Managing postoperative pain continues to be a challenging public health problem. The organization under study was experiencing a prolonged length of hospital stay (LOS) in the post-total knee and hip replacement surgery population that was causing system-wide patient flow issues. The purpose of this quality improvement project was to educate patients through an established education class on pain expectations, strategies on managing pain, discharge planning, and physical therapy expectations with a goal of reducing pain and LOS. The health belief model was used as a guide to incorporate new content into the educational program that addressed patient knowledge on pain, concerns, fears, and misconceptions related to surgery. New content was added to the class on strategies to improve postoperative pain to help the organizational need to meet 2- to 3-day LOS. The project compared differences in pain levels and LOS in participants who completed the preoperative education and those who did not. The project methodology was a retrospective nonexperimental pretest and posttest design, and a quantitative analysis was used to compare pain levels measured by visual analog scale in documented charts during hospital stay. LOS was measured from data collected from chart review. The findings revealed lower pain levels during the hospital stay of those who completed the educational program. The patients who did not attend the class had an average mean LOS of 5 days as compared to 3 days LOS for those who attended the preoperative class. The project impacts social change on an organizational level by demonstrating that patients undergoing joint replacement surgery benefit from the revised educational plan, which results in early mobility, better pain control, and decreased LOS.

Objective: This study aims to evaluate the application of Pictorial Representation of Illness and Self-Measure (PRISM) in educating patients regarding oral health before endoprosthesis (EP). Methods: The study consisted of two parts: (I) a cross-sectional study, where patients received a PRISM interview, oral health briefing and oral examinations (treatment need, oral focus). (II) In an observational part, patients were randomly assigned to either PRISM task (Test) or flyer-based verbal briefing (Control). Before and after the interviews, patients answered a questionnaire regarding importance of oral health for EP. Results: (I) 122 patients were included. The distance between subject (“myself”) and objects (oral health issues or EP) in the PRISM task were mainly not associated with age, gender, and oral conditions. In part (II), 80 patients (PRISM: n = 40, Control: n = 40) were included. After the interview, the values for perceived relationship between EP and teeth (p < 0.01), EP and gums (p < 0.01), and EP and dental consultations (p < 0.01) significantly increased in both groups. Both groups perceived a high benefit of the interview and felt well educated. Conclusions: PRISM has comparable positive effects like a flyer-based verbal briefing. PRISM as a novel visual tool can support the patient education regarding oral health before EP

BACKGROUND: There has been an enormous rise in total joint arthroplasties (TJA) in the United States over the past several years. Researchers have documented the increase in healthcare costs associated with unplanned hospital readmissions among patients post-TJA, specifically total hip and total knee arthroplasties. Additionally, researchers have reported the burden that these costs place on the healthcare system, private payers and on patients and their caregivers. Social routines, quality of life and occupational functioning are often interrupted because of a patient’s unplanned hospital readmission after receiving a total hip or total knee arthroplasty. Investigators have identified the major causes of costly unexpected hospital readmissions among patients with a TJA; they include surgical site infections, blood clots, joint dislocations and periprosthetic fractures. The Occupational Therapy Practice Framework: Domain and Process describes the practice of occupational therapy as promoting health, well-being, and engagement in meaningful occupation. Nonetheless, there is limited literature in the occupational therapy field directed towards reducing hospital readmissions among patients with a total hip or knee arthroplasty, thus suggesting an area that is well-positioned for intervention development and testing. PURPOSE: This Occupational Therapy Doctoral Project entitled Teaching Intervention to Reduce Readmissions-Post Surgery (TIRR-PS) is a proposed program for an acute care hospital setting which: (a) described the problem of hospital readmissions among patients with a total hip or total knee arthroplasty, (b) investigated evidence and best practices for imparting knowledge and/or teaching skills to hospital administrators, healthcare professionals, occupational therapy staff, patients, and caregivers, (c) proposed an intervention based on empirically supported strategies and theoretical frameworks, (d) recommended activities to include as part of the program evaluation, the funding plan and the dissemination plan to promote this multi-level, multi-component pilot program. TIRR-PS will aim to reduce unplanned 30-day hospital readmissions and their associated healthcare costs. Unplanned readmissions are in part caused by inadequate education of hospital administrators, occupational therapy staff, patients, and caregivers. The TIRR-PS program will raise awareness about how to address common medical complication risks and promote the support of hospital administration for the education and skill building activities directed towards healthcare professionals with an emphasis on occupational therapy. CONCLUSION: TIRR-PS was designed for an acute care setting to reduce hospital readmission rates, to reduce healthcare costs, to improve patient quality of life, and to reduce the societal burden of unplanned hospital care. TIRR-PS is an innovative program designed to be comprehensive and to impart knowledge and skills to all relevant professionals in an acute care setting with a particular emphasis on the contribution of the OT profession. TIRR-PS, once evaluated, will provide a standardized, systematic approach to reducing unexpected hospitalizations post-TJA and shows promise for contributing to routine orthopaedic rehabilitative practice in acute care hospitals. This in turn will not only reduce healthcare costs, but will improve the post-surgery quality of life for patients with a recent total hip or total knee arthroplasty.

Yes / Less than optimal particle isolation techniques have impeded analysis of orthopaedic wear debris in vivo. The purpose of this research was to develop and test an improved method for particle isolation from tissue. A volume of 0.018 mm3 of clinically relevant CoCrMo, Ti-6Al-4V or Si3N4 particles was injected into rat stifle joints for seven days of in vivo exposure. Following sacrifice, particles were located within tissues using histology. The particles were recovered by enzymatic digestion of periarticular tissue with papain and proteinase K, followed by ultracentrifugation using a sodium polytungstate density gradient. Particles were recovered from all samples, observed using SEM and the particle composition was verified using EDX, which demonstrated that all isolated particles were free from contamination. Particle size, aspect ratio and circularity were measured using image analysis software. There were no significant changes to the measured parameters of CoCrMo or Si3N4 particles before and after the recovery process (KS tests, p > 0.05). Titanium particles were too few before and after isolation to analyse statistically, though size and morphologies were similar. Overall the method demonstrated a significant improvement to current particle isolation methods from tissue in terms of sensitivity and efficacy at removal of protein, and has the potential to be used for the isolation of ultra-low wearing total joint replacement materials from periprosthetic tissues.

Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.

Blood products, either whole blood or its components, are vital healthcare commodities for patients across all age groups, multiple diagnoses, and in a variety of settings. Meanwhile, blood shortages are common, and are projected to significantly increase in the near future in both developing and developed countries due to a limited supply of and increasing demand for blood, lack of resources, infrastructure. Unfortunately, today there remains a definable risk associated with the transfusion of blood and blood products. We explored, in depth, the resource allocation problem in reducing the risks of transfusion-transmitted infections (TTI). We developed models and algorithms to study the problem of selecting a set of blood screening tests for risk reduction, which we show to be very efficient in numerical studies with realistic-sized problems. This analysis also motivates the development of effective lower bounds with co-infection; our analysis indicates that these algorithms are very efficient and effective for the general problem. We also incorporate other objective functions and constraints (i.e., waste) into the analysis. Waste, defined as the fraction of disposed blood in the ``infection-free" blood, is incorporated into the risk-based model as a constraint. As an important extension, we compared our results of the blood screening problem in risk model with that of weighted risk objectives, which allows for different weights for each TTI. We further explored efficient algorithms to study this extension of the model and analyze how the test composition changes with the different objectives. Finally, in the context of blood screening, the last extension we investigated is to include a ``differential" testing policy, in which an optimal solution is allowed to contain multiple test sets, each applied to a fraction of the total blood units. In particular, the decision-maker faces the problem of selecting a collection of test sets as well as determining the proportion (or fraction) of blood units each test set will be administered to. We proposed the solution methodology and determined how the test sets under differential policy relate to those under the "same-for-all" policy; and how these changes impact the risk, and allow for better budget utilization. / Ph. D.

Osteoarthritis is a degenerative disease of joints, which can be solved with implantation of total joints prosthesis. A high-quality proprioception of knee joint protects the joint against possible bending injury, it is also participating in stabilizing the knee in static position and it is important in the process of coordination of the motion system and precise flexibility of the knee joint. In this thesis are summed up the knowledge of osteoarthritis, total joints prosthesis and proprioception, all is taken in context of connection. The research includes comparison of proprioception of knee joint with arthrosis and total joints prosthesis. Also, the research compared mentioned knee joints with the healthy verification group. All monitored individuals absolved a medical examination of the quality of proprioception in the form of move sensitivity in position of 30ř, 50ř and 80ř. Amongst the knees with arthrosis and knees with total joints prosthesis there were not found a differences with static importance in each of the angle test. In the total comparison there was significantly better proprioception of the knees with the total joints prosthesis. The knee joints of the verification group unlike the joints with arthrosis and total prosthesis showed significantly better flexibility in position of...

Title Physiotherapy after arthroplasty procedures for rheumatic patients. Defining the problem The main problem this thesis solves is to find and compare findings on the practice of physiotherapy in rheumatic patients, patients with rheumatoid arthritis (RA) who have undergone surgery, joint replacement of lower limb arthroplasty, with a focus on the ankle joint. It will be a comparison of the approaches used in the workplace catchment for the Czech Republic, Institute of Rheumatology (RU) in Prague and the world. Aim The aim is to create a comprehensive overview and comparison of physiotherapy procedures used in rheumatic patients who underwent joint replacement legs, zjm. ankle joint, in the CR is in the hands, and in the world and see whether these practices vary significantly, or are identical. The method of solution The work is prepared by comparing the findings relating to the care of patients with available literature. The findings are grouped and arranged tables are created with recording procedures. The work is written in the form of research. Key worlds revmatoidní artritida totální náhrada hlezenního kloubu (TEP) hlezenní kloub fyzioterapie

Title: Effect of physiotherapy to reduce the length of hospital stay in patients with total hip arthroplasty: a literature review Objective: The purpose of this thesis is to research and compare available studies investigating the effect of extra physiotherapy in reducing the length of stay for patients with total hip arthroplasty. In addition, to make a compilation of available sources about issue of the hip, total hip arthroplasty in terms of anatomy, kinesiology and biomechanics and length of hospital stay. Methods: This diploma thesis has descriptively-analytical character and is structured in the form of literary review. Results: Physiotherapy decreases length of stay in patients with total hip arthroplasty. Future research could address a specific group of subjects and the issue of cost-effectiveness in reducing the length of hospital stay by physiotherapy. Key words: Hip joint, total joint replacement, THA, physiotherapy, length of stay

The objective of this study was to examine the link between radiographic measures of bone quality and total knee implant migration as measured by radiostereometric analysis (RSA). Two uncemented total knee arthroplasty studies (n=65) with RSA and bone mineral density (BMD) exams up to two years post surgery, and one study with cemented total knees with one year RSA data (n=18) were examined. Radiograph image texture analysis was used to characterize the bone microarchitecture, and a feasibility study was conducted to determine if a given x-ray machine could be used to obtain bone mineral density at the same time as the RSA exams. Random ForestTM ensemble classification tree statistical models classified patients into groups based on implant migration with a range of cut-points. Models based on bone texture parameters measured from the two year radiographs had a sensitivity of 87.5% and specificity of 80% when classifying patients who had more than 0.3mm maximum total point motion (MTPM) at two years using the one year exam as reference. Other cut-points were examined, with models generally having a lower specificity if the acceptable migration was smaller, and lower sensitivity if higher migrations were tolerable. In a predictive model, post-operative bone texture could be used to create a model with a sensitivity of 75% and a specificity of 80% when predicting those subjects with cemented implants who went on to more than 0.4mm total migration by one year. Bone mineral density of the proximal tibia, as determined by clinical scanners, was not found to increase the accuracy of implant migration group classification. An empirical fit to central regions of a purposed-built cross-wedge calibration phantom returned residuals of less than ±1.5% for the bone-equivalent thicknesses. The coefficient of variation of the region greyscale values in three images spread over three days is under 4%, showing the stability of the system to hold a calibration between phantom exams and patient scans. Scatter and dynamic range issues will need to be considered for an accurate calibration across the full range of areal bone mineral densities in the distal femur and proximal tibia.