Rationality and its Other

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Significant cost savings and similar patient outcomes associated with early discharge following total knee arthroplasty

© 2019 Joule Inc. or its licensors. Background: A substantial portion of the cost of total knee arthroplasty (TKA) results from the postoperative inpatient length of stay (LOS). Considering the annual increase in TKAs, reducing LOS represents a potential for cost savings. We sought to compare in-hospital costs and patient-reported outcomes for an early discharge protocol compared with the standard LOS following TKA. Methods: We conducted a retrospective matched cohort study, matching patients on age, sex, body mass index and preoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score. We compared costs associated with time in the operating room, intraoperative pain control and inpatient stay as well as 1-year postoperative patient-reported outcomes between early discharge and standard LOS groups. Results: We included 50 patients in our study (25 per group). The average LOS in the early discharge group was 26.5 hours, compared with 48.9 hours in the standard care group. The early discharge group had higher intraoperative costs associated with pain control (mean difference 26.98, 95% confidence interval 14.41-37.90, p \u3c 0.01); however, this difference was offset by substantial savings associated with the reduced LOS. The mean total cost for the early discharge group was $649.62 ±$281.71 versus $1279.71 ±$515.98 for the standard care group. There were no significant differences in SF12 or WOMAC scores between groups at 1 year postoperative. Conclusion: In-hospital costs were significantly lower with a postoperative day 1 discharge protocol than with standard LOS following TKA, with no difference in patient-reported outcomes

Towards Better Integrators for Dissipative Particle Dynamics Simulations

Coarse-grained models that preserve hydrodynamics provide a natural approach to study collective properties of soft-matter systems. Here, we demonstrate that commonly used integration schemes in dissipative particle dynamics give rise to pronounced artifacts in physical quantities such as the compressibility and the diffusion coefficient. We assess the quality of these integration schemes, including variants based on a recently suggested self-consistent approach, and examine their relative performance. Implications of integrator-induced effects are discussed.Comment: 4 pages, 3 figures, 2 tables, accepted for publication in Phys. Rev. E (Rapid Communication), tentative publication issue: 01 Dec 200

FIRE Spectroscopy of Five Late-type T Dwarfs Discovered with the Wide-field Infrared Survey Explorer

We present the discovery of five late-type T dwarfs identified with the Wide-field Infrared Survey Explorer (WISE). Low-resolution near-infrared spectroscopy obtained with the Magellan Folded-port InfraRed Echellette (FIRE) reveal strong water and methane absorption in all five sources, and spectral indices and comparison to spectral templates indicate classifications ranging from T5.5 to T8.5:. The spectrum of the latest-type source, WISE J1812+2721, is an excellent match to that of the T8.5 companion brown dwarf Wolf 940B. WISE-based spectrophotometric distance estimates place these T dwarfs at 12-13 pc from the Sun, assuming they are single. Preliminary fits of the spectral data to the atmosphere models of Saumon & Marley indicate effective temperatures ranging from 600 K to 930 K, both cloudy and cloud-free atmospheres, and a broad range of ages and masses. In particular, two sources show evidence of both low surface gravity and cloudy atmospheres, tentatively supporting a trend noted in other young brown dwarfs and exoplanets. In contrast, the high proper motion T dwarf WISE J2018-7423 exhibits a suppressed K-band peak and blue spectrophotometric J-K colors indicative of an old, massive brown dwarf; however, it lacks the broadened Y-band peak seen in metal-poor counterparts. These results illustrate the broad diversity of low-temperature brown dwarfs that will be uncovered with WISE.Comment: 19 pages, 13 figures; accepted for publication to Ap

Risk of SARS-CoV-2 Transmission During Flexible Laryngoscopy: A Systematic Review.

IMPORTANCE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reportedly infected otolaryngologists disproportionately in the early parts of the coronavirus disease 2019 pandemic. Recommendations from national and international health organizations suggest minimizing the use of flexible laryngoscopy as a result. OBJECTIVE: To review evidence on the risks of aerosolization and transmission of SARS-CoV-2 from patients to health care personnel during endoscopy of the upper aerodigestive tract. EVIDENCE REVIEW: A comprehensive review of literature was performed on April 19, 2020, using the PubMed/MEDLINE (1966-April 2020), Embase (1975-April 2020), and Web of Science (1900-April 2020) databases. All English-language primary research studies were included if they assessed the transmission of SARS-CoV-2 or SARS-CoV-1 during procedures in the upper aerodigestive tract. The primary outcome measure was disease transmission among health care workers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for accuracy of reporting. FINDINGS: The queries for SARS-CoV-2 and SARS-CoV-1 identified 6 articles for systematic review. No studies included in this review provided data for SARS-CoV-2 transmission during flexible laryngoscopy. A total of 204 of 1264 health care workers (16.1%) had procedure-specific infections of SARS-CoV-1 or SARS-CoV-2. Among those, 53 of 221 (24.0%) were exposed during intubation, 1 of 15 (6.7%) during bronchoscopy, and 1 of 1 (100%) during endoscopy-assisted intubation. CONCLUSIONS AND RELEVANCE: A substantial lack of research precludes formal conclusions about the safety of flexible laryngoscopy and transmission of SARS-CoV-2 from patients to health care workers. The use of appropriate precautionary measures and personal protective equipment appears to reduce the risk of transmission. Given the uncertainty in transmission and the known benefits of safety precautions, upper airway endoscopy may be reasonable to perform if precautionary steps are taken

Implementation of outpatient total joint arthroplasty in canada: Where we are and where we need to go

© 2020 Zomar et al. Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers

The economic impact of periprosthetic infection in total hip arthroplasty

© 2020 Canadian Medical Association. All rights reserved. Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today\u27s health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p \u3c 0.001), mean number of clinic visits (9.2 v. 3.8, p \u3c 0.001), number of readmissions (12 v. 1, p \u3c 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p \u3c 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA