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A Systematic Review of the Social Determinants of Health in Shoulder Arthroplasty Outcomes
No full textThis systematic review investigates the impact of social determinants of health (SDOH) on outcomes in shoulder arthroplasty (SA). SA, a common orthopedic procedure, has seen an increasing focus on SDOH influencing postoperative results. The study aims to comprehensively assess this impact on both surgical and patient-reported outcomes.
Through a systematic search of databases, 34 studies (2011-2021) met the inclusion criteria, involving 4,825,547 patients. Explored SDOH included insurance status, race/ethnicity, age, sex, income, social support, and veteran status. Outcomes considered were length of stay, American Shoulder and Elbow Surgeons scores, total SA rates, revision rates, complication rates, and discharge status.
Findings revealed associations between non-white race, female sex, and increased high-impact and bothersome chronic pain. Risk factors for dislocations post-SA included male sex, morbid obesity, cardiovascular abnormalities, depression, opioid use disorder, and tobacco use. Higher age, private health insurance, primary surgery, absence of chronic alcoholism, retired or lightly physically working patients correlated with higher satisfaction.
Discussion highlights that SDOH factors (younger age, female gender, non-white race) are linked to prolonged operative time, increased pain, and higher postoperative complication risks. Insurance, work status, and primary surgery impact patient satisfaction post-SA. Overall, demographic factors significantly affect TSA outcomes and complications, emphasizing the need for further research and addressing healthcare barriers to improve patient care. Orthopedic surgeons and policymakers should recognize these SDOH implications for future patient management
Amniotic Bladder Therapy in Patients with Interstitial Cystitis/Bladder Pain Syndrome
Get PDFIntroduction and Objectives: Our study hypothesis postulates that if patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) bladders exhibit increased inflammation, fibrosis, and urothelial dysfunction, then treatment modalities that modulate inflammation and fibrosis, while promoting a regeneration may have a therapeutic effect in such patients. Amniotic membrane (AM) has been shown to foster a regenerative wound-healing environment. This study investigates the safety and efficacy of bladder injections of AM in patients with treatment resistant IC/BPS.
Methods: Fifteen consecutive treatment resistant IC/BPS patients (mean age 50.7 ± 14.4 years) with a median disease duration of 7 years (5-12 years) were included in the study. Under general anesthesia patients received intra-detrusor injections of reconstituted 100mg micronized AM and were followed for 24 weeks. Clinical evaluation and patient-reported outcome were assessed through several different scoring modalities.
Results: After amniotic bladder therapy (ABT), the lower urinary tract symptoms improved gradually up to 12 weeks in all patients. At 16 weeks, 3 patients experienced a resurgence of symptoms and requested another injection which resulted in improvement after 2, 4, and 8 weeks respectively. For the twelve patients who only received one injection, the symptoms were still significantly lower at 20 and 24 weeks compared to baseline. No safety concerns were noticed during the study.
Conclusions: Our findings suggest that ABT shows promise as a treatment for refractory IC/BPS patients. However, further study is needed to establish treatment protocol, better understand the mechanism of action and determine the durability of therapeutic response of ABT in IC/BPS
Amniotic Bladder Therapy in Covid-Associated Cystitis (CAC)
Get PDFIntroduction:
SARS-coV-2 is linked to genitourinary symptoms of overactive bladder (OAB), marked by increased frequency, urgency, and nocturia, and has been recently labeled COVID-associated cystitis (CAC). The predominant pathophysiology is proposed to be overexpression of pro-inflammatory cytokines causing bladder inflammation, fibrosis, and bothersome urinary symptoms. Research supports that amniotic membrane (AM) can be used to induce apoptosis of pro-inflammatory cells, inhibit differentiation of pro-fibrotic cells, and expedite wound healing. We investigated the therapeutic response and safety of AM in 5 CAC patients with resistant OAB symptoms.
Methods:
All study patients were admitted for treatment of COVID-19 in spring 2019 and on discharge complained of de novo OAB symptoms. Five CAC patients with a mean age of 73 ± 1.0 years and a median disease duration of 2.4 years received intra detrusor injections of reconstituted 100mg micronized AM under general anesthesia and were followed for 20 weeks. OAB Assessment Tool, volume of first involuntary detrusor contraction and maximum cystometric capacity were measured as the objective parameters to assess treatment response.
Results
All patients demonstrated improved bladder function on urodynamic studies and OAB Assessment scores at 4 weeks post-treatment and were sustained until 12 weeks. At 20 weeks recurrence of symptoms were observed in all patients (Table 1, Figure 1). No safety concerns arose during the study.
Conclusion
These results indicate the promise of ABT as a viable treatment for CAC patients with refractory OAB symptoms. More comprehensive studies in managing CAC with ABT is needed to validate its therapeutic potential
Pessary Use in Urology Clinics
Get PDFIntroduction: Pessaries are a non-invasive treatment option for patients with pelvic organ prolapse (POP) or stress urinary incontinence (SUI). There is currently limited data regarding pessary usage among urology patients. The aim of this study is to determine the patient characteristics that predict long term pessary usage versus surgical intervention. Methods: A 10-year retrospective review of pessary usage in women with either SUI or POP was performed. Patients were stratified into pessary longevity of less than or greater than one year. Quality of life measures before and after pessary use included pads per day, incontinence symptom index (ISI) scores, and pelvic organ prolapse distress inventory-6 (POPDI-6) scores. A comparison of study groups was adjusted for the following covariates: age, body mass index (BMI), initial pelvic organ prolapse quantification (POP-Q) score, race, smoking status, presence of concomitant stress urinary incontinence, diabetes mellitus, cardiovascular disease, and stroke. Multivariate logistic regression was used to compare the two groups while accounting for covariates. Results: A total of 321 women with POP and/or SUI were managed with pessaries between 2012 and 2022. The median patient age was 70 (IQR 61-79) and the most common POP-Q stage was a 2, 42.2% (n=132), with 55.5% of patients reporting SUI (n=177). Pad use was documented in 56% of patients. Median pad use pre-pessary was 2 (IQR 0-3), post-pessary was 1 (IQR 0-3). Median ISI score pre-pessary was 15 (IQR 8-24), post-pessary was 11 (IQR 6-19). Median POPDI-6 score pre-pessary was 8 (IQR 4-12), post-pessary was 4 (IOR 1-9). 116 patients (36.1%) underwent POP or SUI surgery. Older patients and individuals without SUI were more likely to keep the pessary for at least one year, OR 1.03 and 1.72, respectively. Conclusions: Pessary usage provides strong statistical improvement in pad usage, ISI scores, and POPDI-6 scores. Younger patient age and stress incontinence are strongest predictors of patient transition from pessary usage to surgical intervention. More studies are needed to determine the pessary type that predicts highest patient satisfaction
Impact of COVID-19 Pandemic on Student-Run Free Clinic Services for an Underserved Urban Patient Population
Get PDFBackground:
The COVID-19 pandemic significantly impacted healthcare delivery in high density urban communities. This clinic provides free medical care to patients in an urban Midwestern community including limited prescriptions, vaccines, and over-the-counter medications. This study aims to understand how the patient demographics and medical services offered at the clinic have been impacted by the COVID-19 pandemic.
Methods:
Walk-in student-run clinics were held weekly on Saturday mornings in an urban Midwestern city, with patients consisting of underinsured and uninsured residents experiencing housing instability. Number of returning and new patients, physicals, flu shots, blood glucose readings, HbA1c, lipid panels, and referrals were collected by student coordinators and recorded by year (2019-2020 vs 2021-2022). Comparisons were made using paired two-tailed t-tests.
Results:
A total of 274 and 293 patients were seen between 2019-2020 and 2021-2022, respectively. Preliminary results demonstrate the number of patients significantly varied from December to February (p\u3c0.05). Number of physicals and the number of blood glucose tests in 2021-2022 significantly differ from those of 2019-2020 (p\u3c0.05). Number of Covid-19 vaccines significantly differed between these two time periods (p\u3c0.01), while the number of flu shots did not.
Conclusion:
Patients at walk-in clinics rely on free, interdisciplinary services to obtain healthcare services, medications, and vaccines. Patients during the 2021-2022 year became more vigilant about their health, reflected by the increase in total physicals and increase in total patients. The clinic\u27s improved pre-screening of patients\u27 overall health aims to diagnose individuals earlier, expedite essential medication provision, and reduce the frequency of patient visits
Utility of the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) in Pediatric Stevens-Johnson Syndrome Patients
Get PDFIntroduction
The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) is a scoring system that seeks to predict in-hospital mortality for disorders affecting skin integrity. The scoring system has been validated and widely utilized in adults, but not pediatrics. This study aims to determine the accuracy of the SCORTEN in pediatrics.
Methods
A retrospective review of pediatric patients admitted at a verified pediatric burn center with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) from 2008 to 2022 was performed.
Results
Twenty-seven eligible SJS/TEN patients were identified. Three patients were excluded due to incomplete data, allowing twenty-four patients to be analyzed. Ten patients had 0-1 risk factors (3.2% mortality rate), thirteen had 2 risk factors (12.1% mortality risk) and one had 3 risk factors (35.1% mortality risk). There was no correlation between initial BUN, bicarbonate, glucose, or initial heart rate on the length of ICU stay or ventilator days. Student T-tests were performed comparing the 0-1 vs. 2 risk factor groups. Those with 2 risk factors had significantly higher TBSA affected on admission (32.72 ± 20.55 vs 8.26 ± 13.55 p = .0005). Interestingly, hospital length of stay, ICU length of stay, and ventilator days were not statistically significant between those having 0-1 and 2 risk factors.
Conclusion
A higher SCORTEN category did not correlate to a longer hospital stay, ICU days, or ventilator days. This study suggests that the SCORETEN system is not accurate in pediatric patients. A different scoring system is needed to estimate the disease severity in pediatric SJS/TEN patients
