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Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR.
This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score.
Of 505 included patients, 405 received a postoperther research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures.Level of Evidence Level III.Women living in underserved communities are at an increased risk for substance use disorders and other comorbid health issues, a public health concern that was exacerbated as the COVID-19 pandemic took hold. In response to the challenges the pandemic presented, services delivered by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) adapted nimbly, including WIC nutrition managers' and counselors' efforts to provide reactive referrals of clients raising concern about substance misuse and related consequences. This adaptation signaled an opportunity to consider integrating more proactive, evidence-based strategies for substance use disorders such as standardized brief assessments, advice, and referral procedures (i.e., Screening, Brief Interventions, and Referral to Treatment [SBIRT]), as part of routine WIC operations. Integration of such routine practice would improve the quality of care WIC provides to their clients and families, while addressing a major gap in public health by connecting clients at high risk for substance use disorders and substance-related problems to much needed services. Given the adaptability of WIC to reactively manage the wide array of psychosocial and mental health problems that increased during the pandemic, opportunities exist for future research to examine the feasibility, acceptability, and efficacy of proactive implementation of brief screening, advice, and treatment referral to reduce substance-related harm among women living in underserved communities.Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results There was a significant association between increasing CSA and increasing EDS severity (P less then .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.
The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people.
The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the
(National University of Asunción, Paraguay).
A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the
were also interviewed about their rate of satisfaction with Telepsychiatry.
A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach's alpha for the scale was .897, indicating a good internal conson.Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.
We surveyed a large sample of health-related sciences undergraduate students at the Medical University of Gdańsk (MUG), Poland in a pilot study to assess self-reported somatic/mental health-related issues, measure the level of burnout using Oldenburg Burnout Inventory (OLBI), the presence of depressive symptoms with Patient Health Questionnaire 9-item (PHQ-9) and assess the problematic alcohol intake (CAGE questionnaire). Additionally, stress coping mechanisms were investigated.
A total of 864 students participated in the survey. Ubiquitin inhibitor The mean total OLBI and PHQ-9 scores equalled 43.3 ± 2.7 and 11.3±5.8 points, respectively. The CAGE questionnaire was positive in 21.6% of students. Three most prevalent stress coping mechanisms included TV binge-watching, binge-eating and cigarette chain smoking (51.0%, 45.0% and 28.0% respectively).
Future studies are required to confirm the obtained results, assess, and monitor trends and set-up interventions to improve the welfare of health-related science MUG students.
Future studies are required to confirm the obtained results, assess, and monitor trends and set-up interventions to improve the welfare of health-related science MUG students.
This article identifies the most influential methods reports for group-randomized trials and related designs published through 2020. Many interventions are delivered to participants in real or virtual groups or in groups defined by a shared interventionist so that there is an expectation for positive correlation among observations taken on participants in the same group. These interventions are typically evaluated using a group- or cluster-randomized trial, an individually randomized group treatment trial, or a stepped wedge group- or cluster-randomized trial. These trials face methodological issues beyond those encountered in the more familiar individually randomized controlled trial.
PubMed was searched to identify candidate methods reports; that search was supplemented by reports known to the author. Candidate reports were reviewed by the author to include only those focused on the designs of interest. Citation counts and the relative citation ratio, a new bibliometric tool developed at the National Inest methods for design, analysis, and sample size.Survivors of COVID-19 can present with varied and persisting symptoms, regardless of hospitalisation. We describe the ongoing symptoms, quality of life and return to work status in a cohort of non-hospitalised COVID-19 survivors with persisting respiratory symptoms presenting to clinic, who consented and completed patient-reported outcome measures. We identified fatigue, reduced quality of life and dysregulated breathing alongside the breathlessness. Those with co-existent fatigue had worse mood and quality of life and were less likely to have returned to normal working arrangements compared to those without fatigue. For non-hospitalised people with persisting symptoms following COVID-19 referred to a respiratory assessment clinic, there was a need for a wider holistic assessment, including return to work strategies.
Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches.
This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps.
We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is ry in order to work toward healthy vegetable-rich diets for everyone everywhere.
Significant preoperative varus tibiotalar deformity was once believed to be a contraindication for total ankle arthroplasty (TAA). Our primary goal was to evaluate the influence of increasing preoperative varus tibiotalar deformity on the accuracy of final implant positioning using computed tomography (CT)-derived patient-specific guides for TAA.
Thirty-two patients with varus ankle arthritis underwent TAA using CT-derived patient-specific guides. Patients were subcategorized into varying degrees of deformity based on preoperative tibiotalar angles (0°-5° neutral, 6°-10° mild, 11°-15° moderate, and >15° severe). Postoperative weightbearing radiographs were used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template. Average follow-up at the time of data collection was 36.8 months.
Average preoperative varus deformity was 6.06° (range 0.66°-16.3°). Postoperatively, 96.9% (30/31) of patients demonstrated neutral implant alignment.
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