A comparison of paper with electronic patient-completed questionnaires in a preoperative clinic

In this unblinded randomized control trial we compared electronic self-administered Pre-Admission Adult Anesthetic Questionnaires (PAAQ) using touchscreen technology with pen and paper. Patients were recruited in the Pre-assessment Clinic if they had completed a PAAQ in the surgeon's office. Patients were randomized to study PAAQ using paper, hand-held computer (PDA), touchscreen desktop computer (kiosk), or tablet. Patients also completed a preference and satisfaction survey. The main outcome measures were percent agreement between the prestudy and study PAAQ and time to completion. Only six of the 366 patients approached refused to participate. The median time to completion of the PAAQ was shortest on the kiosk (2.3 min) and longest on the PDA (3.2 min) (chi2 = 14.5; P = 0.002). The mean agreement between the prestudy and the study PAAQ was approximately 94% across all study arms. The proportion of participants expressing comfort before and after completing the PAAQ increased from 10% to 97% on the computerized arms and from 60% to 64% on the paper arm. Touchscreen computer technology is an accurate, efficient platform for patient-administered PAAQ. Patients expressed comfort using the technology and preference for computerized versus paper for future questionnaires. IMPLICATIONS: Self-administered electronic health questionnaires using touchscreen computer technology are an accurate means of collecting patient information in the preoperative setting and can provide a valuable basis for an electronic perioperative patient record. Patients expressed comfort and satisfaction with this method of questionnaire completion.     

Total elbow arthroplasty after interposition arthroplasty for elbow arthritis

BACKGROUND: Interposition arthroplasty is an option for the treatment of arthritis of the elbow. Conversion to a total elbow arthroplasty can be considered later, when the patient reaches a suitable age. We investigated the results of conversion of an interpositional elbow arthroplasty to a semiconstrained total elbow arthroplasty in a series of patients. METHODS: The results of twelve consecutive linked semiconstrained total elbow arthroplasties in twelve patients who had had a prior interposition arthroplasty for the treatment of degenerative arthritis of the elbow were evaluated at an average of ten years postoperatively. The average age at the time of the total elbow arthroplasty was fifty years, and the average interval from the interposition arthroplasty to the total elbow arthroplasty was 9.9 years. Pain and elbow performance as measured with the Mayo Elbow Performance Score were assessed in a retrospective chart review and an evaluation of questionnaires, and postoperative radiographs were reviewed. RESULTS: At the time of the latest follow-up, postoperative pain was rated as mild or none in ten of the twelve patients, and the result was rated as subjectively satisfactory in ten patients. The average Mayo Elbow Performance Score improved from 32.1 points (range, 10 to 70 points) preoperatively to 80.4 points (range, 40 to 100 points) postoperatively (p < 0.001). According to these objective criteria, there were three excellent, six good, one fair, and two poor results. All of the elbows were stable following the arthroplasty. Radiographs demonstrated a well-fixed prosthesis in all but one patient who had extensive osteolysis at the site of the humeral component. One other patient had radiographic evidence of bushing wear. Both of these patients required revision procedures. CONCLUSIONS: Semiconstrained total elbow arthroplasty can be performed successfully in patients with a prior interposition arthroplasty. Reliable pain relief and a satisfactory result can be achieved in most patients.     

The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model

PURPOSE: Ablative techniques for the treatment of urological malignancy are gaining acceptance and they are likely to become more widely used in clinical practice. Indications and limitations of the technologies are still evolving. In a porcine model we evaluated the safety and efficacy of cryotherapy and radio frequency ablation (RFA) of cortical and deep renal tissue. MATERIALS AND METHODS: In 11 swine argon gas based cryoablation or RFA of renal tissue adjacent to the collecting system was performed using a laparoscopic or percutaneous approach. Lesions created in renal units 30 days or 2 hours prior to harvest were termed chronic or acute. Using single or multiple 17 gauge cryoneedles or 3.0 mm cryoprobes and 2 freeze-thaw cycles (10-minute freeze and 5-minute thaw) 13 acute and 10 chronic cryolesions were made. Using a single 16 gauge umbrella-shaped RFA probe and 2 heating cycles to maximum impedance 13 acute and 4 chronic RFA lesions were made. Gross and microscopic tissue analysis was performed to assess lesion size and renal parenchymal, collecting system and arterial effects. Acute cryolesion size estimation by laparoscopic or transcutaneous ultrasound (US) was compared with pathological lesion size. RESULTS: Acute cryolesions on hematoxylin and eosin staining demonstrated uniform coagulative necrosis of renal parenchyma and chronic cryolesions demonstrated uniform necrosis with fibrous scar formation. Interlobar artery (adjacent to renal pyramid) preservation occurred in 7 of 13 acute and 5 of 9 chronic cryolesions. Urothelial architecture was preserved in 8 of 13 acute and 7 of 9 chronic cryolesions. Acute and chronic RFA lesions demonstrated indeterminate necrosis on hematoxylin and eosin staining, although triphenyl tetrazolium chloride staining of gross specimens confirmed necrosis most definitively in renal cortex. Interlobar artery preservation occurred in 6 of 13 acute and 3 of 4 chronic RFA lesions. Urothelial architecture was preserved in 1 of 13 acute and 2 of 4 chronic RFA lesions. Acute cryolesion dimensions measured by laparoscopic US equaled or underestimated lesion size measured grossly in all 6 cases. Lesion dimensions measured by transcutaneous US equaled or underestimated true lesion size in 3 of 6 cases. In 3 of 6 lesions transcutaneous US overestimated true lesion size by 20%, 76% and 260%, respectively. CONCLUSIONS: Renal cortical tissue can be effectively destroyed by cryoablation or RFA. However, treatment of deep parenchymal lesions with either modality may result in incomplete ablation. Cryosurgery but not RFA spares the collecting system in an acute setting. However, healing or regrowth of the urothelium may occur with time after RFA. Laparoscopic US is more accurate for cryolesion monitoring than transcutaneous US.     

A mouthstick for quadriplegic patients

An improved method for designing a mouthstick prosthesis has been described. The device was constructed at the University of Missouri-Kansas City School of Dentistry and found ready acceptance by a 17-year-old quadriplegic boy at the Kansas University Medical Center Hospital. Further use of the design is planned.     

Conversion of painful hemiarthroplasty to total shoulder arthroplasty: long-term results

The purpose of this study was to evaluate the outcome after conversion of painful hemiarthroplasty to total shoulder arthroplasty (TSA). Sixteen consecutive patients who underwent revision TSA for failed humeral head replacement (HHR) at our institution from 1988 to 2000 were evaluated. The mean interval from the time of HHR to revision TSA was 3.5 years (range, 11 months to 10.5 years). At a mean 5.5-year follow-up (range, 2-14 months), the results were excellent in 3 of 15 (20%), satisfactory in 5 of 15 (33%), and unsatisfactory in 7 of 15 (47%). The mean American Shoulder and Elbow Surgeons score was 73.6 (range, 46.7-95) out of a possible 100. The mean visual analog pain score was 2.4 (range, 0-6) out of 10. Evidence of posterior glenoid erosion was found in 64% (7/11) of these patients. On the basis of the complexity of the surgery and the 47% unsatisfactory rate, we conclude that revision of a failed HHR to a TSA is a salvage procedure whose results are inferior to those of primary TSA.