No abstract

Further research is needed to establish quantifiable associations between hepatitis C and postoperative complications among patients with the disease who undergo total joint arthroplasty.

No abstract

Preoperative narcotic use is the most significant patient specific risk factor for prolonged postoperative narcotic use. POUs and PPUs are at a significantly higher risk of postoperative infection and revision surgery.

Electroconvulsive therapy (ECT) is a safe and effective treatment for mood disorders (1,2) and schizophrenia. (3) The mechanism of ECT is not completely understood but is likely to involve changes in cerebral noradrenaline, serotonin and dopamine activities, permeability of the blood-brain barrier and neurogenesis. (4) Common side effects include headache, myalgia and transient cognitive impairment, (5) with an estimated mortality rate of 2.4 per 100,000 treatments. (6) Many surveys have been conducted in several countries and regions worldwide, reflecting that ECT practice is highly heterogeneous. (7) For instance, in Europe and Australia, (8)(9)(10)(11) ECT is primarily used for the treatment of depression, while in Asia, it is also frequently used for psychotic disorders (12)(13)(14)(15) and high suicide risk. (16) The United States and most Asian countries use bitemporal ECT, (7,(17)(18)(19)(20) while in Europe and Australia, the most prevalent electrode placement is right unilateral. (7,21) While this information is valuable, specific data on ECT parameters (e.g. pulse width), anaesthetic technique, methods of dosing, monitoring of ECT outcomes and credentialing is still lacking. For this reason, we developed a questionnaire exploring detailed information about ECT practice. This survey was conducted in Singapore to provide insights into current ECT practice and identify areas for future clinical improvement.Singapore is a small nation state at the tip of the Malaysian archipelago. It has a population of approximately 5.5 million people consisting of 74.3% ethnic Chinese, 13.3% Malays and 9.1% Indians. The average per capita gross domestic product in 2015 was USD 53,947.93. (22) The lifetime prevalence of depression in Singapore is 5.8%, with a 12-month prevalence of 2.2% (23) and mean annual cost of treatment of USD 7,638. (24) Treatment of depression is estimated to give a 5.7-to-1 benefit-tocost ratio. (25) While equivalent figures for schizophrenia are not available in Singapore, it is widely accepted that the economic burden of schizophrenia is significant, estimated between 0.02% and 1.65% of gross domestic product. (26) ECT is a highly effective short-term treatment for depression and should be considered for patients who have not responded to standard antidepressant therapy. (27) There are currently 26 general hospitals and specialist centres, of which 12 offer specialist psychiatry services. (28) ECT was introduced in Singapore in 1947; (29) however, ECT practice has been little studied since then. Data on Singapore has been included in general Asian surveys on ECT practice, (18,30,31) and suggests that the usage of ECT for schizophrenia in Singapore decreased in 2000-2009 and that continuation ECT was performed by some centres in Singapore. Another survey published in 1992 examined the

No abstract

A high rate of patients lost to follow-up is a common problem in orthopedic trauma surgery. This adversely affects the ability to produce accurate clinical outcomes research. The purpose of this project was to (1) evaluate the rate of loss to follow-up at an academic level I trauma center; (2) identify the patient-reported reasons for loss to follow-up; and (3) evaluate the efficacy of a routine patient callback program. All patients who underwent surgery in the orthopedic trauma division of the University of Virginia Medical Center from April 1, 2014, to September 30, 2014, and did not complete their postoperative clinic follow-up were analyzed. The characteristics of these patients were evaluated, and the primary reason for not completing the recommended follow-up was identified. All patients were then offered additional orthopedic follow-up at the time of contact. Of the 480 patients who met the inclusion criteria, 41 (8.5%) failed to complete the recommended postoperative follow-up course. The most common reason for being lost to follow-up was feeling well and not having the need to be seen (46.3%). Only 6 (14.6%) of the 41 patients requested follow-up care at the time of contact. The lost to follow-up rate in this study, 8.5%, was considerably lower than that previously reported, but patient characteristics were consistent with those of prior studies on this subject. The low lost to follow-up rate may reflect a difference in geographic location or patient population. The patient callback program had a low yield of patients requesting additional follow-up after being contacted. [Orthopedics. 2017; 40(2):e312-e316.].

CON programs appear to have influenced the delivery of care for TKA. Although our data suggest that these laws are associated with lower per capita utilization of TKA and the use of higher-volume facilities, we were unable to detect any strong evidence that CON regulations have been associated with improved quality of care or have limited growth in the utilization of this procedure over time. Confounding population and geographic factors may influence these findings and further study is needed to determine whether or not these programs have served their purpose and should be retained.