26
|
Curcio J, Little A, Bolyard C, Gupta A, Secic M, Sharkey M. Emergency Department "Bounce-Back" Rates as a Function of Emergency Medicine Training Year. Cureus 2020; 12:e10503. [PMID: 33094046 PMCID: PMC7571604 DOI: 10.7759/cureus.10503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Since the 1990s, the emergency department (ED) unscheduled return visit (URV), or “bounce-back,” has been used as a quality of care measurement. During that time, resident training was also scrutinized and uncovered a need for closer resident supervision, especially of second-year residents. Over the years, bounce-backs have continued to be analyzed with vigor, but research on residency training and supervision has lagged with few studies concurrently investigating residency supervision and bounce-backs. Other literature on resident supervision suggests that with adequate attending supervision, resident performance is equivalent to attending performance. With that in mind, it was hypothesized that resident bounce-back rates will be equivalent to attending bounce-back rates, and there will be no change among residency years. The primary objective of this study was to determine the rate at which patients are seen as a bounce-back visit within 72 hours of their initial visit to a community hospital ED during the study time frame. The secondary aims were to evaluate if the ED bounce-back rate is impacted by training level (residents or attending) and to describe bounce-back patient characteristics, including primary complaint/disease, age, comorbidities and issues with compliance. Methods: A retrospective chart review of 1000 charts was conducted from September 2015 to September 2017. Charts were randomly selected by the Quality & Patient Safety (QPS) team and, after applying inclusion/exclusion criteria, 732 charts were analysed. Inclusion criteria included age ≥ 18 years, patients treated by an Emergency Medicine (EM) resident during their initial visit and patients with a “discharge” disposition. Exclusion criteria included patients seen as a scheduled return visit (e.g., two-day return for blood pregnancy recheck, wound check, etc.). Demographics, initial visit variables, comorbidities and bounce-back data were collected based on electronic record query or chart review. Data was analysed using means, standard deviations, medians and ranges for continuous variables. Logistic regression modelling techniques were used to examine factors that affect whether the patient had a bounce-back visit. Results: The rate of URVs within 72 hours of the patient's initial visit was 4.65%. PGY1 and PGY2's bounce-back rate was 3.8% and 3.6%, respectively, and PGY3 and PGY4's bounce-back rate was 5.7% and 5.6%, respectively (p-value=.63). There was no statistically significant change among residency years. Most bounce-back characteristics analysed including primary complaint, age, and comorbidities demonstrated no statistical significance in the increased rate of bounce-back except for patients with a history of tobacco abuse, alcohol abuse and chronic pain. Current smokers were 6.5 times more likely to bounce back than former smokers (odds ratio=6.485, 95% confidence interval = 2.089 to 20.133, p-value=0.0012) and those with chronic pain were 2.5 times more likely to bounce back than those without chronic pain (odds ratio=2.518, 95% confidence interval =1.029 to 6.164, p=0.0431). Conclusion: EM residency training year does not increase the frequency of bounce-backs in a community hospital ED. Finally, patients with substance abuse and chronic pain were more likely to bounce back.
Collapse
|
27
|
Little A, Kalnow A, Walker AR, Capone P. Podcasting in Medicine: The Current Content by Emergency Medicine Subspecialty. Cureus 2020; 12:e9848. [PMID: 32953355 PMCID: PMC7497762 DOI: 10.7759/cureus.9848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Podcasts and their use in medical education, particularly emergency medicine (EM), are growing and becoming more popular. Many podcasts focus on EM, but the number of podcasts on each EM subspecialty remains unknown. Therefore, the goal of this study was to ascertain the number of podcasts available by EM subspecialty and collect the basic characteristics of each podcast. Methods We conducted a Google-based, investigational study of EM podcasts by subspecialty from July 2019 to January 2020. Search terms included “podcasts in ____”, where the EM subspecialties of Toxicology, Ultrasound, Wilderness Medicine, Emergency Medicine Services, Medical Education, and Simulation were inserted to identify podcasts. Results Emergency Medical Services (EMS) and Medical Education subspecialties have the most active podcasts. Toxicology and EMS have the most inactive podcasts, while Medical Education and Simulation were the only subspecialties found to not have any identified inactive podcasts. Conclusions The use of podcasts in EM has been increasing overall, but physicians in specific subspecialties, such as EMS and Medical Education, have access to a larger number of podcasts specific to their subspecialty than others. There is an opportunity for experts in Toxicology, Simulation, and Ultrasound to create podcast content.
Collapse
|
28
|
Li K, Qu Y, An Y, Breinlinger E, Webster MP, Wen H, Ding D, Zhao M, Shi X, Wang J, Su W, Cui W, Satz AL, Yang H, Kuai L, Little A, Peng X. DNA-Compatible Copper-Catalyzed Oxidative Amidation of Aldehydes with Non-Nucleophilic Arylamines. Bioconjug Chem 2020; 31:2092-2097. [DOI: 10.1021/acs.bioconjchem.0c00392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
29
|
He S, Lai D, Mott S, Little A, Grock A, Haas MRC, Chan TM. Remote e-Work and Distance Learning for Academic Medicine: Best Practices and Opportunities for the Future. J Grad Med Educ 2020; 12:256-263. [PMID: 32595840 PMCID: PMC7301927 DOI: 10.4300/jgme-d-20-00242.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
30
|
Bowers KM, Smith J, Robinson M, Kalnow A, Latham R, Little A. The Impact of Advanced Cardiac Life Support Simulation Training on Medical Student Self-reported Outcomes. Cureus 2020; 12:e7190. [PMID: 32377461 PMCID: PMC7199904 DOI: 10.7759/cureus.7190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Simulation has become a well-recognized and innovative tool in medical education. While there has been tremendous growth of simulation curricula at the level of graduate medical education, there have been few studies looking at simulation as a learning tool for undergraduate medical education. The goal of this study was to determine if high-fidelity simulation training impacts medical student perception of knowledge and confidence regarding comprehension and application of advanced cardiac life support (ACLS) algorithms. Methods: This is a prospective observational survey study of third and fourth year medical students who participated in an ACLS simulation training during their emergency medicine rotation between January 2018 and October 2018. Cases covered several ACLS topics including unstable bradycardia, supraventricular tachycardia and ventricular tachycardia. After each session, students received a short survey to assess their simulation experience pertaining to knowledge and comfort levels with ACLS topics before and after the simulation experience. Results: A total of 89 students were included in the study with 86.5% of those being fourth year students. There was a significant increase in both knowledge (pre-training 3.17 vs. 4.11 post-training, p<0.001) and comfort scores (pre-training 2.54 vs. 3.74 post-training, p<0.001) after the ACLS simulation training. Overall, 77.5% of students reported an increase in knowledge and 83.1% reported an increase in confidence after the training session. Conclusions: The study revealed a statistically significant increase in both perceived knowledge and comfort and confidence of medical students after high-fidelity simulation using ACLS scenarios.
Collapse
|
31
|
Little A, Hampton Z, Gronowski T, Meyer C, Kalnow A. Podcasting in Medicine: A Review of the Current Content by Specialty. Cureus 2020; 12:e6726. [PMID: 32104642 PMCID: PMC7032601 DOI: 10.7759/cureus.6726] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Podcasts and their use in medical education is growing and becoming more popular, all while not knowing what podcasts are available for each specialty. Objectives To ascertain the number of podcasts available by specialty and collect basic characteristics of each podcast. Methods This was a Google-based, investigational study of medical podcasts by specialty undertaken by all authors from January to June 2019. Search terms included “podcasts in ____”, where various specialties were inserted to identify current podcasts. Results Over the course of a six month period, 19 specialties were investigated for podcasting content. Emergency medicine, internal medicine, and pediatrics had the most active podcasts. Obstetrics and gynecology, ophthalmology, and orthopedic surgery have the most inactive podcasts. Neurosurgery was the only specialty searched without any identifiable active podcasts. Conclusions While emergency medicine has a large number of podcasts, both active and available other specialties have less of a selection.
Collapse
|
32
|
Bowers KM, Shelton J, Cortez E, Lowe R, Casey J, Little A. Administration of Naloxone by Prehospital Personnel: A Retrospective Analysis. Cureus 2019; 11:e5602. [PMID: 31700715 PMCID: PMC6822568 DOI: 10.7759/cureus.5602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Patient-specific discrepancies in prehospital naloxone administration have been documented. As the opioid epidemic continues to evolve, further evaluation of prehospital naloxone administration practices is needed. The objective of this study was to compare patients who received prehospital naloxone and received an emergency department (ED) diagnosis of opioid overdose with patients who received prehospital naloxone and received an alternative ED diagnosis. Methods This was a retrospective, multicenter chart review of patients who received naloxone by prehospital personnel for suspected opioid overdose between October 1, 2016, and October 31, 2017. Patients were excluded if age was less than 18 years, naloxone was administered by non-emergency medical service (EMS) personnel, not transported, or if prehospital records could not be linked with ED records. Demographic information and several prehospital clinical findings, including unresponsiveness, apnea, and miosis, were compared between patients diagnosed with opioid overdoses versus an alternative ED diagnosis. Descriptive statistics were utilized. Results A total of 837 patients had complete data available and were included in the analysis. Overall, 402 (48%) of patients received an ED diagnosis of opioid overdose, and 435 (52%) of patients received an alternative ED diagnosis. Patients in the alternative diagnosis group were older, had less known drug use, were more likely to be admitted, and had lower incidences of apnea, unresponsiveness, and miosis. In the opioid overdose group, there was a higher proportion of previous drug use, apnea, unresponsiveness, and miosis in the EMS setting, whereas there was a higher proportion of previous overdose, previous suicide attempts, and neurological deficits in the ED setting. Conclusions In this retrospective review evaluating patients who received prehospital naloxone, several demographic and clinical differences were noted between the two groups. Further elucidation of the safety and efficacy of prehospital naloxone in alternative diagnoses is needed.
Collapse
|
33
|
Walker CT, Gullotti DM, Prendergast V, Radosevich J, Grimm D, Cole TS, Godzik J, Patel AA, Whiting AC, Little A, Uribe JS, Kakarla UK, Turner JD. Implementation of a Standardized Multimodal Postoperative Analgesia Protocol Improves Pain Control, Reduces Opioid Consumption, and Shortens Length of Hospital Stay After Posterior Lumbar Spinal Fusion. Neurosurgery 2019; 87:130-136. [DOI: 10.1093/neuros/nyz312] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/30/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Multimodal analgesia regimens have been suggested to improve pain control and reduce opioid consumption after surgery.
OBJECTIVE
To institutionally implement an evidence-based quality improvement initiative to standardize and optimize pain treatment following neurosurgical procedures. Our goal was to objectively evaluate efficacy of this multimodal protocol.
METHODS
A retrospective cohort analysis of pain-related outcomes after posterior lumbar fusion procedures was performed. We compared patients treated in the 6 mo preceding (PRE) and 6 mo following (POST) protocol execution.
RESULTS
A total of 102 PRE and 118 POST patients were included. The cohorts were well-matched regarding sex, age, surgical duration, number of segments fused, preoperative opioid consumption, and baseline physical status (all P > .05). Average patient-reported numerical rating scale pain scores significantly improved in the first 24 hr postoperatively (5.6 vs 4.5, P < .001) and 24 to 72 hr postoperatively (4.7 vs 3.4, P < .001), PRE vs POST, respectively. Maximum pain scores and time to achieving appropriate pain control also significantly improved during these same intervals (all P < .05). A concomitant decrease in opioid consumption during the first 72 hr was seen (110 vs 71 morphine milligram equivalents, P = .02). There was an observed reduction in opioid-related adverse events per patient (1.31 vs 0.83, P < .001) and hospital length of stay (4.6 vs 3.9 days, P = .03) after implementation of the protocol.
CONCLUSION
Implementation of an evidence-based, multimodal analgesia protocol improved postoperative outcomes, including pain scores, opioid consumption, and length of hospital stay, after posterior lumbar spinal fusion.
Collapse
|
34
|
Hampton Z, Shahrestani N, Little A. Gabapentin-induced Facial Myoclonus in the Setting of Acute on Chronic Kidney Disease. Cureus 2019; 11:e4758. [PMID: 31363439 PMCID: PMC6663113 DOI: 10.7759/cureus.4758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An 82-year-old male with chronic kidney disease presented to the emergency department with sudden onset of left sided facial myoclonus. Myoclonus is a rare, but known side effect of gabapentin; however, there does not appear to be documented cases of gabapentin-induced facial myoclonus described in the emergency medicine literature. This case discusses the emergency department evaluation and inpatient treatment of gabapentin-induced facial myoclonus in the setting of acute on chronic kidney disease. Though rare, side effects of gabapentin should remain on a broad differential diagnosis in patients taking the medication who present with myoclonus, especially in the setting of chronic kidney disease.
Collapse
|
35
|
Yuen K, Little A, Youssef E. MON-440 Cyberknife Radiosurgery for Functional and Non-Functional Pituitary Adenomas: Long-Term Single-Center Experience. J Endocr Soc 2019. [PMCID: PMC6551074 DOI: 10.1210/js.2019-mon-440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: In recent years, CyberKnife radiosurgery (CKRS) has become an accepted adjuvant treatment modality when surgery has failed to achieve biochemical control of functional pituitary adenomas or after subtotal removal of non-secretory and secretory adenomas. However, long-term experience and clinical follow-up is limited. We present a retrospective review of our institutional experience with CKRS in patients with functional and non-functional pituitary adenomas. Methods: Forty-eight patients (23M/25F, age range 24-83 years) with pituitary adenomas received CKRS. Median follow-up period was 50 months (range 1 to 123 months). Patients consisted of 31 with non-functioning adenomas, 10 with acromegaly, 5 with Cushing disease (CD) and 2 with prolactinomas. Changes in hormonal function and treatment complications were analyzed in each case. Results: The ranges of radiation doses administered and prescription isodose line were 2500-3500 cGy/5 fractions and 62-78%, respectively. Pituitary hormone secretion improved in all 17 functioning adenomas, with hormonal normalization observed in 11/17 (65%) patients over median of 14 months. In patients with nonfunctioning adenomas, 4/31 (13%) patients subsequently developed panhypopituitarism over a median duration of 16 months. Radiological data was available in 42 patients, and 11/42 (26%) patients had reduction in tumor size over median of 16.5 months, 4/42 (10%) patients had local tumor recurrence over median of 41.5 months, and 27/11 (64%) patients had stable and unchanged tumor size. Of those with local tumor recurrence, 1 patient that had CD was treated with a low dose of 2500 cGy of salvage radiation therapy, 1 patient had Crooke’s changes after a dose of 2500 cGy salvage surgery, and 2 patients had high MIB scores (> 10). Post-treatment complications included temporal radiation-induced changes (n=2), 6th nerve palsy (n=1), and secondary malignancy (n=1). No patients developed visual field deficits. Five- and 7-year local progression free survival rates were 90% and 83%, respectively. Four patients died due to the following reasons: suicide, unknown reason, previously diagnosed testicular malignancy and infield neuroendocrine malignancy. Conclusion: We describe the long-term efficacy, safety and complication profile of CKRS in the treatment of functional and non-functional pituitary adenomas in our cohort of patients. Our data demonstrated that CKRS is a safe and effective adjunct for salvage therapy in patients with pituitary adenomas that have failed first-line therapy. In functioning pituitary adenomas, hormone hypersecretion improved in all patients, with the majority of patients achieving biochemical remission. Post-radiosurgery pituitary hormone deficiencies resulting in panhypopituitarism was observed in only a minority of patients. Overall, local tumor control and survival rates were relatively high.
Collapse
|
36
|
Hughes J, Yuen K, Youssef E, Chapple K, Matthees N, Farnworth M, Leach G, Ngo T, Rabang J, White W, Little A. SUN-459 Analysis of the Evolution of Postoperative Pituitary Resection Cavities Assessed by Magnetic Resonance Imaging and Implications Regarding Choice of Radiation Therapy Modality. J Endocr Soc 2019. [PMCID: PMC6553172 DOI: 10.1210/js.2019-sun-459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surgical resection is the standard initial therapy for patients with symptomatic non-prolactin secreting adenomas and other pituitary tumors (1). After surgical resection select patients will require adjuvant radiation therapy. There are a number of radiation modalities available for treatment. One factor that influences the choice of radiation modality is proximity of tumor to local critical anatomy, namely the optic chiasm (2). MRI is the modality of choice for evaluating pituitary tumors, postoperative resection cavities and the relationship between tumor and the optic chiasm (3). To study the expected evolution of postoperative pituitary resection cavities and the relationship between residual sellar tissue and the optic chiasm we retrospectively reviewed MRI’s of patients with surgically resected pituitary tumors obtained during the preoperative (PreO), immediate postoperative (IPO) (<72 h) and delayed postoperative (DPO) (>3 mo) phases. 91 patients (45 F, 46 M, mean age 50.9 yrs) with functional adenomas (26.4%), non-functional adenomas (46.2%), Rathke cleft cysts (9.9%), craniopharyngioma’s (3.3%) and other lesions (14.2%) were studied. PreO estimated tumor volume was 4.3 cc (0-28.7), craniocaudal (CC) dimension 17.2 mm (2-49), and distance between tumor and optic chiasm 2.0 mm (0-10). 9.9 % of patients had cavernous sinus invasion by imaging criteria. On IPO imaging 83.5 % of patients had gross total resection. Average IPO and DPO resection cavity estimated volumes were 3.3 cc (0.1-16.3) and 1.6 cc (0.0-8.7), respectively. Average % decrease in cavity volume from IPO to DPO scans was 51.5%. Average distance between residual sellar tissue and chiasm was 2.5 mm on IPO and 4.7 mm on DPO scans. The distance between tissue and chiasm on IPO and DPO scans was greater for tumors <10 mm vs >10mm (p=0.019). Percent change in CC dimension of resection cavities from IPO to DPO scans was higher for cavities without fat packing (63.2%) vs cavities with fat packing (52.1%) (p=0.025). Tumor histology, cavernous sinus invasion, degree of PreO chiasm mass effect, and presence of fluid or blood within the IPO cavity did not correlate with distance between tissue and chiasm on DPO scans. Conclusion: There is a significant reduction in cavity volume and increased distance between the chiasm and residual sellar tissue on DPO vs IPO scans. Evaluation for radiosurgery as a treatment option, which has less total and chiasm dose, may be an option after reviewing DPO scans. References: (1) Rim et al., Radiat Oncol J. 2011;29(3):156-63. (2) Minniti et al., Radiat Oncol. 2016;(11)135. (3) Patel et al., World Neurosurg. 2014;82(5):770-80.
Collapse
|
37
|
Little A, Yuen K, Chicoine M, Kelly D, Gardner P, Fernandez-Miranda J, Barkhoudarian G, Chandler J, Prevedello D, Mayberg M. MON-439 Evaluation of Surgical Resection Goal and Its Relationship to the Extent of Resection and Patient Outcomes in 221 Patients following Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas: Data from the TRANSSPHER Study. J Endocr Soc 2019. [PMCID: PMC6551158 DOI: 10.1210/js.2019-mon-439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Prospective data of the influence of the neurosurgeon’s preoperative goal regarding the extent of tumor resection and patient outcomes are scarce in patients with pituitary adenomas who have undergone transsphenoidal pituitary surgery using modern gland-sparing surgical techniques. Objective: We analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study of patients with nonfunctioning pituitary adenomas (ClinicalTrials.gov NCT02357498). Methods: Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. Results: A total of 221 patients were treated with transsphenoidal surgery at 7 pituitary centers in the United States from February 2015 to June 2017. GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = 0.001). Sensitivity, specificity, positive predictive value, and negative predictive values of GTR goal were 82.2%, 43.9%, 86.5%, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced neurosurgeon were associated with neurosurgeons choosing GTR as the goal (P < 0.01). However, there was no association between surgical goal and the presence of pituitary hormone deficiencies 6 months after surgery (P = 0.31). There was a trend towards a higher rate of major neurological complications in the STR goal cohort (4/50 patients, 8.0%) compared to the GTR cohort (4/171, 2.3%) (p=0.079). Tumor Knosp grade (P = 0.004) and size (P = 0.001) were stronger predictors of GTR than was surgical goal (P = 0.014). The most common site of detecting residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). Conclusion: This is the first prospective multi-center pituitary surgery study that examined surgical goal regarding extent of tumor resection and associated patient outcomes. We found that surgical goal is not a reliable predictor of actual tumor resection, and a more aggressive surgical goal does not correlate with pituitary gland dysfunction or major neurological complications 6 months after surgery. A better understanding of the ability of neurosurgeons to meet their expectations and of the factors associated with surgical result could improve prognostication and preoperative counseling of the extent of tumor resection, and postoperative functionality of pituitary hormone secretion.
Collapse
|
38
|
Tanquary G, Little A, Morales-Torres JA. Air of the Dog: Impending Respiratory Failure After a Dog Bite. Cureus 2019; 11:e4304. [PMID: 31183284 PMCID: PMC6538109 DOI: 10.7759/cureus.4304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Animal and human bites represent a significant health issue worldwide. However, penetrating neck trauma secondary to animal bites is a rare presentation. We present the case of a 32-year-old female with neck pain and difficulty breathing after suffering a dog bite to the neck. Bedside ultrasound and subsequent computed tomography (CT) showed findings consistent with subcutaneous emphysema. Due to rapidly progressing neck swelling and stridor, she required advanced airway management followed by emergent exploratory surgery. We present a case report on impending respiratory failure after a dog bite and review the management of penetrating neck trauma.
Collapse
|
39
|
Bohl MA, Mooney MA, Sheehy J, Morgan CD, Donovan MJ, Little A, Nakaji P. The Barrow Innovation Center: A Novel Program in Neurosurgery Resident Education and Medical Device Innovation. Cureus 2018; 10:e2142. [PMID: 30515363 PMCID: PMC6257602 DOI: 10.7759/cureus.2142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medical innovation is the application of scientific knowledge and problem solving for the betterment of the human condition. Every great advancement in the field of neurosurgery can be traced back to a novel surgical procedure or technology that challenged existing standards of care. Considering the critical importance of innovation to the advancement of neurosurgery, and a surprising lack of formal training in innovation among residency programs, we sought to create a residency training program in neurosurgical innovation. Neurosurgery residents at the authors’ institution envisioned the creation of a program that contained all the necessary equipment, personnel, and information required to bring their ideas from theoretical concepts to functional devices implemented in a clinical setting. The Barrow Innovation Center was established as a result. The center currently comprises a rapid prototyping laboratory and several collaborative partnerships between neurosurgery residents, patent law students, and biomedical engineering students. The creation of this model was guided by an overarching mission to educate the next generation of neurosurgical innovators. With modest start-up capital and strong faculty and institutional support, the center has grown from a simple idea to a multistate, multidisciplinary collaboration in just 18 months; it has generated substantial intellectual property, educational opportunities, and a new business entity. We hope that by continuing to advance the Barrow Innovation Center and its core mission of innovation education, we will advance the field of neurosurgery by providing the next generation of surgeon-scientists with the skills, knowledge, and opportunity needed to revolutionize the field.
Collapse
|
40
|
Mooney M, Bohl M, Sarris C, Jahnke H, White W, Little A. Sodium and Water Regulation after Pituitary Surgery: Results of a Prospective Pilot Study of Early Postoperative Water Load. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
41
|
Hardesty D, Mooney M, Oravec C, Paisan G, Sadeh M, Bohl M, Sheehy J, Little A. Thirty-Day Postoperative Emergency Department Utilization and Hospital Readmission after 559 Sequential Endonasal Operations. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
42
|
Mooney M, Herro A, Fintelman R, Jahnke H, Mayberg M, Barkhoudarian G, Prevedello D, Chicoine M, Kelly D, Gardner P, Chandler J, White W, Little A. Visual Field Outcome Reporting in Neurosurgery: Lessons Learned from a Prospective, Multicenter Study in Transsphenoidal Pituitary Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
43
|
Little A, Wu L, Lampen-Kelley P, Banerjee A, Patankar S, Rees D, Bridges CA, Yan JQ, Mandrus D, Nagler SE, Orenstein J. Antiferromagnetic Resonance and Terahertz Continuum in α-RuCl_{3}. PHYSICAL REVIEW LETTERS 2017; 119:227201. [PMID: 29286790 DOI: 10.1103/physrevlett.119.227201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 06/07/2023]
Abstract
We report measurements of optical absorption in the zigzag antiferromagnet α-RuCl_{3} as a function of temperature T, magnetic field B, and photon energy ℏω in the range ∼0.3-8.3 meV, using time-domain terahertz spectroscopy. Polarized measurements show that threefold rotational symmetry is broken in the honeycomb plane from 2 to 300 K. We find a sharp absorption peak at 2.56 meV upon cooling below the Néel temperature of 7 K at B=0 that we identify as the magnetic-dipole excitation of a zero-wave-vector magnon, or antiferromagnetic resonance (AFMR). With the application of B, the AFMR broadens and shifts to a lower frequency as long-range magnetic order is lost in a manner consistent with transitioning to a spin-disordered phase. From a direct, internally calibrated measurement of the AFMR spectral weight, we place an upper bound on the contribution to the dc susceptibility from a magnetic excitation continuum.
Collapse
|
44
|
Mendelson RM, Sutherland T, Little A. Computed tomography colonography: underutilised in Australia. Med J Aust 2017; 207:139-140. [DOI: 10.5694/mja16.00684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
|
45
|
Mooney M, Hardesty D, Sheehy J, Bird R, Chapple K, White W, Little A. Rater Reliability of the Hardy Classification for Pituitary Adenomas in the MRI Era. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
Little A. Randomized, Double-Blinded, Placebo-Controlled Trial Comparing Two Multimodal Opioid-Minimizing Pain Management Regimens Following Transsphenoidal Surgery. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Little A, Kelly D, Barkhoudarian G, Gravbrot N, White W. The Minimally Clinically Important Difference of The Anterior Skull Base Nasal Inventory-12. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Leonardi M, Scaratti C, Little A, Walsh D, Clarke H, Craven A, Ayadi R, De Torres L, Raggi A. The European Federation of Neurological Associations patients’ survey: what insights for neurologists? Eur J Neurol 2017; 24:451-452. [DOI: 10.1111/ene.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Harding AT, Weeks BK, Horan SA, Little A, Watson SL, Beck BR. Validity and test-retest reliability of a novel simple back extensor muscle strength test. SAGE Open Med 2017; 5:2050312116688842. [PMID: 28255442 PMCID: PMC5315361 DOI: 10.1177/2050312116688842] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To develop and determine convergent validity and reliability of a simple and inexpensive clinical test to quantify back extensor muscle strength. METHODS Two testing sessions were conducted, 7 days apart. Each session involved three trials of standing maximal isometric back extensor muscle strength using both the novel test and isokinetic dynamometry. Lumbar spine bone mineral density was examined by dual-energy X-ray absorptiometry. Validation was examined with Pearson correlations (r). Test-retest reliability was examined with intraclass correlation coefficients and limits of agreement. Pearson correlations and intraclass correlation coefficients are presented with corresponding 95% confidence intervals. Linear regression was used to examine the ability of peak back extensor muscle strength to predict indices of lumbar spine bone mineral density and strength. RESULTS A total of 52 healthy adults (26 men, 26 women) aged 46.4 ± 20.4 years were recruited from the community. A strong positive relationship was observed between peak back extensor strength from hand-held and isokinetic dynamometry (r = 0.824, p < 0.001). For the novel back extensor strength test, short- and long-term reliability was excellent (intraclass correlation coefficient = 0.983 (95% confidence interval, 0.971-0.990), p < 0.001 and intraclass correlation coefficient = 0.901 (95% confidence interval, 0.833-0.943), p < 0.001, respectively). Limits of agreement for short-term repeated back extensor strength measures with the novel back extensor strength protocol were -6.63 to 7.70 kg, with a mean bias of +0.71 kg. Back extensor strength predicted 11% of variance in lumbar spine bone mineral density (p < 0.05) and 9% of lumbar spine index of bone structural strength (p < 0.05). CONCLUSION Our novel hand-held dynamometer method to determine back extensor muscle strength is quick, relatively inexpensive, and reliable; demonstrates initial convergent validity in a healthy population; and is associated with bone mass at a clinically important site.
Collapse
|
50
|
Adams DZ, Little A, Vinsant C, Khandelwal S. The Midline Catheter: A Clinical Review. J Emerg Med 2016; 51:252-8. [DOI: 10.1016/j.jemermed.2016.05.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
|