Post-operative Immobilization in Total Elbow Arthroplasty for Rheumatoid Arthritis: A Systematic Review of Outcomes.

The purpose of this analysis is to determine the effect of length of immobilization following total elbow arthroplasty (TEA) for rheumatoid arthritis on the outcomes, complications, and survival of the implant. A review of TEA literature was performed. Post-operative motion was categorized into three groups: no post-operative immobilization (group 1), short-term 2-5 days immobilization (group 2), and extended 7-14 days immobilization (group 3). Thirty-six articles reporting on 43 studies involving 2,346 elbows in 2015 patients were included. Total complication rates were 23% at 8.9 years for group 1, 31% at 6.8 years for group 2, and 31% at 6.9 years for group 3. Survival rates were 79% at 15.3 years, 75% at 10.4 years, and 92% at 9.1 years for each group, respectively. Total complication rates were lowest in elbows without post-operative immobilization. However, survival rates were greatest in elbows with extended post-operative immobilization. (Journal of Surgical Orthopaedic Advances 31(4):209-217, 2022).

Patient-Reported Outcomes and Provocative Testing in Peripheral Nerve Injury and Recovery.

Background Peripheral nerve function is often difficult to assess given the highly variable presentation and subjective patient experience of nerve injury. If nerve assessment is incomplete or inaccurate, inappropriate diagnosis and subsequent treatment may result in permanent dysfunction. Objective As our understanding of nerve repair and generation evolves, so have tools for evaluating peripheral nerve function, recovery, and nerve-related impact on the quality of life. Provocative testing is often used in the clinic to identify peripheral nerve dysfunction. Patient-reported outcome forms provide insights regarding the effect of nerve dysfunction on daily activities and quality of life. Methods We performed a review of the literature using a comprehensive combination of keywords and search algorithms to determine the clinical utility of different provocative tests and patient-reported outcomes measures in a variety of contexts, both pre- and postoperatively. Results This review may serve as a valuable resource for surgeons determining the appropriate provocative testing tools and patient-reported outcomes forms to monitor nerve function both pre- and postoperatively. Conclusion As treatments for peripheral nerve injury and dysfunction continue to improve, identifying the most appropriate measures of success may ultimately lead to improved patient outcomes.

Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature.

Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

Assessment of Motor Function in Peripheral Nerve Injury and Recovery.

Introduction: Peripheral nerve injuries can be difficult to diagnose, treat, and monitor given their highly variable presentation. When the status of nerves is not accurately assessed, treatment may be delayed or overlooked and can result in lasting functional deficits. As our understanding of nerve repair and generation evolves, so will tools for evaluating both the functional and morphological status of peripheral nerves. Objective: There is currently no single article which provides a detailed, comprehensive view of the literature comparing the clinical utility of various assessment modalities. Furthermore, there is no consensus on the optimal assessment algorithm for peripheral nerve injuries. Methods: We performed a literature review using a comprehensive combination of keywords and search algorithm. The search was focused on clinical data regarding the assessment of peripheral nerves Results: This review may help to determine the appropriate tools that are currently available for monitoring nerve function both pre and postoperatively. Additionally, the review demonstrates possible roles and areas of improvement for each tool used to assess motor function. Conclusion: As surgeons work to improve treatments for peripheral nerve injury and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

Ectopic craniopharyngioma of the orbit: illustrative case.

BACKGROUND: Craniopharyngiomas are uncommon malformations of the sellar or parasellar region that are partly cystic and calcified and have low histological grade. The typical age of presentation is bimodal, with peak incidence rates in children at age 5 to 14 years and in adults at age 50 to 74 years. The usual clinical manifestations are related to endocrine deficiencies due to mass effect along with visual impairment and increased intracranial pressure. If a tumor is favorably localized, the treatment of choice is complete resection. OBSERVATIONS: The authors presented a unique case of a 61-year-old man with a suspicious cystic lesion in the right orbital roof that was causing right-sided headaches with pressure and pain in the right eye. Both computed tomography and magnetic resonance imaging were used for further evaluation and showed a suspicious lytic bone lesion that had an epicenter within the orbital rim, which was highly suggestive of a tumor of interosseous origin. After removal, the tumor was identified by pathology as a craniopharyngioma. LESSONS: The importance of this case report is in documenting a unique case of an ectopic craniopharyngioma in the orbit, adding to current hypotheses of the pathogenesis of ectopic craniopharyngiomas, and presenting an extensive review of literature.

Implications of Age on Social Media Utilization in Health Care Practice Development: Cross-sectional Survey Study.

BACKGROUND: Medical practices, which are businesses through which one or more physicians treat patients, have likely not yet taken full advantage of the reach of social media. This study analyzed data collected using an anonymous survey to assess the potential utilization of large, established social media platforms in health care. The survey collected data from a diverse population of health care professional students, faculty, and physicians affiliated with the Texas Tech University Health Sciences Center (TTUHSC). This study provides significant, actionable data to more efficiently implement a social media strategy focused on age to help developing private practices and outpatient clinics from the perspective of those with experience in the field of medicine. OBJECTIVE: This cross-sectional, exploratory, descriptive study aims to explore the most effective strategies to use social media based on patient age to bring further success to a medical practice. METHODS: Data were gathered from an anonymous, peer-validated Qualtrics survey created by the corresponding authors based on the recommendations from a panel of experts including executive leadership at TTUHSC. The survey used a variety of question styles to measure differences between social media platforms, including frequency of use, current and future implications in medicine, and comfort in a health care setting. The sample population included students, interns, faculty, and physicians affiliated with the TTUHSC located throughout West Texas. RESULTS: The anonymous survey included 673 individuals from several different age groups predetermined at the beginning of the study. There were 154 respondents aged between 18 and 25 years, 171 aged between 26 and 35 years, 133 aged between 36 and 45 years, 104 aged between 46 and 55 years, and 111 aged between 56 and 89 years. The sample population also has a variety of educational achievements. The respondents were grouped based on the highest level of education attained, and this included 23.5% (n=158) of respondents who earned a high school diploma, 42% (n=283) who earned a bachelor's degree, 17.1% (n=115) who earned a master's degree, and 17.4% (n=117) who earned a doctorate degree. CONCLUSIONS: As social media continues to gain momentum, efficient utilization of the available platforms can help medical practices achieve larger patient populations and deliver more personalized care. However, privacy and security concerns should be considered while using social media in health care settings. Although this study demonstrated overwhelming interest in using social media in the medical field across all age groups, adoption willingness appears to be higher in younger respondents than in older respondents. Facebook was the most widely accepted social media platform in health care settings among all age groups. Nonetheless, other social media platforms could potentially be used more effectively depending on the age range of the targeted patient population.