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Copyright of Revista HISTEDBR on-line is the property of Universidade Estadual de Campinas - Portal de Periodicos Eletronicos Cientificos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista HISTEDBR on-line is the property of Universidade Estadual de Campinas - Portal de Periodicos Eletronicos Cientificos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medicina is the property of Revista Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El Síndrome de Marfán es una patología autosómica dominante que afecta predominantemente el sistema cardiovascular, sin embargo, también afecta otros órganos y sistemas, como el músculo esquelético, el sistema pulmonar y la visión. Existe una mutación en el gen FBN-1 que codifica la proteína fibrilina 1, que genera una disfunción en la contractilidad de la célula muscular y disminución en la fuerza tensil del tejido aórtico principalmente, afectando la función e integridad normal de las paredes de los vasos sanguíneos. Es por esta razón que la enfermedad aórtica es la complicación más frecuente y mortal en los pacientes con Síndrome de Marfán, principalmente causado por el aneurisma y disección de aorta, que usualmente ocurre en la zona ascendente de la misma. Otras complicaciones cardiovasculares son las valvulopatías, como la válvula aórtica bicúspide, que es el defecto cardiaco congénito más frecuente, la insuficiencia cardiaca en niños y niñas con enfermedad rápidamente progresiva y la hipertensión arterial, que se presenta mayormente en la adultez. La hipertensión arterial es el principal factor de riesgo para presentar un evento aórtico en una persona con esta patología, ya que la dilatación de la raíz de la aorta es progresiva, por lo que el uso de antihipertensivos ha sido de gran importancia en los y las pacientes, principalmente los beta bloqueadores y antagonistas del receptor de angiotensina II. El objetivo del uso de estos medicamentos es disminuir el riesgo de progresión de dilatación de la raíz de la aorta, evitando la formación de aneurismas y disección de aorta, al disminuir la presión arterial sistémica y al controlar el inotropismo cardiaco.

Of Human Bondage, whose plot is based on the homonymous and well-known Somerset Maugham’s novel, presents the growing and sick linkage between a dominant and deceitful waitress and an oppressed crippled and weak-willed medical student. This relationship reaching its peak and subsequently leading to the solution of the melodramatic storyline may be useful not only for viewing and exploring psychological features, not distant from Medicine, but aspects related with a mature and emphatic physician-patient relationship where formal leadership have to prevail over any other autocratic variant. Furthermore, it shows facets of the nowadays designed domestic violence.

Background Context: While free-standing ambulatory surgical centers (ASCs) have been extolled as lower cost settings than hospital outpatient facilities/departments (HOPDs) for performing routine elective spine surgeries, differences in 90-day costs and complications have yet to be compared between the two types of treatment facilities.Purpose: We carried a comprehensive analysis to report the differences on payments to providers and facilities as a reflection of true costs to patients, employers and health plans for patients undergoing primary, single-level lumbar microdiscectomy/decompression at ASC versus HOPD.Study Design: Retrospective review of Medicare advantage and commercially insured enrollees from the Humana dataset from 2007 to 2017Q1.Outcome Measures: To understand the differences in 90-day complications, readmissions, emergency department visits and costs for patients undergoing primary, single-level lumbar microdiscectomy/decompressions at an ASC versus HOPD.Methods: The Humana 2007 to 2017Q1 was queried using Current Procedural Terminology codes to identify patients undergoing primary, single-level lumbar microdiscectomy/decompressions. Patients undergoing two-level surgery, open laminectomies, fusions, revision discectomies, and/or deformities were excluded. Service Location codes for HOPD (Location Code 22) and free-standing ASC (Location Code 24) were used to determine surgery treatment facilities. Using propensity scoring, we matched two groups who had surgery performed in ASCs or HOPDs based on age, gender, race, region and Elixhauser comorbidity index. Multivariable logistic regression analyses were performed on matched cohorts to assess for differences in 90-day outcomes between facilities, while controlling for age, gender, race, region, plan, and Elixhauser comorbidity index.Results: A total of 1,077 and 10,475 primary single-level decompressions were performed in ASCs and HOPDs, respectively. Following a matching algorithm with propensity scoring, the two cohorts were comprised of 990 patients each. Observed differences in 90-day complication rates were not statistically or clinically significant (ASC=9.1% vs. HOPD=10.3%; p=.362) nor were readmissions (ASC=4.5% vs. HOPD=5.3%; p=.466). On average, performing surgery in an ASC versus HOPD resulted in significant cost savings of over $2,000/case in Medicare Advantage ($5,814 vs. $7,829) and over $3,500/case ($10,116 vs. $13,623) in commercial beneficiaries.Conclusion: Performing single-level decompression surgeries in an ASC compared with HOPDs was associated with approximately $2,000 to $3,500 cost-savings per case with no statistically significant impact on complication or readmission rates. [ABSTRACT FROM AUTHOR]

Copyright of Scire Salutis is the property of CBPC - Companhia Brasileira de Producao Cientifica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Studies evaluating the effects of depressive disorders in patients undergoing primary total knee arthroplasty (TKA) are sparse. Therefore, the purpose of this study is to investigate whether patients who have depressive disorders undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) readmission rates, (3) medical complications, (4) implant-related complications, and (5) costs of care.Methods: Patients with depressive disorders undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 138,076 patients who had (n = 23,061) or did not have (n = 115,015) depressive disorders. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, and costs of care. A P value less than .003 was considered statistically significant.Results: Patients who have depressive disorders had significantly longer in-hospital LOS (6.2 days vs 3.1 days; P < .0001). Additionally, study group patients had a higher incidence and odds of readmissions (15.5% vs 12.1%; odds ratio [OR], 1.33; P < 001), medical complications (5.0% vs 1.6%; OR, 3.34; P < .0001), and implant-related complications (3.3% vs 1.7%; OR; 1.97; P < .0001) Study group patients also incurred significantly higher day of surgery ($12,356.59 vs $10,487.71; P < .0001) and 90-day costs ($23,386.17 vs $22,201.43; P < .0001).Conclusion: After adjusting for age, sex, and comorbidities, this study demonstrated that patients who have depressive disorders have increased rates of in-hospital LOS, readmissions, complications, and cost. The study is useful in allowing orthopedists to adequately educate patients of potential complications which may occur. [ABSTRACT FROM AUTHOR]

Despite the increasing national incidence, osteoporosis and its associated comanagement, often remain an overlooked issue in the orthopedic world. Screening and associated management of osteoporosis is often only considered by providers when patients present with multiple fragility fractures. Current evidence with regard to the trends in screening and medical comanagement/antiosteoporotic therapy of osteoporotic vertebral compression fractures (VCFs) remains limited. To understand trends, costs, and clinical impact associated the utilization of antiosteoporotic medication and screening with the 1 year following occurrences of sentinel/primary osteoporotic VCFs. Retrospective review of 2008–2015Q3 Humana Administrative Claims (HAC) database. The 2008-2015Q3 HAC database was queried using International Classification of Diseases 9th Edition (ICD-9) diagnosis codes 805.2 and 805.4 to identify patients with primary closed osteoporotic thoracolumbar VCFs. Patients with a concurrent diagnosis of trauma and/or malignancy were excluded. Patients experiencing a fragility fracture of the hip, distal radius or proximal humerus, and/or those already on osteoporotic medications within the year before the VCF were excluded to prevent an overlap in the screening and/or antiresorptive medication rates. Finally, only those patients who had complete 2-year follow-up data were analyzed. To understand trends over time in the utilization of medication for osteoporosis and screening within 1 year following sentinel VCFs. The study also aimed to report per-prescription and per-patient average costs associated with different antiosteoporotic medications. As secondary objectives, we also assessed (1) risk factors associated with not receiving antiosteoporotic medication within the year following sentinel VCFs and (2) differences in rates of experiencing a secondary fragility fracture of vertebrae, hip, distal radius, and proximal humerus between patients who received medication following the sentinel VCF versus those who did not receive any medication. A total of 6,464 primary osteoporotic VCFs were retrieved from the database. A majority of the VCFs were seen in females (N=5,199; 80.4%). Only 28.8% (N=1,860) patients received some form of medication for osteoporosis medication in the year following the VCF. Over a 6-year interval, treatment with medication for osteoporosis declined from 38% in 2008 to 24% in 2014. The average cost of antiosteoporotic treatment per patient was $1,511. The most commonly prescribed treatment and associated average cost/patient was alendronate sodium (N=1,239; 66.6% to $120/patient). The most costly prescribed treatment was Forteo (N=177; 2.7%) with an average cost/patient of $12,074 and cost/injection being $2,373. Only 36.7% (N=2,371) received a dual-energy X-ray absorptiometry/bone density scan in the year following the VCF with an average cost/patient of $76. Risk factors associated with no prescription of medication for osteoporosis within 1 year of VCF were male gender (odds ratio [OR] 1.17 [95% confidence interval {CI} 1.01–1.35]; p=.027), history of cerebrovascular accident/stroke (OR 1.56 [95% CI 1.08–2.32]; p=.022), history of diabetes mellitus (OR 1.28 [95% CI 1.04–1.58]; p=.023). Of note, patients in the West versus Midwest (OR 1.26 [95% CI 1.04–1.51]; p=.016) and commercial insurance beneficiaries (OR 1.95 [95% CI 1.08–3.52]; p=.027) were more likely to receive antiosteoporotic medication. Patients who were placed on antiosteoporotic medication were significantly less likely to suffer a second fragility fracture compared with patients that did not receive medication (OR 0.27 [95% CI 0.24–0.31]; p=.033). The proportion of patients starting antiosteoporotic medication within a year after a VCF remains low (28.8%). Furthermore, a declining trend of antiosteoporotic medication prescription was noted over time. Providers who care for patients with sentinel VCFs need to be more diligent in their efforts to diagnose and treat the underlying osteoporosis to reduce the burden of future fragility fractures. [ABSTRACT FROM AUTHOR]

Anterior lumbar interbody fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologic entities. Despite an increasing number of ALIFs performed nationally, to the best of our knowledge, no study has evaluated the costs associated with the 90-day episode of care postoperatively. The 2007–2016 Humana Administrative Claims data set, a national database of commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients who had undergone single-level ALIF. The 90-day costs were defined using the following categories: facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehabilitation, emergency department visits, and readmissions. A total of 365 ALIF procedures (MA, n = 244; commercial, n = 121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for the MA and commercial enrollees, respectively. The major proportion of 90-day costs was attributable to facility reimbursement (74%–76%), followed by surgeon costs (9%–11%). Postacute care (i.e., office visits and physical therapy/rehabilitation) was not a major driver of the 90-day costs, consisting of only 0.7%–1.3% of the total 90-day reimbursement. Of patients who had required readmission, the costs of the readmission increased the average 90-day costs by 65%–66%. Facility costs were the major drivers of a stipulated 90-day reimbursement for patients undergoing single-level ALIF. Health policy makers and providers can use these data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs and allow them to identify areas in which cost reduction strategies can be performed. [ABSTRACT FROM AUTHOR]

Objectives: To identify patterns of health-care utilization and costs associated with management of glenohumeral osteoarthritis in the year prior to undergoing an anatomic total shoulder arthroplasty (ATSA). Methods: The PearlDiver Humana database, an administrative database of Medicare Advantage (MA) and Commercial insurance beneficiaries was queried for active records of patients undergoing a primary ATSA from the fourth quarter of 2010–2015. Pre-operative health-care utilization was categorized as 1) Procedures & Anesthesia, 2) Office visits, 3) Radiology, 4) Injections – a) Steroid injections and b) Hyaluronic Acid (HA) injections, 5) Physical Therapy, 6) Non-opioid pain medications and 7) Opioids. Overall costs/reimbursement and Per-patient average reimbursements (PPARs) were calculated for each category. Results: A total of 3,920 patients (MA = 3,691; Commercial = 229) undergoing primary ATSA were retrieved. Based on defined categories, the total costs prior to ATSA were $368,137 and $2,812,617 for Commercial and MA beneficiaries, respectively. Overall 1-year PPAR for each category was as follows: Procedures & Anesthesia (MA = $1765; Commercial = $5333), Office visits (MA = $441; Commercial = $396); Radiology (MA = $253; Commercial = $558), Injections (MA = $117, Commercial = $173), Physical therapy (MA = $473; Commercial = $372), Non-opioid pain meds (MA = $49; Commercial = $147) and Opioids (MA = $26; Commercial = $49). The highest utilization was seen in the three months prior to ATSA with 42–81% of overall PPAR being accounted for various categories. Conclusion: A high utilization of all health-care resource categories was noted within three months prior to surgery. Providers should consider judicious use of such interventions, particularly in patients which ultimately require surgery in a short frame of time, to reduce the costs associated with the overall episode of care. [ABSTRACT FROM AUTHOR]

Background: Research regarding the impact of hypogonadism following primary total knee arthroplasty (TKA) is limited. Therefore, the purpose of this study is to investigate whether patients with hypogonadism undergoing primary TKA are at increased odds of (1) medical complications, (2) revisions, (3) in-hospital lengths of stay (LOSs), and (4) cost of care.Methods: A Humana patient population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision codes. Patients were filtered by male gender and patients with hypogonadism were matched to controls in a 1:4 ratio according to age and medical comorbidities. The query yielded 8393 patients with (n = 1681) and without (6712) hypogonadism undergoing primary TKA. Primary outcomes analyzed included medical complications, revision rates, in-hospital LOS, and cost of care. Logistic regression analysis was used to calculate odds ratios (OR) of 90-day medical complications and 2-year revisions. Welch's t-test was used to test for significance in LOS and cost of care between cohorts. A P-value less than .05 was considered statistically significant.Results: Hypogonadal patients undergoing primary TKA were found to have increased incidence and odds (9.45% vs 4.67%; OR 2.12, P < .0001) of developing 90-day medical complications. Hypogonadal patients undergoing primary TKA were found to have a greater incidence and odds (3.99% vs 2.80%; OR 1.89, P < .0001) of 2-year revisions. Hypogonadal patients had a 6.11% longer LOS (3.47 vs 3.27 days, P = .02) compared to controls, and incurred greater 90-day costs ($15,564.31 vs $14,856.69, P = .018) compared to controls.Conclusion: This analysis of over 1600 patients demonstrates that patients with hypogonadism undergoing primary TKA have greater odds of postoperative medical complications, revisions, increased LOS, and cost of care. [ABSTRACT FROM AUTHOR]