Kansas journal of medicine最新文献

Introduction: Post-operative pain management varies across healthcare systems and cultural contexts. While opioids are central in the United States, many countries rely on non-opioid strategies due to limited access or cultural norms. Authors of this study compared pain management strategies and outcomes among orthopedic trauma patients at academic centers in the United States and Ethiopia.

Methods: A retrospective cohort study was conducted of patients undergoing orthopedic trauma surgery at Tikur Anbessa Specialized Hospital (Ethiopia) and the University of Kansas Health System (United States) between May and October 2022. Visual Analog Scale (VAS) pain scores at 24 and 48 hours post-operatively, analgesic use, and demographics were analyzed.

Results: Ethiopian patients often were more male, younger, and had lower body mass indexes and fewer comorbidities (e.g., obesity, diabetes, smoking) than United States patients. Despite receiving fewer analgesics and no post-operative nerve blocks, Ethiopian patients reported lower VAS pain scores at both 24 and 48 hours. In the United States cohort, patients with nerve blocks had lower pain scores than those without; however, both groups reported higher scores than Ethiopian patients. In the United States, pain scores correlated positively with the number of analgesics administered.

Conclusions: Ethiopian patients reported better pain control despite fewer interventions, suggesting that systemic, demographic, and cultural factors may strongly influence postoperative pain experiences. These findings underscore the importance of context-sensitive approaches to pain management and highlight the need for further research to inform equitable, effective strategies across diverse settings.

Introduction: Oscillation drilling (OD) commonly is used in orthopaedic surgery to minimize soft tissue damage and control drill advancement, thereby reducing the risk of "plunging" through cortical bone. However, its effect on screw purchase compared to forward drilling (FD) remains unstudied. The purpose of this study was to compare maximal insertional torque (MIT), a proxy for screw purchase, following OD and FD in a synthetic bone model.

Methods: Pilot holes were drilled into synthetic femoral shaft models using OD and FD with three drill bit sizes (2.0 mm, 2.6 mm, and 3.2 mm). Corresponding self-tapping stainless-steel screws (2.7 mm, 3.5 mm, and 4.5 mm) were inserted into the pilot holes. MIT was measured during screw insertion using an axial torsion testing device, with five trials per condition.

Results: For 2.7 mm screws, mean MIT was 195.8 ± 47.0 N·cm (FD) versus 232.8 ± 11.8 N·cm (OD); for 3.5 mm screws, 336.8 ± 100.6 N·cm (FD) versus 357.4 ± 150.7 N·cm (OD); and for 4.5 mm screws, 943.5 ± 551.8 N·cm (FD) versus 1089.2 ± 232.2 N·cm (OD). No statistically significant differences in MIT were found between FD and OD across screw sizes (p = 0.85), although MIT increased significantly with the 4.5 mm screws (p <0.001).

Conclusions: OD and FD produced comparable screw purchase across screw sizes, suggesting that either technique may be used without compromising fixation strength in orthopaedic applications.

Introduction: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections among children and older adults. Two RSV prefusion F protein (RSVpreF) vaccines currently are approved for adults aged 60 years and older. However, little is known about the adverse events reported among individuals in this age group who have received an RSVpreF vaccine. The purpose of this study was to compare adverse events reported by nonpregnant adults (≥60 years old) who received an RSVpreF vaccine.

Methods: This study included individuals who reported a vaccine-related adverse event to the Vaccine Adverse Event Reporting System (VAERS). Data abstracted from VAERS were recoded into standardized adverse event categories for analysis.

Results: A total of 2,321 individuals were included. The three most frequently reported adverse event categories were neurologic, musculoskeletal, and constitutional symptoms. Recipients of Arexvy™ (Respiratory Syncytial Virus Vaccine, Adjuvanted) reported more injection site reactions compared with those who received Abrysvo™ (Respiratory Syncytial Virus vaccine). There were no adverse event categories that were more commonly reported among Abrysvo™ recipients compared with Arexvy™ recipients.

Conclusions: The adverse events observed in this study were consistent with findings from previous Phase II/III trials. The higher frequency of injection site symptoms among Arexvy™ recipients may be attributable to the adjuvant included in Arexvy™ but absent in Abrysvo™. Overall, these findings indicate that both vaccines provide safe protection against RSV for older adults, with minimal side effects, in a population that previously had no vaccination option.

Introduction: The purpose of this quality improvement study was to implement a standardized prophylactic antibiotic protocol for type 3 open fractures and to evaluate changes in both subjective comfort and objective knowledge of open fracture management among trauma team personnel.

Methods: A simplified protocol for antibiotic selection in open fractures was developed and implemented at two regional Level 1 trauma centers. We used pre-intervention surveys to assess participants' ability to select the preferred antibiotic regimen for open fracture clinical scenarios and their comfort with open fracture management. The intervention consisted of instructional posters displayed in trauma bays showing the Gustilo classification for open fractures and the approved prophylactic antibiotic regimen for each fracture type. After a six-week intervention period, unmatched post-education survey responses were compared with pre-intervention responses using Fisher's Exact Test or the Fisher-Freeman-Halton Exact Test, with significance set at p <0.05.

Results: Participants included 16 orthopedic residents and 18 trauma staff members. The proportion of respondents who reported being very comfortable selecting antibiotics for type 3 open fractures increased from 6% to 68% (p <0.001). Correct identification of the preferred antibiotic regimen across three clinical scenarios involving type 3 open fractures increased by an average of 58%, with all improvements reaching statistical significance (p <0.001).

Conclusions: Implementation of a simplified antibiotic prophylaxis protocol, reinforced with instructional posters in the emergency department, significantly improved participants' knowledge and confidence in antibiotic selection for type 3 open fractures. These findings support the adoption of standardized treatment algorithms in trauma care settings.

Objective: The aim of this scoping review was to evaluate hip internal rotation (IR) range of motion (ROM) across different age groups of baseball athletes to identify those at greater risk of injury. Additional objectives included comparing hip IR ROM between dominant and non-dominant legs and between pitchers and position players.

Data sources: PubMed, Embase, OVID, and CINAHL.

Study selection: Inclusion criteria required studies to be full text, written in English, involve healthy baseball athletes cleared for participation, and include measurements of bilateral passive hip IR ROM prior to any interventions.

Data extraction: Three independent reviewers systematically extracted data on population age, competition level, passive dominant hip IR ROM, and passive non-dominant hip IR ROM. When available, means, standard deviations, and sample sizes also were extracted.

Data synthesis: The initial search yielded 155 studies, of which 23 met inclusion criteria. Aggregate data were analyzed using weighted means, pooled standard deviations, and sample sizes. Athlete groups were categorized as youth (<13 years), high school, college, and professional. College and professional groups were further stratified into pitchers and position players.

Conclusions: All groups exhibited deficits in bilateral passive hip IR ROM. Professional athletes demonstrated greater bilateral hip IR compared to college-aged athletes. The difference in mean non-dominant versus dominant hip IR between pitchers and position players was minimal, measuring less than two degrees.

Introduction: Alcohol consumption is a leading preventable cause of morbidity and mortality in the United States, contributing to over 178,000 deaths annually. Despite known links to liver disease and cancer, few adults report receiving counseling on alcohol-related risks from health care professionals. Authors of this cross-sectional, population-based study assessed the prevalence of alcohol-related counseling among United States adults and identified sociodemographic and behavioral factors associated with receiving such advice.

Methods: Data were drawn from the 2022 Health Information National Trends Survey, a nationally representative sample of United States adults. The primary outcome was whether respondents reported receiving information from a health care professional about the negative health risks of alcohol use, including specific negative health consequences. Survey-weighted univariate, bivariate, and multivariable logistic regression analyses were used to identify predictors of receiving counseling.

Results: Only 26.1% of respondents reported receiving alcohol-related counseling, and just 10.9% specifically were informed about liver disease. Multivariable analysis showed higher odds of counseling among adults aged 18-34 (OR = 2.43; 95% CI, 1.84-3.21), non-Hispanic Black respondents (OR = 1.45; 95% CI, 1.20-1.75), those with income under $20,000 (OR = 1.27; 95% CI, 1.02-1.59), and individuals consuming more than one alcoholic drink per week (OR = 1.40; 95% CI, 1.22-1.61). Lower odds were found among women (OR = 0.67; 95% CI, 0.59-0.77), and those worried about cancer (OR = 0.81; 95% CI, 0.67-0.96).

Conclusions: Findings highlight important gaps and disparities in alcohol-related counseling. Standardized interventions and improved outreach are needed to align prevention efforts with patient risk.