Inappropriate electrolyte repletion for patients undergoing endoscopic procedures

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures Goals Clarify policies regarding electrolyte repletion Determine frequency of inappropriate electrolyte checking and repletion Determine monetary cost of this action Decrease frequency of inappropriate electrolyte lab check and repletionhttps://jdc.jefferson.edu/patientsafetyposters/1023/thumbnail.jp

Mechanical concepts for disc regeneration

Different strategies exist to treat intervertebral disc degeneration. Biological attempts to regenerate the disc are promising. However, degeneration of the disc is always accompanied by alterations of disc height, intradiscal pressure, load distribution, and motion patterns, respectively. Since those preconditions are independent factors for disc degeneration, it is unlikely that regeneration may occur without firstly restoring the physiological status of the affected spinal segment. In vitro and in vivo animal studies demonstrate that disc distraction normalizes intradiscal height and pressure. Furthermore, histological and radiological examinations provided some evidence for regenerative processes in the disc. Only dynamic stabilization systems currently offer the potential of a mechanical approach to intervertebral disc regeneration. Dynamic stabilization systems either using pedicle screws or with an interspinous device, demonstrate restabilization of spinal segments and reduction of intradiscal pressure. Clinical reports of patients with degenerative disc disease who underwent dynamic stabilization are promising. However, there is no evidence that those implants will lead to disc regeneration. Future treatment concepts should combine intradiscal cell based therapy together with dynamic restoration of the affected spinal segment