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991.
992.
Nathan SS Simmons KA Lin PP Hann LE Morris CD Athanasian EA Boland PJ Healey JH 《The Journal of bone and joint surgery. American volume》2006,88(5):1066-1070
BACKGROUND: Patients with cancer who undergo surgery about the hip are at increased risk for the development of deep vein thrombosis. We implemented a program of chemical and mechanical prophylaxis to prevent this problem. This study was performed to assess the effectiveness of that program. METHODS: Eighty-seven consecutive patients with an active malignant tumor who underwent hip replacement surgery at our institution over a two-year period were included in the study. All patients were treated with intermittent pneumatic compression devices. Seventy-eight patients received anticoagulants, and nine did not. Postoperative surveillance for proximal deep vein thrombosis was routinely performed on all patients with duplex Doppler ultrasonography. RESULTS: Four patients had proximal deep vein thrombosis, and one patient, who did not receive anticoagulation, had a nonfatal pulmonary embolism. The use of prophylactic low-molecular-weight heparin (dalteparin) was associated with a 4% rate of proximal deep vein thrombosis (three of seventy-eight patients). Proximal deep vein thrombosis developed in three of eight patients with pelvic disease, one of nineteen patients with femoral disease, and zero of sixty patients with hip disease (p < 0.00001). The prevalence of proximal deep vein thrombosis was significantly higher (p < 0.02) following replacements in patients with sarcoma (three of twenty-one) than it was after replacements in patients with carcinoma (zero of fifty-seven) or hematologic malignant disease (one of nine). On multivariate analysis, only the location of the disease (the pelvis, femur, or hip) was found to be independently significant for an association with deep vein thrombosis. A wound complication developed in four of twenty-one patients with sarcoma and no patient with carcinoma or hematologic malignant disease (p < 0.001). The pathologic type was the only factor studied that was independently significant for an association with wound complications on multivariate analysis. CONCLUSIONS: The rate of proximal deep vein thrombosis in patients who had undergone hip replacement for oncologic indications was low when the use of an intermittent pneumatic compression device was supplemented with prophylaxis with low-molecular-weight heparin. 相似文献
993.
Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis 总被引:11,自引:0,他引:11
Limaye AP Bakthavatsalam R Kim HW Randolph SE Halldorson JB Healey PJ Kuhr CS Levy AE Perkins JD Reyes JD Boeckh M 《Transplantation》2006,81(12):1645-1652
BACKGROUND: Antiviral prophylaxis has been shown to decrease the incidence of cytomegalovirus (CMV) disease in organ transplant recipients, but whether CMV disease that occurs despite prophylaxis is associated with mortality remains unknown. METHODS: The clinical features and risk factors for CMV disease in a cohort of liver transplant recipients who received antiviral prophylaxis were assessed retrospectively. Cox proportional hazard regression was used to assess the relationship of CMV to mortality during the first posttransplant year. RESULTS: CMV disease developed in 37 of 437 (8.5%) recipients at a median of 4.5 (range, 2.5 to 12) months posttransplant and was associated only with donor-seropositive/recipient-seronegative serostatus in multivariate analysis (P<0.0001). Mortality at 1 year was 12% (51 of 437) and was infection-associated in 49% of cases. In multivariate analysis, CMV disease was independently associated with overall mortality at 1 year (HR, 5.1, P=0.002) and even more strongly with infection-associated mortality (HR 11, P=0.002). There was no association of CMV with noninfection-associated mortality (P>0.05). CONCLUSIONS: Late CMV disease is an important clinical problem in liver transplant recipients who receive antiviral prophylaxis, and is strongly and independently associated with mortality. Strategies to prevent late CMV disease are warranted. 相似文献
994.
Tyler WK Vidal AF Williams RJ Healey JH 《The Journal of the American Academy of Orthopaedic Surgeons》2006,14(6):376-385
Pigmented villonodular synovitis is a proliferative condition of the synovium. Monoarticular involvement, the most common process, occurs in two forms: localized and diffuse. The localized form is characterized by focal involvement of the synovium, with either nodular or pedunculated masses; the diffuse form affects virtually the entire synovium. The localized form has an excellent prognosis and a low recurrence rate when managed surgically. The more common diffuse form has a reported recurrence rate of up to 46%. Although the condition can present in any joint, the knee is the most commonly affected site. Pigmented villonodular synovitis is often aggressive, with marked extra-articular extension. Open synovectomy is the standard method of management. Arthroscopic synovectomy, which has gained popularity, has several advantages over the open technique, but it is associated with higher recurrence rates in diffuse pigmented villonodular synovitis. Synovectomy by any approach, however, may prevent secondary osteoarthritis and subsequent joint arthroplasty. Radiation-induced synovectomy has shown mixed results. Combined surgical and nonsurgical approaches may be necessary, and in some patients, total joint arthroplasty may be the only effective treatment. 相似文献
995.
Introduction and hypothesis
This study assesses the prevalence of interstitial cystitis (IC)/bladder pain syndrome (BPS) in women with chronic pelvic pain (CPP).Methods
This was a prospective study of 150 women undergoing laparoscopy as investigation for CPP in an Endometriosis and Pelvic Pain unit. Preoperative questionnaires [demographic details, pelvic pain symptoms, the Pelvic Pain and Urgency/Frequency (PUF) and O’Leary-Sant (OLS) Symptom and Problem Index scores] were completed, and concurrent standardized cystoscopy with hydrodistention performed at laparoscopy. The primary outcome measures the proportion of IC in this group, defined by presence of glomerulations with CPP and urinary symptoms (urinary frequency, nocturia, urgency). The secondary outcome measures the proportion of BPS [defined by the European Society of the Study of Interstitial Cystitis (ESSIC)].Results
IC was diagnosed in 48/150 (32%) individuals, and 80/150 (53%) had BPS. There were no significant differences in symptomatology or questionnaire results between groups with and without IC. Women with BPS had higher PUF (17.2 vs 12.9, p?0.001), OLS Symptom (8.2 vs 6.0, p?=?0.001) and Problem (7.5 vs 4.2, p?0.001) scores and more severe pain symptoms. Visually proven endometriosis was seen in 90/150 (60%), and 27/150 (18%) had both endometriosis and IC. Of the 80 women with BPS, 45/80 (60%) had endometriosis.Conclusions
The prevalence of IC/BPS varies depending on the definition used. This study showed IC in 32% of women with CPP based on symptoms and presence of glomerulations. BPS as defined by ESSIC was diagnosed in 53%. History and questionnaires did not correlate with positive cystoscopic findings. 相似文献996.
Waters B Panicek DM Lefkowitz RA Antonescu CR Healey JH Athanasian EA Brennan MF 《AJR. American journal of roentgenology》2007,188(2):W193-W198
OBJECTIVE: Low-grade myxofibrosarcoma often relentlessly recurs after surgical resection, with an unusual infiltrative growth pattern and sometimes without a discrete tumor nodule at pathologic examination. This study was undertaken to determine and show patterns of recurrent low-grade myxofibrosarcoma at CT and MRI. CONCLUSION: Unlike in most other histologic types of low-grade soft-tissue sarcoma, recurrent low-grade myxofibrosarcoma often is infiltrative; shows a tapering, tail-like margin and superficial spreading configuration; and metastasizes to various distant sites, including lungs, pleura, bone, adrenal gland, soft tissue, and mesentery. Knowledge of these unusual characteristics is important in assessing the presence and extent of recurrent low-grade myxofibrosarcoma before surgical reexcision. 相似文献
997.
Tony W. Trinh Ivan Ip Michael J. Healey Adam B. Landman Charles Morris Giles W. Boland Ramin Khorasani 《Journal of the American College of Radiology》2019,16(8):1018-1026
ObjectiveAssess whether introducing order priorities with defined performance expectations in the electronic health record (EHR) reduces immediate inpatient radiology orders.Materials and MethodsThis Institutional Review Board–approved, retrospective study was performed at a 776-bed academic hospital conducting 164,000+ inpatient radiology examinations annually. Study period was January 2, 2017, to July 23, 2017; 14 weeks pre- and postimplementation of an education-only intervention including replacing urgent and as soon as possible priorities with imaging within next 6, 12, or 24 hours; imaging in the morning; and required for discharge priorities. STAT routine, timed, today order priorities remained unchanged. Institution-wide training immediately pre- and postimplementation was provided through two waves of e-mail and electronic tip sheets. Primary outcome measure was total STAT studies ordered of total radiology studies ordered per week (STAT rate). Secondary outcomes were non-STAT, non-routine (non-SR) order rate, and routine order rate. Paired t test and statistical process control (SPC) analysis were performed.ResultsSTAT rate pre- (22.5%, 7,150 STAT of 31,765 total; weeks 1-14) and postintervention (23.4%, 7,481 STAT of 32,034 total; weeks 16-29) remained unchanged (P = .37). SPC demonstrated no special cause variation. Postintervention non-SR rate increased 3-fold (2.7%, 859 non-SR of 31,765 total pre-intervention versus 8.2%, 2,615 non-SR of 32,034 total postintervention; 8.2%/2.7% = 3.0; P < .0001). There was an 8.8% relative reduction in routine rate postintervention (73.9%, 23,471 routine of 31,765 total pre-intervention; 67.4%, 21,579 routine of 32,034 total postintervention; (73.9% ? 67.4%)/73.9% × 100 = 8.8%; P < .0001).ConclusionImplementing ordering priorities with defined performance expectations in the EHR reduced routine but did not reduce STAT inpatient radiology orders. More stringent interventions may be needed to reduce unnecessary STAT inpatient radiology ordering to improve use of limited imaging resources. 相似文献
998.
Terrance T. Healey Bradford T. March Grayson Baird Damian E. Dupuy 《Journal of vascular and interventional radiology : JVIR》2017,28(2):206-211
Purpose
To determine the long-term safety and efficacy of microwave (MW) ablation in the treatment of lung tumors at a single academic medical center.Materials and Methods
Retrospective review was performed of 108 patients (42 female; mean age, 72.5 y ± 10.3 [standard deviation]) who underwent computed tomography (CT)–guided percutaneous MW ablation for a single lung malignancy. Eighty-two were primary non–small-cell lung cancers and 24 were metastatic tumors (9 colorectal carcinoma, 2 renal-cell carcinoma, 4 sarcoma, 2 lung, and 7 other). Mean maximum tumor diameter was 29.6 mm ± 17.2. Patient clinical and imaging data were reviewed. Statistical analysis was performed by Kaplan–Meier modeling and logistic regression.Results
Odds of primary technical success were 11.1 times higher for tumors < 3 cm vs those > 3 cm (95% confidence interval [CI], 2.97–41.1; P = .0003). For every millimeter increase in original tumor maximal diameter (OMD), the odds of not attaining success increased by 7% (95% CI, 3%–10%; P = .0002). For every millimeter increase in OMD, the odds of complications increased by 3% (95% CI, 0.1%–5%; P = .04). Median time to tumor recurrence was 62 months (95% CI, 29, upper bound not reached; range, 0.2–96.6 mo). Recurrence rates were estimated at 22%, 36%, and 44% at 1, 2, and 3 years, respectively. Recurrence rates were estimated at 31% at 13 months for tumors > 3 cm and 17% for those < 3 cm. Complications included pneumothorax (32%), unplanned hospital admission (28%), pain (20%), infection (7%), and postablation syndrome (4%).Conclusions
This study further supports the safe and effective use of MW ablation for the treatment of lung tumors. 相似文献999.
Olivier D.R. van Wulfften Palthe Stein J. Janssen Jay S. Wunder Peter C. Ferguson Guo Wei Peter S. Rose Micheal J. Yaszemski Franklin H. Sim Patrick J. Boland John H. Healey Francis J. Hornicek Joseph H. Schwab 《The spine journal》2017,17(5):636-644
Background Context
Patient-reported outcomes are becoming increasingly important when investigating results of patient and disease management. In sacral tumor, the symptoms of patients can vary substantially; therefore, no single questionnaire can adequately account for the full spectrum of symptoms and disability.Purpose
The purpose of this study is to analyze redundancy within the current sacral tumor survey and make a recommendation for an updated version based on the results and patient and expert opinions.Study Design/Setting
A survey study from a tertiary care orthopedic oncology referral center was used.Patient Sample
The patient sample included 70 patients with sacral tumors (78% chordoma).Outcome Measures
The following 10 questionnaires included in the current sacral tumor survey were evaluated: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Item short form, PROMIS Pain Intensity short form, PROMIS Pain Interference short form, PROMIS Neuro-QOL v1.0 Lower Extremity Function short form, PROMIS v1.0 Anxiety short form, the PROMIS v1.0 Depression short form, the International Continence Society Male short form, the Modified Obstruction-Defecation Syndrome questionnaire, the PROMIS Sexual Function Profile v1.0, and the Stoma Quality of Life tool.Methods
We performed an exploratory factor analysis to calculate the possible underlying latent traits. Spearman rank correlation coefficients were used to measure to what extent the questionnaires converged. We hypothesized the existence of six domains based on current literature: mental health, physical health, pain, gastrointestinal symptoms, sexual function, and urinary incontinence. To assess content validity, we surveyed 32 patients, 9 orthopedic oncologists, 1 medical oncologist, 1 radiation oncologist, and 1 orthopedic oncology nurse practitioner with experience in treating sacral tumor patients on the relevance of the domains.Results
Reliability as measured by Cronbach alpha ranged from 0.65 to 0.96. Coverage measured by floor and ceiling effects ranged from 0% to 52% and from 0% to 30%, respectively. Explanatory factor analysis identified three traits to which the questionnaires that were expected to measure a similar construct correlated the most: mental health, physical function, and pain. Content validity index demonstrated low disagreement among patients (range: 0.10–0.18) and high agreement among physicians (range: 0.91–1.0) on the relevance of the proposed domains. Social health was identified by 50% of the commenting patients as an important yet missing domain.Conclusions
The current sacral tumor survey is incomplete and time-consuming, and not all surveys are appropriate for the sacral tumor population. Our recommended survey contains less than half the questions and includes the newly recognized social health domain. 相似文献1000.
Background Teamwork in surgical teams is at the forefront of good practice guidelines and empirical research as an important aspect of
safe surgery. We have developed a comprehensive assessment for teamwork in surgery—the Observational Teamwork Assessment for
Surgery (OTAS)—and we have tested it for general surgical procedures. The aim of the research reported here was to extend
the assessment to urology procedures.
Methods After refining the original assessment, we used it to observe 50 urology procedures. The OTAS comprises a procedural task
checklist that assesses patient, equipment/provisions, and communication tasks as well as ratings on five team behavior constructs
(communication, cooperation, coordination, leadership, and monitoring). Teamwork was assessed separately in the surgical,
anesthesia, and nursing subteams in the operating theater. We also assessed the reliability of the behavioral scoring.
Results Regarding task completion, a number of communication and equipment/provisions tasks were not routinely performed during the
operations we observed. Regarding teamwork-related behaviors, adequate reliability was obtained in the scoring of behaviors.
Anesthetists and nurses obtained their lowest scores on communication. Surgeons’ scores revealed a more complex pattern. In
addition to low scores on communication, surgeons’ teamwork behaviors appeared to deteriorate as the procedures were finishing.
Conclusions Our findings suggest that OTAS is applicable to various branches of surgery. Separate assessment of the subteams in the operating
theater provides useful information that can be used to build targeted teamwork training aiming to improve surgical patients’
safety and outcomes. 相似文献