Austin Orthopedics is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of orthopedics & muscular system. The renowned editorial team ensures a balanced, expert assessment of the articles published with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in all areas of orthopedics.
Austin Orthopedics accepts original research articles, review articles and short communication covering all aspects of orthopedics for review and possible publication.
Austin Orthopedics strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
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Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
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Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1âyr or less) in 177 patients over the age of 60âyr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1âyr after hip fracture was 12.43%, and the mean age was 77.77âyr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90âyr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1âyr has a high-risk potential, especially for male patients over 71âyr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Winner of the Richard O'Connor Research Award from the Arthroscopy Association of North America 2017. This study demonstrates major improvement in the outcome of ACL reconstruction when an extra-articular procedure (ALL reconstruction) is also performed. The full manuscript is published in AJSM. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI (Scientific ACL NeTwork International) Study Group
Presentation by Dr Adnan Saithna, Professor of Orthopedic Surgery, Kansas City University, delivered at American Academy of Orthopedic Surgeons Annual Meeting 2020. This presentation reports that professional athletes are at higher risk of septic arthritis after ACL reconstruction than recreational athletes
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
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Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
Â
Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1âyr or less) in 177 patients over the age of 60âyr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1âyr after hip fracture was 12.43%, and the mean age was 77.77âyr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90âyr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1âyr has a high-risk potential, especially for male patients over 71âyr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Winner of the Richard O'Connor Research Award from the Arthroscopy Association of North America 2017. This study demonstrates major improvement in the outcome of ACL reconstruction when an extra-articular procedure (ALL reconstruction) is also performed. The full manuscript is published in AJSM. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI (Scientific ACL NeTwork International) Study Group
Presentation by Dr Adnan Saithna, Professor of Orthopedic Surgery, Kansas City University, delivered at American Academy of Orthopedic Surgeons Annual Meeting 2020. This presentation reports that professional athletes are at higher risk of septic arthritis after ACL reconstruction than recreational athletes
Lecture given by Dr Saithna, Orthopedic Surgeon, Overland Park, Kansas on his latest research related to knee and shoulder injuries, including: Anterior cruciate ligament (ACL), ACL repair, ACL reconstruction, ACL rehabilitation, Rotator cuff and Long head of biceps injuries
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
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To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Medicine Science (Med-Science) is an international open access journal which published by Society of TURAZ BÄ°LÄ°M in English language, peer-reviewed electronic journal dealing with General Medicine.
PDF, Full-Text Articles http://www.medicinescience.org
Medcrave - Long term follow up of regnauldâs procedureMedCrave
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We performed a retrospective study to assess the long-term outcome of regnauldâs procedure, as originally described by Regnauld [1], for the treatment of hallux valgus. This procedure includes the treatment of hallux limitus, hallux rigidus and hallux valgus with associated degenerative joint disease.
Case-control Study on 2nd Hammertoe Deformity Correction TechniquesWenjay Sung
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This is my case-control study on second hammertoe deformity correction techniques: arthroplasty, arthrodesis, and interpositional implant arthroplasty.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
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SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patientâs clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Lecture given by Dr Saithna, Orthopedic Surgeon, Overland Park, Kansas on his latest research related to knee and shoulder injuries, including: Anterior cruciate ligament (ACL), ACL repair, ACL reconstruction, ACL rehabilitation, Rotator cuff and Long head of biceps injuries
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
Â
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Medicine Science (Med-Science) is an international open access journal which published by Society of TURAZ BÄ°LÄ°M in English language, peer-reviewed electronic journal dealing with General Medicine.
PDF, Full-Text Articles http://www.medicinescience.org
Medcrave - Long term follow up of regnauldâs procedureMedCrave
Â
We performed a retrospective study to assess the long-term outcome of regnauldâs procedure, as originally described by Regnauld [1], for the treatment of hallux valgus. This procedure includes the treatment of hallux limitus, hallux rigidus and hallux valgus with associated degenerative joint disease.
Case-control Study on 2nd Hammertoe Deformity Correction TechniquesWenjay Sung
Â
This is my case-control study on second hammertoe deformity correction techniques: arthroplasty, arthrodesis, and interpositional implant arthroplasty.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
Â
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patientâs clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
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Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P Œ .001) and 34
(P Œ .001) respectively; the average Quick DASH decreased by 29 (P Œ .001). Average range of motion
was improved by 35 (P Œ.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Fractures that occur against the background of osteoporosis represent a global medical and social problem. In elderly people, 90% of hip fractures, as international studies have shown, occur against the background of osteoporosis. According to WHO, it is the fractures of the proximal femur that put osteoporosis on the 4th place among all causes of disability and mortality.
EVALUATION OF THE EFFICIENCY OF BISPHOSPHONATES IN THE TREATMENT OF OSTEOPORO...indexPub
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Osteoporosis (OP) is a widespread metabolic disease of the skeleton, leading to decreased bone strength and increased risk of fractures. OP is a disease of varying nature that affects all age groups, but is most common in older people. For a long time, doctors did not have serious tools to treat this insidious disease and mainly dealt with its consequences - fractures.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
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Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Assessment of Musculoskeletal complications for Immobilized Stroke Patients a...iosrjce
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IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Austin Journal of Robotics & Automation is an international scholarly, peer review, Open Access journal, initiated with an aim to promote the research in Robotics & Automation, which deals with design, construction, operation, and application of robots.
Austin Journal of Robotics & Automation is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials).
Austin Journal of Robotics & Automation supports the scientific modernization and enrichment in Robotics & Automation research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary technology.
Austin Journal of Multiple Sclerosis & Neuroimmunology is an open access, peer review Journal publishing original research & review articles on aetiology, epidemiology, and pathogenesis of inflammatory demyelinating diseases of the central nervous system. Austin Journal of Multiple Sclerosis & Neuroimmunology is aimed to provide a strong platform for challenging cases that includes but not excludes the damage of insulating covers of both central nervous system and spine. It is a grounding platform for all neurologists, neuroimmunologists, neurovirologists, researchers, medical doctors, health professionals, scientists, and scholars to publish their research work & update the latest research information.
Topics include but not limited to Clinical Neurology, Biomarkers, Glial, Myelin Chemistry, Neuroimaging, Neuropathology, Neuroepidemiology, Therapeutics, Genetics/Transcriptomics, Experimental Models, Pathobiology, Neuroimmunology, Neuropsychology, Neurorehabilitation, Pathobiology of the Brain, Psychology, Measurement Scales, Teaching, and Neuroethics.
Austin Journal of Multiple Sclerosis & Neuroimmunology supports the scientific transformation and fortification in Medical and Clinical research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Austin Leukemia is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Leukemia.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Leukemia. Austin Leukemia accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Leukemia.
Austin Leukemia strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Autism & Related Disabilities is a developmental disorder that affects the brain's normal development of social and communication skills. It is also known as a complex developmental disability. Austin Journal of Autism & Related Disabilities is an open access, peer reviewed scholarly journal committed to publication of unique contributions concerned with Autism & Related Disabilities.
Austin Journal of Autism & Related Disabilities accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of Autism & Related Disabilities.
Austin Journal of Asthma: Open Access is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Asthma.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Asthma. Austin Journal of Asthma: Open Access accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Asthma.
Austin Journal of Asthma: Open Access strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Austin Journal of Anesthesia and Analgesia is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of anesthesiology and pain management.
The aim of the journal is to provide a forum for anesthesiologists, researchers, physicians, and other health professionals to find most recent advances in the areas of anesthesiology. Austin Journal of Anesthesia and Analgesia accepts original research articles, review articles, case reports and rapid communication on all the aspects of anesthesiology and pain management.
Austin Journal of Anesthesia and Analgesia strongly supports the scientific upgradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Journal of Accounting, Audit and Finance Management is a peer reviewed open access journal in publishes manuscripts from all the areas of accounting, accountancy, finance, auditing.
Austin Journal of Accounting, Audit and Finance Management Original Articles, Review, Discussion, Editorials, Letter, type of manuscripts from all the areas of the accounting, accountancy, finance, auditing.
Austin Virology and Retrovirology is an international scholarly peer reviewed Open Access journal, aims to promote the research in the field of Virology.
Austin Virology and Retrovirology is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Case Reports, Short Communications, Perspectives (Editorials), Clinical Images
Austin Virology and Retrovirology supports the scientific modernization and enrichment in virology research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Austin Journal of Urology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Urology.
The aim of the journal is to provide a forum for urologists, nephrologists, research scholars, physicians, and other healthcare professionals to find most recent advances in the field of Urology.
Austin Journal of Urology accepts original research articles, review articles, case reports and short communication on all the aspects of Urology and relevant basic science issues.
Annals of Thyroid Research is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of thyroid hormones and thyroid diseases and their interaction with the cardiovascular system, pulmonary system, gastroenteron system, metabolic and nervous systems. The journal also focuses upon all the thyroid disease symptoms and treatments, including hyperthyroid and hypothyroid, plus a range of other thyroid problems including thyroid cancer.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Annals of Thyroid Research accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of all related aspects of thyroid hormones and thyroid diseases.
Austin Journal of Robotics & Automation is an international scholarly, peer review, Open Access journal, initiated with an aim to promote the research in Robotics & Automation, which deals with design, construction, operation, and application of robots.
Austin Journal of Robotics & Automation is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials).
Austin Journal of Robotics & Automation supports the scientific modernization and enrichment in Robotics & Automation research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary technology.
Austin Journal of Orthopedics & Rheumatology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Orthopedics.
The aim of the journal is to provide a forum for orthopedicians, researchers, physicians, and other health professionals to find most recent advances in the areas of Orthopedics.
Austin Journal of Orthopedics & Rheumatology accepts original research articles, review articles, case reports and rapid communication on all the aspects of Orthopedics and its related areas.
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
The aspire of the journal is to present a platform for scientists and academicians all over the world to encourage, distribute, and discuss various new issues and developments in different areas of Pediatrics and to promote responsible and balanced debate on controversial issues that influence child health, including non-clinical areas such as ethics, law, surroundings and economics.
Austin Pediatrics accepts innovative research articles, review articles, case reports and rapid communication on all the aspects of Pediatrics.
Austin Pediatrics is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of science and practice of Pediatrics.
Austin Otolaryngology is an open access, peer review journal publishing original research & review articles in all the fields of Otolaryngology. Otolaryngology deals with the study of ear, nose and throat. Austin Otolaryngology provides a new platform for students to publish their research work & update the latest research information in Otolaryngology.
Austin Otolaryngology is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Otolaryngology supports the scientific modernization and enrichment in Otolaryngology research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Clinics in Oncology Research is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of oncology.
The journal aims to promote latest information and provide a forum for oncologists, doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of oncology. Clinics in Oncology Research accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of oncology.
Clinics in Oncology Research strongly support the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Austin Journal of Obesity & Metabolic Syndrome is an international scholarly peer reviewed Open Access journal, aims to promote the research in all the related fields of Metabolic Syndrome.
Austin Journal of Obesity & Metabolic Syndrome is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Journal of Obesity & Metabolic Syndrome supports the scientific modernization and enrichment in Metabolic Syndromes research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Austin Journal of Nutrition and Food sciences is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of nutrition and food sciences
The aim of the journal is to provide a forum for dietitians, researchers, physicians, and other health professionals to find most recent advances in the areas of clinical nutrition and nutritional disorders.
Austin Journal of Nutrition and Food sciences accepts original research articles, review articles, case reports and rapid communication on all the aspects of internal medicine.
Austin Journal of Clinical Neurology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of neurology, neurophysiology and stroke.
The aim of the journal is to provide a forum for neurologists, researchers, physicians, and other health professionals to find most recent advances in the areas of clinical and experimental neurology. Austin Journal of Clinical Neurology accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of clinical neurology and nervous system diseases.
Austin Journal of Clinical Neurology strongly supports the scientific upgradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Journal of Clinical Neurology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of neurology, neurophysiology and stroke.
Austin Journal of Musculoskeletal Disorders is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system. The Journal focuses upon all the related aspects of musculoskeletal system disorders and the new advancements in the related treatments including Complex issues and injuries involving the musculoskeletal system and surgeries.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Musculoskeletal Disorders accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system.
Austin Hypertension is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Hypertension.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Hypertension. Austin Hypertension accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of hypertension.
Austin Hypertension strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
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The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.Â
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctorsâ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
 Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratoryÂ
 to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
Â
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
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painless and functioning joints which would necessitates a
multidisciplinary team (MDT) approach [4].
Though surgery isnât usually needed in the early stages of the
disease, early referral for surgical evaluation especially for patients
who are not responding well for medical treatment or having
increasing deformity, would benefit the patients [4,10,20]. Surgical
treatment for rheumatoid wrist in the early stages tends to be mainly
symptomatic as synovectomy and tendon transfer, while in more
advanced cases a salvage procedure as arthrodesis (partial/complete)
or arthroplasty would be needed [10]. One third of patients would
undergo at least one surgery along the course of the disease with total
joint arthroplasty being the commonest [21].
The aim of this review was to search the literature for evidence
comparing outcomes and complications between arthroplasty (joint
replacement) and arthrodesis (joint fusion) in treating elderly with
advanced rheumatoid arthritis of the wrist, then to critically appraise
the evidence, and at the end to assess how the evidence could be
implemented in the treatment of these patients. A foreground
question was used, as it was meant to influence clinical decision, and it
was structured according to the Population Intervention Comparison
Outcome (PICO) framework [22] âWould wrist arthroplasty as
compared to wrist arthrodesis for treatment of advanced rheumatoid
arthritis in the elderly, result in better functional and clinical
outcomes?â (Table 1).
Paper 1 Paper 2
Research question Not clear Not clear
P
Patients with advanced
rheumatoid arthritis of the
wrist
ALL patients with
advanced RA of the wrist
between 1997-2001
I Arthrodesis Arthroplasty
C Arthroplasty Arthrodesis
O
- Pain
- Motion
- Complications
- Satisfaction
- DASH
- PRWE
- Patient satisfaction
Table 1: PICO model.
Key words used (in titles) MEDLINE (Ovid) Pub Med
Wrist 5850 6424
Rheumatoid or RA 51850 54846
Arthrodesis or fusion 32088 34669
Arthroplasty or replacement 60932 65016
Add all the above 9 10
Limit to English 9 10
Last 20 years (1993) 5 6
Table 2: Search terms.
Paper 1 Paper 2
Number
Total 1363 51
Arthrodesis 860 24
Arthroplasty 503 27
Age
Arthrodesis 57.2 years 52 years
Arthroplasty 55.8 years 51 years
Gender
Arthrodesis F/M: 79% F/M: 16/6
Arthroplasty F/M: 79% F/M: 27/0
Follow up At least 1 year (average 4.5) 1-5 years
Inclusion
-Primary data
-Human
-English language publication
-Mean follow-up 1 yr
-80% of patients with RA
-Metal-plastic total wrist prosthesis or total wrist arthrodesis
-Complications and frequency of complications documented
-Revisions and additional operations reported
-At least 10 patients included in study
- All patients with symptomatic, severe wrist arthritis presenting to one
of the authors between 1997 and 2001
Exclusion
-Review article
-Animal or cadaveric studies
-Non-English publication
-Mean follow-up 1 yr
-Unclear diagnoses, 80% of patients with RA or unable to
separate outcomes for RA patients
-Other procedures
-Complications unclear or frequency of complications not
specified
-Revision operations and additional procedures unclear or not
specified
-Case report or fewer than 10 patients included in study
-Study of revision operations after failed total wrist
arthroplasty or arthrodesis
- Non-mentioned
Table 3: Demographic data and selection criteria in both studies.
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Materials and Methods
Eligibility
OVID Medline and Pub Med were the databases used for the
search. The references of the found studies were screened for any
missed studies. The search was done by 15 April 2014.
Study identification
The title and abstract of each study on our results list were
reviewed as to their potential eligibility. Full text papers of the
relevant studies were ordered or downloaded and were reviewed
against the eligibility criteria. The inclusion criteria included only
studies comparing arthrodesis to arthroplasty in elderly patients with
advanced rheumatoid arthritis of the wrist. Time limit of 15 years was
made and only studies in English were included. Primary outcomes
were functional outcome and symptomatic relief while the secondary
outcome was cost of treatment. The Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) guidelines [23],
were strictly followed in reporting our review.
Results
In an attempt to reach the best available evidence a strategy for
the search was used. Key words were targeting the primary problem,
which is treatment of advanced rheumatoid arthritis in elderly using
either arthrodesis or arthroplasty. For both databases, the following
terms were used in the search (Table 2). Pub Med showed the five
studies resulted in Medline in addition to another one [24]. None of
the studies revealed was a randomized controlled study (RCT). One
was a systematic review [25], another was a retrospective study [26],
one was a cost effectiveness [27], two were expert reviews [24,28]
and the last one was a case study [29]. The systematic review, the
retrospective study (Table 3), and the cost-utility would be critically
appraised, the expert reviews, as they have the least weight in the
hierarchy of evidence [30], and the last case study, as it was regarding
a revision procedure, shall be excluded. Eligible studies were critically
appraised using the Critical Appraisal Skills Program checklists.
Paper 1
A systematic review of total wrist arthroplasty compared with
total wrist arthrodesis for rheumatoid arthritis [25]: The first study
is a systematic review published in 2008 under the management
of Rheumatoid Wrist in the textbook âPlastic and Reconstructive
Surgeryâ.
It is an appropriate study design, which addresses the functional
outcomes in patients with advanced rheumatoid arthritis of the wrist
treated with either wrist arthrodesis or arthroplasty. It also looked at
complications, revision surgeries and patientsâ satisfaction.
Though the study was aiming to compare the outcomes of
both modalities of treatment helping decision making in treating
rheumatoid arthritis of the wrist, the high variety of procedures
achieving arthrodesis or arthroplasty made it hard to formulate
a focused research question and due to the heterogeneity of the
available data, it was not possible to do statistical analysis for the
results, thatâs why the author chose to do a systematic review rather
than a meta-analysis.
The systematic review looked at all the information available on
wrist arthrodesis and arthroplasty in the treatment of rheumatoid
arthritis of the wrist in general no specific age group or clear outcomes,
whether primary or secondary, were identified.
Only one database was used in the search (Medline), which can
miss studies not available on this specific database but they tried to
overcome this by screening the references of the resulted studies
for other possible missed citations. Time limit was set to 40 years
(1966-2006) which seems very reasonable and considering the rapid
development of the arthroplasty prostheses, the author identified the
potential bias that can occur on the overall results when including
early arthroplasty studies, which used implants that might not
be even in use anymore, together with the more recent ones so
arthroplasty results were evaluated combined and separately for the
latest generations of prostheses.
Only studies in English language were included, which may be
due to funding reasons regarding translation, but how many non-
English studies were excluded and whether any of them is worth
considering was not mentioned.
Search terms for each procedure were mentioned and inclusion
and exclusion criteria were clearly identified and well presented
in a table which all helps in the reproducibility of the research.
Complications, as an important factor in decision making when
considering a surgical intervention, were well defined and studies not
clearly mentioning they were excluded.
The study provided a flow diagram for the search strategy with
a well descriptive paragraph regarding reasons of exclusion making
the choice of studies easy to follow. No randomized control trials
were available for the review and apart from one retrospective cohort
study [26], which shall be discussed later, other studies were multiple
nonrandomized case series.
Searching only one database with exclusion of non-English
studies, lack of personal contact with experts regarding the subject
and not searching unpublished studies as well as the published ones
would question whether all important relevant studies were included
or not. After the secondary search nothing was mentioned regarding
the assessors who assessed the titles and abstract or did the articles
review. It was clearly declared that there was no potential conflict of
interest.
The systematic review, as expected, led to increase of the overall
sample size and the demographic data was consistent with that of the
disease with women in their 6th
decade being affected 3 folds more
than men.
Outcome measures used were very suitable and targeting the
aim of the study; pain is the main reason why a salvage procedure
would be offered to the patient, motion is the main advantage of
doing arthroplasty, complications are always important in surgical
procedures and patientsâ satisfaction which is eventually the main
aim of any modality of treatment and the results for these measures
Non-operative Arthrodesis Arthroplasty
Utility
weight
Patient 12.3 QALY 15.3 QALY 20.4 QALY 0.41
Clinicians 16.5 QALY 24.0 QALY 25.5 QALY 0.55
Table 4: Patients utility weight.
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were well presented in tables.
Most of the included studies lacked a proper preoperative
assessment so that the author assumed the level of preoperative pain
and range of movement was significant without having any reported
scores for these parameters and though most the studies recorded the
postoperative results no validated score systems were used.
The heterogeneity of the data prevented statistical analysis of
the results in a meta-analysis and hence no statistical significant
difference could be detected.
The gap in the available evidence was detected by the review and
limitations regarding the study and available studies were identified
along the review with efforts to eliminate possible bias of the results,
which was not possible completely, and the authorâs conclusion that
more well-structured studies are needed is appropriate.
Paper 2
Comparisonofarthroplastyandarthrodesisfortherheumatoid
wrist [26]: This study, which was included in the discussed systematic
review, was selected, as it was directly comparing arthrodesis and
arthroplasty of rheumatoid wrist. Though itâs a retrospective cohort
study, but in the absence of RCTs, it would be considerable level of
evidence as it follows RCT in the hierarchy of evidence [30].
The abstract was well structured mentioning the aim of the study
at the beginning. The current practice with potential benefits and
complications of the procedures was mentioned in the introduction
alongside with the aim of the study and the tested hypothesis was that
the wrist arthroplasty, using the Universal prosthesis, would show
better functional outcomes that can justify the costs and risks of the
procedure. The study obtained approval from the Institutional review
board approval of each institution.
The main study group, which was the arthroplasty one, was a non-
randomized group of patients operated upon in one institute then
four other surgeons in other institutes, who didnât do arthroplasty in
their practice, were asked to provide the comparison group. The level
of experience of the surgeons was not mentioned but it seemed that
arthroplasty isnât common even among hand surgeons, which would
make the study more experimental than pragmatic.
Patients in the first group were not randomized instead they
were offered a treatment option and the decision was left for them
to choose and surprisingly all of them chose the arthroplasty but still
no information on the consenting process or how the option was
presented to the patients was mentioned.
Some of the outcome measures and classifications used were
validated; DASH, PRWE and Wrightington classification, while the
medication score and the questionnaire sent for the patients were not,
good description of the outcome measures was provided and was well
illustrated in tables.
Numbers of patients needed in the study were not decided
through a power calculation instead all patients presenting to one
author within a time frame were included without any clear inclusion
or exclusion criteria and the other surgeons were asked to provide the
matching group.
More care was given for the analysis of the results, details
regarding the arthroplasty and the follow up plan was not mentioned
in this study but in another one were those patients were enrolled in
a prospective non-comparative study [31], which would question the
external validity and replication of the procedures.
No statistical differences between the two groups were detected
when analyzing the results, instead there was just a trend favoring the
arthroplasty regarding the personal hygiene and fastening buttons. No
declaration regarding absence of conflict of interest was mentioned.
Paper 3
A cost utility analysis of non-operative management, total
wrist arthroplasty, and total wrist fusion in rheumatoid arthritis
[27]: The third paper discussed is one looking at the cost of different
ways of treating advanced rheumatoid arthritis of the wrist, the two
modalities included in our main question beside the non-surgical
option of treating the same condition.
Cost utility analysis is an economic assessment method used to
estimate the ratio between the cost and the benefit of a procedure
presenting added years of full health measured in QALY (Quality
Adjusted Life Year), which is estimated years of life multiplied by
utility weight (in this study was TTO, which is how many years of
life with advanced rheumatoid wrist the patient would trade for a less
symptomatic wrist). Though cost-utility analysis allow comparison
between different treatment methods but it relies on patientsâ
preferences, which is very subjective and hard to measure.
The study had a well-structured abstract with a clear aim
mentioned at the beginning. The three possible treatments for
the condition were included in the study, two surgical, fusion and
arthroplasty, which were the main concern of our study together
with the non-operative management, which is always an option in
treatment.
The study recognized that the perspective, which is the way
of analyzing the cost-effectiveness, should cover all possible
consequences of the treatment not only the narrow scope of the
medical costs, but as rheumatoid arthritis is a widely disabling disease
it was concluded, based on other studies, that patients presenting
with advanced condition in the wrist will not be participating in paid
employment and most likely to be retired, thatâs why the productivity
gain or loss was not included in the general cost calculations, but apart
from that the calculation included all relevant medical costs from
surgeon and anesthesia fee, surgery center cost and hardware cost
were included, besides a good estimate to the cost of non-operative
treatment was done.
A clear diagram for decision tree was given but as there were no
RCTs available, as revealed by our study, the possible complications
were based on the published literature of which the systematic review
discussed earlier was the best available.
Time trade-off (TTO) was used as a direct method of measuring
the utility weight that would be expressed as Quality-Adjusted-Life-
Years (QALYs).
Uncertainty in the literature regarding the rate of complications
of the two surgical procedures was identified and together with
the remaining years of life, as QALY was used, were considered
as variables that can change the outcome measures resulting in an
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adequate sensitivity analysis.
Patients as well as clinicians were included in the study and
as there was no enough evidence in the literature, the analysis
considered the extreme scenarios, patients living only one year or
living 40 years with multiple revisions and final arthroplasty, and
even considered the patientsâ utility weight (0.41), which would result
in higher differences compared to results based on clinicians respond
(0.55) (Table 4).
Incremental cost of arthroplasty compared with non-operative
treatment was $2,281/QALY and $2,328/QALY respectively and
even when adding an intense hand therapy course, not needed in
arthrodesis, the cost would be $3,034/QALY.
One interesting finding in this study was the difference in utility
weight between patients and clinicians which would suggest that
either the pain and importance of keeping some function of the
wrist is not well appreciated by the clinicians or clinicians feels that
operative complications still overweigh the benefits of the surgery.
Patients covered in this study are more or less similar to our
served population and though medical expenses can vary from one
country to the other we do believe that the figures given in this study
gives a reasonable estimate that can be considered in our setting.
Discussion
Systematicreviewisamethodtohaveanoverviewofthepublished
literature on a specific question, if proper studies were found it
becomes an important tool in evidence-based decision making and
if not it would identify the need of future research. When separate
studies include few numbers of patient, systematic reviews help to
increase sample sizes giving more power to the concluded results.
Cavaliere and Chung showed in their systematic review that there
was no difference between arthroplasty and arthrodesis in treatment
of advanced rheumatoid arthritis of the wrist regarding pain, range
of movement, complications including revision surgeries and patient
satisfaction but, as the studies reviewed were not well-structured and
lacked lots of documentation which limited the data gained, detecting
significant differences through statistical analysis was not possible
[27].
When movements were assessed it was compared to the
normal functioning range, which is not practical when considering
rheumatoid patients. On the other hand, retrospective studies records
data through reviewing patientsâ notes, which would depend on
accuracy of documentation, or asking patients to fill questionnaire
depending on their memory making it liable to recall bias. Murphy
et al tried to compare the results of one group of patients enrolled
in a prospective study for arthroplasty to another matched group
retrospectively. In this study no significant differences were detected
just positive trends in favor of the arthroplasty regarding personal
hygiene, and the prospective study results [31], showed better range
of movements in the same group.
Pain and movements are the main clinical outcomes targeted
when treating rheumatoid wrist. Arthrodesis was traditionally
offered to these patients aiming to achieve a painless wrist but on the
expense of loss of movements [32,33]. In a recent study assessing the
functional outcomes after bilateral arthrodesis [34], it was concluded
that bilateral total wrist arthrodesis improved pain while enabling
patients with severe carpal arthrosis to maintain a satisfactory level
of extremity function and quality of life. Patients adapted and were
satisfied with functional capabilities.
Rheumatoid arthritis is a disabling condition that affects not just
the wrist but other joints in the upper limb as well, so fusing the wrist
would make patients daily activity and personal care harder, which
significance for the patients, as shown by the cost-utility study [27],
might be underestimated, thatâs where the role of arthroplasty comes.
Arthroplasty aims to provide fairly painless and mobile wrist not to
the normal range but enough for patientsâ daily needs. Early results
for arthroplasty were not promising, with high rates of failure but
more recent results are promising [33,35,36].
When adopting a treatment option, it should be ideally both
clinically and cost effective. Clinically, many factors may influence
the final outcome of an arthroplasty within the rheumatoid wrist.
These factors should be taken into consideration while planning
for wrist replacement [37]. Patientâs motivation, pain threshold and
tissue elasticity are unique to each patient, and are critical of the
surgical result. The state of the hand and the degree of soft tissue and
bony destruction is an influential factor leading to the final outcome
[37]. It has been suggested that wrist replacement is recommended
for those patients with greatest joint destruction and deformity [38],
but the results of total wrist arthroplasty may improve significantly
if surgery is done at an early stage when the bone stock is good and
soft-tissue destruction less [33]. The postoperative therapist may
influence the outcome as much as the surgeon himself [37]. The type
of the prosthesis could almost lead to an unsatisfactory result as its
longevity still remains unclear. However, fourth generation implants
have had better durability with survivorship reported to be greater
than 90% [35].
Concerning the cost effectiveness, the National Institute for
Health and Care Excellence (NICE) threshold range for adopting
new treatment is ÂŁ20,000 to ÂŁ30,000 per QALY [39], and as reported
by the third study wrist arthroplasty falls far below this range. And
though wrist arthroplasty in rheumatoid patients seems to be within
the reasonable cost range, it needs more evidence to support this
clinically and a well-structured RCT would be needed.
Conclusion
For now, we think wrist arthroplasty can be a valid option for
treating advanced rheumatoid arthritis of the wrist, which needs a
skilled surgeon and we would consider recording functional scores
for our patients which can add to the present available evidence.
References
1. Allaire S, Wolfe F, Niu J, Lavalley MP. Contemporary prevalence and
incidence of work disability associated with rheumatoid arthritis in the US.
Arthritis Rheum. 2008; 59: 474-480.
2. Hochberg MC, Spector TD. Epidemiology of rheumatoid arthritis: update.
Epidemiol Rev. 1990; 12: 247-252.
3. Hochberg MC. Adult and juvenile rheumatoid arthritis: current epidemiologic
concepts. Epidemiol Rev.1981; 3: 27-44.
4. Ilan DI and Rettig ME. Rheumatoid arthritis of the wrist. Bull Hosp Jt Dis.
2003; 61: 179-185.