Functional assessment of bipolar hemiarthroplasty versus total hip replacement in trans cervical neck fracture of femur in elderly patients a prospective observational study

Background: Bipolar hemiarthroplasty and total hip arthroplasty are widely accepted methods of treatment for displaced femoral neck fracture in elderly patients. This study is to compare the functional outcomes of bipolar hemiarthroplasty and total hip arthroplasty in such patients. Methods: This is a prospective study in which data of all patients with age more than 60 with trans cervical neck of femur fracture undergoing total hip arthroplasty and bipolar hemiarthroplasty in a tertiary care centre in Mumbai is studied. They were followed up and compared with the Modified Harris Hip Score. The results were compared between the two groups for statistical significance. Results: There was a significant difference seen in pain and gait at 6 and 12 months between two groups with better scores in the total hip arthroplasty group. Better functional activities were seen at 3 and 6 months in the total hip arthroplasty group. A significant difference was seen in the Total Modified Harris Hip Score at 3, 6 and 12 months and was better in the total hip arthroplasty group as compared to the hemiarthroplasty group. Conclusions: Bipolar hemiarthroplasty is the preferred approach after a displaced femoral neck fracture in the elderly population, but due to potential complications like inguinal pain and low functional outcome, total hip replacement should be considered as the first line of surgical management for the neck of femur fracture in such patients. It has been found to have a good functional outcome, fewer gait disturbances and less post-operative pain

Composite Scores for Transplant Center Evaluation: A New Individualized Empirical Null Method

Risk-adjusted quality measures are used to evaluate healthcare providers while controlling for factors beyond their control. Existing healthcare provider profiling approaches typically assume that the risk adjustment is perfect and the between-provider variation in quality measures is entirely due to the quality of care. However, in practice, even with very good models for risk adjustment, some between-provider variation will be due to incomplete risk adjustment, which should be recognized in assessing and monitoring providers. Otherwise, conventional methods disproportionately identify larger providers as outliers, even though their provider effects need not be "extreme.'' Motivated by efforts to evaluate the quality of care provided by transplant centers, we develop a composite evaluation score based on a novel individualized empirical null method, which robustly accounts for overdispersion due to unobserved risk factors, models the marginal variance of standardized scores as a function of the effective center size, and only requires the use of publicly-available center-level statistics. The evaluations of United States kidney transplant centers based on the proposed composite score are substantially different from those based on conventional methods. Simulations show that the proposed empirical null approach more accurately classifies centers in terms of quality of care, compared to existing methods

Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation

INTRODUCTION: Pulmonary hypertension is common among patients with end-stage renal disease, although data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited. We hypothesized that echocardiographic findings of RV dilation and dysfunction are associated with adverse clinical outcomes after renal transplant. METHODS: A retrospective review of adult renal transplant recipients at a single institution from January 2008 to June 2010 was conducted. Patients with transthoracic echocardiograms (TTEs) within 1 year leading up to transplant were included. The primary end point was a composite of delayed graft function, graft failure, and all-cause mortality. RESULTS: Eighty patients were included. Mean follow-up time was 9.4 ± 0.8 years. Eight patients (100%) with qualitative RV dysfunction met the primary end point, while 39/65 patients (60.0%) without RV dysfunction met the end point (p = 0.026). Qualitative RV dilation was associated with a significantly shorter time to all-cause graft failure (p = 0.03) and death (p = 0.048). RV systolic pressure was not measurable in 45/80 patients (56%) and was not associated with outcomes in the remaining patients. CONCLUSION: RV dilation and dysfunction are associated with adverse outcomes after renal transplant. TTE assessment of RV size and function should be a standard part of the pre-kidney transplant cardiovascular risk assessment

The temporal and long‐term impact of donor body mass index on recipient outcomes after kidney transplantation – a retrospective study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153284/1/tri13505_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153284/2/tri13505.pd

Safety and efficacy of direct- acting oral anticoagulants versus warfarin in kidney transplant recipients: a retrospective single- center cohort study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155941/1/tri13599.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155941/2/tri13599_am.pd

Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains

Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150616/1/ajt15325.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150616/2/ajt15325_am.pd

Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation

Hypertension guidelines recommend calcium channel blockers (CCBs), thiazide diuretics, and angiotensin‐converting‐enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) as first‐line agents to treat hypertension. Hypertension is common among kidney transplant (KTx) recipients, but data are limited regarding patterns of antihypertensive medication (AHM) use in this population. We examined a novel database that links national registry data for adult KTx recipients (age > 18 years) with AHM fill records from a pharmaceutical claims warehouse (2007‐2016) to describe use and correlates of AHM use during months 7‐12 post‐transplant. For patients filling AHMs, individual agents used included: dihydropyridine (DHP) CCBs, 55.6%; beta‐blockers (BBs), 52.8%; diuretics, 30.0%; ACEi/ARBs, 21.1%; non‐DHP CCBs, 3.0%; and others, 20.1%. Both BB and ACEi/ARB use were significantly lower in the time period following the 2014 Eighth Joint National Committee (JNC‐8) guidelines (2014‐2016), compared with an earlier period (2007‐2013). The median odds ratios generated from case‐factor adjusted models supported variation in use of ACEi/ARBs (1.51) and BBs (1.55) across transplant centers. Contrary to hypertension guidelines for the general population, KTx recipients are prescribed relatively more BBs and fewer ACEi/ARBs. The clinical impact of this AHM prescribing pattern warrants further study.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154651/1/ctr13803.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154651/2/ctr13803_am.pd