المؤلفون: Alves, Kristin, Penny, Norgrove, Ekure, John, Olupot, Robert, Kobusingye, Olive, Katz, Jeffrey N, Sabatini, Coleen S

مصطلحات موضوعية: Gluteal fibrosis, Post-injection paralysis

الوصف: Background: The purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital. Methods: We conducted a retrospective cohort study by reviewing the musculoskeletal clinic and community outreach logs for children (age < 18 yrs) diagnosed with either PIP or GF from Kumi Hospital in Kumi, Uganda between 2013 and 2015. We estimated the prevalence as a ratio of the number of children seen with each disorder over the total population of children seen for any musculoskeletal complaint in musculoskeletal clinic and total population of children seen for any medical complaint in the outreach clinic. Results: Of 1513 children seen in the musculoskeletal clinic, 331 (21.9% (95% CI 19.8–24.1%)) had PIP and another 258 (17.1% (95% CI 15.2–19.0%)) had GF as their diagnosis. Of 3339 children seen during outreach for any medical complaint, 283 (8.5% (95% CI 7.6–9.5%)) had PIP and another 1114 (33.4% (95% CI 31.8–35.0%)) had GF. Of patients with GF, 53.9% were male with a median age of 10 years (50% between 7 and 12 years old). Of patients with PIP, 56.7% were male with a median age of 5 years (50% between 2 and 8 years old). Conclusion: PIP and GF comprise over 30% of clinical visits for musculoskeletal conditions and 40% of outreach visits for any medical complaint in this area of Uganda. The high estimated prevalence in these populations suggest a critical need for research, treatment, and prevention. ; Medicine, Faculty of ; Non UBC ; Orthopaedic Surgery, Department of ; Reviewed ; Faculty

العلاقة: BMC Musculoskeletal Disorders. 2018 Sep 24;19(1):343; http://hdl.handle.net/2429/67262Test

الإتاحة: https://doi.org/10.1186/s12891-018-2254-9Test
http://hdl.handle.net/2429/67262Test

المؤلفون: Pereira, Joseph A., Hannibal, Kari, Stecker, Jasmine, Kasper, Jennifer, Katz, Jeffrey N., Molina, Rose L.

المصدر: BMC Med Educ

مصطلحات موضوعية: Research Article, edu, lang

الوصف: BACKGROUND: Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. METHODS: Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar’s test for comparing proportions with paired data. The study was determined not to constitute human subjects research. RESULTS: The response rate was 26% (206/803). More than half of respondents (n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar’s p-value < 0.0001). Respondents (n = 113, 56%) reported that clinical electives abroad influenced their cultural understanding of the local in-country population and their language proficiency. Only 13% (n = 27) of respondents have worked in a setting that required formal assessments of non-English language proficiency. CONCLUSIONS: HMS alumni of the Medical Language Program reported improved language proficiency after the medical language courses’ conclusion, suggesting that the courses may catalyze long-term language learning. We found that a majority of .

العلاقة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648424Test/

الإتاحة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648424Test/

المؤلفون: Edwards, Robert R., Campbell, Claudia, Schreiber, Kristin L., Meints, Samantha, Lazaridou, Asimina, Martel, Marc O., Cornelius, Marise, Xu, Xinling, Jamison, Robert N., Katz, Jeffrey N., Carriere, Junie, Khanuja, Harpal P., Sterling, Robert S., Smith, Michael T., Haythornthwaite, Jennifer A.

المصدر: BMC Musculoskeletal Disorders; 3/29/2022, Vol. 23 Issue 1, p1-17, 17p

مستخلص: Background: Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors.Methods: This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity.Results: The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related "positive" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain.Conclusions: This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Musculoskeletal Disorders is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Husni, M. Elaine, Losina, Elena, Fossel, Anne H., Solomon, Daniel H., Mahomed, Nizam N., Katz, Jeffrey N.

الوصف: BACKGROUND: Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. METHODS: We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. RESULTS: Two hundred ninety five hospitals (73%) responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (± 5.8). After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication compared to patients in hospitals without pathways (OR 0.68, 95% CI 0.50-0.92). Patients managed on a critical pathway had an average length of stay 0.5 days (95% CI 0.3-0.6) shorter than patients not managed on a pathway. CONCLUSION: Medicare patients undergoing total knee replacement surgery in hospitals that used critical pathways had fewer postoperative complications than patients in hospitals without pathways, even after adjusting for patient and hospital related factors. This study has helped to establish that critical pathway use is associated with lower rates of postoperative mortality and complications following total knee replacement after adjusting for measured variables.

العلاقة: Husni, M Elaine, Elena Losina, Anne H Fossel, Daniel H Solomon, Nizar N Mahomed, Jeffrey N Katz. "Decreasing medical complications for total knee arthroplasty: Effect of Critical Pathways on Outcomes" BMC Musculoskeletal Disorders 11:160. (2010); https://hdl.handle.net/2144/2569Test; 2918540

الإتاحة: https://doi.org/10.1186/1471-2474-11-160Test
https://hdl.handle.net/2144/2569Test

المؤلفون: Kapoor, Alok, Labonte, Alan J., Winter, Michael R., Segal, Jodi B., Silliman, Rebecca A., Katz, Jeffrey N., Losina, Elena, Berlowitz, Dan

الوصف: BACKGROUND: Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR), but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment. METHODS: Using the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates. RESULTS: CHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65) and TKR cohort (OR = 2.47 95% CI 1.95-3.14). COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70). The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence. CONCLUSIONS: Older adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis. ; Boston University School of Medicine Department of Medicine Pilot Grant Program

العلاقة: Kapoor, Alok, Alan J Labonte, Michael R Winter, Jodi B Segal, Rebecca A Silliman, Jeffrey N Katz, Elena Losina, Dan Berlowitz. "Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006)." BMC Geriatrics 10:63. (2010); https://hdl.handle.net/2144/2488Test; 2949673

الإتاحة: https://doi.org/10.1186/1471-2318-10-63Test
https://hdl.handle.net/2144/2488Test

المؤلفون: Meredith, Dennis S., Losina, Elena, Neumann, Gesa, Yoshioka, Hiroshi, Lang, Philipp K., Katz, Jeffrey N.

الوصف: BACKGROUND: In this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee MRI. We assessed the association of pathological change in multiple articular structures involved in the pathoanatomy of osteoarthritis. METHODS: Knee MRI scans from patients over 45 years old were assessed using a semi-quantitative knee MRI assessment form. The form included six distinct elements: cartilage, bone marrow lesions, osteophytes, subchondral sclerosis, joint effusion and synovitis. Each type of pathology was graded using an ordinal scale with a value of zero indicating no pathology and higher values indicating increasingly severe levels of pathology. The principal dependent variable for comparison was the mean cartilage disease score (CDS), which captured the aggregate extent of involvement of articular cartilage. The distribution of CDS was compared to the individual and cumulative distributions of each articular element using the Chi-squared test. The correlations between pathological change in the various articular structures were assessed in a Spearman correlation table. RESULTS: Data from 140 patients were available for review. The cohort had a median age of 61 years (range 45-89) and was 61% female. The cohort included a wide spectrum of OA severity. Our analysis showed a statistically significant trend towards pathological change involving more articular elements as CDS worsened (p-value for trend < 0.0001). Comparison of CDS to change in the severity of pathology of individual articular elements showed statistically significant trends towards more severe pathology as CDS worsened for osteophytes (p-value for trend < 0.0001), bone marrow lesions (p = 0.0003), and subchondral sclerosis (p = 0.009), but not joint effusion or synovitis. There was a moderate correlation between cartilage damage, osteophytes and BMLs as well as a moderate correlation between joint effusion and synovitis. However, cartilage damage and osteophytes were only weakly ...

العلاقة: Meredith, Dennis S, Elena Losina, Gesa Neumann, Hiroshi Yoshioka, Philipp K Lang, Jeffrey N Katz. "Empirical evaluation of the inter-relationship of articular elements involved in the pathoanatomy of knee osteoarthritis using Magnetic Resonance Imaging" BMC Musculoskeletal Disorders 10:133. (2009); https://hdl.handle.net/2144/2568Test; 2774678

الإتاحة: https://doi.org/10.1186/1471-2474-10-133Test
https://hdl.handle.net/2144/2568Test

المؤلفون: Katz, Jeffrey N., Wright, Elizabeth A., Baron, John A., Losina, Elena

الوصف: BACKGROUND: While musculoskeletal problems are leading sources of disability, there has been little research on measuring the number of functionally limiting musculoskeletal problems for use as predictor of outcome in studies of chronic disease. This paper reports on the development and preliminary validation of a self administered musculoskeletal functional limitations index. METHODS: We developed a summary musculoskeletal functional limitations index based upon a six-item self administered questionnaire in which subjects indicate whether they are limited a lot, a little or not at all because of problems in six anatomic regions (knees, hips, ankles and feet, back, neck, upper extremities). Responses are summed into an index score. The index was completed by a sample of total knee replacement recipients from four US states. Our analyses examined convergent validity at the item and at the index level as well as discriminant validity and the independence of the index from other correlates of quality of life. RESULTS: 782 subjects completed all items of the musculoskeletal functional limitations index and were included in the analyses. The mean age of the sample was 75 years and 64% were female. The index demonstrated anticipated associations with self-reported quality of life, activities of daily living, WOMAC functional status score, use of walking support, frequency of usual exercise, frequency of falls and dependence upon another person for assistance with chores. The index was strongly and independently associated with self-reported overall health. CONCLUSION: The self-reported musculoskeletal functional limitations index appears to be a valid measure of musculoskeletal functional limitations, in the aspects of validity assessed in this study. It is useful for outcome studies following TKR and shows promise as a covariate in studies of chronic disease outcomes. ; National Institutes of Health (NIH P60 AR 47782; NIH K24 AR 02123)

العلاقة: Katz, Jeffrey N., Elizabeth A. Wright, John A. Baron, Elena Losina. "Development and validation of an index of musculoskeletal functional limitations" BMC Musculoskeletal Disorders 10:62. (2009); https://hdl.handle.net/2144/2567Test; 2700076

الإتاحة: https://doi.org/10.1186/1471-2474-10-62Test
https://hdl.handle.net/2144/2567Test

المؤلفون: Williams, Emma E., Arant, Kaetlyn R., Leifer, Valia P., Balcom, Mardi Chadwick, Levy-Carrick, Nomi C., Lewis-O'Connor, Annie, Katz, Jeffrey N.

المصدر: BMC Women's Health; 8/27/2021, Vol. 21 Issue 1, p1-11, 11p

مصطلحات موضوعية: COVID-19 pandemic, INTIMATE partner violence, SOCIAL order, STAY-at-home orders, SOCIAL distancing

مصطلحات جغرافية: BOSTON (Mass.)

مستخلص: Background: Early research suggests the COVID-19 pandemic worsened intimate partner violence (IPV) in the US. In particular, stay-at-home orders and social distancing kept survivors in close proximity to their abusers and restricted access to resources and care. We aimed to understand and characterize the impact of the pandemic on delivery of IPV care in Boston.Methods: We conducted individual interviews with providers of IPV care and support in the Greater Boston area, including healthcare workers, social workers, lawyers, advocates, and housing specialists, who continued to work during the COVID-19 pandemic. Using thematic analysis, we identified themes describing the challenges and opportunites providers faced in caring for survivors during the pandemic.Results: Analysis of 18 interviews yielded four thematic domains, encompassing 18 themes and nine sub-themes. Thematic analysis revealed that the pandemic posed an increased threat to survivors of IPV by exacerbating external stressors and leading to heightened violence. On a system level, the pandemic led to widespread uncertainty, strained resources, amplified inequities, and loss of community. On an individual level, COVID-19 restrictions limited survivors' abilities to access resources and to be safe, and amplified pre-existing inequities, such as limited technology access. Those who did not speak English or were immigrants experienced even more difficulty accessing resources due to language and/or cultural barriers. To address these challenges, providers utilized video and telephone interactions, and stressed the importance of creativity and cooperation across different sectors of care.Conclusions: While virtual care was essential in allowing providers to care for survivors, and also allowed for increased flexibility, it was not a panacea. Many survivors faced additional obstacles to care, such as language barriers, unequal access to technology, lack of childcare, and economic insecurity. Providers addressed these barriers by tailoring services and care modalities to an individual's needs and circumstances. Going forward, some innovations of the pandemic period, such as virtual interactions and cooperation across care sectors, may be utilized in ways that attend to shifting survivor needs and access, thereby improving safe, equitable, and trauma-informed IPV care. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Women's Health is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Winter, Amelia R., Collins, Jamie E., Katz, Jeffrey N.

مصطلحات موضوعية: Osteoarthritis, Total knee arthroplasty, Arthroscopic partial meniscectomy, Arthroscopy

الوصف: Background: Arthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy. Methods: We searched PubMed, Embase, and Web of Science for English language manuscripts reporting TKA following arthroscopy for knee OA. We identified 511 manuscripts, of which 20 met the inclusion criteria and were used for analysis. We compared the cumulative incidence of TKA following arthroscopy in each study arm, stratifying by type of data source (registry vs. clinical), and whether the study was limited to older patients (≥ 50) or those with more severe radiographic OA. We estimated cumulative incidence of TKA following arthroscopy by dividing the number of TKAs among persons who underwent arthroscopy by the number of persons who underwent arthroscopy. Annual incidence was calculated by dividing cumulative incidence by the mean years of follow-up. Results: Overall, the annual incidence of TKA after arthroscopic surgery for OA was 2.62% (95% CI 1.73–3.51%). We calculated the annual incidence of TKA following arthroscopy in four separate groups defined by data source (registry vs. clinical cohort) and whether the sample was selected for disease progression (either age or OA severity). In unselected registry studies the annual TKA incidence was 1.99% (95% CI 1.03–2.96%), compared to 3.89% (95% CI 0.69–7.09%) in registry studies of older patients. In unselected clinical cohorts the annual incidence was 2.02% (95% CI 0.67–3.36%), while in clinical cohorts with more severe OA the annual incidence was 4.13% (95% CI 1.81–6.44%). The mean and median duration between arthroscopy and TKA (years) were 3.4 and 2.0 ...

وصف الملف: application/pdf

العلاقة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628417/pdfTest/; BMC Musculoskeletal Disorders; Winter, Amelia R., Jamie E. Collins, and Jeffrey N. Katz. 2017. “The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review.” BMC Musculoskeletal Disorders 18 (1): 408. doi:10.1186/s12891-017-1765-0. http://dx.doi.org/10.1186/s12891-017-1765-0Test.; http://nrs.harvard.edu/urn-3:HUL.InstRepos:34492421Test

الإتاحة: https://doi.org/10.1186/s12891-017-1765-0Test
http://nrs.harvard.edu/urn-3:HUL.InstRepos:34492421Test

المؤلفون: Losina, Elena, Smith, Savannah R., Usiskin, Ilana M., Klara, Kristina M., Michl, Griffin L., Deshpande, Bhushan R., Yang, Heidi Y., Smith, Karen C., Collins, Jamie E., Katz, Jeffrey N.

مصطلحات موضوعية: Physical activity, Workplace, Exercise, Financial incentives

الوصف: Background: We designed and implemented the Brigham and Women’s Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees. Methods: We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently. Results: B-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently. Conclusions: Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial. Trial registration Clinicaltrials.gov, NCT02850094. ...

وصف الملف: application/pdf

العلاقة: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709939/pdfTest/; BMC Public Health; Losina, Elena, Savannah R. Smith, Ilana M. Usiskin, Kristina M. Klara, Griffin L. Michl, Bhushan R. Deshpande, Heidi Y. Yang, Karen C. Smith, Jamie E. Collins, and Jeffrey N. Katz. 2017. “Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study.” BMC Public Health 17 (1): 921. doi:10.1186/s12889-017-4931-2. http://dx.doi.org/10.1186/s12889-017-4931-2Test.; http://nrs.harvard.edu/urn-3:HUL.InstRepos:34651972Test

الإتاحة: https://doi.org/10.1186/s12889-017-4931-2Test
http://nrs.harvard.edu/urn-3:HUL.InstRepos:34651972Test