The Bernese periacetabular osteotomy is commonly used to treat symptomatic acetabular dysplasia. Although periacetabular osteotomy is becoming a more common surgical intervention to relieve pain and improve function, the strength of clinical evidence to support this procedure for these goals is not well defined in the literature. We therefore performed a systematic review of the literature to define the level of evidence for periacetabular osteotomy, to determine deformity correction, clinical results, and to determine complications associated with the procedure. Thirteen studies met our inclusion criteria. Eleven studies were Level IV, one was Level III, and one was Level II. Radiographic deformity correction was consistent and improvement in hip function was noted in all studies. Most studies did not correlate radiographic and clinic outcomes. Clinical failures were commonly associated with moderate to severe preoperative osteoarthritis and conversion to THA was reported in 0% to 17% of cases. Major complications were noted in 6% to 37% of the procedures. These data indicate periacetabular osteotomy provides pain relief and improved hip function in most patients over short-to midterm followup.

The surgical treatment of femoroacetabular impingement has become more common, yet the strength of clinical evidence to support this surgery is debated. We performed a systematic review of the literature to (1) define the level of evidence regarding hip impingement surgery; (2) determine whether the surgery relieves pain and improves function; (3) identify the complications; and (4) identify modifiable causes of failure (conversion to total hip arthroplasty). We searched the literature between 1950 and 2009 for all studies reporting on surgical treatment of femoroacetabular impingement. Studies with clinical outcome data and minimum two year followup were analyzed. Eleven studies met our criteria for inclusion. Nine were Level IV and two were Level III. Mean followup was 3.2 years; range (2-5.2 years). Reduced pain and improvement in hip function were reported in all studies. Conversion to THA was reported in 0% to 26% of cases. Major complications occurred in 0% to 18% of the procedures. Current evidence regarding femoroacetabular impingement surgery is primarily Level IV and suggests the various surgical techniques are associated with pain relief and improved function in 68-96% of patients over short-term followup. Long-term followup is needed to determine survivorship and impact on osteoarthritis progression and natural history.

Critically ill patients are often unable to communicate, placing the onus on clinicians in ICUs to engage family members. In the United States, practice has gradually shifted toward including family members in ICU rounds (1). However, the novel coronavirus disease (COVID-19) pandemic dramatically altered hospital care in the United States. For example, early reports suggested many hospitals restricted access to visitors (2). We sought to understand changes to visitation policies and strategies used to communicate with family members because of COVID-19. We identified all hospitals with ICUs in the state of Michigan using the 2018 American Hospital Association annual survey database and by Internet searches. In early April, Michigan's statewide ICU occupancy was 71%, the fifth highest in the United States (3). Within each hospital, an ICU physician or nurse leader from a medical ICU was identified and surveyed over the telephone between April 6, 2020, and May 8, 2020. If the ICU leader was unavailable by telephone, an online survey was conducted. Participants were asked 1) whether their hospital made any changes to its visitation policy; 2) what changes were made; 3) whether their ICU had changed the way it routinely communicated with family members; and 4) what strategies their ICU was using to communicate with family members. x 2 and t tests were used to compare responding and nonresponding hospitals. All tests were two sided, with a P value of less than 0.05 considered significant. This research was deemed to be exempt from review by the University of Michigan Institutional Review Board (HUM00179422). We surveyed 49 out of 89 Michigan hospitals with ICUs (response rate = 55%). Characteristics between responding and nonresponding hospitals were similar (Table 1). All 49 responding hospitals had changes to their visitation policies because of COVID-19 (Figure 1). One hospital (2%) indicated

Background The COVID-19 pandemic resulted in unprecedented adjustments to intensive care unit (ICU) organization and care processes globally. Research Question Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting; which strategies worked well to mitigate strain as perceived by intensivists? Study Design and Methods : Between August-November 2020, we performed semi-structured interviews of intensivists from tertiary and community hospitals across six regions in the United States (U.S.) that experienced early and/or large surges of COVID-19 patients. We identified themes of hospital emergency responses using the “four S framework” of acute surge planning (i.e., Space, Staff, Stuff, System). Results 33 intensivists from 7 tertiary and 6 community hospitals participated. Clinicians across both settings felt that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly-defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and re-use were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians’ anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped maintain trust among staff. Interpretation We identified several strategies to potentially mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrates the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.

The development of patient safety culture in health care organizations is a necessary precursor to patient safety improvement. However, existing tools to measure patient safety culture are intended for implementation in hospitals. A new, abbreviated patient safety culture survey was developed for use in ambulatory health care settings. This survey was tested for content validity utilizing a panel of six experts. It had a clarity interrater agreement (IR) of 0.75, a clarity content validity index (CVI) of 0.95, a representativeness IR of 0.75 and a representativeness CVI of 0.95. The content validity analysis served as a useful tool for assessing the relevance and comprehensiveness of this survey of patient safety culture in ambulatory care organizations.

Periacetabular osteotomy (PAO) is an effective acetabular reorientation technique for treatment of symptomatic acetabular dysplasia. In hips with severe deformities, an adjunctive femoral osteotomy (PFO) may optimize correction, joint stability, and congruency. We analyzed the clinical and radiographic results of combined PAO/PFO in treating severe hip deformities. Second, we compared the clinical results of patients treated with PAO/ PFO with patients treated with isolated PAO for lesser deformities. Twenty-five patients (28 hips) treated with PAO/PFO were reviewed and followed a minimum of 16 months (mean, 44 months). The matched PAO cohort included 25 patients (28 hips). For the PAO/PFO group, the average Harris hip score improved from 60.9 to 86.3. Eighty-nine percent of the patients demonstrated at least a 10-point improvement in the hip score and 75% had a Harris hip score over 80 points. Radiographic evaluation demonstrated consistent deformity correction. The PAO/ PFO group had a lower average Harris hip score preoperatively, yet hip function after surgery was comparable between groups. These data indicate combined PAO/ PFO is associated with improved hip function in most patients. These clinical results are comparable to those obtained with isolated PAO for lesser hip deformities.

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The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: 'patient safety'; 'medical errors'; 'adverse event'; 'iatrogenic'; and truncated options for 'improve'. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.