No Difference in Reoperations at 2 Years Between Ceramic-on-metal and Metal-on-metal THA: A Randomized Trial.

Background: Hard-on-hard bearings for total hip arthroplasty continue to warrant analysis even though crosslinked polyethylene is performing very well. Ceramic-on-metal (CoM) has low in vitro wear and did well in an early clinical trial. We report on a prospective, randomized, multicenter investigational device trial comparing CoM with metal-on-metal (MoM).

Ezetimibe plus simvastatin for the treatment of hypercholesterolemia.

Introduction: Cardiovascular disease is a major cause of death, and hypercholesterolemia is a major risk factor. Statins, with simvastatin among the most widely used, have ample evidence demonstrating prevention of cardiovascular events and mortality. Ezetimibe is effective at improving serum lipids in combination with statins or alone, but its role has been controversial.

OATP1B1 and tumour OATP1B3 modulate exposure, toxicity, and survival after irinotecan-based chemotherapy.

Background: Treatment of advanced and metastatic colorectal cancer with irinotecan is hampered by severe toxicities. The active metabolite of irinotecan, SN-38, is a known substrate of drug-metabolising enzymes, including UGT1A1, as well as OATP and ABC drug transporters.

Methods: Blood samples (n=127) and tumour tissue (n=30) were obtained from advanced cancer patients treated with irinotecan-based regimens for pharmacogenetic and drug level analysis and transporter expression.

Hip arthroscopy in the setting of hip arthroplasty.

Purpose: Hip arthroscopy has traditionally been viewed as a hip preservation procedure performed in patients with native joint pathology. However, as the list of indications for arthroscopic hip intervention grows, further advances are expanding its use. The purpose of this systematic review was to examine existing evidence supporting the use of hip arthroscopy in the setting of hip arthroplasty.

Feasibility, effectiveness and costs associated with a web-based follow-up assessment following total joint arthroplasty.

The purpose of this study was to assess the feasibility, effectiveness and costs of a web-based follow-up compared to in-person assessment following primary total hip or total knee arthroplasty. Patients who were at least 12 months postoperative were randomized to follow-up method. We excluded patients who had revision surgery, osteolysis, complications or identified radiographic issues.

The effectiveness of superficial subcutaneous lidocaine administration prior to femoral artery sheath removal.

The dynamic world of healthcare requires continuous review of practice to ensure that patient care aligns with current evidence and best practice. Superficial subcutaneous lidocaine injection has been an order option at London Health Sciences Centre-University Hospital (LHSC-UH) for use in post-percutaneous coronary intervention (PCI) prior to femoral artery sheath removal (FASR). The purpose of administering lidocaine is to reduce pain during FASR, subsequently enhancing the patient's experience.

The Lunch Bunch: an innovative strategy to combat depression and delirium through socialization in elderly sub-acute medicine patients.

Hospitalized sub-acute medicine patients face challenges to their functional and cognitive abilities as they await transfer to long-term care facilities or return home. The Continuous Quality Improvement (CQI) Council, representing a multidisciplinary team of healthcare professionals working in the Sub-Acute Medicine Unit (SAMU), implemented a twice-weekly lunch program called the Lunch Bunch in order to combat depression and delirium in our elderly and cognitively impaired patients. The Lunch Bunch initiative includes chaplains, nurses and physiotherapists who have provided a framework through which essential socialization and exercise for this vulnerable population is facilitated.

More than just a simple swish and spit: implementation of oral care best practice in clinical neurosciences.

Suboptimal oral care is well documented in the literature and is linked to increased nosocomial pneumonia rates and prolonged hospitalization, negatively affecting patients' quality of life (Terezakis et al. 2011). A standardized approach to oral care can change these adverse outcomes.

Reducing waste in the critical care setting.

Background: The ICU at London Health Sciences Centre-University Hospital (LHSC-UH) is a 40-bed critical care unit that contains two separate supply rooms that carry all the essential materials necessary for patient care. However, considering the patient acuity in critical care, it is vital that this equipment is made more accessible for practitioners at the bedside. Therefore, nurse servers or bedside supply cabinets are present in each of the patient rooms.

The clinical utility of fMRI for identifying covert awareness in the vegetative state: a comparison of sensitivity between 3T and 1.5T.

In the last few years, mental imagery fMRI paradigms have been used successfully to identify covert command-following and awareness in some patients who are thought to be entirely vegetative. However, to date there is only evidence supporting their use at magnetic fields of 3T, which limits their applicability in clinical settings where lower field strengths are typically used. Here, we test the 'gold standard' fMRI paradigm for detecting residual awareness in non-responsive patients by comparing its sensitivity at 1.

Metal ion levels after metal-on-metal total hip arthroplasty: a five-year, prospective randomized trial.

Background: The U.S. Food and Drug Administration has requested post-market surveillance data, including data on metal ion levels, regarding metal-on-metal total hip arthroplasty.

Low dose naltrexone for induction of remission in Crohn's disease.

Background: Crohn's disease is a transmural, relapsing inflammatory condition afflicting the digestive tract. Opioid signalling, long known to affect secretion and motility in the gut, has been implicated in the inflammatory cascade of Crohn's disease. Low dose naltrexone, an opioid antagonist, has garnered interest as a potential therapy.

Fracture of Two Moderately Cross-Linked Polyethylene Tibial Inserts in a TKR Patient.

Highly cross-linked polyethylene has become the gold standard in total hip replacement for its wear resistance. Moderately crosslinked polyethylene is now available for total knee replacement (TKR), although concerns about reduced mechanical strength have prevented widespread adoption. The purpose of this report is to describe an unusual case where a patient underwent cruciate retaining TKR using a moderately crosslinked polyethylene tibial insert that went on to fracture twice in the same location across the primary and first revision surgery.

Oral and intravenous thyroxine (T4) achieve comparable serum levels for hormonal resuscitation protocol in organ donors: a randomized double-blinded study.

Background: Thyroxine (T4) administration is advocated in the management of organ donors; however, the bioavailability of oral thyroxine is unknown in this patient population.

Objective: The primary objective of this study was to compare the percentage of the study time (from study drug administration to organ procurement) that patients in the oral vs the intravenous group required inotropic support. Secondary objectives included plasma levels of T3 and T4 and number of organs donated following oral vs intravenous T4 administration.

Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position statement on the use of remote monitoring for cardiovascular implantable electronic device follow-up.

Remote monitoring (RM) is a form of telemedicine technology that permits implanted pacemakers and implantable cardioverter-defibrillators to transmit diagnostic information for review by health care professionals without patients needing to visit the device follow-up clinic. A bedside transmitter in the patient's home conveys the device data using standard telecommunication protocol to a protected internet-accessible RM data server, which authorized health care professionals can access at any time using standard web browser software. Evidence indicates it can accelerate identification of clinical events and potential device problems.

The 2012 Mark Coventry award: a retrieval analysis of high flexion versus posterior-stabilized tibial inserts.

Background: High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear.

Questions/purposes: We therefore examined whether the design changes between HF and posterior-stabilized (PS) tibial inserts would affect overall damage or damage on their articular surface, backside, and tibial post and whether flexion angle achieved related to damage.

Extraspinal findings at lumbar spine CT examinations: prevalence and clinical importance.

Purpose: To prospectively determine the prevalence and clinical importance of extraspinal abnormalities in adult outpatients undergoing computed tomography (CT) of the lumbar spine.

Materials And Methods: Institutional review board approval was obtained for this prospective study. Informed consent was obtained from 400 consecutive adult outpatients (mean age, 49 years; 212 male and 188 female patients) undergoing lumbar spine CT for low back pain and/or radiculopathy.

Incidental discovery of a membranous ventricular septal aneurysm in two dissimilar patients.

A ventricular septal aneurysm (VSA) is a rare cardiac anomaly, and an accurate statistic of its prevalence has not been reported in the literature. True incidence is likely underestimated as most patients are thought to be asymptomatic. As a result, most VSAs are discovered incidentally on echocardiography, during angiography, or at autopsy.

A randomized comparison of the GlideRite(®) Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope(®).

Purpose: A stylet is usually necessary when using the GlideScope(®) videolaryngoscope for orotracheal intubation. A special stylet, the GlideRite(®) Rigid Stylet (GRS), was designed for this purpose. A previous trial involving experienced operators showed that the GRS offered no performance improvement vs a standard malleable stylet (SMS).

Continuous EEG monitoring in severe Guillain-Barré syndrome patients.

When patients Guillain-Barré syndrome have complete paralysis clinical measures of sedation cannot be applied. In this situation continuous EEG offers a convenient, effective method of monitoring the depth of sedation, using spectral edge frequency (SEF) to quantify EEG activity. The authors report 3 patients with severe Guillain-Barré syndrome managed with sedation aimed at a SEF95 below 4.

Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest.

Background: Several predictors of poor neurologic outcome after cardiac arrest (CA) were proven to be valid. However, these studies preceded the advent of therapeutic induced mild hypothermia (TIMH), which may alter their validity. The objective of this study is to reassess the validity of these predictors in post-CA patients treated with TIMH.

Tibial tubercle osteotomy in total knee arthroplasty surgery.

Tibial tubercle osteotomy (TTO) is a recognized technique for improving exposure when performing total knee arthroplasty surgery. Forty-two patients were reviewed at a mean of 8 years after TTO. Preoperatively, mean extension was 8 degrees +/- 14 degrees , mean flexion 74 degrees +/- 30 degrees , and Knee Society score 73 +/- 37.

A broken heart: right-to-left shunt in the setting of normal cardiac pressures.

A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO.