1,749 results match your criteria: "Sinai Hospital of Baltimore[Affiliation]"

Beyond the Usual Significance: Fragility Indices of Randomized Controlled Trials in Top General Orthopaedic Journals.

J Am Acad Orthop Surg

December 2024

From the Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran (Poursalehian, Sahebi, Tajvidi, and Sabaghian), the Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran (Sahebi), the Student Research Committee, Faculty of Medicine, Abadan University of Medical Sciences, Abadan, Iran (Tajvidi), the School of Medicine, Iran University of Medical sciences, Tehran, Iran (Sabaghian), the Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran (Asgari), the Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, OH (Tabaie), the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Bhandari), the Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada (Bhandari), and the International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD (Hoveidaei).

Introduction: Understanding the reliability of outcomes in randomized controlled trials (RCTs) is crucial, as standard metrics, such as P-value do not fully capture result fragility. This led to the adoption of specific indices: the fragility index (FI), which measures the strength of trial through significant results by calculating the minimum number of patient status changes from nonevent to event required to make the results statistically insignificant; reverse fragility index (RFI), used for insignificant results; and continuous fragility index (CFI), which acts similar to FI for significant continuous outcomes. The objective is to assess the robustness of orthopaedics RCTs using these indices across leading orthopaedic journals.

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Immune cell effector therapies, including chimeric antigen receptor (CAR)-T cells, T-cell receptor (TCR) T cells, natural killer (NK) cells, and macrophage-based therapies, represent a transformative approach to cancer treatment, harnessing the immune system to target and eradicate malignant cells. CAR-T cell therapy, the most established among these, involves engineering T cells to express CARs specific to cancer cell antigens, showing remarkable efficacy in hematologic malignancies like leukemias, B-cell lymphomas, and multiple myeloma. Similarly, TCR-modified therapies, which reprogram T cells to recognize intracellular tumor antigens presented by major histocompatibility complex (MHC) molecules, offer promise for a range of solid tumors.

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Background: Osteoarthritis (OA) is the leading cause of disability among US adults and most commonly affects the knee. Guidelines for knee OA treatment include behavioral, nonpharmacological, pharmacological, and surgical interventions. While emerging knee OA treatments show promise for pain control, data gaps remain regarding the efficacy, safety, comparative effectiveness, and real-world value of treatments.

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Purpose: The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI.

Methods: We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision.

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De-escalation of dual antiplatelet (DAPT) intensity may be considered in patients with high risk of bleeding after acute coronary syndrome. Some high risk patients after de-escalation may require antithrombotic therapy prolonged over 12 months. With the current guideline recommended strategies, there are some doubts and uncertainties with respect to the transition period.

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Bone tissue engineering (BTE) has emerged as a promising approach to address large bone defects caused by trauma, infections, congenital malformations, and tumors. This review focuses on scaffold design, cell sources, growth factors, and vascularization strategies, highlighting their roles in developing effective treatments. We explore the complexities of balancing mechanical properties, porosity, and biocompatibility in scaffold materials, alongside optimizing mesenchymal stem cell delivery methods.

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Article Synopsis
  • There is currently no universal guideline on how much activity patients should restrict themselves to after total hip arthroplasty (THA), which is the surgery to replace a hip joint.
  • A systematic review analyzed various studies to see if allowing more activity post-surgery affects outcomes like implant survivorship, patient satisfaction, and ability to return to sports.
  • Results indicated that patients who were more active post-THA generally had similar or better results regarding implant longevity, and there was a positive relationship between higher activity levels and improved mental health and satisfaction, although more detailed studies are needed for concrete guidelines.
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Introduction: Many Americans fail to receive equitable access to or positive outcomes from rehabilitation services. These disparities result from broader societal inequities that disproportionately affect certain groups of people due to non-medical factors such as race, gender, education and living status. This scoping review aims to describe research papers that examine social determinants of health (SDOH) that underlie disparities in access to, use of, or outcomes related to rehabilitation (in occupational therapy, physical therapy, recreational therapy, rehabilitation medicine/physiatry and speech-language pathology) among adults in the USA.

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International Consensus Statement on Platelet Function and Genetic Testing in Percutaneous Coronary Intervention: 2024 Update.

JACC Cardiovasc Interv

November 2024

Medizinische Klinik und Poliklinik I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany; Privatklinik Lauterbacher Mühle am Ostsee, Seeshaupt, Germany.

Current evidence indicates that dual antiplatelet therapy with aspirin plus a P2Y inhibitor is essential for the prevention of thrombotic events after percutaneous coronary interventions. However, dual antiplatelet therapy is associated with increased bleeding which may outweigh the benefits. This has set the foundations for customizing antiplatelet treatments to the individual patient.

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The Efficacy of Calcium Sulfate/Hydroxyapatite (CaS/HA) Gentamicin in Osteomyelitis Treatment: A Case Series.

Antibiotics (Basel)

November 2024

International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 2125, USA.

Background: Osteomyelitis is a challenging condition caused by infection and inflammation of the bone, presenting a significant economic burden to healthcare systems. Calcium sulfate/hydroxyapatite (CaS/HA) is a bone void filler composed of 60% calcium sulfate and 40% hydroxyapatite. This case series aimed to report the efficacy and infection-related outcomes of CaS/HA combined with Gentamicin (CaS/HA-G) in treating osteomyelitis.

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Article Synopsis
  • The study focuses on soft-tissue balancing in total knee arthroplasty (TKA), emphasizing a new method called the modified pendulum knee drop (PKD) test to quantitatively assess knee stiffness rather than relying on subjective observations.
  • Eleven cadaver specimens were used in robotic-assisted TKA procedures, with some receiving cruciate-retaining and others posterior-stabilized implants, while the PKD test was applied to analyze the stiffness changes due to varying insert thicknesses.
  • An inertial measurement unit (IMU) sensor recorded the knee's range of motion and oscillation characteristics to calculate stiffness, with results averaged over multiple trials for each insert thickness tested.
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Brain Metastasis in Pediatric Patients with Osteosarcoma.

Curr Oncol

November 2024

Division of Pediatric Oncology, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Background: Brain metastases in pediatric osteosarcoma are infrequent but associated with a dire prognosis.

Methods: This retrospective study examined six pediatric patients at Johns Hopkins Hospital who developed brain metastases from osteosarcoma between April 2015 and November 2023.

Results: Median survival post-brain metastasis was 2.

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Objective:  This study aimed to determine hearing screen outcomes and identify clinical and environmental risk factors for hearing screen failure in very preterm infants at a level IV single-family room (SFR) neonatal intensive care unit (NICU).

Study Design:  We conducted a retrospective study of infants <33 weeks gestational age admitted to a level IV SFR NICU who survived to discharge and had automated auditory brainstem response results available. Demographics, antenatal and postnatal factors, and respiratory support modes and their duration were collected from the electronic medical record.

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Value-based care models are health care economic frameworks that aim to prioritize and financially incentivize quality of care, provider performance, and patient experience. The focus on value-based care metrics will undoubtedly lead to a greater weight placed on economic analyses in arthroplasty. Authors of cost analyses in arthroplasty often use the term "cost" in ways that have vastly different underlying meanings.

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Relative value units (RVUs) were first introduced by the Omnibus Budget Reconciliation Act of 1989 to standardize physician compensation based on the effort, skill, and resources required for medical services. This methodology replaced the "usual, customary, and reasonable" standard, which reduced variability in payments across providers. RVUs are comprised of physician work, practice expenses, and malpractice costs.

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Health care delivery systems throughout the United States have transitioned to a value-based care model, shifting away from a fee-for-service model to instead emphasize patient health outcomes and the quality of medical care. Social determinants of health (SDOH) have been shown to have a large impact on patient health outcomes and thus, must play an integral role in the implementation of a value-based model. This is of particular interest in the field of lower extremity joint arthroplasty, where demand is rising in conjunction with expanded access to care.

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Purpose: Cannabis refers to medications derived from the Cannabis plant. Cannabis has long been used to treat a wide range of conditions. The widespread legalization of cannabis has increased its use.

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Background: The number of revision total hip arthroplasties (THAs) is projected to reach 572,000 cases annually by 2030 in the United States. This may be attributed to the successes of primary THAs combined with an aging population, patients desire to remain active, and expanded indications for younger patients. Given the evolving nature of revision THAs, an epidemiological analysis of (1) etiologies; (2) demographics, including age and region; and (3) lengths of stay (LOSs) may minimize the gap between appropriate understanding and effective intervention.

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Background: The multiplier method is an arithmetic calculation that estimates the amount of growth remaining until skeletal maturity. When predicting lower limb length discrepancy, differences in foot height are added to femur and tibia discrepancies. Foot height multipliers have not been calculated using radiographic measurements, so it is unclear whether foot height develops at the same pace as the femur and tibia.

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Reassessing the role of aspirin in patients with coronary artery disease.

Expert Opin Pharmacother

December 2024

Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA.

Article Synopsis
  • * Ongoing research is evaluating whether aspirin can be safely discontinued in favor of P2Y receptor inhibitor therapy, but there is still no consensus on the best timing for discontinuation.
  • * New findings suggest that using P2Y inhibitors alone may pose a lower risk of bleeding, prompting a reevaluation of aspirin's role, while exploring innovative formulations and delivery methods like inhaled aspirin for improved patient care.
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Background: Older adults with non-ST-segment-elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions.

Methods And Results: We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non-ST-segment-elevation acute coronary syndrome.

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Background: The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90 days: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions.

Methods: A nationwide database was queried for primary THA patients from 2010 to 2020.

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