Bulletin of the NYU hospital for joint diseases
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Clavicle fractures remain one of the more common fractures encountered in the orthopaedic office. Nonoperative management remains the standard of care in most cases. ⋯ When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. This article reviews the midshaft clavicle fracture and discusses recent outcome studies on patients with fracture shortening and approaches to operative management.
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Bull NYU Hosp Jt Dis · Jan 2009
ReviewCan RAPID3, an index without formal joint counts or laboratory tests, serve to guide rheumatologists in tight control of rheumatoid arthritis in usual clinical care?
Tight control of rheumatoid arthritis (RA) may be guided by RAPID3 (routine assessment of patient index data), an index without formal joint counts or laboratory tests, which can be scored on a multidimensional health assessment questionnaire (MDHAQ) in 5 seconds, compared to 42 seconds to score a standard HAQ, 90 seconds to perform a 28-joint count, 114 seconds to score a disease activity score 28 (DAS28), and 106 seconds to score a clinical disease activity index (CDAI). RAPID3 scores are correlated significantly with DAS28 and CDAI (rho > 0.65, p < 0.001), and distinguish active from control treatment similarly to DAS28 and CDAI in clinical trials of methotrexate, lefunomide, adalimumab, abatacept, certolizumab, and infiximab. RAPID3 scores can be used to classify patient disease activity status as high (> 12), moderate (6.1-12), low (3.1-6), and remission (
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Bull NYU Hosp Jt Dis · Jan 2009
ReviewResurfacing versus conventional total hip arthroplasty - review of comparative clinical and basic science studies.
Although standard total hip arthroplasties have a long and successful history as the standard of care for advanced, symptomatic osteoarthritis, there is increasing patient demand and surgeon interest in femoral bone conserving resurfacing alternatives. The purpose of this study was to assess the state of the research that directly compares the outcomes of conventional total hip arthroplasty procedures with the current generation of metal-on-metal resurfacing hip arthroplasties. ⋯ While there is still much debate and room for additional research on this topic, multiple midterm clinical results suggest that resurfacing hip arthroplasty represents a safe, effective alternative to conventional total hip arthroplasty, especially for younger, active patients.
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Bull NYU Hosp Jt Dis · Jan 2009
Comparative StudyResurfacing matched to standard total hip arthroplasty by preoperative activity levels - a comparison of postoperative outcomes.
Some studies have suggested that resurfacing patients are generally more active postoperatively than their conventional total hip arthroplasty (THA)counterparts, but controversy remains over whether this is a reflection of preferential use of resurfacing for younger and higher-activity patients. We hypothesized that, when controlling for preoperative activity levels, in addition to relevant clinical and demographic factors, resurfacing provides similar results to conventional hip arthroplasty. ⋯ The results of this study suggest that patients treated with hip resurfacing arthroplasty have a significantly higher postoperative activity level, as compared to those treated with conventional THA, when controlled for preoperative factors.
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Bull NYU Hosp Jt Dis · Jan 2009
Safety reporting in randomized clinical trials - a need for improvement.
The reporting of adverse events (AEs) in randomized clinical trials (RCTs) is often lacking in the publication of trials. Part of the problem is the way safety data are reported in RCTs. Reporting of "time to event," use of standardized incidence ratios for comparison to normal population or disease controls, use of "patient years" when reporting AE, and adequate sample size and power calculations are some of the problems that need to be addressed and improved in RCTs.