Search

Case: We report a case of progressive angular deformity of the left wrist in a 4-year-old girl with a 2-year history of juvenile idiopathic arthritis (JIA)-oligoarthritis subtype (<4 joints affected) with inflammatory extensor tenosynovitis affecting the left wrist, who underwent a left distal radius osteotomy with tricortical allograft for angular correction and functional recovery. Six years postoperatively, the patient demonstrates a near-anatomic left wrist and has recovered full range of motion and function. Conclusion: This case demonstrates how rare clinically devastating angular deformities in JIA may safely and effectively be surgically managed to promote normal, long-term, extremity function. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between enoxaparin dose adequacy, quantified with anti-Factor Xa (aFXa) levels, and 90-day symptomatic venous thromboembolism (VTE) and postoperative bleeding. Summary Background Data: Surgical patients often develop "breakthrough" VTE events—those which occur despite receiving chemical anticoagulation. We hypothesize that surgical patients with low aFXa levels will be more likely to develop 90-day VTE, and those with high aFXa will be more likely to bleed. Methods: Pooled analysis of eight clinical trials (N = 985) from a single institution over a 4 year period. Patients had peak steady state aFXa levels in response to a known initial enoxaparin dose, and were followed for 90 days. Survival analysis log-rank test examined associations between aFXa level category and 90-day symptomatic VTE and bleeding. Results: Among 985 patients, 2.3% (n = 23) had symptomatic 90-day VTE, 4.2% (n = 41) had 90-day clinically relevant bleeding, and 2.1% (n = 21) had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high aFXa (4.2% vs 1.3%, P = 0.007). In a stratified analysis, this relationship was significant for patients who received twice daily (6.2% vs 1.5%, P = 0.003), but not once daily (3.0% vs 0.7%, P = 0.10) enoxaparin. No association was seen between high aFXa and 90-day clinically relevant bleeding (4.8% vs 2.9%, P = 0.34) or major bleeding (3.6% vs 1.6%, P = 0.18). Conclusions: This manuscript establishes inadequate enoxaparin dosing as a plausible mechanism for breakthrough VTE in surgical patients, and identifies anticoagulant dose adequacy as a novel target for process improvement measures. [ABSTRACT FROM AUTHOR]

Background: Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves.Methods: Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes.Results: A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p < 0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p < 0.001).Conclusions: Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve.Level Of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to evaluate associations between changes in segmental vertebral coronal angulation (screw angulation) and overall height after anterior spinal growth tethering for the treatment of idiopathic scoliosis and to compare the rates of coronal angulation change using the preoperative Sanders stage.Methods: Patients with idiopathic scoliosis who underwent anterior spinal growth tethering between 2012 and 2016 and had ≥2 years of follow-up were retrospectively studied. We calculated each segment's screw angulation rate of change (degrees/month) and each patient's height velocity (cm/month) between each of the visits (3 to 12 visits/patient) and divided the visits into 4 groups by postoperative duration (<1 year, 1 to 2 years, >2 to 3 years, >3 years). Patients were divided into 2 groups according to the preoperative Sanders stage. Generalized estimating equations and repeated-measures correlation were utilized for analyses with non-independent samples.Results: We analyzed 23 patients (16 female, 7 male) with a mean age (and standard deviation) of 12.2 ± 1.6 years who had right thoracic idiopathic scoliosis (mean, 53° ± 8°). All patients were immature at the time of surgery (Risser stage 0 or 1, Sanders stage 2 or 3). The mean duration of follow-up was 3.4 ± 1.1 years (range, 2 to 5 years). The rate of change for each segment's screw angulation after anterior spinal growth tethering was -0.16°, -0.14°, -0.05°, and 0.03° per month (with negative values indicating a reduction in scoliosis) for <1 year, 1 to 2 years, >2 to 3 years, and >3 years, respectively (p ≤ 0.001), and the mean height velocity was 0.65, 0.57, 0.30, and 0.19 cm per month for <1 year, 1 to 2 years, >2 to 3 years, and >3 years, respectively (p < 0.001). Changes in screw angulation correlated with height increases after anterior spinal growth tethering (r = -0.46, p < 0.001). Scoliosis correction for patients in the Sanders stage-2 group continued for 3 years (0.23°, 0.23°, and 0.09° per level per month for the first 3 years, respectively) and occurred at more than twice the rate for patients in the Sanders stage-3 group, for whom scoliosis correction ceased 2 years postoperatively (0.11° and 0.09° per level per month for the first 2 years, respectively).Conclusions: Scoliosis correction was associated with overall height changes and occurred primarily within 2 to 3 years after surgery in this cohort of largely Risser stage-0 patients. The correction rate was 2.8° per segment per year for the first 2 years in the Sanders stage-2 group, compared with 1.2° per segment per year for the Sanders stage-3 group. Surgical timing that considers the patient's skeletal maturity is an important factor in generating proper postoperative correction after anterior spinal growth tethering.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate if the Functional Movement Screen (FMS) total score, individual component test scores, or number of asymmetries can predict noncontact injury risk over three consecutive seasons of National Collegiate Athletic Association Division I football. Methods: Because football teams comprise individuals with vastly different physical characteristics and playing responsibilities, we divided the subjects into three homogeneous groups based on position (big, combo, and skill). Each FMS score was assessed with regard to the total team score and by individual position groups. For our injury analysis, we also controlled for exposure. Two hundred and eight National Collegiate Athletic Association Division I athletes participated over three consecutive seasons, yielding a total of 343 observations. Results: There was no significant relationship between total FMS score and likelihood of injury when analyzed by the total team or by position group. These findings were the same for all groups, for both the total number of injuries and injuries weighted by injury exposure. The only significant findings occurred when we considered individual test item scores to injury by position group. We only found a significant relationship in the expected direction with push-up stability in the combo group. Conclusions: FMS was not a good predictor of noncontact injury. [ABSTRACT FROM AUTHOR]

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews critical care nursing considerations for patients undergoing REBOA. [ABSTRACT FROM AUTHOR]

Enhanced recovery after surgery (ERAS) is a multimodal perioperative strategy originally developed to attenuate the postsurgical stress response in patients after colorectal surgery. Patients undergoing gynecologic surgery who had ERAS had significantly shorter hospital length of stay, reduced hospital-related costs, and acceptable pain management with reduced opioid use, without compromising patient satisfaction. Intrathecal hydromorphone is an effective alternative ERAS protocol analgesia for these patients and will not compromise patient outcomes or healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Anterior vertebral body tethering (AVBT) has been introduced as a means of correcting scoliosis without fusion. The purpose of this study was to compare outcomes for patients with thoracic idiopathic scoliosis between a group of patients who underwent AVBT and a matched cohort of patients treated with posterior spinal fusion and instrumentation (PSF).Methods: A retrospective study of patients who underwent AVBT and PSF for idiopathic scoliosis was conducted. The inclusion criteria were determined on the basis of the AVBT cohort: primary thoracic idiopathic scoliosis with a curve magnitude between 40° and 67°, Risser stage of ≤1, age of 9 to 15 years, no prior spine surgery, index surgery between 2011 and 2016, and minimum follow-up of 2 years. Demographic, radiographic, clinical, and patient-reported outcomes and revisions were compared between groups.Results: There were 23 patients in the AVBT cohort and 26 patients in the PSF cohort. The mean follow-up (and standard deviation) was similar between groups: 3.4 ± 1.1 years for the AVBT group and 3.6 ± 1.6 years for the PSF group (p = 0.6). Preoperatively, the groups were similar in all measurements of radiographic and clinical deformity, with mean main thoracic curves of 53° ± 8° for the AVBT group and 54° ± 7° for the PSF group (p = 0.4). At the time of final follow-up, the AVBT cohort had significantly more residual deformity, with a mean thoracic curve of 33° ± 18° compared with 16° ± 6° for the PSF group (p < 0.001). There were 9 revision procedures in the AVBT cohort (with 3 conversions to PSF and 3 more pending) and none in the PSF cohort. Revisions occurred at a mean postoperative time of 2.3 years (range, 1.2 to 3.7 years). Twelve patients (52%) had evidence of broken tethers; of these patients, 4 underwent revision. The post-intervention patient-reported outcomes were similar.Conclusions: Both AVBT and PSF resulted in postoperative correction; however, 2-year correction was better maintained in the PSF group. There were no differences in post-intervention patient-reported outcomes. AVBT resulted in less deformity correction and more revision procedures than PSF, but resulted in the delay or prevention of PSF in the majority of patients.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews nursing considerations for patients undergoing REBOA. [ABSTRACT FROM AUTHOR]

Consensus has been reached about the important role of partner notification (PN) for HIV prevention and control programs. We used a qualitative study to explore facilitators of and barriers to PNto understand reasons for disclosure and nondisclosure by people living with HIV in China. Our main goal was to identify information related to PN that may be unique to the Chinese cultural context. Of 41 participants who were interviewed, 33 had disclosed their HIV status to sexual partners. Facilitators for PN included preserving the integrity of the partnership, social support, and potential benefits of notification; barriers included perceived discrimination/stigma, possible negative consequences, and safety concerns. Participant physical health conditions, strength of the relationship, and concordant identification were found to be conditional factors of PN. Our findings provide information for a better understanding of PN in Chinese culture and offer a reference for developing more specific strategies to facilitate PN. [ABSTRACT FROM AUTHOR]

Background: Selective fusions of the structural curve remain a common treatment strategy for adolescent idiopathic scoliosis, yet long-term outcomes are not well-understood. The purpose of this study was to report 10-year prospective radiographic and patient-rated outcomes of selective fusions of the main thoracic (MT) or thoracolumbar/lumbar (TL/L) curve, with particular attention to the behavior of the uninstrumented, compensatory curve.Methods: A prospectively collected multicenter database was used to identify patients who had been followed regularly for least 10 years after a selective MT or TL/L fusion for adolescent idiopathic scoliosis. Interval radiographs were evaluated for coronal and sagittal Cobb angles as well as overall coronal balance. Scores on the Scoliosis Research Society Questionnaire (SRS-24) were catalogued and evaluated. Radiographic outcomes and SRS-24 scores were compared between preoperative and postoperative time points using repeated-measures analysis of variance. Individual patient records were screened for recent curve progression of >5°, and these cases were methodically evaluated.Results: Fifty-one patients with selective fusions (21 MT and 30 TL/L) for adolescent idiopathic scoliosis who had been followed for at least 10 years were identified. The instrumented MT and TL/L curves were corrected by an average of 51% and 60%, respectively, at 10 years. The uninstrumented, compensatory curves had gradual spontaneous correction that approached the magnitude of the fused curve at 5 years postoperatively, with the correction maintained at 10 years. This led to excellent coronal balance. A subgroup of patients had recent progression of the primary curve adjacent to the prior fusion or within the instrumented segments, resulting in a compensatory progression of the uninstrumented curve. On the whole, SRS scores did not decrease during follow-up, and no patient had secondary operations.Conclusions: Selective fusion of a primary thoracic or lumbar curve in properly selected patients with adolescent idiopathic scoliosis will result in spontaneous correction of the uninstrumented curve and a durable result for at least 10 years.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Access to HIV care has increased in China, but regional disparities for the unmet symptom management needs of people living with HIV remain. Little attention has been paid to these disparities, especially in rural areas. We describe unmet symptom management needs in 1,214 people living with HIV from five HIV hospitals in the eastern coast, middle, and southern regions of China. Insomnia, abnormal dreams, and fatigue were the most common unmet needs of patients in urban China, whereas cognitive problems and blurry vision were the mostcommonin rural China. Self-management capacity, discrimination, and symptom severity predicted more unmet symptom management needs for patients in urban areas. Medication adherence, basic function, and symptom severity predicted more unmet needs among patients in rural areas. Our results have implications for nurses in HIV care and HIV policymakers. Separate interventions targeting the urban and rural areas must be implemented to meet patient symptom management needs. [ABSTRACT FROM AUTHOR]

Background: Anterior spinal growth tethering (ASGT) has been shown to alter spinal growth with the potential to correct scoliosis while maintaining spine flexibility. The purpose of this study was to report the 2 to 4-year outcomes of ASGT in skeletally immature patients with thoracic scoliosis.Methods: We conducted a retrospective review of patients with thoracic scoliosis who underwent ASGT with a minimum of 2 years of follow-up. Patient demographics, perioperative data, and radiographic outcomes are reported. A "successful" clinical outcome was defined as a residual curve of <35° and no posterior spinal fusion indicated or performed at latest follow-up.Results: Seventeen patients met the inclusion criteria. The etiology was idiopathic for 14 and syndromic for 3. The mean follow-up was 2.5 years (range, 2 to 4 years). Preoperatively, all patients were at Risser stage 0, with a mean age at surgery of 11 ± 2 years (range, 9 to 14 years). There was an average of 6.8 ± 0.5 vertebrae tethered per patient. The average thoracic curve magnitude was 52° ± 10° (range, 40° to 67°) preoperatively, 31° ± 10° immediately postoperatively, 24° ± 17° at 18 months postoperatively, and 27° ± 20° at latest follow-up (51% correction; range, 5% to 118%). Revision surgery was performed in 7 patients: 4 tether removals due to complete correction or overcorrection, 1 lumbar tether added, 1 tether replaced due to breakage, and 1 revised to a posterior spinal fusion. In 3 additional patients, posterior spinal fusion was indicated due to progression. Eight (47%) of the patients had a suspected broken tether. Ten (59%) of the 17 were considered clinically successful.Conclusions: Despite most patients having some remaining skeletal growth at the time of review, the results of the current study demonstrate that at mid-term follow-up, ASGT showed a powerful, but variable, ability to modulate spinal growth and did so with little perioperative and early postoperative risk. Fusion was avoided for 13 of the 17 patients. The overall success rate was 59%, with a 41% revision rate. Understanding the parameters leading to success or failure will be critical in advancing a reliable definitive nonfusion treatment for progressive scoliosis in the future.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]