Venous Thromboembolism in Patients with Sarcoma: A Retrospective Study.

BACKGROUND: Little has been published about the association of venous thromboembolism (VTE) and sarcoma. In this study, we sought to identify clinical features of patients with sarcoma presenting at least one VTE episode. METHODS: Our study was a retrospective case-control study of a single-institution database with univariate and multivariate analysis using chi-square and Student's t test. A p value less than .05 was considered significant. RESULTS: The overall incidence of VTE in patients with sarcoma was 7.9%. Predictive factors identified by multivariate analysis were metastatic disease and administration of chemotherapy. It was not statistically possible to correlate the risk of VTE with specific sarcoma subtypes, but observations suggested malignant peripheral nerve sheath tumor, osteosarcoma, and liposarcoma as having the highest propension. CONCLUSION: VTE is not infrequent in patients with sarcoma. Adoption of common guidelines for cancer-associated thrombosis is recommended.

The influence of walkability on broader mobility for Canadian middle aged and older adults: An examination of Walk Score™ and the Mobility Over Varied Environments Scale (MOVES).

Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008-2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.

Developing a comprehensive measure of mobility: mobility over varied environments scale (MOVES).

BACKGROUND: While recent work emphasizes the multi-dimensionality of mobility, no current measure incorporates multiple domains of mobility. Using existing conceptual frameworks we identified four domains of mobility (physical, cognitive, social, transportation) to create a "Mobility Over Varied Environments Scale" (MOVES). We then assessed expected patterns of MOVES in the Canadian population. METHODS: An expert panel identified survey items within each MOVES domain from the Canadian Community Health Survey- Healthy Aging Cycle (2008-2009) for 28,555 (weighted population n = 12,805,067) adults (≥45 years). We refined MOVES using principal components analysis and Cronbach's alpha and weighted items so each domain was 10 points. Expected mobility trends, as assessed by average MOVES, were examined by sociodemographic and health factors, and by province, using Analysis of Variance (ANOVA). RESULTS: MOVES ranged from 0 to 40, where 0 represents individuals who are immobile and 40 those who are fully mobile. Mean MOVES was 29.58 (95% confidence interval (CI) 29.49, 29.67) (10th percentile: 24.17 (95% CI 23.96, 24.38), 90th percentile: 34.70 (CI 34.55, 34.85)). MOVES scores were lower for older, female, and non-white Canadians with worse health and lower socioeconomic status. MOVES was also lower for those who live in less urban areas. CONCLUSIONS: MOVES is a holistic measure of mobility for characterizing older adult mobility across populations. Future work should examine individual or neighborhood predictors of MOVES and its relationship to broader health outcomes. MOVES holds utility for research, surveillance, evaluation, and interventions around the broad factors influencing mobility in older adults.

Occupational injuries and burn out among orthopedic oncology surgeons.

BACKGROUND: Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries. AIM: The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances. METHODS: A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work. RESULTS: A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice. CONCLUSION: Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.

Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions.

In the event of surgical management of metastases to the humeral shaft, intramedullary nailing (IMN) is often preferred to plate osteosynthesis (PO) fixation despite a lack of consensus. In this study, we hypothesized that plate osteosynthesis will be associated with better functional and pain outcomes, thus better quality of life. Eighteen patients with the diagnosis of humeral shaft metastatic fracture or impending fracture were extracted from a prospective database of 140 metastatic patients collected across three hospitals over a five-year period. Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), Quality of Life (QOL) and Brief Pain Inventory (BPI) score were gathered during the year following the surgery. Statistical analysis was performed to compare the mean score differences between the two surgical options at baseline and five follow-up visits. Both treatment options were associated with an increase in functional outcomes based on both MSTS and TESS, and a decrease in pain level. However, no significant difference was found in quality of life and between the two treatment modalities. Thus, based on our results, a similar improvement in functional status and pain level can be achieved surgically by either intramedullary nailing or plating osteosynthesis.