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Abourisha E, Srinivasan AS, Barakat A, Chong HH, Singh HP. Surgical management of cubital tunnel syndrome: A systematic review and meta-analysis of randomised trials. J Orthop 2024; 53:41-48. [PMID: 38456175 PMCID: PMC10915370 DOI: 10.1016/j.jor.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Background Cubital tunnel syndrome (CUTS) is a common upper limb compression neuropathy with significant consequences when left untreated. Surgical decompression remains gold-standard treatment for moderate to severe disease, however the optimal operative technique remains unclear. This network meta-analysis (NMA) of Level I and II randomised prospective studies aims to discern superiority between open in-situ, endoscopic and anterior transposition (subcutaneous or submuscular techniques) with respect to the primary outcome of response-to-treatment and secondary outcomes which include complications, post-operative chronic pain VAS scale, return to work and re-operation. Methods This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science, Cochrane Central, Science direct and Embase were searched. The MESH database was further searched with the terms 'cubital tunnel' to improve sensitivity of the search. Data pertaining to the primary and secondary outcomes were pooled for NMA. Results Following abstract and full-text screening, 10 randomised prospective trials were included. There was no statistical difference in the response-to-treatment between the four studied techniques. Endoscopic decompression conferred a significantly higher complication rate compared to open decompression (Odds Ratio [OR], 4.21; 95% CI, 1.22-14.59). Endoscopic decompression had a statistically significant lower risk of post-operative chronic pain compared to open in-situ decompression (OR, 0.03, 95% CI, 0.00-0.32). There were no differences between techniques with respect to return to work or re-operation rates. Conclusion Response-to-treatment was similar between the four operative techniques for CUTS. Endoscopic decompression was found to be more hazardous when compared to open-in situ decompression but conferred significantly less post-operative chronic pain. There was significant heterogeneity in reported outcomes between the included articles. The authors suggest conducting more high-quality research with standardised outcome reporting to facilitate comparison. Level of evidence ii Systematic Review and Meta-analysis of Randomised Prospective Trials- Therapeutic study.
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Affiliation(s)
- Eslam Abourisha
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ananth S. Srinivasan
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ahmed Barakat
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Han Hong Chong
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Harvinder P. Singh
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
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Budin JS, Waters TL, Collins LK, Cole MW, Winter JE, Delvadia BP, Iloanya MC, Sherman WF. Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty. Arthroplast Today 2024; 27:101355. [PMID: 38516503 PMCID: PMC10951425 DOI: 10.1016/j.artd.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Background Urinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions. Results Patients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls. Conclusions This study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.
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Affiliation(s)
- Jacob S. Budin
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Timothy L. Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Julianna E. Winter
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Bela P. Delvadia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Michael C. Iloanya
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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Duan Z, Ye Y, Li Z, Zhang B, Liu Q, Zhao Z, Wang W, Yu Z, Zhang H, Zhao Q, Wang B, Lv J, Guo S, Ren H, Gao R, Xu H, Wu Y. Contemporary spectrum, characteristics, and outcomes of adult patients with rheumatic valvular disease in China: Insights from the China-VHD study. Int J Cardiol Cardiovasc Risk Prev 2024; 21:200259. [PMID: 38525097 PMCID: PMC10957411 DOI: 10.1016/j.ijcrp.2024.200259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Background Rheumatic valvular disease (RVD) represents a significant health concern in developing countries, yet a scarcity of detailed data exists. This study conducts a comprehensive examination of RVD patients in China, exploring aspects of the disease's spectrum, characteristics, investigation, management, and outcomes. Methods The China Valvular Heart Disease (China-VHD) study, a nationwide, multicenter, prospective observational study, enrolled 13,917 adults with moderate-to-severe valvular heart disease from April to June 2018. Among these, 2402 patients with native RVD (19.7% of native VHD patients) were analyzed. Results Among the RVD patients, the median age was 57 years (interquartile range 50-65), with 82.5% falling within the 40-70 age range; females were notably predominant (63.9%). Rheumatic etiology prevailed, particularly in southern regions (48.8%). Multivalvular involvement was observed in 47.4% of RVD cases, and atrial fibrillation emerged as the most common comorbidity (43.2%). Severe RVD affected 64.2% of patients. Valvular interventions were undertaken by 66.9% of RVD patients, predominantly involving surgical valve replacement (90.8%). Adverse events, encompassing all-cause mortality and heart failure hospitalization, occurred in 7.3% of patients during the 2-year follow-up. Multivariable analysis identified factors such as age, geographical region, low body mass index, renal insufficiency, left atrial diameter, and left ventricular ejection fraction <50% (all P < 0.05) associated with adverse events, with valvular intervention emerging as a protective factor (HR: 0.201; 95%CI: 0.139 to 0.291; p < 0.001). Conclusions This study delivers a comprehensive evaluation of RVD patients in China, shedding light on the spectrum, characteristics, investigation, management, and outcomes of this prevalent condition.
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Affiliation(s)
- Zhenya Duan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Zhe Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Qingrong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Weiwei Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Zikai Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Haitong Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Bincheng Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Junxing Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Shuai Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Haocheng Ren
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing 100037, China
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Orszulik ST. The quality of antimicrobial susceptibility test discs and implications for clinical outcomes. Diagn Microbiol Infect Dis 2024; 109:116237. [PMID: 38428376 DOI: 10.1016/j.diagmicrobio.2024.116237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Disc diffusion remains the main technique for evaluating antibiotic activity in clinical microbiology laboratories. However, the assay protocol endorsed by the FDA, DIN, and WHO is invalid. Despite decades of research and practice in this field, the quantitative quality of manufactured discs is largely unknown, potentially leading to adverse clinical outcomes. The usual standards expected for new medical devices in terms of quality control, QA, and evidence-based assessment of outcomes are almost completely lacking. Recent data indicate that a large proportion of discs do not meet the specifications, and that disc diffusion is a poor predictor of clinical outcomes. In addition, lack of harmonisation between EUCAST and CLSI, despite many years of effort, strongly suggests that there are serious flaws in these systems. This area lacks scientific rigour, which may have also contributed to adverse clinical outcomes and the emergence of antimicrobial resistance.
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Affiliation(s)
- Stefan T Orszulik
- De La Rue Currency, Overton, Basingstoke, Hampshire, United Kingdom.
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Seung SJ, Saherawala H, Moldaver D, Shokar S, Ammendolea C, Brezden-Masley C. Survival, treatment patterns, and costs of HER2+ metastatic breast cancer patients in Ontario between 2005 to 2020. Breast Cancer Res Treat 2024; 204:341-357. [PMID: 38127177 DOI: 10.1007/s10549-023-07185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To enable the integration of novel therapies, it is critical to understand current long-term outcomes in HER2-positive metastatic breast cancer (mBC), including survival, treatment patterns, and costs. We sought to define these outcomes among patients with mBC in Ontario. METHODS We conducted a retrospective population-level study in Ontario women diagnosed with breast cancer of any stage between January 1, 2005 and December 31, 2019, with follow-up until December 31, 2020. HER2-positivity was based on receipt of a HER2-targeted therapy (HER2-TT) in the first line (1L) metastatic setting. Administrative databases at ICES were used to assess outcomes. RESULTS In Ontario, 2557 patients were diagnosed with mBC and received a HER2-TT, and of these 1606 were diagnosed with early-stage (stage I-III) that became metastatic (recurrent), while 951 were diagnosed with late stage/de novo mBC (stage IV). The average age of all patients was 54.8 years ± 12.7 years. Treatment regimens that included pertuzumab and trastuzumab (cohort name: pert_tras) were the most frequently used HER2-TT for 1L mBC (51.4%), while T-DM1 was the most frequent therapy (87.5%) in second line (2L). The median overall survival (mOS) from initiation of 1L pert_tras was not reached, whereas mOS from initiation of T-DM1 in 2L was 18.7 months. The overall mean cost per patient on pert_tras during 1L was $267,282. The main cost drivers were the cost of systemic therapy, followed by cancer clinic visits, with a mean cost per patient at $158,961 and $73,882, respectively. CONCLUSION The baseline characteristics and treatment patterns for patients who received HER2-TT in our study align with previously reported results. However, the mOS observed for 2L T-DM1 was shorter than that found in pivotal, clinical trial literature. As expected, anti-cancer systemic therapy costs were the main contributor to the over quarter-million dollar mean cost per patient on pert_tras in 1L.
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Affiliation(s)
- S J Seung
- Sunnybrook Research Institute, HOPE Research Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada.
| | - H Saherawala
- Sunnybrook Research Institute, HOPE Research Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada
| | - D Moldaver
- AstraZeneca Canada, Mississauga, ON, Canada
| | - S Shokar
- AstraZeneca Canada, Mississauga, ON, Canada
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6
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Canning ML, Barras M, McDougall R, Yerkovich S, Coombes I, Sullivan C, Whitfield K. Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach. Int J Clin Pharm 2024; 46:451-462. [PMID: 38240963 DOI: 10.1007/s11096-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. AIM To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. METHOD A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. RESULTS Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. CONCLUSION Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia.
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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Nerys-Figueroa J, Parsa A, Curley A, Charif S, Domb BG, Schinsky MF. Slightly reduced early subsidence with similar outcomes and complications rate in collared stems - A systematic review of randomized clinical trials. J Orthop 2024; 50:170-176. [PMID: 38328796 PMCID: PMC10845209 DOI: 10.1016/j.jor.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Purpose Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Study design Systematic Review, Level of Evidence 1. Methods A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Results Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5-72.4 years old, and mean BMI ranged 26.6-29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1-9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Conclusions Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state.
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Affiliation(s)
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Andrew Curley
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sam Charif
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| | - Mark F. Schinsky
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
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Taha K, Catapang M, Becknell B, Matsell DG. Hypertension in children with congenital anomalies of the kidney and urinary tract. Pediatr Nephrol 2024; 39:1185-1192. [PMID: 37910243 PMCID: PMC10922869 DOI: 10.1007/s00467-023-06207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of childhood chronic kidney disease (CKD). We hypothesized that hypertension varies across CAKUT categories and increases the risk of CKD. METHODS This was a retrospective cohort study and included cases with a multicystic dysplastic kidney (MCDK, n = 81), unilateral kidney agenesis (UKA, n = 47), kidney hypoplasia (KH, n = 130), and posterior urethral valves (PUV, n = 75). Hypertension was defined as systolic or diastolic blood pressure ≥ 95th percentile for age, sex and height, and CKD as an estimated glomerular filtration rate < 60 ml/min/1.73 m2, both at 2 consecutive clinic visits at least 3 months apart. RESULTS Sixty-two (19%) out of 333 cases developed hypertension, with significant difference according to CAKUT type. Patients with smaller kidney size (7.7 vs. 8.3, p = 0.045), kidney anomalies in addition to the primary diagnosis (aCAKUT) (53 vs. 38%, p = 0.03), proteinuria (46 vs. 12%, p < 0.001), and CKD (51 vs. 23%, p < 0.001) were more likely to develop hypertension. When adjusted for kidney size, the diagnoses of PUV (OR 10.9, 95%CI 3.0, 40.5), UKA (OR 6.4, 95%CI 1.6, 24.9) and KH (OR 4.2, 95%CI 1.1, 16.1), and aCAKUT (OR 2.1, 95%CI 1.2, 3.9) were independent risk factors for hypertension. Hypertension increased the risk of developing CKD by twofold (HR 1.9, 95%CI 1.19, 2.94). CONCLUSION Hypertension is common in children with CAKUT and increases the risk of CKD. These findings will aid in the development of a standardized clinical pathway for the care of hypertensive children with CAKUT.
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Affiliation(s)
- Khalid Taha
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Marisa Catapang
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Brian Becknell
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas G Matsell
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
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9
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Bhangui P. Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective? Hepatobiliary Pancreat Dis Int 2024; 23:123-128. [PMID: 37880019 DOI: 10.1016/j.hbpd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
Patients with locally advanced hepatocellular cancer (HCC) and portal vein tumor thrombosis (PVTT) have a dismal prognosis since limited treatment options are available for them. In recent years, effective systemic therapy, and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy, have given some hope to prolong survival in them. This review summarized recent evidence in literature regarding the possible role of liver resection (LR) and liver transplantation (LT) in patients with locally advanced HCC and PVTT with no extrahepatic disease. Downstaging therapies have helped make curative resection or LT a reality in selected patients. This review emphasizes on the key points to focus on when considering surgery in these patients, who are usually relegated to palliative systemic therapy alone. Meticulous patient selection based on tumor biology, documented downstaging based on imaging and decrease in tumor marker levels, and an adequate waiting period to demonstrate stable disease, may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.
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Affiliation(s)
- Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta - The Medicity, Sector 38, Gurgaon, Delhi NCR 122001, India.
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10
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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11
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Egro FM, Roy E, Friedstat J. Update on Cold-Induced Injuries. Clin Plast Surg 2024; 51:303-311. [PMID: 38429050 DOI: 10.1016/j.cps.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Cold-induced injuries are a major challenge for burn surgeons, leading to significant sequelae for the patients including amputations, long-term disability, and death. Rapid assessment and diagnosis are essential for optimal outcomes. Various therapies have emerged to improve outcomes. Topical, oral, and intravenous agents have shown to minimize the impact of cold-induced injuries. Thrombolytics have shown the greatest promise in improving tissue perfusion outcomes in cold-induced injuries. This article provides an update on the evidence-based assessment and management of cold-induced injuries, as well as reviews outcomes and future directions of this challenging pathology.
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Affiliation(s)
- Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Suite G103, Pittsburgh, PA 15219, USA; Department of Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Pittsburgh, PA 15219, USA.
| | - Eva Roy
- Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan Friedstat
- Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Fraser Outpatient Burn Center, GWB-1300, 55 Fruit Street, Boston, MA 02114, USA
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Wai J, Kell HJ, Worrell FC. Method considerations for school psychology from longitudinal research on gifted students. J Sch Psychol 2024; 103:101269. [PMID: 38432738 DOI: 10.1016/j.jsp.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/06/2023] [Accepted: 12/01/2023] [Indexed: 03/05/2024]
Abstract
This article draws from longitudinal research on gifted students to provide method considerations for school psychology research. First, we provide some background of gifted and talented education in the United States. Then, drawing from multiple longitudinal samples of gifted students, in particular the Study of Mathematically Precocious Youth (SMPY), we illustrate the role of replications, including constructive replications. In the middle two sections, we highlight methodological design features focused first on predictors, and then on outcomes, considering types, magnitude, and breadth. Finally, we provide additional considerations and future directions, including expanding the outcome domain, overcoming the limitations of past gifted and talented research studies, and suggesting possibilities for future research. Our article may help improve school psychology research as well as assist school psychology researchers interested in conducting their own longitudinal studies using gifted samples.
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Affiliation(s)
- Jonathan Wai
- Dept. of Education Reform and Dept. of Psychology, University of Arkansas, Fayetteville, AR, USA.
| | - Harrison J Kell
- Human Resources Research Organization (HumRRO), Alexandria, VA, USA.
| | - Frank C Worrell
- Berkeley School of Education, University of California, Berkeley, CA, USA.
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Mourey L, Rainho LT, Dalban C, Carril-Ajuria L, Negrier S, Chevreau C, Gravis G, Thibault C, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Tantot F, Chaput N, Naigeon M, Teixeira M, Escudier B, Flippot R, Albiges L. Safety and efficacy of nivolumab in elderly patients with metastatic clear cell renal cell carcinoma: Analysis of the NIVOREN GETUG-AFU 26 study. Eur J Cancer 2024; 201:113589. [PMID: 38382153 DOI: 10.1016/j.ejca.2024.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors are standard of care in metastatic renal cell carcinoma but their activity and safety in elderly patients is insufficiently explored. We evaluated outcomes of elderly patients with mRCC treated with nivolumab in the GETUG-AFU 26 NIVOREN phase 2 trial (NCT03013335) and conducted exploratory circulating biomarker analyses. METHODS Patients with mRCC were treated with nivolumab after at least one antiangiogenic therapy. The main endpoint of this analysis was safety in patients ≥ 70 years old (y.o), as per the rate of treatment-related grade 3-5 events (TRAE). Secondary endpoints included overall response rate (ORR), progression-free survival (PFS), overall survival. Exploration of candidate biomarkers associated with aging included baseline circulating cytokines involved in inflammation, adhesion, immune checkpoints, angiogenesis (IL6, IL7, IL8, BAFF, CXCL13, VCAM-1, 4-1BB, VEGF). RESULTS Of 720 patients, 515 were < 70 y.o and 205 ≥ 70 y.o. Patients ≥ 70 y.o exhibited numerically less IMDC poor risk disease (21.0% vs 26.9%), sarcomatoid component (4.9% vs 9.8%) or brain metastases (5.9% vs. 14.7%), but more previous treatment lines (≥ 2 in 54.1% vs 48.5%). TRAE were higher in patients ≥ 70 y.o (24.9% vs. 17.9%, p = 0.033). Respective ORR (19.2% vs. 22.1%) and median PFS (4.5 versus 3.0 months, HR 0.97 [95%CI 0.81-1.15]) were similar. Overall survival was shorter in patients ≥ 70 y.o (19.3 versus 26.9 months, HR 1.26 [95%CI 1.04-1.51]), but not significantly in a competitive risk model. Only V-CAM1 and 4-1BB were found to be increased in patients ≥ 70 y.o. CONCLUSIONS Nivolumab displayed higher grade 3/4 TRAE but manageable toxicity in elderly patients, with sustained activity. Elderly patients did not display specific inflammatory or angiogenic circulating profiles.
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Affiliation(s)
- Loïc Mourey
- IUCT-Oncopole Claudius Regaud, Toulouse, France
| | - Larissa Tames Rainho
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | - Lucía Carril-Ajuria
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | | | - Gwenaëlle Gravis
- Institut Paoli-Calmettes, Department of Medical Oncology, Aix Marseille Univ, INSERM, CNRS, CRCM, Immunity and Cancer Team, Marseille, France
| | | | | | | | | | - Marine Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | | | | | | | | | - Nathalie Chaput
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marie Naigeon
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marcus Teixeira
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Bernard Escudier
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France.
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França ARM, Rocha E, Bastos LSL, Bozza FA, Kurtz P, Maccariello E, Lapa E Silva JR, Salluh JIF. Development and validation of a machine learning model to predict the use of renal replacement therapy in 14,374 patients with COVID-19. J Crit Care 2024; 80:154480. [PMID: 38016226 DOI: 10.1016/j.jcrc.2023.154480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To develop a model to predict the use of renal replacement therapy (RRT) in COVID-19 patients. MATERIALS AND METHODS Retrospective analysis of multicenter cohort of intensive care unit (ICU) admissions of Brazil involving COVID-19 critically adult patients, requiring ventilatory support, admitted to 126 Brazilian ICUs, from February 2020 to December 2021 (development) and January to May 2022 (validation). No interventions were performed. RESULTS Eight machine learning models' classifications were evaluated. Models were developed using an 80/20 testing/train split ratio and cross-validation. Thirteen candidate predictors were selected using the Recursive Feature Elimination (RFE) algorithm. Discrimination and calibration were assessed. Temporal validation was performed using data from 2022. Of 14,374 COVID-19 patients with initial respiratory support, 1924 (13%) required RRT. RRT patients were older (65 [53-75] vs. 55 [42-68]), had more comorbidities (Charlson's Comorbidity Index 1.0 [0.00-2.00] vs 0.0 [0.00-1.00]), had higher severity (SAPS-3 median: 61 [51-74] vs 48 [41-58]), and had higher in-hospital mortality (71% vs 22%) compared to non-RRT. Risk factors for RRT, such as Creatinine, Glasgow Coma Scale, Urea, Invasive Mechanical Ventilation, Age, Chronic Kidney Disease, Platelets count, Vasopressors, Noninvasive Ventilation, Hypertension, Diabetes, modified frailty index (mFI) and Gender, were identified. The best discrimination and calibration were found in the Random Forest (AUC [95%CI]: 0.78 [0.75-0.81] and Brier's Score: 0.09 [95%CI: 0.08-0.10]). The final model (Random Forest) showed comparable performance in the temporal validation (AUC [95%CI]: 0.79 [0.75-0.84] and Brier's Score, 0.08 [95%CI: 0.08-0.1]). CONCLUSIONS An early ML model using easily available clinical and laboratory data accurately predicted the use of RRT in critically ill patients with COVID-19. Our study demonstrates that using ML techniques is feasible to provide early prediction of use of RRT in COVID-19 patients.
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Affiliation(s)
- Allan R M França
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.
| | - Eduardo Rocha
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil; Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Pedro Kurtz
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Hospital Copa Star, Rio de Janeiro, RJ, Brazil
| | - Elizabeth Maccariello
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - José Roberto Lapa E Silva
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil; Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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Konda SR, Merrell LA, Esper GW, Gibbons K, Ranson R, Ganta A, Egol KA. No difference in clinical and hospital quality outcomes in treatment of reverse obliquity intertrochanteric Hip fractures (AO/OTA 31.A3) based on Cephalomedullary nail length. Injury 2024; 55:111463. [PMID: 38447479 DOI: 10.1016/j.injury.2024.111463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/06/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate outcomes following reverse obliquity (RO) intertrochanteric hip fractures based on the use of short cephalomedullary nails (CMNs) compared to long CMNs for fixation. METHODS An IRB-approved prospectively collected hip fracture registry at an urban academic medical center was queried for all AO/OTA 31A3.1-3 reverse obliquity intertrochanteric (RO) fractures. One hundred and seventy patients with age > 55 years old and minimum 6-month follow-up were identified for analysis. Data was collected for patient demographics, injury details, intraoperative radiographic parameters, perioperative physiologic parameters, hospital quality measures, and outcomes including radiographic time to healing, need for reoperation, nonunion, and mortality. Comparative analyses were conducted between cohorts. Additional multivariable binary logistic and linear regression analyses were performed to evaluate for factors independently associated with short and long nail usage. RESULTS The mean age of the entire cohort was 80.91±10.09 years: 103 patients had a long CMN implanted, and 67 patients had a short CMN implanted. There were no demographic differences or differences in radiographic time to healing, rates of mortality, readmission, nonunion, and need for reoperation. Univariable analysis revealed that short CMN had lower intraoperative blood loss (111.19±83.97 mL vs 176.72±161.45 mL, p = 0.002), decreased need for transfusion (37% vs. 55 %, p = 0.022), and shorter procedures (118.67±57.87 min vs. 148.95±77.83 min, p = 0.002. Multivariable analysis revealed that short nail usage was associated with decreased intraoperative blood loss, decreased need for transfusion, and shorter operative times. CONCLUSION Nail length does not affect healing or hospital quality outcomes in the treatment of RO hip fractures. The use of short CMNs for these fractures did correlate with lower intraoperative blood loss, operative time, and need for blood transfusion, with non-inferior outcomes and similar hospital quality measures when compared to long CMNs.
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Affiliation(s)
- Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Lauren A Merrell
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Kester Gibbons
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Rachel Ranson
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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Alam A, van Zyl JS, Patel R, Jamil AK, Felius J, Carey SA, Gottlieb RL, Guerrero-Miranda CY, Kale P, Hall SA, Sam T. Three-year outcomes of de novo tacrolimus extended-release tablets (LCPT) compared to twice-daily tacrolimus in adult heart transplantation. Transpl Immunol 2024; 83:102009. [PMID: 38325525 DOI: 10.1016/j.trim.2024.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Extended-release tacrolimus for prophylaxis of allograft rejection in heart transplant (HT) recipients is currently not FDA-approved. One such extended-release formulation of tacrolimus known as LCPT allows once-daily dosing and improves bioavailability compared to immediate-release (IR-) tacrolimus. We compared long-term efficacy and safety of LCPT to IR-tacrolimus applied de novo in adult OHT recipients. METHODS 25 prospective recipients on LCPT at our center from 2017 to 2019 were matched 1:2 with historical control recipients treated with IR-tacrolimus based on age, gender, and baseline creatinine. The primary composite outcome of death, acute cellular rejection, and/or new graft dysfunction within 3 years following transplant was compared between groups using non-inferiority analysis. RESULTS LCPT demonstrated non-inferiority to IR-tacrolimus, with a primary outcome risk reduction of 16% (90%CI, -37%, -1%, non-inferiority p = 0.002) up to 3 years following heart transplant. Up to 3-years post-transplant, 14 patients remained on once-daily LCPT and 10 patients were switched to IR-tacrolimus due to lack of insurance coverage. There were no significant differences in the rate of chronic kidney disease requiring dialysis, cytomegalovirus requiring treatment, cardiac allograft vasculopathy, and malignancy within 3 years following transplant. CONCLUSION LCPT is non-inferior in efficacy to IR-tacrolimus in heart transplantation with a similar safety profile. Narrowly-constrained FDA labels specific to kidney transplant remain a barrier to consistent access to many immunosuppressant medications for recipients of non-kidney solid organs. We recommend the FDA consider developing facile pathways for expanding the approved label of extended-release tacrolimus formulations to heart transplant recipients.
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Affiliation(s)
- Amit Alam
- Division of Cardiology, New York University, New York City, NY, USA
| | - Johanna S van Zyl
- Texas A&M Health Science Center, Dallas, TX, USA; Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Raksha Patel
- Department of Pharmacy, Baylor University Medical Center, Dallas, TX, USA
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Robert L Gottlieb
- Texas A&M Health Science Center, Dallas, TX, USA; Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Cesar Y Guerrero-Miranda
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Parag Kale
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Shelley A Hall
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Teena Sam
- Department of Pharmacy, Baylor University Medical Center, Dallas, TX, USA.
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Jiang W, Brown KGM, Koh C, Karunaratne S, Solomon M, Beckenkamp PR, Cole R, Steffens D. Outcome Heterogeneity in Prehabilitation Trials-Are We Comparing Apples and Oranges? J Surg Res 2024; 296:366-375. [PMID: 38306943 DOI: 10.1016/j.jss.2023.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/11/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Over the last decade, the number of prehabilitation randomised controlled trials (RCTs) has increased significantly. Therefore, this review aimed to describe the outcomes reported in prehabilitation RCTs in patients undergoing cancer surgery. METHODS A search was conducted in Embase, Allied and Complementary Medicine Database, The Cochrane Library, PsycINFO, MEDLINE, and Cumulated Index to Nursing and Allied Health Literature from inception to July 2021. We included RCTs evaluating the effectiveness of preoperative exercise, nutrition, and psychological interventions on postoperative complications and length of hospital stay in adult oncology patients who underwent thoracic and gastrointestinal cancer surgery. The verbatim outcomes reported in each article were extracted, and each outcome was assessed to determine whether it was defined and measured using a validated tool. Verbatim outcomes were grouped into standardized outcomes and categorized into domains. The quality of outcome reporting in each identified article was assessed using the Harman tool (score range 0-6, where 0 indicated the poorest quality). RESULTS A total of 74 RCTs were included, from which 601 verbatim outcomes were extracted. Only 110 (18.3%) of the verbatim outcomes were defined and 270 (44.9%) were labeled as either "primary" or "secondary" outcomes. Verbatim outcomes were categorized into 119 standardized outcomes and assigned into one of five domains (patient-reported outcomes, surgical outcomes, physical/functional outcomes, disease activity, and intervention delivery). Surgical outcomes were the most common outcomes reported (n = 71 trials, 95.9%). The overall quality of the reported outcomes was poor across trials (median score: 2.0 [IQR = 0.00-3.75]). CONCLUSIONS Prehabilitation RCTs display considerable heterogeneity in outcome reporting, and low outcome reporting quality. The development of standardized core outcome sets may help improve article quality and enhance the clinical utility of prehabilitation following cancer surgery.
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Affiliation(s)
- Wilson Jiang
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia
| | - Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia.
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Bria J, Shahait A, Nagle L, White M, Tarras S. No Association of Blood Alcohol Concentration on Burn Patient Outcomes. J Surg Res 2024; 296:766-771. [PMID: 38377703 DOI: 10.1016/j.jss.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Alcohol abuse is common among burn patients. Burn patients under the influence of alcohol are at risk for developing organ failure, prolonged hospital duration, and increased intensive care unit (ICU) resources. Our study aims to analyze the association between presenting alcohol levels and the outcomes of burn patients. METHODS A retrospective analysis of admitted burn patients was performed from 2016 to 2021. Patients were divided into two groups based on blood alcohol content (BAC), low (<80), and high (≥80) mg/dL. Data included demographics, comorbidities, and outcomes. Univariate analyses were performed, and a P value <0.05 was significant. RESULTS A total of 197 patients were included (32.5% females, mean age 47.2 ± 15.2, 26.9% smokers, 28.4% illegal drug abuse, and 56.3% no comorbidities). Mortality was 7.6%, morbidity 20.8%, 39.1% required burn ICU admission, and 25.9% were intubated. When comparing BAC groups, we found no differences in demographics, comorbidities, inhalational injury incidence, carbon monoxide level, intubation, or burn ICU admission rates. The high-BAC group had longer ventilator days (high BAC 16.7 ± 19.3 versus low BAC 7.5 ± 9.1, P = 0.026) and longer stays in the ICU (18.6 ± 21.8 versus 10.7 ± 15.4, P = 0.075). The low-BAC group had more 3rd-degree burn percentage (5.0 ± 15.3 versus 15.4 ± 27.5, P = 0.024). Both morbidity and in-house mortality rates were similar for both groups (23.8% versus 16.0%, P = 0.192, and 6.6% versus 9.3%, P = 0.476, respectively). CONCLUSIONS Burn patients with higher BAC had significantly longer mechanical ventilator days. However, higher alcohol concentrations had no association with regard to mortality, overall length of stay, or complication rates.
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Affiliation(s)
- Justin Bria
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Awni Shahait
- Department of Surgery, Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Luz Nagle
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael White
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Samantha Tarras
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
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Asaithambi G, George MG, Tong X, Lakshminarayan K. Sex-specific racial and ethnic variations in short-term outcomes among patients with first or recurrent ischemic stroke: Paul Coverdell National Acute Stroke Program, 2016-2020. J Stroke Cerebrovasc Dis 2024; 33:107560. [PMID: 38214243 PMCID: PMC10939736 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events. METHODS Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we examined 426,062 ischemic stroke admissions from 629 hospitals limited to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic patients. We performed multivariate logistic regression analyses to assess the combined effects of sex-specific race and ethnicity on short-term outcomes for acute ischemic stroke patients presenting with initial or recurrent stroke events. Outcomes assessed include rates of in-hospital death, discharge to home, and symptomatic intracranial hemorrhage (sICH) after reperfusion treatment. RESULTS Among studied patients, the likelihood of developing sICH after reperfusion treatment for initial ischemic stroke was not significantly different. The likelihood of experiencing in-hospital death among patients presenting with initial stroke was notably higher among NHW males (AOR 1.59 [95 % CI 1.46, 1.73]), NHW females (AOR 1.34 [95 % CI 1.23, 1.45]), and Hispanic males (AOR 1.57 [95 % CI 1.36, 1.81]) when compared to NHB females. Hispanic females were more likely to be discharged home when compared to NHB females after initial stroke event (AOR 1.32 [95 % CI 1.23, 1.41]). NHB males (AOR 0.90 [95 % CI 0.87, 0.94]) and NHW females (AOR 0.89 [95 % CI 0.86, 0.92]) were less likely to be discharged to home. All groups with recurrent ischemic strokes experienced higher likelihood of in-hospital death when compared to NHB females with the highest likelihood among NHW males (AOR 2.13 [95 % CI 1.87, 2.43]). Hispanic females had a higher likelihood of discharging home when compared to NHB females hospitalized for recurrent ischemic stroke, while NHB males and NHW females with recurrent ischemic stroke hospitalizations were less likely to discharge home. CONCLUSIONS Sex-specific race and ethnic disparities remain for short-term outcomes in both initial and recurrent ischemic stroke hospitalizations. Further studies are needed to address disparities among recurrent ischemic stroke hospitalizations.
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Affiliation(s)
- Ganesh Asaithambi
- Allina Health Neuroscience, Spine, and Pain Institute, Minneapolis, MN, USA
| | | | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Sung D, Schmidt B, Tward JD. The Ability of the STAR-CAP Staging System to Prognosticate the Risk of Subsequent Therapies and Metastases After Initial Treatment of M0 Prostate Cancer. Clin Genitourin Cancer 2024; 22:426-433.e5. [PMID: 38290900 DOI: 10.1016/j.clgc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION The International Staging Collaboration for Prostate Cancer (STAR-CAP) has been proposed as a risk model for prostate cancer with superior prognostic power compared to the current staging system. This study aimed to evaluate the performance of STAR-CAP in predicting the risk of subsequent therapy after initial treatment and the risk of developing metastases. PATIENTS AND METHODS The study included 3425 men from an institutional observational registry with a median age of 64.9 years and a median follow-up time of 5.4 years. The primary endpoints were metastases and progression to additional therapy after initial therapy (radiation ± surgery). The risk of progression in the STAR-CAP group was estimated using a competing risk model (death). RESULTS The results showed that patients with STAR-CAP stages 1A-1C had a similar risk of requiring additional therapies and developing metastasis. Compared to stage IC, each stage from 2A to 3B incrementally increased the risk of subsequent therapy (hazard ratio (HR) 1.4-5.8, respectively) and metastases (HR 1.5-10.8, respectively). The 5-year probability of receiving subsequent therapy for a patient with stage IC was 8.6%, which increased from 11.4% to 37.4% for those with stages 2A to 3B. The 5-year probability of developing metastases for patients with stage IC was 1.5%, which increased from 2.2% to 8.2% for patients with stages 2A to 3B. CONCLUSIONS The probability of receiving subsequent therapy was higher for patients undergoing surgery, while radiation therapy patients were more likely to receive treatment with intensified multimodality therapies upfront.
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Affiliation(s)
- Daeun Sung
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Bogdana Schmidt
- Division of Urology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Jonathan David Tward
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.
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21
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Mormol J, Krech L, Pounders S, Fisk C, Chapman A, Karek M, Hing KK. Protect the neck: Devastating outcomes of cervical spine fractures in the elderly. Am J Surg 2024; 230:35-38. [PMID: 38061940 DOI: 10.1016/j.amjsurg.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Cervical spine fractures are associated with high mortality in elderly patients. This study aims to identify patient-related and in-hospital factors contributing to this mortality. METHODS A 3-year retrospective study of 235 patients aged 65+ presenting with cervical spine fractures was performed. Age cohorts were 65-74, 75-84, and 85+ years. Mortality was measured at 30, 90, 180 and 365-days post-discharge. RESULTS Mortality was 11 %, 15 %, 19 %, and 22 % at 30-, 90-, 180- and 365-days respectively. Surgery and fracture pattern was not associated with mortality (p = 0.37; p = 0.28). Charlson Comorbidity Index (p < 0.001; hazard ratio [HR] = 1.3), functional dependency (p < 0.001; HR = 2.5) and delirium (p < 0.001; HR = 8.9) were associated with mortality between 0 and 365 days post-discharge. CONCLUSIONS Mortality in cervical spine fractures is associated with CCI and delirium, but not associated with operative management or fracture pattern. This suggests the need for careful consideration in patient selection for cervical spine procedures and aggressive inpatient delirium management.
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Affiliation(s)
- Jeremy Mormol
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA.
| | - Laura Krech
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
| | - Steffen Pounders
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
| | - Chelsea Fisk
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
| | - Alistair Chapman
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
| | - Matthew Karek
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
| | - Kailyn Kwong Hing
- Division of Acute Care Surgery, Corewell Health- West Butterworth Hospital, MI, USA
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22
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Mineva G, Culleton E, Falusi T, Ryan D. Outcomes of abdominal pain among children presenting to the Emergency Department of a tertiary hospital in the Republic of Ireland before and during the COVID-19 pandemic. Ir J Med Sci 2024; 193:1033-1041. [PMID: 37851331 DOI: 10.1007/s11845-023-03547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance. AIMS We compare the burden of paediatric abdominal pain 1 year before and after the start of the COVID-19 pandemic in an Irish ED. METHODS A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS® software. RESULTS Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%). CONCLUSIONS The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes.
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Affiliation(s)
- Gabriela Mineva
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland.
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Emma Culleton
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Tolulope Falusi
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Damien Ryan
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- ALERT, Emergency Department, University Hospital Limerick, St. Nessan's Road, Limerick, Ireland
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23
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Baxter SN, Johnson AH, Brennan JC, MacDonald JH, Turcotte JJ, King PJ. Social vulnerability adversely affects emergency-department utilization but not patient-reported outcomes after total joint arthroplasty. Arch Orthop Trauma Surg 2024; 144:1803-1811. [PMID: 38206446 DOI: 10.1007/s00402-023-05186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Multiple studies demonstrate social deprivation is associated with inferior outcomes after total hip (THA) and total knee (TKA) arthroplasty; its effect on patient-reported outcomes is debated. The primary objective of this study evaluated the relationship between social vulnerability and the PROMIS-PF measure in patients undergoing THA and TKA. A secondary aim compared social vulnerability between patients who required increased resource utilization or experienced complications and those who didn't. MATERIALS AND METHODS A retrospective review of 537 patients from March 2020 to February 2022 was performed. The Centers for Disease Control Social Vulnerability Index (SVI) were used to quantify socioeconomic disadvantage. The cohort was split into THA and TKA populations; univariate and multivariate analyses were performed to evaluate primary and secondary outcomes. Statistical significance was assessed at p < 0.05. RESULTS 48.6% of patients achieved PROMIS-PF MCID at 1-year postoperatively. Higher levels of overall social vulnerability (0.40 vs. 0.28, p = 0.03) were observed in TKA patients returning to the ED within 90-days of discharge. Increased overall SVI (OR = 9.18, p = 0.027) and household characteristics SVI (OR = 9.57, p = 0.015) were independent risk factors for 90-day ED returns after TKA. In THA patients, increased vulnerability in the household type and transportation dimension was observed in patients requiring 90-day ED returns (0.51 vs. 0.37, p = 0.04). CONCLUSION Despite an increased risk for 90-day ED returns, patients with increased social vulnerability still obtain good 1-year functional outcomes. Initiatives seeking to mitigate the effect of social deprivation on TJA outcomes should aim to provide safe alternatives to ED care during early recovery.
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Affiliation(s)
- Samantha N Baxter
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA
| | - Andrea H Johnson
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA
| | - Jane C Brennan
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA
| | - James H MacDonald
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA
| | - Justin J Turcotte
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA.
| | - Paul J King
- Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA
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Kehlet H, Lobo DN. Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review. EClinicalMedicine 2024; 70:102510. [PMID: 38444430 PMCID: PMC10912044 DOI: 10.1016/j.eclinm.2024.102510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
"Enhanced recovery after surgery" is a multimodal effort to control perioperative pathophysiology and improve outcome. However, despite advances in perioperative care, postoperative complications and the need for hospitalisation and prolonged recovery continue to be challenging. This is further complicated by procedure-specific and patient-associated risk factors, given the increase in the number of elderly and frail patients with multiple comorbidities undergoing surgery. This paper is a critical assessment of current methodology for trials in perioperative medicine. We make a plea to reconsider the design of future interventional trials to improve surgical outcome, based upon studies of potentially effective interventions, but often without improvements in recovery. The complexity of perioperative pathophysiology necessitates a procedure- and patient-specific approach whenever outcome is assessed or interventions are planned. With improved understanding of perioperative pathophysiology, the way to improve outcomes looks promising, provided that knowledge and established enhanced recovery programmes are integrated in trial design. Funding None.
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Affiliation(s)
- Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dileep N. Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kelly BS, Mathur P, Vaca SD, Duignan J, Power S, Lee EH, Huang Y, Prolo LM, Yeom KW, Lawlor A, Killeen RP, Thornton J. iSPAN: Explainable prediction of outcomes post thrombectomy with Machine Learning. Eur J Radiol 2024; 173:111357. [PMID: 38401408 DOI: 10.1016/j.ejrad.2024.111357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE This study aimed to develop and evaluate a machine learning model and a novel clinical score for predicting outcomes in stroke patients undergoing endovascular thrombectomy. MATERIALS AND METHODS This retrospective study included all patients aged over 18 years with an anterior circulation stroke treated at a thrombectomy centre from 2010 to 2020 with external validation. The primary outcome was day 90 mRS ≥3. Existing clinical scores (SPAN and PRE) and Machine Learning (ML) models were compared. A novel clinical score (iSPAN) was derived by adding an optimised weighting of the most important ML features to the SPAN. RESULTS 812 patients were initially included (397 female, average age 73), 63 for external validation. The best performing clinical score and ML model were SPAN and XGB (sensitivity, specificity and accuracy 0.290, 0.967, 0.628 and 0.693, 0.783, 0.738 respectively). A significant difference was found overall and our XGB model was more accurate than SPAN (p < 0.0018). The most important features were Age, mTICI and total number of passes. The addition of 11 points for mTICI of ≤2B and 3 points for ≥3 passes to the SPAN achieved the best accuracy and was used to create the iSPAN. iSPAN was not significantly less accurate than our XGB model (p > 0.5). In the external validation set, iSPAN and SPAN achieved sensitivity, specificity, and accuracy of (0.735, 0.862, 0.79) and (0.471, 0.897, 0.67) respectively. CONCLUSION iSPAN incorporates machine-derived features to achieve better predictions compared to existing clinical scores. It is not inferior to our XGB model and is externally generalisable.
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Affiliation(s)
- Brendan S Kelly
- St Vincent's University Hospital, Dublin, Ireland; Insight Centre for Data Analytics, UCD, Dublin, Ireland; Wellcome Trust - HRB, Irish Clinical Academic Training, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland; Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA.
| | | | - Silvia D Vaca
- Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA
| | - John Duignan
- Department of Radiology, Beaumont Hospital Dublin, Ireland
| | - Sarah Power
- Department of Neurointerventional Radiology, Beaumont Hospital Dublin, Ireland
| | - Edward H Lee
- Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA
| | - Yuhao Huang
- Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA
| | - Laura M Prolo
- Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA
| | - Kristen W Yeom
- Lucille Packard Children's Hospital at Stanford, Stanford, CA, USA
| | | | | | - John Thornton
- Department of Neurointerventional Radiology, Beaumont Hospital Dublin, Ireland; School of Medicine, Royal College of Surgeons in Ireland, Ireland
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Dolan DP, Lee DN, Bharat A, Lung K, Odell D, Kim S. Chemical Localization With Robotic Bronchoscopy: Can It Aid Resection of Subsolid Lung Nodules? J Surg Res 2024; 296:93-97. [PMID: 38244320 DOI: 10.1016/j.jss.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Subsolid nodules or those located deep in lung parenchyma are difficult to localize using minimally invasive thoracic surgery. While image-guided percutaneous needle localization has been performed, it is inconvenient and has potential complications. In this study, the role of chemical localization using robotic bronchoscopy to facilitate resection was evaluated. METHODS Consecutive patients undergoing surgical resection for lung nodules between 8/2019-3/2022 were included. Patients with subsolid lung nodules, or small nodules deep in lung parenchyma that were deemed difficult to localize, were chemically localized (CL) using robotic bronchoscopy before resection. Clinico-demographic data were obtained retrospectively using a prospectively maintained database. RESULTS Localization of lung nodules before resection was performed in 139 patients while 110 patients were not localized. Daily activity score was higher for localized patients. Nodules in the localized group were smaller (P < 0.001) and had similar solid:ground glass ratio. In the localized group, larger margins were observed, and no re-resection of the parenchymal margin was required. Twenty patients in the non-localized group required re-resection intraoperatively due to close pathological margins or inability to locate the nodule in the resected specimen. Operative time was a median of 10-15 min longer for localized patients, P < 0.001. Length of stay was shorter in the localized group (P < 0.05). CONCLUSIONS Chemical localization of lung nodules using robotic bronchoscopy appears to be a safe and effective method of identifying the location of nodules with small size and less density and aids increased tumor margins intraoperatively.
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Affiliation(s)
- Daniel P Dolan
- Department of Surgery, Northwestern Memorial Hospital, Surgical Outcomes and Quality Improvement Center, Chicago, Illinois; Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel N Lee
- Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Department of Surgery, Northwestern Memorial Hospital, Surgical Outcomes and Quality Improvement Center, Chicago, Illinois; Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kalvin Lung
- Department of Surgery, Northwestern Memorial Hospital, Surgical Outcomes and Quality Improvement Center, Chicago, Illinois; Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Odell
- Department of Surgery, Northwestern Memorial Hospital, Surgical Outcomes and Quality Improvement Center, Chicago, Illinois; Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel Kim
- Department of Surgery, Northwestern Memorial Hospital, Surgical Outcomes and Quality Improvement Center, Chicago, Illinois; Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Primmaz S, Rochat Negro T, Suh N, Le Terrier C, Wozniak H, Pugin J, Bendjelid K. Pulmonary embolism impacts clinical outcomes of intubated patients with acute respiratory distress syndrome related to COVID-19. Anaesth Crit Care Pain Med 2024; 43:101348. [PMID: 38278355 DOI: 10.1016/j.accpm.2024.101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Pulmonary embolism (PE) in critically ill patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 is a major complication which might impact survival. We aimed to determine the prevalence of PE and assess its impact of PE on clinical outcomes in intubated patients with ARDS due to COVID-19. METHODS All intubated patients with ARDS due to COVID-19 admitted to the intensive care unit (ICU) of Geneva University Hospitals between March 9, 2020, and May 31, 2022, were included. A retrospective analysis was conducted on the occurrence of PE and its association with clinical outcomes. The primary outcome was ventilator-free days during the first 28 days after ICU admission. Linear regressions were performed to investigate the association between PE and outcomes. RESULTS Among the 370 intubated patients with ARDS related to COVID-19, 58 (15.7%) presented with PE. Patients with PE had significantly fewer ventilator-free days than patients without PE (median (IQR) of 3 (0-11) days versus 12 (0-19) days; p < 0.001). Mortality did not differ significantly between groups (12/58 [20.7%] of patients with PE versus 71/312 [22.8%] of patients without PE; p = 0.72). Duration of IMV, and ICU and hospital LOS were significantly longer among patients with PE. The need for ECMO support was similar among both groups. CONCLUSIONS The occurrence of PE in patients with ARDS due to COVID-19 had a significant impact on clinical outcomes. They had fewer ventilator-free days, longer duration of IMV, and longer ICU and hospital lengths of stay. However, pulmonary embolism was not associated with higher mortality. ETHICS APPROVAL Ethical committee of Geneva (BASEC #: 2020-00917).
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Affiliation(s)
- Steve Primmaz
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - Tommaso Rochat Negro
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Noémie Suh
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Christophe Le Terrier
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Hannah Wozniak
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Karim Bendjelid
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
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Tao M, Dhaliwal S, Ghosalkar D, Sheng S, Dianati-Maleki N, Tam E, Rahman T, Mann N, Kort S. Utility of native T1 mapping and myocardial extracellular volume fraction in patients with nonischemic dilated cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2024; 51:101339. [PMID: 38371310 PMCID: PMC10873728 DOI: 10.1016/j.ijcha.2024.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 02/20/2024]
Abstract
Background Cardiac magnetic resonance imaging (CMR) based T1 mapping and extracellular volume fraction (ECV) are powerful tools for identifying myocardial fibrosis. This systematic review and meta-analysis aims to characterize the utility of native T1 mapping and ECV in patients with non-ischemic cardiomyopathy (NICM) and to clarify the prognostic significance of elevated values. Methods A literature search was conducted for studies reporting on use of CMR-based native T1 mapping and ECV measurement in NICM patients and their association with major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR). Databases searched included: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results Native T1 and ECV were significantly higher in NICM patients compared to controls (MD 78.80, 95 % CI 50.00, 107.59; p < 0.01; MD 5.86, 95 % CI 4.55, 7.16; p < 0.01). NICM patients who experienced MACE had higher native T1 and ECV (MD 52.87, 95 % CI 26.59, 79.15; p < 0.01; MD 6.03, 95 % CI 3.79, 8.26; p < 0.01). There was a non-statistically significant trend toward higher native T1 time in NICM patients who experienced VAs. NICM patients who were poor treatment responders had higher baseline native T1 and ECV (MD 40.58, 95 % CI 12.90, 68.25; p < 0.01; MD 3.29, 95 % CI 2.25, 4.33; p < 0.01). Conclusions CMR-based native T1 and ECV quantification may be useful tools for risk stratification of patients with NICM. They may provide additional diagnostic utility in combination with LGE, which poorly characterizes fibrosis in patients with diffuse myocardial involvement.
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Affiliation(s)
- Michael Tao
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Simrat Dhaliwal
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Dhairyasheel Ghosalkar
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Siyuan Sheng
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Neda Dianati-Maleki
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Edlira Tam
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Tahmid Rahman
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Noelle Mann
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Smadar Kort
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
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Giribabu P, Karan N, Sriganesh K, Shukla D, Devi BI. Incidence, risk factors and impact of anemia after elective neurosurgery: A retrospective cohort study. World Neurosurg X 2024; 22:100289. [PMID: 38444872 PMCID: PMC10914572 DOI: 10.1016/j.wnsx.2024.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Objectives Anemia after surgery is common and is associated with adverse clinical outcomes. Understanding the incidence and risk factors for postoperative anemia is important to reduce anemia-related complications and blood transfusion. There is lack of data regarding postoperative anemia and its contributing factors in neurosurgery. This study evaluates the incidence and risk factors of postoperative anemia, and its impact on clinical outcomes. Methods This was a single centre, retrospective study of patients who underwent elective neurosurgery over seven months. Data regarding age, gender, body mass index, American Society of Anesthesiologists (ASA) physical status, diagnosis, surgery, preoperative hemoglobin, surgery duration, intraoperative blood loss and red blood cell (RBC) transfusion, dose of tranexamic acid, intraoperative fluid balance, years of surgeon's experience, postoperative hemoglobin, postoperative RBC transfusion, Glasgow Coma Scale (GCS) score at hospital discharge, and duration of postoperative intensive care unit and hospital stay were collected. Logistic regression was used to identify predictors of postoperative anemia. Results The incidence of postoperative anemia was 11.3% (116/1025). On univariate analysis; age, preoperative hemoglobin, surgery duration, gender, ASA grade, surgery type, and surgeon's experience were associated with postoperative anemia. Lower preoperative hemoglobin (p<0.001) and non-tumor surgery (p<0.001) were predictive of postoperative anemia on multivariate analysis. Postoperative anemia resulted in increased RBC transfusion (p<0.001) and lower GCS score at discharge (p=0.012). Conclusions Atleast one in ten patients undergoing elective neurosurgery develop postoperative anemia. Lower preoperative hemoglobin and non-tumor surgery predict anemia. Anemia results in increased RBC transfusion and lower discharge GCS score.
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Affiliation(s)
- Parthiban Giribabu
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences Bengaluru, India
| | - Nupur Karan
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences Bengaluru, India
| | - Kamath Sriganesh
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences Bengaluru, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Ploussard G, Kesch C, Calleris G, Buhas B, Salin A, Almeras C, Loison G, Lesourd M, Tollon C, Pradère B, Beauval JB. From an On-site Program to a Mobile App for Prehabilitation and Rehabilitation for Robotic Radical Prostatectomy: Lessons Learned from 5 Years of Experience, the COVID-19 Outbreak, and Comparison with Nationwide Data. Eur Urol Oncol 2024; 7:297-299. [PMID: 37865569 DOI: 10.1016/j.euo.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
Prehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes. During the study period, we observed continuous improvements in the same-day discharge rate (from 0% to 26.4%), hospital stay (from 3 to 0.9. d), costs (-63%), days out of hospital within 30 d after surgery in our center, and in comparison to contemporary nationwide data. However, despite these advantages, maintenance and diffusion of this program could be challenging owing to the absence of incentive support and lack of human resources. This led us to develop two free-access mobile apps, available on the app stores for both patients and surgeons, that include checklists, remote monitoring, and multiple educational materials aimed at simplifying the widespread use of optimized perioperative pathways. PATIENT SUMMARY: We found that a prehabilitation program before surgery can help in optimizing patient outcomes after robot-assisted removal of the prostate. We translated this program into a mobile app available for every patient.
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Affiliation(s)
| | - Claudia Kesch
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Giorgio Calleris
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Bogdan Buhas
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Marine Lesourd
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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Sraya R, Amsalem I, Carasso S, Gilad O, Asher E, Dvir D, Harari E, Glikson M, Marmor D, Shuvy M. Mitral valve gradient changes associate with outcomes of patients undergoing transcatheter edge-to-edge repair. Int J Cardiol 2024; 400:131766. [PMID: 38211677 DOI: 10.1016/j.ijcard.2024.131766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Transcatheter edge-to-edge repair (TEER) is typically used to treat mitral regurgitation (MR) in patients with high surgical risk. Increased post-procedural mitral valve gradient (MVG) may impact mortality and hospitalizations. We aim to evaluate and compare the absolute postprocedural MVG and the change in the MVG effect on outcomes for patients undergoing TEER therapy. METHODS Patients who underwent TEER for severe MR were divided into two groups, initially by postprocedural absolute MVG, TTE-based at discharge, and then by the difference between preprocedural and postprocedural MVG. Primary endpoints included all-cause mortality and heart failure hospitalization (HFH) during one year after the procedure. RESULTS The study included 100 patients. The mean MVG increased from 3.39 mmHg immediately after the procedure to 4.83 mmHg the following day, an increase of 1.44 mmHg (p < 0.001). First stratification was by MVG on the day following the procedure - MVG ≤5 mmHg (n = 70) and MVG >5 mmHg (n = 30). There was no significant difference in rates of survival (88.6%, 93.3%, p = 0.716) or HFH (18.6%, 33.3%, p = 0.178). Second stratification was by the difference in preprocedural and postprocedural MVG- delta MVG <3 mmHg (n = 55) and delta MVG ≥3 mmHg (n = 45). While survival rates did not significantly differ (87.3% vs. 93.3%, p = 0.503), delta MVG ≥3 mmHg correlated with higher HFH rates (12.7% vs. 35.6%, p = 0.014). CONCLUSIONS The MVG of patients undergoing TEER usually increases on the day after the procedure compared to the immediate post-procedure MVG. Higher delta MVG is associated with higher HFH rate.
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Affiliation(s)
- Roni Sraya
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Or Gilad
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Emanuel Harari
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mony Shuvy
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Westall GP, Barnes H, Levin K, Gaffney N, Harris J, Martinez O, Emsley C, Fuller L, Levvey B, Snell GI, Winton-Brown T. Utility of the Stanford Integrated Psychosocial Assessment for Transplant in predicting outcomes before and after lung transplantation. J Heart Lung Transplant 2024; 43:571-579. [PMID: 38000763 DOI: 10.1016/j.healun.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Optimizing donor use and achieving maximal survival following lung transplantation (LTx) require a pretransplant assessment that identifies clinical, physiological, and psychosocial patient factors associated with both poor and optimal post-LTx survival. We examined the utility of a psychosocial tool, the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), to identify patient suitability for LTx, as well as its association with clinical outcomes before and after LTx. METHODS This was a retrospective single-center study analyzing LTx assessment clinical variables (age, gender, diagnosis, functional capacity, nutrition, renal function), with a particular focus on the utility of the SIPAT score, to predict patient suitability for LTx. The same variables were analyzed against LTx waitlist mortality, as well as post-LTx survival. RESULTS Over an 8-year period dating from December 2012, 914 patients (male 54.4%, mean age 55.2 years) underwent LTx assessment. Patients declined for LTx (n = 152, 16.6%) were older and had reduced functional capacity, nutritional markers, and renal function but had a higher SIPAT score. Once listed for LTx, a higher SIPAT score was not associated with waitlist mortality or reduced post-LTx survival. CONCLUSIONS The SIPAT tool measures psychosocial suitability for transplantation that can be incorporated into a standardized assessment of LTx suitability. While patients with higher SIPAT score were more likely to be declined for LTx, the SIPAT score did not predict outcome in transplanted patients. A subgroup of patients with high SIPAT scores were successfully transplanted, suggesting that unfavorable psychosocial variables are potentially modifiable with a well-resourced multidisciplinary LTx team.
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Affiliation(s)
- Glen P Westall
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Kovi Levin
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Nicole Gaffney
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Jane Harris
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Otto Martinez
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Christie Emsley
- Department of Nutrition, Alfred Health, Melbourne, Australia
| | - Louise Fuller
- Central Clinical School, Monash University, Melbourne, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Bronwyn Levvey
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Greg I Snell
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Toby Winton-Brown
- Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia
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Scheer JK, Ames CP. Artificial Intelligence in Spine Surgery. Neurosurg Clin N Am 2024; 35:253-262. [PMID: 38423741 DOI: 10.1016/j.nec.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The amount and quality of data being used in our everyday lives continue to advance in an unprecedented pace. This digital revolution has permeated healthcare, specifically spine surgery, allowing for very advanced and complex computational analytics, such as artificial intelligence (AI) and machine learning (ML). The integration of these methods into clinical practice has just begun, and the following review article will describe AI/ML, demonstrate how it has been applied in adult spinal deformity surgery, and show its potential to improve patient care touching on future directions.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA.
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Zamirpour S, Xuan Y, Wang Z, Gomez A, Leach JR, Mitsouras D, Saloner DA, Guccione JM, Ge L, Tseng EE. Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm. Int J Cardiol Heart Vasc 2024; 51:101375. [PMID: 38435381 PMCID: PMC10909604 DOI: 10.1016/j.ijcha.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/13/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Objectives Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up. Methods Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models. Results Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55). Conclusions Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events.
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Affiliation(s)
- Siavash Zamirpour
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
- School of Medicine, University of California, San Francisco, USA
| | - Yue Xuan
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Zhongjie Wang
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Axel Gomez
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Joseph R. Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - David A. Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Julius M. Guccione
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Liang Ge
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Elaine E. Tseng
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
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Shaikh PA, Som A, Deych E, Deng AJ, Reimers MA, Baumann BC, Kim EH, Lenihan DJ, Zhang KW. Incidental Coronary Arterial Calcification for Cardiovascular Risk Assessment in Men With Prostate Cancer Undergoing PET/CT Imaging. Clin Genitourin Cancer 2024; 22:586-592. [PMID: 38369389 DOI: 10.1016/j.clgc.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Cardiovascular (CV) disease is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting. METHODS Consecutive patients who underwent positron emission tomography/computed tomography (PET/CT) for recurrent prostate cancer at a single institution from 2012 to 2017 were identified retrospectively. Clinical data and coronary calcification on nongated CT imaging were obtained. The primary outcome was major adverse CV event (MACE; myocardial infarction, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality) occurring within 5 years of PET/CT. RESULTS Among 354 patients included in the study, there were 98 MACE events that occurred in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%). Coronary calcification was predictive of MACE (HR = 1.9, 95% CI: 1.1-3.4, P = .03) using adjusted Kaplan-Meier analysis. As a comparator, the Framingham risk score was calculated for 198 patients (56%) with complete clinical and laboratory data available. In this subgroup, high baseline Framingham risk (corresponding to 10-year risk of CV disease > 20%) was not predictive of MACE. CONCLUSIONS MACE was common (21%) in men with recurrent prostate cancer undergoing PET/CT over 5 years of follow-up. Incidental coronary calcification on PET/CT was associated with increased risk of MACE and may have utility as a CV risk predictor that is feasible to implement among all prostate cancer providers.
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Affiliation(s)
- Preet A Shaikh
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Avira Som
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Elena Deych
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Alison J Deng
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | - Melissa A Reimers
- Division of Oncology, Section of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO
| | | | - Kathleen W Zhang
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Abildgaard N, Anttila P, Waage A, Rubin KH, Ørstavik S, Bent-Ennakhil N, Gavini F, Ma Y, Freilich J, Hansson M. Real-world treatment patterns and outcomes for patients with multiple myeloma in Denmark, Finland and Sweden: An analysis using linked Nordic registries. Eur J Cancer 2024; 201:113921. [PMID: 38377776 DOI: 10.1016/j.ejca.2024.113921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
AIM The Health outcomes and Understanding of MyelomA multi-National Study (HUMANS) was a large-scale, retrospective study conducted across Denmark, Finland and Sweden using linked data from national registries. We describe the characteristics, treatment patterns and clinical outcomes for patients with newly diagnosed multiple myeloma (NDMM) over 2010-2018. METHODS Patients with NDMM who received MM-specific, first-line treatments, were categorised by treatment (autologous stem cell transplantation [ASCT] or a combination chemotherapy regimen based on bortezomib, lenalidomide or melphalan-prednisolone-thalidomide). RESULTS 11,023 patients received treatment over 2010-2018. Time between diagnosis and treatment was shortest in Denmark (0.9 months), then Sweden (2.9 months) and Finland (4.6 months). Around one third of patients underwent ASCT. Lenalidomide-based regimens were prescribed to 23-28% of patients in Denmark and Finland, versus 12% in Sweden. Patients receiving lenalidomide had the longest wait for treatment, from 3.2 months (Denmark) to 12.1 months (Sweden). Treatment persistence was highest among patients receiving melphalan-prednisolone-thalidomide (7-8 months) in Finland and Sweden and lowest among those receiving bortezomib (3.5 months) in Finland. Overall survival (OS) was longest among patients with ASCT (7-10 years). Among patients receiving chemotherapy, OS (from diagnosis/treatment initiation), varied between cohorts. In a sensitivity analysis excluding patients with smouldering MM, OS decreased for all; for patients receiving bortezomib or lenalidomide, OS from diagnosis was 40-49 and 27-54 months, respectively. CONCLUSIONS This population-based study of patients with NDMM receiving first-line MM-specific treatment, provides real-world data on treatment patterns and outcomes to complement data from randomised clinical trials.
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Affiliation(s)
- Niels Abildgaard
- Hematology Research Unit, Department of Hematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Pekka Anttila
- Comprehensive Cancer Center, Department of Hematology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Anders Waage
- Department of Hematology, St Olav's University Hospital, Trondheim, Norway
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - François Gavini
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Yuanjun Ma
- Parexel International, Stockholm, Sweden
| | - Jonatan Freilich
- Parexel International, Stockholm, Sweden; Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
| | - Markus Hansson
- Sahlgrenska Academy and Sahlgrenska University Hospital, Göteborg, Sweden
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Kayani B, Bengoa F, Howard LC, Neufeld ME, Masri BA. Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes. Orthop Clin North Am 2024; 55:181-192. [PMID: 38403365 DOI: 10.1016/j.ocl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Although one-stage exchange arthroplasty is gaining popularity, two-stage exchange arthroplasty remains the gold standard for the treatment of periprosthetic joint infections. Use of an articulating spacer for this procedure offers an avenue for maintaining hip motion and controlled weight-bearing, allowing local antibiotic elution. However, there is no uniform consensus on the optimal surgical protocol for using articulating spacers. This review describes the surgical technique for undertaking a first-stage exchange arthroplasty using an articulating spacer and discusses the pertinent literature on key concepts relating to periprosthetic joint infections in total hip arthroplasty to guide effective surgical decision making in these patients.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Francisco Bengoa
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Park F, Grigorian A, Swentek L, Kuza C, Kong A, Russell D, Nahmias J. Blunt Adrenal Injury is Not Associated With Worse Outcomes in Adult Trauma Patients. J Surg Res 2024; 296:115-122. [PMID: 38277946 DOI: 10.1016/j.jss.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Blunt adrenal injury is rare. Given production of hormones including catecholamines, adrenal injury may lead to worse outcomes. However, there is a paucity of literature on this topic. As such, we compared blunt trauma patients (BTPs) with and without adrenal injuries, hypothesizing similar mortality and complications between cohorts. METHODS The 2017-2019 Trauma Quality Improvement Program database was queried for adult (≥18-year-old) BTPs. Patients with penetrating trauma, traumatic brain injury, severe thoracic injury, or who were transferred from another hospital were excluded. Patients with adrenal injury were compared to those without using a 1:2 propensity score model. Matched variables included patient age, comorbidities, vitals on admission and concomitant injuries (i.e., liver, spleen, kidney, pancreas, and hollow viscus). Univariable logistic regression was then performed for associated risk of mortality. RESULTS 2287 (0.2%) BTPs had an adrenal injury, with 1470 patients with adrenal injury matched to 2940 without adrenal injury. The rate of all complications including sepsis (0.1% versus 0.0%) was similar between cohorts (all P > 0.05). Patients with adrenal injury had a lower rate of mortality (0.1% versus 0.6%, P = 0.035) but increased length of stay (4 [3-6] versus 3 [2-5] days, P = 0.002). However, there was no difference in associated risk of mortality for patients with and without adrenal injury (odds ratio = 0.234; confidence interval = 0.54-1.015; P = 0.052). CONCLUSIONS Blunt adrenal injury occurred in <1% of patients. After propensity matching, there was a similar associated rate of complications but longer hospital length of stay for patients with adrenal injury. Adrenal injury was not associated with an increased risk of mortality.
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Affiliation(s)
- Flora Park
- School of Medicine, University of California, Irvine, Irvine, California
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Lourdes Swentek
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Catherine Kuza
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Allen Kong
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Dylan Russell
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California.
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Zhuxiao R, Jiangxue H, Yongsheng L, Jingjun P, Shuo Y, Fang X, Qi Z, Shandan Z, Chuan N, Jie Y. Umbilical cord blood cell characteristics in very preterm neonates for autologous cell therapy of preterm-associated complications. BMC Pediatr 2024; 24:214. [PMID: 38528484 DOI: 10.1186/s12887-024-04678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND There are emerging clinical evidence for umbilical cord blood mononuclear cells (UCBMNCs) intervention to improve preterm complications. The first critical step in cell therapy is to obtain high-quality cells. This retrospective study aimed to investigate the quantity and quality of UCBMNCs from very preterm infants (VPIs) for the purpose of autologous cell therapy in prevention and treatment of preterm complications. METHODS Very preterm infants (VPIs) born in Guangdong Women and Children Hospital from January 1, 2017, to December 8, 2022, from whom cord blood was successfully collected and separated for public or private banking, were enrolled. The UCBMNCs characters from route cord blood tests performed in cord blood bank, impact of perinatal factors on UCBMNCs, the relationship between UCBMNCs characteristics and preterm outcomes, and the correlation of UCBMNCs characteristics and peripheral blood cells in VPIs were analyzed. RESULTS Totally, 89 VPIs underwent UCB collection and processing successfully. The median cell number post processing was 2.6 × 108. To infuse a dose of 5 × 107 cells/kg, only 3.4% of infants required a volume of more than 20 mL/kg, which exceeded the maximum safe volume limit for VPIs. However, when infusing 10 × 107 cells/kg, 25.8% of infants required a volume of more than 20 ml/kg volume. Antenatal glucocorticoids use and preeclampsia was associated with lower original UCBMNCs concentration. Both CD34+ hematopoietic stem cells (HSC) frequency and colony forming unit - granulocyte and macrophage (CFU-GM) number correlated negatively with gestational age (GA). UCBMNCs characters had no significant effect on preterm outcomes, whereas a significant positive correlation was observed between UCBMNCs concentration and total white blood cell, neutrophil, lymphocyte and PLT counts in peripheral blood. CONCLUSION UCBMNCs collected from VPIs was feasible for autologous cell therapy in improving preterm complications. Setting the infusion dose of 5 × 107 cells/kg guaranteed a safe infusion volume in more than 95% of the targeted infants. UCBMNCs characters did not affect preterm complications; however, the effect of UCBMNCs concentration on peripheral blood classification count should be considered when evaluating the immunomodulation of UCBMNCs transfusion.
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Affiliation(s)
- Ren Zhuxiao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China
| | - Han Jiangxue
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Li Yongsheng
- Guangdong Cord Blood Bank, Guangzhou, 511440, China
| | - Pei Jingjun
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, 511400, China
| | - Yang Shuo
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xu Fang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China
| | - Zhang Qi
- Department of Clinic Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, 511442, China
| | - Zhang Shandan
- Department of Neonatology, The Maternal and Child Health Care Hospital of HuaDu District, GuangZhou City, Guangdong Medical University, Guangzhou, 510800, China
| | - Nie Chuan
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China.
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China.
- Department of Clinic Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, 511442, China.
| | - Yang Jie
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, 511400, China.
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Kadhum M, Khan K, Al-Ghanim K, Castanov V, Symonette C, Javed MU. Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes. Aesthetic Plast Surg 2024:10.1007/s00266-024-03977-4. [PMID: 38528125 DOI: 10.1007/s00266-024-03977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. METHODS The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. RESULTS Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). CONCLUSION Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). LEVEL OF EVIDENCE III Rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | - Karishma Khan
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Valera Castanov
- London Health Sciences Centre (LHSC), London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
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Shweikeh F, Hong G, Rogers K, Mouchli M, Hoscheit M, Lembo A. Colonoscopy Utilization in Elderly Patients with Dementia: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis. Dig Dis Sci 2024:10.1007/s10620-024-08363-3. [PMID: 38528210 DOI: 10.1007/s10620-024-08363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND It is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia. AIMS Our aims are to describe the utilization of colonoscopy among patients with dementia and compare outcomes in those with and without dementia. METHODS This population-based analysis utilized the National Inpatient Sample (NIS) during 2019. Patients with dementia over the age of 60 years receiving colonoscopy were identified utilizing ICD-10 codes. Logistic regression was used for propensity score matching between the comparison groups. A Greedy one-to-one matching algorithm was utilized along with standardized mean differences to assess balance. Mcnemar test, signed rank sum, and paired t-test were used to compare the outcomes. RESULTS Initially, 50,692 patients without dementia were compared with 4323 patients with dementia. Patients with dementia were more likely to be female, older, less likely White, had lower income, and more likely to be on Medicare. In the matched comparison (4176 in each group), complication analysis showed that patients with dementia did not have higher colonoscopy-related complications. They did have higher rates of other complications including renal/AKI (p = 0.0042), pulmonary/pneumonia (p = 0.003), cerebrovascular accidents (p = 0.0063), and sepsis (< 0.0001). Patients with dementia were also less likely to have routine discharges (< 0.0001), had longer hospital stays (< 0.0001), and higher hospital costs (< 0.0001). CONCLUSIONS Elderly patients with dementia have similar colonoscopy-related complications as patients without dementia. However, they do have higher complications in general. The decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient's history can help with this decision.
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Affiliation(s)
- Faris Shweikeh
- Department of Internal Medicine, Cleveland Clinic Akron General, 1 Akron General Ave., Akron, OH, 44307, USA.
| | - Gordon Hong
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Kathleen Rogers
- Geriatrics Service, Cleveland Clinic Akron General, Akron, OH, USA
| | - Mohamad Mouchli
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew Hoscheit
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anthony Lembo
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Anwar FN, Roca AM, Loya AC, Medakkar SS, Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Sayari AJ, Lopez GD, Singh K. The influence of preoperative Veterans RAND-12 physical composite score in patients undergoing anterior lumbar interbody fusion [Retrospective Review]. J Clin Neurosci 2024; 123:36-40. [PMID: 38522109 DOI: 10.1016/j.jocn.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
No study has evaluated the preoperative impact of Veterans RAND-12 Physical Composite Score (VR-12 PCS) on anterior lumbar interbody fusion (ALIF) patients. This study examines its influence on physical function, mental health, pain, and disability outcomes. Two cohorts of ALIF patients with preoperative VR-12 PCS scores were formed using a single-surgeon registry: VR-12 PCS < 30 and VR-12 PCS ≥ 30. Demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected. PROMs of VR-12 PCS/Mental Composite Score (MCS), Short Form-12 (SF-12) PCS/MCS, Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale-Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected pre/postoperatively up to 2-years. Demographics, perioperative characteristics, and preoperative PROMs were compared. Intercohort postoperative 6-week/final PROMs and improvements were compared. Of 80 patients, there were 41 in the VR-12 PCS < 30 cohort. Besides VR-12 PCS, VR-12 PCS < 30 patients reported inferior preoperative VR-12 MCS/SF-12 PCS/PROMIS-PF/PHQ-9/ODI scores (p ≤ 0.003, all). At 6-weeks postoperatively, VR-12 PCS < 30 reported inferior VR-12 PCS/SF-12 PCS/PROMIS-PF/PHQ-9 (p ≤ 0.030, all). There was greater improvement up to 6-weeks postoperatively in VR-12 PCS < 30 for VR-12 PCS/MCS and SF-12 PCS (p ≤ 0.020, all). VR-12 PCS < 30 reported superior improvement by final follow-up in VR-12 PCS/SF-12 PCS/PHQ-9 (p ≤ 0.006, all). MCID achievement rates were higher in VR-12 PCS < 30 for PHQ-9 and ODI (p ≤ 0.013, both). VR-12 PCS < 30 patients reported inferior postoperative physical function, mental health, and disability, yet superior magnitude of improvement in physical function and mental health. Rates of clinically meaningful improvement for VR-12 PCS < 30 were greater in mental health and disability.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Elmorsi R, Camacho L, Krijgh DD, Tilney GS, Lyu H, Traweek RS, Witt RG, Roubaud MS, Roland CL, Mericli AF. Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15183-2. [PMID: 38520583 DOI: 10.1245/s10434-024-15183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death. PATIENTS AND METHODS In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death. RESULTS Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03-1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001-1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65-0.98; p = 0.030). CONCLUSIONS Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.
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Affiliation(s)
- Rami Elmorsi
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis Camacho
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David D Krijgh
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gordon S Tilney
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lyu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Russell G Witt
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Margaret S Roubaud
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander F Mericli
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Zamaili AM, Kueh YC, Mohamad S, Abdullah B. The impact of middle meatal steroid-eluting implants on the postoperative outcomes of chronic rhinosinusitis: A systematic review and meta-analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00047-4. [PMID: 38521652 DOI: 10.1016/j.anorl.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024]
Abstract
Endoscopic sinus surgery (ESS) has become an established surgical option in refractory chronic rhinosinusitis (CRS). The goal of this review is to assess the impact of steroid-eluting middle meatal implants after ESS. Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PUBMED, and GOOGLE SCHOLAR were searched from inception to November 2022. All randomised controlled trials (RCTs) involving adult patients receiving ESS for CRS utilising a steroid-eluting middle meatal implants were eligible. The primary outcome was adhesion or synechiae. The secondary outcomes were mucosal inflammation, polyp reformation, the need for oral steroids and additional surgery, postoperative bleeding, sinus pain and discomfort, postoperative sinus-related infection, and change in intraocular pressure. Fourteen full articles were examined out of 496 potential abstracts. Seven RCTs satisfied the criteria. At 30days, steroid-eluting implants reduced adhesion (OR: 0.28, 95% CI: 0.14 to 0.56; P<0.001), mucosal inflammation (MD: -13.09, 95% CI: -18.22 to -7.97; P<0.001), polyp reformation (OR: 0.31; 95% CI: 0.22 to 0.44; P<0.001), and requirement of additional oral steroid (OR: 0.44; 95% CI: 0.25 to 0.78; P=0.005) or surgery (OR: 0.25; 95% CI: 0.12 to 0.50; P<0.001). While their use for adhesion (OR: 0.24; 95% CI: 0.11 to 0.54; P<0.001) and polyp reformation (OR: 0.24; 95% CI: 0.12 to 0.51; P<0.001) were favourable, there was no difference in mucosal inflammation (MD: -5.68, 95% CI: -12.39 to 1.03; P=0.100) or the need for surgery (OR: 0.96; 95% CI: 0.07 to 12.37; P=0.980) when evaluated after 30days. Overall, the findings suggest that steroid-eluting middle meatal implants improve ESS outcomes by lowering rates of adhesion formation, postoperative medical and surgical interventions, recurrent polyposis, and inflammation, while having no significant negative impact in the immediate postoperative period. More research is needed into the long-term impacts.
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Affiliation(s)
- A M Zamaili
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Y C Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - S Mohamad
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - B Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Bethell MA, Hurley ET, Rowe D, Crook BS, Cabell G, Klifto CS, Lau BC, Dickens JF, Taylor DC. Type V Superior-Labrum Anterior-Posterior (SLAP) Repair - A Systematic Review. J Shoulder Elbow Surg 2024:S1058-2746(24)00215-5. [PMID: 38522776 DOI: 10.1016/j.jse.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following type V superior labrum anterior-posterior (SLAP) repair. METHODS Two independent reviewers performed a literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies were included if they had clinical outcomes on the patients undergoing type V SLAP repair. Statistical analysis was performed using SPSS (IBM, Armonk, NY, USA). A P value of < 0.05 was considered to be statistically significant. RESULTS Our review found 13 studies, including 451 shoulders meeting our inclusion criteria. The majority of patients were male (89.3%), with an average age of 25.9 years (range 15-58) and a mean follow-up of 53.8 months. The Rowe score was the most utilized functional outcome score, with a weighted mean of 88.5. Additionally, the mean Constant score was 91.0, the mean ASES score was 88.3, the mean SSV score was 85.5%, and the mean VAS pain score was 1.2. The overall rate of return to play was 84.8%, with 80.2% returning to the same level of play. The overall reoperation rate was 6.1%, with a recurrent dislocation rate of 8.2%. In the studies comparing type V SLAP and isolated Bankart repair, there were statistically insignificant differences in VAS pain scores (MD; 0.15, 95% CI, -0.13 to 0.44, I2 = 0%, p = 0.29) and recurrence rates (RR; 1.38, 95% CI, 0.88 to 2.15, I2 = 0%, p = 0.16). CONCLUSION Arthroscopic repair of type V SLAP tears results in excellent functional outcomes, with high return to play rates in athletes. There are low rates of reoperations and recurrent dislocations. Additionally, in comparison to an isolated Bankart repair, SLAP repair does not increase recurrence rates or postoperative pain.
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Affiliation(s)
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dana Rowe
- School of Medicine, Duke University, Durham, NC, USA
| | - Bryan S Crook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Wahadneh OA, Alitter Q, Raju A, Alziadin N, Alshurafa AH, Aldabbas HO, Shaik I. Prevalence and Impact of Pulmonary Hypertension on Acute Decompensated Heart Failure with Preserved Ejection Fraction Hospitalizations: A Five-Year Retrospective Analysis. Curr Probl Cardiol 2024:102537. [PMID: 38522770 DOI: 10.1016/j.cpcardiol.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
Heart Failure with Preserved Ejection Fraction (HFpEF) is a major and common cardiovascular condition with widely variable clinical outcomes. Pulmonary hypertension (PH) often co-exists with HFpEF and tends to affect patient outcomes; this study aims to identify the impact of PH on the clinical outcome of patients admitted to the hospital with acute HFpEF exacerbations. We analyzed data from the National Inpatient Sample between 2016 and 2020, focusing on 464,438 acute HFpEF exacerbation hospitalizations. Outcomes were compared between those with PH (27.1%) and those without PH (72.9%). HFpEF hospitalizations with PH exhibited elevated in-hospital mortality (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [95 CI]: 1.08-1.31, P <0.05), prolonged length of stay (adjusted β: 0.90 days, P <0.05), and increased overall costs (adjusted β: $2,858, P <0.05). Furthermore, HFpEF hospitalizations with PH demonstrated higher rates of atrial fibrillation, ventricular tachycardia, right ventricular failure, and conduction abnormalities. This population also displayed an increased incidence of acute hypoxic respiratory failure, necessitating increased non-invasive and mechanical ventilation. The co-existence of PH in HFpEF presents an increased risk of mortality and morbidity, with higher healthcare costs and the need for ventilatory support, in addition to higher risks of cardiovascular and pulmonary complications. Therefore, an early diagnosis of PH in patients with HFpEF is crucial, and further research is required to determine appropriate management.
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Affiliation(s)
- Omar Al Wahadneh
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL.
| | - Qusai Alitter
- Department of Pulmonary & Critical Care, Hackensack University Medical Center, Hackensack, New Jersey
| | - Apoorva Raju
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL
| | - Nmair Alziadin
- Department of Internal Medicine, HCA Healthcare/Tufts University School of Medicine: Portsmouth Regional Hospital, Portsmouth, NH
| | | | | | - Ibrahim Shaik
- Cardiovascular Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
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Spencer BL, Lotakis DM, Carducci J, Hoff L, Gingrich D, Gadepalli SK, Speck KE. Outcomes of Prolonged Open Abdomen in Children. J Surg Res 2024; 298:1-6. [PMID: 38518531 DOI: 10.1016/j.jss.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/16/2024] [Accepted: 02/16/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION We sought to better characterize outcomes in pediatric patients requiring open abdomen for instability with ongoing resuscitation, second look surgery, or left in discontinuity or congenital or acquired loss of domain that may lead to prolonged open abdomen (POA) or difficulties in successful abdominal wall closure. METHODS We performed a single-institution retrospective review of patients aged less or equal to 18 years who presented to our institution from 2015 to 2022. We defined POA as requiring three or more surgeries prior to abdominal wall closure. Descriptive statistics were performed using median and interquartile range. RESULTS Median age was 15 years (interquartile range 0-6 years), 46% female, and 69% White. Survival rate was 93% for the entire cohort. The most common indication for open abdomen was second look/discontinuity 22/41 (54%). The most common temporary abdominal wall closure was wound vac (43%). Fifty eight percent patients achieved primary tissue closure, the remaining required mesh. Of the 42 patients, 25 required POA. They had increasing rate of secondary infections at 56% compared to 44% (P = 0.17). The groups were further divided into indications for open abdomen including ongoing resuscitation, second look/discontinuity, and loss of domain with similar outcomes. CONCLUSIONS In the largest series of long-term outcomes in pediatric patients with an open abdomen, we found that a majority of children were able to be primarily closed without mesh despite the number of surgeries required. Further studies require a protocolized approach to improve the long-term outcomes of these patients.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
| | - Dimitra M Lotakis
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Lauren Hoff
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Devon Gingrich
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Samir K Gadepalli
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - K Elizabeth Speck
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Hamid SA, Graetz E, Schneider E, Gibbs KE. A Cross-Sectional Analysis of Pediatric Necrotizing Soft Tissue Infection Cases and Racial Disparities From the 2016 to 2020 National Inpatient Sample. J Surg Res 2024; 297:136-143. [PMID: 38518580 DOI: 10.1016/j.jss.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/05/2024] [Accepted: 02/16/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The incidence, treatment, and outcomes of necrotizing soft tissue infections (NSTIs) and associated racial disparities have been described in adults, but research in the pediatric population is limited. The purpose of this study is to provide a nationally representative characterization of pediatric NSTI and determine the presence of any racial disparities. METHODS The National Inpatient Sample was analyzed from 2016 through 2020. Patients aged less than 20 y with a diagnosis of necrotizing fasciitis, Fournier's gangrene, or gas gangrene (based on International Classification of Diseases, Tenth Revision, Clinical Modification codes) were included for analysis. RESULTS A total of 355 patients were identified. Black and Hispanic patients accounted for the most admissions in 2016 and 2018, respectively (P = 0.024). Compared to White patients, more Black patients were insured by Medicaid (P = 0.037) and were in the first zip code-based income quartile (P = 0.005). The leading infection overall was necrotizing fasciitis and most patients (81.7%) underwent a surgical procedure by the first calendar day after admission. Although the proportion of Black patients undergoing subcutaneous tissue and fascia excisions was more than that of White patients (P = 0.005), there were no significant differences by race in the time to first procedure, the total number of procedures, or number of postoperative complications. Our amputation and mortality rates were low and unreportable, but there were no differences by race. CONCLUSIONS NSTI is rare in the pediatric population and mortality is low. Black patients are disproportionately diagnosed, but these disparities do not extend to disease treatment or outcomes.
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Affiliation(s)
- Safraz A Hamid
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - Elena Graetz
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Eric Schneider
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Karen E Gibbs
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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49
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Ayton A, Spitz G, Hicks AJ, Ponsford J. Mental and Physical Health Comorbidities in Traumatic Brain Injury: A Non-TBI Controls Comparison. Arch Phys Med Rehabil 2024:S0003-9993(24)00886-4. [PMID: 38521496 DOI: 10.1016/j.apmr.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To examine whether ageing with a TBI was associated with a greater burden of health-related comorbidities compared to a non-TBI control cohort, and examine the associations between comorbidity burden, emotional outcomes, and health-related quality of life (HRQoL) after TBI across ages. DESIGN Cross-sectional. SETTING Research centre or telephone. PARTICIPANTS The study included 559 participants (NTBI=291, NControls=268). Participants with TBI were recruited during inpatient rehabilitation and had sustained a moderate-severe TBI 1-33 years previously. Non-TBI controls were a convenience sample recruited through advertisements in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The number of cardiovascular, general physical health, and mental health comorbidities was compared between cohorts and age strata using Poisson regression. The relationships between comorbidities, age, emotional outcomes (Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9) and HRQoL (PROMIS Global Health Measure) were examined with linear regression. Distinct subgroups of comorbidities were identified using latent class analysis. Associations between comorbidity classes with demographic and outcome variables were evaluated using multinomial logistic and linear regressions, respectively. RESULTS TBI participants had a significantly higher comorbidity burden than controls, primarily driven by elevated rates of mental health disorders (RR = 2.71, 95% CI [1.37, 5.35]). Cardiovascular and physical health comorbidities were not elevated in the TBI group compared to controls. Both cohorts had three similar comorbidity subgroups, suggesting consistent patterns of co-occurring health conditions regardless of TBI exposure. Physical and mental health comorbidities were associated with elevated depression and anxiety symptoms and diminished HRQoL after TBI compared to controls. CONCLUSION TBI was associated with greater mental, but not physical, health comorbidities in the decades following injury. However, physical and mental health comorbidities significantly impacted emotional and HRQoL status after TBI, underscoring a greater need for long-term support for individuals with TBI coping with both physical and mental health comorbidities.
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Affiliation(s)
- Amber Ayton
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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50
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Baril R, Joffe AR, Andersen JC, Khademioureh S, Dinu IA, Robertson CMT. The Alberta Infant Motor Scale as an Outcomes Measure of Gross Motor Abilities after Early Complex Cardiac Surgery. Pediatr Cardiol 2024:10.1007/s00246-024-03458-0. [PMID: 38512487 DOI: 10.1007/s00246-024-03458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
To address the research hypothesis that the Alberta Infant Motor Scale (AIMS) completed following complex cardiac surgery (CCS) is a useful outcomes measure this study determined: (1) AIMS scores at age 8 months after CCS; (2) predictive validity of AIMS at 8 months for Bayley Scales of Infant and Toddler Development-III Gross Motor-scaled scores (GMSS) and diagnosis of cerebral palsy (CP) at 21 months; and (3) predictive demographic and surgical variables of AIMS scores. A prospective cohort study of 250/271 (92.3%) surviving children from Northern Alberta (born 2009-2020) who had CCS at age < 6 months determined AIMS scores at age mean (SD) 8.6 (2.4) and the GMSS at 21.9 (3.8) months. Gross motor delay was defined as AIMS < 5th percentile and GMSS as < 4 (-2SD). Predictions using multiple logistic regressions were expressed as Odds Ratios (OR) and 95% Confidence Interval (CI). Of children, 100/250 (40%) had AIMS < 5th predicting GMSS < 4 (n = 43); sensitivity, specificity, positive, and negative predictive values were 88%, 71%, 40%, and 97%. Hospitalization days were independently associated with AIMS < 5th, OR 1.02 (95% CI 1.007, 1.032; p = 0.005). Excluding hospital days, ventilation days independently predicted AIMS < 5th, OR 1.08 (95% CI 1.038, 1.125, p < 0.001. Gross motor delay determine by AIMS scores of < 5th percentile occurred in 40% of survivors with good prediction of continued delay. Delay determined by AIMS was predicted by longer hospitalization and ventilation; further investigations about the causes are required. AIMS results provide opportunity for early motor intervention.
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Affiliation(s)
- Rebecca Baril
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - John C Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | | | - Irina A Dinu
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Charlene M T Robertson
- Department of Pediatrics, University of Alberta, Edmonton, Canada.
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
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