The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Timothy L. Smith - One of the best experts on this subject based on the ideXlab platform.
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Evidence-Based Practice: Postoperative Care in Endoscopic Sinus Surgery
Otolaryngologic Clinics of North America, 2012Co-Authors: Luke Rudmik, Timothy L. SmithAbstract:Abstract Postoperative Care following endoscopic sinus surgery (ESS) for medically refractory chronic rhinosinusitis (CRS) is believed to be important to optimize clinical outcomes. There is no standardized approach to Postoperative Care and, because of the numerous reported strategies, there remains a debate as to what constitutes the optimal Postoperative Care protocol. This article reviews the evidence and describes an evidence-based approach for Postoperative Care following ESS for medically refractory CRS.
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early Postoperative Care following endoscopic sinus surgery an evidence based review with recommendations
International Forum of Allergy & Rhinology, 2011Co-Authors: Luke Rudmik, Zachary M. Soler, Richard R Orlandi, Michael G Stewart, Neil Bhattacharyya, David W Kennedy, Timothy L. SmithAbstract:Background: Early Postoperative Care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several Postoperative Care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early Postoperative Care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early Postoperative Care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early Postoperative Care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early Postoperative Care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in Postoperative management. These evidence-based recommendations should not necessarily be applied to all Postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate Care. © 2011 ARS-AAOA, LLC.
Jamie E Collins - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Care navigation for total knee arthroplasty patients a randomized controlled trial
Arthritis Care and Research, 2016Co-Authors: Elena Losina, Jamie E Collins, Meghan E Daigle, Laurel A Donnellfink, Doris Strnad, John Wright, Ilana M Usiskin, Heidi Y YangAbstract:Objective To establish the efficacy of motivational interviewing–based Postoperative Care navigation in improving functional status after total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. Methods We conducted a parallel randomized controlled trial in TKA recipients with 2 arms: Postoperative Care with frequent followup by a Care navigator or usual Care. The primary outcome was the difference between the arms in Western Ontario and McMaster Universities Osteoarthritis Index function score change, over 6 months postsurgery. We performed a preplanned subgroup analysis of differential efficacy by obesity and exploratory subgroup analyses on sex and pain catastrophizing. Results We enrolled 308 subjects undergoing TKA for osteoarthritis. Mean ± SD preoperative function score was 41 ± 17 (0–100 scale, where 100 = worst function). At 6 months, subjects in the navigation arm improved by mean ± SD 30 ± 16 points compared to 27 ± 18 points in the usual-Care arm (P = 0.148). Participants with moderate to high levels of pain catastrophizing were unlikely to benefit from navigation compared to those with lower levels of pain catastrophizing (P = 0.013 for interaction). Conclusion Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from Care navigation, as well as by potential differential effects for subjects with moderate to high degrees of pain catastrophizing. Greater focus on developing programs for reducing pain catastrophizing could lead to better functional outcomes following TKA.
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the avika adding value in knee arthroplasty Postoperative Care navigation trial rationale and design features
BMC Musculoskeletal Disorders, 2013Co-Authors: Elena Losina, Jamie E Collins, Meghan E Daigle, Laurel A Donnellfink, Julian Jz Prokopetz, Doris Strnad, Vladislav Lerner, Benjamin N Rome, Roya GhazinouriAbstract:Background: Utilization of total knee arthroplasty is increasing rapidly. A substantial number of total knee arthroplasty recipients have persistent pain after surgery. Our objective was to design a randomized controlled trial to establish the efficacy of a motivational-interviewing-based telephone intervention aimed at improving patient outcomes and satisfaction following total knee arthroplasty. Methods/Design: The study was conducted at Brigham and Women’s Hospital in Boston, Massachusetts. The study focused on individuals 40 years or older with a primary diagnosis of osteoarthritis who were scheduled for total knee arthroplasty. The study compared two management strategies over the first six months Postoperatively: 1) enhanced Postoperative Care with frequent follow-up by a Care navigator; 2) usual Postoperative Care. Those who were randomized into the enhanced Postoperative Care arm received ten calls from a trained non-clinician Care navigator over the first six Postoperative months. The navigator used motivational interviewing techniques to engage patients in discussions related to their rehabilitation goals, including patient’s plans for and confidence in achieving those goals. Patients in the usual Care arm received standard Postoperative management and received no navigator phone calls. Patients in both arms were assessed at baseline, three months, and six months Postoperatively. Discussion: The primary outcome of the study was improvement in function as measured by the difference in Western Ontario and McMaster Universities Osteoarthritis Index function score between preoperative (baseline) status and six months Postoperatively. Data were collected to identify factors that may be related to total knee arthroplasty outcomes, including preoperative pain, pain catastrophizing, self-efficacy, and depression. A formal economic analysis is also planned to determine the cost-effectiveness of the Care navigator as a component of total knee arthroplasty Care.
Neil Bhattacharyya - One of the best experts on this subject based on the ideXlab platform.
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early Postoperative Care following endoscopic sinus surgery an evidence based review with recommendations
International Forum of Allergy & Rhinology, 2011Co-Authors: Luke Rudmik, Zachary M. Soler, Richard R Orlandi, Michael G Stewart, Neil Bhattacharyya, David W Kennedy, Timothy L. SmithAbstract:Background: Early Postoperative Care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several Postoperative Care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early Postoperative Care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early Postoperative Care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early Postoperative Care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early Postoperative Care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in Postoperative management. These evidence-based recommendations should not necessarily be applied to all Postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate Care. © 2011 ARS-AAOA, LLC.
Luke Rudmik - One of the best experts on this subject based on the ideXlab platform.
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Evidence-Based Practice: Postoperative Care in Endoscopic Sinus Surgery
Otolaryngologic Clinics of North America, 2012Co-Authors: Luke Rudmik, Timothy L. SmithAbstract:Abstract Postoperative Care following endoscopic sinus surgery (ESS) for medically refractory chronic rhinosinusitis (CRS) is believed to be important to optimize clinical outcomes. There is no standardized approach to Postoperative Care and, because of the numerous reported strategies, there remains a debate as to what constitutes the optimal Postoperative Care protocol. This article reviews the evidence and describes an evidence-based approach for Postoperative Care following ESS for medically refractory CRS.
-
early Postoperative Care following endoscopic sinus surgery an evidence based review with recommendations
International Forum of Allergy & Rhinology, 2011Co-Authors: Luke Rudmik, Zachary M. Soler, Richard R Orlandi, Michael G Stewart, Neil Bhattacharyya, David W Kennedy, Timothy L. SmithAbstract:Background: Early Postoperative Care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several Postoperative Care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early Postoperative Care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early Postoperative Care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early Postoperative Care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early Postoperative Care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in Postoperative management. These evidence-based recommendations should not necessarily be applied to all Postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate Care. © 2011 ARS-AAOA, LLC.
Elena Losina - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Care navigation for total knee arthroplasty patients a randomized controlled trial
Arthritis Care and Research, 2016Co-Authors: Elena Losina, Jamie E Collins, Meghan E Daigle, Laurel A Donnellfink, Doris Strnad, John Wright, Ilana M Usiskin, Heidi Y YangAbstract:Objective To establish the efficacy of motivational interviewing–based Postoperative Care navigation in improving functional status after total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. Methods We conducted a parallel randomized controlled trial in TKA recipients with 2 arms: Postoperative Care with frequent followup by a Care navigator or usual Care. The primary outcome was the difference between the arms in Western Ontario and McMaster Universities Osteoarthritis Index function score change, over 6 months postsurgery. We performed a preplanned subgroup analysis of differential efficacy by obesity and exploratory subgroup analyses on sex and pain catastrophizing. Results We enrolled 308 subjects undergoing TKA for osteoarthritis. Mean ± SD preoperative function score was 41 ± 17 (0–100 scale, where 100 = worst function). At 6 months, subjects in the navigation arm improved by mean ± SD 30 ± 16 points compared to 27 ± 18 points in the usual-Care arm (P = 0.148). Participants with moderate to high levels of pain catastrophizing were unlikely to benefit from navigation compared to those with lower levels of pain catastrophizing (P = 0.013 for interaction). Conclusion Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from Care navigation, as well as by potential differential effects for subjects with moderate to high degrees of pain catastrophizing. Greater focus on developing programs for reducing pain catastrophizing could lead to better functional outcomes following TKA.
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the avika adding value in knee arthroplasty Postoperative Care navigation trial rationale and design features
BMC Musculoskeletal Disorders, 2013Co-Authors: Elena Losina, Jamie E Collins, Meghan E Daigle, Laurel A Donnellfink, Julian Jz Prokopetz, Doris Strnad, Vladislav Lerner, Benjamin N Rome, Roya GhazinouriAbstract:Background: Utilization of total knee arthroplasty is increasing rapidly. A substantial number of total knee arthroplasty recipients have persistent pain after surgery. Our objective was to design a randomized controlled trial to establish the efficacy of a motivational-interviewing-based telephone intervention aimed at improving patient outcomes and satisfaction following total knee arthroplasty. Methods/Design: The study was conducted at Brigham and Women’s Hospital in Boston, Massachusetts. The study focused on individuals 40 years or older with a primary diagnosis of osteoarthritis who were scheduled for total knee arthroplasty. The study compared two management strategies over the first six months Postoperatively: 1) enhanced Postoperative Care with frequent follow-up by a Care navigator; 2) usual Postoperative Care. Those who were randomized into the enhanced Postoperative Care arm received ten calls from a trained non-clinician Care navigator over the first six Postoperative months. The navigator used motivational interviewing techniques to engage patients in discussions related to their rehabilitation goals, including patient’s plans for and confidence in achieving those goals. Patients in the usual Care arm received standard Postoperative management and received no navigator phone calls. Patients in both arms were assessed at baseline, three months, and six months Postoperatively. Discussion: The primary outcome of the study was improvement in function as measured by the difference in Western Ontario and McMaster Universities Osteoarthritis Index function score between preoperative (baseline) status and six months Postoperatively. Data were collected to identify factors that may be related to total knee arthroplasty outcomes, including preoperative pain, pain catastrophizing, self-efficacy, and depression. A formal economic analysis is also planned to determine the cost-effectiveness of the Care navigator as a component of total knee arthroplasty Care.
