17 research outputs found

    Strategies for Deficit Recovery for the Orthopaedic Service Line: Lessons Learned from the COVID-19 Pandemic: AOA Critical Issues Symposium

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    ABSTRACT: The COVID-19 pandemic and the mandated cessation of surgical procedures for a substantial portion of the 2020 year placed tremendous strain, both clinically and financially, on the health-care system in the United States. As a surgical specialty that accounts for nearly a quarter of all hospital net income, the revenue recovery of orthopaedic service lines (OSLs) is of particular importance to the financial recovery of their broader health-care institutions. In this American Orthopaedic Association (AOA) symposium report, the OSL leaders from 4 major academic medical institutions explain and reflect on their approaches to address their revenue deficits. Cost-reduction strategies, such as tightening budgets, adopting remote-work models, and limiting costs of human capital, were vital to stabilizing departmental finances at the onset of the pandemic, while strategies that focused on expanding surgical volume, such as those that improve efficiency in clinical and surgical settings, were important in growing revenue once elective procedures resumed. Institutional policy, payer administrative procedures, and the overall context of an ongoing public health crisis all placed limitations on recovery efforts, but engaging relevant stakeholders and working with available resources helped OSLs overcome these limitations. Due to clear strategic actions that were taken to address their deficits, each OSL represented in this AOA symposium saw substantial improvement in its year-end financial performance compared with its financial status at the end of the period of mandatory cessation of elective surgical cases

    Breast Radiation Exposure in Female Orthopaedic Surgeons

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    BackgroundBreast cancer prevalence is higher among female orthopaedic surgeons compared with U.S. women. The most common breast cancer site, the upper outer quadrant (UOQ), may not be adequately shielded from intraoperative radiation. Factors associated with higher breast radiation exposure (protective apron size and type, surgeon position, and C-arm position) have yet to be established.MethodsAn anthropomorphic torso phantom, simulating the female surgeon, was placed adjacent to a standard operating table. Dosimeters were placed over the UOQ and lower inner quadrant (LIQ) of the breast, bilaterally. Scatter radiation dose-equivalent rates were measured during continuous fluoroscopy to a pelvic phantom (simulating the patient). Four apron sizes (small, medium, large, and extra-large), 2 apron types (cross-back and vest), 2 surgeon positions (facing the table and 90° to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested.ResultsThe median dose-equivalent rate of scatter radiation to the UOQ (0.40 mrem/hr) was higher than that to the LIQ of the breast (0.06 mrem/hr) across all testing, although this was not statistically significant (p = 0.05). The cross-back aprons provided higher protection to the LIQ compared with the vests (p < 0.05). Lead protection in sizes that were too small or too large for the torso had higher breast radiation dose-equivalent rates. C-arm cross-table lateral projection was associated with higher breast radiation exposure (0.98 mrem/hr) compared with anteroposterior projection (0.13 mrem/hr) (p < 0.001).ConclusionsBreast radiation exposure is higher in a C-arm lateral projection compared with an anteroposterior projection. Higher dose-equivalent rates were observed for the UOQ compared with the LIQ of the breast and for aprons that were too small or too large, although these differences did not reach significance. Factors that may reduce radiation exposure include lead protection of appropriate size and distancing the axilla from the patient and x-ray tube.Clinical relevanceIncreased breast cancer prevalence has been reported for female orthopaedic surgeons. The UOQ of the breast may be at risk for intraoperative radiation exposure. Methods of reducing exposure are warranted

    Measurement Scales in Clinical Research of the Upper Extremity, Part 1: General Principles, Measures of General Health, Pain, and Patient Satisfaction

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    Measurement is a fundamental cornerstone in all aspects of scientific discovery, including clinical research. To be useful, measurement instruments must meet several key criteria, the most important of which are satisfactory reliability, validity, and responsiveness. Part 1 of this article reviews the general concepts of measurement instruments and describes the measurement of general health, pain, and patient satisfaction
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