Impact of tiered interventions to decrease routine urine cultures in asymptomatic patients undergoing arthroplasty

2018 ◽  
Vol 40 (1) ◽  
pp. 109-110 ◽  
Author(s):  
Ebony C. Jackson ◽  
Xia C. Thai ◽  
Lou Ann Bruno-Murtha ◽  
Amanda E. Barner
Keyword(s):  
Asymptomatic Patients ◽  
Tiered Interventions

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

Are asymptomatic patients likely to benefit from carotid interventions?

2006 ◽  
Vol 39 (2) ◽  
pp. 15
Author(s):  
Barry T. Katzen ◽  
Trevor Cleveland
Keyword(s):  
Asymptomatic Patients

Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

1993 ◽  
Vol 70 (02) ◽  
pp. 266-269 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Benilde Cosmi ◽  
Stefano Radicchia ◽  
Franca Veschi ◽  
Enrico Boschetti ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Diagnostic Accuracy ◽  
High Sensitivity ◽  
Impedance Plethysmography ◽  
Surveillance Programme ◽  
Vein Thrombosis ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
The Mean ◽  
Deep Vein

SummaryImpedance plethysmography (IPG) has high sensitivity and specificity in patients with symptomatic deep vein thrombosis (DVT) while it fails to detect asymptomatic DVT. The aim of this study was to determine whether the features of thrombi such as location, size and occlusiveness could explain the different accuracy of IPG in symptomatic and asymptomatic DVT patients. One-hundred and seventeen consecutive outpatients with a clinical suspicion of DVT and 246 consecutive patients undergoing hip surgery were admitted to the study. In symptomatic patients IPG was performed on the day of referral, followed by venography, while in asymptomatic patients IPG was performed as a surveillance programme, followed by bilateral venography.A venography proved DVT was observed in 37% of the symptomatic patients and 34% of the asymptomatic limbs. A significantly higher proportion of proximal DVTs was found in symptomatic patients than in asymptomatic patients (78% vs 46%; p = 0.001). The mean Marder score, taken as an index of thrombus size, was significantly higher in symptomatic patients than in asymptomatic patients (19.0 vs 9.6; p = 0.0001). A significantly higher proportion of occlusive DVTs was observed in symptomatic than in asymptomatic patients (69% vs 36%; p = 0.001).We conclude that the unsatisfactory diagnostic accuracy of IPG in asymptomatic DVT is due to the high prevalence of distal, small and non occlusive thrombi. Such thrombi are unlikely to cause a critical obstruction of the venous outflow and therefore to produce a positive IPG.

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

1996 ◽  
Vol 75 (02) ◽  
pp. 242-245 ◽  
Author(s):  
Marie Magnusson ◽  
Bengt I Eriksson ◽  
Peter Kãlebo ◽  
Ramon Sivertsson
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Screening Method ◽  
Colour Doppler ◽  
Vein Thrombosis ◽  
Colour Doppler Ultrasound ◽  
Asymptomatic Patients ◽  
Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

Alpha 1 Anti Trypsin Levels in Asymptomatic Patients with Abnormal Liver Function Tests

Endoscopy ◽  
2006 ◽  
Vol 38 (11) ◽  
Author(s):  
BJ Egan ◽  
S Sarwar ◽  
M Anwar ◽  
C O'Morain ◽  
B Ryan
Keyword(s):  
Liver Function ◽  
Liver Function Tests ◽  
Abnormal Liver Function ◽  
Function Tests ◽  
Asymptomatic Patients
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