Flushing After Lumbar Epidural Steroid Injection with Dexamethasone.

PURPOSE OF REVIEW: Epidural steroid injections are an accepted treatment for low back pain and radicular symptoms. While epidural steroid injections are routinely performed without complications, side effects can be seen, including flushing. Flushing has been studied using various steroid preparations, including dexamethasone, but at significantly higher doses. This was a prospective cohort study that examines the rate of flushing in ESIs with a lower dose (4 mg) of dexamethasone. Subjects undergoing lumbar epidural steroid injection were asked about the presence of flushing following the procedure prior to discharge and again at 48 h after. A total of 80 participants received fluoroscopically guided interlaminar and transforaminal epidural injections. All participants received 4 mg of dexamethasone. Of the 80 subjects, 52 were female, and 28 were male. Seventy-one underwent a transforaminal epidural injection and 9 underwent an interlaminar epidural injection. Four (5%) subjects experienced flushing-1 subject experienced immediate post-procedural flushing and 3 experienced flushing within 48 h. All 4 subjects (100%) were female. All 4 subjects received transforaminal injections (100%). RECENT FINDINGS: There is a gap of knowledge about the flushing after lumbar epidural steroid injection with dexamethasone. Flushing is a known and common side effect of epidural steroid injections, varying in frequency based on type of steroid as well as dose. We found 5% incidence in flushing reaction with 4 mg of dexamethasone.

Impact of Opioid Dose and Obstructive Sleep Apnea in Chronic Opioid Patients Using STOP-Bang Questionnaire.

BACKGROUND: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. While patients on chronic opioids are at increased risk of sleep-disordered breathing, there is a lack of data on the relationship between opioid dose and OSA risk in particular. The STOP-Bang Questionnaire (SBQ) is a common screening tool for OSA, but it has not been well studied in patients on chronic opioid therapy. OBJECTIVES: This study uses the SBQ to examine the relationship between total daily opioid dose and the risk of OSA in patients on chronic opioid therapy. STUDY DESIGN: Retrospective chart review. SETTING: Academic medical center pain clinic. METHODS: Patients on stable doses of chronic opioids who completed the SBQ were grouped into 3 OSA risk categories, including low (SBQ score 0-2), medium (SBQ score 3-4), and high risk (SBQ score 5-8). Morphine equivalent daily dose (MEDD) was calculated and compared between the 3 risk groups. In a secondary analysis, patients were instead grouped into opioid dose categories, including low MEDD (≤ 20), medium MEDD (21-50), and high MEDD (> 50). The SBQ scores were then compared between the 3 MEDD groups. RESULTS: The charts of 190 patients on chronic opioid therapy were reviewed. One hundred forty-seven patients did not have a prior diagnosis of OSA. Of these, 92 (63%) patients completed the SBQ. Fifty-five percent were women and 45% men. The average age was 59. The average MEDD was 23.32. In the primary analysis based on the SBQ score, 39% were low risk for OSA, 42% medium risk, and 18% were high risk. There was no difference in total MEDD between the 3 groups (P = 0.83). In the secondary analysis based on total MEDD, 58% had low MEDD, 32% had medium MEDD, and 11% had high MEDD. There was no significant difference in SBQ scores between these groups (P = 0.51). LIMITATIONS: This is a single center study, and only 63% of eligible patients completed the SBQ. The study did not attempt to control for potential confounders. The SBQ results were not confirmed with a polysomnogram. CONCLUSION: We found no relationship between the opioid dose and the risk of OSA as measured by the SBQ score in this chronic opioid population. Opioids may be more associated with sleep apnea due to central rather than obstructive processes, and additional screening tools beyond the SBQ may be needed to better screen for sleep apnea in this population.

CrossFit® Instructor Demographics and Practice Trends.

CrossFit® is an increasingly popular exercise modality that uses high intensity power training. The literature to date regarding CrossFit® has focused on its benefits to VO2 Max, body composition and the motivational variables of participants of CrossFit®. A computerized survey was distributed to CrossFit® instructors using Survey Monkey® (Palo Alto, CA, USA). One hundred and ninety-three CrossFit® instructors responded to the survey. Of these 86.6% (155/179) reported being a certified CrossFit® instructor with 26.7% (48/180) having a bachelor's degree in an exercise-related field. Instructors with a CrossFit® certification have less bachelor's (P=0.04) or master's (P=0.0001) degrees compared to those without a CrossFit® certification, more utilization of Olympic weightlifting (P=0.03), one-on-one teaching (P=0.0001), 1-RM max on snatch (P=0.004), 1-RM on clean and jerk or hang clean (P=0.0003), kettlebell use (P=0.0001) and one-on-one training (P=0.0001). Instructors report differences in their education and differences in use of weightlifting platforms and various types of footwear. Non-certified instructors differ from CrossFit® certified instructors in regards to teaching of Olympic weightlifting and exercise programming.

Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries.

Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA) with 605 personal trainers accessing the survey. An exercise related bachelor's degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2%) and National Strength and Conditioning Association (28.9%). Only 2.9% of all personal trainers surveyed had no exercise-related bachelor's degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%), rotator cuff tear/tendonitis (8.9%), shin splints (8.1%), ankle sprain (7.5%), and cervical muscle strain (7.4%). There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness.

Awareness and Use of the After-Visit Summary Through a Patient Portal: Evaluation of Patient Characteristics and an Application of the Theory of Planned Behavior.

BACKGROUND: Patient portals are being used to provide a clinical summary of the office visit or the after-visit summary (AVS) to patients. There has been relatively little research on the characteristics of patients who access the AVS through a patient portal and their beliefs about the AVS. OBJECTIVE: The aim was to (1) assess the characteristics of patients who are aware of and access the AVS through a patient portal and (2) apply the Theory of Planned Behavior (TPB) to predict behavioral intention of patients toward accessing the AVS provided through a patient portal. METHODS: We developed a survey capturing the components of TPB (beliefs, attitude, perceived norm, and perceived behavioral control). Over a 6-month period, patients with a patient portal account with an office visit in the previous week were identified using our organization's scheduling system. These patients were sent an email about the study and a link to the survey via their portal account. We applied univariate statistical analysis (Pearson chi-square and 1-way ANOVA) to assess differences among groups (aware/unaware of AVS and accessed/did not access AVS). We reported means and standard deviations to depict belief strengths and presented correlations between beliefs and attitude, perceived norm, and perceived behavioral control. We used hierarchical regression analysis to predict behavioral intention toward accessing the AVS through the patient portal. RESULTS: Of the 23,336 patients who were sent the survey, 5370 responded for a response rate of 23.01%. Overall, 76.52% (4109/5370) were aware that the AVS was available through the patient portal and 54.71% of those (2248/4109) accessed the AVS within 5 days of the office visit. Patients who accessed the AVS had a greater number of sessions with the portal (mean 119, SD 221.5) than those who did not access the AVS (mean 79.1, SD 123.3, P<.001); the difference was not significant for awareness of the AVS. The strongest behavioral beliefs with accessing the AVS were being able to track visits and tests (mean 2.53, SD 1.00) followed by having medical information more readily accessible (mean 2.48, SD 1.07). In all, 56.7% of the variance in intention to access the AVS through the portal was accounted for by attitude, perceived norm, and perceived behavioral control. CONCLUSIONS: Most users of a patient portal were aware that the AVS was accessible through the portal. Patients had stronger beliefs about accessing the AVS with the goal of timely and efficient access of information than with engaging in their health care. Interventions to improve patient access of the AVS can focus on providers promoting patient beliefs about the value of the AVS for tracking tests and visits, and timely and efficient access of information.

NCAA strength and conditioning coach demographics, current practice trends and common injuries of athletes during strength and conditioning sessions.

BACKGROUND: NCAA strength and conditioning coaches are responsible for the day-to-day conditioning and strength training of collegiate athletes. NCAA regulations will likely require all strength and conditioning coaches to have a strength and conditioning certification. NCAA strength and conditioning coaches have varied philosophies on exercise programming based on educational background. The study aims to further evaluate the backgrounds and exercise philosophies of NCAA strength and conditioning coaches. METHODS: A survey (Survey Monkey®, Palo Alto, CA, USA) was distributed to NCAA strength and conditioning professionals to evaluate their education background, current practice trends, use of specific equipment and footwear, and what injuries occurred during sessions. RESULTS: Of the 208 survey participants, 77.9% were male with an average age of 34.5±9.1 years old. An exercise-related bachelor's degree was held by 80.4% and an exercise-related master's degree by 72.4%. Over 89% had a strength and conditioning certification. Having a master's, bachelor's, or type strength and conditioning certification had no difference in 1-repetition maximal practice with athletes. Lower extremity injuries made up the highest percentage (58.9%) of injuries seen by NCAA Strength and Conditioning Coaches than lumbar spine injuries (16.7%). The five most common injuries reported during workouts were lumbar strain (N.=431, 14.7%), hamstring strain (N.=332, 11.3%), ankle sprain (N.=299, 10.2%), patellar tendonitis (N.=232, 7.9%), and shin splints (N.=226, 7.7%). CONCLUSIONS: Collegiate education and certifications have impact on practice patterns of strength and conditioning coaches in the NCAA.