The Journal of Trauma: Injury, Infection, and Critical Care, 2009
This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) ... more This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) on departmental revenue within an academic orthopedic department. The effect of the OTS on physician and resident perceptions of job satisfaction, education, and quality of patient care were also evaluated. A proforma financial analysis was undertaken using an optimization model to predict the potential financial performance of an OTS before its implementation. Financial data were then collected prospectively for the first year of the OTS and compared with the preceding year's financial data. All residents and faculty in the department completed visual analog scale surveys after the formation of the service. While maintaining a fixed amount of work production (work relative value units [WRVUs]) per year, our model predicted an $111,000 increase in departmental charges as a result of a shift in the elective case mix. After implementation of the OTS, elective charges/WRVU increased by 7.4% while trauma charges/WRVU increased by 2.6%. This, combined with a minor increase in departmental work volume (115,661 WRVUs pre-OTS vs. 117,577 WRVUs post-OTS) and an improvement in collections/charge (47-48%), yielded a departmental collection increase of 11% ($1.1 million). Resident and faculty job satisfaction improved, as did the perception of the quality of trauma care that was being provided. The organization and implementation of an OTS within an academic orthopedic department can lead to an improved professional experience for residents and faculty, the perception of improved patient care for the trauma patient, and an increase in departmental revenue.
The Journal of Bone and Joint Surgery (American), 2006
Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. Wh... more Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. When a fracture occurs in a femur with substantial proximal bone deficiency, the surgical options for revision are limited. One option includes the use of a proximal femoral allograft. We retrospectively assessed the results and complications of the use of a proximal femoral allograft to treat twenty-five Vancouver type-B3 periprosthetic fractures in twenty-four patients. The mean duration of follow-up was 5.1 years. Clinical results were graded with use of the Harris hip score. Radiographs were assessed for evidence of trochanteric union, host-allograft union, allograft resorption, and component loosening or fracture. Failure of the procedure was defined as the need for revision surgery requiring graft removal. The mean postoperative Harris hip score was 70.8. At the time of the final follow-up, twenty-one of the twenty-four patients reported no or mild pain and twenty-three patients were able to walk; fifteen required a walking aid. The greater trochanter united in seventeen of the twenty-five hips, and osseous union of the allograft to the host femur occurred in twenty hips. There was mild graft resorption in four hips and moderate graft resorption in two. Four (16%) of the twenty-five hips required repeat revision. The use of a proximal femoral allograft for the treatment of a Vancouver type-B3 periprosthetic femoral fracture can provide a satisfactory result in terms of pain relief and function at five years.
Intracerebral haemorrhage (ICH) without demonstrated tissue pathology in previously healthy adult... more Intracerebral haemorrhage (ICH) without demonstrated tissue pathology in previously healthy adults has not been previously linked to anaerobic or aerobic exercise. The possible mechanisms and risk factors for ICH that may be found in a young, "healthy" adult are described. Case reports of two patients who suffered a frontal lobe ICH following aerobic and anaerobic exercise are presented. A review of the literature was carried out to elucidate the risk factors for ICH in previously healthy adults. Hypocholesterolemia below 4.14 mmol/l, phenylpropanolamine use above 75 mg per day and certain apolipoprotein phenotypes (Apo E2 and Apo E4), which can all be found in young, healthy adults have all been described in the literature as contributors to the risk of ICH. There is a need for these risk factors to be researched in more detail, given that potential risk modifiers may help decrease their posed threat.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) ... more This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) on departmental revenue within an academic orthopedic department. The effect of the OTS on physician and resident perceptions of job satisfaction, education, and quality of patient care were also evaluated. A proforma financial analysis was undertaken using an optimization model to predict the potential financial performance of an OTS before its implementation. Financial data were then collected prospectively for the first year of the OTS and compared with the preceding year's financial data. All residents and faculty in the department completed visual analog scale surveys after the formation of the service. While maintaining a fixed amount of work production (work relative value units [WRVUs]) per year, our model predicted an $111,000 increase in departmental charges as a result of a shift in the elective case mix. After implementation of the OTS, elective charges/WRVU increased by 7.4% while trauma charges/WRVU increased by 2.6%. This, combined with a minor increase in departmental work volume (115,661 WRVUs pre-OTS vs. 117,577 WRVUs post-OTS) and an improvement in collections/charge (47-48%), yielded a departmental collection increase of 11% ($1.1 million). Resident and faculty job satisfaction improved, as did the perception of the quality of trauma care that was being provided. The organization and implementation of an OTS within an academic orthopedic department can lead to an improved professional experience for residents and faculty, the perception of improved patient care for the trauma patient, and an increase in departmental revenue.
The Journal of Bone and Joint Surgery (American), 2006
Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. Wh... more Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. When a fracture occurs in a femur with substantial proximal bone deficiency, the surgical options for revision are limited. One option includes the use of a proximal femoral allograft. We retrospectively assessed the results and complications of the use of a proximal femoral allograft to treat twenty-five Vancouver type-B3 periprosthetic fractures in twenty-four patients. The mean duration of follow-up was 5.1 years. Clinical results were graded with use of the Harris hip score. Radiographs were assessed for evidence of trochanteric union, host-allograft union, allograft resorption, and component loosening or fracture. Failure of the procedure was defined as the need for revision surgery requiring graft removal. The mean postoperative Harris hip score was 70.8. At the time of the final follow-up, twenty-one of the twenty-four patients reported no or mild pain and twenty-three patients were able to walk; fifteen required a walking aid. The greater trochanter united in seventeen of the twenty-five hips, and osseous union of the allograft to the host femur occurred in twenty hips. There was mild graft resorption in four hips and moderate graft resorption in two. Four (16%) of the twenty-five hips required repeat revision. The use of a proximal femoral allograft for the treatment of a Vancouver type-B3 periprosthetic femoral fracture can provide a satisfactory result in terms of pain relief and function at five years.
Intracerebral haemorrhage (ICH) without demonstrated tissue pathology in previously healthy adult... more Intracerebral haemorrhage (ICH) without demonstrated tissue pathology in previously healthy adults has not been previously linked to anaerobic or aerobic exercise. The possible mechanisms and risk factors for ICH that may be found in a young, "healthy" adult are described. Case reports of two patients who suffered a frontal lobe ICH following aerobic and anaerobic exercise are presented. A review of the literature was carried out to elucidate the risk factors for ICH in previously healthy adults. Hypocholesterolemia below 4.14 mmol/l, phenylpropanolamine use above 75 mg per day and certain apolipoprotein phenotypes (Apo E2 and Apo E4), which can all be found in young, healthy adults have all been described in the literature as contributors to the risk of ICH. There is a need for these risk factors to be researched in more detail, given that potential risk modifiers may help decrease their posed threat.
Uploads
Papers by Barry Cayen