These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include ...evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.
Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve ...orifice and the effects of PPM after TAVR are less well studied.
The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017.
On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (<0.65 cm
/m
), moderate (0.65 to 0.85 cm
/m
), or none (>0.85 cm
/m
). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage.
Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality-of-life score at 1 year.
Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.
Current techniques for the identification of the infecting organism in prosthetic-joint (e.g., hip or knee) infection remain insensitive. In this study of 331 surgeries involving prosthetic joint ...replacement, a new technique that sonicates the removed artificial joint is found to be more sensitive in identifying the infecting organism than are standard culture techniques.
In surgeries involving prosthetic joint replacement, a new technique that sonicates the removed artificial joint is found to be more sensitive in identifying the infecting organism than are standard culture techniques.
In the United States, 638,000 patients underwent hip or knee replacement in 2003.
1
Although they may improve the quality of life, these procedures are associated with complications, including aseptic failure and prosthetic-joint infection.
2
It is important to distinguish prosthetic-joint infection from other causes of joint failure, because its management is different.
3
Nonmicrobiologic methods developed for diagnosing native-joint infection use different criteria from those used to diagnose prosthetic-joint infection.
4
Microbiologic diagnosis of prosthetic-joint infection may also require different criteria from those used for the microbiologic diagnosis of native-joint infection.
Most clinicians and laboratory workers culture periprosthetic tissue (hereafter referred to as . . .
TECHNICS AND AGENCY Tuckwell, Jason
Angelaki : journal of theoretical humanities,
08/2020, Letnik:
25, Številka:
4
Journal Article
Recenzirano
One of the orienting claims in Yuk Hui’s The Question Concerning Technology in China is that an adequate accounting for the pluralism of technicity remains forthcoming. Hui brings this to our ...attention by arguing that a cosmological dimension, animate in the evolution of technology, leads to distinct “local” technicities; this should be contrasted to the consensus that technology is a universal phenomenon. Hui defends this differentiating role of the cosmic, by way of a Kantian antimony between two genetic problems. In Hui’s presentation, this antimony specifically concerns the status of an “anthropological universality” within technics. On the one hand, technics as the “extension of somatic functions and the externalisation of memory” is only differentiated by its passage through local conditions, but on the other, technics would be genetically affected by a cosmological (cultural, mythic) dimension, that would differently orient distinctive evolutionary developments within it.In this paper, I consider another source for Hui’s technical pluralism by arguing that functional differences inhere within the technical, itself. What this implies, is not only a reconsideration of technic’s “universality,” but also the anthropomorphism implied in the image of homo faber: what defines technicity and technology as an immanent, extensive and human-exclusive prosthesis. In order to do so, I return to Aristotle’s primary (or primitive) centralisation of the technite to argue that his causal accounting of technics should not have been restricted exclusively to the human, but rather considered as a general property of how agents deviate primary processes. I then show how technē – reconstituted as the affective power of many agents – suggests that a technically mediated agency is not only constitutive of human difference (Stiegler’s foundational prosthesis) but must more generally be evident in the agential character of diverse, even primordial species.This also entails a reconsideration of the relationship between technics and telos. This is because it is not only the agential distinction Aristotle draws between humans and other species that requires renovation, but also the widely criticised move to extend telos (the efficient cause specific to the technites) into a teleological purpose animating nature. However, rather than follow the critique of teleology in the Aristotelianism of the early modern period (with Suarez, Descartes and Spinoza), I will rather argue that telos should be recast as a dynamic interventional power that belongs broadly to agents. That is to say, if technē is a model of agency inseparable from the emergence of even primordial life, then we require an analysis of how an artificial, technical dimension inheres within non-human agents. I will finally outline how this technicity of non-human agents remains compatible with Hui’s cosmotechnics.
Periprosthetic joint infection Kapadia, Bhaveen H, MD; Berg, Richard A, MD; Daley, Jacqueline A, BSc ...
The Lancet (British edition),
01/2016, Letnik:
387, Številka:
10016
Journal Article
Recenzirano
Summary Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these ...infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods.
About half of all nosocomial infections are associated with indwelling devices. Infections associated with implanted surgical devices are particularly difficult to deal with because they can require ...prolonged antibiotic treatment and repeated surgical procedures. This review summarizes the diagnostic challenges and explains the approaches to managing infections that are associated with various devices, including prosthetic heart valves, vascular grafts, pacemakers and defibrillators, and joint prostheses.
Infections associated with implanted surgical devices are particularly difficult to deal with.
About half of the 2 million cases of nosocomial infection that occur each year in the United States are associated with indwelling devices. Although less common than infections related to catheters, infections associated with surgical implants are generally more difficult to manage because they require a longer period of antibiotic therapy and repeated surgical procedures.
1
,
2
In 2002, the Multidisciplinary Alliance against Device-Related Infections (www.maadrialliance.org) was established to organize groups of experts to develop guidelines for treatment. The four objectives of this review of infections associated with a variety of surgical implants are to describe the clinical and economic effects, . . .
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