Category: Nevin Manimala

Am J Surg. 2023 Mar 7:S0002-9610(23)00100-9. doi: 10.1016/j.amjsurg.2023.03.004. Online ahead of print.

ABSTRACT

BACKGROUND: The natural history of DCIS may not be progression to invasive breast cancer (IBC). Accelerated partial breast irradiation (APBI) has emerged as an alternative to whole breast radiotherapy (WBRT). The purpose of this study was to assess the impact of APBI on DCIS patients.

MATERIALS AND METHODS: Eligible studies from 2012 to 2022 were identified in PubMed, Cochrane Library, ClinicalTrials, and ICTRP. A meta-analysis was done comparing recurrence rates, breast-related mortality rates, and adverse events of APBI versus WBRT. A subgroup analysis of 2017 ASTRO Guidelines “Suitable” and “Unsuitable” groups was performed. Forest plots and quantitative analysis were done.

RESULTS: Six studies were eligible (3 on APBI versus WBRT, 3 on APBI suitability). All had a low risk of bias and publication bias. The cumulative incidence was the following for APBI and WBRT respectively: IBTR was 5.7% and 6.3% with odds ratio of 1.09, 95% CI [0.84, 1.42], mortality rate was 4.9% and 5.05%, and adverse events was 48.87% and 69.63%. All had no statistical significance between groups. Adverse events were found to favor the APBI arm. Recurrence rate was significantly less in the Suitable group with an odds ratio 2.69, 95% CI [1.56, 4.67], favoring it over the Unsuitable group.

CONCLUSION: APBI was comparable to WBRT in terms of recurrence rate, breast cancer-related mortality rate, and adverse events. APBI was not inferior to WBRT and showed better safety in terms of skin toxicity. Patients classified as suitable for APBI had significantly lesser recurrence rate.

PMID:36914530 | DOI:10.1016/j.amjsurg.2023.03.004

J Foot Ankle Surg. 2023 Feb 18:S1067-2516(23)00030-3. doi: 10.1053/j.jfas.2023.02.007. Online ahead of print.

ABSTRACT

There is no gold standard in the treatment of hallux valgus deformity. The purpose of our study was to compare various aspects of radiographic assessment following scarf and chevron osteotomies and try to determine which technique helps achieve a more pronounced intermetatarsal angle (IMA) and hallux valgus angle (HVA) correction and produces lower rates of complications, including adjacent-joint arthritis. This study included patients who underwent hallux valgus correction with the scarf (n = 32) or chevron (n = 181) method with a follow-up period of over 3 years. We evaluated the following parameters: HVA, IMA, duration of hospital stay, complications, development of adjacent-joint arthritis. The scarf technique helped achieve a mean HVA and IMA correction of 18.3° and 3.6°, respectively, and the chevron technique helped achieve a mean correction of 13.1° and 3.7°, respectively. The achieved deformity correction in terms of both the HVA and IMA was statistically significant in both patient groups. The loss of correction assessed with the HVA was statistically significant only in the chevron group. Neither group showed a statistically significant loss of IMA correction. The duration of hospital stay, reoperation rates, and fixation instability rates were comparable in the 2 groups. Neither of the evaluated methods caused a significant increase in total arthritis scores in the evaluated joints. Our study showed good outcomes of hallux valgus deformity correction in both evaluated groups; however, scarf osteotomy yielded somewhat better radiographic outcomes in HVA correction and no loss of HVA correction at 3.5 years of follow-up.

PMID:36914514 | DOI:10.1053/j.jfas.2023.02.007

Acad Radiol. 2023 Mar 11:S1076-6332(23)00044-2. doi: 10.1016/j.acra.2023.01.027. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Radiologists are responsible for interpreting ultrasound (US) images accurately, troubleshooting, aiding sonographers, and advancing technology and research. Despite this, most radiology residents do not feel confident performing US independently. The purpose of this study is to evaluate the impact of an abdominal US scanning rotation and digital curriculum on radiology residents’ confidence and skills in performing US.

MATERIALS AND METHODS: All residents who were rotating in pediatric US at our institution for the first time were included (PGY 3-5). Those who agreed to participate were recruited sequentially from July 2018 to 2021 into (A) control and (B) intervention. B had a 1-week US scanning rotation and US digital course. Both groups completed a pre-and post-confidence self-assessment. Pre-and post-skills were objectively assessed by an expert technologist while participants scanned a volunteer. At completion, B completed an evaluation of the tutorial. Descriptive statistics summarized the demographics and closed questions. Pre-and post-test results were compared using paired-T tests, and effect size (ES) with Cohen’s d. Open-ended questions were thematically analyzed.

RESULTS: PGY-3 and 4 residents participated, and were enrolled in A (N = 39) and B (N = 30). Scanning confidence significantly improved in both groups, with a greater ES in B (p < 0.01). Scanning skills significantly improved in B (p < 0.01) but not A. Eighty per cent of questionnaire responders used the integrative US tutorial and found it helpful. Free text responses were grouped into themes: 1) Technical issues, 2) Didn’t complete course, 3) Didn’t understand project, 4) Course was detailed and thorough.

CONCLUSIONS: Our scanning curriculum improved residents’ confidence and skills in pediatric US and may encourage consistency in training, thus promoting stewardship of high-quality US.

PMID:36914500 | DOI:10.1016/j.acra.2023.01.027

J Hand Ther. 2023 Mar 11:S0894-1130(22)00096-5. doi: 10.1016/j.jht.2022.09.009. Online ahead of print.

ABSTRACT

STUDY DESIGN: Clinical measurement INTRODUCTION: Dexterity is important for daily activities. The Corbett Targeted Coin Test (CTCT) measures dexterity with palm-to-finger translation and proprioceptive target placement, but lacks established norms.

PURPOSE OF THE STUDY: To establish norms for the CTCT with healthy adult subjects.

METHODS: The inclusion criteria consisted of participants that were community dwelling, non-institutionalized, able to make a fist with both hands, perform finger-to-palm translation of twenty coins, and be at least 18 years of age. CTCT standardized testing procedures were followed. Quality of performance (QoP) scores were determined by speed in seconds and number of coin drops (each a 5-second penalty). QoP was summarized within each age, gender and hand dominance subgroup using the mean, median, minimum, and maximum. Correlation coefficients were computed for relationships between age and QoP, and between handspan and QoP.

RESULTS: Of the 207 individuals who participated, 131 were females and 76 males with an age range of 18-86 and mean age of 37.16. Individual QoP scores ranged from 13.8 to 105.3 seconds, with median scores ranging from 28.7 to 53.3 seconds. The mean for males was 37.5 seconds for the dominant hand (range 15.7-105.3) and 42.3 seconds (range 17.9.-86.8) for the non-dominant hand. The mean for females was 34.7 seconds for the dominant hand (range 14.8-67.0) and 38.6 seconds (range 13.8.-82.7) for the non-dominant hand. Lower QoP scores indicate a faster and/or more accurate dexterity performance. Females showed better median QoP for most age groups. The best median QoP scores were seen in the 30-39 and 40-49 age ranges.

DISCUSSION: Our study agrees to some extent with other research that reported dexterity decreases with age, and increases with smaller hand spans.

CONCLUSION: Normative data for the CTCT can be a guide for clinicians evaluating and monitoring patient dexterity with palm-to-finger translation and proprioceptive target placement.

PMID:36914495 | DOI:10.1016/j.jht.2022.09.009

J Hand Ther. 2023 Mar 11:S0894-1130(22)00091-6. doi: 10.1016/j.jht.2022.09.004. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

BACKGROUND: The QuickDASH is a commonly used questionnaire for the assessment of carpal tunnel patients, although it is unclear whether the questionnaire has suitable structural validity PURPOSE: This study aimed to evaluate the structural validity of the QuickDASH patient-reported outcome measure (PROM), when used in CTS, through exploratory factor analysis (EFA) and structural equation modelling (SEM).

METHODS: Between 2013 and 2019, we recorded preoperative QuickDASH scores of 1916 patients undergoing carpal tunnel decompressions at a single unit. One hundred and eighteen patients with incomplete datasets were excluded leaving a final study group of 1798 patients with complete data. EFA was undertaken using the R statistical computing environment. We then conducted SEM in a random sample of 200 patients. Model fit was assessed using the chi-square (χ²) test, comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA) and standardized root mean square residuals (SRMR). A second “validation” SEM analysis was undertaken by repeating the analysis with a separate sample of 200 randomly-selected patients.

RESULTS: EFA revealed a 2-factor model: items 1-6 represented the first factor (“function”) and items 9-11 measured a different factor (“symptoms”). SEM demonstrated excellent fit (χ² p value 0.167, CFI 0.999, TLI 0.999, RMSEA 0.032, SRMR 0.046) and this was supported in our “validation” sample.

CONCLUSIONS: This study demonstrates that the QuickDASH PROM measures 2 distinct factors in CTS. This is comparable with the findings of a previous EFA that assessed the full-length Disabilities of the Arm, Shoulder and Hand PROM in patients with Dupuytren’s disease.

PMID:36914493 | DOI:10.1016/j.jht.2022.09.004

J Hand Ther. 2023 Mar 11:S0894-1130(22)00105-3. doi: 10.1016/j.jht.2022.10.009. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to identify the relationship between age, body mass index (BMI), weight, height, and wrist circumference and median nerve cross-sectional area (CSA). The study also aimed to examine the difference between CSA in individuals reporting a high amount (>4 hours per day) of electronic device use compared to those reporting a low amount (≤4 hours per day).

MATERIALS/METHODS: One hundred twelve healthy individuals volunteered to participate in the study. Anthropometric, demographic, and self-reported electronic device usage data were collected. A transverse image of the median nerve was captured using ultrasonography from the dominant wrist at the carpal tunnel inlet . A Spearman’s rho correlation coefficient was used to examine correlations between participant characteristics (age, BMI, weight, height, and wrist circumference) and CSA. Separate Mann-Whitney U tests were used to examine differences in CSA in those younger and older than age 40, in those with BMI <25 kg/m2 and BMI ≥25 kg/m2, and in high and low-frequency device users.

RESULTS: BMI, weight, and wrist circumference showed fair correlations with CSA. There were significant differences in CSA between individuals younger than 40 and those older than 40 and between individuals with BMI <25kg/m² and those with BMI ≥25kg/m². There were no statistically significant differences in CSA in the low- and high-use electronic device groups.

DISCUSSION: Anthropometric and demographic characteristics including age and BMI or weight should be considered when examining the CSA of the median nerve, especially when determining cut-off points for establishing a diagnosis of carpal tunnel syndrome.

PMID:36914492 | DOI:10.1016/j.jht.2022.10.009

J Hand Ther. 2023 Mar 11:S0894-1130(22)00101-6. doi: 10.1016/j.jht.2022.10.005. Online ahead of print.

ABSTRACT

BACKGROUND: Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to various diseases with different etiologies. However, there are few large-scale studies of paraffin bath therapy, and there is insufficient evidence of its efficacy.

PURPOSE: The purpose of the study was to investigate the effectiveness of paraffin bath therapy for pain relief and functional improvement in various hand diseases through a meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials.

METHODS: We searched for studies using PubMed and Embase. Eligible studies were selected based on the following criteria: (1) patients with any diseases of the hand; (2) comparison between paraffin bath therapy and no paraffin bath therapy; and (3) sufficient data on changes in the visual analog scale (VAS) score, grip strength, pulp-to-pulp pinch strength, or Austrian Canadian (AUSCAN) Osteoarthritis Hand index before and after paraffin bath therapy. Forest plots were drawn to visualize the overall effect. Jadad scale score, I² statistics, and subgroup analyses were used to assess the risk of bias.

RESULTS: A total of five studies included 153 patients who were treated and 142 who were not treated with paraffin bath therapy. The VAS were measured in all 295 patients included in the study, while the AUSCAN index was measured in the 105 patients with osteoarthritis. Paraffin bath therapy significantly reduced the VAS scores (mean difference [MD], -1.27; 95% confidence interval [CI] -1.93 to -0.60). In osteoarthritis, paraffin bath therapy significantly improved grip and pinch strength (MD -2.53; 95% CI 0.71-4.34; MD 0.77; 95% CI 0.71-0.83) and reduced the VAS and AUSCAN scores (MD -2.61; 95% CI -3.07 to -2.14; MD -5.02; 95% CI -8.95 to -1.09).

DISCUSSION: Paraffin bath therapy significantly reduced the VAS and AUSCAN scores, and improved grip and pinch strength in patients with various hand diseases.

CONCLUSIONS: Paraffin bath therapy is effective for alleviating pain and improving function in hand diseases, thereby improving quality of life. However, owing to the small number of patients included in the study and its heterogeneity, a further large-scale, well-structured study is needed.

PMID:36914488 | DOI:10.1016/j.jht.2022.10.005

J Am Acad Dermatol. 2023 Mar 11:S0190-9622(23)00174-3. doi: 10.1016/j.jaad.2023.01.036. Online ahead of print.

ABSTRACT

BACKGROUND: Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.

OBJECTIVE: To quantify differences between TCS prescribed by dermatologists at consultation and family physicians for patients treated for any skin condition.

METHODS: Using administrative health data in Ontario, we included all Ontario Drug Benefit recipients who filled at least one TCS prescription from a dermatologist at consultation and a family physician in the year prior between January 2014 and December 2019. We estimated mean differences and 95% confidence intervals in amount (in grams) and potency between the index dermatologist prescription and the highest and most recent family physician prescription amounts and potencies in the preceding year using linear mixed-effect models.

RESULTS: A total of 69,335 persons were included. The mean dermatologist amount was 34% larger than the highest amount and 54% larger than the most recent amount prescribed by family physicians. There were small but statistically significant differences in potency using established 7-category and 4-category potency classification systems.

CONCLUSIONS: Compared to family physicians, dermatologists prescribed substantially larger amounts and similarly potent TCS at consultation. Further research is needed to determine the effect of these differences on clinical outcomes.

PMID:36914480 | DOI:10.1016/j.jaad.2023.01.036

Asian J Surg. 2023 Mar 11:S1015-9584(23)00301-9. doi: 10.1016/j.asjsur.2023.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: To analyze and compare the clinical efficacy of transumbilical single-incision laparoscopic surgery TAPP(SILS-TAPP) and conventional laparoscopic TAPP(CL-TAPP) in the treatment of senile inguinal hernia.

METHODS: From January 2019 to June 2021, a total of 221 elderly patients (≥60 years old) with inguinal hernia received SILS-TAPP and CL-TAPP in General Surgery Department of Affiliated Hospital of Nantong University. The perioperative indicators, postoperative complications and follow-up of the two groups were compared to explore the feasibility and superiority of SILS-TAPP in the treatment of inguinal hernia in the elderly.

RESULTS: There was no difference in demographic characteristics between the two groups. The mean operation time (28.6 ± 4.2 min vs 28.2 ± 5.3 min) in the SILS-TAPP group was not significantly different from that in the CL-TAPP group (Ρ = 0.623), and there was no significant increase in hospital costs(Ρ = 0.748). The intraoperative blood loss (7.4 ± 3.4 ml), VAS score on the postoperative day (2.2 ± 0.7), mean time of resuming activity (8.2 ± 1.9 h) and mean postoperative hospital stay (0.8 ± 0.2 d) in the SILS-TAPP group were better than those in the CL-TAPP group (Ρ < 0. 05).There was no statistical difference in the overall incidence of intraoperative (Ρ = 0.128) and postoperative complications (Ρ = 0.125) between the two groups.

CONCLUSION: Single-incision laparoscopic surgery TAPP (SILS-TAPP) is feasible and effective in elderly patients, providing a new alternative surgical method for patients who can tolerate general anesthesia.

PMID:36914474 | DOI:10.1016/j.asjsur.2023.03.009

J Pediatr Health Care. 2023 Mar 11:S0891-5245(22)00340-6. doi: 10.1016/j.pedhc.2022.11.008. Online ahead of print.

ABSTRACT

INTRODUCTION: This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with developmental disabilities.

METHOD: We conducted a national online survey of LGBTQ parents of children with developmental disabilities using social media and professional networks. Descriptive statistics were compiled. Open-ended responses were coded using inductive and deductive approaches.

RESULTS: Thirty-seven parents completed the survey. Most participants identified as highly educated, White, lesbian or queer, cisgender women and reported positive experiences. Some reported bias and discrimination, including heterosexist forms, LGBTQ disclosure challenges, and, because of their LGBTQ identity, feeling mistreated by their children’s providers or being refused needed HC for their child.

DISCUSSION: This study advances knowledge around LGBTQ parents’ experiences of bias and discrimination while accessing children’s HC. Findings highlight the need for additional research, policy change, and workforce development to improve HC for LGBTQ families.

PMID:36914456 | DOI:10.1016/j.pedhc.2022.11.008