Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.

PURPOSE: To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting. METHODS: Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST-Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach's α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations. RESULTS: In total, 92 patients were included. CROST showed excellent feasibility results. Internal consistency (α = 0.58-0.70) and reliability (ICC = 0.52 and 0.55) were moderate. Mean total scores between surgeons only differed 0.2-0.9 with exact agreement 48.9-57.6%. Exact agreement per CROST item showed good results (73.9-98.9%). Kappa statistics revealed moderate agreement for most CROST items. In the prospective analysis a trend was only seen when no concerns at all were expressed by the surgeon (CROST = 0), and moderate to strong positive Spearman correlations were found between CROST at baseline and the scores at follow-up (rs = 0.41-0.64). Comparing the CROST with PROST showed no specific association, nor any Spearman correlations (rs = -0.33-0.07). CONCLUSIONS: The AO Spine CROST showed moderate validity in a true clinical setting including patients from the daily clinical practice.

Does Erector Spinae Plane Block Decrease Analgesia Requirements After Minimal-Invasive Posterior Transpedicular Stabilization in Patients With Vertebral Body Fracture? A Prospective, Randomized, Double-Blind Controlled Study.

STUDY DESIGN: Prospective randomized placebo controlled double blind trial. OBJECTIVE: To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. METHODOLOGY: Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). RESULTS: In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group (P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group (P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group (P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group (P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group (P = .036). No significant differences in ODI were detected. CONCLUSION: The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.

Translation, intercultural adaptation, and validation of the Slovak version of AOSpine patient reported outcome for spinal trauma tool.

OBJECTIVES: The implementation of patient-reported outcome measurements has become a standard component of evaluating the effect of treatment. For spine injuries, an evaluation tool AOSpine Patient Reported Outcome for Spinal Trauma (AOSpine PROST) has been developed. The aim of this study was to translate, interculturally adapt and validate the Slovak version of AOSpine PROST. METHODS: Based on methodologies we translated and culturally adapted the AOSpine PROST into Slovak. We then validated it on a representative sample of patients treated at a single level­one trauma center in the Slovak Republic. Content validity was assessed by evaluating the number of inapplicable or missing questions.  Internal consistency was assessed by calculating Cronbach's alpha and Corrected item-total correlations. RESULTS: 37 patients were included in the study.  The questionnaire was understandable to patients. The mean T-score across questions and participants in the questionnaire was 79.6 with a narrow range of 70.4 to 97.3 for all questions, which is relatively high. The internal consistency of total score was excellent with Cronbach´s alpha of 0.92. Total correlation across questions revealed relatively good results ranging from 0.17 to 0.90. CONCLUSIONS: The results indicate that the Slovak version of AOSpine PROST is reliable and valid and can be used in practice (Tab. 2, Ref. 14). Text in PDF www.elis.sk Keywords: AOSpine PROST, patient reported outcome, spinal trauma, translation, intercultural adaptation.

Challenging management of severe chronic disorders in acute pandemic situation: Chronic liver disease under COVID-19 pandemic as the proof-of-principle model to orchestrate the measures in 3PM context.

Chronic liver disease management is a comprehensive approach requiring multi-professional expertise and well-orchestrated healthcare measures thoroughly organized by responsible medical units. Contextually, the corresponding multi-faceted chain of healthcare events is likely to be severely disturbed or even temporarily broken under the force majeure conditions such as global pandemics. Consequently, the chronic liver disease is highly representative for the management of any severe chronic disorder under lasting pandemics with unprecedented numbers of acutely diseased persons who, together with the chronically sick patient cohorts, have to be treated using the given capacity of healthcare systems with their limited resources. Current study aimed at exploring potentially negative impacts of the SARS CoV-2 outbreak on the quality of the advanced chronic liver disease (ACLD) management considering two well-classified parameters, namely, (1) the continuity of the patient registrations and (2) the level of mortality rates, comparing pre-COVID-19 statistics with these under the current pandemic in Slovak Republic. Altogether 1091 registrations to cirrhosis registry (with 60.8% versus 39.2% males to females ratio) were included with a median age of 57 years for patients under consideration. Already within the very first 3 months of the pandemic outbreak in Slovakia (lockdown declared from March 16, 2020, until May 20, 2020), the continuity of the patient registrations has been broken followed by significantly increased ACLD-related death rates. During this period of time, the total number of new registrations decreased by about 60% (15 registrations in 2020 versus 38 in 2018 and 38 in 2019). Corresponding mortality increased by about 52% (23 deaths in 2020 versus 10 in 2018 and 12 in 2019). Based on these results and in line with the framework of 3PM guidelines, the pandemic priority pathways (PPP) are strongly recommended for maintaining tertiary care uninterrupted. For the evidence-based implementation of PPP, creation of predictive algorithms and individualized care strategy tailored to the patient is essential. Resulting classification of measures is summarized as follows:The Green PPP Line is reserved for prioritized (urgent and comprehensive) treatment of patients at highest risk to die from ACLD (tertiary care) as compared to the risk from possible COVID-19 infection.The Orange PPP Line considers patients at middle risk of adverse outcomes from ACLD with re-addressing them to the secondary care. As further deterioration of ACLD is still probable, pro-active management is ascertained with tertiary center serving as the 24/7 telemedicine consultation hub for a secondary facility (on a physician-physician level).The Red PPP Line is related to the patients at low risk to die from ACLD, re-addressing them to the primary care. Since patients with stable chronic liver diseases without advanced fibrosis are at trivial inherent risk, they should be kept out of the healthcare setting as far as possible by the telemedical (patient-nurse or patient- physician) measurements. The assigned priority has to be monitored and re-evaluated individually-in intervals based on the baseline prognostic score such as MELD. The approach is conform with principles of predictive, preventive and personalized medicine (PPPM / 3PM) and demonstrates a potential of great clinical utility for an optimal management of any severe chronic disorder (cardiovascular, neurological and cancer) under lasting pandemics.

Acute-on-chronic liver failure: a single-centre experience.

AIM OF THE STUDY: We set out to determine the applicability of acute-on-chronic liver failure (ACLF) diagnostic criteria and characteristics of thus defined ACLF sub-cohorts in a real-life clinical context. MATERIAL AND METHODS: Retrospective charts' analysis of consecutive patients hospitalized with decompensated liver disease. Inclusion criteria: acute decompensation, informed consent. Exclusion criteria: malignancy. Diagnostic tools: 1st phase - CLIF-SOFA score calculated manually; 2nd phase - CLIF-C ACLF score calculated at www.efclif.com. RESULTS: Of 432 hospitalized patients aged 52 years, 41% were female, with MELD 20, 32% patients had acute decompensation (AD); main triggers were alcoholic hepatitis (38%), infections (26%), and variceal bleeding (23%). Of patients with AD, ACLF grades 0-3 was present in 64%, 19%, 13%, and 4%, respectively. In hospital mortality according to final AD/ACLF grade in ACLF 0-3 was 7.5%, 42%, 47%, and 80%, respectively (p < 0.0001). CONCLUSIONS: Diagnosing ACLF is nowadays easy; it helps to stratify patients at admission, and refine risk stratification at day 7. The main trigger of AD/ACLF in this region is alcohol. Currently, there are no ACLF-specific treatments; however, timely intensive supportive care can influence the prognosis. Even though still elusive and controversial, the ACLF concept can help systematize management of patients admitted with acute decompensation of advanced chronic liver disease.

Hepatitis C virus antibodies in outpatients with chronic kidney disease.

AIM OF THE STUDY: To determine the seroprevalence of hepatitis C virus (HCV) in outpatients with chronic kidney disease (CKD) attending a nephrology clinic. MATERIAL AND METHODS: Prospective observational study on consecutive outpatients attending a nephrology clinic. Inclusion criteria were age > 18 years, CKD, informed consent. There were no exclusion criterias. Recorded variables were age, gender, CKD grade and etiology, anti-HCV antibodies (Ab). Patients with positive HCV Abs were tracked for HCV RNA detection. Study interval was from November 2015 to March 2016. The study has been approved by the Ethic committee of F.D. Roosevelt University Hospital. Funded by Restricted Grant of AbbVie Slovakia. RESULTS: One hundred and thirty-four patients were enrolled, with median age 70 years (19.7-91), 52% women. CKD grades: G1/2 - 52 patients (39%), G3a - 34 patients (25%), G3b - 32 patients (24%), G4 - 8 patients (6%), G5 - 8 patients (6%); CKD etiology: tubulointerstitial nephritis (TIN) - 53 patients (40%), nephrosclerosis (NS) - 30 patients (22%), diabetic nephropathy (DN) - 23 patients (17%), glomerulonephritis (GN) - 23 patients (17%), others - 5 patients (4%). Anti-HCV antibodies were detected in 8 patients (6%). There were no significant differences in CKD grades between HCV+ and HCV- patients; Heymann nephritis and GN were significantly more frequent in HCV- patients, as was male gender. Of 8 HCV Ab positive patients, 5 were available for HCV RNA testing (2 died after completion of the study, 1 was lost to follow-up); of them, 1 patient tested positive. CONCLUSIONS: Prevalence of anti-HCV antibodies in CKD patients was 6%, which is 4 times higher than in the general population of Slovakia; HCV RNA was detected in 1 patient (12.5%) of anti-HCV positive patients. Based on this result, multicentric, a larger-scale study is considered to be warranted.

Hepatology topics of special interest from Central Europe (Czech Republic, Hungary, Poland, Slovakia).

This compilation represents abstracts of presentations at the first meeting of the Initiative Group for the Central European Hepatologic Collaboration (CEHC, Warsaw, 19-21 November, 2015) on topics with special interest from four Central European countries and includes a summary of a boceprevir-based triple therapy cohort programme (from Hungary), current trends and challenges in liver diseases (from Poland), acute kidney injury in liver cirrhosis (from Slovakia) and treatment of hepatitis C in haemodialysed patients (from the Czech Republic). All these topics are or have been of high interest during the last several years, and many of them are still not completely resolved with the emergence and availability of the novel interferon-free therapies for hepatitis C and with other advances in the pathophysiology and treatment of liver diseases.

Peritoneal dialysis is the better therapy choice for successful anti-hepatitis B vaccination.

Patients treated with renal replacement therapy (RRT) are considered to be at higher risk for infection with hepatitis B virus (HBV). Immunoprophylaxis is therefore deemed a standard of care. Active immunization in RRT patients leads to a lower incidence of protective titers of HBV antibodies (HBAbs) than the titers seen in healthy counterparts. Our hypothesis is that, for complex reasons, active immunization is more effective in patients on peritoneal dialysis (PD) than in patients on hemodialysis (HD), and that the effectiveness of immunization depends on dialysis adequacy (Kt/V). We carried out a prospective multicenter study with an enrollment period that ran from January 1998 to December 2004. Follow-up data were analyzed as of August 2004. Inclusion criteria were an age of 18 years or older and newly indicated RRT Exclusion criteria were a history of HBV or the presence of either HBV antigen (HBAg) or HBAbs in the protective range. The choice of RRT modality (HD or PD) was based on patient preference (preceded by thorough counseling). Active immunization followed accepted guidelines for RRT patients and began after clinical and laboratory steady state had been achieved. The endpoints were the number of patients with a protective HBAb titer and the number with newly diagnosed hepatitis B. In PD patients, we calculated Kt/V on regular basis. We enrolled 211 patients, 171 of whom chose HD treatment, and 40 of whom chose PD. Positive response to immunization (defined as a serum level of HBAbs above 10 mIU/mL) was achieved in 58 HD patients (34%) and 21 PD patients (53%, p = 0.03). In subgroup of PD patients with a weekly Kt/Vgreater than 1.7 (n=28), the response rate rose to 71%--as compared with just 8% in patients with a weekly Kt/V below 1.7 (p = 0.0003). In the PD cohort as a whole, the level of HBAbs correlated with Kt/V No new cases of hepatitis B or HBAg positivity occurred in either group. From the viewpoint of successful HBV immunoprophylaxis in RRT patients, PD is the better modality choice. In PD patients, the success rate of immunoprophylaxis depends on weekly Kt/V, which we propose should be 1.7 or higher