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The Effect of COVID-19 Infection on Clinical Outcomes in Patients Undergoing Surgical Repair of Humerus Fractures
Get PDFIntroduction
Limited research exists on the association between coronavirus 2019 (COVID-19) infection and outcomes following surgical fixation for humerus fractures. The objective of this study was to evaluate the effects of COVID-19 on the clinical outcomes of patients undergoing humerus fracture surgery.
Methods
Approval to utilize insurance claim data from the Change Healthcare dataset was obtained from the Datavant COVID-19 Research Database. Patients older than 55 years old who underwent humerus fracture surgery from April 1, 2020, to March 1, 2022, were included in the analysis. COVID-19 status, comorbidities, and adverse events were identified using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes. Propensity score matching with age, sex, and comorbidities was completed to create a 1:10 matched COVID-19-negative cohort. Univariate and multivariate logistic regressions were performed to assess the association of COVID-19 positivity with perioperative adverse events.
Results
A total of 18,365 patients underwent humerus fracture surgery in this study, of which 132 (0.72%) tested positive for COVID-19. Univariate analysis found that COVID-19-positive patients were at higher risk for myocardial infarction (5.30% vs. 1.74%, p = 0.015) and acute kidney injury (28.79% vs. 12.50%, p \u3c 0.001) when compared to the 1:10 matched COVID-19-negative cohort. In addition, multivariate logistic regression found that COVID-19-positive patients had higher odds of experiencing any adverse event (2.57; 95% CI: 1.69-3.91; p \u3c 0.001) or a minor adverse event (2.44; 95% CI: 1.57-3.79; p \u3c 0.001).
Conclusion
COVID-19-positive patients have increased odds of experiencing adverse events after undergoing humerus fracture surgery in comparison to a matched COVID-19-negative control. Findings from this study stress the importance of using COVID-19 status as a factor in predicting outcomes following orthopedic surgery in this patient population
Commentary on: “I Want It to Look Natural”: Development and Validation of the FACE-Q Aesthetics Natural Module
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Engaging Wheelchair and Scooter Users in the Co-design of an mHealth Application for Fall Prevention and Management: Thematic Analysis of Focus Group Research
No full textThis study aimed to explore the potential of a mobile health (mHealth) application (app) to support the delivery of a fall prevention and management program, Individualized Reduction of FaLLs (iROLL), for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use wheelchairs and scooters (WC/S) full-time by seeking end-users’ input into the functioning and ongoing design of the iROLL-O + mobile app. Two focus group discussions included nine adults with SCI or MS who used a WC/S for at least 75% of mobility, who experienced at least one fall in the past three years and have internet and access to an internet-capable device. One group had prior iROLL experience (n = 4); while the other had none (n = 5). The focus groups examined the app’s usefulness, accessibility, appearance, and ease of use. The participants with prior iROLL experience also discussed how the app would enhance their experience with the program. Thematic analysis revealed five app-related themes: perceived usefulness, perceived usability, accessibility, appearance, and enhancement of the iROLL experience, with participants providing actionable suggestions for improvement. Participants with previous exposure to the iROLL program emphasized the app’s potential to facilitate flexible access to the program and expand its reach to a wider audience. The iROLL-O + app was perceived positively, especially with respect to the enhancement of users’ access and experience with the program. Focus group findings will inform ongoing app development for optimized usability and reduced likelihood of technology abandonment.
IMPLICATIONS FOR REHABILITATION
End-users’ impressions of the Individual Reduction of faLLs Online application (iROLL-O + app) highlight the potential for integrating mHealth apps in fall prevention and management education efforts, offering a promising and accessible avenue to support the delivery of tailored programs.
The study notes that the app facilitates flexible access and wider reach to the program, indicating the importance of incorporating features that enhance accessibility and accommodate the diverse needs of individuals who use wheelchairs and scooters.
Actionable suggestions provided by participants underscore the importance of a user-centered design approach in developing rehabilitation-related mobile apps
A Comparison of Palliative Care Perceptions Across Metastatic Spine Patients and the General Population
No full textBackground: Palliative care (PC) has been shown to benefit patients with metastatic cancer by managing symptoms, improving quality of life, and facilitating advance care planning. Despite this, PC is often misunderstood and underutilized.
Objective: To deepen our understanding of PC barriers seen among the spine metastasis population.
Design/Setting: Between March 2021 and August 2022, people with metastatic spine tumors (MSTs) at a multidisciplinary oncology clinic were administered a survey on PC prior to their scheduled appointment. These responses were compared with the Health Information National Trends Survey 5 (HINTS 5), which is a validated survey created by the National Cancer Institute between February and June of 2020. Chi-squared statistical analysis was used.
Results: Fifty-six people with MST were compared with 3795 patients from the HINTS 5 database. People with MST reported a significantly higher baseline understanding of PC when compared with the general population (GP) (chi-squared = 34.4, p = \u3c0.0001). People with MST had a higher frequency of disagreement with the statement PC is equivalent with death when compared with the GP (chi-squared = 12.8, p = 0.0124). Over 25% of the MST group reported no understanding of PC.
Conclusion: MST patients are often referred to PC services due to the extreme symptom burden of their disease. Based on this study, in comparison to the GP, people with MST tended to have a more accurate and well-adjusted perception of the goals and functions of PC. Although reassuring, there remains a high proportion of patients who have no knowledge of PC, and groups erroneously associated PC with hospice status
Atypical Presentation of Probable Sporadic Creutzfeldt-Jakob Disease: A Patient Without Mental Deterioration
Get PDFCreutzfeldt-Jakob Disease (CJD) is a prion disease that leads to rapid mental deterioration and is always fatal. Prions are glycoproteins found in the brain. While their function is not completely understood, irregular folding of these proteins leads to prion disorders and neurodegenerative disease. CJD is extremely rare (1-2 cases per million people). A 68-year-old woman presented to the family medicine clinic with symptoms of weakness, paresthesia, and foot drop. Some weeks later she presented at the emergency department with left ankle and foot pain. All symptoms were on the left side of the body. An initial workup with labs was performed which all returned normal. Subsequently, a cerebrospinal fluid (CSF) panel was run and findings included elevated neuron-specific enolase and 14-3-3 gamma indicating a neurodegenerative disease. Further, an indeterminate real-time quaking-induced conversion (RT-QuIC) led to our diagnosis of a probable sporadic CJD. The patient was treated for symptoms and died four months following the initial presentation. Typically CJD presents with similar physical symptoms such as myoclonus. CJD is typically accompanied by severe mental deterioration including depression, memory loss, and dementia. CJD presentation without mental deterioration has only been reported in two other cases. Presenting here is a unique presentation of probable CJD that involved all the physical symptoms, including death, but the mental deterioration was absent. Clinicians should be aware of CJD and that presentation is not always standard
Beaton and Anson Type A Classification of the Sciatic Nerve and Piriformis Complex: Clinical Considerations for Sex and Laterality
Get PDFVariations of the sciatic nerve and piriformis muscle (SN-PM) relationship must be considered when discussing orthopedic procedures within the region as they may cause increased risk of SN injuries. Thirty-one formalin-embalmed, prosected donors were evaluated using the Beaton and Anson (B&A) classification system (1939). Major landmarks of the SN-PM relationship were identified, including the posterior superior iliac spine (PSIS), ischial tuberosity (IT), greater trochanter (GT), and the middle of the SN as it exits under the PM (S1). Distances measured included: PSIS-IT, PSIS-GT, IT-GT, PSIS-S1, IT-S1, GT-S1, S1-Q (distance of perpendicular line connecting S1 to PSIS-IT), and S1-R (distance of perpendicular line connecting S1 to PSIS-GT). Measurements from 49 lower extremities were evaluated using a two-tailed t-test to compare by sex and laterality; a one-tailed t-test was utilized to compare groups based on anatomical sex. Six donors displayed asymmetric B&A classifications, demonstrating gross anatomical differences within a single individual; however, no measurements were significant when comparing extremities. Seven measurements were statistically significant (p \u3c 0.05) between sexes, indicating notable sex-based differences. These data highlight sex-based differences in the SN-PM relationship, as well as consistencies within measurements among extremities, which can be utilized by clinicians when treating male and female patients needing unilateral or bilateral orthopedic procedures or injections within the gluteal region
An Unidentified Infiltrative Etiology of Spinal Cord Compression: A Case Report and Literature Review
Get PDFSpinal cord compression is a neurosurgical emergency. Symptoms of this disorder are highlighted as back pain, ambulatory difficulties, and bladder/bowel incontinence. Diagnostic imaging is not indicated in many circumstances of nonspecific back pain; however, the addition of neurologic deficits in the setting of back pain justifies radiologic imaging. Various pathologies can cause constriction of the spinal cord due to the delicate nature of spinal cord anatomy. Etiologies may include trauma, neoplasms, and infections. In this report, we present an unusual case of a 31-year-old male who presented to the emergency department with a history of chronic back pain accompanied by neurological deficits, ataxia, and bladder dysfunction. Contrast-enhanced MRI imaging heightened the suspicion of a neoplastic etiology; however, neuropathology revealed a non-neoplastic nature with abnormal lymphohistiocytic infiltrate suspicious for Langerhans cell histiocytosis or infectious etiology. A second opinion was provided by Mayo Clinic Laboratories, resulting in the definitive conclusion that the mass was non-neoplastic and tested negative for SD1a and Langerhin, biomarkers used to diagnose Langerhans cell histiocytosis. This unusual non-neoplastic lesion exemplifies one of many diverse and multifaceted pathologies that can precipitate spinal cord compression. Additionally, these findings underscore the importance of considering both neoplastic and non-neoplastic causes in the differential diagnosis of spinal cord compression, thereby enhancing clinical vigilance and improving patient outcomes for underlying spinal conditions
A Retrospective Analysis of Thrombosis and COVID-19 Mortality in Rural Midwestern Population
Get PDFBackground
COVID-19 disease has caused a major global impact on health and mortality. This infection may predispose patients to thrombotic disease, caused by excessive inflammation, endothelial dysfunction, platelet activation, and stasis. In this study, we compared mortality rates in patients admitted to the hospital with the diagnosis of COVID-19, who also had the additional diagnosis of thrombosis with those who did not have thrombosis as an additional diagnosis.
Methods
This retrospective observational study compared mortality rates in patients admitted to the hospital with the diagnosis of COVID-19, with and without thrombosis, as well as those patients admitted to the hospital with the diagnosis of thrombosis who did not have COVID-19. The diagnoses were verified using International Classification of Diseases Tenth Revision (ICD-10) codes, a standard among electronic medical records (EMR). The data were taken from the EMR at Freeman Health System in Joplin and Neosho, Missouri, from April 2020 to December 2021. This patient population is representative of not only Southwest Missouri but also the four-state area, including Oklahoma, Arkansas, and Kansas. The ICD-10 codes were used to separate the patient population into three main groups as follows: patients diagnosed with COVID-19 without thrombosis, patients diagnosed with thrombosis without COVID-19, and patients diagnosed with both COVID-19 and thrombosis. These three categories were then subdivided by age and biological sex. Sample proportions were completed using Wald\u27s method, and the two-sample proportion summary hypothesis test with confidence intervals was used for the proportion difference.
Results
A total of 3,094 patients were included in the study population. Excluded from the study were patients who were previously admitted to a hospital for COVID-19 and duplicate admissions. The mortality rate was highest (0.4714) in patients concurrently diagnosed with COVID-19 and thrombosis (Population 1 {P1}), followed by patients diagnosed with COVID-19 without thrombosis (Population 2 {P2}, 0.1187). Patients diagnosed with thrombosis without COVID-19 (Population 3 {P3}, 0.1216) had the lowest mortality. Two sample proportion hypothesis tests determined confidence intervals (CI) for mortality risk comparing P3 to P1 (95% CI: 0.2888-0.4108, p\u3c0.0001) and P2 to P1 (95% CI: 0.2919-0.4135, p\u3c0.0001).
Discussion
In this rural, Midwestern population, patients admitted to the hospital with the diagnosis of COVID-19 and thrombosis had significantly increased mortality rates compared to patients admitted with the diagnosis of COVID-19 or thrombosis alone.
Conclusion
The data from this study indicated that individuals diagnosed with both COVID-19 and thrombosis had a higher likelihood of mortality compared to those diagnosed with COVID-19 without thrombosis and those diagnosed with thrombosis without COVID-19. This information could assist physicians in determining treatment plans for patients diagnosed with COVID-19 and a secondary complication of thrombosis