Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2011
ReviewDefining racial and ethnic disparities in pain management.
Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate. ⋯ Racial/ethnic minority patients with pain need to be empowered to accurately report pain intensity levels, and physicians who treat such patients need to acknowledge their own belief systems regarding pain and develop strategies to overcome unconscious, but potentially harmful, negative stereotyping of minority patients.
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Clin. Orthop. Relat. Res. · Jul 2011
Clinical TrialDoes tranexamic acid save blood in minimally invasive total knee arthroplasty?
Tranexamic acid (TEA) reportedly reduces perioperative blood loss in TKA. However, whether it does so in minimally invasive TKA is not clear. ⋯ Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2011
ReviewGender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function.
Hip fracture is an international public health problem. Worldwide, approximately 1.5 million hip fractures occur per year, with roughly 340,000 in the United States in individuals older than 65 years. In 2050, there will be an estimated 3.9 million fractures worldwide, with more than 700,000 in the United States. However, whether there are disparities in morbidity, mortality, and function between men and women or between races/ethnicities is unclear. ⋯ A PubMed literature review was performed and appropriate articles selected for inclusion in the review. WHERE ARE WE NOW?: Overall, men with hip fracture are younger, are less healthy, and have a higher postoperative mortality and morbidity. African American and Hispanics patients with hip fractures are younger than whites and have a higher incidence of fracture in men. Non-Hispanic black, Hispanic, and Asian race/ethnicity were all associated with higher odds of discharge home but a longer stay when discharged to rehabilitation. WHERE DO WE NEED TO GO?: Expanded knowledge of the influence of gender and race/ethnicity on hip fracture epidemiology, mortality, and outcomes is necessary. HOW DO WE GET THERE?: Additional focused research on gender and racial/ethnic differences in patients with hip fractures is needed. Improving database capture of race/ethnicity data will aid in population studies. Finally, journal editors should require authors to include gender and race/ethnicity data or explain the absence of this information.
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Clin. Orthop. Relat. Res. · Jul 2011
Comparative StudyDoes high tibial osteotomy affect the success or survival of a total knee replacement?
Whether a previous high tibial osteotomy (HTO) influences the long-term function or survival of a total knee arthroplasty (TKA) is controversial. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors. ⋯ A MEDLINE search was conducted using the terms "pain" or "musculoskeletal pain" and "gender differences" or "sex differences" with "health care," "health services," and "physician, attitude." Articles judged relevant were selected for inclusion. WHERE ARE WE NOW?: Higher pain prevalence in women is consistently observed but not well understood. The relative contributions of sex differences in pain mechanisms and gender differences in psychosocial factors (eg, coping, social roles) to explaining differences in prevalence are not yet clear. Gender disparities in the amount of healthcare use for pain may be partially explained by the experience of higher-intensity pain in women. Pain intensity also seems to be a major factor influencing treatment, especially the prescription of medications for acute pain. However, clinicians' gender stereotypes, as well as the clinician's own gender, appear to influence diagnostic and treatment decisions for more persistent pain problems. WHERE DO WE NEED TO GO?: The ultimate goal is optimal pain control for each individual, with gender being one difference between individuals. HOW DO WE GET THERE?: Further research is needed to address all three major purposes, with particular attention to whether gender-specific pain treatment may sometimes be warranted.