No abstract

Study Design Retrospective cohort study Objective The aim of this study was to determine the incidence of and risk factors for persistent opioid use after elective cervical and lumbar spine procedures and to quantify postoperative healthcare utilization in this patient population. Methods Patients were retrospectively identified who underwent elective spine surgery for either cervical or lumbar degenerative pathology between November 1, 2013, and September 30, 2018, at a single academic center. Patients were split into 2 cohorts, including patients with and without opioid use at 180-days postoperatively. Baseline patient demographics, underlying comorbidities, surgical variables, and preoperative/postoperative opioid use were assessed. Health resource utilization metrics within 1 year postoperatively (ie, imaging studies, emergency and urgent care visits, hospital readmissions, opioid prescriptions, etc.) were compared between these 2 groups. Results 583 patients met inclusion criteria, of which 16.6% had opioid persistence after surgery. Opioid persistence was associated with ASA score ≥3 (P = .004), diabetes ( P = .019), class I obesity ( P = .012), and an opioid prescription in the 60 days prior to surgery ( P = .006). Independent risk factors for opioid persistence assessed via multivariate regression included multi-level lumbar fusion (RR = 2.957), cervical central stenosis (RR = 2.761), and pre-operative opioid use (RR = 2.668). Opioid persistence was associated with higher rates of health care utilization, including more radiographs ( P < .001), computed tomography (CT) scans (.007), magnetic resonance imaging (MRI) studies ( P = .014), emergency department (ED) visits (.009), pain medicine referrals (P < .001), and spinal injections ( P = .003). Conclusions Opioid persistence is associated with higher rates of health care utilization within 1 year after elective spine surgery.

No abstract

No abstract

The operating characteristics of wafer production facilities are extremely dynamic, driven by short product life cycles, rapid equipment obsolescence and recurring layout expansion. These factors also have an impact on the design of the Automated Material Handling System (AMHS). The AMHS must be able to react and accept change as rapidly as the production process dictates. The AMHS design engineer faces a significant challenge in that modeling efforts must be proactive and anticipate the longterm requirements of a given facility.There are, of course, several methods available for addressing this issue. This paper will point out the limitations to these methods when applied to AMHS modeling and propose an alternative.Specifically, behavioral trends from historical data can be exploited when appropriate. Simulation results from legacy designs may prove to be an efficient indicator of the validity of new designs.

Background: Stiffness and mid-flexion instability (MFI) is a recognized complication of mechanically aligned (MA) total knee arthroplasty (TKA). Kinematic alignment (KA) has been proposed as a means by which to restore normal joint motion following TKA and potentially avoid stiffness and MFI. Several studies have documented improved function with KA when compared to MA. The aim of this study was to determine if revising MA TKAs failed for either MFI or stiffness into KA resolves MFI, achieves better range of motion, and improves clinical outcomes. Methods: A retrospective, single surgeon review was performed. All consecutive TKAs revised from MA into KA for MFI (def: >5 mm opening between 10° and 45° of flexion) or stiffness (def: flexion ≤90°) between January 2017 and May 2021 were included. The constitutional limb alignment of the operated knee was “reverse engineered” by measuring the coronal alignment of the contralateral healthy knee or pre-operative x-rays. Femoral Rotation was set at 3 degrees internal to the trans epicondylar axis. All coronal and sagittal angles were digitally measured on pre- and post-operative long leg and maximum flexion radiographs (minimum 12 month follow-up). The Knee Society Score (KSS) and range of motion assessments were collected preoperatively and at final follow-up. Comparisons between groups were done with a paired T test. Significance was set at p < 0.05. Results: Seven patients were included. Two were male, the mean age was 70.1 years (±9.3), mean follow-up was 32 months (±26). Three patients were revised for MFI and 4 for stiffness. Constitutional limb alignment was restored within 2 degrees for all patients. The mean total KSS gain was 65.9 (±18.1). The total KSS was significantly improved in all patients (p < 0.001). The mean maximum flexion gain was 30 deg (±23°) (p = 0.01). MFI was absent in all patients. Conclusion: In a limited series of patients, revision of stiff or unstable TKA from MA to KA resulted in improved range of motion by 30° on averages, resolved instability without the use of constrained liners, improved clinical outcomes with a mean gain of 75 points on the KSS, and restored constitutional limb alignment within 2 degrees in all patients. As these short term results are promising, further study is warranted.

No abstract

The financial burden of pursuing a medical education continues to grow, with the average medical student now owing over $240,000 in total student loan debt by the time they graduate. This burden peaks at a time when trainees are making some of the most consequential decisions of their careers. Additionally, many students are simultaneously making important financial decisions related to personal aspirations, all before a drastic change in earning potential once they begin practicing as attending physicians. Medical trainees’ financial stress is linked to specialty choice, mental quality of life, and physician burnout, with additional implications of such stress for patient health and safety. 1 – 3 Despite these issues, there are few examples of medical schools providing direct personal finance education to their students. Given the lack of personal finance education opportunities for medical students, the authors designed and implemented a medical student–specific personal finance curriculum at their home institution in conjunction with the Association of American Medical Colleges’ (AAMC) Financial Information, Resources, Services, and Tools program. The curriculum, which is primarily delivered through interactive lectures, covers topics ranging from the basics of saving and investment to clinicians’ potential future roles as administrators and innovators. The authors (1) present details regarding the creation of their personal finance education program; (2) invite fellow medical trainees and their respective institutions to start their own personal finance education programs or add similar curriculum to their health sciences coursework; and (3) call for recommendations by the American Medical Association (AMA) and AAMC in support of formal personal finance instruction for medical students on a national level.