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1.
AJPM Focus ; 3(1): 100152, 2024 Feb.
Article de Anglais | MEDLINE | ID: mdl-38089427

RÉSUMÉ

Introduction: This study aimed to systematically identify the environmental factors that impacted people with disability during the COVID-19 pandemic. Methods: A scoping literature review was conducted using LitCOVID (January 1-July 31, 2020). Sixty-six articles met the inclusion criteria that (1) discussed disability and/or health conditions related to functioning and (2) considered environmental factors. A qualitative content analysis was conducted using codes from the WHO International Classification of Functioning, Disability and Health. Results: A total of 212 International Classification of Functioning, Disability and Health codes were used in the coding process. The most frequent codes referred to health services policies and public health guidelines. These policies, although generally considered facilitators for minimizing infection, were frequently identified as barriers to the health, participation, and human rights of people with disability. The lack of disability-specific population data was identified as a key barrier to planning and decision making. Conclusions: The social determinants of health for people with disability were not adequately considered in the acute phase of infection prevention at the population level. Integrating the International Classification of Functioning, Disability and Health in emergency management provides a tool to evaluate functioning and address barriers for those in need.

2.
Diagn Cytopathol ; 51(12): E332-E337, 2023 Dec.
Article de Anglais | MEDLINE | ID: mdl-37583345

RÉSUMÉ

Molecular testing is an adjunct test for thyroid fine needle aspirations with indeterminate diagnoses, with certain mutations showing a greater risk of malignancy (ROM). Rat sarcoma (RAS) point mutations are the most common alterations in indeterminate thyroid nodules. While they can have a high ROM, they are also found in benign disease. This study describes the histologic outcomes of indeterminate nodules with RAS mutations. Bethesda III and IV thyroid nodules with ThyroSeq results showing RAS mutations (NRAS, KRAS, and HRAS) were identified between November 1, 2018 and February 28, 2023. Baseline patient characteristics, ThyroSeq results, and surgical diagnoses were collected. We identified 18 nodules with RAS mutations from 17 patients. Fourteen were NRAS (isolated NRAS in 6; NRAS with other abnormalities [NRAS+] in 8); one was isolated KRAS; and three were HRAS with other abnormalities (HRAS+). NRAS Q16R was the most common amino acid change. Twelve cases had follow-up. Two were malignant, a minimally invasive follicular carcinoma (NRAS+) and a papillary thyroid carcinoma, follicular variant (HRAS+). Three were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), 2 HRAS+ and 1 NRAS+. Four were follicular adenomas, one being atypical (3 NRAS+ and one isolated NRAS). One was an oncocytic adenoma (isolated NRAS). Two were nodular hyperplasias (isolated NRAS and NRAS+, respectively). Twenty-eight percent of our RAS-mutated nodules were malignant or NIFTP. All three HRAS-mutated nodules were malignant or NIFTP. The three isolated RAS mutations with follow up were benign (adenomas or nodular hyperplasia). These findings were in line with the literature.


Sujet(s)
Adénocarcinome folliculaire , Adénomes , Tumeurs de la thyroïde , Nodule thyroïdien , Humains , Nodule thyroïdien/génétique , Nodule thyroïdien/anatomopathologie , Protéines proto-oncogènes p21(ras)/génétique , Tumeurs de la thyroïde/anatomopathologie , Mutation , Cancer papillaire de la thyroïde , Adénomes/anatomopathologie , Hyperplasie , Adénocarcinome folliculaire/anatomopathologie , Études rétrospectives
3.
Foot Ankle Orthop ; 8(3): 24730114231188098, 2023 Jul.
Article de Anglais | MEDLINE | ID: mdl-37506113

RÉSUMÉ

Background: It is critical for patients seeking foot and ankle care to have access to quality online resources, as the treatment of their conditions may involve the use of a variety of diagnostic and therapeutic modalities with which they are unfamiliar. This study was performed to enhance our understanding of if and why patients use Internet-based educational materials, to identify trends in utilization, and to delineate the patient-perceived attributes of quality resources. Methods: Questionnaires were distributed to 150 adult foot and ankle patients. The questionnaire consisted of demographic and Internet utilization questions. Statistical analysis was performed to determine the frequency of responses for each question and the relationship between demographics and Internet usage. Results: Younger patients were more likely to use the Internet (P= .006). However, there were no other significant differences in demographic attributes between patients who did (76%) and did not (24%) utilize the Internet (P <.05). Of the participants who didn't search the Internet about their condition, the most commonly cited reason was they preferred to receive information directly from their physician (47%). Among Internet users, most found the quality of resources to be good or very good (75%). However, many patients were unsure of the specific websites they accessed (66%) and if materials were AOFAS sponsored (18%). When asked about the attributes of a reliable website, patients felt that physician and/or medical society endorsement were most important (52% and 46%, respectively). Conclusion: Although physician and medical society endorsement positively shape patients' opinions of online education materials, patients often struggle in remembering the site they visited and if it was sponsored by a certain society. Despite this, patients are generally satisfied with online foot and ankle education resources. Future works must assess whether patient and physician perceptions of quality Internet resources are correlated. Level of Evidence: Level IV, case series.

4.
Evolution ; 76(3): 554-572, 2022 03.
Article de Anglais | MEDLINE | ID: mdl-35103303

RÉSUMÉ

Our understanding of how novel warning color traits evolve in natural populations is largely based on studies of reproductive stages and organisms with endogenously produced pigmentation. In these systems, genetic drift is often required for novel alleles to overcome strong purifying selection stemming from frequency-dependent predation and positive assortative mating. Here, we integrate data from field surveys, predation experiments, population genomics, and phenotypic correlations to explain the origin and maintenance of geographic variation in a diet-based larval pigmentation trait in the redheaded pine sawfly (Neodiprion lecontei), a pine-feeding hymenopteran. Although our experiments confirm that N. lecontei larvae are indeed aposematic-and therefore likely to experience frequency-dependent predation-our genomic data do not support a historical demographic scenario that would have facilitated the spread of an initially deleterious allele via drift. Additionally, significantly elevated differentiation at a known color locus suggests that geographic variation in larval color is currently maintained by selection. Together, these data suggest that the novel white morph likely spread via selection. However, white body color does not enhance aposematic displays, nor is it correlated with enhanced chemical defense or immune function. Instead, the derived white-bodied morph is disproportionately abundant on a pine species with a reduced carotenoid content relative to other pine hosts, suggesting that bottom-up selection via host plants may have driven divergence among populations. Overall, our results suggest that life stage and pigment source can have a substantial impact on the evolution of novel warning signals, highlighting the need to investigate diverse aposematic taxa to develop a comprehensive understanding of color variation in nature.


Sujet(s)
Hymenoptera , Pigmentation , Animaux , Évolution biologique , Hymenoptera/génétique , Larve/génétique , Phénotype , Comportement prédateur
5.
J Psychiatr Res ; 144: 345-352, 2021 12.
Article de Anglais | MEDLINE | ID: mdl-34735838

RÉSUMÉ

Many reports have documented the relationship between post-traumatic stress disorder (PTSD) and substance use. Substance use is commonly comorbid with PTSD and is a risk factor for trauma exposure. The aim of this study was to prospectively examine how recent substance use, abuse, or dependence influenced the development of PTSD in the context of a prior trauma history, including child abuse, and the severity of initial trauma reactions. Participants (N = 81) were recruited and assessed at the emergency department of a large urban hospital in Miami and serum levels of common drugs of abuse were measured. Although substance use appeared to be a risk factor for trauma exposure, neither self-reported nor blood toxicology influenced the development of PTSD. Positive toxicology screens were more likely to be associated with a diagnosis of substance abuse or dependence, χ2 (1) = 4.11, p = .04. Participants with a history of physical abuse were more likely to have a positive toxicology screen, χ2 (1) = 4.03, p = .05. The majority of our trauma-exposed subjects (66%) were found to be positive for one or more illicit substances at presentation at the ED. The current findings provide support for the "high risk" hypothesis in which substance use is associated with increased trauma exposure.


Sujet(s)
Maltraitance des enfants , Troubles de stress post-traumatique , Troubles liés à une substance , Enfant , Comorbidité , Humains , Facteurs de risque , Troubles de stress post-traumatique/diagnostic , Troubles de stress post-traumatique/épidémiologie , Troubles liés à une substance/diagnostic , Troubles liés à une substance/épidémiologie
6.
Subst Abuse Treat Prev Policy ; 16(1): 46, 2021 05 31.
Article de Anglais | MEDLINE | ID: mdl-34059104

RÉSUMÉ

BACKGROUND: People who inject drugs (PWID) suffer high morbidity and mortality from injection related infections (IRI). The inpatient setting is an ideal opportunity to treat underlying substance use disorder (SUD), but it is unclear how often this occurs. OBJECTIVES: To quantify the utilization of behavioral health services for PWID during inpatient admissions for IRI. METHODS: Data for all hospital admissions in Florida in FY2017 were obtained from the Agency for Healthcare Administration. Hospitalization for IRI were obtained using a validated ICD-10 algorithm and treatment for substance use disorder was quantified using ICD-10-Procedure Coding System (ICD-10-PCS) codes. RESULT: Among the 20,001 IRI admissions, there were 230 patients who received behavioral health services as defined by ICD-10-PCS SAT codes for treatment for SUD. CONCLUSIONS: In a state with a large number of IRI, only a very small portion of admissions received behavioral health services. Increased efforts should be directed to studying referral patterns among physicians and other providers caring for this population and increasing utilization of behavioral health services.


Sujet(s)
Préparations pharmaceutiques , Toxicomanie intraveineuse , Floride , Hospitalisation , Humains , Patients hospitalisés
7.
Depress Anxiety ; 38(1): 40-47, 2021 01.
Article de Anglais | MEDLINE | ID: mdl-32789992

RÉSUMÉ

BACKGROUND: Many reports have documented the relationship between previous traumatic experiences, including childhood trauma, and the development of later life psychopathology, including posttraumatic stress disorder (PTSD). Identification of individuals at greatest risk for the development of PTSD could lead to preventative interventions. The present study examined the developmental course of PTSD after trauma exposure, using histories of previous traumatic experiences and the severity of the reaction to the trauma as predictors. METHODS: Participants (N = 713) were recruited from Emergency Departments in Miami and Atlanta immediately following a traumatic experience. Histories of previous traumatic experiences and the immediate reaction to the new trauma were examined at baseline. Follow-up assessments of PTSD severity were conducted at 1, 3, and 6 months. RESULTS: Histories of child abuse and pre-existing trauma symptoms predicted the immediate response to stress (R2 = .21, p < .001) and the initial trauma reaction (p < .005).) A mixed-model repeated-measures analysis of variance found that immediate stress response and a history of prior trauma (p < .001) significantly predicted the course of PTSD symptoms. Area under the curve (AUC) analyses suggested that the presence of PTSD at each successive assessment was predicted most substantially by the severity of PTSD at the immediately prior follow-up assessment (AUC > 0.86). CONCLUSIONS: The current findings suggest that previous traumatic experiences lead to a greater immediate reaction to trauma and combine to predict the development of PTSD, the maintenance of which is not moderated by these earlier experiences. The identification of people likely to develop PTSD may be aided by the assessment of prior experiences and immediate reactions.


Sujet(s)
Maltraitance des enfants , Troubles de stress post-traumatique , Enfant , Humains , Troubles de stress post-traumatique/épidémiologie , Troubles de stress post-traumatique/étiologie
9.
Curr Psychiatry Rep ; 22(11): 59, 2020 09 04.
Article de Anglais | MEDLINE | ID: mdl-32886232

RÉSUMÉ

PURPOSE OF REVIEW: Schizophrenia is a complex severe mental illness with high morbidity and mortality. It is characterized by positive symptoms, negative symptoms, and cognitive impairment. Cognitive impairment is strongly associated with functional impairment and presents a major barrier to recovery. This article reviews some of the most recent research on cognition in schizophrenia and the clinical implications. RECENT FINDINGS: There have been recent studies related to the genomics of cognition and neural structures involved in cognition. We review recent investigations into the assessment of social cognition and the implications of impaired introspective accuracy. A recent network analysis assessed the relationship of neurocognition and social cognition to functional capacity. We further discuss the role of specific symptoms in functioning, including negative symptoms and symptoms related to autism spectrum disorder. We conclude with a discussion of a novel computerized treatment for social cognition. Recent research has sought to better understand several dimensions of cognition including genomics, brain structure, social cognition, functional capacity, and symptomatology. This recent research brings us closer to understanding the complex clinical picture of schizophrenia and the best treatments to achieve recovery.


Sujet(s)
Trouble du spectre autistique , Schizophrénie , Cognition , Humains , Tests neuropsychologiques , Schizophrénie/complications , Psychologie des schizophrènes
10.
Expert Opin Emerg Drugs ; 25(2): 189-200, 2020 06.
Article de Anglais | MEDLINE | ID: mdl-32449404

RÉSUMÉ

INTRODUCTION: While antipsychotics have been generally successful in treating psychosis in schizophrenia, there is a major treatment gap for negative symptoms and cognitive deficits. Given that these aspects of the disease contribute to poor functional outcomes independently of positive symptoms, treatments would have profound implications for quality of life. The 5-HT2A- receptor has been considered a potential target for interventions aimed at negative and cognitive symptoms and multiple antagonists and inverse agonists of this receptor have been tested. AREAS COVERED: Ritanserin and volinanserin, are historically important compounds in this area, while pimavanserin, roluperidone, and lumateperone are either newly approved, in late stages of development, or currently being tested for efficacy in schizophrenia-related features. The focus will be on their efficacy in the treatment of negative symptoms, with a limited secondary discussion of cognition. EXPERT OPINION: In addition to their efficacy in treating negative symptoms and cognition, these compounds may also have a role in modulating antipsychotic-induced dopamine super-sensitivity and preventing relapse. They may also show efficacy in treating patients with milder symptoms such as patients with schizotypal personality disorder and attenuated psychosis syndrome. Their utility may also expand outside the spectrum of schizophrenia to encompass Parkinson's Disease psychosis, major depression, bipolar depression, and dementia-associated apathy.


Sujet(s)
Neuroleptiques/pharmacologie , Schizophrénie/traitement médicamenteux , Antisérotonines/pharmacologie , Animaux , Troubles de la cognition/traitement médicamenteux , Troubles de la cognition/étiologie , Conception de médicament , Développement de médicament , Humains , Qualité de vie , Schizophrénie/physiopathologie
11.
J Neurol Surg Rep ; 81(1): e28-e32, 2020 Jan.
Article de Anglais | MEDLINE | ID: mdl-32257766

RÉSUMÉ

Background and Importance We present a case of a patient with a residual intraosseous sphenoid wing meningioma presenting with proptosis, orbital pain, and monocular vision loss for 8 months who underwent decompression of the optic canal, orbital contents, and orbital reconstruction resulting in significant improvement in her vision loss with full resolution of proptosis and orbital pain. Clinical Presentation A 43-year-old female presented with a 1 year history of headache, peri-orbital pain, proptosis, and severe vision loss. She had previously undergone subtotal resection of a large Simpson Grade 1 spheno-orbital meningioma 3 years prior at an outside institution. Workup at our institution revealed hyperostosis of the left greater wing of the sphenoid bone and narrowing of the optic canal along with bony enhancement concerning for residual tumor. The patient was given the recommendation from outside institutions for radiation, presumably due to the chronicity of her visual loss. Our institution recommended resection of the residual osseous tumor with orbital reconstruction. Less than 2 weeks after surgery, the patient noted significant improvement in orbital pain and vision. At 3 months, she had regained full and symmetric orbital appearance with no orbital pain. Her visual acuity improved to 20/30 with full visual fields. Conclusion Surgical decompression of the optic canal and orbital contents for tumor related sphenoid wing hyperostosis should be strongly considered, despite an extended duration of visual change and loss. This case report shows that vision can be significantly restored even after symptoms have been present for greater than 6 months.

12.
Foot Ankle Orthop ; 5(3): 2473011420940221, 2020 Jul.
Article de Anglais | MEDLINE | ID: mdl-35097399

RÉSUMÉ

BACKGROUND: Active participation in patients' own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. METHODS: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor's degree or higher, were enrolled. RESULTS: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. CONCLUSION: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. LEVEL OF EVIDENCE: Level II, prospective cohort study.

13.
Schizophr Res Cogn ; 19: 002-2, 2020 Mar.
Article de Anglais | MEDLINE | ID: mdl-31832336

RÉSUMÉ

Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.

14.
CNS Spectr ; 25(2): 145-153, 2020 04.
Article de Anglais | MEDLINE | ID: mdl-31248468

RÉSUMÉ

Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.


Sujet(s)
Agressivité , Contrôle du comportement/méthodes , Troubles mentaux/psychologie , Comportement social , Violence/prévention et contrôle , Réduction des dommages , Humains , Troubles mentaux/physiopathologie , Troubles mentaux/thérapie
16.
J Psychiatr Res ; 115: 36-42, 2019 08.
Article de Anglais | MEDLINE | ID: mdl-31102902

RÉSUMÉ

Autistic traits are a feature of schizophrenia and has been found to impair social functioning and social cognition. Other influences on social outcomes in schizophrenia include depression and social avoidance. However, challenges in self-assessment of abilities and functioning (i.e., introspective accuracy) and self-assessment bias also contribute to disability. Depression has been studied for its association with introspective accuracy and bias, but autistic traits have not. Participants were 177 patients with schizophrenia who self-reported their everyday functioning and social cognitive ability as well as their depression. All were rated with the PANSS and a separate rater generated all-sources ratings of everyday functioning and social cognitive ability. Correlations between self-reported everyday functioning and social cognitive ability, ratings of everyday functioning and social cognitive ability, and the discrepancies between those ratings were examined for correlations with depression, autistic features and social avoidance. Accuracy was defined by the absolute value of the difference between self-reports and all-sources ratings and bias was defined by the direction of discrepancy (positive vs. negative). There was a statistically significant difference between sources on every measure. Bias was not directional on average, but patients with the lowest levels of depression overestimated their abilities on every measure and those with the highest depression underestimated. Autistic traits were associated with impairments in everyday functioning and underestimation of those impairments, while social avoidance was associated with impaired social functioning and accurate self-assessment. Features of schizophrenia have differential implications for impaired functioning and self-assessment, with autistic features and low levels of depression associated with consistent self-assessment biases.


Sujet(s)
Activités de la vie quotidienne , Trouble du spectre autistique/physiopathologie , Dépression/physiopathologie , Auto-évaluation diagnostique , Troubles psychotiques/physiopathologie , Schizophrénie/physiopathologie , Comportement social , Compétences sociales , Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Autorapport
17.
Foot Ankle Int ; 40(7): 745-752, 2019 Jul.
Article de Anglais | MEDLINE | ID: mdl-30990076

RÉSUMÉ

BACKGROUND: Arthrodesis of the first metatarsophalangeal (MTP) joint has been shown to be effective in alleviating pain and correcting deformity in hallux rigidus. However, outcomes in specific sports and physical activities remain unclear. The aim of this study was to assess sports and physical activities in young patients following first MTP joint arthrodesis and to compare these results with clinical outcomes. METHODS: Patients between ages 18 and 55 years who underwent MTP arthrodesis were identified by review of a prospective registry. Fifty of 73 eligible patients (68%) were reached for follow-up at a mean of 5.1 (range, 2.2-10.2) years with a mean age at surgery of 49.7 (range, 23-55) years. Physical activity was evaluated with a previously developed sports-specific, patient-administered questionnaire. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS). RESULTS: Patients participated in 22 different sports and physical activities. The most common were walking, biking, weightlifting, swimming, running, and golf. Compared to preoperatively, patients rated 27.4% of activities as less difficult, 51.2% as the same, and 21.4% as more difficult. Patients returned to 44.6% of preoperative physical activities in less than 6 months and reached their maximal level of participation in 88.6% of physical activities. Ninety-six percent of patients (48/50) were satisfied with the procedure regarding return to sports and physical activities. Improvements in the FAOS Symptoms subscore were associated with increased postoperative running and walking duration, and improvements in FAOS Pain subscores were associated with greater patient satisfaction. CONCLUSION: Patients were able to participate in a wide variety of sports and physical activities postoperatively. Some patients reported increased difficulty, but were nonetheless satisfied with the procedure regarding physical activity participation. These findings suggest that first MTP joint arthrodesis is a reasonable option in young, active patients, and may be used to guide postoperative expectations. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Sujet(s)
Arthrodèse , Exercice physique , Hallux rigidus/chirurgie , Articulation métatarsophalangienne/chirurgie , Retour au sport , Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Satisfaction des patients , Études rétrospectives , Enquêtes et questionnaires , Jeune adulte
18.
Foot Ankle Orthop ; 4(3): 2473011419875686, 2019 Jul.
Article de Anglais | MEDLINE | ID: mdl-35097341

RÉSUMÉ

BACKGROUND: While metatarsus primus elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between MPE and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. Additionally, previous studies have only assessed elevation of the first metatarsal with respect to the floor or the second metatarsal, and not with respect to the proximal phalanx. The aim of this study was to examine the reliability of new radiographic measurements that consider the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in patients with hallux rigidus than in a control population. METHODS: A retrospective chart review was conducted from prospectively collected registry data at the investigators' institution to identify patients with hallux rigidus (n = 65). A size-matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis was identified (n = 65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including 2 research assistants, 1 senior orthopedic resident, 1 foot and ankle fellowship-trained orthopedic surgeon, and 1 attending musculoskeletal fellowship-trained radiologist, evaluated 7 radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the 7 were newly designed measurements that include the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using intraclass correlation coefficients (ICCs) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t test. RESULTS: Six of the 7 radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC, 0.800-0.953) between all levels of training, except for the proximal phalanx-first metatarsal angle, which showed moderate reliability (ICC, 0.527). Substantial to almost perfect intrarater reliability (ICC, 0.710-0.982) was demonstrated by the measurements performed by research assistants. All 7 of the measurements taken by the musculoskeletal fellowship-trained radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations, with the hallux rigidus group showing increased elevation (P < .001-.019). CONCLUSION: This study confirmed the reliability of 7 radiographic measurements used to assess for MPE, including 3 previously established and 4 newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that patients with hallux rigidus were more likely to have MPE compared with patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

19.
Foot Ankle Int ; 39(9): 1019-1027, 2018 09.
Article de Anglais | MEDLINE | ID: mdl-29774763

RÉSUMÉ

BACKGROUND: Reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) often requires the use of multiple osteotomies and soft tissue procedures that may not heal well in older patients. The purpose of our study was to determine whether patients older than 65 years with stage II AAFD had inferior clinical outcomes or an increased number of subsequent surgical procedures after flatfoot reconstruction when compared with younger patients. METHODS: One-hundred forty consecutive feet (70 right, 70 left) with stage II AAFD in 137 patients were divided into 3 groups based on age: younger than 45 years (young; n = 21), 45 to 65 years (middle-aged; n = 87), and 65 years and older (older; n = 32). Preoperative and postoperative Foot and Ankle Outcome Scores (FAOSs) at a minimum of 2 years were compared. Hospital records were reviewed to determine if patients underwent a subsequent procedure postoperatively. RESULTS: Patients in the older group did not demonstrate any differences in changes in FAOS subscales compared with patients in the young and middle-aged groups (all P > .15). The older group had significant preoperative to postoperative improvements in all the FAOS subgroups ( P < .01). In addition, patients in the older group were not more likely to undergo a subsequent surgery than were the younger patients (all P > .10). CONCLUSIONS: Our study found that patients older than 65 years with stage II AAFD have improvements in patient-reported outcomes and rates of revision surgery after surgical reconstruction that were not significantly different than those of younger patients. LEVEL OF EVIDENCE: Therapeutic Level III, comparative series.


Sujet(s)
Pied plat/chirurgie , Adulte , Facteurs âges , Sujet âgé , Femelle , Pied plat/classification , Humains , Mâle , Adulte d'âge moyen , , Mesures des résultats rapportés par les patients , Qualité de vie , Réintervention/statistiques et données numériques , Indice de gravité de la maladie
20.
Foot Ankle Int ; 39(2): 149-154, 2018 02.
Article de Anglais | MEDLINE | ID: mdl-29078056

RÉSUMÉ

BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia. METHODS: Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids. RESULTS: Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication. CONCLUSIONS: Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population. LEVEL OF EVIDENCE: Level II, prospective comparative study.


Sujet(s)
Analgésiques morphiniques/usage thérapeutique , Stupéfiants/usage thérapeutique , Douleur postopératoire/prévention et contrôle , Cheville , Pied , Humains , Patients en consultation externe , Période postopératoire , Études prospectives , Enquêtes et questionnaires
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