How to Minimize Infection and Thereby Maximize Patient Outcomes in Total Joint Arthroplasty: A Multicenter Approach: AAOS Exhibit Selection.

How to Minimize Infection and Thereby Maximize Patient Outcomes in Total Joint Arthroplasty: A Multicenter Approach: AAOS Exhibit Selection.

J Bone Joint Surg Am. 2013 Apr 17; 95(8): e501-13
Illingworth KD, Mihalko WM, Parvizi J, Sculco T, McArthur B, Bitar YE, Saleh KJ

Total joint arthroplasty is one of the most common and most successful orthopaedic procedures. Infection after total joint arthroplasty is a devastating problem that expends patient, surgeon, and hospital resources, and it substantially decreases the chances of a successful patient outcome. Postoperative infection affects approximately 1% to 7% of all total joint arthroplasties, at a cost of approximately $ 50,000 per infection. Decreasing postoperative periprosthetic joint infection is of the utmost importance for the total joint arthroplasty surgeon. Preoperative, perioperative, intraoperative, and postoperative measures to minimize infection and optimize patient outcomes in total joint arthroplasty are discussed. Preoperative measures include management of patients colonized by Staphylococcus aureus, nutritional optimization, and management of medical comorbidities. Perioperative measures include skin preparation and prophylactic antibiotics. Intraoperative measures include body exhaust suits, laminar flow, ultraviolet light, operating-room traffic control, surgical suite enclosures, anesthesia-related considerations, and antibiotic-loaded bone cement. Postoperative measures include continued antibiotic prophylaxis, blood transfusions, hematoma formation and wound drainage, duration of hospital stay, and antibiotic prophylaxis for future invasive procedures. HubMed – rehab

Improving Cardiac Rehabilitation Attendance and Completion Through Quality Improvement Activities and a Motivational Program.

J Cardiopulm Rehabil Prev. 2013 Apr 16;
Pack QR, Johnson LL, Barr LM, Daniels SR, Wolter AD, Squires RW, Perez-Terzic CM, Thomas RJ

PURPOSE:: Recent studies have demonstrated that patients who attend more cardiac rehabilitation (CR) sessions have lower subsequent mortality rates than those who attend fewer sessions. METHODS:: We analyzed the impact of several phased-in policy and process changes implemented to increase patient participation in CR. In March 2010, our CR program changed from a policy of individualizing the recommended number of CR sessions per patient to a policy that recommended all 36 CR sessions. In October 2010, we introduced a 7-minute video describing the benefits of CR. In August 2011, we introduced a motivational program that rewarded patients after every sixth CR session. The number of CR sessions attended was determined through review of billing records. Enrollment and completion were defined as attending ?1 session and ?30 sessions, respectively. RESULTS:: We identified 1103 patients sequentially enrolled in CR between May 2009 and January 2012. Overall, the median number of sessions per patient improved from 12 to 20 (P < .001). Completion rate improved from 14% to 39% (P < .001). The motivational program increased attendance by a median of 3 sessions per patient (P = .04), but this effect was limited to local CR participants. Financial analysis suggested that for every $ 100 spent on motivational rewards, patients attended an additional 6.6 (95% CI, -1 to 14) sessions of CR. CONCLUSIONS:: Quality improvement activities significantly increased CR participation. Wide implementation of such programs may favorably impact patient participation in CR and potentially decrease the rate of subsequent cardiac events. HubMed – rehab

Pulmonary Rehabilitation and Interstitial Lung Disease: AIDING THE REFERRAL DECISION.

J Cardiopulm Rehabil Prev. 2013 Apr 16;
Johnson-Warrington V, Williams J, Bankart J, Steiner M, Morgan M, Singh S

BACKGROUND:: Limited evidence exists regarding the effectiveness of pulmonary rehabilitation (PR) within interstitial lung disease (ILD). Oxygen is frequently prescribed for these patients but has not been explored in the context of PR. The aim of this study was to compare short-term outcomes of PR and 2-year mortality in patients with ILD, who use home oxygen against those without oxygen. METHODS:: Using an observational cohort design and principles of comparative effectiveness research, data were collected from patients with ILD referred for a 7-week outpatient PR program. Hospital notes were reviewed, oxygen use was documented, and survival status was recorded at 2 years. Exercise capacity and quality of life were measured at baseline and discharge from PR. RESULTS:: One hundred fifteen patients were identified (96 with idiopathic pulmonary fibrosis); 43 used oxygen and 72 were nonoxygen users. Nonoxygen users improved their Incremental Shuttle Walk Test more than oxygen users (P < .05). Significant improvements were found after PR for nonoxygen users (Incremental Shuttle Walk Test 39.0 ± 54.3 m, Endurance Shuttle Walk Test 319 ± 359 seconds, Chronic Respiratory Questionnaire (CRQ)-Dyspnea 0.74 ± 0.94, CRQ-Fatigue 0.73 ± 1.15, CRQ-Emotion 0.61 ± 0.98, CRQ-Mastery 0.55 ± 1.01), whereas only Endurance Shuttle Walk Test (197 ± 287 seconds) improved for oxygen users (P < .05). Significant differences were found in survival rates between the 2 groups, 2 years after initial PR assessment (hazard ratio, oxygen users vs nonoxygen users: 2.7 [95% CI = 1.41-4.98], P = .002). CONCLUSIONS:: Oxygen users gain less from PR and have a higher mortality rate than nonoxygen users. These results should be used to aid discussion between patients and clinicians regarding referral to PR and the anticipated benefits. HubMed – rehab

Lindsay Lohan on the Late Show with David Letterman (2013) (Full Interview HD) – Lindsay Lohan on the Late Show with David Letterman on April 9, 2013.