We integrated and optimized patient-reported outcome measures into the electronic health record to provide quantitative, objective data regarding patients’ health status, which is important for ...patient care, payer contracts, and research. With a multidisciplinary team from information technology, clinical informatics, population health, and physician champions, we used formal human–computer interaction techniques and user-centered design to integrate several technology platforms and computerized adaptive testing for the National Institutes of Health Patient-Reported Outcomes Measurement Information System. The patient-reported outcome measure system leverages software frequently used by health systems and provides data for research and clinical care via a mobile-responsive web application using Symfony, with REDCap for configuring assessments and de-identified data storage. The system incorporates Oracle databases and Epic flowsheets. Patients complete patient-reported outcome measures, with data viewable in MyChart and Epic Synopsis Reports. Researchers can access data portals. The highly usable, successful patient-reported outcome measures platform is acceptable to patients and clinicians and achieved 73 percent overall completion rates.
IntroductionMore than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%–0.5% fatal PE, and over 1000 deaths. ...Antithrombotic prophylaxis is standard of care but evidence is limited and conflicting. We will compare effectiveness of three commonly used chemoprophylaxis agents to prevent all-cause mortality (ACM) and clinical venous thromboembolism (VTE) while avoiding bleeding complications.Methods and analysisPulmonary Embolism Prevention after HiP and KneE Replacement is a large randomised pragmatic comparative effectiveness trial with non-inferiority design and target enrolment of 20 000 patients comparing aspirin (81 mg two times a day), low-intensity warfarin (INR (International Normalized Ratio) target 1.7–2.2) and rivaroxaban (10 mg/day). The primary effectiveness outcome is aggregate of VTE and ACM, primary safety outcome is clinical bleeding complications, and patient-reported outcomes are determined at 1, 3 and 6 months. Primary data analysis is per protocol, as preferred for non-inferiority trials, with secondary analyses adherent to intention-to-treat principles. All non-fatal outcomes are captured from patient and clinical reports with independent blinded adjudication. Study design and oversight are by a multidisciplinary stakeholder team including a 10-patient advisory board.Ethics and disseminationThe Institutional Review Board of the Medical University of South Carolina provides central regulatory oversight. Patients aged 21 or older undergoing primary or revision hip or knee replacement are block randomised by site and procedure; those on chronic anticoagulation are excluded. Recruitment commenced at 30 North American centres in December 2016. Enrolment currently exceeds 13 500 patients, representing 33% of those eligible at participating sites, and is projected to conclude in July 2024; COVID-19 may force an extension. Results will inform antithrombotic choice by patients and other stakeholders for various risk cohorts, and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants.Trial registrationNCT02810704.
Opioid use rates prior to knee arthroplasty (KA) among people who catastrophize about their pain are unknown. We determined prevalence of opioid use and compared patterns of preoperative opioid use ...and oral morphine equivalent (OME), a measure of daily opioid dose, across varied geographic sites. We also determined which baseline variables were associated with opioid use and OME.
Preoperative opioid use data described type of opioid, dosage, and frequency among 397 patients scheduled for KA. Demographic, knee-related pain, and psychological distress dimensions were examined to identify variables associated with opioid use and opioid dose (OME). Opioid use prevalence and OME were compared across the four sites. A three-level censored regression determined variables associated with opioid use and OME.
The overall opioid use prevalence was 31.7% (95% confidence interval CI = 27.0, 36.3) and varied across sites from 15.9% (95% CI = 9.0, 22.8) to 51.2% (95% CI = 40.5, 61.9). After adjustment, patients using opioids were more likely to be younger, African American, and have higher self-efficacy and comorbidity scores (
< 0.05). The only variable independently associated with OME was lower depressive symptoms (
< 0.05).
People who catastrophized prior to KA did not demonstrate increased preoperative opioid use based on current evidence, but variation in the prevalence of opioid use across study sites was substantial. Variables associated with opioid use were non-modifiable demographic and comorbidity variables.
Model Parameters Used for Base Case Slover, James, MD, MS; Haas, Janet P., DNSc; Quirno, Martin, MD ...
The Journal of arthroplasty,
2011, Letnik:
26, Številka:
3
Journal Article
Recenzirano
Abstract We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee ...arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving.
Abstract We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee ...arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving.
Abstract We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee ...arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving.
Abstract We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee ...arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving.
Abstract We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee ...arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving.
Many extracellular matrix glycoproteins--including laminin, fibronectin, thrombospondin, type I collagen, and other collagens--bind the glycosaminoglycan heparin, yet little is known about the ...functional significance of these interactions. It is also not known if heparin-binding extracellular matrix proteins recognize distinct structural elements in heparin, nor whether all extracellular matrix proteins recognize the same or different aspects of heparin structure. If extracellular matrix proteins each recognize distinct features of heparin, such specificity could be of importance in vivo, where structurally distinct heparan sulfate species occur. To investigate specificity in the binding between extracellular matrix proteins and heparin, the method of affinity coelectrophoresis (ACE) was used Lee, M. K., & Lander, A. D. (1991) Proc. Natl. Acad. Sci. U.S.A. 88, 2768-2772. Low M(r) (approximately 6 kDa) 125I-heparin was fractionated by electrophoresis through agarose gel lanes containing extracellular matrix proteins at various concentrations; from heparin migration patterns, binding affinities were calculated. The results indicate that fibronectin, type I collagen, and laminin--but not thrombospondin--each fractionate heparin into subpopulations that differ substantially in binding affinity. From ACE gels containing either fibronectin, type I collagen, or laminin, fractions of heparin were isolated that represent the 25% of molecules most strongly bound and the 25% least strongly bound by each of these proteins. Subsequent ACE analysis of these six fractions showed that (1) for each of fibronectin, type I collagen, and laminin, strongly- and weakly-binding heparin subfractions differ approximately 5-30-fold in Kd; (2) heparin that binds strongly to any one of fibronectin, type I collagen, or laminin also binds strongly to the other two; (3) heparin that binds weakly to any one of fibronectin, type I collagen, or laminin, also binds weakly to the other two; (4) heparin subfractions that differ greatly in affinity for fibronectin, type I collagen, and laminin show little difference in Kd for thrombospondin or for the heparin-binding growth factor basic fibroblast growth factor (bFGF); (5) neither heterogeneity in molecular charge as measured by diethylaminoethyl (DEAE) chromatography nor size nor the presence or absence of antithrombin III recognition sequences can account for the selective binding of heparin subpopulations to fibronectin, type I collagen, and laminin. These results suggest that structural elements within heparin can confer preferential binding to extracellular matrix proteins. Sensitivity of some, but not all, extracellular matrix proteins to these structural features suggests that similar features, if present in heparan sulfates or other glycosaminoglycans, may be physiologically relevant in vivo.
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