty patients scored better on the AIMS physical activity and mobility subscales than the arthrodesis group, although the latter group fared better on the pain subscale. Overall, global scores favored the arthroplasty patients. The only subscales to show a statistically significant difference between the arthrodesis and arthroplasty groups were the SF-36 physical functioning and the AIMS physical activity subscales. This pilot study demonstrated the ability of a salvage procedure to allow for an independent lifestyle with minimal complications. Furthermore, despite its popularity, the SF-36 does not appear as sensitive as the AIMS to differences in functional status or health outcomes between total knee arthroplasty and arthrodesis patients.
Journal Article
Casuistry in the Final Frontier
Star Trek is a series of philosophical thought experiments that challenges viewers to arrive at consistent positions about some of life's toughest questions. It isn't an exaggeration to say that, with very few exceptions, Star Trek has done more to teach audiences about the nuances of reality, science, morality, and friendship than any other show in the history of television. Casuistry is a method of analysis that makes use of case studies, either real or fictional; in order to examine what should happen in similar real‐life situations. The combination of science and fiction creates three virtues that Star Trek's creative team pushes to their boundaries in order to constantly engage viewers to be active watchers and thinkers. This chapter considers two prime examples of Star Trek's use of casuistry to make tangible contributions to important philosophical discussions.
Book Chapter
Same-day outpatient TJR gains popularity, but careful considerations must be made
Trade Publication Article
