Provident Hospital began as a 10-bed clinic in a private residence at 419 Orchard St, in northwest Baltimore, Maryland in 1894 to provide both medical treatment and training for Black nurses and doctors. The hospital was founded by Negro physicians who were practicing in the Baltimore area just a year after the founding of the first Black-owned and operated hospital, Provident Hospital of Chicago. Within two years it moved to a larger site at 413 W. Biddle Street. Provident Hospital was one of the first black medical facilities located in Baltimore.
Smart knee implants integrate advanced sensor-based technologies, forming a unique technology-embedded total knee arthroplasty (TKA) implant. Such implants introduce the ability to capture new elements of patient-related data for use in the context of recovery in real time including subjective reported outcomes and objective outcomes related to range of motion, and gait parameters. This technology allows for real-time data capture and patient-specific insights, creating opportunities to optimize postoperative care. This brief narrative review discusses the foundations and origin of technology-embedded implants, beginning with research-related roots relating to the derivation of fundamental knee joint force measurements. Analyzing the current market of implants, the present review investigates the technological capacities of modern designs including form and function. Further discussed is an evaluation of smart knee implant effectiveness, focusing on its impact on recovery outcomes such as patient-reported outcome measures (PROMs), functional improvement, gait patterns, and patient adherence/satisfaction. Smart implants represent a significant technological advancement in personalized care, leveraging real-time data including joint motion, alignment, and patient motion to assist surgeons in optimizing rehabilitation protocols. These implants provide insights into recovery progression postoperatively, with the potential for early identification of at-risk individuals. Preliminary studies demonstrate favorable patient outcomes and satisfaction, although further research is necessary to establish the long-term benefits and efficacy of smart knee implants.
Background Obstetric hemorrhage is the leading cause of maternal mortality and severe maternal morbidity (SMM) in Maryland and nationally. Currently, through a quality collaborative, the state is implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on obstetric hemorrhage. Objective To describe SMM events contributed by obstetric hemorrhage and their preventability in Maryland. Study Design This cross-sectional study used data from hospital-based SMM surveillance and review program in Maryland. Hospital-based SMM criteria include admission to an intensive care unit and/or transfusion of 4 or more units of blood products (of any type) during pregnancy or within 42 days postpartum. A total of 193 obstetric hemorrhage events that met the surveillance definition were identified in hospitals participating in SMM surveillance since inception on August 1, 2020 until December 31, 2022. We compared patient and delivery characteristics, practices done well, and recommendations for care improvement among patients with severe obstetric hemorrhage deemed preventable and non-preventable by hospital-based review committees. For obstetric hemorrhage events deemed preventable, we further identified factors that contributed to the SMM outcome at the provider, system, and patient levels. Results Uterine atony was the leading cause of obstetric hemorrhage events (37.8%), followed by uterine rupture, laceration and intra-abdominal bleeding (23.8%). Sixty-six (34.2%) obstetric hemorrhage events were preventable. Patients with preventable obstetric hemorrhage were significantly more likely to have an emergency than planned cesarean delivery and less likely to have a placental complication or >1,500mL blood loss volume. Hospital-based review committees determined that 81.8%, 30.3%, and 22.7% of preventable events could have been prevented or made less severe through changes to provider, system, or patient factors, respectively. Recommendations following event reviews aligned with the Alliance for Innovation on Maternal Health Obstetric Hemorrhage Patient Safety Bundle, particularly regarding elements in the Recognition and Prevention and Response domains. Conclusion About one-third of SMM events contributed by obstetric hemorrhages were deemed preventable. Of AIM bundle elements, assessing hemorrhage risk on admission to labor and delivery, peripartum, and upon transition to postpartum care together with rapid, unit-standardized management of hemorrhage are likely to benefit more than half of patients with preventable SMM contributed by obstetric hemorrhage.
Background:Plastic surgery residency comprises a significant portion of early adulthood. The difficulties of residency are well documented, particularly with the impact on wellness and risk of burnout. Structured wellness programs, mentorship, social support, and autonomy can decrease residency burnout. This study looked at how plastic surgery program websites and GME websites represent wellness and support programs between both integrated and independent plastic surgery residencies.Methods:A cross-sectional analysis of US plastic surgery residency programs was performed during the month of April 2024. The authors conducted a systematic content analysis on the available websites of these residency websites, GME websites, and associated programs' Instagram and X (formally Twitter) pages. Data points included (1) mention of wellness on the program website, (2) vacation time mentioned on the website, (3) protected time available, (4) spouse support options, (5) day care options, (6) connections with mentors, (7) images of social events on the website, and (8) images of social events on Instagram. Data were compiled and analyzed in JASP (JASP Team [2024]. JASP [version 0.18.3; computer software]) as well as Microsoft Excel. Categorical variables were compared using binomial tests and chi-squared tests. Statistical significance was defined a P value less than or equal to 0.05.Results:The majority of plastic surgery residencies did not discuss or describe their wellness programs on their official website, regardless of program size. Similar results were displayed when searching for spousal support and daycare. GME websites were more comprehensive than the program websites but still showed significant discrepancies with vacation policies and day care. Mentorship was mentioned in under half of all plastic surgery residencies. Integrated programs were more likely to display social events on Instagram when compared with independent programs.Conclusions:Plastic surgery residencies do not provide evidence of existing wellness programs on their program websites. Although a lack of public information on wellness programs does not mean they do not exist, this could easily be mitigated by providing more comprehensive information on both GME and program websites.
OBJECTIVES:Symptomatic macromastia can lead to physical and psychosocial challenges, especially in younger patients. Here we aim to assess trends in the volume of pediatric reduction mammoplasties and their associated outcomes. METHODS:A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) Participant Use Data File identified pediatric patients who underwent reduction mammoplasty from 2012 to 2021. Trends in surgical volume were assessed using annual percent change. Patient characteristics and clinical outcomes were compared using standard univariate statistics. Multivariable analysis was used to model the influence of covariates on surgical volume. RESULTS:2129 patients were identified, with majority being White (48.7%) with a mean age of 16.7 (x±1.1) years. Rates of pediatric reduction mammoplasty increased 1,589.7% from 2012 to 2021. This was observed to be correlated with a significant rise in rate of outpatient surgeries being performed. Patient demographics including age, body mass index, and race were not observed to change over time. CONCLUSIONS:There has been a steady increase in pediatric reduction mammoplasties over the past decade irrespective of factors including age and BMI. This is possibly driven by the increasedoccurrence of these procedures being performed in an outpatient setting. These findings underscore the need for ongoing research and awareness to determine additional factors related to evolving patient population.
Background In total hip arthroplasty (THA), proper management of surgical incisions is essential for optimal wound healing and patient outcomes. Despite advances in surgical techniques, significant challenges remain in preventing complications and infections. This study aimed to identify evidence gaps in THA wound care, including presurgical preparation, intraoperative practices, and postsurgical complications. Methods Using a modified Delphi method, 20 expert orthopedic surgeons from Europe and North America participated in a 3-phase consensus process from April 1 to September 30, 2023. This included a preliminary questionnaire, a remote conference, and a final online survey. The panel reviewed literature and achieved agreement on 18 consensus statements regarding wound care in THA. A secondary aim was to identify critical gaps in current wound care knowledge. Results Consensus was reached on 18 statements. Key gaps were identified in the effectiveness of mesh-adhesive dressings, optimal closure methods (skin adhesives, staples, sutures), cost benefit of barbed sutures, and appropriate use of negative pressure wound therapy. These findings highlight the need for further research to validate best practices and guide standardized evidence-based protocols. Conclusions Addressing these evidence gaps is essential to improve THA wound care methods. Future studies should compare closure techniques and new technologies to develop more efficient patient-centered strategies. Bridging these gaps may reduce complications, enhance outcomes, and lower the burden of wound-related issues in THA.
