J Am Acad Orthop Sur
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J Am Acad Orthop Sur · Mar 2007
ReviewOphthalmologic complications associated with prone positioning in spine surgery.
Visual impairment and blindness associated with general anesthesia and prone positioning in spine surgery have been increasing in incidence over the past several decades. Corneal abrasion, the most common ophthalmologic injury, is usually self-limiting. However, prolonged surgical procedures (>7 hours) associated with acute blood loss anemia, hypotension, and hypoxia may lead to posterior ischemic optic neuropathies. ⋯ Cortical blindness usually improves to varying degrees. Effective treatment of perioperative amaurosis is lacking and usually ineffective, making prevention the cornerstone of management. To best prevent permanent ophthalmologic complications associated with prone positioning during spine surgery, orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options.
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Achieving a balanced diversity in orthopaedic residency programs is a critical component in improving the quality of orthopaedic care delivered to all patients. Compared with the demographics of medical school classes, women are notably underrepresented in orthopaedic residency programs, and racial and ethnic minority groups are unevenly represented. Diversifying residency programs positively affects all residents and their ability to deliver care and create positive physician-patient relationships.
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J Am Acad Orthop Sur · Jan 2007
Racial and ethnic disparities in hip and knee joint replacement: a review of research in the Veterans Affairs Health Care System.
Elective total joint arthroplasty is an effective treatment option for end-stage osteoarthritis of the hip and knee. The demand for arthroplasty is anticipated to increase as the proportion of older patients with hip and knee osteoarthritis continues to rise in the United States and worldwide. ⋯ Most of the studies on racial and ethnic disparities in joint arthroplasty utilization have been based on data from the Medicare database. However, Veterans Administration-based studies have recently confirmed these findings and have indicated potential patient-level factors, such as patient perception of and familiarity with joint arthroplasty, that may play a role in this disparity.
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J Am Acad Orthop Sur · Jan 2007
Current activities in orthopaedic culturally competent care education.
Culturally competent care education, which involves educating physicians on being sensitive to the diverse characteristics and traits of each patient (eg, race, ethnicity, sex, faith background), is vital for the well-being of all patients. All medical disciplines are grappling with the best way to provide culturally competent care education. The Diversity Advisory Board of the American Academy of Orthopaedic Surgeons is charged with advancing diversity in the field of orthopaedic surgery. ⋯ In 2006, the AAOS developed the Cultural Competency Challenge CD-ROM, followed in 2007 by the Culturally Competent Care Guidebook, a companion to the CD-ROM. Culturally competent care legislation has been enacted in California and New Jersey, and legislation is pending in Arizona, Illinois, New York, and Texas, making these resources even more timely. To best care for all patients, each physician must be aware of his or her own identity and be sensitive to the unique realities of each patient with whom the physician comes into contact.
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The prevalence, incidence, and severity of osteoarthritis are different in women than in men. Women are more likely than men to suffer from osteoarthritis,and women experience more severe arthritis in the knee. ⋯ Additionally, women are three times less likely than men to undergo hip or knee arthroplasty. Patient education, particularly for women, must be improved so that women with osteoarthritis who are candidates for hip and knee arthroplasty not only receive treatment but also receive it in a timely manner.