Principles for Managing Patients with Spinal Ailments in the Coronavirus Disease 2019 Era: What Do We Know So Far? An Evidence-Based, Narrative Review

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected all specialty practices in medicine, including the field of spinal surgery. Spinal surgery is unique in that the procedures include not only fully elective and fully emergent interventions, but also involve a separate group of semi-emergent surgeries, where delayed intervention may lead to permanent neurological deficits. Here, we present an evidence-based review on the impact of the COVID-19 pandemic on spinal surgery and our current knowledge about this issue. We conducted a thorough search of the PubMed, Medline, and Google Scholar databases using the keywords, “COVID-19,” “COVID-19 impact on spine surgery,” “coronavirus impact on spine surgery,” “COVID-19 impact on neurosurgery,” “coronavirus impact on neurosurgery,” “COVID-19 impact on spine surgeons,” and “coronavirus impact on spine surgeons” on May 6, 2020. A total of 8,322 articles were identified in the initial search. Articles that were duplicated, those that did not pertain to COVID-19 or spine surgeries, those with details not pertaining to the current topic of interest, and those published in languages other than English were excluded from our analyses. After complete screening, six articles were included in this review. During the previous few weeks, the COVID pandemic has significantly influenced all major aspects of spine surgery across the world. Outpatient care has been gradually shifted from physical visits to tele-health and online consultations. General recommendations have favored the conservative approach over surgeries, although no patient should be deprived of standard care owing to concerns about COVID. The general principles followed by spine surgeons should include early detection of COVID symptomatology; triaging of patients based on underlying spinal pathology; prescription of appropriate investigations to confirm the COVID status; isolation, as needed; selection of optimal management method as per the guidelines; adherence to best intraoperative practices; and ensuring protective measures for non-infected patients, family members, fellow heath care providers, and themselves against the disease.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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Navigating Naturopathic Remedies in Oncology

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v89i1.8571 ◽

2020 ◽

Author(s):

Nafis Hossain ◽

Mary Nguyen

Keyword(s):

Cancer Treatment ◽

Health Care Providers ◽

Evidence Based ◽

Care Providers ◽

Middle Ground ◽

Cancer Treatments ◽

Evidence Based Practices ◽

London Health ◽

Clinician Scientist ◽

The Impact

The use of naturopathic and other alternative forms of cancer treatment are pervasive, and many patients may firmly believe in their effectiveness. This can present headwinds for physicians who have been trained to incorporate evidence-based practices into their care. This underscores the need for health care providers to be cognizant of the impact of these alternative therapies; it is imperative to understand patient perspectives regarding their use and find middle ground where it exists. We had the opportunity to speak with Dr. David Palma, who is a radiation oncologist and clinician-scientist at the London Health Sciences Centre who has had a vested interest in improving patient access to quality cancer treatment. In this article, Dr. Palma discusses his thoughts about the rising trend of alternative cancer treatments, and how we as future physicians can reconcile with their growing influence.

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Topical Review: Vision and Gait in Older Adults: A Clinician’s Perspective

Vision Development & Rehabilitation ◽

10.31707/vdr2021.7.2.p95 ◽

2021 ◽

pp. 95-106

Keyword(s):

Sensory Integration ◽

Sensory Feedback ◽

Sensory Input ◽

Management Plan ◽

Vision Impairment ◽

Evidence Based ◽

Care Providers ◽

Risk Of Falling ◽

Human Function ◽

The Impact

Gait is an important human function, and vision is the dominant sensory input used during gait. Vision aids pathfinding decisions and provide ongoing sensory feedback to maintain appropriate balance and prevent falls. Eye care providers who wish to effectively address the impact of vision impairment on the risk of falling will customize their management plan based on specific impairments. This article provides an overview of normal sensory integration as it applies to gait, with an emphasis on vision. It also presents an evidence-based review of visual dysfunctions that cause falls, as well as strategies to reduce falls in adults with visual impairment, with emphasis on patients over age 65.

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Early Enteral Feeding for the Very Low Birth Weight Infant: The Development and Impact of a Research-Based Guideline

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.24.4.9 ◽

2005 ◽

Vol 24 (4) ◽

pp. 9-19 ◽

Cited By ~ 16

Author(s):

Joan Renaud Smith

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Health Care Providers ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Neonatal Period ◽

Evidence Based ◽

Care Providers ◽

Vlbw Infant ◽

The Impact

Providing optimal nutrition for the very low birth weight (VLBW) infant is critical during the neonatal period. Evidence-based practice guidelines are essential in managing these fragile infants. Putting scientific research into daily clinical practice may be arduous at times, however. A multidisciplinary team of health care providers successfully established a practical feeding guideline for a 52-bed, teaching-affiliated, Level III neonatal intensive care unit in St. Louis. This guideline identifies human milk as the recommended source of nutrition for the VLBW infant, a suggestion that has significantly affected lactation services in the unit. This article describes the process of developing, implementing, and evaluating a feeding guideline based on current research and describes the impact on lactation rates of having such a guideline in place within the unit.

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Death from COVID-19 in a Hispanic postpartum woman and review of the literature

BMJ Case Reports ◽

10.1136/bcr-2021-242819 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242819

Author(s):

Janardhan Mydam ◽

Laila Younes ◽

Mohammed Siddiqui ◽

Thana Tarsha

Keyword(s):

Pregnancy Outcomes ◽

Current Knowledge ◽

Obese Woman ◽

Clinical Care ◽

Current Evidence ◽

Postpartum Woman ◽

Postpartum Women ◽

Evidence Based ◽

Review Of The Literature ◽

The Impact

There is still much we do not know about the impact of COVID-19 on the health of pregnant and postpartum women and pregnancy outcomes. Current evidence suggests that there is biological plausibility for worse outcomes among this population. This case report details the clinical care given to a postpartum Hispanic and obese woman diagnosed with COVID-19 in April 2020. We report the care she and her newborn received and her progression through the virus. We discuss the current knowledge surrounding COVID-19 among pregnant and postpartum women. While research supports COVID-19 outcomes being comparable to the general population, there is limited research in this area. Clinical trials, acting on the side of caution, have tended to exclude pregnant women from participation. Therefore, there is a need for further research that can inform evidence-based policy decisions related to COVID-19 in pregnant and postpartum women.

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The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis

Neurosurgery ◽

10.1093/neuros/nyz310_618 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Yahya Othman ◽

Avani Vaishnav ◽

Steven Mcanany ◽

Sravisht Iyer ◽

Todd Albert ◽

...

Keyword(s):

Length Of Stay ◽

Spine Surgery ◽

Spinal Surgery ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Opioid Use ◽

Pain Scores ◽

Patient Reported ◽

The Impact

Abstract INTRODUCTION The purpose of this study is to compile data presented in literature regarding the efficacy of incorporating NSAIDs in the postoperative course for patients undergoing spine surgery, in particular its impact on pain levels, opioid use, complications, and hospital length of stay METHODS This is a meta-analysis and systematic review. A literature search was conducted using the backbone search [spinal surgery] [Nsaid] [complications]. Criteria for inclusion are as follows: use of NSAIDs for postoperative pain management of spinal surgery, comparison between NSAID and NSAID-free cohort, and reporting on any of pain scores, hospital opioid use, hospital length of stay, complications rate, and operative outcomes. RESULTS Out of 799 studies, 19 studies met the inclusion criteria. A total of 1522 patient were included in this analysis. The studies included randomized controlled trials, Prospective and retrospective cohorts. Operations included discectomies, laminectomies, and fusions. Most commonly regimens included the NSAID Ketorelac, as in injection given immediately postoperatively. Patients that received NSAID analgesia postoperatively had significantly lower VAS pain scores at 1 and 12 h postoperatively. This group also had a significantly lower opioid consumption and shorter hospital length of stay. A total of 7 fusion studies reported on arthrodesis, showing a significantly lower odds of fusion after NSAIDs use, however after subgrouping according to smoking, this difference proves to be no longer significant. CONCLUSION Incorporation of NSAIDs into the postoperative regimen for analgesia in patients undergoing spine surgery is an effective approach in reducing hospital length of stay, patient reported pain scores, hospital opioid use, and has no increased risk of complications. Furthermore, use of NSAIDs in the nonsmoking population does not seem to affect arthrodesis rates in patients undergoing spine surgery.

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Second opinion in spine surgery: A scoping review

Surgical Neurology International ◽

10.25259/sni_399_2021 ◽

2021 ◽

Vol 12 ◽

pp. 436

Author(s):

Sandra Gattas ◽

Gianna M. Fote ◽

Nolan J. Brown ◽

Brian V. Lien ◽

Elliot H. Choi ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Economic Value ◽

Second Opinion ◽

Inclusion Criteria ◽

Substantial Impact ◽

The Past ◽

Number Of Patients ◽

Extent Of Surgery ◽

The Impact

Background: As a growing number of patients seek consultations for increasingly complex and costly spinal surgery, it is of both clinical and economic value to investigate the role for second opinions (SOs). Here, we summarized and focused on the shortcomings of 14 studies regarding the role and value of SOs before proceeding with spine surgery. Methods: Utilizing PubMed, Google Scholar, and Scopus, we identified 14 studies that met the inclusion criteria that included: English, primary articles, and studies published in the past 20 years. Results: We identified the following findings regarding SO for spine surgery: (1) about 40.6% of spine consultations are SO cases; (2) 61.3% of those received a discordant SO; (3) 75% of discordant SOs recommended conservative management; and (4) SO discordance applied to a variety of procedures. Conclusion: The 14 studies reviewed regarding SOs in spine surgery showed that half of the SOs differed from those given in the initial consultation and that SOs in spine surgery can have a substantial impact on patient care. Absent are prospective studies investigating the impact of following a first versus second opinion. These studies are needed to inform the potential benefit of universal implementation of SOs before major spine operations to potentially reduce the frequency and type/extent of surgery.

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Grace and Glory: How One Free Clinic Can Make a Difference

Creative Nursing ◽

10.1891/1078-4535.19.3.148 ◽

2013 ◽

Vol 19 (3) ◽

pp. 148-152

Author(s):

Johnny Ng

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Oklahoma City ◽

Evidence Based ◽

Advanced Practice ◽

Care Providers ◽

Free Clinic ◽

Access To Medical Care ◽

Financial Burdens ◽

The Impact

In 2010, a free clinic in northeast Oklahoma City opened its doors and began seeing nonemergent patients. This evidence-based article illustrates the impact of the clinic on its community. It discusses the benefits and financial implications and the operation of the free clinic through contributions and volunteerism, and highlights strengths and limitations. A survey conducted over a period of three months on 50 clinic patients concluded that one free clinic can make a difference by providing much-needed access to medical care, decreasing financial burdens on area hospitals, and enhancing public opinion of Advanced Practice Registered Nurses (APRNs) as primary care providers.

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Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on the Development of Surgical Site Infection after Spinal Surgery: A Prospective Observational Study

Neurosurgery ◽

10.1093/neuros/nyab040 ◽

2021 ◽

Author(s):

Kyle B Mueller ◽

Matthew D’Antuono ◽

Nirali Patel ◽

Gnel Pivazyan ◽

Edward F Aulisi ◽

...

Keyword(s):

Observational Study ◽

Spine Surgery ◽

Negative Pressure ◽

Spinal Surgery ◽

Prospective Observational Study ◽

Statistical Significance ◽

High Risk Patient ◽

Surgical Site Infections ◽

Pressure Therapy ◽

The Impact

Abstract BACKGROUND Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) in spine surgery that lacks robust data. OBJECTIVE To determine the impact of a ci-NPT, as compared with a standard dressing, on the development of SSIs after spine surgery. METHODS This was a prospective observational study over a 2-yr period. Indications for surgery included degenerative disease, deformity, malignancy, and trauma. Exclusion criteria included anterior and lateral approaches to the spine, intraoperative durotomy, or use of minimally invasive techniques. SSIs up to 60 d following surgery were recorded. RESULTS A total of 274 patients were included. SSI rate was significantly lower with ci-NPT dressing (n = 118) as compared with the standard dressing (n = 156) (3.4 vs 10.9%, P = .02). There was no statistical difference in infection rate for decompression alone procedures (4.2 vs 9.1%, P = .63), but there was a statistically significant reduction with the use of a negative-pressure dressing in cases that required instrumentation (3.2 vs 11.4%, P = .03). Patients at higher risk (instrumentation, deformity, and malignancy) had less SSIs with the use of ci-NPT, although this did not reach statistical significance. There were no complications in either group. CONCLUSION SSI rates were significantly reduced with a ci-NPT dressing vs a standard dressing in patients who underwent spinal surgery. The higher cost of a ci-NPT dressing might be justified with instrumented cases, as well as with certain high-risk patient populations undergoing spine surgery, given the serious consequences of an infection.

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An Exploratory Study Investigating the Non-Clinical Benefits of Evidence-Based Veterinary Medicine

Veterinary Evidence ◽

10.18849/ve.v2i2.97 ◽

2017 ◽

Vol 2 (2) ◽

Author(s):

Elizabeth Jackson ◽

Sarah Hauser

Keyword(s):

Veterinary Medicine ◽

Employee Engagement ◽

Exploratory Study ◽

Client Satisfaction ◽

Current Knowledge ◽

Evidence Based ◽

Client Retention ◽

Clinical Benefits ◽

The Uk ◽

The Impact

Objective: As little prior research exists about the non-clinical benefits of evidence-based veterinary medicine (EBVM), this exploratory study was conducted to identify non-clinical benefits of EBVM to veterinary practices, as well as highlighting the barriers to further implementation, and ways to overcome them.Background: A PICO-based literature review (Hauser and Jackson, 2016) was conducted to establish current knowledge about the non-clinical benefits of EBVM. It found that while there are some papers suggesting a link between the practice of EBVM and better non-clinical benefits such as client satisfaction and client retention, a single study, focusing on the non-clinical benefits of EBVM, had yet to be conducted.Evidentiary value: This exploratory study provides a solid basis for the further development of a confirmatory study of the themes identified in the interviews. The impact on practice from our findings is significant as it details the key areas where the use of EBVM can yield commercial benefits from the perspective of a group of EBVM experts via interview. It is entirely possible that international veterinary environments which mirror that of the UK will find this research beneficial.Methods: Due to the paucity of data about the non-clinical benefits of EBVM, an exploratory, qualitative approach was taken to this research in order to build a platform for further confirmatory, quantitative investigation (Zikmund, 2003). In February and March 2016 interviews with 16 RCVS Knowledge Group chairs<a name="_ftnref1" href="#_ftn1"></a>[1] were conducted. The interview guide contained broad, open-ended questions to explore existing tacit knowledge about the non-commercial benefits of EBVM. The interviews were audio recorded and transcribed verbatim and subsequently analysed using NVivo 11 software.Results: This qualitative enquiry showed that the key areas where the use of EBVM can yield non-clinical benefits are through increased client satisfaction and retention, improved reputation and confidence of the veterinarian, as well as employee engagement. In order to yield these benefits the two main barriers, time and resources, need to be overcome.Conclusion: The themes highlighted in this paper provide a solid, real world base for further, quantitative study of the non-clinical benefits of practising EBVM. Application: The results of this research are applicable to practicing veterinarians, nurses and other practice staff. It is clear that practising EBVM not only leads to better clinical outcomes, but can also result in commercial benefits, such as better client retention and employee engagement <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

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