scholarly journals Effect of Delirium on Physical Function in Noncardiac Thoracic Surgery Patients

2020 ◽  
Vol 29 (2) ◽  
pp. e39-e43
Author(s):  
Sikandar H. Khan ◽  
Chenjia Xu ◽  
Sophia Wang ◽  
Sujuan Gao ◽  
Sue Lasiter ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Thoracic Surgery ◽  
Physical Function ◽  
Secondary Analysis ◽  
Functional Independence ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Fisher Exact Test ◽  
Exact Test ◽  
History Of

Background The effect of delirium on physical function in patients undergoing noncardiac thoracic surgery has not been well described and may differ from that in other surgical populations. Objective To determine the effects of delirium on muscle strength and functional independence. The primary end point was change in Medical Research Council sum score (MRC-SS) by delirium status. Methods A secondary analysis of data from a clinical trial involving English-speaking adults aged 18 years or older who were undergoing major noncardiac thoracic surgery. Exclusion criteria were history of schizophrenia, Parkinson disease, dementia, alcohol abuse, or neuroleptic malignant syndrome; haloperidol allergy; being pregnant or nursing; QT prolongation; and taking levodopa or cholinesterase inhibitors. Delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Preoperatively and postoperatively, muscle strength was assessed using the modified MRC-SS and functional independence was assessed using the Katz scale of activities of daily living. Changes in MRC-SS and Katz score by delirium status were analyzed using the Fisher exact test. Results Seventy-three patients were included in the analysis. Median (interquartile range) MRC-SS and Katz score before surgery did not differ significantly between patients without and with delirium (MRC-SS: 30 [30-30] vs 30 [30-30], P > .99; Katz score: 6 [6-6] vs 6 [6-6], P = .63). The percentage of patients with a change in MRC-SS was similar in patients without and with delirium (17% vs 13%, respectively; P > .99). More patients in the delirium group had a change in Katz score (13% vs 0%, P = .04). Conclusions Postoperative delirium was not associated with change in muscle strength. Follow-up studies using other muscle measures may be needed.

scholarly journals Nearly Half of TP53 Germline Variants Predicted To Be Pathogenic in Patients With Osteosarcoma Are De Novo: A Report From the Children’s Oncology Group

2020 ◽  
pp. 1187-1195
Author(s):  
Brandon J. Diessner ◽  
Nathan Pankratz ◽  
Anthony J. Hooten ◽  
Lisa Mirabello ◽  
Aaron L. Sarver ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Rare Variants ◽  
De Novo ◽  
Phase 1 ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Whole Exome ◽  
History Of ◽  
De Novo Variant

PURPOSE To ascertain the prevalence of recurrent de novo variants among 240 pediatric patients with osteosarcoma (OS; age < 20 years) unselected for family history of cancer. METHODS The identification of de novo variants was implemented in 2 phases. In the first, we identified genes with a rare (minor allele frequency < 0.01) de novo variant in > 1 of the 95 case-parent trios examined by whole-exome sequencing (WES) who passed quality control measures. In phase 2, 145 additional patients with OS were evaluated by targeted sequencing to identify rare de novo variants in genes nominated from phase 1. Recurrent rare variants identified from phase 1 and 2 were verified as either de novo or inherited by Sanger sequencing of affected patients and their parents. Categorical and continuous data were analyzed using Fisher exact test and t tests, respectively. RESULTS Among 95 case-parent trios who underwent WES, we observed 61 de novo variants in 60 genes among 47 patients, with TP53 identified as the only gene with a pathogenic or likely pathogenic (P/LP) de novo variant in more than one case-parent trio. Among all 240 patients with OS, 13 (5.4%) harbored a P/LP TP53 germline variant, of which 6 (46.2%) were confirmed to be de novo. CONCLUSION Apart from TP53, we did not observe any other recurrent de novo P/LP variants in the case-parent trios, suggesting that new mutations in other genes are not a frequent cause of pediatric OS. That nearly half of P/LP TP53 variants in our sample were de novo suggests universal screening for germline TP53 P/LP variants among pediatric patients with OS should be considered.

scholarly journals Exploring Subclinical Phenotypic Features in Twin Pairs Discordant for Cleft Lip and Palate

2017 ◽  
Vol 54 (1) ◽  
pp. 90-93 ◽  
Author(s):  
Elizabeth J. Leslie ◽  
Jenna C. Carlson ◽  
Margaret E. Cooper ◽  
Kaare Christensen ◽  
Seth M. Weinberg ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Monozygotic Twins ◽  
Fisher Exact Test ◽  
Orofacial Cleft ◽  
Exact Test ◽  
History Of ◽  
Orbicularis Oris Muscle ◽  
The Difference ◽  
Larger Sample

Objective Monozygotic twins of an individual with an orofacial cleft have a significantly elevated risk for orofacial cleft compared with the general population, but still the concordance rate for orofacial cleft in monozygotic twins is about 40% to 50%. The goal of this study was to determine whether unaffected cotwins have an increased frequency of orbicularis oris muscle defects, a subclinical form of orofacial cleft. The presence of such defects may reduce the overall rate of discordance. Method A total of 63 discordant monozygotic and dizygotic twin pairs, 262 unaffected nontwin siblings, and 543 controls with no history of orofacial clefts were assessed for orbicularis oris defects by high-resolution ultrasound. Frequencies were compared by the Fisher exact test. Results Unaffected cotwins from discordant monozygotic pairs had a higher frequency of defects (12.5%) than the other test groups (6.38% to 6.99%), but the difference was not statistically significant ( P = .74). Conclusions In this study, orbicularis oris defects were not statistically significantly more common among the unaffected twins from orofacial cleft discordant twin pairs. The trends in the results warrant future studies with larger sample sizes and additional subclinical phenotypes.

scholarly journals Preoperative Cognitive Abnormality, Intraoperative Electroencephalogram Suppression, and Postoperative Delirium

2020 ◽  
Vol 132 (6) ◽  
pp. 1458-1468 ◽  
Author(s):  
Bradley A. Fritz ◽  
Christopher R. King ◽  
Arbi Ben Abdallah ◽  
Nan Lin ◽  
Angela M. Mickle ◽  
...  
Keyword(s):  
Effect Size ◽  
Postoperative Delirium ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Analysis ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Total Effect ◽  
Academic Medical ◽  
Cognitive Abnormality

Abstract Background Postoperative delirium is a common complication that hinders recovery after surgery. Intraoperative electroencephalogram suppression has been linked to postoperative delirium, but it is unknown if this relationship is causal or if electroencephalogram suppression is merely a marker of underlying cognitive abnormalities. The hypothesis of this study was that intraoperative electroencephalogram suppression mediates a nonzero portion of the effect between preoperative abnormal cognition and postoperative delirium. Methods This is a prespecified secondary analysis of the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized trial, which enrolled patients age 60 yr or older undergoing surgery with general anesthesia at a single academic medical center between January 2015 and May 2018. Patients were randomized to electroencephalogram-guided anesthesia or usual care. Preoperative abnormal cognition was defined as a composite of previous delirium, Short Blessed Test cognitive score greater than 4 points, or Eight Item Interview to Differentiate Aging and Dementia score greater than 1 point. Duration of intraoperative electroencephalogram suppression was defined as number of minutes with suppression ratio greater than 1%. Postoperative delirium was detected via Confusion Assessment Method or chart review on postoperative days 1 to 5. Results Among 1,113 patients, 430 patients showed evidence of preoperative abnormal cognition. These patients had an increased incidence of postoperative delirium (151 of 430 [35%] vs.123 of 683 [18%], P &lt; 0.001). Of this 17.2% total effect size (99.5% CI, 9.3 to 25.1%), an absolute 2.4% (99.5% CI, 0.6 to 4.8%) was an indirect effect mediated by electroencephalogram suppression, while an absolute 14.8% (99.5% CI, 7.2 to 22.5%) was a direct effect of preoperative abnormal cognition. Randomization to electroencephalogram-guided anesthesia did not change the mediated effect size (P = 0.078 for moderation). Conclusions A small portion of the total effect of preoperative abnormal cognition on postoperative delirium was mediated by electroencephalogram suppression. Study precision was too low to determine if the intervention changed the mediated effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Monitoring and developing volunteer patient navigation intervention to improve mammography compliance in a safety net hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 62-62
Author(s):  
Anitha Srinivasan ◽  
Judith Zwillenberg ◽  
Anisha Chadda ◽  
Hannah Gissel ◽  
Michael Lettera ◽  
...  
Keyword(s):  
Family History ◽  
Patient Navigation ◽  
Compliance Rate ◽  
Intervention Group ◽  
Safety Net ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Safety Net Hospital ◽  
History Of ◽  
History Of Cancer

62 Background: Mammography screening is crucial for cancer detection. Screening rates have been declining in patients of low socioeconomic status and minorities, supporting the need for intervention at our safety-net hospital. Methods: Patients with a primary care provider order for screening mammograms over a one month period were monitored for 90 day compliance. This analysis determined compliance rate and optimal intervention period. A prospective randomized trial was done to improve compliance using a volunteer patient navigator. All patients received educational material and were randomly assigned to the control or intervention group. The latter were further educated on breast cancer and mammograms and, if amenable, were escorted to a walk-in mammogram. The study period was 3 weeks with 49 participants-24 patients in the control and 25 patients in the intervention group. The principal outcome was the 14 day mammography compliance rate. Secondary analysis examined efficacy of the study with respect to patient demographics, prior mammography compliance, family history of cancer, beliefs on mammography and past medical history and analyzed using GraphPad Prism 7. Results: Analysis revealed a noncompliance rate of 52% with majority compliance occurring within two weeks of order placement. The patient navigation intervention significantly improved compliance by 34% (42% in the control group, 76% in the intervention group, p < 0.05 Fisher exact test). Intervention significantly improved compliance in patients with low susceptibility to cancer belief, who understood benefits of mammography and early diagnosis (p < 0.05 Fisher exact test), had a prior mammogram (p < 0.05 Fisher exact test), a family history of cancer (p < 0.01 Fisher exact test), hyperlipidemia (p < 0.05 Fisher exact test), and those employed (p < 0.05 Fisher exact test). Conclusions: A system to monitor compliance and intervene using patient navigation significantly improved mammography compliance of patients in a safety net urban hospital. The relatively straightforward design of the volunteer based intervention makes it affordable, easily replicable and perhaps beneficial at other institutions.

Abstract TP239: Cross-Training In-Hospital Operating Staff Significantly Improves Door-to-Puncture Time in Thrombectomy Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Angela M Callahan ◽  
Axel Rosengart ◽  
Karissa Graham ◽  
Kellie Capone ◽  
Kathryn Wright ◽  
...  
Keyword(s):  
Operating Room ◽  
Patient Characteristics ◽  
Reperfusion Therapy ◽  
Functional Independence ◽  
Stroke Severity ◽  
Fisher Exact Test ◽  
Large Contribution ◽  
Chi Square ◽  
Exact Test ◽  
Significant Difference

Objective: Delay in endovascular reperfusion in patients with acute large-vessel cerebral occlusion decreases the likelihood of functional independence. Given the large contribution of the pre-puncture, in-hospital time period to the overall speed of reperfusion therapy we evaluated the benefits and impediments of utilizing an immediately available OR team to reduce door-to-puncture time compared to a traditional model of an on-call team. Methods: Prospectively collected data were retrospectively analyzed to compare the readiness strategies of 2 comprehensive stroke centers of the Geisinger Health System serving stroke patients in rural and suburban Pennsylvania with different hospital level characteristics: Center A with an in-hospital available operating room team cross-trained in both operating and neuroendovascular procedures and center B with a dedicated on-call neuroendovascular team. Data compared included patient demographics and presentation characteristics, stroke severity, door-to-puncture time, and successful reperfusion ( t test, Fisher exact test, Chi square test). Results: There was no significant difference in the baseline stroke patient characteristics at center A (n=31) and center B (n= 45): 61% vs. 62% females; mean age 72 (range 47 to 93) vs. 69 (range 28 to 96) (p=0.35); admission NIHSS 17 vs 17, respectively. Successful reperfusion (TICI 2b-3) was achieved in 98% and 97% of cases in center A and B, respectively (p=0.79) but door-to-puncture time differed significantly between 50 in center A compared to 121 minutes in center B (58% reduction, p<0.02). Conclusion: Crossed-training in-hospital operating room staff in neuroendovascular procedures significantly reduces door-to-puncture time in thrombectomy patients when compared to a traditional on-call neuroendovascular call team. Based on existing data, this achievement in earlier reperfusion is expected to translate directly to improve clinical outcome.

Assessment of inattention in the context of delirium screening: one size does not fit all!

2016 ◽  
Vol 28 (8) ◽  
pp. 1293-1301 ◽  
Author(s):  
Philippe Voyer ◽  
Nathalie Champoux ◽  
Johanne Desrosiers ◽  
Philippe Landreville ◽  
Johanne Monette ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sensitivity And Specificity ◽  
Secondary Analysis ◽  
Acute Care Hospital ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Entire Group ◽  
Care Hospital ◽  
Term Care ◽  
High Prevalence

ABSTRACTBackground:Despite its high prevalence and deleterious consequences, delirium often goes undetected in older hospitalized patients and long-term care (LTC) residents. Inattention is a core symptom of this syndrome. The aim of this study was to explore the usefulness of ten simple and objective attention tests that would enable efficient delirium screening among this population.Methods:This was a secondary analysis (n = 191) of a validation study conducted in one acute care hospital (ACH) and one LTC facility among older adults with, or without, cognitive impairment. The attention test tasks (n = 10) were drawn from the Concentration subscale the Hierarchic Dementia Scale (HDS). Delirium was defined as meeting the criteria for DSM-5 delirium. The Confusion Assessment Method (CAM) was used to determine the presence of delirium symptoms.Results:The Months of the Year Backward (MOTYB) test, which 57% of participants completed successfully, showed the best balance between sensitivity and specificity (82.6%; 95% CI [61.2–95.0], and 62.5%; 95% CI [54.7–69.8] respectively) for the entire group. Subgroup analyses revealed that no test had both sensitivity and specificity over 50% in participants with cognitive impairment indicated in their medical chart.Conclusions:Our results revealed that these tests varied greatly in performance and none can be earmarked to become a single-item screening tool for delirium among older patients and residents with, or without, cognitive impairment. The presence of premorbid cognitive impairment may necessitate more extensive assessments of delirium, especially when a change in general status or mental state is observed.

scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

scholarly journals Five-year outcome of respiratory muscle weakness at intensive care unit discharge: secondary analysis of a prospective cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216720
Author(s):  
Nathalie Van Aerde ◽  
Philippe Meersseman ◽  
Yves Debaveye ◽  
Alexander Wilmer ◽  
Jan Gunst ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Muscle Strength ◽  
Physical Function ◽  
Respiratory Muscle ◽  
Secondary Analysis ◽  
Respiratory Muscle Weakness ◽  
Absolute Value ◽  
Peripheral Muscle ◽  
Sf 36 ◽  
Icu Discharge

PurposeTo assess the association between respiratory muscle weakness (RMW) at intensive care unit (ICU) discharge and 5-year mortality and morbidity, independent from confounders including peripheral muscle strength.MethodsSecondary analysis of the prospective 5-year follow-up of the EPaNIC cohort (ClinicalTrials.gov: NCT00512122), limited to 366 patients screened for respiratory and peripheral muscle strength in the ICU with maximal inspiratory pressure (MIP) after removal of the artificial airway, and the Medical Research Council sum score. RMW was defined as an absolute value of MIP <30 cmH2O. Associations between RMW at (or closest to) ICU discharge and all-cause 5-year mortality, and key measures of 5-year physical function, comprising respiratory muscle strength (MIP), hand-grip strength (HGF), 6 min walk distance (6MWD) and physical function of the SF-36 quality-of-life questionnaire (PF-SF-36), were assessed with Cox proportional hazards and linear regression models, adjusted for confounders including peripheral muscle strength.ResultsRMW was present in 136/366 (37.2%) patients at ICU discharge. RMW was not independently associated with 5-year mortality (HR with 95% CI 1.273 (0.751 to 1.943), p=0.352). Among 156five-year survivors, those with, as compared with those without RMW demonstrated worse physical function (MIP (absolute value, cmH2O): 62(42–77) vs 94(78–109), p<0.001; HGF (%pred): 67(44–87) vs 96(68–110), p<0.001; 6MWD (%pred): 87(74–102) vs 99 (80–111), p=0.009; PF-SF-36 (score): 55 (30–80) vs 80 (55–95), p<0.001). Associations between RMW and morbidity endpoints remained significant after adjustment for confounders (effect size with 95% CI: MIP: −23.858 (−32.097 to −15.027), p=0.001; HGF: −18.591 (−30.941 to −5.744), p=0.001; 6MWD (transformed): −1587.007 (−3073.763 to −179.253), p=0.034; PF-SF-36 (transformed): 1.176 (0.144–2.270), p=0.036).ConclusionsRMW at ICU discharge is independently associated with 5-year morbidity but not 5-year mortality.

scholarly journals EFFECTIVENESS OF HAND SPLINTING AND SENSORY RE-EDUCATION TO REGAIN FUNCTIONALITY AFTER WRIST DROP

2021 ◽  
pp. 437-443
Author(s):  
Dr. Megha Satyawali ◽  
Dr. S.K. Meena ◽  
Dr. Neha Jain
Keyword(s):  
Muscle Strength ◽  
Quantitative Data ◽  
Descriptive Analysis ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Clinical Indicators ◽  
Exact Test ◽  
Extremity Injuries ◽  
The Individual ◽  
Wrist Drop

Hand problems, which could be cosmetic or functional or both, are hard to hide. Hands function affectedly concern to gesture and express, touch and care, dress, and feed. Impairments can be annihilating. The incidence of upper extremity injuries is significant and accounts for about one-third of all injuries. This study is conducted in order to find the effectiveness of splinting and sensory reeducation in the patient with wrist drop. A different subject prospective, experimental, flexible pre-and-posttest intervention design followed by descriptive analysis with questionnaire has been used for the purpose of this study. Baseline screening assessment was done by using DASH, Goniometer, oxford grading for muscle strength and monofilaments. Out-trigger hand splint was provided to all the subject. Sensory re-education training was given to the patients with conventional therapy for better result, 5 days/week over a period of 12 weeks. After 12 weeks of therapy, post-test will be done by using DASH, Goniometer, oxford grading for muscle strength and monofilament to obtain results. The unpaired t test (for quantitative data to compare two independent two groups was used for quantitative data comparison of all clinical indicators. Chi-square test and fisher exact test were used for qualitative data whenever two or more than two groups were used to compare. Level of significance was set at P≤0.05.The individual overall growth has been considered in the therapy sessions as the patient’s personal life, self-confidence, locomotion and day to day activities were hampered but after therapy session the individuals each aspect has overall growth including muscle strength which helps the patient to lift weight up to 2kg and make them able to hold the objects of different size and shapes for e.g. mainly patient has developed cylindrical, conical and spherical grasp. KEY WORDS : Sensory re-education, Wrist drop, DASH, Splinting, Functionality

Vitiligo and Associated Autoimmune Disease: Retrospective Review of 300 Patients

2012 ◽  
Vol 16 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Jakub Sawicki ◽  
Sanjay Siddha ◽  
Cheryl Rosen
Keyword(s):  
Autoimmune Disease ◽  
Pernicious Anemia ◽  
Retrospective Review ◽  
Age At Onset ◽  
Patient Characteristics ◽  
Thyroid Stimulating Hormone ◽  
Vitamin B ◽  
Fisher Exact Test ◽  
Exact Test ◽  
History Of

Background: Vitiligo, the most common cutaneous depigmentation disorder, has reported associations with other autoimmune diseases. However, literature on the strengths of the associations is conflicting, and no data on the subject exist from a Canadian population. Objective: To determine autoimmune disease associations with vitiligo and which, if any, screening bloodwork is appropriate in vitiligo patients. Methods: A retrospective review of vitiligo patients admitted to the Toronto Western Hospital phototherapy unit was conducted from January 1, 2000, to August 30, 2009. Data regarding patient characteristics, vitiligo clinical features (family history, age at onset, type, extent), associated diseases in the patient and family, and admission bloodwork (hemoglobin, vitamin B12, thyroid-stimulating hormone [TSH], antinuclear antibody) were recorded and compared, using the Fisher exact test where applicable. Results: A total of 300 patient charts were reviewed (average age 41.5 ± 15.5 years; 47% male, 53% female). Hypothyroidism was present in 12.0% and pernicious anemia in 1.3% of patients—significant increases over the population prevalence. No other differences in prevalence were seen compared to the general population. TSH was increased in 3.7% of patients without a history of hypothyroidism. Hemoglobin and vitamin B12 were decreased in 0.3% of vitiligo patients without a history of pernicious anemia. Conclusion: We found a significantly higher prevalence of hypothyroidism and pernicious anemia in vitiligo patients.

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