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Start Over Author "Craig L" Publisher elsevier b.v.
507 results on '"Craig L"'

12. Impact of Chronic Opioid Use on Postoperative Mobility Recovery and Patient-Reported Outcomes: A Propensity-Matched Study.

Author

Nelson, Charles L., Sheth, Neil P., Higuera Rueda, Carlos A., Redfern, Roberta E., Van Andel, David C., Anderson, Mike B., Cholewa, Jason M., and Israelite, Craig L.

Abstract

Opioid use prior to total joint arthroplasty may be associated with poorer postoperative outcomes. However, few studies have reported the impact on postoperative recovery of mobility. We hypothesized that chronic opioid users would demonstrate impaired objective and subjective mobility recovery compared to nonusers. A secondary data analysis of a multicenter, prospective observational cohort study in which patients used a smartphone-based care management platform with a smartwatch for self-directed rehabilitation following hip or knee arthroplasty was performed. Patients were matched 2:1 based on age, body mass index, sex, procedure, Charnley class, ambulatory status, orthopedic procedure history, and anxiety. Postoperative mobility outcomes were measured by patient-reported ability to walk unassisted at 90 days, step counts, and responses to the 5-level EuroQol-5 dimension 5-level, compared by Chi -square and student's t -tests. Unmatched cohorts were also compared to investigate the impact of matching. A total of 153 preoperative chronic opioid users were matched to 306 opioid-naïve patients. Age (61.9 ± 10.5 versus 62.1 ± 10.3, P =.90) and sex (53.6 versus 53.3% women, P =.95) were similar between groups. The proportion of people who reported walking unassisted for 90 days did not vary in the matched cohort (87.8 versus 90.7%, P =.26). Step counts were similar preoperatively and 1-month postoperatively but were lower in opioid users at 3 and 6 months postoperatively (4,823 versus 5,848, P =.03). More opioid users reported moderate to extreme problems with ambulation preoperatively on the 5-level EuroQol-5 dimension 5-level (80.6 versus 69.0%, P =.02), and at 6 months (19.2 versus 9.3%, P =.01). Subjective and objective measures of postoperative mobility were significantly reduced in patients who chronically used opioid medications preoperatively. Even after considering baseline factors that may affect ambulation, objective mobility metrics following arthroplasty were negatively impacted by preoperative chronic opioid use. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Cardio-metabolic health effects of CPAP treatment for sleep apnoea during weight loss: A randomised controlled pilot trial.

Author

Hoyos, Camilla M., Machan, Elizabeth A., Yee, Brendon J., Postnova, Svetlana, Marshall, Nathaniel S., Markovic, Tania, Twigg, Stephen M., Grunstein, Ronald R., and Phillips, Craig L.

Subjects
SLEEP apnea syndrome treatment, CARDIOVASCULAR disease prevention, CONTINUOUS positive airway pressure, WEIGHT loss, RISK assessment, METABOLIC disorders, STATISTICAL sampling, CARDIOVASCULAR diseases risk factors, TREATMENT effectiveness, RANDOMIZED controlled trials, DESCRIPTIVE statistics, LOW density lipoproteins, COMPARATIVE studies, POLYSOMNOGRAPHY, TRIGLYCERIDES
Abstract

This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA). Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by an oral glucose tolerance test. Secondary outcomes: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p =.008), sleep systolic BP (- 16.2 mmHg, p =.0003), sleep diastolic BP (−9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p =.03) and sleepiness (Epworth Sleepiness Score −3.2, p =.0003). In addition, there were reductions in glucose area under the curve (−230 units, p =.009), total (−0.86 mmol/L, p = 0.006) and LDL cholesterol (−0.58 mmol/L, p = 0.007), triglycerides (−0.75 mmol/L, p = 0.004), fat mass (−7.6 kg, p <.0001) and abdominal fat (−310 cm3, p <.0001). Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity. [ABSTRACT FROM AUTHOR]

Published
2024
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