Early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy: a multicentre double-blind pilot randomised controlled trial.

Objective: To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE).

Design: Double-blind pilot randomised controlled trial.

Setting: Eight neonatal units in South Asia.

Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty.

Purpose: Rhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty.

Implementation of Patient-Reported Outcome Measures for Your Practice Needs.

Patient-reported outcome (PRO) measures offer a unique opportunity to systematically incorporate patient perspectives of their health and wellbeing into treatment, view progress over time, and develop opportunities related to clinical decision support, shared decision making, and outcomes-driven payment and practice transformation. As healthcare institutions increasingly look toward adopting PRO measures in their practices, more information is needed regarding the practicalities of implementing a successful PRO program outside of the research setting. This article offers a stepwise approach to implementing a PRO program while overcoming barriers and leveraging facilitators that commonly exist in the realms of human contribution or team building, technological infrastructure, and process design.

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians.

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury.

A Clean Sweep: Initial Experience with a Novel Intracavity Laparoscopic Cleaning Device.

Background: A frequently encountered problem in laparoscopic surgery is an impaired visual field. The Novel Intracavitary Laparoscopic Cleaning Device (NILCD) is designed to adequately clean a laparoscopic lens quickly and efficiently without requiring removal from the surgical cavity. Animal and cadaver studies showed good efficacy and a short learning curve.

Chalazion in a patient with multiple myeloma treated with bortezomib.

We present a case of a woman in her early 60s with multiple myeloma who, while undergoing treatment with cyclophosphamide, bortezomib and dexamethasone (CyBorD), noticed a whitish nodular swelling on the eyelid. This occurred after one cycle of CyBorD and on subsequent treatment, it also involved the contralateral eyelid. The lesions were initially managed with conservative measures by applying warm compresses, but the lesions progressively increased in size.

Baseline renal function and adverse outcomes in pregnancies complicated by pregestational diabetes.

Objective: To examine the relationship between baseline renal function (serum creatinine, urine protein to creatinine ratio) in women with diabetes and adverse pregnancy outcomes.

Study Design: This was a retrospective cohort study of singleton pregnancies with pregestational diabetes and baseline renal function tests <20 weeks gestational age (wga) from the years 2007 to 2013. Those with baseline creatinine ≥1.

Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.

Introduction: Socioeconomic disparities for breast cancer surgical care exist. Although the aetiology of the observed socioeconomic disparities is likely multifactorial, patient engagement during the surgical consult is critical. Shared decision-making may reduce health disparities by addressing barriers to patient engagement in decision-making that disproportionately impact socioeconomically disadvantaged patients.

Financial interventions for family caregivers of individuals with chronic illness: a scoping review protocol.

Introduction: There are 53 million caregivers in the USA providing informal care for individuals with chronic illnesses. These caregivers contribute significantly to the healthcare system, yet they may experience adverse consequences due to caregiving, including financial burden. The purpose of this scoping review is to fill a research gap on understanding the nature and effect of financial interventions for family caregivers.

What Women Really Think About Breastfeeding and Breast Pumping: A Qualitative Analysis of Women Who Deliver at a Baby-Friendly Hospital.

The Baby-Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, posthospital exclusive breastfeeding (EBF) rates remain low. We aimed to analyze thoughts and attitudes toward breastfeeding at the postpartum visit among women who deliver at a Baby-Friendly hospital. Women ≥14 years who delivered a live-born infant at our center were eligible.

Five-year results of randomized bioactive versus bare metal coils in the treatment of intracranial aneurysms: the Matrix and Platinum Science (MAPS) Trial.

Background: No randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix coils to BMCs. The primary objective was to compare the rates of target aneurysm recurrence (TAR) at 12 months.

Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study.

Introduction: Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measured preoperatively with the commonly used Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) questionnaires. We aim to identify (1) the preoperative relationship between HOOS/KOOS and VR-12 scores and several demographic, psychosocial, and clinical patient characteristics and (2) the best modifiable factors for optimization, which may result in improved baseline PROs before TJR.

What Are the Uses and Limitations of Time-driven Activity-based Costing in Total Joint Replacement?

Background: With increasing emphasis on value-based payment models for primary total joint arthroplasty (TJA), there is greater need for orthopaedic surgeons and hospitals to better understand the actual costs and resource use of TJA. Time-driven activity-based costing (TDABC) is a methodology for accurate cost estimation, but its application in the TJA care pathway across institutions/regions has not yet been analyzed.

Questions/purposes: In this systematic review of studies applying TDABC to primary TJA, we investigated the following: (1) Is there variation in TDABC methodology and cost estimates across institutions? (2) Is a standard set of direct and indirect costs included across studies? (3) Is there a difference in cost estimates derived from TDABC and traditional hospital cost-accounting approaches? and (4) How are institutions using TDABC (process and outputs) with respect to the TJA care pathway?

Methods: A comprehensive search strategy was developed that included the keywords "TDABC," "time-driven activity-based cost," "THA," "TKA," "THR," "TKR," and "TJR" in the PubMed/MEDLINE, EMBASE, Web of Science, Ovid SP, Scopus, and ScienceDirect databases for articles published between 2004 and 2018 as well as extensive hand searching and citation mining.

Skilled Nursing Facility Placement Process After Total Hip and Total Knee Arthroplasty: Revised Rating System and Opportunities for Intervention.

Background: With the advent of bundled payment models, identifying high-performing skilled nursing facilities (SNFs) has become increasingly important. The goal of this study is to develop a rating system to rank SNFs within our health system and to use this system to improve the SNF discharge process at our institution.

Methods: All SNF-discharged primary total joint arthroplasty cases in 2017 at a multi-hospital academic health system were queried.

Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications.

Background: With the advent of mandatory bundle payments for total joint arthroplasty (TJA), assessing patients' risk for increased 90-day complications and resource utilization is crucial. This study assesses the degree to which preoperative patient-reported outcomes predict 90-day complications, episode costs, and utilization in TJA patients.

Methods: All TJA cases in 2017 at 2 high-volume hospitals were queried.