Bulletin of the NYU hospital for joint diseases
-
Bull NYU Hosp Jt Dis · Jan 2008
ReviewOrthopaedic anesthesia - part 1. Commonly used anesthetic agents in orthopaedics.
Anesthesia is a broad discipline; for orthopaedic applications, the type and location of the planned orthopaedic procedure is important in the selection of the most appropriate anesthetic agent and technique. The purpose of this overview is to: 1. highlight the role of several anesthetic agents commonly used in an orthopaedic setting and 2. to familiarize the orthopaedist with those techniques of regional anesthesia that have implications for emergency rooms and other ambulatory settings. Because the subject matter is expansive in scope, it is necessary to address each of the above objectives separately, in two different articles. Part 1 describes anesthetic agents, whereas Part 2 encompasses techniques of administering regional anesthesia.
-
Bull NYU Hosp Jt Dis · Jan 2008
Some concerns about adverse event reporting in randomized clinical trials.
Reporting of adverse events (AEs) in randomized clinical trials (RCTs) is often lacking and with limited application in the real world, as RCTs are of short duration, include small numbers of patients, and are selective for subjects lacking in comorbid conditions. It is not surprising that new and unexpected safety concerns emerge with any new drug after it has been launched and used by many more patients. ⋯ This article focuses on some of the shortcomings of AE reporting in RCTs, especially those involving tumor necrosis factor (TNF) inhibitors. Discussion focuses on reporting of "time-to-event" issues, use of standardized incidence ratios for comparison to normal population or disease controls, use of "patient-years" when reporting AEs, and the problem of adequate sample size and power calculations that are lacking in safety outcome data trials.
-
Bull NYU Hosp Jt Dis · Jan 2008
Predictors of mortality after hip fracture: a 10-year prospective study.
The role of medical, social, and functional covariates on mortality after hip fracture was examined over a 16-year period. A total of 1109 patients with hip fractures were included in a prospective database. The inclusion criteria were patients who were age 65 years or older, ambulatory prior to fracture, cognitively intact, living in their own home at the time of the fracture, and had sustained a nonpathological femoral neck or intertrochanteric chip fracture. ⋯ The predictors of mortality were advanced age, male gender, high American Society of Anesthesiologists (ASA)classification, the presence of a major postoperative complication, a history of cancer, chronic obstructive pulmonary disorder, a history of congestive heart failure,ambulating with an assistive device, or being a household ambulator prior to hip fracture. The increased mortality risk was highest during the first year after hip fracture and returned to the risk of the standard population 3 years postoperatively. Males who are 65 to 84 years had the highest mortality risk.
-
Bull NYU Hosp Jt Dis · Jan 2008
The effects of alcohol on in-hospital mortality in drivers admitted after motor vehicle accidents.
The effects of alcohol on morbidity and mortality following motor vehicle accidents (MVAs) are controversial. This study was performed to address the effect of alcohol on in-hospital mortality for drivers in MVAs admitted to a trauma center before and after controlling for injury severity, safety device use, and patient demographics. ⋯ These results suggest the importance of carefully considering the consequences that falsely inlated ISS scores might have for patients with alcohol present. Future work should evaluate the possible inlation of ISS and attempt to reconcile different interpreta- tions of the effects that the presence of alcohol may have on MVA mortality based by jointly considering crash site and in-hospital data.
-
Bull NYU Hosp Jt Dis · Jan 2008
Risk of injury associated with the use of seat belts and air bags in motor vehicle crashes.
Although air bags have been reported to reduce passenger mortality in frontal collisions, they have also been reported as a cause of injury in motor vehicle collisions(MVCs). The purpose of this study was to evaluate a large cohort of patients involved in MVCs to determine mortality and the pattern of injuries associated with seat belt use and air bag deployment. Information on patients involved in MVCs from 1988 to 2004 was obtained from the National Trauma Data Bank (NTDB). ⋯ Air bags and seat belts used in combination decreased the risk of potentially fatal injuries, but increased the risk of lower extremity injuries (odds ratio, 1.35). The use of any type of restraint led to a decrease in the risk of injury or mortality in MVCs. Only half of all individuals in this study used any type of restraint device, which indicates the need for significant improvements in public health and safety seat belt utilization programs.