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A Survey of Sports Concussion Specialists\u27 Clinical Criteria to Determine Concussion Recovery.
No full textOBJECTIVE: We sought to identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in decision-making criteria among three specialist groups, neuropsychologists, physicians, and certified athletic trainers (ATCs), for youth athletes and young adult/adult athletes.
METHOD: We surveyed 156 sports concussion specialists (neuropsychologists = 46, physicians = 42, and ATCs = 68) who rated the importance of specific criteria for determining concussion recovery in youth and young adult/adult athletes. Differences between these specialist groups were examined with Kruskal-Wallis tests. Modal ratings for each age group by specialist were also examined.
RESULTS: There were significant differences (all p \u3c .001) in criteria ratings across specialist groups regarding youth and young adults/adults for use of neurocognitive test scores, balance testing, physical examination, no symptom provocation with neurocognitive testing, athlete report of anxiety about return to sport, and family member\u27s report of recovery. For both age groups, physicians ranked use of neurocognitive test scores and no symptom provocation with neurocognitive testing as less important than other providers, while physician examination was ranked as more important. Neuropsychologists ranked balance testing and athlete report of anxiety about return to sport as less important than other providers, and ATCs ranked family member\u27s report of recovery as less important than other providers. Modal ratings provided more detail.
CONCLUSIONS: These results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers
Intracranial electroencephalographic connectivity analysis to localize epileptogenic networks: Systematic review and meta-analysis from ILAE Epilepsy Surgery Networks Task Force.
No full textIntracranial electroencephalographic (iEEG) connectivity analysis is a promising method to localize epileptic networks and guide surgical planning in focal drug-resistant epilepsy. Despite numerous studies exploring its utility, the added value of iEEG connectivity over standard clinical presurgical evaluation remains unclear. We assess the current evidence on the efficacy of iEEG connectivity analyses to improve seizure outcomes following epilepsy surgery through a systematic review and meta-analysis. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we searched PubMed and Embase for studies (2006-2024) of adult focal drug-resistant epilepsy patients who underwent surgical resection or ablation, reported outcomes at least 1 year postsurgery, and used iEEG connectivity analysis to localize networks. Reviews, nonhuman studies, and studies lacking iEEG connectivity analysis or network localization were excluded. We derived classification metrics (true/false positives/negatives) based on concordance between iEEG findings, clinical localization, and outcome. Subgroup meta-analyses and meta-regressions determined differences by seizure type, lesion status, and analysis approach. Of 2881 studies screened, 25 met criteria (n = 909). The pooled odds ratio comparing seizure outcome prediction using iEEG connectivity versus standard clinical evaluation was 1.36 (95% confidence interval = 1.10-1.69, p = .004), indicating a significant overall benefit. Subgroup analyses found no significant differences by directionality, modeling method (linear/nonlinear), or iEEG epoch (interictal/peri-ictal). Meta-regression revealed greater added value of iEEG connectivity in studies with higher proportions of non-seizure-free patients following surgery for temporal lobe or lesional epilepsy. However, no individual study achieved statistical significance on its own, reflecting limited power and lack of individual patient-level data. Power analysis confirmed that detecting a clinically meaningful effect requires substantially larger, potentially multicenter datasets. iEEG connectivity analysis offers modest but consistent increased value over standard clinical methods to predict seizure freedom in adult patients with focal drug-resistant epilepsy. For clinical translation, we propose recommendations for future studies to address sample size limitations, standardize reporting, and prioritize individual patient-level data sharing
Association of Hemostatic Blood Product Transfusion With Clinical Outcomes in Esophageal Variceal Bleeding.
No full textBACKGROUND/AIMS: Variceal bleeds occur due to portal hypertension and not primary hemostatic dysfunction. However, these patients frequently have low platelet counts and elevated international normalized ratio (INR) values, for which they often receive transfusions upon admission despite guidance from multiple liver societies.
METHODS: We performed a retrospective analysis using the TriNetX United States Collaborative Network. Cohorts were defined based on transfusion of fresh frozen plasma (FFP), platelets, or cryoprecipitate within 72 h of variceal bleeding diagnosis. Propensity score matching was used to balance demographic and clinical characteristics including variables representative of the model for end-stage liver disease score, Child-Pugh class, baseline hemoglobin, and receipt of packed red blood cells. Outcomes included mortality, intubation, intensive care unit (ICU) admission, hospital readmission, and transjugular intrahepatic portosystemic shunt (TIPS) placement at 6 weeks and 6 months.
RESULTS: Of 63,140 patients with variceal bleeding, 5350 received blood products. After matching, each cohort contained 5246 patients. At 6 weeks, transfusion was associated with higher odds of intubation (adjusted odds ratio [aOR]: 1.83; 95% confidence interval [CI]: 1.54-2.16), ICU admission (aOR: 1.49; 95% CI: 1.27-1.74), hospital readmission (aOR: 1.74; 95% CI: 1.52-1.99), TIPS (aOR: 1.92; 95% CI: 1.59-2.33), and mortality (aOR: 3.36; 95% CI: 3.03-3.73). At 6 months, these associations persisted for intubation (aOR: 1.54; 95% CI: 1.33-1.78), hospital readmission (aOR: 1.51; 95% CI: 1.37-1.68), TIPS (aOR: 1.79; 95% CI: 1.50-2.13), and mortality (aOR: 2.36; 95% CI: 2.13-2.62), while ICU admission was not significantly different between groups (aOR: 1.07; 95% CI: 0.93-1.23).
CONCLUSION: In this large, real-world cohort, transfusion of platelets, cryoprecipitate, or FFP in the setting of variceal bleeding was associated with higher odds of adverse outcomes including intubation, hospital readmission, TIPS procedures, and mortality at both 6 weeks and 6 months. These associations underscore the need for careful, individualized consideration of hemostatic product use in cirrhotic patients and highlight the importance of further prospective studies to clarify optimal transfusion practices
Evaluation of Maribavir Use for the Treatment of Cytomegalovirus in Solid Organ Transplant Recipients
No full textRhabdomyolysis and Acute Kidney Injury after Use of 3-Methyl-PCP: A Case Report.
No full textINTRODUCTION: Dissociative agents, such as phencyclidine (PCP) and ketamine, belong to the arylcyclohexylamine class. During illicit synthesis, numerous analogs of PCP can be produced. To date, over 60 psychoactive designer derivatives have been identified, and most are undetectable by standard drug testing. This case describes the first laboratory-confirmed use of 3-methyl-PCP, a novel arylcyclohexylamine dissociative anesthetic.
CASE REPORT: A 29-year-old man presented to the emergency department after a drug overdose experiencing encephalopathy, tachycardia, hypertension, nystagmus and diaphoresis. Diagnostics revealed severe rhabdomyolysis and acute kidney injury. During hospitalization, the patient disclosed the use of 3-methyl-PCP obtained online. The drug product and biological specimens were sent to the Center for Forensic Science Research and Education (CFSRE) for comprehensive drug testing, which confirmed the presence of 3-methyl-PCP using gas chromatography-mass spectrometry and liquid chromatography-quadrupole time-of-flight mass spectrometry.
DISCUSSION: This confirmed case of 3-methyl-PCP intoxication not only demonstrates the potential for severe injury, but also the public health risks of rapidly emerging and unregulated dissociative synthetic anesthetics. Entities such as the CSFRE NPS Discovery Program\u27s early drug warning system can prove critical for both timely clinical response and public health protection
The Impact of Peripheral Nerve Injuries in Burn Outcomes from the Burn Care Quality Platform
No full textIntraoperative Wound Irrigation in Orthopaedic Surgery: A Survey of Current Understanding and Practice Across the United States.
No full textBACKGROUND: Periprosthetic joint infections remain a serious complication following arthroplasty surgery, causing significant patient morbidity and economic burden to health-care systems. While surgical site infection (SSI) preventive measures have shown effectiveness, there remains a significant gap in literature regarding surgeon intraoperative practice, such as the use of intraoperative wound irrigation (IOWI). While studies highlight the potential in reducing SSIs, variability in clinical application and the lack of standardized, evidence-based guidelines necessitate a comprehensive understanding of current practices.
METHODS: A 46-question survey was developed following literature review and validation with high-volume primary and revision arthroplasty surgeons. Deployed via online clinician engagement platform, the survey queried challenges of SSI in relation to IOWI, current IOWI practice, the role of biofilm in periprosthetic joint infections, and ideal properties of irrigation solutions.
RESULTS: A total of 112 orthopaedic surgeons across the United States participated in the survey. Respondents indicated a high level of knowledge regarding the role of IOWI in SSI treatment and prevention. Key attributes of an ideal IOWI varied depending on procedural step (exposure, instrumentation, implantation, and closure) and procedure type (primary or revision). Variation in IOWI practice was evident in irrigant selection and decision rationale, with relatively lower alignment to contact time and residual antimicrobial activity.
CONCLUSIONS: This survey highlights the perception that IOWI is an important part of routine SSI reduction measures and suggests variation in practice interventions and solution preference. Our findings support the necessity for a rigorous, evidence-based consensus via expert guidance to address the key surgical challenges to improve consistency of IOWI solution utilization
