No evidence was found that public reporting (OP-8) reduced MR imaging rates for low back pain without conservative therapy in either Medicare or commercially insured populations in hospital or nonhospital settings.
Background Influenza virus is the most common cause of influenza‐like illness (ILI) in adults. In Argentina, studies on influenza and other respiratory viruses were performed mostly in pediatric populations.
Objectives To determine: (1) the frequency of influenza virus and other common respiratory viruses in adult outpatients with ILI, (2) whether the signs and symptoms predict viral etiology, (3) whether viral diagnosis changes clinical management or infection control measures and (4) to characterize the influenza strains circulating in the community.
Population and methods Nasal and pharyngeal swabs from adult outpatients with ILI attending the emergency room during the winter seasons of 2004 and 2005 in Argentina were evaluated by immunofluorescence and RT‐PCR.
Results Of 151 samples analyzed, 39 (26%) were influenza A positive, 5 (3·3%) influenza B positive and 4 (2·6%) respiratory syncytial virus positive by immunofluorescence. Two samples (1·3%) were human metapneumovirus positive by RT PCR. Cell culture detected six additional influenza viruses and one adenovirus positive sample. The sensitivity of immunofluorescence for influenza compared with culture was 70%. Symptoms did not predict etiology.
Conclusions In this study, 40% of the patients with ILI had a specific viral infection and 83% were influenza viruses. Viral detection was necessary to determine the etiology as signs and symptoms were not different between patients with or without viral infection. Viral diagnosis was important to implement infectious control measures. Circulating influenza strains in this study were similar to the correspondent vaccine strains selected for the Southern hemisphere.
Background
Physical therapy (PT) is an accepted standard of care after total joint arthroplasty (TJA) and essential to maximizing joint functionality and minimizing complications that lead to readmission. However, evidence-based guidelines about appropriate post-discharge rehabilitative care are not well-defined in the orthopedic literature.
Purposes
We sought to determine the average timing for receiving PT rehabilitation and to evaluate the association between PT rehabilitation timing and unplanned readmission within 90 days of a TJA patient being discharged home from acute care.
Methods
This retrospective study examined 11, 545 joint procedures using claims data for the years 2008 to 2013. Outcomes were assessed using a population-averaged approach to regression models.
Results
The average time for initiating PT was 4 days for knee arthroplasty and 6 days for hip arthroplasty in patients discharged home from acute care. Most patients (89%) began PT consultation or supervised exercises during the first week after discharge. The type of joint surgery considerably modified the effect of rehabilitation timing on the likelihood of readmission. Later initiation of rehabilitation was associated with a higher probability of 90-day readmission in both knee and hip arthroplasty, with the effect of rehabilitation timing being more pronounced in hip rather than knee arthroplasty 2 weeks post-discharge from acute care.
Conclusions
Timing for initiating PT may be an important modifiable factor that can affect readmission in patients discharged home from acute care after TJA. Further exploration of the role of PT timing along with other factors such as dosage and frequency among such patients is needed.
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