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Retrograde Tibio-Pedal Access for Endovascular Interventions for Treating Peripheral Arterial Disease
No full textSupport for Transgender/Non-binary Youth during Transition from Pediatric to Adult Care
Get PDFSurvey of transgender/non-binary youth and parent/guardians identified unmet communication and role definition needs during healthcare transition (HCT)https://knowledgeconnection.mainehealth.org/lambrew-retreat-2024/1002/thumbnail.jp
The Association of Season of Surgery and Patient Reported Outcomes Following Total Hip Arthroplasty
Get PDFIntroduction
• Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA).
• Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience.
• The aim of this study was to investigate if there were differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season in an area with 4 distinct seasons.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2024/1001/thumbnail.jp
4-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study
No full textBACKGROUND: Andexanet Alfa (AA) is the only FDA approved reversal agent for apixaban and rivaroxaban (DOAC). There are no studies comparing its efficacy with 4-Factor Prothrombin Complex Concentrate (PCC). This study aimed to compare PCC to AA for DOAC reversal, hypothesizing non-inferiority of PCC. METHODS: We performed a retrospective, non-inferiority multicenter study of adult patients admitted from July 1, 2018 to December 31, 2019 who had taken a DOAC within 12 hours of injury, were transfused red blood cells (RBCs) or had traumatic brain injury, and received AA or PCC. Primary outcome was PRBC unit transfusion. Secondary outcome with ICU length of stay. MICE imputation was used to account for missing data and zero-inflated poisson regression was used to account for an excess of zero units of RBC transfused. 2 Units difference in RBC transfusion was selected as non-inferior. RESULTS: Results: From 263 patients at 10 centers, 77 (29%) received PCC and 186 (71%) AA. Patients had similar transfusion rates across reversal treatment groups (23.7% AA vs 19.5% PCC) with median transfusion in both groups of 0 RBC. According to the Poisson component, PCC increases the amount of RBC transfusion by 1.02 times (95% CI: 0.79-1.33) compared to AA after adjusting for other covariates. The averaged amount of RBC transfusion (non-zero group) is 6.13. Multiplying this number by the estimated rate ratio, PCC is estimated to have an increase RBC transfusion by 0.123 (95% CI: 0.53-2.02) units compared to AA. CONCLUSION: PCC appears non-inferior to AA for reversal of DOACs for RBC transfusion in traumatically injured patients. Additional prospective, randomized trials are necessary to compare PCC and AA for the treatment of hemorrhage in injured patients on DOACs. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level III
Tools used to measure the impact of comorbidities on surgical outcomes in children with complex chronic conditions: A scoping review
No full textAIM: To identify and describe assessment tools used to measure the impact of comorbidities on postoperative outcomes in children with complex chronic conditions (CCC). METHOD: This was a scoping review using five electronic databases. The search was conducted in March 2022 by a medical librarian. There were no date or language restrictions. Included studies were full-text articles published in peer-reviewed journals that described a tool used to measure the impact of comorbidities in children with CCC to assess postoperative outcomes. A standardized data charting tool was used. RESULTS: A total of 2157 articles were retrieved. Five studies reporting on six comorbidity measures met inclusion criteria. All were cohort studies and were secondary analyses of data from an administrative database (n = 4) or a patient registry (n = 1). Sample sizes ranged from 645 to 25 747 participants. One paper described the assessment of reliability. Only one form of validity - predictive validity - was assessed in three papers for five measures. INTERPRETATION: Findings from this scoping review revealed a paucity of comorbidity assessment tools validated for use with children with CCC; significant conceptual and measurement challenges exist in the current scientific literature
Transition to Adult Care for Bleeding Disorders: Building a Multidisciplinary Tool
Get PDFYouth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care transition plan by 2027. Our HTC initiated a quality improvement project to design a documentation tool that captures and tracks the multidisciplinary education provided to prepare our youth for transition to adult specialty care. With this new tool we will have a purposeful and planned process of educating patients to competently manage their chronic conditions
Event-free survival in relapsed and refractory rhabdomyosarcoma treated on cooperative group phase II trials: A report from the Children\u27s Oncology Group
No full textBACKGROUND: Novel therapies are needed for relapsed and refractory rhabdomyosarcoma (RRMS). Phase II clinical trials in RRMS have typically utilized radiologic response as the primary activity endpoint, an approach that poses several limitations in RRMS. In this analysis, we aimed to estimate an event-free survival (EFS) endpoint for RRMS that could be used as a benchmark for future studies. PROCEDURE: We performed a retrospective study of patients with RRMS enrolling on 13 single-agent phase II Children\u27s Oncology Group and legacy group trials from 1997 to 2016. All included trials used radiographic response as their primary activity endpoint. Six-month EFS was estimated from time of trial enrollment with 95% confidence intervals. Clinical characteristics, including trial of enrollment, sex, age, race, histology, number of prior chemotherapies, and radiographic response were evaluated for their impact on 6-month EFS. RESULTS: We identified 175 patients across 13 trials. The 6-month EFS was 16.8% (11.6%-22.8%). No differences were seen in 6-month EFS based on age, sex, race, or histology. There were nonsignificant trends toward improved 6-month EFS for patients with less than or equal to two prior lines of therapy versus higher than two, for patients enrolled on trials that achieved their primary radiographic response endpoint versus trials that did not, and for patients who achieved complete or partial response compared to those achieving stable disease. CONCLUSIONS: The prognosis of RRMS enrolled on single-agent phase II trials is poor. This pooled 6-month EFS of RRMS on single-agent trials may be used as a RRMS-specific benchmark for future single-agent phase II trials
MaineHealth Medical Group Report Inventory
Get PDFVariation of Epic Quality Reports being used across MHMG following the merge of Coastal, Mountain and Southern region quality departments resulting in inconsistent workflows and processes. This can lead to inconsistent care and outcomes of Quality Data we report
A Systematic Review of Retracted Publications in Clinical Orthopaedic Research
No full textBACKGROUND: Retracted publications are an often-overlooked issue affecting the scientific community; recent data confirms the overall number of retracted publications is rising. While this has previously been looked at within orthopaedic surgery, a contemporary understanding of retractions is required due to the rapid expansion in publications. Our study aimed to assess the retracted publications within clinical orthopaedic research to evaluate for characteristics and trends. METHODS: A systematic review was conducted on December 14, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. There were four databases that were queried to identify retracted publications in clinical orthopaedics that assessed operative and non-operative orthopaedic interventions (excluding basic science). Articles were independently screened by two reviewers; those meeting inclusion criteria were evaluated for various characteristics, including reasons for retraction based on Committee on Publication Ethics (COPE) guidelines. RESULTS: There were 233 studies that met inclusion criteria and were retracted between January 1, 1990, and December 14, 2023. Clinical orthopaedics represented 1.18% of all retracted publications identified through PubMed over this period. There were 87 articles that were retracted in 2023, up from 17 in 2022 (a 412% increase). Retracted studies were published in journals with 2022 impact factors up to 9.3, with an average of 3.1 (SD [standard deviation] 1.9). A total of 39.5% of the retracted studies were published in orthopaedic journals, and 60.9% of the retracted articles were published in exclusively open access journals. The mean time from electronic publication to retraction was 2.1 years (SD 2.2). Retracted articles have been cited up to 180 times (mean 8.6; SD 20). Reasons for retraction included misconduct (45.9%), plagiarism (11.6%), redundant publication (11.6%), unethical research (10.3%), error (9.4%), and others (10.7%). CONCLUSIONS: The prevalence of retractions in the clinical orthopaedic literature is increasing. Clinical research is the basis for clinical practice guidelines, the gold standard for informing medical decision making. Retractions may be one harbinger of lower-quality publications; researchers, institutions, and journals together play important roles in maintaining scientific integrity
