Is there a role of calprotectin testing in the diagnosis of surgical site infections after total hip and knee arthroplasty? A preliminary study.

Background: Recent studies have revealed the usefulness of synovial calprotectin (CLP) in diagnosing chronic periprosthetic joint infections (PJIs). However, there is still a lack of evidence to support the use of serum CLP in the diagnosis of early PJIs and surgical site infections (SSIs) after total joint arthroplasties (TJAs).

Objectives: The primary aim of this study is to investigate the standard kinetics of CLP concentrations in the blood during the very early postoperative period after non-complicated total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Lateral or Medial Parapatellar Surgical Approach to the Valgus Osteoarthritic Knee? A Retrospective Single-Center Study.

Aims: Total knee arthroplasty in patients with fixed valgus deformity is a demanding procedure. The aim of this study was to compare the clinical results of using the lateral approach [LA] versus the medial approach [MA] in the treatment of fixed valgus knee deformities. Methods: This single-center study compared the results of 143 consecutive patients with fixed valgus deformity (mean 21.

Efficacy of intravenous tranexamic acid administration in revision hip arthroplasty.

Background: This study aimed to evaluate the efficiency of constant dose intravenous administration of tranexamic acid (TXA) in reducing postoperative blood loss, hemoglobin (Hb) concentration, and the number of transfusions in revision hip arthroplasty (RHA).

Methods: The study included 145 consecutive patients who had undergone RHA: a TXA group (75 patients) who received two doses of TXA (1.0 g 15 min before skin incision and 1.

Development of Subspecialty-Specific Reporting Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S.

Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for internal medicine subspecialties in 2014 but quickly recognized that they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts used an iterative consensus building process between December 2017 and February 2019 to draft new RMs and create a supplemental guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators.

Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S.

Context: A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education.

Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced.

Introduction: The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs.

Material And Methods: In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.

Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States.

Context: Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be "entrusted" to practice without supervision. A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define Hospice and Palliative Medicine (HPM) EPAs.

Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System.

Background: The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants.

Materials And Methods: Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.

The use of calcium carbonate beads containing gentamicin in the second stage septic revision of total knee arthroplasty reduces reinfection rate.

Background: The aim of the study was to analyze effectiveness and safety of packing the medullary canal of the tibia and femur with Herafill (Heraeus Medical GmbH, Wehrheim, Germany), a void filler and antibiotic carrier, during second stage revision total knee arthroplasty (TKA) for periprosthetic joint infection (PJI).

Methods: Two groups were formed of 28 consecutive patients during second stage revision TKA, comparable for gender and age. The study group received Herafill, while the control group did not.

Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis.

Introduction: Correct restoration of the joint line is generally considered as crucial when performing total knee arthroplasty (TKA). During revision knee arthroplasty however, elevation of the joint line occurs frequently. The general belief is that this negatively affects the clinical outcome, but the reasons are still not well understood.

One-stage total knee arthroplasty with pre-existing fracture deformity: post-fracture total knee arthroplasty.

The aim of the study was to assess the results of treating knee osteoarthrosis with total knee arthroplasty (TKA) after previous tibia and/or femur fractures resulting in axial limb deformities. Thirty-six knees (34 patients) were operated on. At the most recent follow-up, 4.

Palliative medicine referral in patients undergoing continuous renal replacement therapy for acute kidney injury.

Background: Referral patterns for palliative medicine consultation (PMC) by intensivists for patients requiring continuous renal replacement therapy (CRRT) have not been studied.

Methods: We retrospectively analyzed clinical data on patients who received CRRT in a tertiary referral center between 1999 and 2006 to determine timeliness and effectiveness of PMC referrals and mortality rate as a surrogate for safety among patients receiving CRRT for acute kidney injury.

Results: Over one-fifth (21.

Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center.

Background: Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined.

Methods: Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period.

[Usefulness of HA+beta-TCP in bone defects repair during revision hip and knee arthroplasty].

Background: Bone deficiency can present a surgical challenge during revision total hip and knee arthroplasty. The amount of bone grafts available for surgical purposes is insufficient. Synthetic bone substitutes can eliminate the risk of infection transmission.

[Total hip arthroplasty after previous support proximal femoral osteotomy].

Clinical outcome and technical difficulties observed after total hip arthroplasty (THA) subsequent to support proximal femur osteotomy were studied in 6 total hip arthroplasties. 6 patients were follow up at an average 6.2 years after THA.

[Scorpio TS prosthesis in severe deformity and revision knee arthroplasty--preliminary report].

Authors present early results of Scorpio TS prosthesis in primary and revision total knee arthoplasty due to aseptic and septic loosening. 26 arthroplasties were performed on 25 patients. There were 19 women and 6 men of age from 37 to 80 (average 68.

Improved pain resolution in hospitalized patients through targeting of pain mismanagement as medical error.

Current strategies to reduce excess pain among hospitalized patients remain inadequate. New, effective approaches are urgently needed. In this prospective observational study of a performance-improvement intervention, we studied the effect of computer-generated, real-time alerts used by nurses on the rate of a medical error in pain management defined as lack of reassessment within 120 minutes from the last observation of severe pain.

[Modular short-stem prosthesis in total hip arthroplasty--preliminary report].

Total hip arthroplasty has become one of the most succesful procedure in orthopaedic surgery. More and more active, young patients undergo primary hip replacement. Bone stock preservation is crucial when performing THR in this group of patients.

Fentanyl-induced neurotoxicity and paradoxic pain.

A patient with pain associated with metastatic leiomyosarcoma received escalating doses of opioids. Upon discontinuation of intravenous morphine, transdermal fentanyl was initiated, and after several days, the dose was increased to 200microg/hour for persistent, severe pain. The patient became somnolent, and further dose adjustments and route change were carried out.

Ketamine: an introduction for the pain and palliative medicine physician.

A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed.

"Nobody understands": on a cardinal phenomenon of palliative care.

In the clinical practice of palliative medicine, recommended communication models fail to approximate the truth of suffering associated with an impending death. I provide evidence from patients' stories and empiric research alike to support this observation. Rather than attributing this deficiency to inadequate training or communication skills, I examine the epistemological premises of the biomedical language governing the patient-physician communication.

Palliative educational outcome with implementation of PEACE tool integrated clinical pathway.

Background: House officers frequently lack basic competency in end-of-life care. Few studies have evaluated educational interventions deliberately utilizing physicians' learning strategies, particularly in the context of a concomitant effort at modification of practice patterns.

Study Design: Prospective controlled trial utilizing pre-intervention and post-intervention cross-sectional surveys.