scholarly journals How Did the COVID-19 Pandemic Affect Trends in Facial Trauma?

2021 ◽  
pp. 194338752110225
Author(s):  
Luke Stanisce ◽  
Alec H. Fisher ◽  
Bo Young Choi ◽  
Andrew Newman ◽  
Ju Lin Wang ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Facial Trauma ◽  
Traumatic Injuries ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Positive Urine ◽  
Volume Level ◽  
Urine Drug ◽  
Level I ◽  
The Impact

Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from January 1 to July 31 in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (March 16–July 31, 2020) and the equivalent pre-pandemic date period in 2019 using X 2, Fishers Exact, and Mann–Whitney U testing. Results: In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) ( p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005). Conclusions: The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region.

scholarly journals Timing of Bisphosphonate Initiation After Fracture: What Does the Data Really Say?

2020 ◽  
Vol 11 ◽  
pp. 215145932098036
Author(s):  
David W. Barton ◽  
C. Taylor Smith ◽  
Amit S. Piple ◽  
Sterling A. Moskal ◽  
Jonathan J. Carmouche
Keyword(s):  
Fracture Healing ◽  
Clinical Studies ◽  
Osteoporosis Treatment ◽  
The Body ◽  
Non Union ◽  
Increased Risk ◽  
Level I ◽  
Timing Of Initiation ◽  
The Impact ◽  
Published Research

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic. Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review. Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

scholarly journals Hypocalcemia in Military Casualties From Point of Injury to Surgical Teams in Afghanistan

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 300-304
Author(s):  
Jeffrey R Conner ◽  
Linda C Benavides ◽  
Stacy A Shackelford ◽  
Jennifer M Gurney ◽  
Edward F Burke ◽  
...  
Keyword(s):  
Blood Product ◽  
Calcium Supplementation ◽  
Cohort Analysis ◽  
Blood Product Transfusion ◽  
Blood Products ◽  
Military Trauma ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Surgical Teams ◽  
Patterns Of Injury

ABSTRACT Introduction Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels. Materials and Methods This is a retrospective cohort analysis of military casualties arriving from point of injury to one of two FSTs in Afghanistan from August 2018 to February 2019 split into four locations. The primary outcome was incidence of hypocalcemia (ionized calcium < 1.20 mmol/L). Results There were 101 patients included; 55 (54.5%) experienced hypocalcemia on arrival to the FST with a mean calcium of 1.16 mmol/L (95% confidence interval [CI], 1.14 to 1.18). The predominant mechanism of injury consisted of blast patterns, 46 (45.5%), which conferred an increased risk of hypocalcemia compared to all other patterns of injury (odds ratio = 2.42, P = .042). Thirty-eight (37.6%) patients required blood product transfusion. Thirty-three (86.8%) of the patients requiring blood product transfusion were hypocalcemic on arrival. Mean initial calcium of patients receiving blood product was 1.13 mmol/L (95% CI, 1.08 to 1.18), which was significantly lower than those who did not require transfusion (P = .01). Eight (7.9%) of the patients received blood products before arrival, with 6/8 (75%) presenting with hypocalcemia. Conclusions Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.

The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

2017 ◽  
Vol 55 (6) ◽  
pp. 651-658 ◽  
Author(s):  
Jonas Daugherty ◽  
Xiwu Lin ◽  
Richard Baxter ◽  
Robert Suruki ◽  
Eric Bradford
Keyword(s):  
Severe Asthma ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Systemic Glucocorticoid ◽  
Retrospective Cohort Analysis ◽  
The Impact

scholarly journals Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020269 ◽  
Author(s):  
Sarah Forster ◽  
Gemma Housley ◽  
Tricia M McKeever ◽  
Dominick E Shaw
Keyword(s):  
Respiratory Disease ◽  
Early Warning ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Scoring Systems ◽  
University Hospitals ◽  
Retrospective Cohort Analysis ◽  
Early Warning Scores ◽  
The Impact ◽  
Higher Sensitivity

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

scholarly journals Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Benedict Morath ◽  
Andreas Meid ◽  
Johannes Rickmann ◽  
Jasmin Soethoff ◽  
Markus Verch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Function ◽  
Hydroxyethyl Starch ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Retrospective Cohort Analysis ◽  
The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

Disruptions to U.S. medical oncology care during the COVID-19 Pandemic: CancerLinQ Discovery (CLQD) analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6547-6547
Author(s):  
Abdul-Rahman Jazieh ◽  
Mark Riffon ◽  
Jennifer C. King ◽  
Gabrielle Betty Rocque ◽  
Electra D. Paskett ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Cohort Analysis ◽  
Healthcare Delivery ◽  
Absolute Number ◽  
Retrospective Cohort Analysis ◽  
Hispanic Patients ◽  
Oncology Care ◽  
Oncology Practice ◽  
The Impact

6547 Background: The COVID-19 pandemic disrupted all facets of healthcare delivery including cancer care. This study evaluates the disruptions to US medical oncology practice during the pandemic in terms of number and type of patients (pts) encounters to determine the impact on continuity of patient care. Methods: We conducted a retrospective cohort analysis using the CLQD electronic health record database, containing data from 2+ million pts from all 50 states. We assessed changes in the monthly proportions of visit encounter types (in-person outpatient [IPOP] and telehealth [TE]) for new and established patients (NP and EP) with an invasive malignancy, benign or in situ neoplasm, or benign hematology diagnosis having an encounter between 1/1/2018 and 9/30/2020. Results: 781,945 pts were studied. Median age on 1/1/2018 was 64 years (IQR: 53-73), 38% were female, and 58% had an invasive malignancy. From 12/2019 to 9/2020, total monthly encounters dropped from 157,964 to 90,662. Monthly IPOP visits for NP dropped from 11.2% to 7.9%, an absolute drop of 3.3% and a relative drop of 30%; TE for NP increased by 1.1% (Table). Monthly IPOP visits for EP, as a percentage of all visits, dropped from 94.4% to 86.6% from 12/2019 to 6/2020 but rebounded to 90.4% by 9/2020. Fraction of TE increased substantially during the pandemic period reaching a peak in 6/2020 (13.8% for EP and 1.6% for NP) and decreased in 9/2020 to 9.6% and 1.1% for EP and NP, respectively. Compared to non-Hispanic patients, Hispanic patients had a larger reduction in IPOP and more TE during the study period. Percentage of monthly encounters, by type, from baseline*. Conclusions: We observed a reduction in the absolute number and monthly percentage of IPOP encounters during the COVID-19 pandemic. For EP, increases in TE does not fully compensate for reductions in IPOP. The reduction in IPOP NP encounters is particularly concerning since it was not accompanied by a compensatory increase in TE. The reduction in NP is consistent with reported pandemic-associated reductions in cancer screening and suggest a notable delay in cancer diagnoses during the pandemic. Reduction in Hispanic IPOP encounters warrants further evaluation.[Table: see text]

scholarly journals Impact of obesity on male urethral sling outcomes

2020 ◽  
Vol 12 ◽  
pp. 175628722092799
Author(s):  
M. Francesca Monn ◽  
Hannah V. Jarvis ◽  
Thomas A. Gardner ◽  
Matthew J. Mellon
Keyword(s):  
Operative Time ◽  
Cohort Analysis ◽  
Obese Patients ◽  
Retrospective Cohort Analysis ◽  
Surgical Complexity ◽  
History Of ◽  
Sling Placement ◽  
The Impact ◽  
Male Urethral Sling

Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

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