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Parikh HB, Gagliardi AG, Carry PM, Albright JC, Mandler TN. How Do We Best Educate Our Patients' Caregivers? Comparing the Efficacy of Print Versus Media-based Education Materials in Peripheral Nerve Catheter and Pain Pump Education. J Pediatr Orthop 2022; 42:35-39. [PMID: 34723897 DOI: 10.1097/bpo.0000000000001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Media-based educational materials (EMs) are becoming prominent. The purpose of this study was to compare print versus media-based EMs given to caregivers of pediatric and young adult patients undergoing surgery. We aimed to see whether print or media-based EMs lead to greater caregiver satisfaction, comfort, and preparedness for outpatient peripheral nerve catheter and pain pump management. We also assessed caregiver preference for EM modality. HYPOTHESIS We hypothesized that media-based EMs would demonstrate greater overall efficacy and thus generate higher caregiver preference. STUDY DESIGN Randomized control trial. METHODS After IRB approval, clinicaltrials.gov registration (17-0638), and informed consent, caregivers were randomized to either media or print-based EM groups. Caregivers reviewed their assigned EM and completed a standardized assessment of their comprehension. We assessed caregiver satisfaction, preparedness, and comfort level with the content on a 5-point Likert scale. On postoperative days 1 to 2, caregivers reported satisfaction, comfort, and preference for EM modality. An intent-to-treat analysis was used to compare the 2 groups. RESULTS From our final cohort of 135 caregivers, we found no difference [P>0.05] in satisfaction, comfort level, level of preparedness, or discharge readiness scores between groups. After the caregivers were given both EMs, they were evenly split in their preference for print (49.6%) versus video (50.4%) based methods. CONCLUSIONS We did not detect a significant difference in caregiver preference or feelings of preparedness between groups. Interestingly, a significant proportion of caregivers (25%) did not feel comfortable managing the peripheral nerve catheter and its pain pump at home. Future studies should work to improve caregiver comfort with educational content before patient discharge. CLINICAL RELEVANCE Providers and institutions should feel comfortable providing both print and media-based patient and caregiver education. Caregiver education may be best suited based on caregiver preference of one EM modality versus the other. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Harin B Parikh
- Departments of Pediatric Anesthesiology
- Pediatric Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
| | | | | | | | - Tessa N Mandler
- Pediatric Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
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Gamberale R, D'Orlando C, Brunelli S, Meneveri R, Mazzola P, Foti G, Bellani G, Zatti G, Munegato D, Volpato S, Zurlo A, Caruso G, Andreano A, Valsecchi MG, Bellelli G. Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery. BMC Geriatr 2021; 21:633. [PMID: 34736422 PMCID: PMC8567587 DOI: 10.1186/s12877-021-02584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. METHODS Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient's functional status at discharge, using the Cumulated Ambulation Score. DISCUSSION This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.
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Affiliation(s)
- R Gamberale
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - C D'Orlando
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - S Brunelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - R Meneveri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - P Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Zatti
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - D Munegato
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - S Volpato
- Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - A Zurlo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Caruso
- Department of Biomedical and Surgical Specialist Sciences, University of Ferrara, Ferrara, Italy
| | - A Andreano
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - M G Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy.
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Mansfield SA, Woodroof J, Murphy AJ, Davidoff AM, Morgan KJ. Does epidural analgesia really enhance recovery in pediatric surgery patients? Pediatr Surg Int 2021; 37:1201-1206. [PMID: 33830298 DOI: 10.1007/s00383-021-04897-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to determine the benefits of epidural anesthesia (EA) in pediatric surgical patients. METHODS This study is a single-institution retrospective review of EA for pediatric patients undergoing thoracotomy or laparotomy from 2015 to 2020. Patients with recent or chronic opioid use were excluded. Urgent or emergent cases, patients with hemodynamic instability, or those with surgical complications that significantly impacted their post-operative course were also excluded. The primary objectives were comparison of pain scores and systemic opioid use between those patients with EA and those without EA. RESULTS Epidural anesthesia was used in 151 (81.6%) laparotomies and 58 (77.3%) thoracotomies. EA use was associated with lower mean systemic opioid administration during the early post-operative period for laparotomy (POD#0-0.33 ± 0.3 oral morphine equivalents per kilogram (OME/Kg) with EA vs 0.93 ± 1.53, p < 0.001, POD#1-1.34 ± 1.79 OME/Kg with EA vs 2.61 ± 2.60, p < 0.001) and thoracotomy (POD#0-0.40 ± 0.37 OME/Kg with EA vs 0.68 ± 0.41, p = 0.008, POD#1-0.89 ± 0.86 OME/Kg with EA vs 2.02 ± 1.92, p < 0.001). There were no differences seen by POD#2. Average pain scores were significantly lower in patients with EA following laparotomy (POD#0-1.22 ± 0.99 with EA vs 1.75 ± 1.33, p = 0.008) and thoracotomy (POD#0-1.71 ± 1.13 with EA vs 2.40 ± 1.52, p = 0.04). CONCLUSIONS The use of EA in pediatric surgery patients was associated with lower pain scores despite lower systemic opioid requirements in the early post-operative period.
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Affiliation(s)
- Sara A Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Jacob Woodroof
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kyle J Morgan
- Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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Novak CB, Mak L, Chang M. Evaluation of written and video education tools after mallet finger injury. J Hand Ther 2020; 32:452-456. [PMID: 30017408 DOI: 10.1016/j.jht.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Successful nonoperative treatment of mallet finger injuries requires compliance to prolonged immobilization and understandable educational materials. PURPOSE OF THE STUDY This study evaluated the use of written and online video education tools after mallet finger injury. METHODS After ethics board approval and informed consent, adults with an acute mallet finger injury referred to hand therapy were included. Standard nonoperative treatment was instituted with orthotic immobilization and verbal instructions, in addition to an education pamphlet and an online video link. A questionnaire regarding the educational materials was administered at the follow-up appointment. RESULTS There were 61 patients (mean age, 42 ± 14 years). The middle (n = 21) and ring (n = 22) fingers were most commonly injured. All patients were fluent in English. Written instructions (n = 57) were used by more patients than the videos (n = 30). Comparing patients who viewed the video with those who did not, there were no differences (P > .05) in demographics (sex, age, education, work status, and second language). Both written and video instructions were reported as helpful; mean helpful score for the video was significantly (P = .03) higher than written instructions. Most patients preferred having written and video instructions, and both were easy to understand and convenient. DISCUSSION In our study of patients with acute mallet finger injuries, written and video instructions were utilized and both were reported as helpful. CONCLUSIONS This study provides evidence of the usefulness of online videos as an educational aid and the opportunity for future investigations to improve patient access to education materials.
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Affiliation(s)
- Christine B Novak
- Division of Plastic and Reconstructive Surgery, Hand & Upper Extremity Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Lonita Mak
- Division of Plastic and Reconstructive Surgery, Hand & Upper Extremity Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mary Chang
- Division of Plastic and Reconstructive Surgery, Hand & Upper Extremity Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Acute Chest Syndrome After Splenectomy in Children With Sickle Cell Disease. J Surg Res 2019; 242:336-341. [DOI: 10.1016/j.jss.2019.04.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 11/22/2022]
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Sun ZP, Wu SP, Liang CD, Zhao CX, Sun BY. The synovial fluid neuropeptide PACAP may act as a protective factor during disease progression of primary knee osteoarthritis and is increased following hyaluronic acid injection. Innate Immun 2019; 25:255-264. [PMID: 30935267 PMCID: PMC6830887 DOI: 10.1177/1753425919839125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/15/2022] Open
Abstract
The correlation of serum and synovial fluid (SF) pituitary adenylate cyclase-activating polypeptide (PACAP) levels with disease progression of primary knee osteoarthritis (OA) was explored. Radiographic severity of OA was determined by Kellgren-Lawrence (K-L) grades. PACAP levels were measured by ELISA before treatment, and 4 and 8 wk following hyaluronic acid (HA) injection. Levels of IL-1β and MMP-3 were also detected. The numeric pain scale (NPS), revised Oxford Knee Score (OKS), and American Knee Society Score (AKSS) were employed to evaluate to symptomatic severity. Receiver-operating-characteristic (ROC) curve analysis was carried out to compare the diagnostic value of PACAP, IL-1β, and MMP-3 for the K-L grade. PACAP concentrations in SF but not serum were significantly lower in OA patients compared with controls. SF PACAP levels were negatively associated with K-L grades and higher NPS as well as worse AKSS and OKS. Further analysis demonstrated that PACAP concentration in SF was negatively correlated with expressions of IL-1β as well as MMP-3 and may act as a marker for radiographic progression along with MMP-3. Last, we found SF PACAP levels exhibited an incremental trend after HA injection. These findings confirmed the crucial role of PACAP deficiency in the development of primary knee OA.
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Affiliation(s)
- Zheng-Ping Sun
- Department of Orthopedics, Guangdong Province Second Hospital of
Traditional Chinese Medicine, Guangzhou, China
| | - Shao-Peng Wu
- Department of Orthopedics, Guangdong Province Second Hospital of
Traditional Chinese Medicine, Guangzhou, China
| | - Can-De Liang
- Department of Orthopedics, Guangdong Province Second Hospital of
Traditional Chinese Medicine, Guangzhou, China
| | - Chuan-Xi Zhao
- Department of Orthopedics, Guangdong Province Second Hospital of
Traditional Chinese Medicine, Guangzhou, China
| | - Bing-Yin Sun
- Department of Orthopedics, Shunde Hospital of Guangzhou
University of Chinese Medicine (ShunDe District Hospital of Chinese Medicine of
Foshan City), Foshan, China*The authors contributed equally to this work
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Zufferey P, Valcov R, Thomas M, Dumusc A, Forien M, So A, Ottaviani S. Efficacy of anakinra in acute hydroxyapatite calcification-induced joint pain: A retrospective study of 23 cases. Joint Bone Spine 2019; 86:83-88. [DOI: 10.1016/j.jbspin.2018.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
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Madjarov JM, Katz MG, Kane PN, Madzharov S, Robicsek F. Early Surgical Reconstruction of Sternum with Longitudinal Rigid Polymer Plating after Acute Chest Trauma. Ann Thorac Cardiovasc Surg 2018; 24:324-327. [PMID: 29491197 PMCID: PMC6300427 DOI: 10.5761/atcs.cr.17-00156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The surgical management of the patients with traumatic sternal fractures remains controversial. The aim of this study was to evaluate the effectiveness of an early surgical reconstruction of a displaced sternal fracture utilizing longitudinal rigid polymer fixation in the settings of an acute chest trauma. Methods: To perform the sternal fixation, we utilized a longitudinal rigid plating system. The plate is made of polyether ether ketone (PEEK), an organic thermoplastic polymer. Results: We used the entire length of the plate on each side of the fracture, secured in multiple places with 6–8 screws. Once the plates have been fully secured we tighten all the screws with a screwdriver. We demonstrated that the method minimizes pain and prevents the development of pulmonary complications. Conclusion: This technique provides cosmetically acceptable results, minimizing risk of sternal nonunion, and decreases length of hospitalization.
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Affiliation(s)
- Jeko M Madjarov
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Michael G Katz
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter N Kane
- Department of Cardiovascular Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Svetozar Madzharov
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Francis Robicsek
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
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Stalker C, Elander J. Effects of a pain self-management intervention combining written and video elements on health-related quality of life among people with different levels of education. J Pain Res 2015; 8:581-90. [PMID: 26316809 PMCID: PMC4548759 DOI: 10.2147/jpr.s85741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Combining written and video material could increase the impact of health education for people with less education, but more evidence is needed about the impact of combined materials in different formats, especially in the context of chronic pain self-management. This study tested the impact of combining written information about self-managing chronic joint pain, which used language at a high reading level, with a DVD containing narrative video material presented directly by patients, using language at a lower reading level. Physical and mental health-related quality of life (36-Item Short Form Health Survey) was measured among 107 men with hemophilia before and 6 months after being randomly assigned to receive an information booklet alone or the booklet plus the DVD. Analysis of covariance was used to compare health outcomes between randomized groups at follow-up, using the baseline measures as covariates, with stratified analyses for groups with different levels of education. The DVD significantly improved mental health-related quality of life among those with only high school education. Video material could therefore supplement written information to increase its impact on groups with less education, and combined interventions of this type could help to achieve health benefits for disadvantaged groups who are most in need of intervention.
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Affiliation(s)
- Carol Stalker
- Centre for Psychological Research, Department of Life Sciences, University of Derby, Derby, UK
| | - James Elander
- Centre for Psychological Research, Department of Life Sciences, University of Derby, Derby, UK
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