Padronização e teste da plataforma de força em padrão ortostático em cães

Prophylaxis for venous thromboembolism (VTE) is underused following major surgery and frequently stopped at hospital discharge despite short stays and high VTE risk for several weeks postsurgery. We evaluated inpatient and postdischarge prophylaxis in patients who underwent major abdominal or orthopedic surgery. Patient records were assessed for anticoagulant use by cross-matching data from the Premier's Perspective discharge database with the i3/Ingenix LabRx outpatient and inpatient database from January 2005 to December 2007. Abdominal or orthopedic surgery patients at risk of VTE according to the 2004 American College of Chest Physicians guidelines and with no contraindications to anticoagulation were included. A total of 14,009 eligible surgical discharges were analyzed. Only 27.9% of the 10,698 abdominal surgery patients received anticoagulation in hospital. Most inpatients received unfractionated heparin (12.3% of the total abdominal surgery population) or enoxaparin (11.8%). Of the 3311 orthopedic surgery patients, 91.1% received in-hospital anticoagulation. Similar proportions of patients received enoxaparin (32.1%), warfarin (31.1%), or other agents (28.0%). Only 1.2% of abdominal surgery patients had an anticoagulant prescription filled 30 days postdischarge. Although orthopedic surgery outpatients had higher anticoagulation rates, only 54.4% had filled a prescription 30 days postdischarge with 31.1% receiving warfarin, 18.5% receiving enoxaparin, and 4.8% receiving other anticoagulants. The higher prophylaxis rate in orthopedic patients may reflect the high VTE risk in orthopedic surgery patients and increased awareness among orthopedic surgeons. This real-world study highlights the underuse of thromboprophylaxis in hospitalized surgical patients, especially following abdominal surgery. Furthermore, a considerable proportion of these patients do not receive postdischarge anticoagulation despite guideline recommendations. Further efforts are needed to improve anticoagulant use, particularly in the outpatient setting.

Use of a custom website by orthopaedic sports medicine surgical patients: If you build it, will they come?

To measure hip flexion, abduction, and internal rotation in a static standing position with the limb maintained with a traditional Ehmer sling (TES), compare these with a commercially available vest-based sling (VBS), and describe short-term tolerability of the VBS in healthy dogs. 12 healthy client-owned dogs were prospectively enrolled between June 2024 and August 2025. A TES and a VBS were sequentially applied to the same hindlimb. Hip flexion, abduction, and internal rotation were measured. Dogs were monitored for VBS tolerability and complications for up to 14 days at home, based on predefined study end points. Compared with the TES, the VBS resulted in greater hip flexion, reflected by a lower mean angle (53° ± 13° vs 66° ± 11°), and greater hip abduction (15° ± 5° vs 8° ± 6°). Internal rotation did not significantly differ between devices (TES: median, 1°; IQR, -5° to 5°; VBS: median, 6°; IQR, 4° to 10°). Only 1 dog completed the intended 14-day wear period. Four dogs reached a study end point due to device-related issues, 2 due to owner noncompliance and 5 due to poor tolerability. This study provides reference goniometric values for hip positioning achieved with a TES and demonstrates that a VBS results in greater hip flexion and abduction, with limited short-term tolerability in healthy dogs. Establishing expected hip joint positioning may help guide clinical application and evaluation of Ehmer slings following reduction of hip luxation. Limited tolerability of the VBS may affect clinical applicability.

Deep venous thromboses (DVT) continue to cause significant morbidity in critically ill patients. Standard prophylaxis for high risk patients includes twice-daily dosing with 30 mg enoxaparin. Despite prophylaxis, DVT rates still exceed 10% to 15%. Anti-Xa levels are used to measure the activity of enoxaparin and 12-hour trough levels <or=0.1 IU/mL have been associated with higher rates of DVT in orthopedic patients. We hypothesized that low Anti-Xa levels would be found in critically ill trauma and surgical patients and that low levels would be associated with higher rates of DVT. All patients on the surgical intensive care unit (ICU) service were prospectively followed. In the absence of contraindications, patients were given prophylactic enoxaparin and anti-Xa levels were drawn after the third dose. Trough levels <or=0.1 IU/mL were considered low. Screening duplex exams were obtained within 48 hours of admission and then weekly. Patients were excluded if they did not receive a duplex, if they had a prior DVT, or if they lacked correctly timed anti-Xa levels. DVT rates and demographic data were compared between patients with low and normal anti-Xa levels. Data were complete for 54 patients. Eighty-five percent suffered trauma (Injury Severity Score of 25 +/- 12) and 74% were male. Overall, 27 patients (50%) had low anti-Xa levels. Patients with low anti-Xa levels had significantly more DVTs than those with normal levels (37% vs. 11%, p = 0.026), despite similar age, body mass index, Injury Severity Score, creatinine clearance, high risk injuries, and ICU/ventilator days. Standard dosing of enoxaparin leads to low anti-Xa levels in half of surgical ICU patients. Low levels are associated with a significant increase in the risk of DVT. These data support future studies using adjusted-dose enoxaparin.

The purposes of this study were to determine (a) the relationship between preoperative uncertainty and anxiety of orthopaedic surgical patients in three adult developmental stages (young, middle, older) and (b) the differences in uncertainty and anxiety among the adult developmental stages, gender, and acuity levels of the disorder. Correlational and comparative with descriptive survey. 106 adult orthopaedic surgical patients. Subjects were contacted 1 to 2 weeks preoperatively during their preadmission visit or upon early admission the day of surgery. All patients responded similarly in terms of having moderate levels of preoperative uncertainty and anxiety. There were no statistically significant differences among developmental stages, gender, or acuity levels for these orthopaedic patients. Nurses need to be aware that adult orthopaedic patients such as these subjects may have moderate levels of uncertainty and anxiety prior to surgery. In addition to physical preparation for surgery, nurses need to help patients with their emotional concerns. The incorporation of preoperative psychoeducational interventions and improved communication into plans of care for all orthopaedic surgical patients is recommended.

Postoperative pain is a common and distressing complication following surgery, particularly among orthopedic patients, due to extensive tissue injury and invasive procedures. Poorly managed POP can delay recovery, prolong hospital stays, increase complications, and reduce patient satisfaction. Despite the known burden, evidence on patient satisfaction with postoperative pain management among adult orthopedic patients in Ethiopia remains limited. This study aimed to assess patient satisfaction with postoperative pain management and its associated factors among adult orthopedic surgery patients at comprehensive specialized hospitals in the Amhara region from September 17 to December 13, 2025. A multicenter, institutional-based cross-sectional study was conducted among adult orthopedic surgical patients. A total of 423 participants were recruited using a consecutive sampling technique. Data were collected via semi-structured questionnaires adapted from validated tools and supplemented with locally relevant variables. Descriptive statistics were used to summarize participant characteristics, and bi-variable and multivariable logistic regression analyses were performed to identify factors associated with satisfaction. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the strength of associations, with p-values < 0.05 considered statistically significant. Among the 423 participants, 79.4% (95% CI 75.30, 83.03) reported satisfaction with postoperative pain management. Factors significantly associated with higher satisfaction included undergoing elective surgery (AOR = 2.92, 95% CI 1.58-5.40), having no or low preoperative anxiety (AOR = 2.98, 95% CI 1.67-5.34), receiving preoperative analgesia (AOR = 2.39, 95% CI 1.29-4.40), shorter surgical duration (≤ 1h) (AOR = 3.71, 95% CI 1.11-12.37), and use of peripheral nerve block-based postoperative analgesia (AOR = 2.98, 95% CI 1.27-7.02). Patient satisfaction with postoperative pain management was moderately high and significantly associated with several factors, including anxiety, preoperative analgesia, and perioperative practices such as elective surgery, shorter procedures, and the use of peripheral nerve block analgesia. To enhance postoperative pain control and patient satisfaction, healthcare facilities may consider prioritizing preoperative anxiety management, routine preoperative analgesia, and the consistent use of peripheral nerve block-based analgesia. In resource-limited settings, landmark-based techniques with appropriate provider training may support safe and effective implementation.

Comparison of circulating CD4+, CD8+ lymphocytes and cytokine profiles between dogs with atopic dermatitis and healthy dogs

As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. This thesis opens with a systematic review of the current literature on frailty and post-operative outcomes in older surgical patients (chapter two). Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical patients with a mean age of 75 and older. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument. Altogether 60 articles investigated the association between frailty and post-operative outcomes, 37 of them had patients with a mean age under 75 years old. The remaining 23 articles included in the review were assessed as medium to high quality. Participants ranged in age from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty.Though many studies have confirmed that frailty is associated with increased adverse outcome in the surgical population, the time point when frailty was assessed in the current literature was unclear. Whether baseline frailty or inpatient frailty predicts adverse outcome in surgical patients has not been investigated previously. The third chapter of the thesis aimed to derive a baseline and an inpatient frailty index (FI) and examine whether each was associated with adverse outcomes in the surgical population. A retrospective analysis was undertaken which derived baseline and inpatient FI from comprehensive geriatric assessment of 208 general surgical and orthopaedic patients aged 70 and over admitted to four acute hospitals in Queensland, Australia. The association of the FIs with adverse outcomes was examined in logistic regression. The mean (SD) baseline FI was 0.19 (0.09) compared to 0.26 (0.12) on admission, with a predominant increase in domains related to functional status. Both baseline and inpatient FIs were significant predictors of one year mortality, inpatient delirium, and a composite adverse outcome, after adjusting for age, sex and acuity of surgery. Baseline frailty and inpatient frailty, though distinct, are both predictive of adverse outcomes in surgical older patients. Frailty assessed at either time point is valid and useful in predicting adverse outcomes.In the fourth chapter of the thesis, a prospective study evaluated the feasibility of FI-CGA (frailty index based on comprehensive geriatric assessment) in 246 surgical patients aged 70 years and over undergoing intermediate to high risk surgery in a tertiary hospital in Queensland, Australia. Frailty was assessed using a 57-item FI-CGA form, with fit, intermediate and frail patients defined as FI l0.25, g0.25-0.4, and g0.4 respectively. nLogistic regression models assessed the relationship between FI and adverse outcomes, adjusting for age, gender and acuity of surgery. Adverse outcomes of interest were complications, prolonged length of stay, new discharge to residential aged care facility, deaths and unplanned hospital readmissions, ascertained intraoperatively, at 30 days and 12 months post-surgery. Mean age of the participants was 79 (SD 6.5), 52% were female, 91% were admitted from community, 65% underwent orthopaedic operations, and 43% underwent acute surgery. FI-CGA was a feasible tool which took on average 12 minutes to complete at the bedside. There were no statistically significant differences between fit, intermediate and frail groups in peri-operative (17.4%, 23.3%, 19.1% for fit, intermediate frail and frail patients p=0.577) and 30 day post-operative complications (35.8%, 47.8%, 46.8% p=0.183), which may have been a reflection of insufficient sample size. However, greater frailty was associated with increased 12 month mortality (6.4%, 15.6% and 23% for fit, intermediate frail and frail patients, p=0.01) and 12 month hospital readmissions (33.9%, 48.9%, 60%, p=0.004). Using FI-CGA peri-operatively may identify patients at high risk of poor long term outcome.In conclusion, there is strong evidence in the current literature that frailty is a predictor of adverse outcomes in surgical older adults. Frailty both at baseline and during an acute illness is predictive of adverse outcomes. FI-CGA is a potentially useful tool for incorporating into routine pre-operative assessment to help with decision making and to identify vulnerable surgical patients who are at higher risk of adverse outcomes.

Orthopedic surgical patients in general have been found to be at higher risk for developing opioid dependence in the postoperative period. However, there is conflicting evidence in the literature whether opioid exposure after hand surgery leads to prolonged use. In the absence of a nonoperative control group, it is not clear whether prolonged opioid use in hand surgical patients is related to undergoing a surgical intervention. The purpose of our study to compare opioid prescription fulfillment patterns in surgical and nonoperative patients in a hand surgery practice. We retrospectively compared 320 patients that underwent elbow, wrist, and hand surgery procedures with 741 nonoperative patients treated by 2 hand surgeons. The Pennsylvania Drug Monitoring Program (PDMP), a mandatory statewide database, was used to evaluate the primary outcomes of filling more than one opioid prescription and filling opioid prescriptions beyond 6 months of the index surgery or clinic visit. Bivariate and multivariable logistic regression analysis was performed using the following variables: surgery, prior benzodiazepine use, and prior opioid use. There was no difference in prior opioid use (15.2% vs 16.9%, P = .51) or prior benzodiazepine (10.4% vs 8.4%, P = .33) use between the nonoperative and operative groups. Patients that underwent surgery had a higher incidence of filling more than one opioid prescription (20.9% vs 8.8%, P < .001). However, continued opioid use was not statistically different between nonoperative and operative patients (2.8% vs 5%, P = .08). Bivariate analysis demonstrated that prior opioids (odds ratio [OR] = 12.94, P < .001) and prior benzodiazepines (OR = 1.95, P < .001) were significant independent risk factors for prolonged opioid use. Multivariable analysis demonstrated prior opioid use to be the only independent risk factor for prolonged opioid use (OR = 12.58, P < .001). Undergoing outpatient hand surgery do not appear to be an independent risk factor for filling opioid prescriptions beyond 6 months. Significant risk factors for prolonged opioid use include prior use of controlled substances, particularly prior opioid use.

Cardiac biomarkers play a crucial role in diagnosing heart disease in veterinary medicine. This collaborative study, involving 2497 dogs of various breeds, ages, and genders, was conducted collaboratively at the Department of Veterinary Clinical Medicine, College of Veterinary and Animal Science, RAJUVAS, Bikaner, and the Chandrika Chimanlal Doshi Cardiovascular Unit for Animals, Department of Veterinary Clinical Medicine, Ethics, and Jurisprudence, Bombay Veterinary College, Parel, Mumbai-12.Through meticulous examination, including historical analysis, clinical evaluation, and advanced diagnostic techniques like echocardiography, researchers conclusively diagnosed 29 cases of Dilated Cardiomyopathy (DCM). Canine-specific cardiac Troponin I (cTnI) levels were measured, showing significant differences between healthy and DCM-affected dogs. Among DCM cases, bilaterally affected dogs exhibited the highest cTnI levels. Similarly, B-type natriuretic peptide (BNP) analysis revealed significant differences between healthy and DCM-affected dogs, with notably elevated levels in bilaterally affected dogs. N-Terminal-pro-BNP analysis also indicated significant differences between healthy and DCM-affected dogs. However, atrial natriuretic peptide (ANP) analysis showed no significant differences between healthy and DCM-affected dogs, except for lower levels observed in right DCM cases. Endothelin 1 analysis showed non-significant differences between healthy and DCM-affected dogs, except for higher levels in bilateral DCM cases. While these biomarkers offer promising diagnostic insights, they have limitations. Proper sample handling, longer turnaround times, and the necessity for concurrent analysis of renal and hepatic function are crucial considerations. Additionally, these biomarkers complement but do not replace other diagnostic methods such as radiography and echocardiography. Further research in larger dog populations is warranted to validate and refine these findings.

Reoperations after lumbar disc surgery: a population‐based study of regional and interspecialty variations. (National Research and Development Center for Welfare and Health (STAKES), Helsinki, Finland) Spine 2000;25:1500–1507.This study aimed to explore rates of reoperation after lumbar disc surgery and their regional and interspecialty variations. Patients who underwent lumbar spine surgery from 1987 to 1995 were identified in the Finnish Hospital Discharge Register. Data on the patient's initial disc operations, subsequent operations, and cause‐of‐death records were linked using personal identification codes. The Kaplan‐Meier method and proportional hazard model were used to analyze risks of reoperation after initial surgery and for neurosurgical and orthopedic patients of university hospitals. Out of 25,359 surgical patients with herniated lumbar discs, 12.3% underwent subsequent lumbar operations corresponding to the cumulative risk of 18.9% in the 9‐year follow‐up. Reoperation rates increased during the study period with the recent patient cohorts exhibiting risks. The reoperation risk showed a systematic geographic variation: the higher the regional disc surgery rate, the higher the reoperation risk. Overall, neurosurgical patients had a higher reoperation risk than orthopedic patients, but it was not a uniform finding. Conclude that the reoperation risk after disc surgery increased during the study period and was higher in hospital catchment areas with higher overall discectomy rates. The reoperation rates varied among the university hospitals, but tended to be higher for neurosurgical rather than for orthopedic patients.

Orthopaedic patients are at particularly high risk for pulmonary embolism. There has been a trend recently toward overdiagnosis of pulmonary embolism; thus, evaluation of the nature of a clinically relevant pulmonary embolism is needed, as is assessment of the timing, risks, and outcomes of therapeutic anticoagulation in surgical patients. Recent literature shows the incidence of pulmonary embolism to be increasing without a corresponding increase in mortality, suggesting that not all emboli may be clinically relevant and that increasingly sensitive tests may be picking up small emboli. The size and location of a clot or clots may matter when deciding on management. A risk-benefit evaluation can assist in deciding treatment.

AHA Scientific Statement: Guide to anticoagulant therapy: heparin: a statement for healthcare professionals from the American Heart Association.

Biologic variability (BV) is one aspect of interpreting changes in biomarker concentrations known to be clinically important in people with cardiac disease, but it has not been adequately addressed in dogs so far. The purpose of the study was to determine BV of cardiac troponin I (cTnI) in healthy dogs and dogs with 3 stages of myxomatous mitral valve disease (MMVD). Healthy dogs and dogs with 3 stages of MMVD were prospectively assigned to groups based on comprehensive clinical evaluation using current guidelines. Concentrations of cTnI were measured hourly, daily, and weekly using standard and high-sensitivity immunoassays. Within- (CVI ) and between-subject (CVG ) coefficients of variability, percent reference change value (RCV), and index of individuality (IoI) were calculated. All 10 healthy dogs and 76/112 (68%) of samples from 28 MMVD dogs had cTnI concentrations below the limit of detection (LOD) using a standard sensitivity immunoassay. Only 49/160 (31%) of healthy dog samples and no MMVD samples had cTnI below the high-sensitivity immunoassay LOD. Data analysis for the high-sensitivity immunoassay revealed CVI of 48.1%, CVG of 60.1%, RCV of 134.0%, and IoI of 0.804 in healthy dogs. In MMVD dogs, CVI was 39.6%, CVG was 80.7%, RCV was 110%, and IoI was 0.494. Of all MMVD dogs, those with Stage B2 had the lowest RCV of 91%. Biologic variability affects cTnI concentrations in healthy dogs and dogs with MMVD. Consideration of BV may be clinically relevant when monitoring individual changes in cTnI values, using high-sensitivity immunoassays.

To compare the variability of symmetry indices within and between days when using one and two force plates for data collection. Seventeen healthy client-owned adult dogs. Vertical ground reaction force data were collected in a crossover study design, with four collection sessions on two consecutive days, and then two weeks apart (days 1, 2, 15, and 16) using both 1-plate and 2-plate collection methods. Symmetry indices were calculated for limb pairs using two standard equations (SI1 and SI2). Repeated measures analysis was used to compare symmetry indices data between plate systems and days. Significance was set at p <0.05. There were no significant differences between plate systems for SI1 and SI2. There were no significant differences between data collected on different days and no significant interaction effects between variables. Symmetry indices were consistently larger for ground reaction forces calculated from non-consecutive footfalls. The use of two force plate systems will minimize variance caused by trial repetition and paired limb variation. When comparing SI1 to SI2, results were not significantly different. However, there were consistently higher mean values for SI1 compared with SI2 and symmetry indices were consistently larger for 1-plate systems compared to 2-plate systems for both symmetry indices.