Spartan medical research journal最新文献

Introduction: This study was performed to identify patient factors associated with hospital-acquired bloodstream infections (HABSI) to guide blood culture collection and empiric antibiotic therapy.

Methods: A retrospective case-control study reviewed the medical records of 350 patients admitted to our health system from September 2017 to April 2020. The patients were 18 years and older and had at least one set of new positive non-contaminant blood cultures collected after 48 hours of admission, defined as HABSI. We developed clinical variables through a literature review associated with it. Univariate relationships between each variable and bacteremia were evaluated by chi-square test. A predictive model was developed through stepwise multivariate logistic regression.

Results: The univariate analysis and stepwise regression analysis showed that temperature >100.4° F (OR: 1.9, CI 1.1 to 3.4), male sex (OR: 1.8, CI 1.0 to 3.0), and platelet count <150,000/µL (OR: 1.8, CI 1.0 to 3.2) were statistically associated with a positive blood culture.

Conclusions: This model helps identify patients with clinical characteristics associated with the likelihood of HABSI. This model can help guide the appropriate initiation of empiric antibiotics in clinical situations and assist with antibiotic stewardship.

Introduction: COPD is a progressive lung disease with marked airflow limitation. It has a large global prevalence and is managed with antibiotics, bronchodilators, and corticosteroids. Despite the prevalence, corticosteroid prescribing regimens differ widely amongst providers. This study aims to evaluate baseline corticosteroid prescribing patterns, the ability to change corticosteroid prescribing patterns with the utilization of an educational initiative, and to evaluate the effect of corticosteroid dose on length of stay, 30-day hospital readmission, mortality, and total hospital insulin dosing.

Methods: This study was conducted via a retrospective observational study. Providers at a single institution answered a baseline questionnaire on COPD corticosteroid prescribing patterns and subsequently received an educational presentation regarding evidence-based corticosteroid recommendations. Data were then retrospectively obtained and analyzed evaluating corticosteroid prescribing patterns both pre- and post-educational intervention. Data were analyzed using IBM SPSS Version 25.

Results: The provider survey revealed that most (95.3%) administered 125 mg of methylprednisolone to patients treated for AECOPD. The most common reason a particular dose of corticosteroid was administered was due to previous teaching or practice patterns. The mean initial steroid dose of methylprednisolone decreased following the educational initiative from 114.24 mg to 72.8 mg (p < 0.01). This corresponded to a 69% (n=41) decrease of providers using 125 mg methylprednisolone (p < 0.01), and increased prescribing of 62.5 mg methylprednisolone by 42.6% (n=66). The mean LOS following hospital admission for AECOPD in the pre-intervention group was 5.80 days, while the mean LOS following the targeted educational intervention decreased to 4.82 days (p = 0.01).

Conclusions: The implementation of an educational intervention may change provider corticosteroid prescribing patterns. Additionally, lower corticosteroid dose in the Emergency Department may decrease patient length of stay. Keywords: Corticosteroid, COPD, LOS, recommendations, steroid.

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disorder (IBD) with periods of relapse and remission. Current advancements in clinical research have led to the development of more refined and effective medical therapy for UC.

Summary of the evidence: Traditional therapeutic agents such as 5-aminosalicylates (5-ASAs), sulfasalazine (SASP), corticosteroids, and immunomodulatory drugs have remained the gold standard for decades. However, their novel formulations and dosage regimens have changed their sequences in the medical management of UC. Several other novel drugs are in the final phases of clinical development or have recently received regulatory approval designed to target specific mechanisms involved in the inflammatory cascade for UC.

Conclusions: This narrative review sought to provide a comprehensive knowledge of the potential benefits of standard and emerging therapies, including novel formulations, new chemical entities, and novel therapeutic approaches in managing UC. Keywords: Ulcerative colitis, 5- Aminosalicylic acid, sulfasalazine, corticosteroids, biologics, immunomodulators, novel formulations.

Background: There is a desire in orthopaedics to have soft tissue, particularly tendon, grow into metallic implants. With the introduction of three-dimensional (3D) printed porous metal implants, we hypothesized that tendons could directly attach to the implants. However, the effects of the porous metal structure on tissue growth and penetration into the pores are unknown. Using a rat model, we investigated the effect of pore size on tendon repair fixation using 3D printed titanium implants.

Methods: There were three experimental groups of eight Sprague Dawley rats (n = 24) plus control (n = 3). Implants had defined pore sizes of 400µm (n = 8), 700µm (n = 8), and 1000µm (n = 8). A defect was created in the Achilles tendon and the implant positioned between cut ends and secured with suture. Specimens were harvested at twelve weeks. Half the specimens underwent mechanical testing to assess tensile load to failure. The remaining specimens were fixed and processed for hard tissue histological analysis.

Results: The average load to failure was 72.6N for controls (SD 10.04), 29.95N for 400µm (SD 17.95), 55.08N for 700µm (SD 13.47), and 63.08N for 1000µm (SD 1.87). The load to failure was generally better in the larger pore sizes. The 700µm and 1000µm specimens performed similarly, while the 400µm showed significant differences vs control (p = 0.039), vs 1000µm (p = 0.010), and approached significance vs 700µm (p = 0.066). There was increasing ingrowth as pore size increased. Histology showed fibrous tendon tissue within and around the implants, with collagen fibers organized in bundles.

Conclusions: Tendon repair utilizing implants with 700µm and 1000µm pores exhibited similar load to failure as controls. Using a defined pore structure at the attachment points of tendons to implants may allow predictable tendon ingrowth onto/into an implant at the time of revision arthroplasty.

Introduction: Balloon sinuplasty (BSP) is a common treatment modality used in the management of chronic rhinosinusitis (CRS). Although it has gained popularity, minimal self-reported data on its utilization and complications have been reported. The goal of this study was to describe current practices and complications experienced during frontal sinus BSP.

Methods: An anonymous 20-question online survey was distributed to members of the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery from August 1, 2022, to August 30, 2022. The questions were listed as multiple choice or percentage sliding bars, and data were collected using a commercial online survey service site. Results were reported as frequencies, means, and percentages.

Results: Forty-two respondents participated in the survey, with the majority practicing in the following hospital settings: community (34, 80.95%), hybrid (5, 11.90%), and academic (3, 7.14%). The southeast had the largest proportion of respondents (13, 30.95%), versus the midwest (12, 28.57%), southwest (10, 23.81%), northeast (5, 11.90%), and northwest (2, 4.76%). On average, 50.52% of cases were performed in the hospital setting, 48.50% in-office, and 42.40% in surgery centers. Respondents who primarily used BSP, reported a yearly average of 35.72 cases, a median of 12 cases, and a range of 0-361 cases. Respondents who used BSP with functional endoscopic sinus surgery (FESS), reported a yearly average of 48.62 cases, a median of 31 cases, and a range of 0-189 cases. Nasal packing was utilized both intraoperatively (11.72%) and postoperatively (3.62%). Early complications included postoperative headaches (9.86%), acute bacterial sinusitis (ABRS) (3.52%), and tooth/facial numbness (0.86%). Reported long-term complications included postoperative synechiae (5.10%), orbital complications (0.14%), and skull base complications (0.10%). A previously unreported complication was identified through this study, accidental sphenopalatine fossa dilation.

Conclusions: This study contributes to the growing body of literature on frontal sinus BSP by characterizing utilization and complications from a large otolaryngologic academy.

Background: Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized postoperative complication is flexion contracture of the knee. While early physical therapy and range of motion (ROM) exercises have helped improve ROM postoperatively, flexion contractures still remain a significant postoperative complication of TKA.This study evaluated postoperative sleeping position and its effect on terminal knee extension and ROM following primary TKA. We hypothesized that patients who slept in the supine position would achieve earlier knee extension and ROM when compared to those in the lateral recumbent position.

Methods: A total of 150 consecutive primary total knee arthroplasties (TKAs) were conducted by a single surgeon (JMC). Prospective data collection included assessments of preoperative range of motion (ROM), postoperative ROM, patient-reported outcome measures, and sleeping positions. Functional outcomes and patient-reported measures were compared between pre- and postoperative phases, as well as across different sleeping position groups.

Results: Postoperative follow up was a mean of 29.6 days. Mean postoperative terminal extension ROM at one month was 2.98 degrees in the supine group versus 6.03 degrees in the lateral group (P < 0.001). Overall, there was significant improvement in patient reported outcome measures (WOMAC, Oxford, and pain) after surgery, but no difference existed between sleeping groups. For knee extension, a two-way ANOVA revealed that there was a statistically significant interaction between the effects of surgery and sleep position (p = 0.0053).

Conclusions: Our results demonstrate that sleeping position does affect initial postoperative knee terminal extension; however, there is no effect on patient reported outcomes. We found a statistically significant difference in extension when comparing patients in the supine versus lateral group. Patients who slept in the lateral position lacked 6.03 degrees of extension which is greater than the 5 degrees threshold needed for normal gait mechanics. Conversely, those in the supine group only lacked 2.98 degrees of extension, allowing for normal gait mechanics. This study identifies an easy, effective means of increasing patient knee range of motion following TKA.

Introduction: An emergency department (ED) resident believed ED patients, who needed a simple laceration repair, would be better served if the ED used a laceration cart for supplies, as opposed to the hunt-and-gather method for collecting needed supplies. To address this issue, a two-step Plan-Do-Study-Act/Patient-Safety quality improvement (PDSA/PS QI) project was initiated, with the intent that the project could be completed in a timely manner regardless of staffing levels. The primary purpose of the project was two-fold: 1) to explore the possible time-to-repair benefits of using a laceration repair supply cart in the emergency department and 2) to determine the feasibility of conducting a simple multi-cycle PDSA/PS QI project in a potential staffing-shortage environment.

Methods: A prospective study using a simple 2-cycle PDSA/PS QI procedure was initiated. During cycle 1, baseline data, to determine the time to complete simple-laceration repairs using a hunt-and-gather supply process, was collected in the form of sign-out/return sheets located next to a laceration repair kit. Cycle 2 introduced the use of a simple-laceration supply cart in the ED, with data collected in the form of a sign-out/return sheet located on the supply cart. Data analysis included a two-sample Wilcoxon rank-sum (Mann-Whitney) test to assess the effectiveness of the suture cart implementation.

Results: Pre-intervention. Twelve valid cases were recorded on the sign-out/return sheets. The baseline time range to complete a simple laceration repair varied from 26 minutes to 151 minutes, with an average of 68.3 minutes (SD=40.8).Post-intervention. Twenty-nine valid cases were recorded on the revised sign-out/return sheet. The time to complete a simple laceration repair, using the supply cart, varied from 10 minutes to 116 minutes, with a mean of 36.9 minutes (SD=25.0), a statistically significant average decrease (p = 0.005) of 31.4 minutes.

Conclusion: The use of a suture repair cart in the ED reduced the time required for physicians to perform a simple laceration repair. A minimal 2-cycle PDSA/PS QI process allowed residents and staff to participate in a quality-improvement project, even in a potential staffing-shortage environment.