Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register

Background Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD. Methods This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery. Results Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score. Conclusion LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.

Decreasing Headache Pain Secondary to a Subarachnoid Hemorrhage with the use of Osteopathic Manipulative Medicine

Background: Controlling a headache (HA) secondary to a subarachnoid hemorrhage (SAH) can be challenging for most physicians. At Maine Medical Center in Portland, Maine, the neurointensivist and staff noticed a trend in decreasing HA pain caused by a SAH in patients treated with osteopathic cranial manipulative medicine and osteopathic manipulative medicine (OMM), more so than those treated solely with the traditional opioid approach. It was requested that a chart review of these patients be evaluated for an objective analysis of this observation. Hypothesis: A decrease in HA caused by SAH will be observed in the group treated with OMM in comparison to those treated with opioids alone. Methods and Materials: A retrospective, IRB approved, and exempted study reviewed 21 subjects with a SAH that were treated with OMM. This population was analyzed for a decrease in pain score following osteopathic treatment as well as for adverse events 6-month post treatment. Results: Pain scores were consistently reduced when comparing pre-and-post OMM treatment. After the first treatment, pain scores decreased by an average of 4 points, after the second treatment scores decreased by an average of 3 points and after the third treatment pain scores decreased by an average of 2.5 points. The number of adverse events recorded were found to be less than the national averages. Conclusion: The use of OMM as an adjunct with traditional treatments for a SAH can lead to a decrease in HA pain caused by a SAH. Minimal adverse events were observed.

Real-Time Music Following in Score Sheet Images via Multi-Resolution Prediction

The task of real-time alignment between a music performance and the corresponding score (sheet music), also known as score following, poses a challenging multi-modal machine learning problem. Training a system that can solve this task robustly with live audio and real sheet music (i.e., scans or score images) requires precise ground truth alignments between audio and note-coordinate positions in the score sheet images. However, these kinds of annotations are difficult and costly to obtain, which is why research in this area mainly utilizes synthetic audio and sheet images to train and evaluate score following systems. In this work, we propose a method that does not solely rely on note alignments but is additionally capable of leveraging data with annotations of lower granularity, such as bar or score system alignments. This allows us to use a large collection of real-world piano performance recordings coarsely aligned to scanned score sheet images and, as a consequence, improve over current state-of-the-art approaches.

Intra-operative peri-articular cocktail injection in inflammatory arthritis patients undergoing total knee arthroplasty

<p class="abstract"><span lang="EN-US">Pain following TKA is often severe in most patients. The purpose of this case series was to assess the efficiency of intra-operative peri-articular cocktail injection in management of pain following total knee arthroplasty. This case series involves 16 patients with inflammatory arthritis of knee undergoing total knee arthroplasty (TKA). All patients had received peri-articular cocktail of drugs before the implantation of prosthesis with cement. In our study, there was significant improvement of Knee Clinical Score and Knee Functional Score following TKA. The mean KSS score was 37.5 (range: 31-44) improved to 92.5 (range, 86-99) and the functional score improved from 25.5 (range, 18-33) to 76 (range, 72- 80) at 6 months and 93 (range: 90-96) at 12 months. Intraoperative peri-articular injection with 20 ml of 0.5% ropivacaine, 1 ml of ketorolac, 1ml of clonidine and 0.5ml noradrenaline diluted in 20 ml of saline is effective in reducing immediate post-operative pain and thereby improving the overall functional outcome.</span></p>

Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days–3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups (p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups (p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Improvement in BMI z-score following adenotonsillectomy in adolescents aged 12–18 years: a retrospective cohort study

Background Characteristics of obstructive sleep apnea (OSA) changes with age. Infants, toddlers and prepubertal children with OSA are usually underweight and may suffer from failure to thrive (FTT). Adenotonsillectomy (T&A) is the first line of treatment for OSA in childhood. In adults OSA is commonly associated with obesity and the metabolic syndrome. The change in body mass index (BMI) in adolescents with OSA following T&A was only sporadically studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. Methods Clalit Health Services is the largest health care organization in Israel with the largest patient registry (more than 50% of the population). Two hundred and forty two adolescents aged 12–18 who underwent T&A between 2006 and 2015 were identified in the Clalit registry and their characteristics including height and weight were retrieved. The BMI z-score of these adolescents at baseline (up to 3 months prior to T&A) and during the consecutive 3 years after T&A were analyzed and compared. Results Changes in BMI Z-score were observed to all directions following T&A with overall small increase, not statistically significant (P = 0.26) from a median of 0.79 prior to T&A to a median of 0.835 after it. There was a minimal trend toward BMI z-score reduction in overweight children (n = 74) from 1.508 to 1.48 following T&A (p = NS), and in obese children (n = 33) from 2.288 to 2.000 (P = 0.06, 2 tailed). Interestingly thin individuals (n = 6) increased their BMI z-score following T&A from − 2.4 to − 0.59 (p = 0.046). Conclusions Adolescents show variable changes in their BMI z-score following T&A. In this aspect their BMI z-score change is closer to the change seen in adults treated for OSA and not that of young children. The changes observed show a trend toward normalization of the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.