Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2020
What Is the Financial Impact of Orthopaedic Sequelae of Intravenous Drug Use on Urban Tertiary-care Centers?
Orthopaedic sequelae such as skin and soft-tissue abscesses are frequent complications of intravenous drug use (IVDU) and comprise many of the most common indications for emergency room visits and hospitalizations within this population. Urban tertiary-care and safety-net hospitals frequently operate in challenging economic healthcare environments and are disproportionately tasked with providing care to this largely underinsured patient demographic. Although many public health initiatives have been instituted in recent years to understand the health impacts of IVDU and the spreading opioid epidemic, few efforts have been made to investigate its economic impact on healthcare systems. The inpatient treatment of orthopaedic sequelae of IVDU is a high-cost healthcare element that is critically important to understand within the current national context of inflationary healthcare costs. ⋯ Level, IV, economic and decision analyses.
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Clin. Orthop. Relat. Res. · Oct 2020
Comparative StudyIs Surgical Resection of the Primary Site Associated with an Improved Overall Survival for Patients with Primary Malignant Bone Tumors Who Have Metastatic Disease at Presentation?
The management of primary malignant bone tumors in patients with metastatic disease at presentation remains a challenge. Although surgical resection has been a mainstay in the management of nonmetastatic malignant bone tumors, there is a lack of large-scale evidence-based guidance on whether surgery of the primary site/tumor improves overall survival in malignant bone tumors with metastatic disease at presentation. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Oct 2020
Meta AnalysisDoes the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis.
Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Oct 2020
Multicenter StudyWhat Is the Accuracy of Three Different Machine Learning Techniques to Predict Clinical Outcomes After Shoulder Arthroplasty?
Machine learning techniques can identify complex relationships in large healthcare datasets and build prediction models that better inform physicians in ways that can assist in patient treatment decision-making. In the domain of shoulder arthroplasty, machine learning appears to have the potential to anticipate patients' results after surgery, but this has not been well explored. ⋯ Three different commercially available machine learning techniques were used to train and test models that predicted clinical outcomes after aTSA and rTSA; this device-type comparison was performed to demonstrate how predictive modeling techniques can be used in the near future to help answer unsolved clinical questions and augment decision-making to improve outcomes after shoulder arthroplasty.
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Clin. Orthop. Relat. Res. · Oct 2020
Minimum Clinically Important Differences of the Hospital for Special Surgery Dysphagia and Dysphonia Inventory and Other Dysphagia Measurements in Patients Undergoing ACDF.
Postoperative dysphagia is a common complication after anterior cervical surgery, and it can be measured using patient-reported outcome measures (PROMs). The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a condition-specific PROM to evaluate dysphagia and dysphonia after anterior cervical discectomy and fusion (ACDF). The minimum clinically important difference (MCID) of the HSS-DDI has not, to our knowledge, been established. Other PROMs have been used to assess dysphagia (SWAL-QOL and MD Anderson Dysphagia Inventory [MDADI]) in ACDF. Currently, few studies have addressed the MCIDs of these PROMs. ⋯ Level III, therapeutic study.