Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation.
The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.
To aid the burden of large dosing volumes, concentrated insulin products have been available in some form since the 1950s, albeit requiring significant and cumbersome detail in prescribing, converting doses from other products, and educating patients on how to administer. In 2015 and 2016, new concentrated products have been introduced that are available exclusively in pen devices that perform the conversion automatically, and thus, help to bypass the necessity for confusing calculations or administration. Providers and patients accustomed to traditional methods must recognize the differences and utility of these products to avoid dosing errors, as there are major differences in dosing procedures as well as their role in clinical practice. For example, the novel concentrated insulins (aside from U-500 products) are not solely indicated for severe insulin resistance. Use of novel agents may decrease the number of injections required, decrease complexity for patients and providers, reduce errors, and avoid conversion calculations. It is imperative that clinicians appreciate the nuances among the agents to choose an insulin product that is appropriate and fits a patient's needs and preferences.
Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.
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