Irrigation Solutions and Antibiotic Powders: Should I Use Them in Primary and Revision Total Joint Arthroplasty?

BackgroundThe prevention and treatment of periprosthetic joint infection is of utmost importance to orthopedic surgeons. Irrigation solutions have become a popular additive to the prevention and treatment armamentarium.MethodsThis symposium summarizes the mechanism of action, basic science, and clinical research to date on the use of irrigation solutions. The four most commonly used irrigation solutions, povidone iodine, chlorhexidine, hydrogen peroxide, and acetic acid, are discussed. In addition, the role of antibiotic powers is reviewed.ResultsEach solution has its risks and benefits that must be weighed by the surgeon. There is no clear irrigation solution that is superior. The role of additive antibiotic powder (vancomycin) remains controversial.ConclusionMore rigorous prospective clinical trials are needed to determine the optimal irrigation solution for the prevention and treatment of periprosthetic joint infection.     

Impact of COVID-19 Protocols on Primary and Revision Total Hip Arthroplasty

BackgroundSurgical site infection (SSI) after total hip arthroplasty (THA) is associated with increased morbidity, mortality, and healthcare expenditures. Our institution intensified hygiene standards during the COVID-19 pandemic; hospital staff exercised greater hand hygiene, glove use, and mask compliance. We examined the effect of these factors on SSI rates for primary THA (pTHA) and revision THA (rTHA).MethodsA retrospective review was performed identifying THA from January 2019 to June 2021 at a single institution. Baseline characteristics and outcomes were compared before (January 2019 to February 2020) and during (May 2020 to June 2021) the COVID-19 pandemic and during the first (May 2020 to November 2020) and second (December 2020 to June 2021) periods of the pandemic. Cohorts were compared using the Chi-squared test and independent samples t-test.ResultsA total of 2,682 pTHA (prepandemic: 1,549 [57.8%]; pandemic: 1,133 [42.2%]) and 402 rTHA (prepandemic: 216 [53.7%]; Pandemic: 186 [46.2%]) were included. For primary and revision cases, superficial and deep SSI rates were similar before and during COVID-19. During COVID-19, the incidence of all (?0.43%, P = .029) and deep (?0.36%, P = .049) SSIs decreased between the first and second periods for rTHA. pTHA patients had longer operative times (P < .001) and shorter length of stay (P = .006) during COVID-19. Revision cases had longer operative times (P = .004) and length of stay (P = .046). Both pTHA and rTHA were discharged to skilled nursing facilities less frequently during COVID-19.ConclusionDuring COVID-19, operative times were longer in both pTHA and rTHA and patients were less likely to be discharged to a skilled nursing facility. Although intensified hygienic standards may lower SSI rates, infection rates did not significantly differ after our hospital implemented personal protective guidelines and a mask mandate.     

The Workforce in Critical Care Nephrology: Challenges and Opportunities

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Survival Rate and Application Number of Total Hip Arthroplasty in Patients With Femoral Neck Fracture: An Analysis of Clinical Studies and National Arthroplasty Registers

BackgroundTotal hip arthroplasty (THA) is an increasingly popular treatment option for fractured neck of femur (NOF). The primary aim of this study is to systematically review all literature on primary THA and hemiarthroplasty (HA) after fractured NOF to calculate an overall revision rate. Furthermore, we wanted to compare primary THA implantations after fractured NOF between different countries in terms of THA number per inhabitant.MethodsAll clinical studies on THA and HA for femoral neck fractures between 1999 and 2019 were reviewed and evaluated with a special interest on revision rate. Revision rate was calculated as “revision per 100 component years.” THA registers were compared between different countries with respect to the number of primary implantations per inhabitant.ResultsTHA studies showed a mean revision rate of 11.8% after 10 years, which was lower than a 24.6% 10-year revision rate for HA. We identified 8 arthroplasty registers that revealed an annual average incidence of THA for fractured NOF of 9.7 per 100,000 inhabitants.ConclusionThis study showed that patients with THA were less likely to be revised at 10 years compared to HA. We found similar annual numbers of THAs for fractured NOF per inhabitant across countries. The results of this analysis can be used to rank present and future national THA numbers within an international context.     

360度评价在住培学员岗位胜任力评价中的应用

目的运用360度评价对我院住培学员的岗位胜任力进行评价,对学员岗位胜任力的现状进行探讨分析。方法使用问卷调查表分别从专业基地教学主任、学员指导教师、同专业学员及学员本人的角度,对2017级222名住培学员的岗位胜任力进行360度评价,利用SPSS22.0对数据进行统计分析。结果连续两年的测评,住院学员8类岗位胜任力的自评和他评得分低于满分,学员在临床基本能力、医患沟通能力、掌握与运用医学知识、团队合作能力4项内容的评分,差异有统计学意义(P<0.05);同时学员在临床基本能力、医生职业精神与素质、医患沟通能力、掌握与运用医学知识、团队合作能力5项内容的评分较上一年相比,差异也有统计学意义(P<0.05)。结论调查结果提示360度评价可帮助住培学员提高岗位胜任力,后续培训应围绕调查结果和以岗位胜任力为导向来调整与设置,需增加人文属性内容的培训以及再量化培训测评内容、指标和进一步完善考评反馈机制。     

Pilates for rehabilitation in patients with multiple sclerosis: A systematic review of effects on cognition,health-related physical fitness,general symptoms and quality of life

ObjectiveThe aims of this systematic review is to analyze the effectiveness of Pilates intervention programs on cognitive function, health-related physical fitness, general symptoms, physical function, quality of life, and the impact Pilates can have on activities of daily living in Multiple Sclerosis (MS) patients. This review also aims to provide a synthesis of the most commonly used protocols regarding exercise parameters, such as periodicity and treatment duration.Data sourcesSystematic review of the literature was carried out following the PRISMA guidelines (PROSPERO no. CRD42017070004). A literature search was undertaken for studies that investigated the effects of Pilates training on MS patients, using databases included PubMed, Medline, Scopus and the Physiotherapy Evidence Database (PEDro) up to May 2018.Study selectionThree researchers independently reviewed the titles and abstract of each article to screen the papers in relation to the inclusion criteria.Data extractionData were extracted by three researchers independently. The eligible articles were read in full and their levels of evidence were evaluated using the PEDro scale.Data synthesisForty-two papers were found during the research phase. Duplicated (n = 23) or incomplete articles (n = 1) were excluded. Studies were also eliminated from the sample based on methodological approach (study design) quality assessment (n = 6). Twelve studies were ultimately selected and analyzed.ConclusionsThe majority of the studies analyzed showed positive results after Pilates training intervention and concluded that Pilates intervention is safe and effective for the treatment of dysfunction of balance, strength, quality of life, cognition, physical performance, walking and posture parameters on MS patients. The articles investigated in this review provide a scientific basis to support Pilates as an option for rehabilitation programs for MS patients.     

神经干刺激疗法配合言语康复训练在卒中后失语症患者中的应用

目的 评价神经干刺激疗法配合言语康复训练在卒中后失语症患者中的应用效果。方法 选择我院康复科2016年3月～2018年10月收治的卒中后失语症患者82例作为本次研究对象,采用随机数字表法将患者随机分为对照组(n=41)与观察组(n=41)。两组患者均开展常规治疗,对照组在此基础上开展言语康复训练,观察组开展神经干刺激疗法配合言语康复训练,对比两组患者治疗后临床效果,治疗前后语言功能情况。结果 两组患者治疗前后语言功能情况:治疗前,两组患者语言功能自发谈话、理解、复述、命名、阅读、书写6项评分比较,差异均无统计学意义(P0.05),治疗后两组6项评分均明显上升,观察组高于对照组,差异均有统计学意义(P0.05);临床效果:观察组治疗总有效率为95.12%,明显高于对照组的80.49%,差异有统计学意义(P0.05)。结论 神经干刺激疗法配合言语康复训练在卒中后失语症患者中应用效果肯定,能够提升患者口语表达能力、改善理解障碍与复述能力、提高文字阅读能力及书写准确率。     

Suivi à long terme des effets d’un entraînement de la mémoire de travail (Cogmed) auprès d’enfants présentant un TDA/H

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder associated with working memory deficits. In that optic, new interventions designed to train working memory have been developed. Cogmed Working Memory Training (CWMT) is a popular online training program that is said to increase working memory (WM) and related skills in the ADHD population. However, follow-up measures are not systematically included, and long-term effects of CWMT are controversial. Also, the number of studies examining transfer of learning and controlling for medication or comorbidities are limited.ObjectivesThis study investigates the long-term effects of CWMT combined with psychostimulant medication on WM and related skills.MethodsThis study included 31 participants aged 7 to 13 years, diagnosed with ADHD (mixed subtype) associated with learning disorders, oppositional-defiant disorder and/or Tourette syndrome. Participants first completed CWMT and were evaluated at follow-up six months later. We used a randomized, double-blind, placebo-controlled design.ResultsThe results found no significant impact of CWMT at follow-up. There were no improvements of WM nor transfer effects on related skills, academic achievement or ADHD symptoms at six months’ follow-up.ConclusionLong-term efficacy of CWMT is not demonstrated. We can’t support CWMT as an effective complementary treatment for children with ADHD and associated comorbidities.