Perioperative Morbidity and Mortality of Same-Day Bilateral TKAs: Incidence and Risk Factors.

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors.

Clin Orthop Relat Res. 2013 Jul 9;
Poultsides L, Memtsoudis S, Gonzalez Della Valle A, De Martino I, Do HT, Alexiades M, Sculco T

Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified.We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities.We analyzed institutional data from 3960 same-day, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Same-day patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality.There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group.In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that same-day bilateral TKAs appeared to be safe.Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. HubMed – rehab


The influence of transformational leadership on employee well-being: results from a survey of companies in the information and communication technology sector in Germany.

J Occup Environ Med. 2013 Jul; 55(7): 772-8
Jacobs C, Pfaff H, Lehner B, Driller E, Nitzsche A, Stieler-Lorenz B, Wasem J, Jung J

The aim of this study was to investigate the impact of a transformational leadership style on employee well-being.Data for the study were taken from an on-line survey of all employees from six German companies in the information and communication technology sector. The data obtained were analyzed using multiple logistic regressions.Analysis of data from a total of 318 employees (response rate 58.4%) revealed a significant relationship between transformational leadership and employee well-being (P = 0.00; OR = 1.13; 95% CI = 1.05 to 1.22). A higher degree of perceived transformational leadership is associated with greater well-being.The results of this study suggest that a transformational leadership style, which both conveys a sense of trust and meaningfulness and individually challenges and develops employees, also has a positive effect on employee well-being. HubMed – rehab


Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans With Polytrauma Injuries.

J Head Trauma Rehabil. 2013 Jul 3;
Lang KP, Veazey-Morris K, Andrasik F

Soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom experience polytrauma injuries including traumatic brain injury. Traumatic brain injury is often complicated by symptoms of insomnia, posttraumatic stress disorder (PTSD), and pain that can impact treatment and rehabilitation.The medical records of 137 veterans seen at a Veterans Affairs Medical Center Polytrauma clinic who sustained traumatic brain injury in combat were reviewed for this study. Demographic variables include age, sex, ethnicity, military branch, and service connection. Outcome measures include PTSD, pain, and insomnia.Analyses revealed a high prevalence of PTSD, insomnia, and pain co-occurring in 51.8% of veterans. Increased PTSD symptomatology was significantly correlated with reports of more pain severity (r = 0.53), pain interference (r = 0.61), and insomnia (r = 0.67). Further analyses, controlling for service connection, indicated that insomnia partially mediated the relation between PTSD and both pain severity and interference.These results highlight the overlap and complexity of presenting complaints in veterans and help identify the role of sleep disturbances in complicating diagnosis and treatment of veterans. As sleep problems reduce pain tolerance and exacerbate other symptoms, such as cognitive deficits and irritability, failure to address sleep disturbances may compromise rehabilitation efforts, suggesting the importance of a multidisciplinary team approach to assessing and treating these veterans. HubMed – rehab


Development of a Traumatic Brain Injury Model System Within the Department of Veterans Affairs Polytrauma System of Care.

J Head Trauma Rehabil. 2013 Jul 3;
Lamberty GJ, Nakase-Richardson R, Farrell-Carnahan L, McGarity S, Bidelspach D, Harrison-Felix C, Cifu DX

In 2008, the Department of Veterans Affairs Polytrauma Rehabilitation Centers partnered with the National Institute on Disability and Rehabilitation Research to establish a Model Systems program of research that would closely emulate the civilian Traumatic Brain Injury (TBI) Model Systems Centers Program established in 1987.To describe the development of a TBI Model Systems program within the Department of Veterans Affairs Polytrauma System of Care.Enrollment criteria and data collection/data quality efforts for the newly established Department of Veterans Affairs sites are reviewed.Significant progress has been made in the establishment of a Model Systems program for the Polytrauma System of Care. Data collection has moved forward and program-specific modifications have been implemented.The Veterans Affairs TBI Model System program is established and growing, with many projects underway and a strong working relationship with the civilian TBI Model System programs. HubMed – rehab



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