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Branko Kopjar

Publications and source records attributed to Branko Kopjar.

14 recordsLinked to original sources
PubMed2006

The prevalence and outcomes of in-hospital acute myocardial infarction in the Department of Veterans Affairs Health System.

BACKGROUND: Most studies of the epidemiology and treatment of acute myocardial infarction (AMI) have focused on patients who experienced onset of their symptoms in the community and then presented to the hospital. There are, however, patients whose symptoms of AMI begin after hospitalization for other medical conditions. The purposes of this study were to determine the prevalence of in-hospital AMI in the Veterans Health Administration (VHA) and to compare baseline characteristics, treatments, and outcomes according to whether individuals presented with AMI or had an in-hospital AMI. METHODS: This was a retrospective cohort study of 7054 veterans who were hospitalized for AMI in 127 VHA medical centers between July 2003 and August 2004. The main outcome measure was 30-day mortality. Key covariates included age, body mass index, admission systolic blood pressure, heart rate, previous use of lipid-lowering drugs, elevated admission troponin value, prolonged and/or atypical chest pain on admission, and ST-segment elevation on the initial electrocardiogram. RESULTS: There were 792 patients (11.2%) who had AMI while hospitalized for other medical conditions. These patients differed substantially from those who presented to the hospital with AMI. The odds of 30-day mortality were greater in the in-hospital group (odds ratio, 3.6; 95% confidence interval, 3.1-4.3; P<.001) and remained higher after statistical adjustment (odds ratio, 2.0; 95% confidence interval, 1.7-2.4; P<.001). CONCLUSION: Although most attention has been paid to patients with AMI admitted via the community emergency medical system or through the emergency department, AMI occurring during hospitalization for other medical problems is an important clinical problem.

Age Distribution↗
PubMed2006

Issues in the planning and conduct of non-randomised studies.

This paper discusses topics related to the planning and implementation of non-randomised clinical studies in orthopaedics. A well-conducted case-series is appropriate to demonstrate the safety of a surgical intervention. The case-series design involves the provision of a defined intervention to a group of patients with the ultimate objective of describing the final outcome, including such occurrences as complications. There is no alternative procedure serving as a control. The key aspects are to ensure enrolment of all eligible patients and to obtain a sufficiently large sample size to allow precise and valid estimation of complication risks. Targeted complications should be clearly defined and fully documented during a pre-defined follow-up period. Loss to follow-up should be minimised. Comparative studies are required to demonstrate treatment effectiveness. If a randomised controlled trial (RCT) is not feasible, an observational design such as a cohort or a case-control study should be considered. In observational designs, the treatment decision is made by the surgeons. In a case-control study, patients are selected based on their outcomes and their treatment or exposure status is recorded retrospectively. In a cohort study, groups of patients are selected based on their treatment and are followed for outcomes. There are numerous variations. Data can be collected prospectively or retrospectively; comparison groups may be concurrent or non-concurrent, or studied at different locations. The optimal design is tailored to clinical questions and research settings, while keeping in mind the respective methodological strengths and weaknesses of available options. The strength of the observational study is its proximity to daily clinical practice. The limitations are the possibility of numerous biases and confounding factors. Despite many challenges to the internal validity of non-randomised studies in orthopaedics surgery, it is possible to use such designs in order to provide reasonably valid answers to clinically important questions.

Algorithms↗
PubMed2005

[Deliberate self-poisonings treated in hospitals].

BACKGROUND: Due to lack of person-based national statistics, the exact incidence of deliberate self-poisoning in Norway is unknown. This study describes incidence of hospital discharges for deliberate self-poisoning with drugs based on data from Norwegian National Hospital Discharge Register. POPULATION AND METHODS: Cases of patients aged 15 years or older discharged with a diagnosis T4n or T50.9 "Intoxication with medical drugs and biological substances" from January 1, 2000 to December 31, 2002 were selected. We have calculated age- and sex-specific national incidence rates and age- and sex-adjusted regional rates. RESULTS: Annualized incidence was 4307 cases (120 per 100,000 person-years). The incidence was higher among women (144 per 100,000 person-years) than men (94 per 100,000 person-years). Incidence was higher among younger than older people and it was the highest in women aged 20 - 24. In-hospital mortality was 5 per 1000 cases. There were statistically significant differences in incidence among Norwegian counties, with one county having the highest incidence, 50 % above the national average. INTERPRETATION: Deliberate self-poisoning with drugs is a significant public health problem in Norway. Priority should be focused on high incidence among young people, particularly women. The causes of significant regional variations should be researched further.

Adolescent↗
PubMed2005

Clinical studies in spinal surgery.

There is a growing interest in applying evidence-based approaches also in orthopedic surgery. Despite many challenges to the validity of clinical trials in orthopedic surgery, it is possible to conduct well-designed trials in this field and to produce clinically important findings and reasonably valid conclusions about effectiveness, prognosis and diagnosis in orthopedic surgery. We describe the main principles for conducting clinical trials in this field as well as some of the most common errors and ways to avoid them.

Bias↗
PubMed2005

Adherence to heart-healthy behaviors in a sample of the U.S. population.

INTRODUCTION: Following national recommendations for physical activity, diet, and nonsmoking can reduce both incident and recurrent coronary heart disease. Prevalence data about combinations of behaviors are lacking. This study describes the prevalence of full adherence to national recommendations for physical activity, fruit and vegetable consumption, and nonsmoking among individuals with and without coronary heart disease and examines characteristics associated with full adherence. METHODS: We performed a cross-sectional analysis of data from the 2000 Behavioral Risk Factor Surveillance System, a national population-based survey. We included respondents to the cardiovascular disease module and excluded individuals with poor physical health or activity limitations. RESULTS: Subjects were most adherent to smoking recommendations (approximately 80%) and less adherent to fruit and vegetable consumption and physical activity (approximately 20% for both). Only 5% of those without coronary heart disease and 7% of those with coronary heart disease were adherent to all three behaviors (P < .01). Among those without a history of coronary heart disease, female sex (odds ratio [OR] 1.47; 95% confidence interval [CI], 1.23-1.76), highest age quintile (OR 1.67; 95% CI, 1.28-2.19), more education (OR 2.48; 95% CI, 1.69-3.64), and more income (OR 1.19; 95% CI, 1.04-1.36) were associated with full adherence. Among those with coronary heart disease, mid-age quintile (OR 3.79; 95% CI, 1.35-10.68), good general health (OR 2.05; 95% CI, 1.07-3.94), and more income (OR 1.51; 95% CI, 1.06-2.16) were associated with full adherence. CONCLUSION: These data demonstrate the lack of a heart-healthy lifestyle among a sample of U.S. adults with and without coronary heart disease. Full adherence to combined behaviors is far below adherence to any of the individual behaviors.

Cardiovascular Diseases↗
PubMed2005

Femoral revision with impaction grafting and a collarless, polished, tapered stem.

Femoral impaction allografting has been done with and without variations of the original description. The purpose of this study was to review Harris hip scores, radiographs, and complications in patients in whom we used the original technique without significant modifications. Preoperative and postoperative hip scores and radiographic data were available at a mean of 4.7 years for 43 of 44 hips that had femoral component impaction allografting with a collarless, polished, tapered stem. Bone stock was classified according to the Endo-Klinik classification. Survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97%. The mean Harris hip score improved from 45 to 90 with pain improved in all. Subsidence 4 mm and greater occurred in only two hips, but neither has been revised. One hip was revised for mechanical loosening after a fall on the surgically treated extremity 6 years after surgery. Complications included three intraoperative fractures, one femoral fracture recognized postoperatively, one trochanteric nonunion, and one dislocation. Femoral component revision with impaction allografting and a collarless, polished, tapered stem was reproducible and improved Harris hip scores in patients with aseptic femoral component loosening and bone loss at a mean of 4.7 years after surgery.

Adult↗
PubMed2005

Humeral component modularity may not be an important factor in the outcome of shoulder arthroplasty for glenohumeral osteoarthritis.

We examined the outcomes of using 3 types of humeral prostheses in total shoulder arthroplasty for osteoarthritis: a modular prosthesis with variable head diameters (MV), a nonmodular prosthesis with variable head diameters (NV), and a nonmodular prosthesis with a fixed head diameter (NF). Patients (N=101) completed self-assessments of shoulder function and health status before surgery and at follow-up between 30 and 60 months after surgery. Outcomes for the MV and NV prostheses did not differ statistically. The NF prosthesis trended toward poorer functional scores. Two Short Form-36 dimensions were statistically significantly lower (P<.05) in the NF group than in the MV and NV groups. These results fail to confirm that humeral component modularity is an important factor in the outcome of shoulder arthroplasty.

Aged↗
PubMed2004

Do drug-free workplace programs prevent occupational injuries? Evidence from Washington State.

OBJECTIVE: To evaluate the effect of a publicly sponsored drug-free workplace program on reducing the risk of occupational injuries. DATA SOURCES: Workers' compensation claims data from the Washington State Department of Labor and Industries covering the period 1994 through 2000 and work-hours data reported by employers served as the data sources for the analysis. STUDY DESIGN: We used a pre-post design with a nonequivalent comparison group to assess the impact of the intervention on injury risk, measured in terms of differences in injury incidence rates. Two hundred and sixty-one companies that enrolled in the drug-free workplace program during the latter half of 1996 were compared with approximately 20,500 nonintervention companies. We tested autoregressive, integrated moving-average (ARIMA) models to assess the robustness of our findings. PRINCIPAL FINDINGS: The drug-free workplace intervention was associated (p < .05) with a statistically significant decrease in injury rates for three industry groups: construction, manufacturing, and services. It was associated (p < .05) with a reduction in the incidence rate of more serious injuries involving four or more days of lost work time for two industry groups: construction and services. The ARIMA analysis supported CONCLUSIONS: The drug-free workplace program we studied was associated with a selective, industry-specific preventive effect. The strongest evidence of an intervention effect was for the construction industry. Estimated net cost savings for this industry were positive though small in magnitude.

Accidents, Occupational↗
PubMed2003

Adherence with statin therapy in secondary prevention of coronary heart disease in veterans administration male population.

This retrospective cohort study enrolled 8,768 male Veterans Administration patients with coronary heart disease who were prescribed statins from July 1, 1999, to June 30, 2000. After 18 months of follow-up, 71% of the patients had been dispensed >or=80% of the medication. Our population's persistence in using statins was higher than in other open-population cohorts but lower than in randomized controlled trials.

Aged↗
PubMed2002

Characterizing the functional improvement after total shoulder arthroplasty for osteoarthritis.

BACKGROUND: Both shoulder surgeons and patients who are considering total shoulder arthroplasty are interested in the anticipated improvement in shoulder comfort and function after the procedure. The purpose of the present study was to characterize shoulder-specific functional gains in relation to preoperative shoulder function and to present this information in a way that can be easily communicated to patients who are considering this surgery. METHODS: We analyzed the preoperative and follow-up shoulder function in patients managed with total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis. Functional self-assessments were available for 102 (80%) of 128 shoulders after thirty to sixty months of follow-up. Outcome was assessed with respect to the change in the number of shoulder functions that were performable, the change in shoulder function as a percentage of the preoperative functional deficit, and the change in the ability to perform specific shoulder functions. RESULTS: The average number of shoulder functions that were performable improved from four of twelve preoperatively to nine of twelve postoperatively (p < 0.01). Function improved in ninety-six shoulders (94%). The number of functions that were performable at the time of follow-up was positively associated with preoperative shoulder function (p < 0.05): the better the preoperative function, the better the follow-up function. The improvement in function was greatest for shoulders with less preoperative function (p < 0.01). On the average, patients regained approximately two-thirds of the functions that had been absent preoperatively. Significant improvement was noted in eleven of the twelve shoulder functions that were examined (p < 0.01). The chance of regaining a function that had been absent before surgery was 73%, whereas the chance of losing a function that had been present before surgery was 6%. Older men tended to have greater functional improvement than younger men. CONCLUSION: Total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis significantly improves shoulder function. Postoperative function is related to preoperative function. The improvement that was observed in this clinical series can be conveyed to patients most simply by stating that, after surgery, shoulders typically regained approximately two-thirds of the functions that had been absent preoperatively.

Adult↗
PubMedDate not supplied

The effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting.

The purpose of this study was to assess the impact of total shoulder arthroplasty on the self-assessed health status of a large series of patients with glenohumeral osteoarthritis. In 91 patients we were able to compare the 8 quantitative domains of Short Form-36 (SF-36) before surgery and at 30 to 60 months after surgery. These preoperative and postoperative scores were compared with data from an age- and gender-matched control population. These results were also compared with those reported for patients who underwent other common, effective surgical procedures. Preoperative SF-36 values were significantly lower than population controls for 6 of 8 SF-36 domains (physical function, social function, physical role function, emotional role function, vitality, and comfort). Patients improved significantly in 4 of 8 SF-36 domains at 30 to 60 months after total shoulder arthroplasty: physical role function (P <.01), comfort (P <.01), social function (P <.01), and mental health (P <.05). Although the improvements were significant and similar to the postoperative scores reported for total hip arthroplasty and coronary bypass procedures, the scores did not reach those of the general population.

Aged↗