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Around 18.5% patients underwent arthroplasty within 2 years after primary arthroscopy. Following Cox regression an existing diagnosis of osteoarthritis, ages 65-69, ages 70-74, and arthroscopies done in the West were associated with higher risk of conversion to THA within 2 years. Undergoing a repeat arthroscopy was not significantly associated with a higher risk of conversion.
Despite inconclusive clinical evidence, hip arthroscopies are being increasingly used in patients older than 65 in the Medicare population. We conclude that patients in the age bracket of 65-74 years and with a pre-existing diagnosis of osteoarthritis, arthroscopy should be approached with caution.
Despite inconclusive clinical evidence, hip arthroscopies are being increasingly used in patients older than 65 in the Medicare population. We conclude that patients in the age bracket of 65-74 years and with a pre-existing diagnosis of osteoarthritis, arthroscopy should be approached with caution.
SARS-CoV-2 is a novel coronavirus that was first isolated from a group of patients hospitalized with pneumonia in China at the end of 2019, and, in February 2020, the syndrome it caused was named coronavirus disease 2019 (COVID-19) by the World Health Organization. In the absence of specific antiviral treatments capable of neutralizing the etiological agent, one therapeutic approach is to control the cytokine storm responsible for the most severe forms of the disease. The characteristic cytokine profile of severely affected patients is increased levels of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, and tumor necrosis factor alpha (TNF-α).
This article discusses the pathogenesis of COVID-19 as a rationale for using the biological and targeted synthetic drugs used in rheumatology (anti-TNF, anti-IL-1 and anti-IL-6 agents and baricitinib) to treat the disease, and provides key information concerning their potential benefits and adverse effects.
Interleukin inhibition seems to be a promising means of treating COVID-19 patients when respiratory function declines (or even earlier) if there are laboratory data indicating the presence of a cytokine storm because the interleukins are key drivers of inflammation. However, it is important to consider the risks and benefits of biological agents carefully, and critically analyze the evidence concerning their use in COVID-19 patients.
Interleukin inhibition seems to be a promising means of treating COVID-19 patients when respiratory function declines (or even earlier) if there are laboratory data indicating the presence of a cytokine storm because the interleukins are key drivers of inflammation. However, it is important to consider the risks and benefits of biological agents carefully, and critically analyze the evidence concerning their use in COVID-19 patients.
To assess the level of glycemic control among type 2 diabetes patients on sodium-glucose cotransporter 2 inhibitor (SGLT2i) and metformin dual therapy.
Observational, retrospective database study in adult type 2 diabetes mellitus patients from the IQVIA Electronic Medical Record (EMR) database was conducted. The observation period was June 2015 to June 2018. Patient's earliest encounter in the observation period while on SGLT2i and metformin dual therapy served as the index date. Patients were required to have at least one HbA1c measure in the 12 months prior to the index date and be on SGLT2i and metformin dual therapy and no other antihyperglycemic treatment as of the HbA1c measurement date or any time during the 90 days prior. The associations between sociodemographic factors and clinical burden on achievement of HbA1c <8% were assessed using multivariable logistic regression with backward stepwise selection.
Of 3491 patients, 2176 (62.3%) achieved HbA1c <8%, with a median distance to goal of 1.1% (IQR 0.5-2.3%) for those not at glycemic target. Mean age was 56.5 years and 52.6% were male. At baseline, 28.3% of patients had established cardiovascular disease/chronic kidney disease, and of those 63.8% had HbA1c <8%. African American patients had lower odds of attaining HbA1c <8% when compared with white patients [OR 0.69], while older patients had marginally higher odds [OR 1.01].
Approximately 3 out of 5 patients on metformin and SGLT2i dual therapy achieved HbA1c <8%, with African Americans having a lower likelihood of achieving this glycemic goal.
Approximately 3 out of 5 patients on metformin and SGLT2i dual therapy achieved HbA1c less then 8%, with African Americans having a lower likelihood of achieving this glycemic goal.
Increasing demand for reliable evidence in patient care and its delivery has necessitated the development of several approaches for generating quality evidence. In particular, the solicitation of expert opinion has been recognised as a reliable data collection method. However, there are variations and limitations in study approaches using expert opinion as a method of data collection, thereby necessitating the development of a standardised, novel consensus method.
A systematic literature review was conducted to assess the characteristics of all studies utilising a "Delphi" or "Modified Delphi" methods between January 2008 and December 2018. A search framework was developed, and the review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
In total, 764 studies met the study inclusion and exclusion criteria and were included in the review. Heterogeneity on core defining characteristics of the constituent study types was observed in this ignificant modifications by successive authors over time, including ones contradicting core principles where an original method had been defined. The Jandhyala method for generating group consensus and awareness is unique in observing consensus and measuring awareness of subject matter across experts. The Jandhyala method also improves upon the traditional Delphi-style methodologies, through the introduction of new insights into awareness of subject matter in the expert group. A wider application of the Jandhyala method is required to corroborate findings from this research.This 24-mo randomized controlled trial was based on a double-blind parallel design, and it compared the effectiveness of 2 fluoride application protocols in arresting dentine caries in primary teeth. Three-year-old children with active dentine caries were recruited and randomly allocated to 2 treatment groups. Children in group A received a semiannual application of a 25% silver nitrate (AgNO3) solution followed by a commercially available varnish with 5% sodium fluoride (NaF) on the carious tooth surfaces. Children in group B received a semiannual application of a 25% AgNO3 solution followed by another commercially available varnish with 5% NaF containing functionalized tricalcium phosphate (fTCP). Carious tooth surfaces that were hard when probing were classified as arrested. Intention-to-treat analysis and a hierarchical generalized linear model were undertaken. A total of 408 children with 1,831 tooth surfaces with active dentine caries were recruited at baseline, and 356 children (87%) with 1,607 tooth savailable 5% NaF varnish without fTCP semiannually (ClinicalTrials.gov NCT03423797).Primary Objective This study explored the sibling relationship across the lifespan after acquired brain injury (ABI). Trichostatin A datasheet Research Design A qualitative approach was used to explore the perspectives of siblings with ABI and uninjured siblings. Methods and Procedures Semi-structured interviews with 19 siblings with ABI and 20 uninjured siblings (aged 6-61 years) were analyzed using reflexive thematic analysis. Main Outcomes and Results Four themes were identified Living with ABI; Being normal siblings; Being part of a family; Experiencing social stigma of ABI. ABI was a traumatic event which differentiated siblings but increased understanding helped accommodate its impact. This impact was experienced within perceptions of typical sibling relationships as involving closeness and conflict. The family context shaped relationships, with parents mediating across the lifespan, while siblings' partners and children contributed to adult sibling relationships. Finally, social stigma led to distance but also protectiveness between siblings. Conclusions The sibling relationship was experienced as a continually evolving source of closeness and conflict within the family context. ABI enhanced preexisting dynamics and created new dynamics, shaped by social attitudes toward ABI. Increased understanding of ABI supported closer relationships, highlighting a need for psychoeducational interventions across the lifespan.
Occupational therapists are experts in determining domestic assistance levels. It is a complex multi-dimensional process resulting in different opinion regarding care hours.
Therapists providing medicolegal reports on domestic care for the courts within Australia were surveyed.
58 occupational therapists responded with most aged between 41 to 50 years of age. There was a strong correlation between years of clinical and medicolegal experience (
 = 0.730,
 = 58,
 = 0.000) as well as between years and numbers of medicolegal assessments conducted in 2017 (
 = 0.264,
 = 58,
 = 0.420). Assessment based on occupational analysis interview combined observation of the claimant performing tasks in their home, medical information, and contextual factors such as family expectations. Translation of data to hours of care was based on therapist's clinical experience of medical diagnosis (x
6.89,
 = 0.009) and claimant's statements of performance combined with therapist's clinical experience (x
= 5.58,
ecision is the key to understanding clinical reasoning. Implication for rehabilitation When estimating domestic care occupational therapists should •Provide written documentation that clearly explains the assessment methods used, the results and conclusion made regarding domestic care. •Triangulate data including claimant's statements of performance, confirmation by observation on tasks, medical report information in the context of the claimant's environmental and contextual factors. •Be aware their own years of experience do not equate to level of expertise.
Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures.
52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively.
Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1 1.1; Group 2 3.00,
= 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period.