Introduction: Weight-bearing protocols for rehabilitation of lower extremity fractures are the gold standard despite not being data-driven. Additionally, current protocols are focused on the amount of weight placed on the limb, negating other patient rehabilitation behaviors that may contribute to outcomes. Wearable sensors can provide insight into multiple aspects of patient behavior through longitudinal monitoring.
View Article and Find Full Text PDFBackground: There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery.
View Article and Find Full Text PDFCurr Opin Anaesthesiol
August 2020
Purpose Of Review: The unique demands of modern anesthesia practice require that medications be effective, well tolerated, and efficient. These attributes are increasingly achieved with the soft drug approach, wherein novel active compounds are specifically designed to be susceptible to rapid biotransformation to inactive metabolites. The present review summarizes the historical background and recent trends in soft drug development in anesthesiology.
View Article and Find Full Text PDFWe have developed a real-time graphical display that presents anesthetic pharmacology data (drug effect site concentrations (Ce) and probability of anesthetic effects including hypnosis, loss of response to tracheal intubation), improving a previous prototype. We hypothesized that the use of the display alters (1) clinical behavior of anesthesiologists (i.e.
View Article and Find Full Text PDFAudiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group.
View Article and Find Full Text PDFTo study the impact of anesthesia opioid-related outcomes and acute and chronic postsurgical pain, we organized a multicenter study that comprehensively combined detailed perioperative data elements from multiple institutions. By combining pre- and postoperative patient-reported outcomes with automatically extracted high-resolution intraoperative data obtained through the Multicenter Perioperative Outcomes Group (MPOG), the authors sought to describe the impact of patient characteristics, preoperative psychological factors, surgical procedure, anesthetic course, postoperative pain management, and postdischarge pain management on postdischarge pain profiles and opioid consumption patterns. This study is unique in that it utilized multicenter prospective data collection using a digital case report form integrated with the MPOG framework and database.
View Article and Find Full Text PDFObjectives: To compare 3 common techniques for assessing femoral malrotation through a response analysis.
Methods: Ten intact human cadaveric pelvis-to-knee specimens were used to create a fracture model. A mobile C-arm x-ray system was used to capture images of an intact control femur and a contralateral test femur on each specimen.
Gene variants may contribute to individual differences in the experience of pain and the efficacy and reward of treatments. We explored gene variation in opioid-naïve and opioid-consuming patients undergoing elective lower extremity total joint replacement. We focused on 3 gene pathways including prostaglandin, gamma-aminobutyric acid (GABA)-ergic reward, and hepatic metabolism pathways.
View Article and Find Full Text PDFOpioid consumption and addiction are increasing worldwide, yet the USA stands out for its high addiction rates and opioid-related deaths. Considering that patient characteristics are comparable across western countries, physicians' prescribing modalities may influence opioid consumption. We conducted a pilot study to examine opioid-related beliefs and prescription habits of Dutch and American physicians.
View Article and Find Full Text PDFThe purpose of this study was to compare failure and complication rates associated with short cephalomedullary nail vs long cephalomedullary nail fixation for stable vs unstable intertrochanteric femur fractures. This study included 201 adult patients with nonpathologic intertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1.1-3, 31-A2.
View Article and Find Full Text PDFObjective: To determine if an open, semi-extended, parapatellar tibial nailing technique (SEK) imparts any undue knee symptoms/pain compared with the traditional infrapatellar tibial nailing technique (FK).
Design: Randomized controlled trial.
Setting: Level 1 trauma center.
Opioids may influence inflammation. We compared genes associated with pain and inflammation in patients who consumed opioids (3-120 mg of oral morphine equivalents per day) with those who did not for differential expression. White blood cells were assayed in 20 patients presenting for total lower extremity joint replacement.
View Article and Find Full Text PDFBackground: In the United States intertrochanteric and pertrochanteric fractures occur at a rate of more than 150,000 cases annually. Current standard of care for these fractures includes fixation with either a cephalomedullary nail (CMN) or a sliding hip screw (SHS). The purpose of this study was to compare failure and medical complications of intertrochanteric femoral fractures repaired by CMN or SHS.
View Article and Find Full Text PDFObjective: In orthopaedic trauma, patients' functional status scores cannot be collected before injury. Due to the lack of these data, it is difficult to reliably determine if patients have returned to their preinjury level of physical function. The goal of this article is to determine if patients' assessment of preinjury function agrees with that of familiar proxies, to determine whether patient assessment of preinjury function may be regarded as reliable.
View Article and Find Full Text PDFObjectives: To better characterize operative agreement and disagreement among orthopaedic surgeons treating lateral compression type 1 (LC-1) pelvic fractures in an effort to improve communication between care providers and improve patient care.
Design: Decision analysis.
Setting: Level 1 trauma center.
Purpose: Patient-reported outcomes are important to assess effectiveness of clinical interventions. For orthopaedic trauma patients, the short Musculoskeletal Function Assessment (sMFA) is a commonly used questionnaire. Recently, the Patient-Reported Outcome Measurement Information System (PROMIS) PF Function Computer Adaptive Test (PF CAT) was developed using item response theory to efficiently administer questions from a calibrated bank of 124 PF questions using computerized adaptive testing.
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