The Impact of Intraoperative Image-Guidance Modalities and Neurophysiologic Monitoring in the Safety of Sacroiliac Fusions

Study Design: Retrospective observational cohort. Objective: A review of efficiency and safety of fluoroscopy and stereotactic navigation system for minimally invasive (MIS) Sacroiliac (SI) fusion through a lateral technique. Methods: Retrospective analysis of an observational cohort of 96 patients greater than 18 years old, that underwent MIS SI fusion guided by fluoroscopy or navigation between January 2013 and April 2020 with a minimum of 3 months follow-up. Intraoperative neuromonitoring (IONM) with a variable combination of electromyography (EMG), somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) was also utilized. Results: The overall complication rate in the study was 9.4%, and there was no difference between the fluoroscopy (10.1%), and navigation groups (8%). Neurological complication rate was 2.1%, without a significant difference between both intraoperative guidance modality groups (p = 0.227). There was a significant difference between the modalities of IONM used and the occurrence of neurological injury (p = 0.01).The 2 patients who had a neurological complication postoperatively were monitored only with EMG and SSEP, but none of the patients (n = 76) in which MEPs were utilized had neurologic complication. The mean pain improvement 3 months after surgery was greater in the navigation group (2.44 ± 2.72), but was not statistically different than the improvement in the fluoroscopy group (1.90 ± 2.07) (p = 0.301). Conclusions: No difference in the safety of the procedure was found between the fluoroscopy and the stereotactic navigation techniques. The contribution of the IONM to the safety of SI fusions could not be determined, but the data indicates that MEPs provide the highest level of sensitivity.

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Intra-operative neurophysiological monitoring

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.165035 ◽

2015 ◽

Vol 02 (03) ◽

pp. 179-192

Author(s):

Zulfiqar Ali ◽

Parmod Bithal

Keyword(s):

Evoked Potentials ◽

Surgical Procedures ◽

Complication Rate ◽

Motor Evoked Potentials ◽

Neurological Complication ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Sensory Evoked Potentials ◽

Sensory Evoked

AbstractIntraoperative neurophysiological monitoring has achieved importance due to complexity of cranio-spinal surgical procedures being performed frequently these days. Many studies have proven a decreased neurological complication rate after its introduction. It is broadly of two types: Sensory evoked potentials and motor evoked potentials which are further sub-divided. Its use during surgery requires a controlled anaesthesia technique with no or minimal influence on its recording. Its success depends upon three way communication among the surgeon the neurophysiologist and the anaesthesiologist.

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The influence of the dynamics and the level of maturity of the cortical functions as a prerequisite for the development of speech in children

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180510046d ◽

2019 ◽

Vol 147 (3-4) ◽

pp. 199-204

Author(s):

Maja Davidovic ◽

Jadranka Otasevic ◽

Nada Dobrota-Davidovic ◽

Ivana Petronic ◽

Dragomir Davidovic ◽

...

Keyword(s):

Motor Control ◽

Evoked Potentials ◽

Physiological Changes ◽

Articulation Disorder ◽

Significant Difference ◽

Cortical Responses ◽

Quasi Experimental ◽

Waveform Amplitude ◽

And Control ◽

The Impact

Introduction/Objective. The development of speech is the result of interaction of different systems of the cortex, which gradually acquires the ability of phonological presentation and motor control, in the presence of a series of physical and physiological changes in the morphology of the articulation system. The objective of the study was to examine the impact of laterality and cortical responses on the development of speech in children. Methods. Research is a quasi-experimental design with two groups. The sample covered 60 children from Belgrade, of both sexes, ages 5.5?7 years, divided into two groups, experimental (30) and control (30). We used the following instruments: test for assessing laterality and ascertaining evoked potentials. Results. On the visual lateralization subtest there was a statistically significant difference (?2 = 7.56, p < 0.05) between the observed groups. The visual evoked potentials on all measured parameters gave a statistically significant difference between the groups: waveform cortical responses ? left (?2 = 30.00, df = 1, p < 0.05); cortical responses ? right (?2 = 6.667, df = 1 , p < 0.05); waveform amplitude ? left (?2 = 13.469, df = 1, p < 0.05); amplitude ? right (?2 = 40.00, df = 1, p < 0.05), somatosensory potentials (?2 = 18.261, df = 1, p <0.05); waveform amplitude (?2 = 12.000, df = 1, p < 0.05); waveform latency (?2 = 5.455, df = 1, p < 0.05). Conclusion. Visual laterality, as well as visual and somatosensory cortical responses to stimuli is better in children without the present articulation disorder, which could be used for timely prevention planning.

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Complication Profile Associated With S1 Pedicle Subtraction Osteotomy Compared to Other Spinal Levels

Neurosurgery ◽

10.1093/neuros/nyz310_441 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Christopher P Ames

Keyword(s):

Complication Rate ◽

Diastolic Heart Failure ◽

Adult Spinal Deformity ◽

Neurological Complication ◽

Pedicle Subtraction Osteotomy ◽

Senior Author ◽

Complication Rates ◽

Multicenter Studies ◽

Complication Risk ◽

Significant Difference

Abstract INTRODUCTION S1 pedicle subtraction osteotomy (PSO) is rarely indicated. Therefore, its complication profile is not well defined. This study compares complication rates following S1 PSO to PSO performed at other spinal levels. METHODS A retrospective study of a consecutive cohort of adult spinal deformity (ASD) patients who underwent thoracolumbar 3 column osteotomy (3CO) by the senior author from 2006 to 2018 was performed. Multivariate analysis was used to asses complication risk stratified by osteotomy level. RESULTS A total of 363 patients underwent 3CO: 54 lower thoracic, 305 lumbar, and 6 S1. The number of lumbar PSO by level are as fsollows: L1 (24), L2 (26), L3 (135), L4 (102), and L5 (16). The indications for S1 PSO in this series were: high grade spondylolisthesis (spondyloptosis) in 4 cases and sacral fracture in 2 cases. Overall complication rate was 27.5%. Surgical and neurologic complications occurred in 7.7% and 5.8% of cases, respectively. Complication rate by 3CO level are as follows: thoracic (31.5%), L1 (29.2%), L2 (34.6%), L3 (20.7%), L4 (32.4%), L5 (12.5%), and S1 (50.0%). Relative to the thoracic level, S1 PSO was independently associated higher complication with an increase odd ratio of 39.60 (CI 3.12-503.41, P = .005). For S1 PSO, surgical and neurological complication rate was 16.7% for both outcomes; there was no significant difference between the 3CO levels. Specific complications encountered was a case of atrial flutter causing diastolic heart failure, a case of anaphylactic transfusion reaction, and a case with L5 weakness requiring hematoma evacuation and reduction of correction. One patient (16.7%) required revision surgery secondary to pseudarthrosis. Mean follow-up was 35.7 mo. CONCLUSION S1 PSO is a formidable procedure and associated with significantly higher complication rates than PSO performed at other levels. However, the technique is feasible with experienced surgeons. Large multicenter studies are needed to investigate this further.

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199. Prospective Observational Cohort Of Transition to Oral Antibiotics in Persons Who Inject Drugs with Invasive Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.401 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S207-S208

Author(s):

Sophia Lewis ◽

Laura Marks ◽

Liang Stephen ◽

Nathan Nolan ◽

Michael Durkin

Keyword(s):

Bacterial Infections ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Readmission Rates ◽

Persons Who Inject Drugs ◽

Increased Risk ◽

Significant Difference ◽

Health Coaches ◽

Observational Cohort ◽

The Impact

Abstract Background Persons who inject drugs (PWID) are at increased risk of invasive bacterial infections. Increasing data supports the efficacy of transition to oral antibiotic therapy to complete treatment of invasive bacterial infections including osteomyelitis and endocarditis. The aim of this study is to evaluate the impact of transition to oral antibiotics on a prospective observational cohort of PWID. Methods We prospectively analyzed PWID admitted 2/2020 - 2/2021 at Barnes-Jewish Hospital in St. Louis with osteomyelitis, endocarditis, epidural abscesses or septic arthritis. All patients were offered multidisciplinary support during their inpatient hospitalization including addiction medicine consultation and medications for opioid use disorder, if appropriate. Health coaches and case managers met with patients during their hospitalization and followed patients for up to 90 days after discharge. Patients were offered the option of transition to oral antibiotics if they were not able to complete recommended IV antibiotics. Patients discharged on oral antibiotics were offered post-discharge infectious diseases follow-up. Antibiotic adherence was documented by health coaches through phone out-reach. We collected data on demographics, comorbidities, microbiologic data, antibiotic selection, mortality and readmission rates. We compared 90-day readmission rates between PWID who completed IV antibiotics inpatient and those who discharged early with oral antibiotics. Results Of 166 PWID, 61 completed IV antibiotics inpatient (37%) while 105 were discharged with oral antibiotics (63%). Causative pathogens were not significantly different between inpatient IV vs oral antibiotics; MSSA (34.4% vs 35.2%, p= 0.92), MRSA (34.4% vs. 28.6%, p=0.43), or streptococcal species (26.6% vs. 24.8%, p=0.85). Of patients discharged on oral antibiotics 7.6% had documented non-adherence to therapy, 23% had unknown adherence and 67% had documented adherence. There was no significant difference in all-cause 90-day readmission rates (p=0.819) (Figure 1). All-cause readmissions by antibiotic strategy Conclusion Oral antibiotic regimens provided similar efficacy to IV antibiotics in our prospective cohort analysis of PWID. Disclosures All Authors: No reported disclosures

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Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2018-200278 ◽

2019 ◽

Vol 45 (4) ◽

pp. 296-301 ◽

Cited By ~ 1

Author(s):

Rebecca Elizabeth Finch ◽

Kevin McGeechan ◽

Anne Johnstone ◽

Sharon Cameron

Keyword(s):

Success Rate ◽

Medical Abortion ◽

Self Administration ◽

Significant Difference ◽

Observational Cohort ◽

Effective Contraception ◽

Long Acting ◽

The Impact ◽

Home Administration ◽

At Home

IntroductionIn October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.ObjectiveTo evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.MethodsA prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.ResultsThere was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.ConclusionsSelf-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.

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30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

International Journal of Obesity ◽

10.1038/s41366-021-01048-1 ◽

2021 ◽

Author(s):

Rishi Singhal ◽

Victor Roth Cardoso ◽

Tom Wiggins ◽

Jonathan Super ◽

Christian Ludwig ◽

...

Keyword(s):

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Propensity Score ◽

Complication Rate ◽

Morbidity And Mortality ◽

One Anastomosis Gastric Bypass ◽

Complication Rates ◽

Significant Difference ◽

Observational Cohort ◽

Insulin Dependent

Abstract Background There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

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LAPAROSCOPIC CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2059 ◽

2011 ◽

Vol 18 (02) ◽

pp. 237-242

Author(s):

AWAIS SHUJA ◽

ABID BASHIR ◽

ABID RASHID

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Complication Rate ◽

Conversion Rate ◽

Gall Stone ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

The Impact

Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitating hospital admission. Objective: To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity. Period: Jan 2008-2010. Setting: Department of Surgery, Independent University Hospital, Faisalabad. Study Design: Experimental study. Material & Methods: The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A (Surgery within 72 hrs of onset symptoms). Group B (surgery between 72hrs to 96 hours of onset of symptoms). Group C (surgery after 96 hours of onset of symptoms). Results: The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Mean hospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8&. The mean hospital stay and conversion rate had no significant difference. Conclusions: The timing of laparoscopic cholecystectomy has no significant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higher when surgery performed after 72 hours of onset of symptoms.

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Design, validation and implementation of the post-acute (long) COVID-19 quality of life (PAC-19QoL) instrument

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01862-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ravi Jandhyala

Keyword(s):

Quality Of Life ◽

Control Group ◽

Upper Respiratory Tract ◽

Global Pandemic ◽

Quality Of Life Indicators ◽

Significant Difference ◽

Observational Cohort ◽

Novel Coronavirus ◽

The Impact

Abstract Background The novel coronavirus (SARS-CoV-2) has led to a global pandemic, resulting in a disease termed COVID-19, which commonly presents in adults as a typical infection of the upper respiratory tract. Although the disease is often acute, one in ten patients can continue to be affected for weeks or months, resulting in a state called long COVID. Existing evidence suggests there are no patient-centred instruments for capturing the impact of long COVID on the quality of life of people affected. Methods The Jandhyala Method was used to identify indicators of long COVID quality of life. The resulting post-acute (long) COVID-19 Quality of Life (PAC-19QoL) instrument was validated with a control group of unaffected participants and finally implemented in the dedicated patient registry, PAC-19QoLReg. Participants 15 participants suffering from long COVID, who have been positively diagnosed with COVID-19, either via diagnostic or antibody tests and a validation control group of 16 healthy participants who have not suffered from COVID-19. Main outcome measures Indicators submitted by participants with long COVID that address the specific impact of the illness on their quality of life. Results Forty-four Quality of Life Indicators (QoLI) across four domains, namely, psychological, physical, social, and work, were agreed by the participants with long COVID to be relevant for the assessment of their quality of life (CI > 0.5). The validation stage identified 35/44 QoLIs that differentiated between the two groups, with a statistically significant difference between the mean QoLI Likert Scores (p < 0.05). Conclusions The PAC-19QoL instrument and PAC-19QoLReg prospective observational cohort clinical study will enable an understanding of disease progression, on and off treatment, on the quality of life of patients with long COVID beyond simple symptomatology. Trial registration: ClinicalTrials.gov Identifier NCT04586413; 14th October 2020.

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Measuring Impact of Stress in Sandwich Generation Caring for Demented Parents

GeroPsych ◽

10.1024/1662-9647/a000114 ◽

2014 ◽

Vol 27 (4) ◽

pp. 171-179 ◽

Cited By ~ 6

Author(s):

Laurence M. Solberg ◽

Lauren B. Solberg ◽

Emily N. Peterson

Keyword(s):

Factor Analysis ◽

Exploratory Factor Analysis ◽

Social Worker ◽

Resource Availability ◽

Well Being ◽

Sandwich Generation ◽

Item Questionnaire ◽

Significant Difference ◽

Adult Caregivers ◽

The Impact

Stress in caregivers may affect the healthcare recipients receive. We examined the impact of stress experienced by 45 adult caregivers of their elderly demented parents. The participants completed a 32-item questionnaire about the impact of experienced stress. The questionnaire also asked about interventions that might help to reduce the impact of stress. After exploratory factor analysis, we reduced the 32-item questionnaire to 13 items. Results indicated that caregivers experienced stress, anxiety, and sadness. Also, emotional, but not financial or professional, well-being was significantly impacted. There was no significant difference between the impact of caregiver stress on members from the sandwich generation and those from the nonsandwich generation. Meeting with a social worker for resource availability was identified most frequently as a potentially helpful intervention for coping with the impact of stress.

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Implicit and explicit corrective feedback and feedback exposure conditions

Instructed Second Language Acquisition ◽

10.1558/isla.38113 ◽

2020 ◽

Vol 4 (1) ◽

pp. 3-48

Author(s):

Takehiro Iizuka ◽

Kimi Nakatsukasa

Keyword(s):

Explicit Knowledge ◽

Corrective Feedback ◽

Significant Difference ◽

Oral Corrective Feedback ◽

Post Test ◽

Picture Description ◽

Potential Factors ◽

Implicit And Explicit ◽

Instructional Settings ◽

The Impact

This exploratory study examined the impact of implicit and explicit oral corrective feedback (CF) on the development of implicit and explicit knowledge of Japanese locative particles (activity de, movement ni and location ni) for those who directly received CF and those who observed CF in the classroom. Thirty-six college students in a beginning Japanese language course received either recast (implicit), metalinguistic (explicit) or no feedback during an information-gap picture description activity, and completed a timed picture description test (implicit knowledge) and an untimed grammaticality judgement test (explicit knowledge) in a pre-test, immediate post-test and delayed post-test. The results showed that overall there was no significant difference between CF types, and that CF benefited direct and indirect recipients similarly. Potential factors that might influence the effectiveness of CF, such as instructional settings, complexity of target structures and pedagogy styles, are discussed.

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