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Klinger D, Oehlke SM, Riedl S, Eschbaum K, Zesch HE, Karwautz A, Plener PL, Kothgassner OD. Mental health of non-binary youth: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2024; 18:126. [PMID: 39385290 PMCID: PMC11465615 DOI: 10.1186/s13034-024-00822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 09/27/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Non-binary identities are increasingly recognized within the spectrum of gender diversity, yet there is a dearth of research exploring the mental health challenges specific to this population. Therefore, this systematic review and meta-analysis aimed to comprehensively assess the mental health outcomes of non-binary youth in comparison to their transgender and cisgender peers. METHODS A systematic search was conducted to identify relevant studies across three electronic databases (PubMed, Scopus, Web of Science) covering the period from inception to October 2023. The meta-analysis was performed employing a random-effects model. Inclusion criteria encompassed studies comparing non-binary youth with transgender or cisgender youth, providing data on mental health outcomes such as general mental health, depressive and anxiety symptoms, self-harm and suicidality. RESULTS Twenty-one studies, meeting the inclusion criteria and originating from six different countries, were included in the analysis. The sample encompassed 16,114 non-binary, 11,925 transgender, and 283,278 cisgender youth, with ages ranging from 11 to 25 years. Our meta-analysis revealed that non-binary youth exhibit significantly poorer general mental health compared to both transgender (d = 0.24, 95% CI, 0.05-0.43, p =.013) and cisgender youth (d = 0.48, 95% CI, 0.35-0.61, p <.001), indicating a more impaired general mental health in non-binary youth. Regarding depressive symptoms, when comparing non-binary and cisgender individuals, a moderate and significant effect was observed (d = 0.52, 95% CI, 0.41-0.63, p <.001). For anxiety symptoms, a small but significant effect was observed in the comparison with cisgender individuals (d = 0.44, 95% CI, 0.19-0.68, p =.001). Furthermore, non-binary individuals exhibited lower rates of past-year suicidal ideation than transgender peers (OR = 0.79, 95% CI, 0.65-0.97, p =.023) and higher rates of lifetime suicidal ideation than cisgender youth (OR = 2.14, 95% CI, 1.46-3.13, p <.001). CONCLUSION Non-binary youth face distinct mental health challenges, with poorer general mental health, elevated depressive and anxiety symptoms compared to cisgender, and similar rates of self-harm and suicidal behavior compared to transgender individuals. These findings underscore the urgent need for targeted interventions, including gender-affirming mental health support, to address the specific needs of non-binary youth.
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Affiliation(s)
- Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Ken Eschbaum
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Heidi Elisabeth Zesch
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Marsh SA, Parsafar S, Byrne MK. Should my child be given antibiotics? A systematic review of parental decision making in rural and remote locations. Antimicrob Resist Infect Control 2024; 13:105. [PMID: 39294826 PMCID: PMC11412025 DOI: 10.1186/s13756-024-01409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/10/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND The emergence and growth in antibiotic resistant bacteria is a critical public health problem exacerbated by the misuse of antibiotics. Children frequently succumb to illness and are often treated with antibiotic medicines which may be used improperly by the parent. There is limited evidence of the factors influencing parental decision-making about the use of antibiotics in low-resource contexts. The aim of this systematic review was to understand and describe how parents living in rural and remote locations make choices about their children's antibiotic use. METHOD The CINAHL, Web of Science, Medline, Scopus and Academic Search Premier databases were systematically searched from 31 January until 28 June in 2023. No date restrictions were applied and additional search methods were utilised to identify further studies that met inclusion criteria. Eligibility criteria included studies which reported on factors contributing to parental decisions about their children's use of antibiotics in rural and remote settings. The Joanna Briggs Institute Critical Appraisal Checklists were employed to evaluate studies. Characteristics and findings were extracted from studies, and data was synthesised descriptively and presented in summary tables. RESULTS A total of 3827 articles were screened and 25 worldwide studies comprising of quantitative, qualitative and prospective designs were included in the review. Studies that reported the number of rural caregivers consisted of 12 143 participants. Data analysis produced six broad themes representing the mechanisms that influenced parents in their access and use of antibiotics: the child's symptoms; external advice and influences; parent-related determinants; barriers to healthcare; access to antibiotics; and socio-demographic characteristics. CONCLUSIONS A number of factors that influence parents' prudent use of antibiotics in rural contexts were identified. In seeking to enhance appropriate use of antibiotics by parents in rural and remote settings, these determinants can serve to inform interventions. However, the identified studies all relied upon parental self-reports and not all studies reviewed reported survey validation. Further research incorporating validated measures and intervention strategies is required. REGISTRATION DETAILS Should my child be given antibiotics? A systematic review of parental decision making in rural and remote locations; CRD42023382169; 29 January 2023 (date of registration). Available from PROSPERO.
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Affiliation(s)
- Stephanie A Marsh
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Sara Parsafar
- Discipline of Psychology, School of Arts and Sciences, The University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Mitchell K Byrne
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Kalluri AL, Ejimogu E, Kilgore C, Nair SK, Ran KR, Abdulrahim M, Xie ME, Halbert-Elliott K, Yedavalli V, Lim M, Jackson CM, Huang J, Bettegowda C, Xu R. Preoperative Opioid Use and Postoperative Outcomes in Patients Undergoing Microvascular Decompression for Trigeminal Neuralgia. Neurosurgery 2024; 95:548-555. [PMID: 38483172 DOI: 10.1227/neu.0000000000002904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The prescription of opioid analgesics for trigeminal neuralgia (TN) is controversial, and their effect on postoperative outcomes for patients with TN undergoing microvascular decompression (MVD) has not been reported. We aimed to describe the relationship between preoperative opioid use and postoperative outcomes in patients with TN undergoing MVD. METHODS We reviewed the records of 920 patients with TN at our institution who underwent an MVD between 2007 and 2020. Patients were sorted into 2 groups based on preoperative opioid usage. Demographic information, comorbidities, characteristics of TN, preoperative medications, pain and numbness outcomes, and recurrence data were recorded and compared between groups. Multivariate ordinal regression, Kaplan-Meier survival analysis, and Cox proportional hazards were used to assess differences in pain outcomes between groups. RESULTS One hundred and forty-five (15.8%) patients in this study used opioids preoperatively. Patients who used opioids preoperatively were younger ( P = .04), were more likely to have a smoking history ( P < .001), experienced greater pain in modified Barrow Neurological Institute pain score at final follow-up ( P = .001), and were more likely to experience pain recurrence ( P = .01). In addition, patients who used opioids preoperatively were more likely to also have been prescribed TN medications including muscle relaxants and antidepressants preoperatively ( P < .001 and P < .001, respectively). On multivariate regression, opioid use was an independent risk factor for greater postoperative pain at final follow-up ( P = .006) after controlling for variables including female sex and age. Opioid use was associated with shorter time to pain recurrence on Kaplan-Meier analysis ( P = .005) and was associated with increased risk for recurrence on Cox proportional hazards regression ( P = .008). CONCLUSION Preoperative opioid use in the setting of TN is associated with worse pain outcomes and increased risk for pain recurrence after MVD. These results indicate that opioids should be prescribed cautiously for TN and that worse post-MVD outcomes may occur in patients using opioids preoperatively.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Emeka Ejimogu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Mostafa Abdulrahim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Kyra Halbert-Elliott
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Vivek Yedavalli
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto , California , USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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Salpynov Z, Kosherova Z, Sarría-Santamera A, Nurkatov Y, Gusmanov A, Semenova Y. The Worldwide Prevalence of Internet Addiction among Medical Students: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1146. [PMID: 39338027 PMCID: PMC11430859 DOI: 10.3390/ijerph21091146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/17/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND The internet helps us obtain necessary information, facilitates social communication, and provides access to entertainment content. The internet can also lead to the behavioral addictive condition termed internet addiction (IA) if used excessively. As active internet users, medical students are susceptible to IA, which is known to lead to depression and improper medical care delivery, poor academic performance, worse sleep quality, and undesirable financial issues. This systematic review and meta-analysis aimed to assess medical students' pooled IA prevalence. METHODS The analysis included thirteen cross-sectional studies involving 4787 medical students. Cumulative, subgroup, and meta-regression meta-analyses were applied, using the random-effects model and the restricted maximum likelihood method. RESULTS The cumulative meta-analysis revealed a rise in the proportion of IA from 0.08 to 0.29, with minor fluctuations between 2015 and 2022. The IA prevalence in lower-middle-income countries was approximately three times higher than in high-income ones. Age and gender were not associated with IA among medical students. CONCLUSIONS The worldwide prevalence of IA was 0.29, with a 95% CI between 0.19 and 0.41. Considering negative IA implications for medical students' well-being, policymakers and all stakeholders should pay special attention to addressing IA within the medical student community.
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Affiliation(s)
- Zhandos Salpynov
- Department of Surgery, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
| | - Zhanar Kosherova
- Department of Surgery, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
| | - Antonio Sarría-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
| | - Yerbol Nurkatov
- Department of Medicine, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
| | - Yuliya Semenova
- Department of Surgery, School of Medicine, Nazarbayev University, 010000 Astana, Kazakhstan
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Pezzulo JD, Farronato DM, Juniewicz R, Kane LT, Kellish AS, Davis DE. Surgeon Prescribing Patterns And Perioperative Risk Factors Associated With Prolonged Opioid Use After Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-01074. [PMID: 39197075 DOI: 10.5435/jaaos-d-24-00051] [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] [Received: 01/15/2024] [Accepted: 07/05/2024] [Indexed: 08/30/2024] Open
Abstract
INTRODUCTION The opioid epidemic in the United States has contributed to a notable economic burden and increased mortality. Total shoulder arthroplasty (TSA) has become more prevalent, and opioids are commonly used for postoperative pain management. Prolonged opioid use has been associated with adverse outcomes, but the role of surgeons in this context remains unclear. This study aims to investigate the incidence and risk factors of prolonged opioid utilization after primary TSA. METHODS After obtaining institutional review board approval, a retrospective review of 4,488 primary total shoulder arthroplasties from 2014 to 2022 at a single academic institution was conducted. Patients were stratified by preoperative and postoperative opioid use, and demographic, clinical, and prescription data were collected. Prescriptions filled beyond 30 days after the index operation were considered prolonged use. Multivariate analysis was conducted to determine the independent risk factors associated with prolonged opioid utilization. RESULTS Among 4,488 patients undergoing primary TSA, 22% of patients developed prolonged opioid use with 70% of prolonged users being opioid-exposed preoperatively. Independent risk factors of prolonged use include patient age younger than 65 years (Odds Ratio (OR) 1.02, P < 0.001), female sex (OR 1.41, P < 0.001), race other than Caucasian (OR 1.36, P = 0.003), undergoing reverse TSA (OR 1.28, P = 0.010), residing in an urban community (OR 1.33, P = 0.039), preoperative opioid utilization (OR 6.41, P < 0.001), preoperative benzodiazepine utilization (OR 1.93, P < 0.001), and increased postoperative day 1-30 milligram morphine equivalent (OR 1.003, P < 0.001). DISCUSSION Nearly 22% of patients experienced prolonged opioid use, with preoperative opioid exposure being the most notable risk factor in addition to postoperative prescribing patterns and benzodiazepine utilization. Surgeons play a crucial role in opioid management, and understanding the risk factors can help optimize benefits while minimizing the associated risks of prolonged opioid use. Additional research is needed to establish standardized definitions and strategies for safe opioid use in orthopaedic surgery.
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Affiliation(s)
- Joshua D Pezzulo
- From the Thomas Jefferson University School of Medicine, Philadelphia, PA (Pezzulo, Farronato, and Juniewicz), and The Rothman Institute at Thomas Jefferson University, Philadelphia, PA (Kane, Kellish, and Davis)
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Takeshita J, Kawaguchi A, Kawasaki T, Ishihara T, Shime N. Local Adverse Events Associated with Peripheral Vasoactive Infusion in Children: A Systematic Review with Meta-analysis. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00539-1. [PMID: 39227190 DOI: 10.1053/j.jvca.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/17/2024] [Accepted: 08/11/2024] [Indexed: 09/05/2024]
Abstract
Prior meta-analysis suggested a low incidence of local adverse events after infusion of vasoactive agents via a peripheral venous catheter in children. However, the number of included patients was relatively low, and the vasoactive agents used were mostly dopamine. We performed an updated systematic review with meta-analysis using databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials to explore the safety of infusing vasoactive agents, including epinephrine and norepinephrine, through peripheral venous catheters or intraosseous access in critically ill children. The primary outcome was the occurrence of local adverse events associated with peripheral vasoactive infusion, such as extravasation or infiltration. Twelve observational studies and 1 randomized controlled trial were finally included. The pooled incidence rates of local adverse events associated with infusion of vasoactive agents through peripheral venous catheters or intraosseous access, peripheral venous catheters only, and intraosseous access only were 2.1% (95% confidence interval [CI]: 0.8%-3.9%), 2.3% (95% CI: 1.0%-4.0%), and 1.1% (95% CI: 0.0%-9.8%), respectively. Based on the findings of this meta-analysis, the incidence rate of local adverse events associated with peripheral vasoactive infusion appears to be low. Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, can be considered when necessary.
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Affiliation(s)
- Jun Takeshita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Atsushi Kawaguchi
- Department of Pediatrics, St. Marianna University, School of Medicine, Kawasaki, Japan; Department of Anesthesia and YCU Centre of Novel Exploratory Clinical Trials, Yokohama City University, Yokohama, Japan; CHU Sainte Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care Medicine/Children's Emergency Center, Juntendo University, Urayasu Hospital, Urayasu, Chiba, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
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Ndongo Sonfack DJ, Tanguay Boivin C, Touzel Deschênes L, Maurand T, Maguemoun C, Berthod F, Gros-Louis F, Champagne PO. Bioengineering Human Upper Respiratory Mucosa: A Systematic Review of the State of the Art of Cell Culture Techniques. Bioengineering (Basel) 2024; 11:826. [PMID: 39199784 PMCID: PMC11352167 DOI: 10.3390/bioengineering11080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The upper respiratory mucosa plays a crucial role in both the physical integrity and immunological function of the respiratory tract. However, in certain situations such as infections, trauma, or surgery, it might sustain damage. Tissue engineering, a field of regenerative medicine, has found applications in various medical fields including but not limited to plastic surgery, ophthalmology, and urology. However, its application to the respiratory system remains somewhat difficult due to the complex morphology and histology of the upper respiratory tract. To date, a culture protocol for producing a handleable, well-differentiated nasal mucosa has yet to be developed. The objective of this review is to describe the current state of research pertaining to cell culture techniques used for producing autologous healthy human upper respiratory cells and mucosal tissues, as well as describe its clinical applications. METHODS A search of the relevant literature was carried out with no time restriction across Embase, Cochrane, PubMed, and Medline Ovid databases. Keywords related to "respiratory mucosa" and "culture techniques of the human airway" were the focus of the search strategy for this review. The risk of bias in retained studies was assessed using the Joanna Briggs Institute's (JBI) critical appraisal tools for qualitative research. A narrative synthesis of our results was then conducted. RESULTS A total of 33 studies were included in this review, and thirteen of these focused solely on developing a cell culture protocol without further use. The rest of the studies used their own developed protocol for various applications such as cystic fibrosis, pharmacological, and viral research. One study was able to develop a promising model for nasal mucosa that could be employed as a replacement in nasotracheal reconstructive surgery. CONCLUSIONS This systematic review extensively explored the current state of research regarding cell culture techniques for producing tissue-engineered nasal mucosa. Bioengineering the nasal mucosa holds great potential for clinical use. However, further research on mechanical properties is essential, as the comparison of engineered tissues is currently focused on morphology rather than comprehensive mechanical assessments.
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Affiliation(s)
- Davaine Joel Ndongo Sonfack
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
- LOEX, CHU de Québec—Laval University Research Center, Quebec, QC G1J 5B3, Canada;
- Laval University Neurosurgery Innovation Laboratory (LINUL), Quebec, QC G1J 5B3, Canada
- Department of Neurosurgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Clémence Tanguay Boivin
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
| | - Lydia Touzel Deschênes
- LOEX, CHU de Québec—Laval University Research Center, Quebec, QC G1J 5B3, Canada;
- Laval University Neurosurgery Innovation Laboratory (LINUL), Quebec, QC G1J 5B3, Canada
| | - Thibault Maurand
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
| | - Célina Maguemoun
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
| | - François Berthod
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
- LOEX, CHU de Québec—Laval University Research Center, Quebec, QC G1J 5B3, Canada;
| | - François Gros-Louis
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
- LOEX, CHU de Québec—Laval University Research Center, Quebec, QC G1J 5B3, Canada;
| | - Pierre-Olivier Champagne
- Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada; (C.T.B.); (T.M.); (C.M.); (F.B.); (F.G.-L.); (P.-O.C.)
- LOEX, CHU de Québec—Laval University Research Center, Quebec, QC G1J 5B3, Canada;
- Laval University Neurosurgery Innovation Laboratory (LINUL), Quebec, QC G1J 5B3, Canada
- Department of Neurosurgery, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
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Bao R, Wade L, Leahy AA, Owen KB, Hillman CH, Jaakkola T, Lubans DR. Associations Between Motor Competence and Executive Functions in Children and Adolescents: A Systematic Review and Meta-analysis. Sports Med 2024; 54:2141-2156. [PMID: 38769244 PMCID: PMC11329584 DOI: 10.1007/s40279-024-02040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Motor competence and executive functions co-develop throughout childhood and adolescence, and there is emerging evidence that improvements in motor competence may have cognitive benefits in these populations. There is a need to provide a quantitative synthesis of the cross-sectional, longitudinal and experimental studies that have examined the association between motor competence and executive functions in school-aged youth. OBJECTIVES The primary aim of our systematic review was to synthesise evidence of the association between motor competence and executive functions in school-aged children and adolescents (5-18 years). Our secondary aim was to examine key moderators of this association. METHODS We searched the PubMed, PsycINFO, Scopus, Ovid MEDLINE, SPORTDiscus and EMBASE databases from inception up to 27 June 2023. We included cross-sectional, longitudinal and experimental studies that assessed the association between motor competence (e.g., general motor competence, locomotor skills, object control skills and stability skills) and executive functions (e.g., general executive functions, inhibition, working memory and cognitive flexibility) in children and adolescents aged 5-18 years. RESULTS In total, 12,117 records were screened for eligibility, and 44 studies were included. From the 44 included studies, we meta-analysed 37 studies with 251 effect sizes using a structural equation modelling approach in the statistical program R. We found a small positive association (r = 0.18, [95% confidence interval (CI) 0.13-0.22]) between motor competence and executive functions. The positive associations were observed in cross-sectional (r = 0.17, [95% CI 0.13-0.22]), longitudinal (r = 0.15, [95% CI 0.03-0.28]) and experimental studies (r = 0.25, [95% CI 0.01-0.45]). We also found that general motor competence (r = 0.25, [95% CI 0.18-0.33]), locomotor (r = 0.15, [95% CI 0.09-0.21]), object control (r = 0.14, [95% CI 0.08-0.20]) and stability (r = 0.14, [95% CI 0.08-0.20]) skills were associated with executive functions. We did not find any moderating effects for participants' age on the associations between motor competence and executive functions. CONCLUSIONS Our findings suggest a small-to-moderate positive association between motor competence and executive functions in children and adolescents. The small number of experimental studies included in this review support the assertion that interventions targeting children's motor competence may be a promising strategy to improve their executive functions; however, more research is needed to confirm these findings. Future studies should explore the underlying mechanisms linking motor competence and executive functions as their comprehension may be used to optimise future intervention design and delivery. PROSPERO REGISTRATION CRD42021285134.
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Affiliation(s)
- Ran Bao
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
- College of Human and Social Futures, School of Education, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Levi Wade
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
- College of Human and Social Futures, School of Education, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Angus A Leahy
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
- College of Human and Social Futures, School of Education, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Katherine B Owen
- SPRINTER, Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Charles H Hillman
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA, USA
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - David Revalds Lubans
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia.
- College of Human and Social Futures, School of Education, University of Newcastle, Callaghan, NSW, Australia.
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland.
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Nelson CL, Sheth NP, Higuera Rueda CA, Redfern RE, Van Andel DC, Anderson MB, Cholewa JM, Israelite CL. Impact of Chronic Opioid Use on Postoperative Mobility Recovery and Patient-Reported Outcomes: A Propensity-Matched Study. J Arthroplasty 2024; 39:S148-S153. [PMID: 38401614 DOI: 10.1016/j.arth.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Opioid use prior to total joint arthroplasty may be associated with poorer postoperative outcomes. However, few studies have reported the impact on postoperative recovery of mobility. We hypothesized that chronic opioid users would demonstrate impaired objective and subjective mobility recovery compared to nonusers. METHODS A secondary data analysis of a multicenter, prospective observational cohort study in which patients used a smartphone-based care management platform with a smartwatch for self-directed rehabilitation following hip or knee arthroplasty was performed. Patients were matched 2:1 based on age, body mass index, sex, procedure, Charnley class, ambulatory status, orthopedic procedure history, and anxiety. Postoperative mobility outcomes were measured by patient-reported ability to walk unassisted at 90 days, step counts, and responses to the 5-level EuroQol-5 dimension 5-level, compared by Chi-square and student's t-tests. Unmatched cohorts were also compared to investigate the impact of matching. RESULTS A total of 153 preoperative chronic opioid users were matched to 306 opioid-naïve patients. Age (61.9 ± 10.5 versus 62.1 ± 10.3, P = .90) and sex (53.6 versus 53.3% women, P = .95) were similar between groups. The proportion of people who reported walking unassisted for 90 days did not vary in the matched cohort (87.8 versus 90.7%, P = .26). Step counts were similar preoperatively and 1-month postoperatively but were lower in opioid users at 3 and 6 months postoperatively (4,823 versus 5,848, P = .03). More opioid users reported moderate to extreme problems with ambulation preoperatively on the 5-level EuroQol-5 dimension 5-level (80.6 versus 69.0%, P = .02), and at 6 months (19.2 versus 9.3%, P = .01). CONCLUSIONS Subjective and objective measures of postoperative mobility were significantly reduced in patients who chronically used opioid medications preoperatively. Even after considering baseline factors that may affect ambulation, objective mobility metrics following arthroplasty were negatively impacted by preoperative chronic opioid use.
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Affiliation(s)
- Charles L Nelson
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Craig L Israelite
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Budzisz A, Jung A, Adamczyk WM, Szikszay TM, Carvalho GF, Bąbel P, Luedtke K. Body Image Measured via the Fremantle Awareness Questionnaire in Individuals With and Without Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104530. [PMID: 38599266 DOI: 10.1016/j.jpain.2024.104530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Research suggests that pain negatively affects body image, and body image may also influence reported pain levels. This review aims to summarize the literature on differences in body image distortion between individuals with pain compared to pain-free individuals. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement and an a priori preregistered protocol. The literature was searched using 5 electronic databases. Studies assessing body image with the Fremantle Awareness Questionnaire (FAQ) in individuals with and without pain were eligible for inclusion. Screening and selection of eligible studies were performed by independent reviewers. Methodological quality was assessed with the Joanna Briggs Institute critical appraisal tool. Meta-analyses, meta-correlations, and metamean analyses were performed using random-effect models. The primary outcome was the FAQ score; secondary outcomes were reported pain variables. Data from individuals with pain (n = 2277) and without pain (n = 615) were summarized. Significant body image distortions were found in individuals with pain compared to individuals without pain. Compared to pain-free individuals, the pain group rated significantly higher in the FAQ when experiencing back pain (standardized mean differences=1.33, 95% confidence interval=.88-1.77) or other body parts (standardized mean differences=1.25, 95% confidence interval=.51-1.99). The results of meta-correlation analyses confirmed the positive relationship between body image distortion and pain intensity (r = .31), pain at rest (r = .31), or pain during movement (r = .36), but not for pain duration. A difference in mean FAQ results was observed between individuals with pain in different areas (knee and back). PERSPECTIVE: This review confirms differences in body image distortion between pain and pain-free individuals. Pain intensity was correlated with altered body perception, but not pain duration. A moderate correlation was observed between body image distortion and reported pain variables. Body image was more impaired by knee pain than back pain. REGISTERED PROTOCOL AT PROSPERO: CRD42022309937; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309937.
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Affiliation(s)
- Aleksandra Budzisz
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
| | - Andres Jung
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
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11
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Zhang SC, Makebeh T, Mesinovic J, Djopseu K, Martin C, Lui LY, Cawthon PM, Schneider ALC, Zmuda JM, Strotmeyer ES, Schafer A, Ebeling PR, Zebaze RM. Epidemiology of fractures in adults of African ancestry with diabetes mellitus: A systematic review and meta-analysis. Bone 2024; 185:117133. [PMID: 38789095 DOI: 10.1016/j.bone.2024.117133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Diabetes mellitus (DM) is associated with increased fracture risk in White adults. However, the impact of DM on fractures in Black adults is unknown. This systematic review and meta-analysis investigated the association between DM and fractures in adults of African ancestry. MEDLINE, Scopus, CINAHL and Embase databases were searched from their inception up to November 2023 for all studies in the English language investigating the epidemiology of fractures (prevalence, incidence, or risk) in Black men and women (age ≥ 18 years) with type 1 or type 2 DM. Effect sizes for prevalence of previous fractures (%) and incident fracture risk (hazard ratio [HR]) were calculated using a random-effects model on Stata (version 18.0). There were 13 eligible studies, of which 12 were conducted in Black adults from the United States, while one was conducted in adults of West African ancestry from Trinidad and Tobago. We found no fracture data in Black adults with DM living in Africa. Five studies were included in a meta-analysis of incident fracture risk, reporting data from 2926 Black and 6531 White adults with DM. There was increased risk of fractures in Black adults with DM compared to non-DM (HR = 1.65; 95 % confidence interval [CI]: 1.14, 2.39). The risk of fractures was also higher in White adults with DM compared to non-DM (HR = 1.31; 95 % CI: 1.06, 1.61) among these studies. Five studies were included in a meta-analysis of fracture prevalence, of which three also reported fracture prevalence in White adults. There were 175 previous fractures among 993 Black adults with DM and 384 previous fractures among 1467 White adults with DM, with a pooled prevalence of 17.5 % (95 % CI: 15.4, 19.6) and 25.8 % (95 % CI: 4.8, 46.8), respectively. Our results indicate a high burden of fractures in Black adults with DM.
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Affiliation(s)
- Simon C Zhang
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | | | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joseph M Zmuda
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne Schafer
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, USA.; Department of Medicine, University of California, San Francisco, CA, USA
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Roger M Zebaze
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
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12
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Sydora BC, Whelan LJ, Abelseth B, Brar G, Idris S, Zhao R, Leonard AJ, Rosenbloom BN, Clarke H, Katz J, Beesoon S, Rasic N. Identification of Presurgical Risk Factors for the Development of Chronic Postsurgical Pain in Adults: A Comprehensive Umbrella Review. J Pain Res 2024; 17:2511-2530. [PMID: 39100136 PMCID: PMC11297490 DOI: 10.2147/jpr.s466731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types. Methods Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed. Results Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing. Conclusion This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.
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Affiliation(s)
- Beate C Sydora
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Lindsay Jane Whelan
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Benjamin Abelseth
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gurpreet Brar
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Sumera Idris
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Rachel Zhao
- Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Sanjay Beesoon
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Nivez Rasic
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada
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13
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Farronato DM, Pezzulo JD, Juniewicz R, Rondon AJ, Cox RM, Davis DE. Effects of socioeconomic burden on opioid use following total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00406-3. [PMID: 38852706 DOI: 10.1016/j.jse.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Preoperative opioid users experience worse outcomes and higher complication rates compared to opioid-naïve patients following shoulder arthroplasty. This study evaluates the effects of socioeconomic status, as measured by the Distressed Communities Index (DCI), on pre- and postoperative opioid use and its influence on clinical outcomes such as readmission and revision surgery. METHODS A retrospective review of patients who underwent primary shoulder arthroplasty (Current Procedural Terminology code 23472) from 2014 to 2022 at a single academic institution was performed. Exclusion criteria included arthroplasty for fracture, active malignancy, and revision arthroplasty. Demographics, Charlson Comorbidity Index, DCI, and clinical outcomes including 90-day readmission and revision surgery were collected. Patients were classified according to the DCI score of their zip code. Using the Prescription Drug Monitoring Program database, patient pre- and postoperative opioid use in morphine milligram equivalents was gathered. RESULTS Individuals from distressed communities used more opioids within 90 days preoperatively compared to patients from prosperous, comfortable, mid-tier, and at-risk populations, respectively. Patients from distressed communities also used significantly more opioids within 90 days postoperatively compared with prosperous, comfortable, and mid-tier, respectively. Of patients from distressed communities, 35.1% developed prolonged opioid use (filling prescriptions >30 days after surgery), significantly more than all other cohorts. Among all patients, 3.5% were readmitted within 90 days and were more likely to be prolonged opioid users (38.9 vs. 21.3%, P < .001). Similarly, 1.5% of patients underwent revision surgery. Those who underwent revision were significantly more likely to be prolonged opioid users (38.2 vs. 21.7%, P = .002). CONCLUSIONS Shoulder arthroplasty patients from distressed communities use more opioids within 90 days before and after their surgery and are more likely to become prolonged opioid users, placing them at risk for readmission and revision surgery. Identifying patients at an increased risk for excess opioid use is essential to employ appropriate strategies that minimize the detrimental effects of prolonged use following surgery.
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Affiliation(s)
- Dominic M Farronato
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Pezzulo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert Juniewicz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander J Rondon
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan M Cox
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel E Davis
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
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14
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Raj G, Raj M, Saigo L. Accuracy of conventional versus cone-beam CT-synthesised lateral cephalograms for cephalometric analysis: A systematic review. J Orthod 2024; 51:160-176. [PMID: 37340975 DOI: 10.1177/14653125231178038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To assess the accuracy of cone-beam computed tomography (CBCT)-synthesised lateral cephalograms (CSLCs) compared with conventional lateral cephalograms for cephalometric analysis in human participants and skull models. METHODS The authors performed a search of PubMed, Scopus, Google Scholar and Embase databases on 4 October 2021. Included studies met the following criteria: published in English; compared conventional lateral cephalograms and CSLCs; assessed hard- and soft-tissue landmarks; and were performed on human or skull models. Data extraction from eligible studies was performed by two independent reviewers. The quality of evidence was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist tool - diagnostic accuracy studies. RESULTS A total of 20 eligible articles were included in this systematic review. Of these 20 studies, 17 presented with a low risk of bias, while three were found to have a moderate risk of bias. Hard- and soft-tissue analyses were evaluated for each imaging modality. The findings reveal that CSLCs are accurate and comparable to conventional lateral cephalograms for cephalometric analysis and demonstrate good inter-observer reliability. Four studies reported a higher accuracy with CSLCs. CONCLUSION Overall, the diagnostic accuracy and reproducibility of CSLCs were comparable to conventional lateral cephalograms in cephalometric analysis. It is justified that patients who have an existing CBCT scan do not need an additional lateral cephalogram, minimising unnecessary radiation exposure, expenses and time for the patient. Larger voxel sizes and low-dose CBCT protocols can be considered to minimise radiation exposure. REGISTRATION This study was registered with PROSPERO (CRD42021282019).
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Affiliation(s)
- Grace Raj
- National Dental Centre Singapore, Singapore
| | - Mary Raj
- National Dental Centre Singapore, Singapore
| | - Leonardo Saigo
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
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15
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Alsabbagh MW, Beazely MA, Spasik L. Association Between Opioid-Related Mortality and History of Surgical Procedure: A Population-Based Case-Control Study. ANNALS OF SURGERY OPEN 2024; 5:e412. [PMID: 38911620 PMCID: PMC11191927 DOI: 10.1097/as9.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/06/2024] [Indexed: 06/25/2024] Open
Abstract
Objective This study examined whether there is an association between opioid-related mortality and surgical procedures. Methods A case-control study design using deceased controls compared individuals with and without opioid death and their exposure to common surgeries in the preceding 4 years. This population-based study used linked death and hospitalization databases in Canada (excluding Quebec) from January 01, 2008 to December 31, 2017. Cases of opioid death were identified and matched to 5 controls who died of other causes by age (±4 years), sex, province of death, and date of death (±1 year). Patients with HIV infection and alcohol-related deaths were excluded from the control group. Logistic regression was used to determine if there was an association between having surgery and death from an opioid-related cause by estimating the crude and adjusted odds ratios (ORs) with the corresponding 95% confidence interval (CI). Covariates included sociodemographic characteristics, comorbidities, and the number of days of hospitalization in the previous 4 years. Results We identified 11,865 cases and matched them with 59,345 controls. About 11.2% of cases and 12.5% of controls had surgery in the 4 years before their death, corresponding to a crude OR of 0.89 (95% CI: 0.83-0.94). After adjustment, opioid mortality was associated with surgical procedure with OR of 1.26 (95% CI: 1.17-1.36). Conclusions After adjusting for comorbidities, patients with opioid mortality were more likely to undergo surgical intervention within 4 years before their death. Clinicians should enhance screening for opioid use and risk factors when considering postoperative opioid prescribing.
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Affiliation(s)
- Mhd Wasem Alsabbagh
- From the School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Michael A. Beazely
- From the School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Leona Spasik
- From the School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
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16
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Bao R, Qin H, Memon AR, Chen S, López-Gil JF, Liu S, Zou L, Cai Y. Is adherence to the 24-h movement guidelines associated with greater academic-related outcomes in children and adolescents? A systematic review and meta-analysis. Eur J Pediatr 2024; 183:2003-2014. [PMID: 38416259 DOI: 10.1007/s00431-024-05461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
The purpose of this systematic review was to synthesise the evidence for the association of adherence to the 24-h movement guidelines with academic-related outcomes in children and adolescents. This systematic review was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. PubMed, PsycINFO, Scopus, WOS, SPORTDiscus, and EMBASE were searched from their inception to 12 December 2023. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess the risk of bias of included studies. In total, 4326 records were identified through database searches; 10 articles met the inclusion criteria and were included in this systematic review. There were eight cross-sectional studies and two longitudinal studies; the main academic-related outcomes were academic achievement and cognitive function. A small association between adherence to all three recommendations and academic achievement (k = 5, r = 0.17, 95% CI = 0.10-0.24, I2 = 49%) was found compared to those who did not adhere to any recommendations. Conclusion: Findings from this systematic review and meta-analysis reveal a small association between adherence to all three recommendations and greater academic achievement in children and adolescents. Nevertheless, it is imperative to underscore the need for more studies to establish robust evidence underpinning this relationship. Trial registration: PROSPERO (CRD42021295403). What is Known: • Regular physical activity, reduced screen time, and optimal sleep duration are independently associated with improved academic-related outcomes in children and adolescents. • The associations between adherence to the 24-h movement guidelines and academic-related outcomes in children and adolescents have not been quantitatively synthesised. What is New: • There is a small but positive association between adherence to all three recommendations of the 24-h movement guidelines and greater academic achievement in children and adolescents. • Further well-designed research is needed to focus on academic achievement, cognitive function and classroom behaviours in young individuals.
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Affiliation(s)
- Ran Bao
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Huimin Qin
- ShanghaiTech Colleges, ShanghaiTech University, Shanghai, 201210, China
| | - Aamir Raoof Memon
- Institute for Health and Sport, Victoria University, Melbourne, 8001, Australia
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne, 8001, Australia
| | | | - Shijie Liu
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China
| | - Liye Zou
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Yujun Cai
- School of Physical Education, Shanghai University of Sport, Shanghai, 200438, China.
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17
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Ercis M, Sanchez-Ruiz JA, Webb LM, Solares-Bravo M, Betcher HK, Moore KM, Frye MA, Veldic M, Ozerdem A. Sex differences in effectiveness and adverse effects of mood stabilizers and antipsychotics: A systematic review. J Affect Disord 2024; 352:171-192. [PMID: 38367709 DOI: 10.1016/j.jad.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Psychiatric disorders differ in their prevalence, symptom profiles, and disease courses in men and women. However, sex differences in psychiatric disorders have not received enough attention to guide treatment recommendations. This systematic review aims to summarize sex differences in the treatment responses and adverse effects of mood stabilizers and antipsychotics transdiagnostically. METHODS We conducted a systematic review following the PRISMA 2020 statement (CRD42020212478). A literature search was conducted using MEDLINE, Embase, Cochrane Central, PsycINFO, Web of Science Core Collection, and Scopus databases. Studies comparing mood stabilizer or antipsychotic treatment outcomes in men and women were included. JBI critical appraisal checklists were used to assess bias risk. RESULTS Out of 4866 records, 129 reports (14 on mood stabilizers, 115 on antipsychotics) with varying designs were included. Sample sizes ranged from 17 to 22,774 participants (median = 147). The most common psychiatric diagnoses were schizophrenia spectrum (n = 109, 84.5 %) and bipolar disorders (n = 38, 29.5 %). Only four studies explored sex differences in mood stabilizer treatment response. In 40 articles on antipsychotic treatment response, 18 indicated no sex difference, while 16 showed females had better outcomes. Women had more adverse effects with both mood stabilizers and antipsychotics. The risk of bias was low in 84 (65.1 %) of studies. LIMITATIONS Substantial heterogeneity among the studies precluded performing a meta-analysis. CONCLUSION Number of studies focusing on sex differences in treatment outcomes of mood stabilizers is limited. Women may respond better to antipsychotics than men, but also experience more side effects. The impact of pharmacokinetics on sex differences warrants more attention.
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Affiliation(s)
- Mete Ercis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Lauren M Webb
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hannah K Betcher
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
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18
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Wagner ER, Hussain ZB, Karzon AL, Cooke HL, Toston RJ, Hurt JT, Dawes AM, Gottschalk MB. Methylprednisolone taper is an effective addition to multimodal pain regimens after total shoulder arthroplasty: results of a randomized controlled trial: 2022 Neer Award winner. J Shoulder Elbow Surg 2024; 33:985-993. [PMID: 38316236 DOI: 10.1016/j.jse.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perioperative corticosteroids have shown potential as nonopioid analgesic adjuncts for various orthopedic pathologies, but there is a lack of research on their use in the postoperative setting after total shoulder arthroplasty (TSA). The purpose of this study was to assess the effect of a methylprednisolone taper on a multimodal pain regimen after TSA. METHODS This study was a randomized controlled trial (clinicaltrials.gov NCT03661645) of opioid-naive patients undergoing TSA. Patients were randomly assigned to receive intraoperative dexamethasone only (control group) or intraoperative dexamethasone followed by a 6-day oral methylprednisolone (Medrol) taper course (treatment group). All patients received the same standardized perioperative pain management protocol. Standardized pain journal entries were used to record visual analog pain scores (VAS-pain), VAS-nausea scores, and quantity of opioid tablet consumption during the first 7 postoperative days (POD). Patients were followed for at least one year postoperatively for clinical evaluation, collection of patient-reported outcomes, and observation of complications. RESULTS A total of 67 patients were enrolled in the study; 32 in the control group and 35 in the treatment group. The groups had similar demographics and comorbidities. The treatment group demonstrated a reduction in mean VAS pain scores over the first 7 POD. Between POD 1 and POD 7, patients in the control group consumed an average of 17.6 oxycodone tablets while those in the treatment group consumed an average of 5.5 tablets. This equated to oral morphine equivalents of 132.1 and 41.1 for the control and treatment groups, respectively. There were fewer opioid-related side effects during the first postoperative week in the treatment group. The treatment group reported improved VAS pain scores at 2-week, 6-week, and 12-week postoperatively. There were no differences in Europe Quality of Life, shoulder subjective value (SSV), at any time point between groups, although American Shoulder and Elbow Surgeons questionnaire scores showed a slight improvement at 6-weeks in the treatment group. At mean follow-up, (control group: 23.4 months; treatment group:19.4 months), there was 1 infection in the control group and 1 postoperative cubital tunnel syndrome in the treatment group. No other complications were reported. CONCLUSIONS A methylprednisolone taper course shows promise in reducing acute pain and opioid consumption as part of a multimodal regimen following TSA. As a result of this study, we have included this 6-day methylprednisolone taper course in our multimodal regimen for all primary shoulder arthroplasties. We hope this trial serves as a foundation for future studies on the use of low-dose oral corticosteroids and other nonnarcotic modalities to control pain after shoulder surgeries.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA.
| | - Zaamin B Hussain
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
| | - Anthony L Karzon
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
| | - Roy J Toston
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
| | - John T Hurt
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
| | - Alexander M Dawes
- Department of Orthopaedic Surgery Emory University, Atlanta, GA, USA
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19
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Genel F, Harris IA, Pavlovic N, Lewin A, Mittal R, Huang AY, Penm J, Patanwala AE, Brady B, Adie S, Naylor JM. Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study. ARTHROPLASTY 2024; 6:11. [PMID: 38438888 PMCID: PMC10913630 DOI: 10.1186/s42836-024-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/03/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Few Australian studies have examined the incidence of prescribed opioid use prior to primary total knee or total hip arthroplasty (TKA, THA) and whether it predicts post-surgery outcomes. A recent Australian study demonstrated that the prevalence of pre-arthroplasty opioid use was approximately 16%. In the United States, approximately 24% of people undergoing TKA or THA are chronic opioid users preoperatively. PURPOSE This study aimed to determine (i) the proportion of TKA and THA patients who use prescribed opioids regularly (daily) before surgery (i.e., opioid use reported between the time of waitlisting and any time up to 3 months before surgery), (ii) if opioid use before surgery predicts (a) complication/readmission rates to 6-months post-surgery, and (b) patient-reported outcomes to 6-months post-surgery. METHODS A retrospective cohort study of patients who underwent TKA or THA between January 2013 and June 2018 from two Australian public hospitals was undertaken utilizing linked individual patient-level data from two prospectively collected independent databases comprising approximately 3,500 and 9,500 people (database contained known opioid usage data within the 5-year time frame). Inclusion criteria included (i) primary diagnosis of osteoarthritis of the index joint, (ii) primary elective THA or TKA, and (iii) age ≥ 18 years. Exclusion criteria included (i) revision arthroplasty, (ii) non-elective arthroplasty, (iii) hip hemiarthroplasty, (iv) uni-compartmental knee arthroplasty, and (v) previous unilateral high tibial osteotomy. RESULTS Analysis was completed on 1,187 study participants (64% female, 69% TKA, mean (SD) age 67 [9.9]). 30% were using regular opioids preoperatively. Adjusted regression analyses controlling for multiple co-variates indicated no significant association between preoperative opioid use and complications/readmission rates or patient-reported outcomes to 6 months post-surgery. Model diagnostics produced poor discrimination for area under the curves and non-significant goodness of fit tests. Pre-arthroplasty opioid use was associated with lower health-related quality of life (EuroQol-Visual Analogue Scale) compared to non-opioid users undergoing primary THA (mean difference -5.04 [-9.87, -0.22], P = 0.04, Adjusted R2 = 0.06) CONCLUSION: In this study, 30% of patients were using prescribed opioids daily prior to primary TKA or THA. Pre-arthroplasty opioid use was not associated with postoperative adverse events or patient-reported pain, function, or global perceived improvement up to six months post-surgery.
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Affiliation(s)
- Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia.
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia.
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, 2176, Australia
| | - Adriane Lewin
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Andrew Y Huang
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Prince of Wales Hospital and Community Health Services, Randwick, NSW, 2031, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Sam Adie
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia
- St. George and Sutherland Centre for Clinical Orthopaedic Research, Kogarah, NSW, 2217, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
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20
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Chen LM, Mirkazemi C, Veal FC. Are we educating patients about postoperative analgesics following orthopaedic surgery? A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 120:108123. [PMID: 38159507 DOI: 10.1016/j.pec.2023.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To identify interventions educating patients undergoing orthopaedic surgery about postoperative analgesics and explore their associated outcomes. METHODS A scoping review using six databases was conducted. Eligible interventions were delivered to adult patients undergoing open orthopaedic procedures that could be feasibly implemented into any setting. Content, delivery methods and outcomes for interventions were described where available. RESULTS Eleven studies were included. Content and delivery methods differed substantially. Eight studies aimed to reduce postoperative harm by reducing opioid consumption. Studies also explored pain control (n = 6) and patient satisfaction (n = 4). Health literacy was not assessed in any study. Previous surgical or analgesic experience was infrequently reported. CONCLUSION This is the first scoping review assessing globally adaptable interventions designed to educate orthopaedic patients about postoperative analgesics. A paucity of interventions was found, with a limited range of patient-centred outcomes assessed. Further research is required. Co-designed educational materials with patients is recommended. PRACTICE IMPLICATIONS Despite the unclear benefit, clinicians should consider providing postoperative analgesic education to patients. Well-designed education has the potential to improve quality of life at low cost with low risk. Educational material adapted to local health literacy levels and prior surgical and analgesic experience is recommended to maximise engagement and impact.
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Affiliation(s)
- Leah M Chen
- Unit for Medication Outcomes Research & Education (UMORE) School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia.
| | - Corinne Mirkazemi
- Unit for Medication Outcomes Research & Education (UMORE) School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Felicity C Veal
- Unit for Medication Outcomes Research & Education (UMORE) School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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21
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Selznick A, Kruse C, Al-Mohrej OA, Valente G, Khan M, Al-Asiri J, Petrisor B. The Role of Preoperative Opioid Use in Foot and Ankle Surgery: A Systematic Review. J Foot Ankle Surg 2024; 63:305-311. [PMID: 37923116 DOI: 10.1053/j.jfas.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/18/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Prescription opioids, particularly for treating musculoskeletal pain, are a significant contributor to the opioid epidemic in North America. There is also evidence to suggest that chronic use of opioids is associated with poor outcomes after orthopedic surgery. However, whether this association is relevant in foot and ankle surgery is still unclear. Accordingly, a systematic review of the literature was undertaken to assess the impact of preoperative opioid use in patients undergoing foot and ankle surgery concerning postoperative pain, complications, and postoperative opioid dependence. Four databases, including EMBASE, MEDLINE, PubMed, and CINAHL, were searched to March 2022 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use after foot and ankle surgery. A total of 22,092 patients were included in the final synthesis of 8 studies. Most of which were level 3 evidence (5 studies). Around 18% of the patients used opioids preoperatively. Preoperative opioid use was associated with more quantities and prolonged use of opioids postoperatively. Two studies showed an increased risk of complications postoperatively in patients who used opioids preoperatively compared to the nonopioid group. Preoperative opioid use in patients undergoing foot and ankle surgeries is associated with increased and prolonged use of opioids postoperatively and may therefore predict the potential for misuse.
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Affiliation(s)
- Asher Selznick
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton ON, Canada
| | - Colin Kruse
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton ON, Canada
| | - Omar A Al-Mohrej
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton ON, Canada; Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
| | - Giuseppe Valente
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Moin Khan
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Jamal Al-Asiri
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Bradley Petrisor
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton ON, Canada
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22
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Sun IG, Chu CH, Lo ECM, Duangthip D. Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis. J Dent 2024; 142:104841. [PMID: 38246307 DOI: 10.1016/j.jdent.2024.104841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE The objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors. METHODS The systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences. RESULTS A total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25). CONCLUSIONS This systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children. CLINICAL SIGNIFICANCE This study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children. REGISTRATION PROSPERO (CRD42023446464).
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Affiliation(s)
- Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Duangporn Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; College of Dentistry, The Ohio State University, Columbus, OH, USA.
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23
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Nagino K, Sung J, Midorikawa-Inomata A, Eguchi A, Fujimoto K, Okumura Y, Miura M, Yee A, Hurramhon S, Fujio K, Akasaki Y, Hirosawa K, Huang T, Ohno M, Morooka Y, Zou X, Kobayashi H, Inomata T. Clinical Utility of Smartphone Applications in Ophthalmology: A Systematic Review. OPHTHALMOLOGY SCIENCE 2024; 4:100342. [PMID: 37869018 PMCID: PMC10587618 DOI: 10.1016/j.xops.2023.100342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 10/24/2023]
Abstract
Topic Numerous smartphone applications have been devised for diagnosis, treatment, and symptom management in ophthalmology. Despite the importance of systematic evaluation of the purpose, target disease, effectiveness, and utility of smartphone applications to their effective utilization, few studies have formally evaluated their validity, reliability, and clinical utility. Clinical Relevance This report identifies smartphone applications with potential for clinical implementation in ophthalmology and summarizes the evidence on their practical utility. Methods We searched PubMed and EMBASE on July 28, 2022, for articles reporting original data on the effectiveness of treatment, disease detection, diagnostic accuracy, disease monitoring, and usability of smartphone applications in ophthalmology published between January 1, 1987, and July 25, 2022. Their quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results The initial search yielded 510 articles. After removing 115 duplicates and 285 articles based on inclusion and exclusion criteria, the full texts of the remaining 110 articles were reviewed. Furthermore, 71 articles were included in the final qualitative synthesis. All studies were determined to be of high (87.3%) or moderate (12.7%) quality. In terms of respective application of interest, 24 (33.8%) studies assessed diagnostic accuracy, 17 (23.9%) assessed disease detection, and 3 (4.2%) assessed intervention efficacy. A total of 48 smartphone applications were identified, of which 27 (56.3%) were publicly available. Seventeen (35.4%) applications included functions for ophthalmic examinations, 13 (27.1%) included functions aimed at disease detection, 10 (20.8%) included functions to support medical personnel, five (10.4%) included functions related to disease education, and three (6.3%) included functions to promote treatment adherence for patients. The largest number of applications targeted amblyopia (18.8%), followed by retinal disease (10.4%). Two (4.2%) smartphone applications reported significant efficacy in treating diseases. Conclusion In this systematic review, a comprehensive appraisal is presented on studies related to diagnostic accuracy, disease detectability, and efficacy of smartphone applications in ophthalmology. Forty-eight applications with potential clinical utility are identified. Appropriate smartphone applications are expected to enable early detection of undiagnosed diseases via telemedicine and prevent visual dysfunction via remote monitoring of chronic diseases. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ken Nagino
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alan Yee
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shokirova Hurramhon
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Ohno
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Morooka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Xinrong Zou
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Fengcheng Hospital, Shanghai, China
| | - Hiroyuki Kobayashi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- AI Incubation Farm, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Shahid F, Doherty A, Wallace E, Schmiedl S, Alexander GC, Dreischulte T. Prescribing cascades in ambulatory care: A structured synthesis of evidence. Pharmacotherapy 2024; 44:87-96. [PMID: 37743815 DOI: 10.1002/phar.2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/04/2023] [Accepted: 06/23/2023] [Indexed: 09/26/2023]
Abstract
The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized. To perform a structured, systematic, and transparent review of the evidence supporting ambulatory care prescribing cascades. Ninety-four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterize prescribing cascades. (1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I-strong evidence [i.e. multiple high-quality studies]; Level II-moderate evidence [i.e. single high-quality study]; Level III-fair evidence [no high-quality studies but one or more moderate-quality studies]; and Level IV-poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events. Of 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n = 51), cohort (n = 30), and case-control (n = 7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n = 86) but not all of the 94 prescribing cascades. Although we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance.
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Affiliation(s)
- Faiza Shahid
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ann Doherty
- Department of General Practice, University College Cork, Cork, Ireland
| | - Emma Wallace
- Department of General Practice, University College Cork, Cork, Ireland
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - G Caleb Alexander
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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25
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Olsen AA, Dannenbaum JH, Horan T, Niu R, Talmo CT. Correlation of Patient-Reported Preoperative Narcotic Use and Postoperative Requirements in Total Joint Arthroplasty. Orthopedics 2024; 47:34-39. [PMID: 37216566 DOI: 10.3928/01477447-20230517-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Preoperative narcotic use is associated with diminished outcomes and increased complications in patients undergoing primary total joint arthroplasty (TJA). The goal of this study was to compare self-reported and state database identified preoperative narcotic use and correlate it with perioperative narcotic requirements in patients undergoing primary arthroplasty. A total of 788 patients undergoing unilateral TJA from a single institution were examined using self-reported preoperative narcotic use questionnaires and were verified using the Massachusetts Prescriber Awareness Tool (MassPAT). Demographic data, perioperative morphine milligram equivalents, and postdischarge refills were recorded and analyzed. Of the total population, 16.4% of patients undergoing TJA had verified MassPAT narcotics prescriptions preoperatively. Of these patients, 55% accurately reported use to their surgeon. Patients with verified MassPAT narcotic prescriptions required more morphine milligram equivalents than patients without MassPAT prescriptions, regardless of their preoperative self-report at all time points in the study. Patients who accurately reported use required more narcotics than those who did not. Patients with MassPAT prescriptions required more postdischarge refills than patients without MassPAT prescriptions. These data suggest that state-run narcotics databases may be more useful than self-reports for identifying which patients may require more opioids both immediately postoperatively and after hospital discharge. [Orthopedics. 2024;47(1):34-39.].
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Aktoz F, Loreti S, Darici E, Leunens L, Tournaye H, De Munck N, Blockeel C, Roelens C, Mackens S. IVF with reception of oocytes from partner in lesbian couples: a systematic review and SWOT analysis. Reprod Biomed Online 2024; 48:103411. [PMID: 37925228 DOI: 10.1016/j.rbmo.2023.103411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 11/06/2023]
Abstract
The growing utilization of assisted reproductive technology (ART) by the LGBTQ+ community, especially among lesbian couples, challenges societal norms and promotes inclusivity. The reception of oocytes from partner (ROPA) technique enables both female partners to have a biological connection to their child. A systematic review was conducted of the literature on ROPA IVF to provide the latest data and a SWOT analysis was subsequently performed to understand the strengths, weaknesses, opportunities and threats associated with ROPA IVF. Publications from 2000 to 2023 with relevant keywords were reviewed and 16 records were included. Five studies provided clinical information on couples who used ROPA IVF. ROPA IVF provides a unique opportunity for a biological connection between the child and both female partners and addresses concerns related to oocyte donation and anonymity. Weaknesses include limited cost-effectiveness data and unresolved practical implications. Opportunities lie in involving both partners in parenthood, advancing ART success rates and mitigating risks. Threats encompass increased pregnancy complications, ethical concerns, insufficient safety data, legal or cultural barriers, and emotional stress. In conclusion, ROPA IVF offers a promising solution for lesbian couples seeking to create a family in which both partners want to establish a biological connection with their child.
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Affiliation(s)
- Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey.
| | - Sara Loreti
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ezgi Darici
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lize Leunens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Tournaye
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Neelke De Munck
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Blockeel
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Roelens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Shari Mackens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Guilcher SJT, Cimino SR, Tadrous M, McCarthy LM, Riad J, Tricco AC, Hagens S, Lien J, Tharmalingam S, Gomes T. Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review. J Med Internet Res 2023; 25:e49173. [PMID: 38153776 PMCID: PMC10784986 DOI: 10.2196/49173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/31/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. OBJECTIVE This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. METHODS A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. RESULTS Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. CONCLUSIONS This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie R Cimino
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Jessica Riad
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Andrea C Tricco
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | | | | | | | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
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Cambriel A, Choisy B, Hedou J, Bonnet MP, Fellous S, Lefevre JH, Voron T, Gaudillière D, Kin C, Gaudillière B, Verdonk F. Impact of preoperative uni- or multimodal prehabilitation on postoperative morbidity: meta-analysis. BJS Open 2023; 7:zrad129. [PMID: 38108466 PMCID: PMC10726416 DOI: 10.1093/bjsopen/zrad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to increase patients' preoperative health status and thereby improve postoperative outcomes. However, reported results of prehabilitation are contradictory. The objective of this systematic review is to evaluate the effects of prehabilitation on postoperative outcomes (postoperative complications, hospital length of stay, pain at postoperative day 1) in patients undergoing elective surgery. METHODS The authors performed a systematic review and meta-analysis of RCTs published between January 2006 and June 2023 comparing prehabilitation programmes lasting ≥14 days to 'standard of care' (SOC) and reporting postoperative complications according to the Clavien-Dindo classification. Database searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO. The primary outcome examined was the effect of uni- or multimodal prehabilitation on 30-day complications. Secondary outcomes were length of ICU and hospital stay (LOS) and reported pain scores. RESULTS Twenty-five studies (including 2090 patients randomized in a 1:1 ratio) met the inclusion criteria. Average methodological study quality was moderate. There was no difference between prehabilitation and SOC groups in regard to occurrence of postoperative complications (OR = 1.02, 95% c.i. 0.93 to 1.13; P = 0.10; I2 = 34%), total hospital LOS (-0.13 days; 95% c.i. -0.56 to 0.28; P = 0.53; I2 = 21%) or reported postoperative pain. The ICU LOS was significantly shorter in the prehabilitation group (-0.57 days; 95% c.i. -1.10 to -0.04; P = 0.03; I2 = 46%). Separate comparison of uni- and multimodal prehabilitation showed no difference for either intervention. CONCLUSION Prehabilitation reduces ICU LOS compared with SOC in elective surgery patients but has no effect on overall complication rates or total LOS, regardless of modality. Prehabilitation programs need standardization and specific targeting of those patients most likely to benefit.
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Affiliation(s)
- Amélie Cambriel
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin Choisy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Julien Hedou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Marie-Pierre Bonnet
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université Paris Cité, CRESS, EPOPé, INSERM, INRA, Paris, France
| | - Souad Fellous
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie H Lefevre
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Voron
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dyani Gaudillière
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Cindy Kin
- Division of General Surgery, Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Fernández-de-las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Ortega-Santiago R, Cigarán-Méndez M, Fuensalida-Novo S, Plaza-Manzano G, Arendt-Nielsen L, Valera-Calero JA, Navarro-Santana MJ. Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med 2023; 12:6624. [PMID: 37892762 PMCID: PMC10607727 DOI: 10.3390/jcm12206624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (>6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ana I. de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | | | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos J. Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Bolgarina Z, Gonzalez-Gonzalez LF, Rodroiguez GV, Camacho A. Cranberry Supplements for Urinary Tract Infection Prophylaxis in Pregnant Women: A Systematic Review of Clinical Trials and Observational Studies on Efficacy, Acceptability, Outcomes Measurement Methods, and Studies' Feasibility. Cureus 2023; 15:e46738. [PMID: 38022216 PMCID: PMC10631496 DOI: 10.7759/cureus.46738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Cranberry supplements are commonly used to prevent urinary tract infections (UTIs). However, their usefulness is uncertain in pregnant women. We aimed to comprehensively summarize the current knowledge on cranberry supplements' efficacy and acceptability during pregnancy in addition to the outcomes measurement methods and studies' feasibility. To achieve it, we searched PubMed, PMC, and Europe PMC databases plus screened citations followed by critical appraisal of included eligible English-written primary studies that (1) focused on pregnant women supplemented with any cranberry supplements; (2) provided data on cranberry supplements' efficacy, acceptability, outcomes measurement methods, and studies' feasibility; (3) included human subjects; and (4) published worldwide. Two randomized clinical trials (RCTs) and one nested cohort study, including 1156 pregnant women in total, contributed to our analysis. A tendency toward UTI reduction was demonstrated, although the results' validity was impacted by significant juice-induced gastrointestinal intolerance (23%; 44 of 188 subjects). Changing the form of supplementation from cranberry juice to capsules reduced the issue, causing side effects in one of 49 subjects (2%). Nevertheless, both RCTs still experienced significant recruitment and retention problems, which were at 33% and 59% on average, respectively. Newly acquired safety data on 919 more subjects suggests no increased risks of all malformations, vaginal bleeding, and neonatal complications. Investigating cranberry capsules' efficacy as a non-antibacterial option for UTI prevention in pregnant women has become a feasible and important direction with the current advancement in understanding cranberry supplements' actions, recommended doses plus regimens, and their safety in the population. We reviewed the challenges and discovered knowledge gaps and the implementation strategies for future studies.
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Affiliation(s)
- Zoryana Bolgarina
- Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health, Boston, USA
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | | | - Alejandro Camacho
- Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health, Boston, USA
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Purcell KF, Scarcella N, Chun D, Holland C, Stauffer TP, Bolognesi M, Lachiewicz P. Treating Sleep Disorders After Total Hip and Total Knee Arthroplasty. Orthop Clin North Am 2023; 54:397-405. [PMID: 37718079 DOI: 10.1016/j.ocl.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Disorders of sleep are common after total hip and knee arthroplasty and may contribute to patient dissatisfaction and poorer outcomes in the early postoperative period. Multiple factors contribute to sleep disorders, including poorly controlled pain, opioid medication, perioperative stress, and anxiety. Both pharmacologic and nonpharmacologic methods have been used for perioperative sleep disorders, but there is no consensus on the optimal treatment.
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Affiliation(s)
- Kevin F Purcell
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA.
| | | | - Danielle Chun
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | | | | | | | - Paul Lachiewicz
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
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Broggi MS, Oladeji PO, Spenser C, Kadakia RJ, Bariteau JT. Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery. Foot Ankle Spec 2023; 16:476-484. [PMID: 34369179 DOI: 10.1177/19386400211029123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. METHODS The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. RESULTS In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). CONCLUSION Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. LEVELS OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
| | | | - Corey Spenser
- Department of Orthopaedics, Emory University, Atlanta, Georgia
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Crawford AM, Karhade AV, Agaronnik ND, Lightsey HM, Xiong GX, Schwab JH, Schoenfeld AJ, Simpson AK. Development of a machine learning algorithm to identify surgical candidates for hip and knee arthroplasty without in-person evaluation. Arch Orthop Trauma Surg 2023; 143:5985-5992. [PMID: 36905425 PMCID: PMC10008010 DOI: 10.1007/s00402-023-04827-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Arthroplasty care delivery is facing a growing supply-demand mismatch. To meet future demand for joint arthroplasty, systems will need to identify potential surgical candidates prior to evaluation by orthopaedic surgeons. MATERIALS AND METHODS Retrospective review was conducted at two academic medical centers and three community hospitals from March 1 to July 31, 2020 to identify new patient telemedicine encounters (without prior in-person evaluation) for consideration of hip or knee arthroplasty. The primary outcome was surgical indication for joint replacement. Five machine learning algorithms were developed to predict likelihood of surgical indication and assessed by discrimination, calibration, overall performance, and decision curve analysis. RESULTS Overall, 158 patients underwent new patient telemedicine evaluation for consideration of THA, TKA, or UKA and 65.2% (n = 103) were indicated for operative intervention prior to in-person evaluation. The median age was 65 (interquartile range 59-70) and 60.8% were women. Variables found to be associated with operative intervention were radiographic degree of arthritis, prior trial of intra-articular injection, trial of physical therapy, opioid use, and tobacco use. In the independent testing set (n = 46) not used for algorithm development, the stochastic gradient boosting algorithm achieved the best performance with AUC 0.83, calibration intercept 0.13, calibration slope 1.03, Brier score 0.15 relative to a null model Brier score of 0.23, and higher net benefit than the default alternatives on decision curve analysis. CONCLUSION We developed a machine learning algorithm to identify potential surgical candidates for joint arthroplasty in the setting of osteoarthritis without an in-person evaluation or physical examination. If externally validated, this algorithm could be deployed by various stakeholders, including patients, providers, and health systems, to direct appropriate next steps in patients with osteoarthritis and improve efficiency in identifying surgical candidates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Aditya V Karhade
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | | | - Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Grace X Xiong
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Kumar S, Dwivedi H, Singh B, Jha AK, Jain R, Singh S. A Systematic Review on Prosthodontic Rehabilitation of Hemimandibulectomy Defects. Cureus 2023; 15:e44647. [PMID: 37799255 PMCID: PMC10548848 DOI: 10.7759/cureus.44647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives available for rehabilitation of acquired hemimandibulectomy defects according to mandibular reconstruction type and extent (Cantor-Curtis classification) are unclear. This systematic review aims to assess the spectrum of prosthodontic rehabilitation approaches with regard to reconstruction type and extent of mandibular surgical defects. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 15 years were included. A total of 202 records were identified from the database search of which 19 duplicates were removed. The remaining articles were assessed for eligibility, and 55 articles (comprising 58 cases) were finally included in the study. This review revealed various prosthetic alternatives ranging from guide flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures to implant-supported prosthesis including a few innovative prosthetic approaches. This systematic review provides a plethora of prosthodontic rehabilitation approaches according to the extent of hemimandibular surgical defect and type of reconstruction. This will facilitate practitioners and prosthodontists in sequential treatment planning and management of hemimandibulectomy cases in their routine practice.
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Affiliation(s)
- Surender Kumar
- Department of Prosthodontics, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Hemlata Dwivedi
- Department of Prosthodontics, Rama Dental College and Hospital, Kanpur, IND
| | - Bishnupati Singh
- Department of Prosthodontics, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Awanindra K Jha
- Department of Orthodontics and Dentofacial Orthopedics, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Reeta Jain
- Department of Prosthodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, IND
| | - Sunil Singh
- Department of Prosthodontics, Dental College Azamgarh, Azamgarh, IND
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Nascimento MB, Vilarinho LG, Lobato DFM, Dionisio VC. Role of gluteus maximus and medius activation in the lower limb biomechanical control during functional single-leg Tasks: A systematic review. Knee 2023; 43:163-175. [PMID: 37422984 DOI: 10.1016/j.knee.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Single-leg (SL) tasks are included as assessment and intervention strategies in several dysfunctions due to the inherent motor control requirement. The recruitment of gluteus maximus (GMAX) and medius (GMED) muscles is essential for proper biomechanical control of the knee and hip joints. The study aims to identify the role of gluteal activation in the biomechanical control of the lower limb during SL tasks. METHODS This is a systematic review with searches performed in Pubmed, CINAHL, MEDLINE, Web of Science, and Sportdiscus databases. Cross-sectional studies carried out with asymptomatic individuals were selected, containing hip and knee kinematic and kinetic outcomes assessed through 3D or 2D movement analysis and EMG activity of GMED and GMAX muscles. Two independent reviewers performed the procedures to select the studies, determine the methodological quality and extract the data. RESULTS The initial search resulted in 391 studies, and after the assessment procedures, 11 studies were included. Lower GMAX activation was associated with greater hip internal rotation (HIR) excursion and greater HIR moment, and lower GMED activation was associated with greater hip adduction (HAD)/knee abduction (KAB) excursions and greater KAB moment during single-leg squat (SLS). CONCLUSIONS The SL tasks showed a relevant association between the gluteal EMG and other biomechanical outcomes, mainly the SLS task. Interpretation must be cautious, as most studies present high and moderate methodological quality, especially on kinetic data.
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Affiliation(s)
- Matheus Batista Nascimento
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil.
| | - Lucas Gois Vilarinho
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil
| | | | - Valdeci Carlos Dionisio
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil
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Gazendam AM, Ghert M, Gundle KR, Hayden JB, Doung YC. Opioid Use in Surgical Management in Musculoskeletal Oncology. J Bone Joint Surg Am 2023; 105:10-14. [PMID: 37466574 DOI: 10.2106/jbjs.22.00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Opioid prescribing in the context of orthopaedic surgery has been recognized as having a critical role in the ongoing opioid epidemic. Given the negative consequences of chronic opioid use, great efforts have been made to reduce both preoperative and postoperative opioid prescribing and consumption in orthopaedic surgery. Musculoskeletal oncology patients represent a unique subset of patients, and there is a paucity of data evaluating perioperative opioid consumption and the risk for chronic use. The objective of the present study was to describe opioid consumption patterns and evaluate predictors of chronic opioid use in musculoskeletal oncology patients undergoing limb-salvage surgery and endoprosthetic reconstruction. METHODS The present study was a secondary analysis of the recently completed PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) trial and included musculoskeletal oncology patients undergoing lower-extremity endoprosthetic reconstruction. The primary outcome was the incidence of opioid consumption over the study period. A multivariate binomial logistic regression model was created to explore predictors of chronic opioid consumption at 1 year postoperatively. RESULTS Overall, 193 (33.6%) of 575 patients were consuming opioids preoperatively. Postoperatively, the number of patients consuming opioids was 82 (16.7%) of 492 at 3 months, 37 (8%) of 460 patients at 6 months, and 28 (6.6%) of 425 patients at 1 year. Of patients consuming opioids preoperatively, 12 (10.2%) of 118 had continued to consume opioids at 1 year postoperatively. The adjusted regression model found that only surgery for metastatic bone disease was predictive of chronic opioid use (odds ratio, 4.90; 95% confidence interval, 1.54 to 15.40; p = 0.007). Preoperative opioid consumption, older age, sex, longer surgical times, reoperation rates, and country of origin were not predictive of chronic use. CONCLUSIONS Despite a high prevalence of preoperative opioid use, an invasive surgical procedure, and a high rate of reoperation, few patients had continued to consume opioids at 1 year postoperatively. The presence of metastases was associated with chronic opioid use. These results are a substantial departure from the existing orthopaedic literature evaluating other patient populations, and they suggest that specific prescribing guidelines are warranted for musculoskeletal oncology patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aaron M Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Ghert
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth R Gundle
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon
| | - James B Hayden
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon
| | - Yee-Cheen Doung
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon
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Kagan R, Welling S, Mildren ME, Smith S, Philipp T, Yoo J. It is the Opioids Not the Spine Surgeon; Dislocation After Total Hip Arthroplasty is Associated With Opioid Use in Patients Who Have Prior Lumbar Spine Fusion. J Arthroplasty 2023; 38:S336-S339. [PMID: 36889529 DOI: 10.1016/j.arth.2023.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Patients who have prior lumbar spine fusion (LSF) have an increased risk for dislocation after total hip arthroplasty (THA). These patients also have elevated rates of opioid use. We aimed to evaluate the associated risk of dislocation after THA in patients who have prior LSF comparing those who have opioid use to those who do not. METHODS This was a retrospective review using a large national database of 246,617 primary and 34,083 revision THA cases from 2012 to 2019. There were 1,903 primary THA and 288 revision THA cases identified with LSF prior to THA. Postoperative hip dislocation was our primary outcome variable and patients were stratified to use or nonuse of opioid at THA. Demographic data including age, sex, and obesity were collected. Multivariate analyses evaluated association of opioid use and dislocation after adjusting for demographics. RESULTS There was increased odds of dislocation for opioid use at THA for both primary (adjusted Odds Ratio [aOR] = 2.29, 95% Confidence Interval [CI] 1.46 to 3.57, P < .0003) and revision THA (aOR = 1.92, 95% CI 1.62 to 3.08, P < .0003), in patients who have prior LSF. Prior LSF without opioid use was associated with increased odds of dislocation (aOR = 1.38, 95% CI 1.01 to 1.88, P = .04), but this was lower than the associated risk of opioid use without LSF (aOR 1.72, 95% CI 1.63 to 1.81, P < .001). CONCLUSION Increased odds of dislocation were noted with opioid use at time of THA in patients who have prior LSF. Associated risk of dislocation was higher for opioid use than prior LSF. This suggests that dislocation risk is multifactorial and we should look to strategies to reduce opioid use prior to THA.
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Affiliation(s)
- Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Sebastian Welling
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | | | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Travis Philipp
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Gamberini C, Juliana NCA, de Brouwer L, Vogelsang D, Al-Nasiry S, Morré SA, Ambrosino E. The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1107931. [PMID: 37351522 PMCID: PMC10282605 DOI: 10.3389/frph.2023.1107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as "sexually transmitted infections", "non-viral", "adverse pregnancy outcome", "Africa", "sub-Saharan Africa", "pregnant women", "pregnancy", and "pregnancy outcome". Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.
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Affiliation(s)
- Carlotta Gamberini
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Lenya de Brouwer
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Dorothea Vogelsang
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Salwan Al-Nasiry
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Research School GROW for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, UP, India
- Dutch Chlamydia trachomatis Reference Laboratory on Behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
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Al-Mohrej OA, Prada C, Madden K, Shanthanna H, Leroux T, Khan M. The role of preoperative opioid use in shoulder surgery-A systematic review. Shoulder Elbow 2023; 15:250-273. [PMID: 37325382 PMCID: PMC10268141 DOI: 10.1177/17585732211070193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 09/20/2023]
Abstract
Background Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing shoulder surgery with respect to preoperative clinical outcomes, postoperative complications, and postoperative dependence on opioids. Methods EMBASE, MEDLINE, CENTRAL, and CINAHL were searched from inception to April, 2021 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. Results Twenty-one studies with a total of 257,301 patients were included in the final synthesis. Of which, 17 were level III evidence. Of those, 51.5% of the patients reported pre-operative opioid use. Fourteen studies (66.7%) reported a higher likelihood of opioid use at follow-up among those used opioids preoperatively compared to preoperative opioid-naïve patients. Eight studies (38.1%) showed lower functional measurements and range of motion in opioid group compared to the non-opioid group post-operatively. Conclusion Preoperative opioid use in patients undergoing shoulder surgeries is associated with lower functional scores and post-operative range of motion. Most concerning is preoperative opioid use may predict increased post-operative opioid requirements and potential for misuse in patients. Level of evidence Level IV, Systematic review.
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Affiliation(s)
- Omar A Al-Mohrej
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Pagan DN, Hernandez VH, Reddy GB, D'Apuzzo MR. Chronic Opioid Use Independently Increases Complications and Resource Utilization After Primary Total Joint Arthroplasty. J Arthroplasty 2023; 38:1004-1009. [PMID: 36529200 DOI: 10.1016/j.arth.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Current literature suggests a link between the chronic use of opioids and musculoskeletal surgical complications. Given the current opioid epidemic, the need to elucidate the effects of chronic opioid use (OD) on patient outcomes and cost has become important. The purpose of this study was to determine if OD is an independent risk factor for inpatient postoperative complications and resource utilization after primary total joint arthroplasty. METHODS A total of 3,545,565 patients undergoing elective, unilateral, primary total hip (THA) and knee (TKA) arthroplasty for osteoarthritis from January 2016 to December 2019 were identified using a large national database. In-hospital postoperative complications, length of stay, and total costs adjusted for inflation in opioid + patients were compared with patients without chronic opioid use (OD). Logistic regression analyses were used to control for cofounding factors. RESULTS OD patients undergoing either THA or TKA had a higher risk of postoperative complications including respiratory (odds ratio (OR): 1.4 and OR: 1.3), gastrointestinal (OR: 1.8 and OR: 1.8), urinary tract infection (OR: 1.1 and OR: 1.2), blood transfusion (OR: 1.5 and OR: 1.4), and deep vein thrombosis (OR: 1.7 and OR: 1.6), respectively. Total cost ($16,619 ± $9,251 versus $15,603 ± $9,181, P < .001), lengths of stay (2.15 ± 1.37 versus 2.03 ± 1.23, P < .001), and the likelihood for discharge to a rehabilitation facility (17.8 versus 15.7%, P < .001) were higher in patients with OD. CONCLUSION OD was associated with higher risk for in-hospital postoperative complications and cost after primary THA and TKA. Further studies to find strategies to mitigate the impact of opioid use on complications are required.
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Affiliation(s)
- Dianne N Pagan
- University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, Florida
| | - Victor H Hernandez
- University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, Florida
| | - Gireesh B Reddy
- University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, Florida
| | - Michele R D'Apuzzo
- University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, Florida
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Sitinjak BDP, Murdaya N, Rachman TA, Zakiyah N, Barliana MI. The Potential of Single Nucleotide Polymorphisms (SNPs) as Biomarkers and Their Association with the Increased Risk of Coronary Heart Disease: A Systematic Review. Vasc Health Risk Manag 2023; 19:289-301. [PMID: 37179817 PMCID: PMC10167955 DOI: 10.2147/vhrm.s405039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Human genetic analyses and epidemiological studies showed a potential association between several types of gene polymorphism and the development of coronary heart disease (CHD). Many studies on this pertinent topic need to be investigated further to reach an evidence-based conclusion. Therefore, in this current review, we describe several types of gene polymorphisms that are potentially linked to CHD. A systematic review using the databases EBSCO, PubMed, and ScienceDirect databases was searched until October of 2022 to find relevant studies on the topic of gene polymorphisms on risk factors for CHD, especially for the factors associated with single nucleotide polymorphisms (SNPs). The risk of bias and quality assessment was evaluated by Joanna Briggs Institute (JBI) guidelines. From keyword search results, a total of 6243 articles were identified, which were subsequently narrowed to 14 articles using prespecified inclusion criteria. The results suggested that there were 33 single nucleotide polymorphisms (SNPs) that can potentially increase the risk factors and clinical symptoms of CHD. This study also indicated that gene polymorphisms had a potential role in increasing CHD risk factors that were causally associated with atherosclerosis, increased homocysteine, immune/inflammatory response, Low-Density Lipoprotein (LDL), arterial lesions, and reduction of therapeutic effectiveness. In conclusion, the findings of this study indicate that SNPs may increase risk factors for CHD and SNPs show different effects between individuals. This demonstrates that knowledge of SNPs on CHD risk factors can be used to develop biomarkers for diagnostics and therapeutic response prediction to decide successful therapy and become the basis for defining personalized medicine in future.
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Affiliation(s)
- Bernap Dwi Putra Sitinjak
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Niky Murdaya
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Tiara Anisya Rachman
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Melisa Intan Barliana
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Biological Pharmacy, Biotechnology Pharmacy Laboratory, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Bess S, Line B, Ames C, Burton D, Mundis G, Eastlack R, Hart R, Gupta M, Klineberg E, Kim HJ, Hostin R, Kebaish K, Lafage V, Lafage R, Schwab F, Shaffrey C, Smith JS. Would You Do It Again? Discrepancies Between Patient and Surgeon Perceptions Following Adult Spine Deformity Surgery. Spine J 2023:S1529-9430(23)00191-2. [PMID: 37149153 DOI: 10.1016/j.spinee.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Adult spinal deformity (ASD) surgery can improve patient pain and physical function but is associated with high complication rates and long postoperative recovery. Accordingly, if given a choice, patients may indicate they would not undergo ASD surgery again. PURPOSE Evaluate surgically treated ASD patients to assess if given the option 1) would surgically treated ASD patients choose to undergo the same ASD surgery again, 2) would the treating surgeon perform the same ASD surgery again and if not why, 3) evaluate for consensus and/or discrepancies between patient and surgeon opinions for willingness to perform/receive the same surgery, and 4) evaluate for associations with willingness to undergo or not undergo the same surgery again and patient demographics, patient reported outcomes, and postoperative complications. STUDY DESIGN Retrospective review of a prospective ASD study. PATIENT SAMPLE Surgically treated ASD patients enrolled into a multicenter prospective study. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36) physical component summary (PCS) and mental component summary (MCS), Oswestry Disability Index (ODI), numeric pain rating for back pain (NRS back) and leg pain (NRS leg), minimal clinically important difference (MCID) for SRS-22r domains and ODI, intraoperative and postoperative complications, surgeon and patient satisfaction with surgery. METHODS Surgically treated ASD patients prospectively enrolled into a multicenter study were asked at minimum two year postoperative, if, based upon their hospital and surgical experiences and surgical recovery experiences, would the patient undergo the same surgery again. Treating surgeons were then matched to their corresponding patients, blinded to the patients' preoperative and postoperative patient reported outcome measures, and interviewed and asked if 1) the surgeon believed that the corresponding patient would undergo the surgery again, 2) if the surgeon believed the corresponding patient was improved by the surgery and 3) if the surgeon would perform the same surgery on the corresponding patient again, and if not why. ASD patients were divided into those indicating they would (YES), would not (NO) or were unsure (UNSURE) if they would have same surgery again. Agreement between patient and surgeon willingness to receive/perform the same surgery was assessed and correlations between patient willingness for same surgery, postoperative complications, spine deformity correction, patient reported outcomes (PROs). RESULTS 580 of 961 ASD patients eligible for study were evaluated. YES (n=472) had similar surgical procedures performed, similar duration of hospital and ICU stay, similar spine deformity correction and similar postoperative spinal alignment as NO (n=29; p>0.05). UNSURE (n=79) had greater preoperative depression and opioid use rates, UNSURE and NO had more postoperative complications requiring surgery, and UNSURE and NO had fewer percentages of patients reaching postoperative MCID for SRS-22r domains and MCID for ODI than YES (p<0.05). Comparison of patient willingness to receive the same surgery vs. surgeon perceptions on patient's willingness to receive the same surgery demonstrated surgeons accurately identified YES (91.1%) but poorly identified NO (13.8%; p<0.05). CONCLUSIONS If given a choice, 18.6% of surgically treated ASD patients indicated they were unsure or would not undergo the surgery again. ASD patients indicating they were unsure or would not undergo ASD surgery again had greater preoperative depression, greater preoperative opioid use, worse postoperative PROs, fewer patients reaching MCID, more complications requiring surgery, and greater postoperative opioid use. Additionally, patients that indicated they would not have the same surgery again were poorly identified by their treating surgeons compared to patients indicating they would be willing to receive the same surgery again. More research is needed to understand patient expectations and improve patient experiences following ASD surgery.
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Affiliation(s)
- Shay Bess
- Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO.
| | - Breton Line
- Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO
| | - Christopher Ames
- University of California San Francisco School of Medicine, Department of Neurosurgery, San Francisco CA
| | - Douglas Burton
- University of Kansas School of Medicine, Department of Orthopedic Surgery, Kansas City KS
| | | | | | | | - Munish Gupta
- Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis MO
| | - Eric Klineberg
- University of California Davis School of Medicine, Department of Orthopedic Surgery, Sacramento CA
| | - Han Jo Kim
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York NY
| | | | - Khaled Kebaish
- Johns Hopkins University School of Medicine, Department of Orthopedic Surgery, Baltimore, MD
| | - Virgine Lafage
- Lenox Hill Hospital, Department of Orthopedic Surgery, New York NY
| | - Renaud Lafage
- Lenox Hill Hospital, Department of Orthopedic Surgery, New York NY
| | - Frank Schwab
- Lenox Hill Hospital, Department of Orthopedic Surgery, New York, NY
| | | | - Justin S Smith
- University of Virginia School of Medicine, Department of Neurosurgery, Charlottesville VA
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Pasqualini I, Rullán PJ, Deren M, Krebs VE, Molloy RM, Nystrom LM, Piuzzi NS. Team Approach: Use of Opioids in Orthopaedic Practice. JBJS Rev 2023; 11:01874474-202303000-00008. [PMID: 36972360 DOI: 10.2106/jbjs.rvw.22.00209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
» The opioid epidemic represents a serious health burden on patients across the United States. » This epidemic is particularly pertinent to the field of orthopaedics because it is one of the fields providing the highest volume of opioid prescriptions. » The use of opioids before orthopaedic surgery has been associated with decreased patient-reported outcomes, increased surgery-related complications, and chronic opioid use. » Several patient-level factors, such as preoperative opioid consumption and musculoskeletal and mental health conditions, contribute to the prolonged use of opioids after surgery, and various screening tools for identifying high-risk drug use patterns are available. » The identification of these high-risk patients should be followed by strategies aimed at mitigating opioid misuse, including patient education, opioid use optimization, and a collaborative approach between health care providers.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Pedersen C, Vilhelmsen FJ, Laigaard J, Mathiesen O, Karlsen APH. Opioid consumption and non-opioid multimodal analgesic treatment in pain management trials after hip and knee arthroplasties: A meta-epidemiological study. Acta Anaesthesiol Scand 2023; 67:613-620. [PMID: 36759566 DOI: 10.1111/aas.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The leading principle in peri-operative pain management is multimodal analgesia, which reduces opioid requirements and associated adverse effects. Pragmatic pain trials should optimally test interventions in addition to multimodal non-opioid analgesics and interventions to ensure clinical relevance and baseline levels of opioid consumption that reflect clinical settings. We aimed to investigate opioid consumption and use of non-opioid analgesics administered adjunct to interventions in post-operative pain trials after total hip and knee arthroplasty. METHODS A systematic literature search was conducted 7 January 2020 in The Cochrane Library's CENTRAL, PubMed, and EMBASE. Trials investigating analgesic interventions for post-operative pain in adults undergoing total hip or knee arthroplasty were included. The primary outcome was the aggregated median 0-24 h post-operative opioid consumption. Further, we assessed the use of paracetamol, non-steroidal anti-inflammatory drugs, gabapentinoids, high-dose glucocorticoids, local infiltration analgesia and nerve blocks administered as co-interventions equally to all participants. We assessed trends over time for all outcomes. RESULTS Of 14,200 records, 570 trials were included. Median 0-24 h opioid consumption was 21 and 22 mg iv morphine equivalents in hip and knee arthroplasty trials, respectively. Meta-regression showed no overall linear correlation between opioid consumption and publication year. The use of multimodal non-opioid analgesia increased over time, though only 48% of trials published from 2010 to 2020 administered two or more non-opioid analgesics. Applying more non-opioid analgesics was associated with lower opioid consumption in intervention groups. CONCLUSION Post-operative 0-24 h morphine consumption was median 21-22 mg. The demonstrated differences in non-opioid multimodal analgesic regimens between research and clinical settings, can potentially diminish the demonstrated opioid-sparing effects of trial interventions when such are implemented in a clinical context.
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Affiliation(s)
- Casper Pedersen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Frej Juul Vilhelmsen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Jens Laigaard
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Anders Peder Højer Karlsen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark.,Department of Anaesthesia, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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De Gregorio M, Tiang T, Lee T, Stellingwerf ME, Singh S, Thompson AJ, D'Souza B, Ding NS. Autologous fat graft injections for the treatment of perianal fistulas in Crohn's disease: a systematic review and single-arm meta-analysis. ANZ J Surg 2023; 93:1162-1168. [PMID: 36658773 DOI: 10.1111/ans.18231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Crohn's perianal fistulas are often refractory to standard management. Fat graft injections are hypothesised to improve fistula healing rates. We evaluated the treatment efficacy of fat graft injections for Crohn's perianal fistulas in a systematic review (PRISMA). METHODS We completed database searches of MEDLINE (Ovid), Embase, and PubMed. All studies published in English in full text or abstract, from January 2001 to August 2021, evaluating fat graft injections for Crohn's perianal fistulas were selected. Included randomized controlled trials, single-arm intervention trials, cohort studies, and case series; excluded single case reports. Primary outcome was pooled clinical healing, defined as non-draining treated fistulas, or closure, defined as closure of treated fistulas. Secondary outcomes were clinical healing, clinical closure, radiologic response, and adverse events. RESULTS Of 1258 publications identified, 891 articles were assessed for eligibility, and 107 relevant for manuscript review. Forty-nine patients received fat graft injections for Crohn's perianal fistulas across four single-arm intervention trials. Clinical healing or closure was achieved in 74% in a pooled single-arm meta-analysis (95% confidence interval: 57%, 85%), with moderate heterogeneity between studies. Clinical healing was achieved in 20% and 60% at 3 and 12 months, respectively. Clinical closure was achieved in 83% at 6 months. Variable parameters were used to define radiologic response, with success rates from 20% to 67%. Minimal adverse events were reported. CONCLUSION Fat graft injections show promise as a novel treatment for Crohn's perianal fistulas in this systematic review and meta-analysis. Assessment in controlled matched studies is warranted.
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Affiliation(s)
- Michael De Gregorio
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Tiang
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tanya Lee
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Siddharth Singh
- Department of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Basil D'Souza
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Discharge to inpatient rehabilitation following arthroplasty is a strong predictor of persistent opioid use 90 days after surgery: a prospective, observational study. BMC Musculoskelet Disord 2023; 24:31. [PMID: 36639624 PMCID: PMC9840321 DOI: 10.1186/s12891-023-06142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Total knee and hip arthroplasty are considered a clinically and cost-effective intervention, however, persistent pain post-surgery can occur, and some continue to take opioid medications long-term. One factor which has infrequently been included in prediction modelling is rehabilitation pathway, in particular, one which includes inpatient rehabilitation. As discharge to inpatient rehabilitation post-arthroplasty is common practice, we aimed to identify whether rehabilitation pathway (discharge to in-patient rehabilitation or not) predicts continued use of opioids at 3 months (90 days) post- total knee arthroplasty (TKA) and total hip arthroplasty (THA) whilst controlling for other covariates. METHODS The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses. RESULTS Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001). CONCLUSION The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels. TRIAL REGISTRATION The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443).
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Alsabeeha NHM, Atieh MA, Balakrishnan MS. Older Adults' Satisfaction with Telemedicine During the COVID-19 Pandemic: A Systematic Review. Telemed J E Health 2023; 29:38-49. [PMID: 35613380 DOI: 10.1089/tmj.2022.0045] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aims: This systematic review aimed to evaluate the satisfaction of older adults with telemedicine during the COVID-19 pandemic, assess preferences to telemedicine or in-person visits, and identify factors of influence on the satisfaction with telemedicine. Methods: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. A search through key electronic databases identified 228 citations. After duplicate record removal, and title and abstract screening, 43 articles were eligible for full-text review. Of these, 10 studies meeting the inclusion criteria of the review were finally included. Results: Older adults were satisfied with telemedicine during the COVID-19 pandemic. Patients were in favor of telemedicine compared to in-person visits, but the evidence support for this preference was limited. Factors influencing satisfaction were identified and categorized under four main categories: system-related factors, patient-related factors, socioeconomic factors, and factors related to the nature of the medical intervention. Conclusions: Older adults were satisfied with telemedicine during the COVID-19 pandemic. A positive trend of preference toward telemedicine was observed, but not well established due to the lack of an objective measure of assessment. Technical issues related to the telemedicine delivery system were the main challenges. The socioeconomic status and level of education of older adults can relatively influence the level of satisfaction with telemedicine. The experience of older adults with telemedicine is still evolving and advanced technologies specifically designed to address their needs must be explored to increase the telemedicine uptake among the older adult population during and beyond the COVID-19 pandemic.
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Affiliation(s)
| | - Momen A Atieh
- Department of Periodontology, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
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Goplen CM, Pedersen ME, Ramadi A, Beaupre LA. Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada. BMC PRIMARY CARE 2022; 23:116. [PMID: 35549666 PMCID: PMC9097109 DOI: 10.1186/s12875-022-01722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes.
Methods
In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery.
Results
Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01).
Conclusions
A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.
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Bernstein J, Rankin KA, Green T. Movement if Life-Optimizing Patient Access to Total Joint Arthroplasty: Alcohol and Substance Abuse Disparities. J Am Acad Orthop Surg 2022; 30:1074-1078. [PMID: 35442926 DOI: 10.5435/jaaos-d-21-00939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Alcohol use disorders (AUDs) and substance use disorders (SUDs) place patients undergoing total joint arthroplasty at notable risk for complications. AUD and SUD disproportionately affect vulnerable communities and often coexist. Following is a discussion of the presence of these disorders in vulnerable populations and approaches to screening for them to optimize care and reduce the risks of joint arthroplasty surgery. 25.1% of American adults report binge drinking in the past year, and 5.8% of American adults carry a diagnosis of AUD. Alcohol consumption and AUD disproportionately affect American Indians/Alaskan Natives, and heavy episodic drinking is highest in Latinx and American Indians. AUD is higher in those who are unemployed, have lower education level, and those who are single/divorced. Alcohol use in the preoperative period is associated with difficulty maintaining blood pressure during surgery, infections, wound disruptions, and increased length of stay. In addition, patients with AUD or unhealthy alcohol use have a greater comorbidity burden, including liver disease and dementia, that predisposes them to poor surgical outcomes. Optimization in these vulnerable populations include proper screening, cessation programs, psychosocial interventions, assessment of support systems, and pharmacologic interventions. 38% of adults battle a drug use disorder. Twenty-one million Americans have at least one addiction, but only 10% receive treatment. Rates of opioid use and opioid-related deaths have continued to rise. Recreational drug use is highest in American Indians. Marijuana use is highest in Black and Latinx lesbian, gay, and bisexual women. Overall, substance use is associated with depression and anxiety; discrimination based on race, ethnicity, sex, or sexual preference is also deeply interwoven with depression, anxiety, and substance use. Preoperative use of opioids is the number one predictor of prolonged chronic postoperative opioid use. Optimization in these vulnerable groups begins with appropriate screening, followed by psychosocial interventions, social work and substance abuse counseling, and pharmacologic therapies.
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Affiliation(s)
- Jenna Bernstein
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Bernstein and Rankin), and Virginia Mason Medical Center, Seattle, WA (Green)
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Cheung T, Cheng CPW, Fong TKH, Sharew NT, Anders RL, Xiang YT, Lam SC. Psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis. Front Public Health 2022; 10:1004558. [PMID: 36407973 PMCID: PMC9673757 DOI: 10.3389/fpubh.2022.1004558] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Any infectious disease outbreak may lead to a negative detrimental psychological impact on individuals and the community at large, however; there was no systematic review nor meta-analysis that examined the relationship between the psychological/mental health impact of SARS and COVID-19 outbreak in Asia. Methods and design A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms. Result Twenty-three eligible studies (N = 27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1-54.5, P < 0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1-40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P < 0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P < 0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7-72.6, P < 0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%). Conclusion The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden. Systematic review registration CRD42020182787, identifier PROSPER.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tommy Kwan Hin Fong
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | | | - Robert L. Anders
- School of Nursing, University of Texas at EI Paso, EI Paso, TX, United States
| | - Yu Tao Xiang
- Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Simon Ching Lam
- School of Nursing, Tung Wah College, Kowloon, Hong Kong SAR, China,*Correspondence: Simon Ching Lam ;
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