Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis

Background In this study, we systematically analyze the effectiveness of the uniportal full-endoscopic (UPFE) and minimally invasive (MIS) decompression for treatment of lumbar spinal stenosis patients. Methods We performed a systematic search in Medline, Embase, Europe PMC, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, China national knowledge infrastructure, and Wanfang Data databases for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. Results A total of 9 articles with 522 patients in the UPFE group and 367 patients in the MIS group were included. The results of the meta-analysis showed that the UPFE group had significantly better results in hospital stay time (mean difference [MD]: –2.05; 95% confidence interval [CI]: –2.87 to –1.23), intraoperative blood loss (MD: –36.56; 95% CI: –54.57 to –18.56), and wound-related complications (MD: –36.56; 95%CI: –54.57 to –18.56) compared with the MIS group, whereas the postoperative clinical scores (MD: –0.66; 95%CI: –1.79 to 0.47; MD: –0.75; 95%CI: –1.86 to 0.36; and MD: –4.58; 95%CI: –16.80 to 7.63), satisfaction rate (odds ratio [OR] = 1.24; 95%CI: 0.70–2.20), operation time (MD: 30.31; 95%CI: –12.55 to 73.18), complication rates for dural injury (OR = 0.60; 95%CI: 0.29–1.26), epidural hematoma (OR = 0.60; 95%CI: 0.29–1.26), and postoperative transient dysesthesia and weakness (OR = 0.73; 95%CI: 0.36–1.51) showed no significant differences between the two groups. Conclusions The UPFE decompression is associated with shorter hospital stay time and lower intraoperative blood loss and wound-related complications compared with MIS decompression for treatment of lumbar spinal stenosis patients. The postoperative clinical scores, satisfaction rate, operation time, complication rates for dural injury, epidural hematoma, and postoperative transient dysesthesia and weakness did not differ significantly between two groups.

Treatment of restenosis after lumbar decompression surgery: decompression versus decompression and fusion

OBJECTIVE The aim of this study was to compare perioperative complications and postoperative outcomes between patients with lumbar recurrent stenosis without lumbar instability and radiculopathy who underwent decompression surgery and those who underwent decompression with fusion surgery. METHODS For this retrospective study, the authors identified 2606 consecutive patients who underwent posterior surgery for lumbar spinal canal stenosis at eight affiliated hospitals between April 2017 and June 2019. Among these patients, those with a history of prior decompression surgery and central canal restenosis with cauda equina syndrome were included in the study. Those patients with instability or radiculopathy were excluded. The patients were divided between the decompression group and decompression with fusion group. The demographic characteristics, numerical rating scale score for low-back pain, incidence rates of lower-extremity pain and lower-extremity numbness, Oswestry Disability Index score, 3-level EQ-5D score, and patient satisfaction rate were compared between the two groups using the Fisher’s exact probability test for nominal variables and the Student t-test for continuous variables, with p < 0.05 as the level of statistical significance. RESULTS Forty-six patients met the inclusion criteria (35 males and 11 females; 19 patients underwent decompression and 27 decompression and fusion; mean ± SD age 72.5 ± 8.8 years; mean ± SD follow-up 18.8 ± 6.0 months). Demographic data and perioperative complication rates were similar. The percentages of patients who achieved the minimal clinically important differences for patient-reported outcomes or satisfaction rate at 1 year were similar. CONCLUSIONS Among patients with central canal stenosis who underwent revision, the short-term outcomes of the patients who underwent decompression were comparable to those of the patients who underwent decompression and fusion. Decompression surgery may be effective for patients without instability or radiculopathy.

Specificity of the work of physicians in inpatient healthcare facilities of the Gomel region in the situation of the COVID-19 pandemic

Objective. To study the specificity of the functioning of inpatient healthcare facilities in the Gomel region in the spread of the coronavirus disease COVID-19.Materials and methods. A survey among 78 physicians of the inpatient healthcare facilities was conducted, which provided an opportunity to analyze the specificity of the work in the spread of the coronavirus disease COVID-19 and related difficulties.Results. According to the respondents, in the situation of the COVID-19 pandemic, there has been a considerable growth in working hours and intensity of the work of the physicians in the inpatient healthcare facilities. In the vast majority of the cases (74.7 %), the physicians in the inpatient healthcare facilities underwent training on prevention, diagnostics, adoption of anti-epidemic measures in the detection and treatment of COVID-19 patients. Nevertheless, only 25.6 % of the respondents considered their professional competence level with regard to their work with COVID-19 patients to be high. Moreover, the physicians` satisfaction rate for the existing strategies for rendering medical care to COVID-19 patientswas 6.87 ± 2.06 outof 10.Conclusion. To a large extent, the physicians of inpatient healthcare facilities of the Gomel region during their work with patients are concerned about such circumstances as longer working hours and increased working intensity, complexity of making balanced and optimal decisions regarding the organization of the work of inpatient healthcare facilities during the pandemic, as well as issues related to contact with patients (worrying about getting infected and infecting family, organization of childcare due to the closure of schools and preschool institutions during quarantine and others).

Reconstruction of Anterior Cruciate Ligament Over 50 Years Old? Yes, or No

Background: The aim of the study is to compare the results of anterior cruciate ligament reconstruction (ACL-R) in people aged more than 50 and under 30 years of age. Methods: A total of 64 patients with ACL rupture were evaluated for eligibility. Thirty-two patients with ACL rupture, aged more than 50 years (54.38 ± 1.26) were matched in all of the background factors, with 32 patients suffering from ACL rupture under 30 years old. They were followed for clinical and functional results at six and on average 45.58 months after surgery. These evaluations included the Lachman test, KT-1000, International Knee Documentation Committee (IKDC) score, Lysholm knee score (LKS), return to exercise activity, post-operative satisfaction rate, and pain intensity based on Visual Analogue Scale (VAS) and rates of extension and flexion loss. Results: Our findings indicated that knee stability, return to exercise activity, LKS and IKDC scores, as well as pain intensity and satisfaction were significantly improved in both groups. Indeed, the satisfaction rate of patients over 50 years at six months after surgery was less than those under 30 years (P < 0.001); however, it was approximately similar to the group under 30 years of age in the final follow-up (P > 0.05). The rate of return to sports activity was also lower in patients over 50 years. Conclusions: The comparable results at the patients with < 30 years demonstrated that arthroscopic ACL-R in patients over 50 years of age with no or mild DJD has good results.

Percutaneous Transforaminal Endoscopic Diskectomy for Lumbar Disk Herniation: Young (Age <60 years) versus Older (Age ≥60 years) Patients

Background We compare the differences in the efficacy of percutaneous transforaminal endoscopic diskectomy (PTED) between the younger (age <60 years) and older (age ≥60 years) patients with lumbar disk herniation (LDH). Methods From December 2016 to December 2017, 128 patients with symptomatic LDH underwent PTED and were followed up. Forty-four 60 years old and above, including 19 males and 25 females with an average age of 68.7 (61–82) years, were classified as the elderly age group. Eighty-four patients younger than 60 years were classified as the young age group, which included 48 males and 36 females with an average age of 44.7 (16–58) years. The visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, and satisfaction rates of the two groups before and after surgery were compared. Results The operation was completed successfully in both groups. The average follow-up times of the elderly and young age groups were 18.47 ± 2.62 (12–23) and 17.90 ± 3.27 (12–23) months, respectively. One patient in the young age group had recurrence 7 months after surgery, and the symptoms were relieved after PTED was performed again. Two patients with nerve root injury after surgery in the young age group completely recovered after 2 months of conservative treatment. There were no significant surgical complications in the elderly age group. There was no significant difference in postoperative VAS, JOA, and MacNab scores between the two groups. The MacNab scores in the elderly age group were excellent for 28 patients, good for 10 patients, and fair for 6 patients; the satisfaction rate was 86.3%. In the young age group, scores were excellent for 63 patients, good for 14 patients, fair for 5 patients, and poor for 2 patients; the satisfaction rate was 91.7%. Conclusion The clinical effectiveness of PTED for treatment of LDH in both elderly and young patients is satisfactory. Age is not a predictor of poor outcomes of PTED.

Experiences and Challenges of an English as a Medium of Instruction Course in Taiwan during COVID-19

Recently, Taiwan’s higher education has been impacted by COVID-19 and the necessity of English as a Medium of Instruction (EMI). In 2018, the Taiwanese government approved a roadmap for the development of a bilingual nation by 2030. This resulted in a renewed focus on EMI. However, the fluctuating surges of COVID-19 have caused university classes to shift from face-to-face to online. To assess its effectiveness, the current paper describes the quantitative and qualitative experiences and challenges associated with a blended EMI course within a private Taiwanese university. The data was collected from the students in the spring semester of 2020 (40 students) and 2021 (23 students). Overall satisfaction rate is calculated at 4.13; indicating that the transition from face-to-face to online has not affected the students’ overall satisfaction with the course. In addition, interviews and focus groups respondents pointed out the importance of a student-centered course approach and the opportunity to practice English in order to improve their competitiveness. While the flexibility offered by the blended learning approach during COVID-19 has given students more freedom to learn at their own pace. Lastly, in times of uncertainty, a careful pedagogical design will help to make the learning process fruitful and sustainable.

Investigating the demands for mobile internet-based home nursing services for the elderly

The great value of home nursing services in the treatment of ailments in elderly patients has attracted increasing attention. This study describes a new mobile internet-based home nursing service system and investigates the reasons for its use among elderly patients. 520 cases of mobile internet-based home nursing services were investigated. The proportion of major reasons to use mobile internet-based home nursing services among the elderly was analyzed and the satisfaction rate was investigated. The constituent ratios of nursing care for pressure ulcers, peripherally inserted central catheter (PICC), subcutaneous injection, general stoma care, psychological care, and intramuscular injection were 61.35%, 28.85%, 6.15%, 1.92%, 1.35%, and 0.38%, respectively. The satisfaction rate with mobile internet-based home nursing services among elderly patients was 100%. Considering the demand for home nursing services for elderly patients, this is the first time that a new mobile internet-based home nursing service has been applied to provide home nursing services to elderly patients and meet their home nursing service needs. Treatment for pressure ulcers, PICC, subcutaneous injection, general stoma care, psychological care, and intramuscular injection were found to be the main reasons to use mobile internet-based home nursing services among the elderly. The new mobile internet-based home nursing service system provides convenient home nursing services to elderly patients and ensures that they get equal rights in home nursing. The results provide basis for healthcare policy makers to formulate new home nursing policies for elderly patients.

Spreader Graft Versus Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes

Background Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons recently pay much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault. Objectives The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes. Methods An inclusive search was performed using PubMed/Medline, Google Scholar, Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation (NOSE) scale, and active anterior rhinomanometry (AAR) were evaluated. Also, a meta-analysis was performed on included articles that provided adequate data for mentioned factors. Results After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 (range: 18- 65) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, NOSE scale, and AAR. Conclusions However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.

Readiness of health facilities in providing basic antenatal care laboratory test services and client satisfaction in Ethiopia

Background: To enable early identification of pregnancy-related health complications and other potential problems that affect the outcomes of pregnancy, pregnant women need to receive the basic laboratory test services during antenatal care. The provision of antenatal care laboratory test services is influenced by the availability and capacity of support systems.Methods: A health facility based cross-sectional study design was employed. Results: One hundred and ninety-nine facilities and 960 pregnant women were involved. Sixty-seven-point one percent of facilities had the minimum required infrastructure; the minimum required laboratory documents were present in 67.2% of facilities; the minimum laboratory equipment needed was present in 49.6% of facilities; and 76% of facilities had trained laboratory personnel who could provide basic antenatal care laboratory test services. The average stockout rate on the date of the visit was 29.6%; stockouts during the past thirty days was 32%; and the mean number of days that the available stocks last was for 93 days. The average availability of basic antenatal care laboratory test services in health facilities was 84% with infrastructure (p=0.018) and equipment (p=0.000) being the significant predictors of service availability. The satisfaction rate for overall laboratory test services provided in the health facilities was 83.2%. Conclusions: Readiness of health facilities to deliver basic antenatal care laboratory test services in terms of infrastructure, documents, equipment, reagents, and human resource was low but the client satisfaction rate was within an acceptable range. The gaps in infrastructure, documents, medical equipment, reagents, and human resource of facilities need to be addressed to ensure better laboratory test services.

Three-year observational study of immediate post-abortion insertion versus menstrual insertion of etonogestrel contraceptive implant

Objective This study aimed to estimate the difference in vaginal bleeding pattern, discontinuation rate, and satisfaction between immediate after abortion and menstrual insertions of etonogestrel contraceptive implants. Study design Between May 2013 and November 2015, 66 women were recruited in the abortion group who selected etonogestrel implants as their contraceptive immediately after induced abortion. 84 women who underwent the placement of the etonogestrel implant during their menstrual period were enrolled as the menstrual group. The two groups participated in 3-year follow-up outpatient visits at 1, 6, 12, 24, and 36 months after implantation. The vaginal bleeding pattern, discontinuation rate, satisfaction rate were recorded and compared. Results No woman had pregnancy over the study period of 3 years. The incidence of amenorrhea/infrequent bleeding did not differ between the two groups after 12, 24, and 36 months of implantation (53.0% vs. 58.4%, 47.8% vs. 51.6%, and 48.6% vs. 55.6%, respectively). In the abortion group, the incidences of frequent/prolonged bleeding were 15.1%, 32.6%, and 27.0% after 12, 24, and 36 months of implantation, respectively, while the other group showed 27.3%, 25.8%, and 20.4%, respectively. After 12 and 24 months, the continuation use rates were 69.7% and 56.1% in the abortion group and 73.8% and 64.2% in the menstrual group. The 12-month satisfaction rate between abortion group and menstrual group was 69.6% versus 72.6%. Statistical analyses show that there was no difference in vaginal bleeding pattern, discontinuation rate or satisfaction between the two groups. Conclusions Immediately post-abortion may be also a favorable time to undergo etonogestrel implantation.