Expectations of recovery and functional outcomes following thoracolumbar trauma: an evidence-based medicine process to determine what surgeons should be telling their patients

OBJECT The aim of this study was to define the expected functional and health-related quality of life outcomes following common thoracolumbar injuries on the basis of consensus expert opinion and the best available literature. Patient expectations are primarily determined by the information provided by health care professionals, and these expectations have been shown to influence outcome in various medical and surgical conditions. This paper presents Part 2 of a multiphase study designed to investigate the impact of patient expectations on outcomes following spinal injury. Part 1 demonstrated substantial variability in the information surgeons are communicating to patients. Defining the expected outcomes following thoracolumbar injury would allow further analysis of this relationship and enable surgeons to more accurately and consistently inform patients. METHODS Expert opinion was assembled by distributing questionnaires comprising 4 cases representative of common thoracolumbar injuries to members of the Spine Trauma Study Group (STSG). The 4 cases included a thoracolumbar junction burst fracture treated nonoperatively or with posterior transpedicular instrumentation, a low lumbar (L-4) burst fracture treated nonoperatively, and a thoracolumbar junction flexion-distraction injury managed with posterior fusion. For each case, 5 questions about expected outcomes were posed. The questions related to the proportion of patients who are pain free, the proportion who have regained full range of motion, and the patients' recreational activity restrictions and personal care and social life limitations, all at 1 year following injury, as well as the timing of return to work and length of hospital stay. Responses were analyzed and combined with the results of a systematic literature review on the same injuries to define the expected outcomes. RESULTS The literature review identified 38 appropriate studies that met the preset inclusion criteria. Published data were available for all injuries, but not all outcomes were available for each type of injury. The survey was completed by 31 (57%) of 53 surgeons representing 24 trauma centers across North America (15), Europe (5), India (1), Mexico (1), Japan (1) and Israel (1). Consensus expert opinion supplemented the available literature and was used exclusively when published data were lacking. For example, 1 year following cast or brace treatment of a thoracolumbar burst fracture, the expected outcomes include a 40% chance of being pain free, a 70% chance of regaining pre-injury range of motion, and an expected ability to participate in high-impact exercise and contact sport with no or minimal limitation. Consensus expert opinion predicts reemployment within 4–6 months. The length of inpatient stay averages 4–5 days. CONCLUSIONS This synthesis of the best available literature and consensus opinion of surgeons with extensive clinical experience in spine trauma reflects the optimal methodology for determining functional prognosis after thoracolumbar trauma. By providing consistent, accurate information surgeons will help patients develop realistic expectations and potentially optimize outcomes.

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An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine21790 ◽

2021 ◽

pp. 1-10

Author(s):

Jacob K. Greenberg ◽

Stephen Shelby Burks ◽

Christopher F. Dibble ◽

Saad Javeed ◽

Vivek P. Gupta ◽

...

Keyword(s):

Literature Review ◽

Minimally Invasive ◽

Expert Opinion ◽

Treatment Algorithm ◽

Interrater Agreement ◽

Neurological Deficits ◽

Spine Trauma ◽

Thoracolumbar Injury ◽

Survey Results ◽

Neurologically Intact

OBJECTIVE Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. METHODS A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. RESULTS Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. CONCLUSIONS Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.

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Active vitamin D analogues and oral phosphate for the treatment of X-linked hypophosphataemia in paediatric patients: A systematic literature review and survey of expert opinion on current needs

Bone Abstracts ◽

10.1530/boneabs.7.p75 ◽

2019 ◽

Author(s):

Gema Ariceta ◽

Carmen de Lucas Collantes ◽

Ravi Jandhyala ◽

Zulf Mughal

Keyword(s):

Vitamin D ◽

Literature Review ◽

Expert Opinion ◽

Systematic Literature Review ◽

Active Vitamin ◽

Active Vitamin D ◽

Vitamin D Analogues ◽

Paediatric Patients

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Tildrakizumab Inadequate Responders Switching to an Alternative IL-23 Inhibitor: A Case Series

Journal of Psoriasis and Psoriatic Arthritis ◽

10.1177/24755303211037308 ◽

2021 ◽

pp. 247553032110373

Author(s):

Eingun James Song ◽

Audrey Jia Shin Wong

Keyword(s):

Adverse Events ◽

Expert Opinion ◽

Case Series ◽

Tnf Alpha ◽

Published Data ◽

Inadequate Response ◽

Limited Time ◽

Case Description ◽

Single Institution ◽

Inadequate Responders

Background: Biologic switching is not uncommon in the treatment of psoriasis and is most often due to inadequate response of adverse events. Staying within or switching out of the class is still based on expert opinion but there are published data on intra-class switching with TNF-alpha and IL-17 inhibitors. Less is known about the IL-23 inhibitors because of their limited time in the market. We would like to present our experience with inadequate responders to tildrakizumab, a selective IL23 inhibitor, who were switched to an alternative IL-23 inhibitor. Case Description: This is a case series of 6 patients at a single institution considered inadequate responders to tildrakizumab, which included primary failures, secondary failures, and intermediate responders, who were subsequently switched to another IL-23 inhibitor. Conclusion: All 6 patients who were inadequate responders to tildrakizumab showed significant improvement after switching to another IL-23 inhibitor, with 5/6 reaching IGA 0/1 after 16 weeks of treatment.

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Susceptibility of the Candida haemulonii Complex to Echinocandins: Focus on Both Planktonic and Biofilm Life Styles and a Literature Review

Journal of Fungi ◽

10.3390/jof6040201 ◽

2020 ◽

Vol 6 (4) ◽

pp. 201

Author(s):

Lívia S. Ramos ◽

Laura N. Silva ◽

Marta H. Branquinha ◽

André L. S. Santos

Keyword(s):

Literature Review ◽

Therapeutic Potential ◽

Multidrug Resistant ◽

Antifungal Drugs ◽

Clinical Isolates ◽

Published Data ◽

Life Styles ◽

Fungal Isolates ◽

Candida Haemulonii ◽

Almost All

Candida haemulonii complex (C. haemulonii, C. duobushaemulonii and C. haemulonii var. vulnera) is well-known for its resistance profile to different available antifungal drugs. Although echinocandins are the most effective class of antifungal compounds against the C. haemulonii species complex, clinical isolates resistant to caspofungin, micafungin and anidulafungin have already been reported. In this work, we present a literature review regarding the effects of echinocandins on this emergent fungal complex. Published data has revealed that micafungin and anidulafungin were more effective than caspofungin against the species forming the C. haemulonii complex. Subsequently, we investigated the susceptibilities of both planktonic and biofilm forms of 12 Brazilian clinical isolates of the C. haemulonii complex towards caspofungin and micafungin (anidulafungin was unavailable). The planktonic cells of all the fungal isolates were susceptible to both of the test echinocandins. Interestingly, echinocandins caused a significant reduction in the biofilm metabolic activity (viability) of almost all fungal isolates (11/12, 91.7%). Generally, the biofilm biomasses were also affected (reduction range 20–60%) upon exposure to caspofungin and micafungin. This is the first report of the anti-biofilm action of echinocandins against the multidrug-resistant opportunistic pathogens comprising the C. haemulonii complex, and unveils the therapeutic potential of these compounds.

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559 Benzocaine-Lidocaine-Tetracaine (BLT) Cream Adverse Effects in Burn Patients: A Case Report and Literature Review

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.209 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S129-S129

Author(s):

Todd A Walroth ◽

Michelle E Brown ◽

Katelyn Gordon ◽

Moises Martinez ◽

Cortni Grooms ◽

...

Keyword(s):

Literature Review ◽

Adverse Effects ◽

Surface Area ◽

Total Body Surface Area ◽

Neurological Deficits ◽

Published Data ◽

Burn Patients ◽

Burn Wound ◽

Lidocaine Concentration ◽

Topical Lidocaine

Abstract Introduction Historically, BLT cream has been used at our burn center in laser procedures and tattoo removal with 6–8% lidocaine to improve tolerance of outpatient procedures. Recently, the laser BLT formulation (8%) has been trialed as an opioid-sparing alternative for managing pain during inpatient microneedling procedures. When utilizing this formulation for microneedling, the high percentage of lidocaine absorption may correlate with adverse central nervous system (CNS) effects. Methods A literature evaluation and retrospective chart review of burn patients receiving BLT cream for inpatient microneedling was performed. Results From January to June 2020, two elderly females (77 and 78 years old) received several doses of BLT cream during inpatient microneedling procedures with no documented adverse events attributed to the medication. A 68 year old male with a total body surface area (TBSA) of 8% reported dizziness shortly after he received BLT cream. Vitals were normal, but the patient was unable to focus his eyes or communicate clearly. Neurological exam revealed sluggish, pinpoint pupils. Patient remained disoriented with gargling and tongue thrusting though vitals remained stable. At this time, the remainder of the BLT cream was removed from the wound and his mentation returned to baseline within 90 minutes. No residual neurologic deficits occurred. No other potential causes were identified. Literature review revealed topical lidocaine can be absorbed systemically and cause CNS depression, confusion, and disorientation. Based on limited published data in healthy patients, it is recommended to use no more than 5% of topical lidocaine in large quantities, especially over raw surfaces or blistered areas. The amount of lidocaine systemically absorbed is linked to both the duration of application and the surface area over which it is applied. Using study data from lidocaine/prilocaine 2.5% cream and lidocaine patches, we explored a safer BLT formulation for burn patients as published data do not exist for this group. Conclusions Based on our review, we determined 2% to be the maximum lidocaine concentration to apply to a burn wound, 5% TBSA as the maximum surface area involved, and total exposure time limited to 30 minutes or less to reduce incidence of adverse effects. Specifically, formulations with a higher lidocaine concentration applied to a burn wound have the potential to result in untoward neurological deficits.

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Bioethanol Production From High Sugary Corn Genotypes by Decreasing Enzyme Consumption

Advances in Library and Information Science - Social Research Methodology and New Techniques in Analysis, Interpretation, and Writing ◽

10.4018/978-1-5225-7897-0.ch010 ◽

2019 ◽

pp. 216-240 ◽

Cited By ~ 1

Author(s):

Hossain Zabed

Keyword(s):

Biological Sciences ◽

Literature Review ◽

Product Quality ◽

Ethanol Production ◽

Comparative Evaluation ◽

Field Experiments ◽

Bioethanol Production ◽

Research Questions ◽

The University ◽

Expected Outcomes

This is a PhD proposal defended in a 2012-2013 session at the Institute of Biological Sciences, Faculty of Science, University of Malaya, Malaysia. The proposal has been written in accordance with the requirements of the university under the sub-headings: background, problem statement, rationale, hypothesis and research questions, research objectives, literature review, methodology, scope, expected outcomes and concluding remarks, work schedule, and references. This proposal provides a comprehensive study on bioethanol production from corn. First, it discusses development and field experiments of high sugary genotypes (HSGs). Secondly, it provides a comparative evaluation of enzyme consumptions and ethanol production between normal and HSG corn genotypes. Finally, this proposal provides evaluation of the co-product quality for both groups of genotypes. The readers who are interested to conduct any further study on corn-based bioethanol would be benefited from this proposal.

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Lipoma arborescens of the knee: Report of a case with a full range of motion and literature review

Saudi Journal of Sports Medicine ◽

10.4103/1319-6308.131629 ◽

2014 ◽

Vol 14 (1) ◽

pp. 55

Author(s):

V Prabhakar ◽

Shiva Naik

Keyword(s):

Literature Review ◽

Range Of Motion ◽

Full Range ◽

Lipoma Arborescens

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Epidemiology of Microsatellite Instability High (MSI-H) and Deficient Mismatch Repair (dMMR) in Solid Tumors: A Structured Literature Review

Journal of Oncology ◽

10.1155/2020/1807929 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17 ◽

Cited By ~ 1

Author(s):

Maria Lorenzi ◽

Mayur Amonkar ◽

Jacky Zhang ◽

Shivani Mehta ◽

Kai-Li Liaw

Keyword(s):

Literature Review ◽

Solid Tumors ◽

English Language ◽

Meta Analysis ◽

Evidence Base ◽

Published Data ◽

Cancer Type ◽

Pooled Prevalence ◽

Tumor Types ◽

Structured Literature Review

Background. Given limited data on the epidemiology of MSI-H and dMMR across solid tumors (except colorectal cancer (CRC)), the current study was designed to estimate their prevalence. Materials and Methods. A structured literature review identified English language publications that used immunohistochemistry (IHC) or polymerase chain replication (PCR) techniques. Publications were selected for all tumors except CRC using MEDLINE, EMBASE, and Cochrane databases and key congresses; CRC and pan-tumor genomic publications were selected through a targeted review. Meta-analysis was performed to estimate pooled prevalence of MSI-H/dMMR across all solid tumors and for selected tumor types. Where possible, prevalence within tumor types was estimated by disease stages. Results. Of 1,176 citations retrieved, 103 and 48 publications reported prevalence of MSI-H and dMMR, respectively. Five pan-tumor genomic studies supplemented the evidence base. Tumor types with at least 5 publications included gastric (n = 39), ovarian (n = 23), colorectal (n = 20), endometrial (n = 53), esophageal (n = 6), and renal cancer (n = 8). Overall MSI-H prevalence (with 95% CI) across 25 tumors was based on 90 papers (28,213 patients) and estimated at 14% (10%–19%). MSI-H prevalence among Stage 1/2 cancers was estimated at 15% (8%–23%); Stages 3 and 4 prevalence was estimated at 9% (3%–17%) and 3% (1%–7%), respectively. Overall, dMMR prevalence across 13 tumor types (based on 54 papers and 20,383 patients) was estimated at 16% (11%–22%). Endometrial cancer had the highest pooled MSI-H and dMMR prevalence (26% and 25% all stages, respectively). Conclusions. This is the first comprehensive attempt to report pooled prevalence estimates of MSI-H/dMMR across solid tumors based on published data. Prevalence determined by IHC and PCR was generally comparable, with some variations by cancer type. Late-stage prevalence was lower than that in earlier stages.

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