Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery

To determine after knee arthroplasty surgery the feasibility of discharging patients home on postoperative day 1 with continuous adductor canal blocks.

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Variations in the distance between the cricoid cartilage and targets of stellate ganglion block in neutral and extended supine positions: an ultrasonographic evaluation

Abstract

Purpose

Anatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions.

Methods

Forty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions.

Results

C6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women.

Conclusion

C6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.

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Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death among Medicare Beneficiaries Over Two Years

Publication date: Available online 30 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hillary R. Bogner, Heather F. de Vries McClintock, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Sean Hennessy, Joel E. Streim, Margaret G. Stineman
ObjectiveTo examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.DesignA national representative sample with two year follow-up.SettingMedicare Current Beneficiary Survey (MCBS) from calendar years 2001-2008.ParticipantsOur study sample included 23,470 community-dwelling adults aged 65 years and older followed for two years.InterventionsNot applicable.Main Outcome Measure(s)A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activity of daily living (ADL) stage transitions, institutionalization, or death after two years, adjusting for baseline socioeconomics and health-related characteristics.ResultsOut of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2,508 (10.7% weighted) improved, 3,210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2,281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.54-0.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR = 0.87, 95% CI: 0.79-0.97), be institutionalized (adjusted RRR = 0.72, 95% CI: 0.56-0.92), or die (adjusted RRR = 0.86, 95% CI: 0.75-0.98).ConclusionsKnowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related healthcare disparities and the impact of ongoing policy changes among Medicare beneficiaries.



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High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy

Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with "resolved" HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression.

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The multidisciplinary management of gastro-oesophageal junction tumours

The management of GOJ cancers remains controversial and may vary between countries. Evidence-based attitudes and guidelines are not easy to elaborate since most of the trials and studies reported mixed cases of oesophageal (both adenocarcinoma and squamous cell tumours), GOJ and gastric cancers. The aim of this expert discussion and position paper is to elaborate practical recommendations that integrate evidence-reported literature and experience-based attitude covering all clinical aspects of GOJ cancer across different specialities and countries in Europe.

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High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy

Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with "resolved" HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression.

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The multidisciplinary management of gastro-oesophageal junction tumours

The management of GOJ cancers remains controversial and may vary between countries. Evidence-based attitudes and guidelines are not easy to elaborate since most of the trials and studies reported mixed cases of oesophageal (both adenocarcinoma and squamous cell tumours), GOJ and gastric cancers. The aim of this expert discussion and position paper is to elaborate practical recommendations that integrate evidence-reported literature and experience-based attitude covering all clinical aspects of GOJ cancer across different specialities and countries in Europe.

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