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1.
World Neurosurg ; 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33857673

RESUMO

OBJECTIVE: The 2020 coronavirus disease 2019 (COVID-19) pandemic resulted in state-specific quarantine protocols and introduced the concept of social distancing into modern parlance. We assess the impact of the COVID-19 pandemic on neurotrauma presentations in the first 3 months after shutdown throughout Pennsylvania. METHODS: The Pennsylvania Trauma Systems Foundation was queried for registry data from the Pennsylvania Trauma Outcomes Study between March 12 and June 5 in each year from 2017 to 2020. RESULTS: After the COVID-19 shutdown, there was a 27% reduction in neurotrauma volume, from 2680 cases in 2017 to 2018 cases in 2020, and a 28.8% reduction in traumatic brain injury volume. There was no significant difference in neurotrauma phenotype incurred relative to total cases. Injury mechanism was less likely to be motor vehicle collision and more likely caused by falls, gunshot wound, and recreational vehicle accidents (P < 0.05). Location of injury was less likely on roads and public locations and more likely at indoor private locations (P < 0.05). The proportion of patients with neurotrauma with blood alcohol concentration >0.08 g/dL was reduced in 2020 (11.4% vs. 9.0%; P < 0.05). Mortality was higher during 2020 compared with pre-COVID years (7.7% vs. 6.4%; P < 0.05). CONCLUSIONS: During statewide shutdown, neurotrauma volume and alcohol-related trauma decreased and low-impact traumas and gunshot wounds increased, with a shift toward injuries occurring in private, indoor locations. These changes increased mortality. However, there was not a change in the types of injuries sustained.

2.
World Neurosurg ; 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33894398

RESUMO

INTRODUCTION: The Coronavirus-19 (COVID) pandemic presented a significant challenge to healthcare providers. Neurosurgeons work with critically ill patients who were at particularly high risk for COVID and the pandemic produced ever-shifting circumstances to allow this continued care. This study explores the psychological impact of the pandemic on neurosurgical residents at a single institution. METHODS: Residents completed the Perceived Stress Scale (PSS) and the Inventory of Depressive Symptomology 30 (IDS-30) two validated surveys prior to and during the pandemic. PSS scores may range from 0 to 40 with higher scores indicative of increased stress. IDS-30 ranges from 0 to 84 with higher scores indicating more severe levels of depression. Survey results were compared collectively amongst residents and statistically analyzed. RESULTS: The surveys had 19 out of 28 total responders (68%). Mean score on the PSS was 16.1 pre-pandemic and 14.7 during the pandemic (p>0.05). The mean score on the IDS-30 was 14.7 pre-pandemic and 12.0 during the pandemic (p> 0.05). Matching the survey questionnaire results by each resident revealed an average decrease of 2.3 and 2.4 for the PSS and IDS-30, respectively. CONCLUSION: There were no significant changes in perceived stress or depressive symptoms during the pandemic. Resilience and perseverance are commonly sought traits amongst neurosurgical residents and are components stressed during their training. Neurosurgical residents prove unwavering while caring for patients during the COVID pandemic.

3.
World Neurosurg ; 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33839338

RESUMO

BACKGROUND: Academic productivity plays a growing role in professional advancement in academic medicine. This study aimed to assess academic productivity among spine surgeons by investigating differences in h indices between neurological and orthopedic spine surgeons. METHODS: The American Association of Neurological Surgeons (AANS) Neurosurgical Residency Training Program Directory provided names of U.S. and Canadian academic neurological surgeons. The National Institutes of Health (NIH) Research Portfolio Online Reporting Tools database was consulted for NIH funding statuses of the surgeons. Scopus yielded the h indices. Orthopedic spine surgeons were identified at the same institutions as the neurological spine surgeons, and NIH funding statuses and h indices were identified from the same databases. Differences between the disciplines and across the categories of NIH funding receipt, having a Ph.D., and academic rank were analyzed. RESULTS: Inclusion criteria were met by 215 neurological spine surgeons and 513 orthopedic spine surgeons. Neurological spine surgeons had a mean h index of 21.16, and orthopedic spine surgeons had a mean h index of 14.08 (P < 0.0001). Neurological surgeons with NIH funding had higher (P < 0.0001) h indices (34.15) than surgeons without funding (19.29). Likewise, orthopedic surgeons with NIH funding had higher (P < 0.001) h indices (42.83) than surgeons without funding (13.39). Analysis of variance showed that department chairmen and professors had higher h indices than associate or assistant professors among neurological (P < 0.01) and orthopedic (P < 0.001) surgeons. CONCLUSIONS: These results demonstrate the importance of the h index in measuring academic productivity among neurological and orthopedic spine surgeons.

4.
Clin Neurol Neurosurg ; 204: 106585, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33813370

RESUMO

BACKGROUND: Knowledge of free-hand screw technique remains critical to adequately train neurosurgical residents. The purpose of this study was to evaluate the accuracy of screw placement via the free-hand technique in lumbar, thoracic, and cervical spine by neurosurgical residents completing an enfolded spine fellowship. METHODS: Medical records of all patients who underwent free-hand screw placement at all spinal levels over a 6-month period by senior neurosurgical residents enrolled in an in-folded spine fellowship were retrospectively reviewed. Postoperative CT images were assessed for presence and direction of cortical breach. RESULTS: Twenty-six patients underwent 162 free-hand screw placements. The most commonly placed screws were cervical lateral mass screws (n = 69), thoracic (n = 41), and lumbar pedicle screws (n = 41). The most common indication for surgery was deformity (n = 22), followed by infection (n = 2) and trauma (n = 2). Fifty-five breaches were identified in 44 (27 %) screws placed in 21 patients (81 %). Anterior breach was identified in 22 cases (40.0 %), lateral in 12 (23.6 %), superior in 7 (12.7 %), and inferior in 7 (12.7 %), and medial in 6 (10.9 %). The most common level of breach was observed in cervical lateral mass screws (n = 19, 43 %) and least common in C2 pars screws (n = 1, 2%). With an average length of follow up of 12.1 ± 7.7 months of follow-up, no clinical sequalae of screw breach was observed. CONCLUSIONS: Despite the high prevalence of screw breach using the free-hand technique by neurosurgical residents, the absence of clinical sequelae implies safety and emphasizes the importance of early exposure to this technique during neurosurgical residency training.

5.
Neurosurg Focus ; 50(3): E19, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33789227

RESUMO

We received so many biographies of women neurosurgery leaders for this issue that only a selection could be condensed here. In all of them, the essence of a leader shines through. Many are included as "first" of their country or color or other achievement. All of them are included as outstanding-in clinical, academic, and organized neurosurgery. Two defining features are tenacity and service. When faced with shocking discrimination, or numbing indifference, they ignored it or fought valiantly. When choosing their life's work, they chose service, often of the most neglected-those with pain, trauma, and disability. These women inspire and point the way to a time when the term "women leaders" as an exception is unnecessary.-Katharine J. Drummond, MD, on behalf of this month's topic editors.

6.
J Clin Neurosci ; 85: 78-83, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581795

RESUMO

Anticoagulation for postoperative venous thromboembolism (VTE) may infer a higher risk of intracranial hemorrhage. We treat patients with VTE using slowly titrating intravenous heparin drip without bolus. When PTT is greater than 60 s, a head CT is obtained to monitor for the development of a intracranial hemorrhage before transition to oral anticoagulation. We evaluated the utility of routine surveillance head CT to monitor for intracranial hemorrhage during anticoagulation. This is a case series of neurosurgical patients in an academic quaternary hospital who developed a VTE after cranial procedures between 2007 and 2017. Over 11,000 patients were screened for the study. Patients' demographics data, surgical indication, PTT at the time of surveillance CT head, surveillance CT head findings, and patient's clinical course were reviewed. A total of 83 patients were included. Three patients (3.6%) developed a new subclinical hemorrhage on CT head imaging while on heparin drip. Interval CT head showed stable hemorrhage in all patients. Heparin drip was stopped in two patients and they both progressed from DVT to pulmonary embolism: one patient died due to cardiac arrest, the other patient was transitioned to oral anticoagulation. In the third patient heparin drip was continued uneventfully and transitioned to oral anticoagulation with no further clinical sequalae. Surveillance CT while on heparin drip for VTE management detected subclinical intracranial hemorrhage in a small subset of patients. Patients whose anticoagulation was stopped had progression of VTE. Undertreatment of VTE in the presence of subclinical hemorrhage may lead to significant morbidity and mortality.


Assuntos
Craniotomia/efeitos adversos , Hemorragias Intracranianas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Heparina/uso terapêutico , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X/métodos , Tromboembolia Venosa/etiologia
7.
ANZ J Surg ; 91(4): 730-739, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33543578

RESUMO

BACKGROUND: Large right adrenal tumours may invade the liver and mimic primary hepatic malignancy, presenting diagnostic and management challenges. The 'anterior approach hepatectomy' (AAH) using hanging manoeuvre may be safe for resection of such tumours. METHODS: Prospectively maintained database was analysed to identify the large tumours of adreno-hepatic region subjected to hepatectomy. Clinico-biochemical, radiological and surgical details were reviewed. AAH and hanging manoeuvre was adopted for the patients requiring right hepatectomy. RESULTS: Out of the eight patients with adreno-hepatic tumour, four had indeterminate origin of the mass, two had complex cysts, and two were diagnosed as hepatocellular carcinoma on the pre-operative imaging. The median age was 38 years (23-66); male:female ratio was 5:3. AAH was performed in four patients, while others underwent non-anatomical resection of involved segment(s). This accounted for 1.01% of 789 hepatectomies performed during the study period. The median intra-operative blood loss was 525 mL (150-2200 mL) and the median tumour size was 9 cm (6-17 cm). All patients underwent R0 resection. The final histopathological diagnoses were: three phaeochromocytomas (two malignant and one benign), two adrenocortical carcinomas, one malignant paraganglionomas and two adrenal cysts. Major complication (grade IVa) was experienced in one patient. On median follow-up of 67.5 months (7-84), all were alive and one patient had tumour recurrence. CONCLUSION: Adrenal tumours mimicking primary hepatic malignancy are rare but pose diagnostic challenges. The AAH is a safe approach with acceptable R0 resection, blood loss, surgical complications and overall outcome for the patients requiring right hepatectomy.

8.
World Neurosurg ; 2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33578021

RESUMO

In an effort, to curtail rising health care costs, government and private payers have begun to focus on measuring quality of care. Along with quality improvement initiatives, clinical practice guidelines may also be utilized to provide better care. Clinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. This review provides an overview of clinical practice guidelines and quality improvement initiatives to highlight strategies to optimize patient outcomes.

9.
J Neurosurg Pediatr ; : 1-7, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33636695

RESUMO

OBJECTIVE: Myelomeningocele (MMC) is frequently complicated by symptomatic hydrocephalus, necessitating early permanent CSF diversion and revision surgeries. Shunt infections are a common cause of shunt malfunction. This study aims to characterize long-term shunt-related outcomes of patients undergoing MMC closure. METHODS: A total of 170 patients undergoing MMC closure between the years of 1995 and 2017 were identified from a retrospective review of a prospectively populated surgical database at the Children's Hospital of Pittsburgh. Patients who underwent MMC closure and required ventriculoperitoneal (VP) shunt insertion met criteria and were included in the primary study analysis. Analysis with a Fisher exact test was performed for categorical variables, and Mann-Whitney U-tests were utilized for numerical data. RESULTS: Of the 158 total patients undergoing MMC closure and meeting inclusion criteria, 137 (87%) required VP shunt insertion. These 137 patients demonstrated a shunt revision rate of 21.1% per person-year and a shunt infection rate of 2.1% per person-year over a mean follow-up of 10.8 years. Patients had a mean of 3.4 ± 0.6 shunt surgeries prior to their first infection. Patients undergoing immediate shunt removal, external ventricular drain placement, or shunt replacement after clearing the infection had lower rates of subsequent infections than patients who initially were managed with shunt externalization (p < 0.001). Placement of a shunt at the time of MMC closure was not found to be a risk factor for infection. Of patients with initial shunt placement after the implementation of the Hydrocephalus Clinical Research Network protocol in 2011, the authors' institution has had a shunt infection rate of 4.2% per person-year and a revision rate of 35.7% per person-year. CONCLUSIONS: This study describes long-term outcomes of shunted MMC patients and factors associated with shunt infections. Most patients underwent multiple revisions prior to the first shunt infection. Shunt externalization may be ineffective at clearing the infection and should be avoided in favor of early shunt removal and external ventricular drainage, followed by shunt replacement once infection is demonstrated to have cleared.

10.
World Neurosurg ; 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33548536

RESUMO

Participation in the health care and government advocacy arena may represent new and challenging perspectives for the traditional neurosurgeon. However, those with a strong understanding of the laws, rules, regulations, and fiscal allocation process can directly influence the practice of neurosurgery in the United States. We seek to shine light on the black box of how health care laws are passed, the influence and techniques of lobbying, and the role and rules surrounding political action committees. This practical review of health care advocacy is supplemented by a blueprint for engagement in the political arena for the practicing neurosurgeon.

11.
Pain ; 162(5): 1334-1351, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33492037

RESUMO

ABSTRACT: Diabetes is a leading cause of peripheral neuropathy (diabetic peripheral neuropathy, DPN), and uncontrolled long-lasting hyperglycemia leads to severe complications. A major proportion of diabetics develop excruciating pain with a variable course. Mechanisms leading to painful DPN are not completely understood and treatment options limited. We hypothesized that epigenetic modulation at the level of microRNA (miRNA) expression triggered by metabolic imbalance and nerve damage regulates the course of pain development. We used clinically relevant preclinical models, genome-wide screening, in silico analyses, cellular assays, miRNA fluorescent in situ hybridization, in vivo molecular manipulations, and behavioral analyses in the current study. We identified miRNAs and their targets that critically impact on nociceptive hypersensitivity in painful DPN. Our analyses identify miR-33 and miR-380 expressed in nociceptive neurons as critical denominators of diabetic pain and miR-124-1 as a mediator of physiological nociception. Our comprehensive analyses on the putative mRNA targets for miR-33 or miR-124-1 identified a set of mRNAs that are regulated after miR-33 or miR-124-1 overexpression in dorsal root ganglia in vivo. Our results shed light on the regulation of DPN pathophysiology and implicate specific miRNAs as novel therapeutic targets for treating painful DPN.

12.
Nat Commun ; 12(1): 426, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462216

RESUMO

Painful neuropathy is a frequent complication in diabetes. Proopiomelanocortin (POMC) is an endogenous opioid precursor peptide, which plays a protective role against pain. Here, we report dysfunctional POMC-mediated antinociception in sensory neurons in diabetes. In streptozotocin-induced diabetic mice the Pomc promoter is repressed due to increased binding of NF-kB p50 subunit, leading to a loss in basal POMC level in peripheral nerves. Decreased POMC levels are also observed in peripheral nervous system tissue from diabetic patients. The antinociceptive pathway mediated by POMC is further impaired due to lysosomal degradation of µ-opioid receptor (MOR). Importantly, the neuropathic phenotype of the diabetic mice is rescued upon viral overexpression of POMC and MOR in the sensory ganglia. This study identifies an antinociceptive mechanism in the sensory ganglia that paves a way for a potential therapy for diabetic neuropathic pain.


Assuntos
Diabetes Mellitus Experimental/complicações , Neuropatias Diabéticas/patologia , Nociceptividade/fisiologia , Pró-Opiomelanocortina/deficiência , Células Receptoras Sensoriais/patologia , Idoso , Idoso de 80 Anos ou mais , Animais , Diabetes Mellitus Experimental/induzido quimicamente , Neuropatias Diabéticas/etiologia , Feminino , Gânglios Espinais/citologia , Gânglios Espinais/patologia , Humanos , Lisossomos , Masculino , Camundongos , Camundongos Knockout , Pró-Opiomelanocortina/genética , Proteólise , Receptores Opioides mu/genética , Receptores Opioides mu/metabolismo , Estreptozocina/toxicidade
13.
Neurosurgery ; 88(3): 552-557, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33372214

RESUMO

BACKGROUND: With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE: To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS: As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS: From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION: Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

16.
Dermatol Online J ; 26(11)2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33342170

RESUMO

BACKGROUND: As skin cancer is the most common cancer in the U.S., many publications focus on cutaneous malignancies. The objective was to identify and analyze the 100 most-cited articles pertaining to skin cancers to provide clarity on past, and insight for future research. METHODS: Using a two-stage search of Thomson Reuters Web of Science database, the 100 most-cited skin cancer articles between 1945 and 2018 were identified and analyzed. RESULTS: The articles were cited an average total of 558.49 times (range: 259 to 3429). There were relatively few significant publications until 1988. Linear correlation revealed that journal impact factor was not correlated with average number of citations per year per article (R2=0.06). Molecular pathogenesis and UV exposure were the most common topics. The topics that received the highest average citations per year per article were prevention (50.44 citations per year), diagnosis (47.32 citations per year), and management (41.37 citations per year). Basic science articles accounted for the most publications, followed by narrative literature reviews. CONCLUSIONS: These results may indicate that future publications with similar characteristics are more likely to be cited and thus, more influential.

17.
World Neurosurg ; 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33248304

RESUMO

BACKGROUND CONTEXT: The assessment of academic physicians should utilize field-independent publication metrics to measure improvement of grant outcomes, promotion, and continued evaluation of research productivity. Publication metrics such as the author-level h-index are often used to evaluate and compare research productivity in academia. The h-index, however, is not a field-normalized statistic and has been criticized as inappropriate for comparison of authors from different fields. For example, fields such as internal medicine have a larger audience and thus afford publications a higher likelihood of increased citations compared to a perhaps equally impactful paper in a smaller field such as neurosurgery. The National Institutes of Health (NIH) has developed a new, field-normalized article-level metric called the relative citation ratio (RCR) that can be used to more accurately compare author productivity between fields. The spinal subspecialty represents a special subset of the neurosurgical field with a designated fellowship and distinct differences in the RCR metrics. The authors look to analyze the unique results found in the academic spinal surgeon RCR values compared to all academic neurosurgeons. PURPOSE: The assessment of academic physicians should utilize field-independent publication metrics to measure improvement of grant outcomes, promotion, and continued evaluation of research productivity. Here, we provide an analysis of RCR indices for 358 academic spine neurosurgeons in the United States, including the mean RCR of each author's total publications and the weighted RCR, which is the sum of all an author's publication-level RCR values. We further assess the impact of gender, career duration, academic rank, and PhD acquisition on the RCR scores of U.S. academic spinal neurosurgeons. STUDY DESIGN: Literature review METHODS: The mean RCR is a total citations per year of a publication divided by average citations per year received by NIH-funded papers in the same field. A value of 1 is the normal NIH-funded standard. iCite database searches were performed for all physician faculty members affiliated with ACGME-accredited neurological surgery programs who have sub-specialized in spine as of November 1, 2019. Gender, career duration, academic rank, additional degrees, total publications, mean RCR, and weighted RCR were collected for each individual. RCR and weighted RCR were compared between variables to assess patterns of analysis. RESULTS: A total of 358 fellowship-trained academic spine surgeons from 125 institutions were included in the analysis. Neurological spine surgeons had exceptionally research productivity, with a median RCR of 1.38 [IQR = 0.94 - 1.95] and a weighted median RCR of 25.28 [IQR = 6.87 - 79.93]. Overall, gender and academic rank were associated with increased mean RCR and weighted RCR values. Career duration and PhD acquisition were not. All subgroups analyzed had an RCR value above 1.0, with professor-level faculty or department chair having the highest mean and weighted RCR values overall. CONCLUSIONS: Current academic spine neurosurgeons have high median RCR values relative to the NIH standard RCR value of 1.0. Relative to the field of neurological surgery overall, RCR values for the spinal subspecialty are comparable. These data offer a more accurate means for self-evaluation of academic neurosurgeons as well as evaluation of faculty by institutional and departmental leaders.

18.
J Clin Neurosci ; 81: 246-251, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222924

RESUMO

We sought to evaluate feasibility and cost-reduction potential of a pilot screening program involving neurosurgeon tele-consultation for inter-facility transfer decisions in TBI patients with GCS 14-15 and abnormal CT head at a community hospital. The authors performed a retrospective comparative analysis of two patient cohorts during the pilot at a large hospital system from 2015 to 2017. In "screened" patients (n = 85), images and examination were reviewed remotely by a neurosurgeon who made recommendations regarding transfer to a level 1 trauma center. In the "unscreened" group (n = 39), all patients were transferred. Baseline patient characteristics, outcomes, and costs were reviewed. Patient demographics were similar between cohorts. Traumatic subarachnoid hemorrhage was more common in screened patients (29.4% vs 12.8%, P = 0.02). The presence of midline shift >5 mm was comparable between groups. Among screened patients, 5 were transferred (5.8%) and one required evacuation of chronic subdural hematoma. In unscreened patients, 7 required evacuation of subdural hematoma. None of the screened patients who were not transferred deteriorated. Screened patients had significantly reduced average total cost compared to unscreened patients ($2,003 vs. $4,482, P = 0.03) despite similar lengths of stay (2.6 vs. 2.7 days, P = 0.85). In non-surgical patients, costs were less in the screened group ($2,025 vs. $2,939), although statistically insignificant (P = 0.38). In this pilot study, remote review of images and examination by a neurosurgeon was feasible to avoid unnecessary transfer of patients with traumatic intracranial hemorrhage and GCS 14-15. The true potential in cost-reduction will be realized in system-wide large-scale implementation.

19.
Asian J Transfus Sci ; 14(1): 19-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33162700

RESUMO

BACKGROUND: Administration of anticoagulant citrate and dextrose (ACD-A) chelates ionized calcium in blood and causes hypocalcemia in plateletpheresis donors. The aim of the study was to observe the effects of oral calcium (Ca) supplementation during plateletpheresis on various parameters related to calcium metabolism. MATERIALS AND METHODS: This study was performed between January 2014 and December 2014 on 200 plateletpheresis donors. They were divided into two groups. In group A donors (n=100), no prophylactic oral calcium supplementation was given. In group B (n=100) donors, 2000 mg of calcium was given one hour before the start of the procedure, 500 mg was given at the start of the procedure and 500 mg calcium was given just before the end of procedure. Biochemical parameters like serum total calcium (T Ca), serum total magnesium (T Mg) and ionized calcium level (iCa) were measured before and after the procedure. Relative risk of citrate toxicity was measured between the two groups. RESULTS: There was a significant fall in total calcium (pre 9.02 mg/dl, post 8.23 mg/dl,), ionized calcium level (pre 1.14 mmol/L, post 0.91 mmol/L) and total magnesium (pre 1.92 mg/dl, post 1.79 mg/dl) amongst the donors who did not receive prophylactic calcium supplementation. Despite calcium intake, in prophylactic calcium intake group, we did observe a significant drop in total magnesium (pre 2.04 mg/dl, post 1.94 mg/dl) and ionized calcium level (pre 1.25 mmol/L, post 1.12 mmol/L, p<0.01). We did observe a drop in total calcium level, however, this observation was not statistically significant. The risk (RR=5.44) of citrate toxicity was higher among group A donors. CONCLUSION: Prophylactic oral calcium carbonate supplementation would help in to reduce the risk of citrate toxicity. Therefore, we suggest for prophylactic oral administration of 3000 mg elemental calcium carbonate in three divided doses to make PP procedures uneventful.

20.
Orthopedics ; : 1-5, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33141234

RESUMO

The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(x):xx-xx.].

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