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1.
HSS J ; 14(3): 228-232, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30258325

ABSTRACT

BACKGROUND: Current studies reporting on patients following prosthesis removal and spacer placement for periprosthetic joint infection (PJI) of the shoulder have largely been descriptive and insufficiently powered to determine risk factors for outcomes other than reimplantation. PURPOSE: The objective of the present study is to provide a national perspective on the 1-year outcomes following prosthesis removal and spacer placement and risk factors for outcomes other than reimplantation for treatment of PJI following shoulder arthroplasty. METHODS: A national database was queried for Medicare patients who underwent prosthesis removal and spacer placement for PJI between 2005 and 2012. These patients were then evaluated for 5 major study endpoints including: (1) replantation of a shoulder prosthesis within 1 year postoperatively, (2) a repeat irrigation and debridement with second antibiotic spacer placement procedure within 1 year postoperatively, (3) in-hospital death within 1 year postoperatively, (4) a shoulder Girdlestone-type procedure within 1 year postoperatively, and (5) the remaining patients, who were considered to have a retained spacer. Patients with a study endpoint within 1 year postoperatively were included in the study: (1) mortality, (2) repeat debridement, (3) resection arthroplasty, and (4) reimplantation. While it is possible that some patients were not captured due to errors in coding, it is unlikely that patients were lost to follow-up due to change in location of services, given that the database captures all episodes of care that are coded throughout the USA. Independent risk factors were evaluated using logistic regression analysis. RESULTS: Nine hundred seventy-five patients who underwent prosthesis removal and spacer placement were included. Within 1 year postoperatively, 21 patients died (2.2%), 70 patients had a repeat debridement procedure (7.2%), 55 patients had a resection arthroplasty procedure (5.6%), 349 patients retained their spacers (35.8%), and the remaining 480 patients had a shoulder arthroplasty reimplanted (49.2%). Numerous independent risk factors exist for all outcomes studied. CONCLUSION: The fate of antibiotic spacers placed for PJI of the shoulder at 1 year is variable, with numerous independent risk factors for outcomes other than reimplantation. Patients with PJI following total shoulder arthroplasty should be counseled on the risk factors that influence the outcomes of staged revision for shoulder PJI.

2.
HSS J ; 14(2): 108-113, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29983650

ABSTRACT

BACKGROUND: While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA). PURPOSE: The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not undergo BS, and those who undergo BS after TSA compared with those who undergo BS prior to TSA. METHODS: A Medicare database was queried for morbidly obese patients who underwent BS either before or after TSA, as well as those who underwent TSA but no BS. Of 12,277 morbidly obese patients who underwent TSA between 2005 and 2014, 304 underwent BS (165 of them prior to TSA and 139 following TSA) and 11,923 did not undergo BS. Rates of mechanical complications were then compared between groups using a logistic regression analysis. RESULTS: Patients who underwent BS after TSA had significantly higher rates of mechanical complications (12.9%) compared to controls (8.8%) or patients who underwent prior BS (7.9%). Patients who underwent BS after TSA had higher rates of both instability (7.9%) and loosening (8.6%) than did controls (5.1 and 4.9%, respectively) or patients who underwent BS before TSA (4.8 and 4.2%, respectively). CONCLUSIONS: BS following TSA is associated with increased rates of mechanical complications, including instability and loosening, compared to BS prior to TSA. These findings suggest that it may be prudent to consider performing BS prior to TSA in morbidly obese patients, rather than waiting until after TSA is performed.

3.
J Abnorm Psychol ; 105(2): 204-11, 1996 May.
Article in English | MEDLINE | ID: mdl-8723001

ABSTRACT

Performance on a directed forgetting task was assessed in 24 individuals with borderline personality disorder and early life parental abuse, 24 borderline individuals with no history of abuse, and 24 healthy nonclinical controls under conditions of explicit and implicit memory. In the explicit memory condition, individuals with abuse histories showed greater differential recall of "to-be-remembered" versus "to-be-forgotten" material compared to the 2 comparison groups. Implicit memory performance was equivalent for all 3 groups. The enhanced selective memory in the abused group was the result of better recall for "remember" and not poorer recall for "forget" information, indicating that abused individuals have an enhanced ability to sustain attention to designated "remember" information. Because most people with childhood abuse recall their abuse, enhanced remembering of designated events (e.g., information not associated with abuse) may be a coping strategy.


Subject(s)
Child Abuse, Sexual/psychology , Child Abuse/psychology , Memory , Parents , Adult , Age of Onset , Child , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Psychiatric Status Rating Scales
4.
Child Abuse Negl ; 20(3): 213-9, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8734551

ABSTRACT

OBJECTIVE: The purpose of this paper is to describe a standardized questionnaire of histories of abuse among women with serious and persistent mental illness, and to assess its test-retest reliability and its validity. METHODS: Seventy women enrolled in an outpatient clinic were asked about childhood histories of physical and sexual abuse in a structured clinical interviews at two times. RESULTS: Test-retest reliability yielded a Kappa of .63 for the measure of physical abuse, and .82 for the measure of sexual abuse. Validity, assessed as consistency with an independent clinical assessment, showed 75% agreement for reports of physical abuse, and 93% agreement for reports of sexual abuse. CONCLUSIONS: Childhood histories of physical and sexual abuse can be reliably and validly assessed in women with severe and persistent mental illness using a standardized instrument.


Subject(s)
Child Abuse/diagnosis , Mental Disorders/complications , Surveys and Questionnaires , Adult , Chi-Square Distribution , Child , Child Abuse/classification , Child Abuse, Sexual/classification , Child Abuse, Sexual/diagnosis , Female , Humans , Interviews as Topic , Middle Aged , Reproducibility of Results , Sensitivity and Specificity
5.
Behav Res Ther ; 33(3): 305-7, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7726806

ABSTRACT

Individuals with social phobia were compared with normal controls on their memory for socially-related threat words in contrast to positive and neutral words. A memory paradigm used in a previous study of panic disorder patients [Cloitre, M. & Liebowitz, M. R. (1991) Cognitive Therapy and Research, 15, 609-619] was applied to test the generalizability of findings of threat-biased memory in a semantic memory task (free recall) and a perceptual memory task (high-speed recognition) to social phobics. No evidence of threat-related memory bias among social phobics was obtained. Since both the social phobic and control groups showed better memory for affectively valenced (threat and positive) compared to neutral information, it is unlikely that the absence of threat-biased memory among social phobics was the result of insensitive measurement.


Subject(s)
Anxiety Disorders/psychology , Attention , Mental Recall , Phobic Disorders/psychology , Semantics , Adult , Anxiety Disorders/diagnosis , Female , Humans , Male , Phobic Disorders/diagnosis , Psycholinguistics , Reaction Time
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