The association between continuity of care and surgery in lumbar disc herniation patients

Evaluating the value of progressive muscle relaxation therapy for patients with lumbar disc herniation after surgery based on a difference-in-differences model

We evaluate the value of progressive muscle relaxation (PMR) for patients with lumbar disc herniation after surgery based on a difference-in-differences model. A total of 128 patients with lumbar disc herniation who underwent surgery were randomly assigned to undergo either conventional intervention (conventional intervention group, n = 64) or conventional intervention combined with PMR (PMR group, n = 64). Perioperative anxiety level, stress level and lumbar function were compared between the two groups and compared pain between the two groups before and 1 week and 1 and 3 months after surgery. After 3 months, no one was lost to follow-up. At 1 day before surgery and 3 days after surgery, Self-rating Anxiety Scale score in the PMR group was significantly lower than that in the conventional intervention group (P < 0.05). At 30 min before surgery, heart rate and systolic blood pressure in the PMR group were significantly lower than those in the conventional intervention group (P < 0.05). After intervention, the scores of subjective symptoms, clinical signs and restrictions on activities of daily living were significantly higher in the PMR group than those in the conventional intervention group (all P < 0.05). Visual Analogue Scale score in the PMR group was significantly lower than that in the conventional intervention group (all P < 0.05). The amplitude of change in VAS score in the PMR group was greater than that in the conventional intervention group (P < 0.05). PMR can relieve perioperative anxiety and stress in patients with lumbar disc herniation, reduce postoperative pain and improve lumbar function.

Enhancing Post-Mastectomy Care: Telehealth's Impact on Breast Reconstruction Accessibility for Breast Cancer Patients

OBJECTIVE

To examine how the recent sharp rise in telemedicine has impacted trends in accessibility of breast reconstruction (BR).

PATIENTS AND METHODS

A retrospective study reviewed patients who underwent a total mastectomy at our institution from 1 August 2016 to 31 January 2022. By comparing cohorts before and during the widespread implementation of telemedicine, we assessed telehealth's impact on healthcare accessibility, measured by distance from patients' residences to our institution.

RESULTS

A total of 359 patients were included in this study. Of those, 176 received total mastectomy prior to the availability of telemedicine, and 183 in the subsequent period. There were similar baseline characteristics among patients undergoing mastectomy, including distance from place of residence to hospital (p = 0.67). The same proportion elected to receive BR between groups (p = 0.22). Those declining BR traveled similar distances as those electing the procedure, both before the era of widespread telemedicine adoption (40.3 and 35.6 miles, p = 0.56) and during the height of telemedicine use (22.3 and 61.3 miles, p = 0.26). When tracking follow-up care, significantly more patients during the pandemic pursued at least one follow-up visit with their original surgical team, indicative of the increased utilization of telehealth services.

CONCLUSIONS

While the rate of BR remained unchanged during the pandemic, our findings reveal significant shifts in healthcare utilization, highly attributed to the surge in telehealth adoption. This suggests a transformative impact on breast cancer care, emphasizing the need for continued exploration of telemedicine's role in enhancing accessibility and patient follow-up in the post-pandemic era.

AI-Powered Patient-Centered Care: A Call to Action for Innovation

SUMMARY

The influential report Crossing the Quality Chasm: A New Health System for the 21st Century established six core objectives to enhance healthcare quality. It highlighted the necessity for healthcare to encompass safety, effectiveness, a patient-centered approach, timeliness, efficiency, and equity. This essay focuses on one of these six core objectives: a patient-centered approach. Healthcare leaders actively seek solutions to improve and ensure the delivery of high-quality care. The imperative to provide quality healthcare underscores the need for artificial intelligence (AI) to become an essential component in a patient-centered approach rather than merely an optional advantage. Despite the expansion of AI, there is a lack of understanding of how AI can improve patient-centered care. This essay examines the fundamental aspects of patient-centered care, as outlined by the Picker Institute, while also exploring the prospective role of AI in advancing the core principles of patient-centered care and proposing frameworks for applying AI in healthcare.

Outdoor walking, genetic predisposition, and the risk of incident osteoporosis among older adults: A prospective large population-based cohort study

This large-scale prospective study showed that a significant association between longer duration of daily outdoor walking and reduced osteoporosis risk was found among older adults, particularly among those with a low genetic predisposition to osteoporosis, which highlighted the importance of outdoor walking as a simple, cost-effective adjunct for preventing osteoporosis.

PURPOSE

The available cross-sectional data and small-scale studies indicate that outdoor walking benefits bone metabolism. Nevertheless, there is a scarcity of comprehensive prospective research investigating the enduring correlation between outdoor walking and osteoporosis. This study aims to conduct a prospective analysis of the correlation between outdoor walking and osteoporosis while also examining potential variations influenced by genetic susceptibility to osteoporosis.

METHODS

24,700 older adults without osteoporosis at baseline were enrolled. These individuals were followed up until December 31, 2021, during which data on outdoor walking was gathered. The genetic risk score for osteoporosis was comprised of 14 single-nucleotide polymorphisms.

RESULTS

4,586 cases of osteoporosis were identified throughout a median follow-up period of 37.3 months. Those who walked outside for > 30 but ≤ 60 min per day had a hazard ratio (HR) of 0.83 (95% confidence interval (CI): 0.72-0.95) for incident osteoporosis, whereas those who walked outside for > 60 min per day had an HR of 0.60 (95% CI: 0.39-0.92). We found that osteoporosis risk exhibited a declining trend in individuals with low genetic risk. Individuals walking outside for > 60 min per day tended to have the lowest overall osteoporosis risk among those with high genetic risk.

CONCLUSIONS

A significant negative correlation exists between an extended period of daily outdoor walking and osteoporosis incidence risk. This correlation is particularly pronounced among individuals with low genetic risk. The results above underscore the significance of outdoor walking as a simple and economical adjunct to public health programs to prevent osteoporosis.

Effect and Clinical Value of Protective Motivation Intervention Rehabilitation Model on Pain Perception and Dysfunction in Patients with Lumbar Disc Herniation: Based on a Retrospective Cohort Study

Objective

To examine the potential medical benefits of protective motivation intervention rehabilitation mode on pain perception and dysfunction in patients with lumbar disc herniation (LDH).

Methods

140 LDH patients hospitalized from January 2021 to September 2021 were totally selected. The control group received regular rehabilitation, and the research group received protective motivation intervention rehabilitation. The comparisons of scores of disease knowledge, visual analogue scale (VAS), pain belief and perception scale (PBPI), Japanese Orthopedic Association Score (JOA), Roland-Morris dysfunction (RMDQ), and quality of life scale (SF-36) were made across different groups.

Results

The scores of disease knowledge in the two cohorts at 1 month, 2 months, and 3 months after intervention were greater than those before intervention, and the difference is statistically significant (P < 0.05). The scores of VAS, PBPI, JOA, and RMDQ at 1 month, 2 months, and 3 months after intervention were downregulated. At 1 month, 2 months, and 3 months after intervention, the experimental scores of VAS, PBPI, JOA, and RMDQ were markedly fewer than the control group, and the difference is statistically significant (P < 0.05). The scores of SF-36 after intervention were statistically upregulated, and the difference is statistically significant (P < 0.05). After intervention, the score of SF-36 in the research group was significantly higher than that in the control group, and the difference is statistically significant (P < 0.05).

Conclusion

The application of protective motivation intervention in rehabilitation of LDH patients can more effectively improve their cognitive level, reduce their pain perception, improve their lumbar function, and enhance their well-being.

A retrospective comparative study of local anesthesia only and local anesthesia with sedation for percutaneous endoscopic lumbar discectomy

It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO₂) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.