OBJECTIVES: Increase parent/caregiver ability to correctly identify the attending in charge and define terminology of treatment team members (TTMs). We hypothesized that correct TTM identification would increase with use of an electronic communication tool. Secondary aims included assessing subjects’ satisfaction with and trust of TTM and interest in computer activities during hospitalization. METHODS: Two similar groups of parents/legal guardians/primary caregivers of children admitted to the Pediatric Hospital Medicine teaching service with an unplanned first admission were surveyed before (Phase 1) and after (Phase 2) implementation of a novel electronic medical record (EMR)-based tool with names, photos, and definitions of TTMs. Physicians were also surveyed only during Phase 1. Surveys assessed TTM identification, satisfaction, trust, and computer use. RESULTS: More subjects in Phase 2 correctly identified attending physicians by name (71% vs. 28%, P < .001) and correctly defined terms intern, resident, and attending (P ≤ .03) compared with Phase 1. Almost all subjects (>79%) and TTMs (>87%) reported that subjects’ ability to identify TTMs moderately or strongly impacted satisfaction and trust. The majority of subjects expressed interest in using computers to understand TTMs in each phase. CONCLUSIONS: Subjects’ ability to correctly identify attending physicians and define TTMs was significantly greater for those who used our tool. In our study, subjects reported that TTM identification impacted aspects of the TTM relationship, yet few could correctly identify TTMs before tool use. This pilot study showed early success in engaging subjects with the EMR in the hospital and suggests that families would engage in computer-based activities in this setting.
The final version of the above article was posted prematurely on 16 July 2021, owing to a technical error. The final, corrected version of record will be made fully available at a later date.
Purpose To describe a surgical technique in correcting valgus deformity during total knee replacement and evaluate mediumterm clinical outcomes. Methods This was a retrospective consecutive series of total knee replacement for severe valgus deformity of patients who underwent a lateral ligament complex release with a sliver osteotomy of the lateral femoral condyle with a minimum 1-year follow-up and recording objective and patient-reported outcome measures. Results Twenty-three patients (25 knees) were included with median follow-up of 5 years (range 1-15 years) and average age 67.7 years (range 43-87). The primary diagnosis was osteoarthritis in 14 patients (61%) and inflammatory arthritis in 9 patients (39%). At final follow-up, the median mechanical tibiofemoral angle was restored to 4° (range 2-7) compared with a median valgus of 20° (range 13-30) preoperatively. This was statistically significant (P < 0.00001). Median Oxford Knee Score at final follow-up was 43 (range 36-48) indicating satisfactory outcomes. There were no revisions for any cause with a mean arc range of movement 110° (range 85-120). ConclusionThis study shows that a technique utilising the familiar medial parapatellar approach, staged soft tissue releases, and a novel sliver lateral femoral condylar osteotomy with intact periosteum to release the lateral ligament complex leads to satisfactory medium-term outcomes, improved range of movement and patients' reported outcome measures. Sliver osteotomy is a useful technique in correcting valgus deformity in total knee replacements at medium-term follow-up. Level of evidence IV.
Stage length and perforation cluster spacing are important design parameters for multi-stage hydraulic fracturing. This study aims to demonstrate that the interplay between subtle variations of the least principal stress (Shmin) with depth and the stress shadows induced by simultaneously propagating hydraulic fractures from multiple perforation clusters, primarily determines the propped and fractured area in the target formations. This principle is illustrated with the help of a case study in a prolific unconventional formation in the north eastern US, where the vertical stress variations are well characterized through discrete multi-depth stress measurements and actual stage design parameters used by the operator are known. At first, we show how the hydraulic fracture footprint and proppant distribution varies with a change in the vertical stress profile. The stress profile is shown to be a very important in determining the optimal vertical and lateral well spacing. The evolution of the stress shadow in the different layers is shown during the pumping as the fracture propagates across multiple layer boundaries. Subsequently, we demonstrate that by changing the magnitude of stress perturbations caused by the stress shadow effect, the distribution of propped area can be altered significantly. We use this method to determine the optimal cluster spacing keeping other design parameters constant such as flow rate, perforation diameter, etc. Simulations from selected cluster spacing realizations are run with high and low permeability scenarios to show the importance of correct matrix permeability inputs in determining the three-dimensional depletion profile and ultimate production. By varying the cluster spacing we show the hydraulic fracture propagation change from being solely stress layering driven to stress shadow influenced. The effect of stress shadow on the final fracture footprint is highly specific depending on the given stress layering and is thus case-dependent. This study demonstrates that knowledge of stress variations with depth and modeling are critical for optimizing stimulation efficiency.
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