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Association of Alcohol Use Disorder and Perioperative Complications and Adverse Events After Spinal Fusion Surgery During the In-Hospital Period: An Analysis of the National Inpatient Sample Database
No full textOBJECTIVE: Alcohol use disorder (AUD) carries major effects shown to limit social support, increase recovery times, and lead to a higher incidence of surgical complications. This retrospective cohort study investigated the influence of AUD on perioperative outcomes and adverse events after spinal fusions in the largest sample size to date and spanning 11 years. METHODS: Data for adult (\u3e18 years old) patients who underwent a spinal fusion as their primary surgery were identified from the National Inpatient Sample database for the years 2009-2020. Patients were separated into an AUD cohort and a no AUD (control) cohort. Univariable and multivariable linear and logistic regression analyses were utilized to highlight statistically significant differences in their perioperative complications and adverse events. RESULTS: A total of 4,896,757 patients who underwent spinal fusion were identified. AUD was present in 97,565 (2.0%) patients, with the remaining patients serving as a control group. On multivariable analysis, patients with AUD had significantly increased odds of longer length of stay (odds ratio [OR] = 3.40; 95% confidence interval [CI] [3.24-3.57] P \u3c 0.001, and of the following perioperative complications and adverse events: neurologic injury (OR = 3.24; 95% CI [3.05-3.44] P \u3c 0.001), respiratory-related (OR = 3.06; 95% CI [2.91-3.21] P \u3c 0.001), systemic infectious (OR = 2.79; 95% CI [2.48-3.13] P \u3c 0.001), neurologic (stroke) (OR = 2.73; 95% CI [2.22-3.35]) P \u3c 0.001, urinary-related (OR = 2.23; 95% CI [2.11-2.36] P \u3c 0.001), venous thrombotic-related (OR = 2.12; 95% [1.87-2.40] P \u3c 0.001), gastrointestinal-related (OR: 1.91; 95% CI [1.79-2.03] P \u3c 0.001), wound-related (OR = 2.32; 95% CI [2.10-2.56] P \u3c 0.001), cardiac-related (OR = 1.44; 95% CI [1.34-1.55] P \u3c 0.001), and fusion disorders (OR = 1.22; 95% CI [1.15-1.2] P \u3c 0.001). CONCLUSIONS: We found that AUD carries a significantly negative influence over perioperative outcomes and adverse events after spinal fusion in a large database population
OSHA Injury Data: An Opportunity for Improving Work Injury Prevention
No full textMillions of US workers are seriously injured on the job annually. These injuries have a significant and deleterious impact on injured workers, their families, and their communities. The limitations of the historical work injury surveillance systems have constrained research into the distribution and determinants of work injuries and efforts to improve allocation of limited injury prevention resources. Most work injury data sets suffer from significant limitations and fail to include a sizable proportion of work injuries. In recent years, the Occupational Safety and Health Administration has begun to collect and make available to the public more detailed data on work injuries at thousands of high hazard establishments. These data sets provide the opportunity to greatly improve our work injury surveillance system. Researchers are now using these data to investigate and compare injury risk in industries and high-hazard firms where workers are at increased risk of musculoskeletal disorders. However, these rich data sets are underused. Maintaining and facilitating access to accurate, current data can contribute to improved prevention of work-related injuries and deaths. (Am J Public Health. Published online ahead of print February 13, 2025:e1-e8. https://doi.org/10.2105/AJPH.2024.307934)
Vincristine Sulfate Liposome Injection with Combination Chemotherapy for Children, Adolescents, and Young Adults with Relapsed Acute Lymphoblastic Leukemia: A Therapeutic Advances in Childhood Leukemia and Lymphoma Consortium Trial
No full textINTRODUCTION: Vincristine sulfate liposome injection (VSLI), a liposomal formulation of vincristine, may be better tolerated than standard aqueous vincristine and enable dose intensification. PROCEDURES: Based on single-agent tolerability, activity, and FDA approval in adults with acute lymphoblastic leukemia (ALL), we tested the safety and feasibility of VSLI as replacement for standard vincristine in the UK ALL R3 mitoxantrone-based four-drug induction (Cohort A), a three-drug anthracycline-free induction (Cohort B), and maintenance chemotherapy (Cohort C) in children and young adults with relapsed/refractory B-cell ALL. RESULTS: Among 29 participants with a median age of 12.4 years (range: 1.8-19.6 years), 16 received Cohort A, eight received Cohort B, and five received Cohort C therapy. Dose level 1 (DL1): 1.5 mg/m and dose level 2 (DL2): 2 mg/m of VSLI, each without a dose cap, were tested. Collectively, the median VSLI dose administered was 1.9 mg (range: 0.71-4.06 mg), and 13 (44.8%) received a dose above the standard 2 mg vincristine dose cap. Dose-limiting toxicities (DLTs) at DL2 were seen in three patients, two in Cohort A and one in Cohort B, prompting further evaluation at DL1 for both cohorts. No DLTs were experienced at DL1. Only DL2 was tested in Cohort C-without DLT. Complete remissions were seen in 14 of 16 (87.5%) participants in Cohort A; three of eight (37.5%) in Cohort B; and one (20%) in Cohort C. VSLI with combination chemotherapy at DL1 was generally well tolerated. CONCLUSION: Based on the promising response signal in this heavily pretreated population, further study of VSLI is warranted. (ClinicalTrials.gov NCT02879643)
State of the art in menopause: current best practice approaches from the IMS World Congress 2024, Melbourne
No full textThe 19th World Congress on Menopause, hosted by the International Menopause Society in 2024, convened global experts to discuss the latest advances in menopause management. This review highlights key focus areas presented at the congress, offering insights into best practices for clinical application. Cardiovascular health remains a priority, with emphasis on recognizing sex-specific risk factors and exploring emerging therapies. Osteoporosis management underscores the role of menopausal hormone therapy (MHT) as foundational, complemented by anti-resorptive and bone-forming agents in high-risk populations and those not candidates for MHT. Addressing genitourinary symptoms and sexual health, vaginal estrogen therapy is confirmed as a safe and effective option with vaginal dehydroepiandrosterone (DHEA) and oral ospemifene as suitable alternatives, while testosterone therapy offers benefits for hypoactive sexual desire disorder in postmenopausal women. Sleep disturbances, depression and workplace challenges linked to menopause were explored, with tailored interventions such as MHT and cognitive behavioral therapy specifically for sleep recommended. Cancer risk management stressed the need for a multidisciplinary approach to risk reduction beginning with lifestyle modification, and with non-hormonal therapies prioritized for symptomatic treatment of menopausal symptoms in those with hormone-sensitive cancers. Lastly, perimenopause management highlighted comprehensive approaches integrating symptom relief and contraceptive needs
Treating seizures faster: The quality improvement in time to treat status epilepticus (QuITT-SE) multicenter randomized stepped wedge clinical trial protocol
No full textBACKGROUND: Acute seizures may evolve into status epilepticus (SE), prolonged and self-sustaining seizures that may result in brain injury or death. Rapid treatment with a benzodiazepine (BZD) is most effective. However, SE treatment remains delayed in many cases. We previously performed a single-center quality improvement study which resulted in more rapid treatment, decreased intensive care utilization, and decreased cost. Now, we are conducting a multicenter trial to test the hypothesis that pragmatic changes in treating acute inpatient seizures reduce time and are implementable across diverse hospital settings. METHODS/DESIGN: We designed a multicenter stepped wedge cluster randomized trial with three unidirectional 12-month steps following one baseline step. After dissemination visits, sites will attempt to implement a standardized bundle consisting of: (1) standardize default BZD to non-IV; (2) target treatment time within 10 min; (3) relocate and bundle items for BZD administration to a single location; (4) prioritize basic seizure first aid as initial assessment; (5) implement SE-specific documentation templates; (6) implement multidisciplinary site QI teams. Our primary outcome is median time from seizure diagnosis to BZD administration. Secondary outcomes are median changes in Pediatric Cerebral Performance Category score, ICU transfer rate, and cost of hospitalization. We will study implementation outcomes using mixed methods based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION: QuITT-SE is designed to test the effect and implementation of a pragmatic set of interventions on treatment times in SE. If successful, results will provide a generalizable roadmap for broad implementation through healthcare systems that should improve outcomes in SE. TRIAL REGISTRATION: Clinicaltrials.gov (NCT06194747). Funded by the National Institutes of Health (R01NS133037)
Incidence and Outcomes of Cataract in Eyes with Ocular Cicatricial Pemphigoid
No full textPURPOSE: To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP). METHODS: Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome. RESULTS: Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95-10.23 for age 60-75 inclusive and aHR = 8.37; 95% CI, 3.60-19.42 for age \u3e 75, each compared with age \u3c60 years). Seventy-nine eyes of 61 patients were monitored for \u3e = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome. CONCLUSIONS: The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines\u27 gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring
Psychometric Evaluation of the Scleroderma Skin Questionnaire: A Novel Patient-Reported Outcome for Skin Disease in Patients With Systemic Sclerosis
No full textOBJECTIVE: We aimed to evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc)-related skin symptoms. METHODS: Participants were recruited from the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach α and McDonald ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan skin score (mRSS), physician global assessment (PGA), Scleroderma Health Assessment Questionnaire, 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and patient global assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients\u27 self-reported recall of skin changes over the past 6 months ( SSQ 6-Month ) and 6-month change in mRSS. RESULTS: The SSQ was administered to 799 adults (mean age 52.7; 83% female) enrolled in CONQUER. Cronbach α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r 0.56), with stronger correlations in diffuse (r 0.54) vs limited cutaneous subtypes (r 0.24; all P \u3c 0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical function (r -0.50) and pain interference subscales (r 0.61), strongly with Health Assessment Questionnaire score (r 0.63) and severity subscale (r 0.62), and moderately with PGA SSc activity score (r 0.48; all P \u3c 0.05). SSQ 6-Month correlated weakly with the 6-month change in mRSS (r 0.26; P \u3c 0.05). CONCLUSION: SSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ, but not SSQ 6-Month, to assess skin symptoms in patients with SSc
Non-right-handedness, male sex, and regional, network-specific, ventral occipito-temporal anomalous lateralization in adults with a history of reading disability
No full textBased on historic observations that children with reading disabilities were disproportionately both male and non-right-handed, and that early life insults of the left hemisphere were more frequent in boys and non-right-handed children, it was proposed that early focal neuronal injury disrupts typical patterns of motor hand and language dominance and in the process produces developmental dyslexia. To date, these theories remain controversial. We revisited these earliest theories in a contemporary manner, investigating demographics associated with reading disability, and in a subgroup with and without reading disability, compared structural imaging as well as patterns of activity during tasks of verb generation and non-word repetition using magnetoencephalography source imaging. In a large group of healthy aging adults (n = 282; average age 72.3), we assessed reading ability via the Adult Reading History Questionnaire and found that non-right-handedness and male sex significantly predicted endorsed reading disability. In a subset of participants from the larger cohort who endorsed reading disability (n = 14) and a group who denied reading disability (n = 22), we compared structural and functional imaging data. We failed to detect structural differences in volumetric brain morphometry analyses, however we observed decreased neural activity on magnetoencephalography within the reading disability group. The detected differences were largely restricted to left hemisphere ventral occipito-temporal and posterior-lateral temporal cortices, the visual word form area and middle temporal gyrus, regions implicated in developmental dyslexia. Moreover, these observed disruptions occurred in a focal, network-specific manner, preferentially disturbing the ventral/sight reading recognition pathway, resulting in a pattern of regional anomalous lateralization of function that distinguished the reading disability cohort from normal readers. Collectively, the results presented here align with old theories regarding the etiology of developmental dyslexia and highlight how results from investigating neurodevelopmental differences in healthy aging individuals can powerfully contribute towards our overall understanding of neurodevelopment and neurodiversity
Orthopedic Injuries Caused by Electric Scooters: A Systematic Review
No full textBACKGROUND: Orthopedic-related injuries are a significant proportion of electric scooter (e-scooter) injuries that present to hospitals. There is a lack of global regulatory consensus for e-scooter use. AIMS: We aimed to synthesize existing data on orthopedic injuries due to e-scooters and identify modifiable risk factors that will help guide policymaking, reduce hospital burden, and aid clinicians in the management of these injuries. METHODS: A systematic review of the literature was conducted to identify studies pertaining to e-scooter injuries. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to November 2022, utilizing keywords pertinent to electric scooter, orthopedic or musculoskeletal injuries, incidence, and prevalence. RESULTS: In total, 30 studies met inclusion criteria. Among all riders, 5.5% were helmeted. Among those injured, 26.3% were intoxicated at the time of injury, 7.6% required inpatient admission, and 20.5% required surgery. The most common orthopedic injuries were to the distal extremities, with wrist fractures being the most reported upper extremity fractures (average 14.9%) and ankle fractures being the most reported lower extremity fractures (average 8.3%). CONCLUSIONS: Orthopedic injuries caused by using e-scooters are commonly encountered in the hospital setting. These injuries may continue to rise with the increased accessibility of e-scooters. Lawmakers should instill strict usage guidelines to help prevent injuries from e-scooter use