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To identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors.
We conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA.
The orthopedics department of a university health center.
Patients undergoing THA or TKA.
Surgeons revised their UTI screening and treatment practices.
Positive leukocyte esterase (P<.0001; P<.0001) and urine white blood cell count>5 (P=.01; P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase.
Urine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase.
Electroconvulsive therapy (ECT) is an effective treatment for major
depression. Optimising efficacy and minimising cognitive impairment are
goals of ongoing technical refinements.
To compare the efficacy and cognitive effects of a novel electrode
placement, bifrontal, with two standard electrode placements, bitemporal
and right unilateral in ECT.
This multicentre randomised, double-blind, controlled trial (NCT00069407)
was carried out from 2001 to 2006. A total of 230 individuals with major
depression, bipolar and unipolar, were randomly assigned to one of three
electrode placements during a course of ECT: bifrontal at one and a half
times seizure threshold, bitemporal at one and a half times seizure
threshold and right unilateral at six times seizure threshold.
All three electrode placements resulted in both clinically and
statistically significant antidepressant outcomes. Remission rates were
55% (95% CI 43–66%) with right unilateral, 61% with bifrontal (95% CI
50–71%) and 64% (95% CI 53–75%) with bitemporal. Bitemporal resulted in a
more rapid decline in symptom ratings over the early course of treatment.
Cognitive data revealed few differences between the electrode placements
on a variety of neuropsychological instruments.
Each electrode placement is a very effective antidepressant treatment
when given with appropriate electrical dosing. Bitemporal leads to more
rapid symptom reduction and should be considered the preferred placement
for urgent clinical situations. The cognitive profile of bifrontal is not
substantially different from that of bitemporal.
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