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Canary in the Carpal Tunnel: A Pilot Study of the Value of the Screening for Amyloidosis in Carpal Tunnel Syndrome
Get PDFIntroduction/Purpose:
Transthyretin amyloidosis occurs in two forms, hereditary transthyretin amyloidosis (hATTR), and wild-type ATTR (wtATTR)2. Amyloidosis can result in restrictive cardiomyopathy presenting as heart failure with preserved ejection fraction (HFpEF)4. A growing body of evidence demonstrates that amyloidosis may be underdiagnosed and can be caught earlier in the disease course5. The proteins causing amyloidosis can also deposit into various tissues including the carpal tunnel leading to carpal tunnel syndrome 2.
In this pilot study, we propose that early detection of amyloid via a biopsy of the transverse carpal ligament or tenosynovium in the carpal tunnel will allow early detection of systemic amyloidosis and referral to cardiology clinic for consideration of disease-modifying treatment. Furthermore, a calculation using incremental cost effectiveness ratio (ICER) was used to determine the value of these biopsies in early detection of this disease process.
Methods:
Patients undergoing carpal tunnel release who meet criteria for biopsy, as described by Donnelly et al. in 2019, are included 2. Qualifying patients meet two tier 1 criteria or one tier 1 criteria and one tier 2 criteria (inclusion criteria included in Figure 1). Tenosynovial biopsies are taken during open or endoscopic carpal tunnel release and are sent to pathology for congo red staining. If positive, patients are referred to high risk cardiology for additional evaluation and follow up for monitoring and treatment of cardiac involvement. Additionally, ICER calculations including cost of hospitalizations 9, cost of therapeutic intervention 5, cost of biopsy, relative risk reduction of hospitalization with amyloidosis pharmacotherapy 7, rate of hospitalizations stratified by New York Heart Association (NYHA) classification 1, incremental life extension due to early treatment 10, and a quality of life measurement were performed 4,12.
Results:
Of 48 patients matching eligibility criteria screened to date, 6 have had positive biopsy results and have been referred to high-risk cardiology. Of the 6 patients referred, two are currently undergoing advanced cardiac workup and 1 has begun treatment with Tafamadis. When treatment is initiated when the patient is in class 1 NYHA heart failure there is an estimated savings of 65 per stain, one positive biopsy creates a savings that will offset 6 negative screens. A positivity rate of 14% is required to remain cost effective and offset the cost associated with a negative biopsy result.
Conclusion:
Early diagnosis of transthyretin amyloidosis via biopsy of the carpal tunnel as well as this interdisciplinary treatment pathway can allow for earlier treatment to alter the disease\u27s course for patients with cardiac amyloidosis
Patient and Healthcare Provider Knowledge of Exercise During Pregnancy.
Get PDFTitle: Patient and Healthcare Provider Knowledge of Exercise During Pregnancy.
Authors: Leone, R., Kim, S., Sharma, V., Swain, M.
Introduction:
Physical activity before and during pregnancy can significantly improve pregnancy outcomes. ACOG’s evidence-based recommendations help healthcare providers (HCPs) educate patients regarding the benefits of exercise during pregnancy. However, many patients do not engage in regular physical activity. We aim to determine how provider counseling on exercise per ACOG recommendations impacts patients’ exercise and perception of exercise during pregnancy.
Methods:
This is a survey study of HCPs offering prenatal and postpartum care, and pregnant patients. HCPs were given surveys to assess their counseling practices and knowledge of exercise during pregnancy. Patients were given surveys on their knowledge and exercise habits during pregnancy. Univariate analysis compared providers’ and patients’ familiarity with ACOG recommendations and patients’ exercise habits during pregnancy.
Results:
Of 76 patient responses, those counseled on ACOG recommendations reported significantly more moderate (p=0.047) and vigorous (p=0.017) exercise than those not counseled. Patients counseled on ACOG recommendations were less likely to cite “fear of harming baby” (18.8% versus 32.3%) and “fear of harming myself” (0% versus 8.5%) as reasons for lack of exercise. Of 43 provider responses, 62.5% reported feeling comfortable counseling on exercise. However, the frequency of exercise counseling varied (Rarely 21.2%, Sometimes 27.3%, Often 45.5%, Always 6.1%).
Conclusions/Implications:
Our study demonstrates the importance of routine HCP counseling on exercise in pregnancy and how this may impact patients’ participation. It also highlights the importance of providers to become familiar with ACOG recommendations. Further data collection to identify specific gaps in counseling and patient knowledge may help improve maternal-fetal outcomes
BMI, Opioid Use, and Pain Perception: Insights from the DIPA Scale in Orthopedic Patients
Get PDFIntroduction
Body Mass Index (BMI) and Morphine Milligram Equivalents (MMEs) are critical factors in pain management, especially for patients undergoing orthopedic procedures such as joint replacement and spinal surgeries. The Detroit Interventional Pain Assessment (DIPA) scale is a novel tool for stratifying pain severity to optimize pain management strategies. This study evaluates the relationship between BMI, MME levels, and pain ratings using this scale, to inform tailored analgesic strategies for orthopedic patients.
Methods
527 patients undergoing joint replacement or spinal procedures were included in this retrospective analysis. Patients were categorized by BMI (\u3c30 or ≥30) and MME levels (0, 1–20, 21–49 MME). Pain ratings (no pain, tolerable, intolerable) were assessed using the DIPA scale. Chi-squared tests were used to evaluate associations between BMI and MME levels for each pain rating category. Sample sizes varied across groups, with higher MME categories limited by smaller sample sizes. Statistical significance was determined at p\u3c0.05.
Results
For MME=0, a significant association was observed between BMI and pain ratings (p=0.022). For MME=1–20 and MME=20–49, no significant associations were noted (p=0.528 and p=0.313, respectively). These findings suggest that BMI may play a significant role in pain perception without opioid usage but becomes less predictive with increasing MME levels due to limited sample sizes.
Conclusion
This study highlights the interplay between BMI, MMEs, and pain ratings, demonstrating significant associations with no opioid usage. Future research should explore larger cohorts for higher MMEs to refine individualized pain management strategies using the DIPA scale
Evaluating the Preclinical Curriculum for Women’s Health Content and Clinical Preparedness at Wayne State University School of Medicine
Get PDFIntroduction:
We evaluated the preclinical curriculum at WSU SOM to determine if there is sufficient coverage of women\u27s health topics and its impact on students’ clinical preparedness. We hypothesized that students perceive inadequate coverage across multiple women’s health disciplines, leading to low clinical preparedness. Knowledge from this study can guide recommended changes to the curriculum.
Methods:
A Qualtrics survey was distributed to the classes of 2024, 2025, and 2026, collecting feedback on women’s health topic coverage, and self-rated comfort with addressing these topics clinically.
Results:
Students reported that HDF provided the most comprehensive coverage, except for preventive health, which was attributed mainly to Clinical Skills. Cardiovascular health in women was the least covered, while psychiatric health received attention across multiple courses. Only 15% of respondents felt extremely comfortable with any women’s health topic. Cardiovascular and maternal/infant health had the highest “extremely uncomfortable” responses. Overall, 49% of students were dissatisfied with the women’s health content, with specific gaps in abortion care, contraception, and the physiology and medical management of female sexual pleasure.
Discussion:
The survey findings reveal that most students are dissatisfied with the women’s health content in WSUSOM’s preclinical curriculum. Our study was limited by responses predominantly coming from students identifying as women, as well as students pursuing specialties like OB/GYN or Internal Medicine, which may skew perceptions toward a greater need for women’s health content. Additionally, students’ clinical comfort might be affected by prior experiences, such as work in healthcare or completing an OB/GYN rotation before responding to the survey. Overall, the findings suggest that targeted curriculum changes could improve students\u27 confidence and preparedness for clinical practice specific to women’s health
There’s More Than One Way to Skin a Cat: Animal Impersonation on the Pantomime Stage
No full textFrom the cow in Jack and the Beanstalk to the cat in Dick Whittington and goose in Mother Goose, animals are central characters in many pantomime narratives adapted for the stage from fairy and folktales. This article charts the evolution of the pantomime skin role, from the Victorian practice of specialist animal performers in costumes made from natural materials, to today’s bipedal walking, talking, comedic creatures who constitute fairy-tale best friends and family members. Paying particular attention to key practitioners and their costumes, I explore how pantomimes, and through them fairy tales, capture, embed, and disseminate changing ideas about human and animal relationships
Slippers, Shoes, Clogs, Galoshes, and Boots: The History and Materiality of Footwear in European Fairy Tales
No full textUsing an object-oriented methodology, this article investigates the symbolic and cultural significance of footwear. Shoes are more than just accessories; they are symbols of desire, change, mobility, identity, and social status. This research examines how footwear links to social, cultural, and historical domains. Through an exploration of uses, formats, and materials, it reveals the intertextual relationships and latent meanings in fairy tales, shedding light on their lasting impact on human society
Whatever Happened to Queenie\u27s Law?
Get PDFThis column illustrates how the history of a specific legislative measure that has been introduced over multiple legislative sessions can deepen our understanding of its legislative purpose
