The Impact of the Spine Patient Outcome Research Trial (SPORT) Results on Orthopaedic Practice

Background: COVID-19 is caused by novel Coronavirus Severe Acute Respiratory Syndrome-Corona Virus (SARS-Cov-2). It is purported to have originated from bat in Wuhan province of China in December, 2019. The epidemic spreads rapidly, reaching a pandemic proportion in January, 2020. The economic implications of the pandemic and burden on health care are enormous. We, therefore, review the impact of this disease to orthopaedic practice.Methods: A comprehensive review of the literature, using suitable keywords, such as COVID -19, viral disease, orthopaedic surgery, on the search engines of PUBMED, Google Scholar and SCOPUS in June 2020.Results: The current treatment of COVID-19 is largely supportive. Lockdown, social distancing, are among many social preventive measures that had been adopted in an attempt to halt the spread of this disease. These Social adjustments, are achieving remarkable results. Intensive monitoring is key. Profound modifications had been made in all spheres of orthopaedic practice, suspending elective surgical cases and modifying the handling of inpatients and outpatients.Conclusions: Globally, orthopaedic practice has been altered in elaborate terms, to accommodate peculiarities of this emerging viral disease, COVID-19. Whilst not neglecting the needs of our patients who depend on us for due care, strict precautions have been adopted to protect patients and health care workers or halt the spread of the disease. Key words: COVID-19, pandemic, orthopaedic surgeon

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An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

10.1101/2021.02.23.21252226 ◽

2021 ◽

Author(s):

Christopher A. Okeahialam ◽

Ali A. Rabaan ◽

Albert Bolhuis

Keyword(s):

Patient Outcome ◽

Saudi Arabia ◽

Antimicrobial Stewardship ◽

Laboratory Data ◽

Hospitalized Patients ◽

Antimicrobial Stewardship Program ◽

Repeated Testing ◽

Clostridioides Difficile ◽

Stewardship Program ◽

The Impact

AbstractBackgroundAntimicrobial stewardship has been associated with a reduction in the incidence of health care associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognized in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalized patients may offer an alternative metric for these settings, but its utlity remains largely untested.Aim/ObjectiveTo examine the impact of an antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalized patients presenting with diarrhoeaMethodsA 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programResultThere was a significant decline in the rate of toxigenic C difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship program, and a reversal of a rising trend.DiscussionThe rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is however dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

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The Impact of Focality and Centricity on Vulvar Intraepithelial Neoplasia on Disease Progression in HIV+ Patients: A 10-Year Retrospective Study

Dermatology ◽

10.1159/000500469 ◽

2019 ◽

Vol 235 (4) ◽

pp. 327-333

Author(s):

Thangesweran Ayakannu ◽

Sughashini Murugesu ◽

Anthony H. Taylor ◽

Priya Sokhal ◽

Limandhee Ratnasekera ◽

...

Keyword(s):

Patient Outcome ◽

Intraepithelial Neoplasia ◽

Disease Recurrence ◽

Treatment Modalities ◽

Vulvar Intraepithelial Neoplasia ◽

Hiv Patients ◽

Risk Patients ◽

Cd4 Lymphocyte ◽

Multifocal Disease ◽

The Impact

Background: The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. Materials and Methods: All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. Results: Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. Conclusion: Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as “high-risk” patients and treated accordingly.

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An evaluation of the impact of a large group psycho-education programme (Stress Control) on patient outcome: does empathy make a difference?

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x10000012 ◽

2010 ◽

Vol 3 (1) ◽

pp. 1-17 ◽

Cited By ~ 3

Author(s):

Anne Joice ◽

Stewart W. Mercer

Keyword(s):

Mental Health ◽

Patient Outcome ◽

Mental Health Problems ◽

Positive Impact ◽

Health Problems ◽

Individual Therapy ◽

Large Group ◽

Therapist Empathy ◽

The Impact

AbstractLarge psycho-education groups are being increasingly used in mental-health promotion and the treatment of common mental-health problems. In individual therapy there is a well-established link between therapist empathy, therapeutic relationship and patient outcome but the role of empathy within large psycho-educational groups is unknown. This service evaluation investigated the impact of a 6-week large psycho-education group on patient outcome and the role of perceived therapist empathy on outcome. Within a before–after experimental design, 66 participants completed baseline and endpoint measures; Clinical Outcome Routine Evaluation (CORE), Patient Enablement Instrument (PEI), and the modified Consultation and Relational Empathy (CARE) measure. The results showed that the intervention had a positive impact on patient outcome; the CORE score reduced significantly over the 6 weeks by 0.63 (95% CI 0.82–1.14) (t= 9.18, d.f. = 55,p= <0.001) and attendees felt highly enabled. Attendees perceived the course leader as highly empathetic. However, the relationship between perceived empathy and attendee outcome was less clear; no significant relationship was found with the main outcome measure (the change in CORE score). Factors that influenced the main outcome included age, symptom severity at baseline, having a long-term illness or disability, and whether attendees tried the techniques at home (homework). These findings suggest that large group psycho-education is an effective treatment for mild to moderate mental-health problems, at least in the short term. The role of therapist empathy remains ambiguous but may be important for some patient outcomes.

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