Cost-containment strategies may discourage hospitals from performing surgery for patients with preexisting risk factors such as those high body mass index (BMI), hemoglobin A1c (HbA1c), or who smoke cigarettes. Because these not appear in equal proportions across the population, using inflexible eligibility criteria lower extremity joint arthroplasty exacerbate existing racial-ethnic, gender, and socioeconomic disparities pertaining to access an operation that can improve health quality of...

A diverse physician workforce improves the quality of care for all patients, and there is a need greater diversity in orthopaedic surgery. It important that medical students backgrounds be encouraged to pursue specialty, but do so, we must understand students' perceptions inclusion orthopaedics. We also currently lack knowledge about how participation an clinical rotation might influence these perceptions.(1) How surgery compare among different gender identities, races or ethnicities, sexual...

Since the development of assisted reproductive technologies, infertile individuals have crossed borders to obtain treatments unavailable or unaffordable in their own country. Recent media coverage has focused on outsourcing surrogacy developing countries, where cost for is significantly less than equivalent a more developed This paper discusses ethical arguments against international surrogacy. The major opposition viewpoints can be broadly divided into about welfare, commodification and...

The Centers for Medicare and Medicaid Services has initiated bundled payments hip knee total joint replacement in an effort to decrease healthcare costs increase quality of care. ethical implications this program have not been studied. This article considers the ethics patient selection improve outcomes; specifically, screening patients by body mass index determine eligibility replacement. I argue that type is ethically defensible, payment as structured likely lead unfair restrictions on who...

Abstract Background Letters of recommendation are considered one the most important factors for whether an applicant is selected interview orthopaedic surgery residency programs. Language differences in letters describing men versus women candidates may create differential perceptions by gender. Given gender imbalance surgery, we sought to determine there language Questions/purposes (1) Are word count and categories applicants, regardless author gender? (2) Is associated with category...

Abstract Background Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- post-KT mortality. Centers often assess frailty status function during evaluation to help identify appropriate candidate. Yet, there no ethical guidelines regarding use this evaluation. We seek develop a clinical consensus on balancing utility justice in access KT for cognitively impaired patients. Methods Twenty-seven experts caring ESRD patients...

1Chief, Penn Orthopaedics Foot and Ankle Service, The Hospitals of the University Pennsylvania, Philadelphia, PA, USA C. J. Humbyrd, 230 West Washington Square, 5th Floor, Farm Journal Building, PA 19104, USA, Email: [email protected] A note from Editor-in-Chief: I am pleased to share next installment "Virtue Ethics in a Value-driven World." In this column, Casey Jo Humbyrd MD, MBE uses virtue ethics—the branch normative ethics that focuses on moral character—to explore controversies...

Submission Type: Other Research Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Foot structural changes and pain are some of the most common musculoskeletal conditions experienced during pregnancy [1]. Symptomatic flatfoot pronation is hypothesized to result from increased body mass circulating hormones that promote ligament laxity [2,3]. Accurately reliably tracking foot structure critical understand effects on identify patients at risk long-term...

Background To encourage high-quality, reduced-cost care for total joint arthroplasty (TJA), the Centers of Medicare & Medicaid Services mandated a pay-for-performance model, Comprehensive Care Joint Replacement (CJR), as part Patient Protection and Affordable Act (PPACA). The CJR incentivizes cost containment, it was anticipated that its implementation would reduce access to TJA high-cost populations. Patients with end-stage kidney disease (ESKD) undergoing replacement therapy (dialysis...

Disparities in THA use may lead to inequitable care. Prior research has focused on disparities based individual-level and isolated socioeconomic demographic variables. To our knowledge, the role of composite, community-level geographic disadvantage not been studied United States. As persist, exploring potential underlying drivers these inequities help developing more targeted recommendations how achieve equitable use.(1) Is associated with decreased rates Medicare-aged patients? (2) Do...

Background: On April 1, 2016, the Centers for Medicare & Medicaid Services (CMS) introduced bundled-payment programs hip replacement and knee (HKR) in selected metropolitan statistical areas (MSAs) to decrease costs cost variability of HKR increase quality care. Early program analyses showed savings; however, studies also demonstrated a trend toward selection healthier patients performed under bundled system. We compared characteristics who underwent before implementation system...

Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR).We studied Medicare with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted a transplant, not waitlisted, or received transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR factors,...

Background The allocation of scarce deceased donor kidneys is a complex process. Transplant providers are increasingly relying on constructs such as frailty and cognitive function to guide kidney transplant (KT) candidate selection. Patient views the ethical issues surrounding use unclear. We sought assess KT candidates’ attitudes beliefs about waitlist selection.Methods candidates were randomly recruited from an ongoing single-center cohort study function. Semi-structured interviews...

OBJECTIVES Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and at risk for age‐related adverse events including fractures. Understanding recipient, transplant, donor factors the outcomes associated fractures may help identify older KT recipients increased risk. We determined incidence of hip, vertebral, extremity fractures; assessed incident estimated associations between subsequent death‐censored loss (DCGL) mortality. DESIGN This was...

While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, time to DRF evaluation treatment are unknown. We sought determine if geographic socioeconomic disadvantage is associated with imaging the emergency department (ED) surgery for DRFs.We performed a time-to-event analysis 105 patients undergoing after ED triage within our hospital system between January 1, 2015, 2020. Area Deprivation Index (ADI) national percentile was used as...

Background. Falls occur in 28% of hemodialysis patients and increase the risk physical impairment, morbidity, mortality. Therefore, it is likely that kidney transplantation (KT) candidates with recurrent falls are less to access KT more experience adverse post-KT outcomes. Methods. We used a 2-center cohort study (n = 3666) recipients 770) (January 2009 January 2018). Among candidates, we estimated time listing, waitlist mortality, transplant rate by (≥2 falls) before evaluation using...

Image-guided percutaneous needle biopsy has become the preferred diagnostic modality for bone and soft tissue tumors. However, to authors' knowledge, levels of patient anxiety, pain, satisfaction before after procedure have not been studied. Sixty-five patients undergoing image-guided a possible or tumor were prospectively surveyed quantify preprocedure postprocedure anxiety pain determine demographic clinical correlates satisfaction. Anxiety was measured with Spielberger State-Trait...