Spartan medical research journal最新文献

{"title":"Assessing Root Causes of First Case On-time Start (FCOTS) Delay in the Orthopedic Department at a Busy Level II Community Teaching Hospital.","authors":"Blake Saul, Elise Ketelaar, Amjad Yaish, Michael Wagner, Robert Comrie, Grace D Brannan, Carolina Restini, Michelle Balancio","doi":"10.51894/001c.36719","DOIUrl":"10.51894/001c.36719","url":null,"abstract":"<p><strong>Introduction: </strong>Due to the high cost of operating room time, hospitals have been under increasing pressure to optimize operating room (OR) efficiency. One parameter that has been used to predict OR efficiency is First Case On-Time Start (FCOTS). In this brief report, the authors describe results from a quality improvement project designed to identify the rates and primary causes of first case delay for elective procedures within the orthopedic department at their suburban community hospital.</p><p><strong>Methods: </strong>This was a retrospective, quality improvement project. The authors reviewed information from their anesthesia group to identify the rate and causes for delayed FCOTS, as well as observations and employee interviews to map contributing factors of delay.</p><p><strong>Results: </strong>Surgery data on 159 days reviewed indicated that 107 (67.3%) days had first case delays. Of the 398 total first cases during this period, 156 (39.2%) were found to be delayed. The authors identified surgeon practices, with 74 (56.5%) as the main contributor to delay, followed by pre-operative processes, with 24 (18.3%), and room-related causes, 17 (13.0%). The anesthesia department and the patient were minor causes of delay, with 9 (6.9%) and 7 (5.3%) of case delays respectively.</p><p><strong>Discussion: </strong>Results were similar to other studies, indicating surgeons and pre-operative as main cause for delay. A fishbone diagram revealed patient factors, inefficiency in the pre-operative process, and staff tardiness as some of the causes.</p><p><strong>Conclusions: </strong>During this project, surgeon practices and preoperative processes were the main factors contributing to OR inefficiency within the community-based hospital. Future strategies to improve daily OR flow within similar institutions should target surgeon on-time arrival and streamlining of the pre-operative process to effectively reduce FCOTS delays.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"36719"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Covid-19 Severity And Residing In High Lead Level Locations.","authors":"Vanessa Foxworth, Larry Kage, Kimberly Barber","doi":"10.51894/001c.35880","DOIUrl":"10.51894/001c.35880","url":null,"abstract":"<p><strong>Introduction: </strong>This 2021 retrospective study explored the association between patients that resided in high lead-exposed areas and Covid-19 severity.</p><p><strong>Methods: </strong>Adults that resided within a metropolitan area hospitalized with Covid-19 at a community hospital between January 2020 and November 2020 were included in the study. Data including patient's age, sex, length of stay, and co-morbid conditions were extracted from the hospital electronic health record. The patients were classified according to severity of disease based on a Covid Severity Index (qCSI) score, using patient's vitals upon admission. Patient locations were classified per EPA mapping for lead exposure from water pipes.</p><p><strong>Results: </strong>The qCSI score was significantly higher in the high exposure group, with a mean of 4.6 (SD = 4.4), than the low exposure group, which had a mean of 2.1 (SD = 3.2) (p = 0.004). The median risk stratification levels differed significantly (p = 0.006). Length of stay was also significantly greater in the high exposure group, mean 11.4 (SD 10.7), then in the low exposure group, mean 6.2 (SD = 7.2) (p = 0.01).</p><p><strong>Conclusion: </strong>This study demonstrated an association between Covid-19 severity and patients that have had high lead level exposure. Further research is needed to explore this possible association, such as studies involving larger datasets.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 2","pages":"35880"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Vaccine Survey among Healthcare Workers. A Community Experience.","authors":"Nikita Theophilus, Carlos Rios-Bedoya, Ghassan Bachuwa","doi":"10.51894/001c.35628","DOIUrl":"10.51894/001c.35628","url":null,"abstract":"<p><strong>Introduction: </strong>In December 2019, the coronavirus (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) made its first appearance in Wuhan, China with a pandemic declared by March 2020. As the death toll continued to rise, the Centers for Diseases Control and Prevention (CDC) recommended healthcare workers to strongly encourage the general population to receive COVID-19 vaccinations. For this to be effective, it is important to understand the general perceptions of the health care workers and persons associated with the healthcare industry towards their acceptance of the vaccine.</p><p><strong>Methods: </strong>The authors of this 2021 cross-sectional study administered a 28-item survey to a convenience sample of 1,257 (43.1%) healthcare system workers out of a total of 2,915. The survey assessed respondents' demographic information, COVID-19 vaccine status, work-related exposures to COVID-19, reasons for receiving or refusing the vaccine, and primary sources of vaccine related information. Respondents were classified as vaccine status/intention positive or negative.</p><p><strong>Results: </strong>Those in the youngest 18 - 35 years age group were significantly less likely to receive the vaccine (p < 0.01) and male healthcare workers were significantly more likely to receive the vaccine (p = 0.01). White respondents, 759 (77.9%) were also more likely to receive the vaccine than African-American, 127 (13%). It was more likely for persons to be vaccinated when encouraged/provided (p = 0.01) information by their respective employers. A subgroup of 277 (22.0%) respondents reported their employer as the primary source of vaccine information, causing the authors to conclude that employer information was the most influential informational factor impacting COVID-19 vaccination.</p><p><strong>Conclusion: </strong>Vaccine hesitancy continues to be a major obstacle hampering the success of COVID-19 vaccination promotion programs. Results indicate that a combination of a prior COVID-19 diagnosis, information dispensed by a person's employer, persons' home living situations, and contact with persons who had an uneventful post vaccination experience increased the likelihood of vaccination.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"35628"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous positive airway pressure reduces the incidence of atrial fibrillation in patients with obstructive sleep apnea: A Meta-Analysis and Systematic Review.","authors":"Ziad Affas, Saif Affas, Kutiba Tabbaa","doi":"10.51894/001c.34521","DOIUrl":"10.51894/001c.34521","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are disorders that have increased in the United States during recent years. Earlier investigations have shown that underlying undiagnosed and unmanaged OSA plays a significant role in high rates and also as a trigger for newly diagnosed AF. Since the introduction of continuous positive airway pressure (CPAP) as a main therapy for OSA, more studies have evaluated the effect of CPAP on the development or recurrence of AF in OSA patients. However, sample sizes in a limited number of studies have been too small to conclude whether CPAP therapy has a significant effect on the development of AF in patients with OSA. The authors report results of their systematic review and meta-analysis summarizing what is currently known about the efficacy of CPAP for mitigating AF in patients with OSA.</p><p><strong>Method: </strong>The authors systematically reviewed the published reports on CPAP use and the incidence of AF from PubMed, Google Scholar, EMBASE, Web of Science, meeting abstracts, and Cochrane databases published between January 2015 and November 2021. Study data were extracted by two reviewers and a random-effects meta-analysis was performed using RevMan version 5.4.</p><p><strong>Results: </strong>A total of 17 studies that met inclusion criteria were identified Studies included a total of 6,523 patients, 3,248 (49.8%) who used CPAP and 3,275 (50.2%) who did not use CPAP. In a random effects model, patients treated with CPAP showed a decrease in the incidence of AF (OR, 0.51; 95% CI; 0.27; 0.97, p = 0.04). High heterogeneity among the included studies was also observed (I2 = 97%).</p><p><strong>Conclusion: </strong>Our results add to the increasing evidence that CPAP therapy may reduce the incidence of development of AF in patients with OSA. Prospective future studies and clinical trials are needed to refine our understanding of the relationship between OSA and AF and how CPAP may reduce cardiovascular disease development.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 2","pages":"34521"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9650937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Compliance with the CMS SEP-1 Sepsis Bundle at a Community-Based Teaching Hospital Emergency Department.","authors":"Marius Alexander, Melissa Sydney, Ari Gotlib, Megan Knuth, Olga Santiago-Rivera, Nikolai Butki","doi":"10.51894/001c.37707","DOIUrl":"10.51894/001c.37707","url":null,"abstract":"<p><strong>Introduction: </strong>The Centers for Medicare & Medicaid Services (CMS) designed Hospital Quality Initiatives (HQI) to assure delivery of quality health care for institutions receiving Medicare payments. Like many teaching institutions, the SEP-1 compliance rates at McLaren Oakland in Pontiac fluctuated monthly and were not achieving institutional target expectations.</p><p><strong>Methods: </strong>The project team designed a Sepsis Macro and a Sepsis Order Set in the electronic medical record system. The project team also implemented an educational initiative targeted at emergency medicine resident and attending physicians. The educational initiative instructed emergency medicine resident and attending physicians in the metrics measured in the SEP-1 bundle as well as how to properly use the newly designed Sepsis Macro and Sepsis Order Set.</p><p><strong>Results: </strong>After implementation of the Sepsis Macro and Sepsis Order Set, the overall compliance with the SEP-1 bundle improved from 57% to 62%, above national averages and at the institutional target expectations. However, there were not statistically significant differences (p = 0.562) between the compliance rate before and after program implementation (Pre = 57% (SD = 0.27); 95% CI: 0.29 - 0.85); Post= 62% (SD = 0.11); 95% CI: 0.55 - 0.70). After program implementation the SEP-1 compliance rate was met in 82% of the months in comparison with 50% of the months in the pre-intervention (p = 0.28).</p><p><strong>Conclusions: </strong>Although not achieving statistical significance, this intervention demonstrated that simple, cost-effective measures of education and standardization in documentation and order entry in EMR's can improve clinically significant compliance to CMS HQI metrics in community-based teaching institutions.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"37707"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Fantasy Points\" associated with Professional Athlete Performance after Lumbar Discectomy or Microdiscectomy.","authors":"Marvin Kajy, Devan O Higginbotham, Guy Ball, Rahul Vaidya","doi":"10.51894/001c.30766","DOIUrl":"10.51894/001c.30766","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of Lumbar Disc Herniation (LDH) in elite athletes is a debated topic that lacks consensus in the literature due to varying outcome reporting methods. The objective of this study was to quantify the overall performance of a sample of professional athletes before and after receiving a lumbar discectomy or microdiscectomy in a cohort of players in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL) and Major League Baseball (MLB).</p><p><strong>Methods: </strong>The authors identified publicly accessible data from a cohort of different types of professional players who received either a lumbar discectomy or a microdiscectomy. These records were identified through newspaper archives, injury reports, player profiles and press releases between 1993 through 2015. Fantasy and Wins Above Replacement (WAR) scores were calculated for each player.</p><p><strong>Results: </strong>A total of 38 professional players met study inclusion criteria. NFL players had the lowest return-to-play (RTP) at nine of 14 (64%). The RTP for NBA, NHL and MLB players were comparable with 6/7 (86%) vs 8/9 (89%) vs 7/8 (88%). NFL players had the lowest average career length after surgery at 34.8 months, while NBA players had the longest average career length at 48 months. MLB players on average required the longest time to return to presurgical level of performance (24 months) and required the longest average recovery time at 12 months.</p><p><strong>Conclusions: </strong>Based on these results, the average performance of most elite athletes are likely to decrease after undergoing a lumbar discectomy. Although it appears that performance peaks in the initial years after the operation for some players, there was an overall long-term decline in this sample of elite athletes. Study limitations included small sample size, lack of controlling for possible confounding variables (e.g., age, etc.) and use of variable reporting sources. Additional studies with larger sample sizes and age-matched controls are needed to examine the effects of lumbar discectomy more comprehensively in elite athletes.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 1","pages":"30766"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Sequence of Measurement Affects Blood Pressure Level in an African American Cohort.","authors":"Michael Marshall, Nancy Jackson, Brittni McClellan, Max Zlatopolsky, Susan Steigerwalt, Grace D Brannan","doi":"10.51894/001c.30124","DOIUrl":"10.51894/001c.30124","url":null,"abstract":"<p><strong>Introduction: </strong>Uncontrolled hypertension can result in severe clinical conditions such as stroke, chronic kidney disease and congestive heart failure, especially in African American populations. To the knowledge of the authors, the effect of time sequence on blood pressure (BP) using an Automated Office Blood Pressure (AOBP) device has not been documented in an African American cohort. The objective of this study was to investigate the possible influence of time sequence of measurement (pre- and post-physician visit) on BP readings in an African American cohort, in the presence or absence of a Medical Assistant (MA) via AOBP monitoring.</p><p><strong>Methods: </strong>A two-phase, single-blinded, non-randomized trial was conducted at MI-based Ascension Providence Hospital with a convenience sample of hypertensive patients. BP readings were taken using both an Omron 907 (Omron Corp., Kyoto, Japan) and a Welch Allyn (WA) Connex Spot Monitor (Welch Allyn, Inc., Skaneateles Falls, NY) AOBP devices. Descriptive statistics were generated, and T-tests were performed.</p><p><strong>Results: </strong>In Phase 1, (N = 148), the mean systolic/diastolic readings for the pre-physician visits (141/82 mmHg) were statistically significantly higher than the post-visit readings (134/80 mmHg) (p ≤ 0.02). Post-visit physician readings from either AOBP device did not differ statistically (p = 0.72). In Phase 2 (n = 50), the presence of an MA resulted in significantly higher readings than when an MA was absent, however, the results of Phase 2 also supported the trends for lower BP post-physician visit found in Phase 1.</p><p><strong>Conclusion: </strong>Based on the consistency of these results, a post-physician visit AOBP reading, in the presence or absence of an MA, may provide a more accurate BP measurement to determine whether or not to treat hypertension in African American patients.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 1","pages":"30124"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Fat Deposition of Renal Sinus a Concomitant Finding to Fatty Liver Disease? The First Study Regarding the Relationship Between Kidney and Liver Fat Content with Non-Contrast Computed Tomography.","authors":"Emrah Doğan, Ferda Bacaksızlar Sarı","doi":"10.51894/001c.32411","DOIUrl":"10.51894/001c.32411","url":null,"abstract":"<p><strong>Introduction: </strong>It has been established that abnormal fat deposits are associated with fat deposition in other abdominal regions and linked to obesity, diabetes mellitus, hypertension, vascular and metabolic diseases. This study aimed to determine whether there was a relationship between fat deposition of the renal (i.e., kidney) sinus (FRS) and fatty liver disease (FLD) in a sample of adults. The authors hypothesized that FRS could be a diagnostic finding associated with Hepatosteatosis (HS) in a sample of younger patients. This study was the first apparent investigation of this possible phenomenon.</p><p><strong>Methods: </strong>A convenience sample of 92 adult patients of which 19 (20.7%) were females and 73 (79.3%) were males, and with a mean age of 30.19 (SD = 6.00) were included. The authors calculated Hounsfield Units (HU) (i.e., relative quantitative measurement of radio density) of patients' livers and spleens on non-contrast computed tomography (CT). Liver and spleen differences < 10 HU were considered steatosis (FLD). The authors stratified sample patients into two analytic subgroups according to the presence of FLD or not and compared them based on their FRS widths.</p><p><strong>Results: </strong>In the FLD subgroup (N = 48), the difference of HU values between liver and spleen was -5.19 (SD = 11.32), with a range of -38 - 8 HU, while, in the non-steatosis subgroup (N = 44), the mean difference was 16.36 (SD = 3.90), range of 11 - 26 HU. The average diameter of FRS width was 12.5 mm in those patients with steatosis (FLD subgroup) although 9.3 mm in non-FLD patients. (p = 0.02).</p><p><strong>Conclusions: </strong>Based on these results, FRS may be able to be used by radiologists as an ancillary method in the detection of hepatic steatosis in younger adults. The effectiveness of premedical processes (e.g., exercise and diet modification) can also be increased by non-radiologists after detection of lower-grade HS.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"32411"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48390546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed Fracture Treatment in Adults, When is it Still Relevant?","authors":"Matthew Coon, Marek Denisiuk, Derrek Woodbury, Benjamin Best, Rahul Vaidya","doi":"10.51894/001c.28060","DOIUrl":"10.51894/001c.28060","url":null,"abstract":"<p><strong>Introduction: </strong>Fracture treatment has been documented since the times of ancient Egyptian and Greek civilization, with fracture reduction techniques and the apparatus for immobilization developed over three millennia. Over the last 150 years, aseptic technique, anesthesia, antibiotics, and internal implants have changed how orthopedic specialists approach fracture care. More recently, there has been an increased promotion in the medical literature to evaluate the clinical outcomes of nonsurgical treatment of common upper and lower extremity closed fractures.</p><p><strong>Methods: </strong>In this paper, the authors review the history of closed extremity fracture treatments, outline contemporary studies regarding treatments of non-displaced fractures, and discuss the recent literature that has informed orthopedic surgeon-patient decision-making discussions regarding closed fracture management.</p><p><strong>Conclusions: </strong>Based on the results of this literature review, orthopedic providers should consider the preferable outcomes associated with nonoperative fracture management such as lower infection rates, the possibility of rapid functional improvements and lower healthcare costs. Nonoperative methods for closed fractures can sometimes be more safely delivered even with more difficult fractures. This may be of particular benefit to patients with higher surgical risks, minimizing exposure to treatments that are not only more invasive and expensive, but that can impose greater postoperative risks.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"28060"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44216724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis Screening via Chest X-Ray is Financially Burdensome in Previously Independently Living Elective Total Knee Arthroplasty Patients.","authors":"Haseeb Khan, Mayank Gupta, Therese Bou-Akl, David Markel","doi":"10.51894/001c.30158","DOIUrl":"10.51894/001c.30158","url":null,"abstract":"<p><strong>Background: </strong>In 1995, to reduce the transmission of Tuberculosis (TB) the Centers for Disease Control and Prevention recommended that all patients discharged from hospitals be required to have chest x-rays (i.e., radiography) performed before admission to long term care facilities (LTCFs). Previously independently living patients (PILPs) who undergo elective total knee replacement (TKA) surgery are a population at higher risk to end up in LTCFs for rehabilitation. By 2017, the incidence of TB was 9,105 cases compared to 22,762 in 1995. However, the recommendations that hospitals be required to perform a chest x-ray in all patients (including PILPs) being transferred to LTCF's have remained in place. The purposes of this study were to: a) determine the incidence of TB-positive chest x-rays in PILPS discharged to LTCFs after undergoing elective TKA surgery, and b) assess the cost (i.e., both financial and possible exposure to unnecessary radiation) of mandated chest x-rays before hospital discharge to LTCF for PILPs.</p><p><strong>Methods: </strong>Retrospective 2012-2017 patient chart data were collected from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) to identify all elective TKAs for PILPs performed at two Ascension participating centers. Study data included sex, age, body mass index (BMI), length of stay, comorbidities, and chest x-ray results before discharge. Patients who underwent surgery for fracture, infection, trauma, or malignancy were excluded from the study. Categorical data were analyzed using Fisher's exact test and Student's t-test were used for continuous data.</p><p><strong>Results: </strong>The authors identified 4,041 total elective TKA's, from which 500 PILPs were discharged to a LTCF due to functional, medical and/or social concerns. Chest x-rays were associated with 500 (100%) negative findings for TB. Overall hospital costs for chest x-rays for patient's being discharged to an extended care facility totaled $90,848.</p><p><strong>Conclusions: </strong>The mandated use of chest x-rays for TB screening of PILPs undergoing elective surgery TKA prior to discharge to LTCFs appear to place an unnecessary financial burden on the healthcare system. The mandatory use of x-rays for assessment of possible TB infection before transfer to LTCFs appears to also expose PILPs unnecessarily to radiation. Although further studies are needed to verify these results, the authors recommend that perhaps instead chest x-rays should be reserved for patients with specific comorbidities (e.g., patients on immunosuppressive therapy, with HIV, etc.) or for those patients residing in LTCFs prior to surgery.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 1","pages":"30158"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10874043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}