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lobelsteve

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View attachment 314423
PRP and stem cells are great for this issue.
Love it. I am pretty sure the wallet is not under the ischial bursa when sitting. But the double meaning....you take their money out of the wallet with stem cells and prp and the thinning of the wallet cures them.
 
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drusso

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Love it. I am pretty sure the wallet is not under the ischial bursa when sitting. But the double meaning....you take their money out of the wallet with stem cells and prp and the thinning of the wallet cures them.
PRP works better than BMAC for SIJ issues...

Pain Med

. 2020 Jun 18;pnaa170.
doi: 10.1093/pm/pnaa170. Online ahead of print.
The Effectiveness of Platelet-Rich Plasma Injection for the Treatment of Suspected Sacroiliac Joint Complex Pain; a Systematic Review
Taylor Burnham 1, Josh Sampson 1, Rebecca A Speckman 1 2, Aaron Conger 1, Daniel M Cushman 1, Zachary L McCormick 1
Affiliations expand
Abstract
Objective: To determine the effectiveness of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) for the treatment of suspected sacroiliac joint complex (SIJC) pain.
Design: Systematic review.
Subjects: Persons aged ≥18 with suspected SIJC pain.
Comparison: Sham, placebo procedure, or active standard of care treatment.
Outcomes: The primary outcome was ≥50% pain improvement, and the secondary outcome was functional improvement of ≥30% at three or more months after the treatment intervention.
Methods: Publications in PubMed, MEDLINE, Embase, Scopus, and Cochrane Databases were reviewed up to April 3, 2019. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Grades of Recommendation, Assessment, Development, and Evaluation system and the joint consensus American Academy of Orthopedic Surgery/National Institutes of Health recommendations were used for quality assessment and reporting standards.
Results: Query identified 151 publications; three were appropriate for inclusion. There were no studies of BMAC that met inclusion criteria. There were three eligible PRP studies: one randomized comparative trial (RCT) and two case series. In the single RCT comparing ultrasound-guided PRP with corticosteroid injection for suspected SIJC pain, the PRP group had a significantly increased likelihood of achieving ≥50% improvement of pain at three months (adjusted odds ratio = 37, 95% confidence interval [CI] = 4.65-298.69). Pooled pain outcomes from two studies showed that 28/30, 93% (95% CI = 93-100%), experienced ≥50% pain improvement at three months.
Conclusions:
The literature supporting the effectiveness of PRP for SIJC pain is very low-quality according to the GRADE system. Well-designed RCTs and large cohort studies with consistent selection protocols and reporting characteristics are needed to determine the effectiveness of PRP and BMAC for the treatment of SIJC pain.
Keywords: Platelet-rich Plasma; Sacroiliac Joint.
© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].
 

lobelsteve

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You meant PRP>steroids.

BMAC not studied based on inclusion criteria.
 

lonelobo

PAIN DOC
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Centeno also says prolotherapy works better than steroids

 

Doctodd

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Centeno also says prolotherapy works better than steroids

reviewed some records today from University of Miami pain doc where they are still injecting bupivacaine into joints. wtf
 

lobelsteve

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jayel

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We always used Ropi for intra-articular injections in my PMR residency



Chondrotoxic Effects of Local Anesthetics on Human Knee Articular Cartilage: A Systematic Review
Prathap Jayaram et al. PM R. 2019 Apr.

Abstract

Objective: To review the current literature on the effects of intraarticular local anesthetics on human knee articular cartilage.

Literature survey: PubMed; MEDLINE; SCOPUS; PEDro; CINAHL databases (1/1990-06/1/2018) were searched for local anesthetic effects on human knee articular cartilage.

Methodology: Sixteen studies met the inclusion criteria, with outcome measures assessing chondrocyte viability, morphology, and histology. A systematic review was performed using PRISMA guidelines.

Synthesis: Seven studies were identified evaluating lidocaine, with five of them demonstrating statistically significant chondrotoxic effects. Fourteen studies examined bupivacaine, with all but one study demonstrating a chondrotoxic effect. Eight studies examined ropivacaine and found a dose-dependent chondrotoxicity starting at 0.75%. Two studies evaluated levobupivacaine showing chondrotoxicity, with one study showing it to be more chondrotoxic than bupivacaine. One study looked at mepivacaine and showed it to have more chondrotoxicity than ropivacaine. When studied the chondrotoxicity was found to be both dose and time dependent. Also, the addition of corticosteroids appeared to worsen the chondrotoxic effects.

Conclusions: Lidocaine, bupivacaine, ropivacaine, levobupivacaine, and mepivacaine were reported to have dose- and time-dependent deleterious effects on chondrocytes that appeared to be made worse by the coadministration of corticosteroids. Ropivacaine at concentrations of 0.5% or less was found to be the least chondrotoxic anesthetic.

Level of evidence: I.
 

gaseous_clay

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Having a great starting salary in a bad situation or getting overpaid early and having difficulty earning that salary in subsequent years will lead to great stress and problems. You will make a lot more than in fellowship regardless. Bet on yourself to be a producer and put yourself in a good situation to thrive. A guaranteed salary is either a way to suck someone in or bare minimum expectation that should be far surpassed. Don’t put much weight in it. I’d argue “fair” compensation is more tied to your production. A generous starting salary may be inversely proportional to how you will be treated.
Furthermore, you a higher base salary may only be guaranteed for 1-2 years, after which, more of your compensation may be tied to production. Read the fine print.
 
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chudat

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Furthermore, you a higher base salary may only be guaranteed for 1-2 years, after which, more of your compensation may be tied to production. Read the fine print.
Is this a good package? That is to say 1 to 2 yrs of guaranteed salary, then moving to more production bonused structure?
 

cowboydoc

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Is this a good package? That is to say 1 to 2 yrs of guaranteed salary, then moving to more production bonused structure?
It depends. If your production is reasonably compensated and you produce, your guarantee will only be seen in the rearview mirror. If you are overpaid with your guarantee and/or have a bonus/production structure in which you don't meet your guarantee, you'll struggle to make payments on the boat and fancy house you bought in the previous 2 years when you THOUGHT you were a "balla."

Your "guarantee" should be looked at as a goodwill gesture to get your practice running over the first 6 months (unless you are a salaried employee.)
 
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Doctodd

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Laryngospasm

Trench Dog
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A lot depends on private practice vs hospital. Just read the contract and discuss with someone you trust. Hospital should be tied to mgma somehow. Private practice usually production minus expenses with a smaller guarantee and less benefits. Due diligence is your friend here.
 

gaseous_clay

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Is this a good package? That is to say 1 to 2 yrs of guaranteed salary, then moving to more production bonused structure?
Hard to define what is good. It has to fit your needs. You many not have an established patient base at the beginning and if you’re a new grad, you have loans to pay. Hence, the guaranteed base is appealing. The idea is your patient base will increase and more of you salary will come from RVU based production incentives so the hospital makes you share some of the financial burden of your salary. It really depends upon how long of a commitment you want to make to the hospital.
 

chudat

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Hard to define what is good. It has to fit your needs. You many not have an established patient base at the beginning and if you’re a new grad, you have loans to pay. Hence, the guaranteed base is appealing. The idea is your patient base will increase and more of you salary will come from RVU based production incentives so the hospital makes you share some of the financial burden of your salary. It really depends upon how long of a commitment you want to make to the hospital.
Lets says they offer you 300 salary, is it kosher to ask them to match the mgma for median or 7th percentile salary? Especially if hospital is in undesirable area?
 

Laryngospasm

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Don’t work in an undesirable area for less than 50% mgma. That is standard. Ask for that guarantee for a year. After a year in an underserved undesired area you will be way above the average. And don’t feel bad.. they will be making multiples of your salary off of you. Ask for loan repayment, moving allowance and sign on bonus as well.
 
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drusso

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Don’t work in an undesirable area for less than 50% mgma. That is standard. Ask for that guarantee for a year. After a year in an underserved undesired area you will be way above the average. And don’t feel bad.. they will be making multiples of your salary off of you. Ask for loan repayment, moving allowance and sign on bonus as well.
Do you have any sense of what that "multiple of your salary" is or how to surface the topic in a conversation with the hospital?
 

Ducttape

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Don’t work in an undesirable area for less than 50% mgma. That is standard. Ask for that guarantee for a year. After a year in an underserved undesired area you will be way above the average. And don’t feel bad.. they will be making multiples of your salary off of you. Ask for loan repayment, moving allowance and sign on bonus as well.
that is not necessarily true.

one of the most notable factors of an undesirable area is the population and its people. most people in such populations are decidedly not interested in interventional pain procedures. the other notable factor is the a rather high lack of compliance, particularly with appointments.
 
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