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Peter-Okaka UI, Shiri S, Owodunni O, Bagheri SR, Jalilian A, Uzoukwu C, Eden S, Alimohammadi E. Are there any benefits for post-operative splinting after carpal tunnel release? A systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:163. [PMID: 38383364 PMCID: PMC10880356 DOI: 10.1186/s12891-024-07230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate various outcomes regarding the effectiveness of post-operating splinting in CTR surgery. METHODS Multiple databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, were searched for terms related to carpal tunnel syndrome. A total of eight studies involving 596 patients were included in this meta-analysis. The quality of studies was evaluated, and their risk of bias was calculated using the methodological index for non-randomized studies (MINORS) and Cochrane's collaboration tool for assessing the risk of bias in randomized controlled trials. Data including the visual analogue scale (VAS), pinch strength, grip strength, two-point discrimination, symptom severity score (SSS), and functional status scale (FSS) were extracted. RESULTS Our analysis showed no significant differences between the splinted and non-splinted groups based on the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. The calculated values of the standardized mean difference (SMD) or the weighted mean difference (WMD) and a 95% confidence interval (CI) for different variables were as follows: VAS [SMD = 0.004, 95% CI (-0.214, 0.222)], pinch strength [WMD = 1.061, 95% CI (-0.559, 2.681)], grip strength [SMD = 0.178, 95% CI (-0.014, 0.369)], SSS [WMD = 0.026, 95% CI (- 0.191, 0.242)], FSS [SMD = 0.089, 95% CI (-0.092, 0.269)], and the two-point discrimination [SMD = 0.557, 95% CI (-0.140, 1.253)]. CONCLUSIONS Our findings revealed no statistically significant differences between the splinted and non-splinted groups in terms of the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. These results indicate that there is no substantial evidence supporting a significant advantage of post-operative splinting after CTR.
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Affiliation(s)
| | - Samira Shiri
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Oluwafemi Owodunni
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalilian
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sonia Eden
- Semmes Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Goeddel LA, Murphy Z, Owodunni O, Esfandiary T, Campbell D, Shay J, Tang O, Bandeen-Roche K, Gearhart S, Brown CH. Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery. Ann Surg 2023; 278:e226-e233. [PMID: 36124773 PMCID: PMC10025167 DOI: 10.1097/sla.0000000000005720] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Preoperative frailty has been consistently associated with death, severe complications, and loss of independence (LOI) after surgery. LOI is an important patient-centered outcome, but it is unclear which domains of frailty are most strongly associated with LOI. Such information would be important to target individual geriatric domains for optimization. OBJECTIVE To assess whether impairment in individual domains of the Edmonton Frail Scale (EFS) can predict LOI in older adults after noncardiac surgery. DESIGN Retrospective Cohort Study. SETTING One Academic Hospital. PARTICIPANTS Patients aged 65 or older who were living independently and evaluated with the EFS during a preoperative visit to the Center for Preoperative Optimization at the Johns Hopkins Hospital between June 2018 and January 2020. MAIN OUTCOME LOI defined as discharge to increased level of care outside of the home with new mobility deficit or functional dependence. New mobility deficit and functional dependence were extracted from chart review of the standardized occupational therapy and physical therapy assessment performed before discharge. RESULTS A total of 3497 patients were analyzed. Age (mean±SD) was 73.4±6.2 years, and 1579 (45.2%) were female. The median total EFS score was 3 (range 0-16), and 725/3497 (27%) were considered frail (EFS≥6). The frequencies of impairment in each EFS domain were functional performance (33.5% moderately impaired, 11% severely impaired), history of hospital readmission (42%), poor self-described health status (37%), and abnormal cognition (17.1% moderately impaired, 13.8% severely impaired). Overall, 235/3497 (6.7%) patients experienced LOI. Total EFS score was associated with LOI (odds ratio: 1.37, 95% CI, 1.30-1.45, P <0.001) in a model adjusted for age, sex, body mass index, American Society of Anesthesiologists rating, congestive heart failure, valvular heart disease, hypertension diagnosis, chronic lung disease, diabetes, renal failure, liver disease, weight loss, anemia, and depression. Using a nested log likelihood approach, the domains of functional performance, functional dependence, social support, health status, and urinary incontinence improved the base multivariable model. In cross-validation, total EFS improved the prediction of LOI with the final model achieving an area under the curve of 0.840. Functional performance was the single domain that most improved outcome prediction, but together with functional dependence, social support, and urinary incontinence, the model resulted in an area under the curve of 0.838. CONCLUSION AND RELEVANCE Among domains measured by the EFS before a wide range of noncardiac surgeries in older adults, functional performance, functional dependence, social support, and urinary incontinence were independently associated with and improved the prediction of LOI. Clinical initiatives to mitigate LOI may consider screening with the EFS and targeting abnormalities within these domains.
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Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zachary Murphy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oluwafemi Owodunni
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tina Esfandiary
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Demetria Campbell
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joanne Shay
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olive Tang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan Gearhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Tsai SHL, Osgood GM, Canner JK, Mehmood A, Owodunni O, Su CY, Fu TS, Haut ER. Trauma Center Outcomes After Transition From Level 2 to Level 1: A National Trauma Data Bank Analysis. J Surg Res 2021; 264:499-509. [PMID: 33857794 DOI: 10.1016/j.jss.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous US-based studies have shown that a trauma center designation of level 1 is associated with improved patient outcomes. However, most studies are cross-sectional, focus on volume-related issues and are direct comparisons between levels. This study investigates the change in patient characteristics when individual trauma centers transition from level 2 to level 1 and whether the patients have similar outcomes during the initial period of the transition. STUDY DESIGN We performed a retrospective cohort study that analyzed hospital and patient records included in the National Trauma Data Bank from 2007 to 2016. Patient characteristics were compared before and after their hospitals transitioned their trauma level. Mortality; complications including acute kidney injury, acute respiratory distress syndrome, cardiac arrest with CPR, deep surgical site infection, deep vein thrombosis, extremity compartment syndrome, surgical site infection, osteomyelitis, pulmonary embolism, and so on; ICU admission; ventilation use; unplanned returns to the OR; unplanned ICU transfers; unplanned intubations; and lengths of stay were obtained following propensity score matching, comparing posttransition years with the last pretransition year. RESULTS Sixteen trauma centers transitioned from level 2 to level 1 between 2007 and 2016. One was excluded due to missing data. After transition, patient characteristics showed differences in the distribution of race, comorbidities, insurance status, injury severity scores, injury mechanisms, and injury type. After propensity score matching, patients treated in a trauma center after transition from level 2 to 1 required significantly fewer ICU admissions and had lower complication rates. However, significantly more unplanned intubations, unplanned returns to the OR, unplanned ICU transfers, ventilation use, surgical site infections, pneumonia, and urinary tract infections and higher mortality were reported after the transition. CONCLUSIONS Trauma centers that transitioned from level 2 to level 1 had lower overall complications, with fewer patients requiring ICU admission. However, higher mortality and more surgical site infections, pneumonia, urinary tract infections, unplanned intubations, and unplanned ICU transfers were reported after the transition. These findings may have significant implications in the planning of trauma systems for administrators and healthcare leaders.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Greg Michael Osgood
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amber Mehmood
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland
| | - Oluwafemi Owodunni
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Elliott Richard Haut
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Medicine, Baltimore, Maryland
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Gearhart SL, Do EM, Owodunni O, Gabre-Kidan AA, Magnuson T. Loss of Independence in Older Patients after Operation for Colorectal Cancer. J Am Coll Surg 2020; 230:573-582. [PMID: 32220448 DOI: 10.1016/j.jamcollsurg.2019.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Disease-free survival is the cornerstone for colorectal cancer outcomes. Maintenance of independence may represent the preferred cancer outcome in older patients. Frailty and cognitive impairment are associated with adverse clinical outcomes after operation in patients ≥65 years. The aim of this study was to determine the impact of frailty and cognitive impairment on loss of independence (LOI) among colorectal cancer patients. STUDY DESIGN From 2016 to 2018, patients undergoing operation for colorectal cancer and having geriatric-specific American College of Surgeons NSQIP variables recorded were included. Frailty was assessed using the modified frailty index. Loss of independence was defined by the need for assistance with activities of daily living. Complications were assessed using the Clavien-Dindo (CD) scoring system. Multivariable analyses examining LOI, length of stay (LOS), and 30-day postoperative complication and readmission were performed. RESULTS There were 1,676 patients included. Preoperatively, 118 (7%) patients reported cognitive impairment, 388 (23%) patients used a mobility aid, and 82 (5%) patients were partially or totally dependent. Loss of independence upon discharge was seen in 344 (20.5%) patients and was independently associated with an increase in LOS (incidence rate ratio [IRR] 1.44, 95% CI 1.30 to 1.59) and major complication (odds ratio [OR] 1.86, 95% CI 1.36 to 2.53). Risk factors predictive of LOI upon discharge were increasing age, cognitive impairment, use of mobility aid, and postoperative delirium. In patients ≥80 years old, 93 (18%) had LOI at 30 days. Risk factors predictive of LOI at 30 days included a preoperative mobility aid, postoperative delirium, and the need for a new mobility aid. CONCLUSIONS One of 5 older patients undergoing operation for colorectal cancer experience LOI, and risk factors include a decline in cognition and mobility. Future studies should evaluate risks for long-term LOI and explore interventions to optimize this patient population.
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Affiliation(s)
- Susan L Gearhart
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD.
| | - Eric M Do
- Department of Geriatric Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Oluwafemi Owodunni
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | - Thomas Magnuson
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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Abusamaan M, Quillin J, Owodunni O, Kang IG, Yu B, Ma B, Bailey L, Razzak AR, Smith TJ, Bodurtha J. Missed opportunities: Oncologists and palliative care specialists may be the last chance to explore hereditary cancer among cancer in-patients before information and DNA is lost. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - A. Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore, MD
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Razzak AR, Bailey L, Yu B, Abusamaan M, Kang IG, Ma B, Emidio B, Owodunni O, Smith TJ, Bodurtha J. Hereditary cancer prevalence and communication about family history risks in palliative care. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
56 Background: Hereditary cancer (CA) assessment & communication about family history (FH) risks in palliative care are underexplored & could be critical for surviving relatives. FH may not be adequately reviewed & appropriate information conveyed in the palliative care (PC) setting, even though family health is a legacy concern of patients. Cancer patients seeking PC never wish for their relatives to have CA & may be an important resource for communication about their relative’s CA risk & appropriate referrals. Methods: This prospective observational study among cancer patients receiving PC consultations was conducted at a 977-bed academic urban hospital between June 2016 & March 2017. Data were collected through structured interviews and chart review during hospitalizations. Results: 75 adult cancer patients were enrolled. Patients’ average age at diagnosis was 55.3 ± 15.7 years. 41(55%) self-identified as male; 34(45%) as female; 20(27%) as black, 49 (65%) white, and 6(8%) other. 24 patients (32%) were considered to have pedigrees that merited referral as high-risk. 32 patients (43%) thought that their CA had a likely genetic or inherited component. 48(64%) thought the palliative care setting was an appropriate place to discuss the implications. The mean comfort level in addressing these questions was 8.7 on a 10 point scale with 10 indicating extremely comfortable. Conclusions: Review of FH may be an intervention that PC providers & families can discuss & incorporate in legacy activities. This could enhance CA prevention, especially among high-risk families. There is room for enhancement in how FH & patient and family concern are integrated in the palliative & cancer care continuum.
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Affiliation(s)
- A. Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Bunmi Emidio
- Johns Hopkins University School of Medicine, Baltimore, MD
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Sateri S, Azefor TB, Ouanes JPP, Ken Lee K, Owodunni O, Bettick D, Magnuson T, Duncan M, Wick E, Gearhart S. Real time compliance monitoring with NSQIP: Successful method for enhanced recovery pathway implementation. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.pcorm.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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