Background Google Glass has been used in a variety of medical settings with promising results. We explored the use and potential value of an asynchronous, near-real time protocol-which avoids transmission issues associated with real-time applications-for recording, uploading, and viewing of high-definition (HD) visual media in the emergency department (ED) to facilitate remote surgical consults. Study Design First-responder physician assistants captured pertinent aspects of the physical examination and diagnostic imaging using Google Glass' HD video or high-resolution photographs. This visual media were then securely uploaded to the study website. The surgical consultation then proceeded over the phone in the usual fashion and a clinical decision was made. The surgeon then accessed the study website to review the uploaded video. This was followed by a questionnaire regarding how the additional data impacted the consultation. Results The management plan changed in 24% (11) of cases after surgeons viewed the video. Five of these plans involved decision making regarding operative intervention. Although surgeons were generally confident in their initial management plan, confidence scores increased further in 44% (20) of cases. In addition, we surveyed 276 ED patients on their opinions regarding concerning the practice of health care providers wearing and using recording devices in the ED. The survey results revealed that the majority of patients are amenable to the addition of wearable technology with video functionality to their care. Conclusions This study demonstrates the potential value of a medically dedicated, hands-free, HD recording device with internet connectivity in facilitating remote surgical consultation.
Total hip arthroplasty (THA) is a common surgical procedure in the elderly. Varying degrees of cognitive impairment (CI) are frequently seen in this patient population. To date, there has been no systematic review of the literature specifically examining the impact of CI on outcomes after elective THA. The aim of this systematic review was to identify studies that compare the postoperative outcomes of patients with and without CI after undergoing elective primary THA. Design: We conducted a systematic review of prospective and retrospective studies. A systematic literature review was conducted by searching MEDLINE, PubMed, and Embase from between January 1, 1997 and January 1, 2018. A total of 234 articles were reviewed and 22 studies were selected. Setting: Operating room and short-term and long-term postoperative recovery up to 2 years. Patients: Patients with CI who underwent an elective primary THA that required general anesthesia with a comparator group of patients who did not have dementia. Interventions: Patients who underwent elective primary total hip arthroplasty. Measurements: Outcomes included post-operative delirium (POD), mortality and other complications, discharge disposition, length of stay (LOS), mortality, short-term (30 days) and long-term (1 month-2 years) complications. Main results: 22 studies with 5,705,302 participants were included in the systematic review. Sample sizes varied greatly, ranging from 14 to 2,924,995 participants. There was an association between patients with CI and an increase in POD, in-hospital mortality, complications during hospitalization, non-routine disposition, LOS, mortality between 1 month to 2 years, and worse postoperative functional status. Conclusions: We demonstrate that there are strong associations between patients with pre-existing CI undergoing THA and increased POD, hospital mortality, hospital complications, and hospital LOS. We report good quality evidence linking complications after THA to preexisting CI. Screening for CI can improve care and better predict the risk of developing postoperative complications such as delirium. Further investigations can address perioperative factors that can help reduce complications and show the utility of more widespread assessment of preoperative cognitive impairment.
ABSTRACT! BACKGROUND: An understanding of the relationship between patient factors and healthcare
Introduction:To evaluate the body of evidence on the predictive value of preoperative cognitive impairment on in-hospital, short-term, and midterm postoperative outcomes for elderly patients undergoing total knee arthroplasty (TKA).Significance:With an aging population, an increasing percentage of the U.S. patient population will be living with cognitive impairment. There is currently no systematic review that assesses postoperative outcomes of patients with mild cognitive impairment (MCI) or preexisting diagnosis of dementia while undergoing elective primary TKA.Results:A database search between January 1, 1997, and November 1, 2017 in EMBASE, MEDLINE, and PubMed was conducted to identify articles that compared postoperative outcomes after TKA between patients aged 60 years with and without cognitive impairment. Cognitive impairment included preexisting diagnosis of dementia or MCI identified during preoperative assessment. Eligible articles were selected using dual reviewer and third-party arbitrator. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 6163 abstracts were screened. Only 11 full text articles met inclusion criteria, including 1 case–control, 5 prospective cohort, and 5 retrospective cohort studies. Two studies were of poor quality. Overall, there is moderate strength of evidence for increased risk of postoperative delirium, increased length of stay, and discharge to health-care facility among patients with preoperative MCI or preexisting dementia. The body of evidence is weak for other outcomes of interest including mortality, functionality and complications while in-hospital and in the short- and midterm.Conclusion:This review highlights the need for additional good quality studies to provide more information about MCI and dementia as risk factors in primary TKA.
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