To investigate racial disparities in shoulder arthroplasty (SA), accounting for demographic factors such as sex and age. Methods: Data for SAs (2011)(2012)(2013)(2014) was queried from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Population-adjusted SA utilization rates, racial and sex differences by age, length of stay, insurer, and comorbidities were calculated. Results: Caucasians aged 45-64 are 54% more likely than African-Americans and 74% than Hispanics to receive surgery. For patients aged 65-84, the disparity is wider for African-Americans and narrower for Hispanics. Conclusions: Policymakers and physicians should focus on further national efforts to alleviate healthcare disparities.
Unstable slipped capital femoral epiphysis can have disastrous complications including osteonecrosis and chondrolysis. It has been shown that 20% to 80% of patients may develop a contralateral slip ≤18 months after diagnosis. The purpose of this article is to report and characterize patients who developed bilateral unstable slips. After Institutional Review Board approval, the patients included were only those with bilateral unstable slipped capital femoral epiphyses. A minimum 2-year follow-up was required. Seven patients, all female, were included in the study, with an average age of 11.4 years at the time of their first slips. The interval between slips averaged 127 days (range, 0-245 days). All but 1 patient presented with a severe slip. The second slip was also severe in 3 patients and less severe in 4 patients. The triradiate cartilage was open in 3 patients. Two patients required corrective osteotomies. Chondrolysis developed in 2 patients with no osteonecrosis reported. The incidence of bilateral unstable slips ranged from 4% to 20% of all unstable slipped capital femoral epiphyses based on our findings. Skeletal immaturity was not a risk factor. The surgeon must be vigilant for the possibility of bilateral slips. The family must be instructed on precautions patients must take while recuperating from unstable slipped capital femoral epiphyses. Contralateral fixation of the unaffected side may be warranted in patients with initial severe unstable slipped capital femoral epiphyses to prevent this condition.
The authors present proposed hypothetical protocols addressing both the prevention and treatment of acute anthrax and smallpox, as may occur in relation to bio-terrorism events or incidents. The potential bene t of additional or 'integrative' modalities with conventional allopathic approaches is discussed, with speci c emphasis on applied medical nutrition and homeopathy. An in-depth discussion of the pathophysiology of inhalation anthrax and a unique approach to intervention based on seminal research by Hanna et al. is presented; the treatment protocol includes aggressive parenteral administration of N-acetyl cysteine and other nutriceutical antioxidants, as well as inhalation therapy with L-glutathione.
<p>Minimizing blood loss in total joint arthroplasty (TJA) involves multiple interdisciplinary approaches and has experienced significant evolution over the last decade. TJA often requires post-operative blood transfusion, conferring significant risks upon TJA patients. Minimizing these risks by limiting blood loss has garnered recent interest. Variable strategies have been developed to manage perioperative bleeding, such as autologous donation, electrocautery, hemodilution, blood salvage systems, tourniquets, controlled hypotension, lower transfusion triggers, erythropoietic stimulating agents, and antifibrinolytics. This study reviews current blood loss reduction techniques and underscores the importance of antifibrinolytics and their impact on transfusion reduction. </p>
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