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Efficacy of Submuscular Transposition for Revision Cubital Tunnel Release: Comparative Outcomes Analysis
Get PDFPurpose: To assess outcomes after revision cubital tunnel release and submuscular transposition and compare these to a cohort of patients undergoing primary release with in situ decompression. Methods: Patients who underwent revision cubital tunnel release and submuscular transposition (n = 16) were enrolled. Mean follow-up was 21.4 months (range 12.8–55.6). Patients were evaluated in person using the Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH). Dellon stage, McGowan grade, visual analog scale for pain, and improvement of symptoms using the Messina\u27s criteria and Modified Bishop score were assessed. Comparative analysis was performed with a cohort of primary patients who underwent in situ decompression (n = 18), with a mean follow-up of 26.6 months (range 13.3–63.3). Results: In revision patients, postoperative improvement in Dellon stage was seen in 13 (81.3%) and McGowan grade in 12 (75.0%). Messina\u27s criteria showed inferior but still satisfactory outcomes in the revision compared to primary cohort. Median MHQ was 57.1 (48.8–79.4) in the revision cohort and 76.3 (71.6–93.7) in the primary cohort. Median DASH was 26.3 (16.1–45.3) in the revision cohort and 11.7 (5.6–14.2) in the primary cohort. Differences between MHQ and DASH in both cohorts were statistically significant (P \u3c .05). Median visual analog scale was 2.5 (0–6) in the revision cohort and 1.5 (0–4.5) in the primary cohort. Conclusions: The majority of patients undergoing revision cubital tunnel release and submuscular transposition have relief of symptoms. However, improvement is incomplete and inferior compared to patients undergoing primary release. Type of study/level of evidence: Therapeutic III
Factors associated with the use of combined nutritional complementary and alternative medicine among southern US older adults: results from the study of aging II
Get PDFBackground: Older adults use nutritional complementary and alternative medicine (CAM) to reduce the risk of (or treat) non-communicable conditions and diet deficiencies. While prior research has explored the individual use of dietary supplements, vitamins, and minerals among older adults, few studies have examined factors influencing the combined use of these modalities, especially among Southern, older adults in the United States. Methods: Data were extracted from 419 participants from the University of Alabama at Birmingham Study of Aging II, a population-based longitudinal study of mobility among community-dwelling older adults. Self-reported data, including insurance and rural residence status, was collected. Comorbidity burden was assessed using the Charlson Comorbidity Index. Participants reported their use of non-prescribed medications, including dietary supplements, vitamins, and minerals. Logistic regression was used to identify factors associated with the use of combined nutritional CAM modalities. Results: We found a statistically significant association between sex (p \u3c 0.001), age (p = 0.024), rural living status (p = 0.008), and education (p \u3c 0.001) in use of combined nutritional CAM (dietary supplements, vitamins, and minerals). For the use of vitamins and minerals only, our findings suggest a significant association between sex (p = 0.027), age (p \u3c 0.001), and education (p = 0.009). Lastly, for the use of dietary supplements only, our findings suggest a significant association between age (p = 0.050) and education (p = 0.002). Conclusion: Our study addresses a critical gap by examining the sociodemographic and chronic disease burden predictors of concurrent use of combined nutritional CAM modalities among older adults in the Southern United States. Such insights can help inform public health strategies and clinical guidance aimed at supporting the health and well-being of older adults, particularly as they navigate complex health decisions in the context of aging
Impact of Team Composition on Learning Outcomes Following Simulation-Based Training of Teamwork Competencies: A Systematic Review
No full textINTRODUCTION: This systematic review aims to investigate the impact of team composition on learning outcomes following simulation-based training of teamwork competencies for healthcare professionals and healthcare students. METHODS: We searched Ovid Embase, CINAHL, and OVID Medline from 2011 to July 3, 2023, and included randomized trials and observational studies with a control group. Risk of bias was assessed using the revised Cochrane Risk-of-Bias tool and the Risk of Bias in Non-Randomized Studies tool. We did not conduct a meta-analysis because of heterogeneity. We evaluated certainty of evidence using GRADE methodology. RESULTS: We screened 14,309 abstracts and included 11 studies. We found 6 studies investigating uniprofessional (UP) versus multiprofessional (MP) teams, 3 studies investigating team size, 1 study investigating dynamic versus stable teams, and 1 study investigating the effect of gender composition. Studies overall found that team composition may affect team performance. Studies on UP versus MP teams investigated skill acquisition, knowledge acquisition, and self-efficacy, showing no difference between groups or a small benefit of MP team training. The certainty of evidence was very low. DISCUSSION: We identified very low certainty evidence, suggesting that team composition affects team performance and MP team training should be considered as opposed to UP team training when providers are expected to work together across professions in clinical practice. Further research is needed to identify the optimal team composition for training of teamwork competencies
Grandchildren of GRNDaD: Shifts in disease-modifying therapy at the adolescent transition in sickle cell disease
No full textCharacterizing the modern person living with sickle cell disease (SCD) in the United States has been limited without a well-curated longitudinal registry. To address this, the Globin Research Network for Data and Discovery (GRNDaD) registry strives to collect clinical outcomes and quality of life metrics from Institutional Review Board-approved centres across the United States. Here, we examined the use of different disease-modifying therapies in (actively consented) adults and children with HgbSS and HgbS-β0 thalassaemia (SCA) from 38 sites. Of the 3169 active patients in GRNDaD, about 65% of subjects were on hydroxyurea (hydroxycarbamide; HU), and 2130 had SCA. As predicted, the absolute neutrophil counts were lower and mean corpuscular volumes were higher for patients on HU. However, there was a lower proportion of patients on HU in older age groups. In contrast, chronic RBC transfusion utilization was nearly twice as high in the 18- to 29-year-old age group than in the 11- to 17-year-old age group. For novel therapeutics, we examined use prior to voxelotor\u27s removal from the market and prior to publication of the negative phase III trial of crizanlizumab. Voxelotor utilization in this cohort was three times that reported by claims data while crizanlizumab usage was nearly double, suggesting high-quality comprehensive sickle cell care could increase utilization of novel therapies
Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort
No full textBACKGROUND: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. OBJECTIVE: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. DESIGN: Prospective observational cohort study. SETTING: 33 states plus Washington, DC, and Puerto Rico. PARTICIPANTS: Adults (aged ≥18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. MEASUREMENTS: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. RESULTS: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). LIMITATION: Selection bias may influence observed associations and generalizability. CONCLUSION: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection. PRIMARY FUNDING SOURCE: National Institutes of Health
Editorial Comment on Frequent Urethrovesical Foreign Object Insertion: Resource Utilization and Outcomes
No full textAntibiotic stewardship in pediatric head and neck surgery
Get PDFOBJECTIVE: This study seeks to determine the rate of postoperative surgical site infections (SSI) among clean head and neck surgeries and review perioperative antibiotic administration practices. STUDY DESIGN: Retrospective review. SETTING: Pediatric tertiary care institution in New Orleans over a ten-year period. METHODS: A retrospective review was undertaken to identify clean head and neck surgical procedures performed at Manning Family Children\u27s between 2013 and 2023. EPIC SlicerDicer™ was used to identify patients between ages 0-18 who underwent clean head and neck surgeries. Each chart was reviewed for perioperative antibiotic administration and occurrence of postoperative SSI. Rates of SSI were compared between the control group that received no perioperative antibiotics and the study group that received perioperative antibiotics using Chi-square test. Exact Binomial proportion confidence intervals were obtained. RESULTS: 99 patients were identified for the control group, while 93 patients were included in the study group. In the control group, the infection rate was determined to be 3.03 %, with 95 % CI = (0.0063, 0.086). In the study group, the infection rate was found to be 0 with 95 % CI = (0, 0.0389). There was no statistically significant difference in infection rate between the groups (p = 0.2468). CONCLUSION: There are no current pediatric studies to guide evidence-based antibiotic prophylaxis in clean head and neck procedures. This small study did not find a statistically significant difference in infection rate between groups, and that empiric perioperative antibiotic treatment may not change the rate of SSI development in pediatric clean head and neck surgeries. Further studies with larger sample sizes are needed to confirm these findings
Current Trends in Clinical Trials for Merkel Cell Carcinoma (MCC)
Get PDFMerkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cutaneous malignancy with high rates of recurrence and metastasis. The treatment of MCC has historically involved surgery, radiation, and chemotherapy; however, current clinical trials are investigating immunotherapies, intratumoral injections, and combination therapies to improve outcomes. This review explores the current trends in clinical trials for MCC, highlighting recent advances in management
Breast Reconstruction in Becker Nevus Syndrome
Get PDFBecker nevus syndrome is a rare cutaneous disorder characterized by the presence of a hyperpigmented patch of skin typically occurring on the upper trunk, often associated with hypertrichosis, and sometimes associated with musculoskeletal abnormalities ipsilateral to the nevus. Becker nevus syndrome can lead to breast hypoplasia. Unlike other forms of breast hypoplasia, treatment should begin before the completion of breast development. Due to the rarity of the disease, breast reconstruction in these patients has no gold-standard approach, and treatment is often delayed. Therefore, our case report highlighted the need for early treatment and provided options for reconstruction in this population. Our case reported a single surgeon approach to breast hypoplasia in Becker nevus syndrome. Consent was obtained for medical photography and research purposes. A 37-year-old woman with hypertension presented with concerns regarding drastic breast asymmetry. On examination, she was noted to have significant breast asymmetry with right-sided hypoplasia, left macromastia, and a patchy hyperpigmented lesion along the right chest wall. After a discussion of surgical options, a right breast augmentation and left breast reduction was performed. The patient had no postoperative complications. She was satisfied with her breast size and symmetry at her 6-month postoperative clinic follow-up. Becker nevus syndrome in women may be more frequent than previously described in the literature, as it often goes undiagnosed. Little literature exists on providing surgical options. This article demonstrated a single-stage reconstruction that provided satisfactory results and improvement in symmetry
Nicolas Bazan Interview
No full textThis interview of Nicolas Bazan was conducted by Chandler Smith on August 25, 2025. Interview transcribed by Sam Howat.https://digitalscholar.lsuhsc.edu/oral_hist/1019/thumbnail.jp