Miller Orthopedic Specialist

The aim of this study was to investigate the moderating effect of sex on the relationship between physical activity (PA) and quality of life (QoL) in Chinese patients with coronary heart disease (CHD) not participating in cardiac rehabilitation. Chinese patients with CHD (aged 18-80 yr) were selected 12 mo after discharge from three Hebei Province tertiary hospitals. The International Physical Activity Questionnaire was used to assess PA in metabolic equivalents of energy (METs) and the Chinese Questionnaire of Quality of Life in Patients With Cardiovascular Disease was used to assess QoL. Data were analyzed using Student's t test and the χ 2 test, multivariant and hierarchical regression analysis, and simple slope analysis. Among 1162 patients with CHD studied between July 1 and November 30, 2017, female patients reported poorer QoL and lower total METs in weekly PA compared with male patients. Walking ( β= .297), moderate-intensity PA ( β= .165), and vigorous-intensity PA ( β= .076) positively predicted QoL. Hierarchical regression analysis showed that sex moderates the relationship between walking ( β= .195) and moderate-intensity PA ( β= .164) and QoL, but not between vigorous-intensity PA ( β= -.127) and QoL. Simple slope analysis revealed the standardized coefficients of walking on QoL were 0.397 (female t = 8.210) and 0.338 (male t = 10.142); the standardized coefficients of moderate-intensity PA on QoL were 0.346 (female, t =7.000) and 0.175 (male, t = 5.033). Sex moderated the relationship between PA and QoL among patients with CHD in China. There was a greater difference in QoL for female patients reporting higher time versus those with lower time for both walking and moderate-intensity PA than for male patients.

Objectives:The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury.Methods:An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients’ home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman’s rank correlation coefficients (ρ) while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression.Results:A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 ± 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (ρ = 0.141, p = 0.009) as well as to undergo surgery from time of injury (ρ = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model.Conclusions:Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes.

To describe trajectories of functioning up to 5 years after traumatic brain injury (TBI) that required inpatient rehabilitation in the United States using individual growth curve models conditioned on factors associated with variability in functioning and independence over time. Secondary analysis of population-weighted data from a multicenter longitudinal cohort study. Acute inpatient rehabilitation facilities. A total of 4624 individuals 16 years and older with a primary diagnosis of TBI. Ratings of global disability and supervision needs as reported by participants or proxy during follow-up telephone interviews at 1, 2, and 5 years postinjury. Many TBI survivors experience functional improvement through 1 and 2 years postinjury, followed by a decline in functioning and decreased independence by 5 years. However, there was considerable heterogeneity in outcomes across individuals. Factors such as older age, non-White race, lower preinjury productivity, public payer source, longer length of inpatient rehabilitation stay, and lower discharge functional status were found to negatively impact trajectories of change over time. These findings can inform the content, timing, and target recipients of interventions designed to maximize functional independence after TBI.

Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis elimination strategy. Because of recent policy changes, some LTBI treatment may shift from public health departments to the private sector. To (1) develop methodology to estimate initiation and completion of treatment with isoniazid for LTBI using claims data, and (2) estimate treatment completion rates for isoniazid regimens from commercial insurance claims. Medical and pharmacy claims data representing insurance-paid services rendered and prescriptions filled between January 2011 and March 2015 were analyzed. Four million commercially insured individuals 0 to 64 years of age. Six-month and 9-month treatment completion rates for isoniazid LTBI regimens. There was an annual isoniazid LTBI treatment initiation rate of 12.5/100 000 insured persons. Of 1074 unique courses of treatment with isoniazid for which treatment completion could be assessed, almost half (46.3%; confidence interval, 43.3-49.3) completed 6 or more months of therapy. Of those, approximately half (48.9%; confidence interval, 44.5-53.3) completed 9 months or more. Claims data can be used to identify and evaluate LTBI treatment with isoniazid occurring in the commercial sector. Completion rates were in the range of those found in public health settings. These findings suggest that the commercial sector may be a valuable adjunct to more traditional venues for tuberculosis prevention. In addition, these newly developed claims-based methods offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate tuberculosis prevention.

Thank you very much for your interest and insight regarding our study. We agree that any potential clinical implementation of contrast-enhanced MR neurography for trauma would require a thoughtful risk-benefit analysis. However, the current widespread use and established safety profile of Gd-DTPA

This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.

Background:We observed that medical devices advertised in journals are often no longer available 5 to 10 years after first being advertised. In this study, we quantified the percentage of products advertised from 2003 to 2008 in the Journal of Bone and Joint Surgery, American, which were still available 5 to 10 years after first being advertised.Methods:We created a database of 427 unique orthopaedic products advertised in the Journal of Bone and Joint Surgery. In 2013, we classified products into categories: available in advertised form, available in modified form, available under a different manufacturer, and available but temporarily recalled, discontinued voluntarily, or discontinued by forced recall.Results:A total of 13.8% of products were discontinued 5 to 10 years after being advertised. Three percent were discontinued through forced recall, and 10.8% were discontinued voluntarily. Of the products still available, 60.2% were in current form, 12.9% were modified, 11.9% were available under a different company, and 1.2% were available but were temporarily recalled.Conclusion:Five to 10 years after the initial advertisement, nearly 40% of products were not available in their original advertised form.

Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are synthetic amino acid derivatives that interfere with fibrinolysis, promoting hemostasis by pharmacological means. Although both drugs have been shown to decrease blood loss with a minimal risk of thromboembolic adverse events following cardiac and vascular surgery, we are aware of only 1 published trial that directly compared the antifibrinolytic effects of EACA with those of TXA after total knee arthroplasty (TKA). The primary aim of this prospective, randomized, controlled trial was to determine whether TXA provides superior blood conservation following TKA compared with that provided by EACA. A total of 194 patients scheduled to undergo a primary unilateral TKA in the same community-based hospital were prospectively randomized to receive intravenous EACA (n = 96) or TXA (n = 98). Both the patients and the operating surgeons were blinded to the treatment assignments. Primary outcome measures included transfusions, estimated blood loss, and the drop in the hemoglobin (Hgb) level. Secondary outcomes measures included the change in the serum creatinine level, postoperative complications, and length of hospital stay. Although the patients who received TXA averaged less estimated blood loss than the patients who received EACA (t185 = 2.18, p = 0.031; mean difference = 144.2 mL, 95% confidence interval = 13.62 to 274.78 mL), no transfusions were required in either group. We observed no statistically significant or clinically relevant between-group differences in the change in Hgb or serum creatinine level, postoperative complications, or length of hospital stay. Although the estimated blood loss was significantly greater in the EACA group, no transfusions were required and no significant between-group differences were observed for any other outcomes measured. We concluded that EACA may be an acceptable alternative to TXA for blood conservation following TKA, although replication of our results in noninferiority trials is necessary. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Uchida, Mai MD; Schmertz, Stefan K. PhD; Miller, Martin MD; Yeung, Albert MD, ScDEditor(s): Goisman, Robert M. MD Author Information