Cohort Comparison Study Research Articles

Effect of time on biomechanics during exercise on the functional re-adaptive exercise device

ABSTRACTMechanistic studies of the Functional Re-adaptive Exercise Device (FRED) have shown it automatically recruits Lumbar Multifidus (LM) and Transversus Abdominis (TrA) – two deep-spinal muscles that are atrophied and show altered motor control in low back pain (LBP). No studies have investigated the time required to familiarise to FRED exercise, which is required to inform future FRED based clinical trial protocols. This study therefore determined the effect of time, during FRED exercise, on biomechanical outcome measures, to establish the familiarisation period, and assess for loss of technique throughout a ten minute trial. A cohort comparison study of 148 participants, 70 experiencing low back pain, had lumbopelvic kinematics, exercise frequency and movement variability measured during a 10 minute trial. Magnitude-based inference was used to assess for familiarisation, using plots of variation over time with familiarised reference ranges. The no pain group took 170 seconds, and the back pain group took 150 seconds, to familiarise. A familiarisation period of at least 170 seconds (2.8 minutes) is recommended. This justifies, and provides a familiarisation time for use of the FRED as a motor control intervention.

Hear-Communicate-Remember: Feasibility of delivering an integrated intervention for family caregivers of people with dementia and hearing impairment via telehealth.

To evaluate the feasibility of Hear-Communicate-Remember, a training programme developed for family caregivers of people with dementia and hearing impairment that integrated hearing, communication and memory strategies, which was intended to be delivered via telehealth. Participants included six dyads consisting of adults with dementia and hearing impairment and their family caregivers. Data collection involved a combination of semi-structured interviews, self-report questionnaires and field notes. Analysis of the qualitative interviews revealed four themes: appropriateness of intervention resources, considerations for the delivery of intervention via telehealth, knowledge and application of intervention strategies, and impact of the intervention on day-to-day life. Results from the satisfaction survey indicated that caregiver participants were mostly satisfied with all aspects of the intervention except the use of some technological components. The field notes described challenges with implementation via telehealth. Future research involving a cohort comparison study with a larger cohort of dyads is needed to establish treatment efficacy.

Safety of Outpatient Single-level Cervical Total Disc Replacement: A Propensity-Matched Multi-institutional Study.

A retrospective cohort comparison study. The aim of this study was to investigate the perioperative adverse event profile of cervical total disc replacement (CTDR) performed as an outpatient relative to inpatient procedure. Recent reimbursement changes and a push for safe reductions in hospital stay have resulted in increased interest in performing CTDRs in the outpatient setting. However, there has been a paucity of studies investigating the safety of outpatient CTDR procedures, despite increasing frequency. Patients who underwent single-level CTDR were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Outpatient versus inpatient procedure status was defined by length of stay, with outpatient being less than 1 day. Patient baseline characteristics and comorbidities were compared between the two groups. Propensity score matched comparisons were then performed for 30-day perioperative complications and readmissions between the two cohorts. In addition, perioperative outcomes of outpatient single-level CTDR versus matched outpatient single-level anterior cervical discectomy and fusion (ACDF) cases were compared. In total, 373 outpatient and 1612 inpatient single-level CTDR procedures were identified. After propensity score matching was performed to control for potential confounders, statistical analysis revealed no significant difference in perioperative complications between outpatient versus matched inpatient CTDR. Notably, the rate of readmissions was not different between the two groups. In addition, there was no difference in rates of perioperative adverse events between outpatient single-level CTDR versus matched outpatient single-level ACDF. The perioperative outcomes evaluated in the current study support the conclusion that, for appropriately selected patients, single-level CTDR can be safely performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient CTDR or outpatient single-level ACDF. 3.

Sense of Effort and Articulatory Contact Pressure Associated with Talking by Individuals Using Tracheoesophageal Speech

Background/Aims: The aims of this study were (1) to determine locations of increased effort in the body when talking using tracheoesophageal speech (TES); (2) to compare talking effort for participants using TES and those using laryngeal speech; (3) to compare tongue-palate contact pressure during talking for TES and laryngeal speech; and (4) to assess the relationship between talking effort and articulatory contact pressure (ACP). Methods: This cohort comparison study included 16 individuals using TES and 10 using laryngeal speech. Participants rated talking effort on a visual analog scale and then rated effort in the lungs, throat, oral cavity, brain (cognitive) and arm/shoulder. ACP for /t/, /d/, and /n/ produced in sentences was measured using a pressure sensor on the alveolar ridge. Results: Factor analysis of effort ratings across body locations by participants using TES revealed two latent variables associated with non-voice production locations and voice production. Ratings of effort and ACP were statistically significantly higher in participants using TES. The correlation between overall talking effort and ACP was strong and statistically significantly. Conclusions: The effort ratings suggest adults with functional TES experience talking as more effortful than adults with a larynx. Some increased effort was focused in the voice production process, but regions outside of voicing were also implicated.

Clinical and Angiographic Predictors of Patient-Reported Angina 1 Year After Coronary Artery Bypass Graft Surgery.

Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG. Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQ angina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQ angina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%. Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQ angina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABG angina symptoms requires further study. URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.

Early start of clean intermittent catheterization versus expectant management in children with spina bifida

PurposeWe instituted early clean intermittent catheterization (CIC) in 1997 for all newborn infants with spina bifida (SB). We compared this group to a historical group managed expectantly to see if early catheterization was associated with a reduction in renal scar rate as determined by DMSA scanning. MethodsData were studied retrospectively on all infants with SB over a recent 13-year period who were treated with early universal CIC in a regional pediatric urology department. These were compared to our previously published outcomes in a historical group (1985–1994) that was managed expectantly [Brown et al. Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 1999;9 Suppl 1:29–30.] Results114 infants were born with SB from 1997 to 2010, of which 13 were excluded from this analysis. Mean follow-up was 11.4 years. In the historical cohort there were 126 infants born from 1985 to 1994, with 26 exclusions; follow-up then ranged from 4 to 13 years. DMSA scan showed renal scarring in 19/101 (18.8%) of the recent cohort versus 39/100 (39%) of the previous group (P = 0.002). Renal scarring at a later age also appeared to be a feature of the recent group, with first detection occuring by 4 years in only 9/19 (47%) in the latest cohort compared to 28/39 (72%) in the historical cohort. ConclusionBased on these renal protective data, we recommend indwelling and then intermittent catheterization from birth in all patients with SB. Level of evidenceLevel III. Type of studyRetrospective, cohort comparison study.

Cohort comparison study of neurosurgical procedures after closure of myelomeningocele by fetal surgery versus by neonatal surgery in patients in the national spina bifida patient registry

Cohort comparison study of neurosurgical procedures after closure of myelomeningocele by fetal surgery versus by neonatal surgery in patients in the national spina bifida patient registry

Medication reconciliation in the emergency department performed by pharmacists

Patients are at risk of having their medication histories inaccurately documented while being admitted to an emergency department (ED). Allowing a pharmacist to access patient medication history is an effective way of reducing the number of errors. We sought to determine if having a pharmacist (as opposed to the admitting clinical team) verify patients’ medication histories would result in fewer discrepancies in inpatient medication regimens. We performed a prospective cohort comparison study of adult ED patients admitted to general medicine floors for continuing care. In the intervention group, pharmacists in the ED performed a brief inquiry into the patients’ medication history, a process called medication reconciliation. In the control group, the admitting clinical team conducted the medication reconciliation. Both groups received a second reconciliation by a trained pharmacy team and all discrepancies were recorded. Our cohort had 172 intervention and 172 control subjects. In the control group, 561 medication discrepancies were recorded while no medication discrepancies were observed in the intervention group. Having pharmacists consult with patients in the ED about their medication histories led to fewer discrepancies than when admitting clinical teams performed the same inquiry.

Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department

Suicidal behavior is a major public health problem in the United States. The suicide rate has steadily increased over the past 2 decades; middle-aged men and military veterans are at particularly high risk. There is a dearth of empirically supported brief intervention strategies to address this problem in health care settings generally and particularly in emergency departments (EDs), where many suicidal patients present for care. To determine whether the Safety Planning Intervention (SPI), administered in EDs with follow-up contact for suicidal patients, was associated with reduced suicidal behavior and improved outpatient treatment engagement in the 6 months following discharge, an established high-risk period. Cohort comparison design with 6-month follow-up at 9 EDs (5 intervention sites and 4 control sites) in Veterans Health Administration hospital EDs. Patients were eligible for the study if they were 18 years or older, had an ED visit for a suicide-related concern, had inpatient hospitalization not clinically indicated, and were able to read English. Data were collected between 2010 and 2015; data were analyzed between 2016 and 2018. The intervention combines SPI and telephone follow-up. The SPI was defined as a brief clinical intervention that combined evidence-based strategies to reduce suicidal behavior through a prioritized list of coping skills and strategies. In telephone follow-up, patients were contacted at least 2 times to monitor suicide risk, review and revise the SPI, and support treatment engagement. Suicidal behavior and behavioral health outpatient services extracted from medical records for 6 months following ED discharge. Of the 1640 total patients, 1186 were in the intervention group and 454 were in the comparison group. Patients in the intervention group had a mean (SD) age of 47.15 (14.89) years and 88.5% were men (n = 1050); patients in the comparison group had a mean (SD) age of 49.38 (14.47) years and 88.1% were men (n = 400). Patients in the SPI+ condition were less likely to engage in suicidal behavior (n = 36 of 1186; 3.03%) than those receiving usual care (n = 24 of 454; 5.29%) during the 6-month follow-up period. The SPI+ was associated with 45% fewer suicidal behaviors, approximately halving the odds of suicidal behavior over 6 months (odds ratio, 0.56; 95% CI, 0.33-0.95, P = .03). Intervention patients had more than double the odds of attending at least 1 outpatient mental health visit (odds ratio, 2.06; 95% CI, 1.57-2.71; P < .001). This large-scale cohort comparison study found that SPI+ was associated with a reduction in suicidal behavior and increased treatment engagement among suicidal patients following ED discharge and may be a valuable clinical tool in health care settings.

Efficacy and safety of ticagrelor versus clopidogrel associated with aspirin for dual antiplatelet therapy in cerebral aneurysm stenting treatment: Monocentric cohort experience

Background and purpose Adverse events in endovascular treatment for ruptured and unruptured cerebral aneurysms are feared particularly thromboembolic complications when stent device is used. Dual antiplatelet therapy is a standard of care but choice of appropriate association doesn’t reach any consensus in neurovascular context. Objective is to match efficiency of aspirin-clopidogrel and aspirin-ticagrelor associations in the prevention of thromboembolic complications after cerebral aneurysms stenting treatment. Methods This is a monocentric, retrospective, cohort comparison study design. We compared both groups treated with either clopidogrel or ticagrelor in association with aspirin in consecutive aneurysms protected with flow diverter embolization device or stent-assisted coiling. Data were collected on patient demographics and thromboembolic risk factors, procedural details, antiplatelet treatment regime, complications, angiographic and functional outcomes. Results One hundred and sixteen patients were treated by cerebral stenting between January 2013 and September 2017 and benefited from dual anti-agregation. Sex, age, smoking status and procedural details did not differ between the two groups. We show no difference about onset of thromboembolic complications and functional outcomes. Conclusion Aspirin and ticagrelor association in the field of interventional neuroradiology is not accepted in routine. Questions are to be solved about treatment resistance (absence of prerequisite agregability test) and hemorrhagic complications.

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy.

Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care. Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests. There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group. A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

Outpatient elective posterior lumbar fusions appear to be safely considered for appropriately selected patients

Background ContextThere has been growing interest in performing posterior lumbar fusions (PLFs) in the outpatient setting to optimize patient satisfaction and reduce cost. Although still done in only a small percentage of cases, this has been more possible because of advances in surgical techniques and anesthesia. However, data on the perioperative course of outpatient compared with inpatient PLF in a large sample size are scarce. PurposeThis study aimed to compare perioperative complications between outpatient and inpatient PLF in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Study Design/SettingA retrospective cohort comparison study was carried out. Patient SamplePatients undergoing PLF with or without interbody fusion from the 2005 to 2015 NSQIP database comprised the sample. Outcome MeasuresOutcome measures were postoperative complications within 30 days and readmission within 30 days. MethodsPatients who underwent PLF with or without interbody fusion were identified in the 2005–2015 NSQIP database. Outpatient procedures were defined as cases that had hospital length of stay (LOS)=0 days, whereas inpatient procedures were defined as LOS=1–30 days. Patient characteristics, comorbidities, and procedural variables (inclusion of interbody fusion, instrumentation, and number of levels fused) were compared between the two cohorts. Propensity score-matched comparisons were then performed for postoperative complications and 30-day readmissions between the two groups. ResultsThe current study included 360 outpatient and 36,610 inpatient PLF cases. After propensity matching to control potential confounding factors, statistical analysis revealed no significant difference in postoperative adverse events other than significantly lower blood transfusions in the outpatient group (2.78% vs. 10.83%, p<.001). Notably, the rate of readmissions was not different between the groups. ConclusionsBased on the lack of differences in rates of most perioperative complications and 30-day readmissions between the outpatient and inpatient cohorts, it seems that outpatient PLF may be appropriately considered for select patients. However, extremely careful patient selection should be exercised.

The use of endoscopic-assisted burr-hole craniostomy for septated chronic subdural haematoma: A retrospective cohort comparison study

ObjectiveTo complete a retrospective comparison of endoscope-assisted burr-hole craniostomy (EBHC) and ordinary burr-hole craniostomy (OBHC) in the treatment of septated chronic subdural hematoma (SCSH). MethodsA retrospective case note review comparing EBHC and OBHC of SCSH was therefore performed. Data of patients with a SCSH for EBHC or OBHC during the period from January 2011 to December 2016 were retrospectively collected and analysed. Of 73 patients, 42 underwent EBHC and 31 patients were treated by OBHC. The primary outcome measure was recurrence rate and secondary outcome measures were clinical outcome at first postoperative day, discharge and 6 months, the length of hospital stay for neurosurgery, the operative time, and the placement time of drainage tube. ResultThe rate of recurrence was significantly lower in the EBHC (0/42 0%) than in the OBHC (8/31, 25.8%) group (p = .0030). The rate of morbidity was significantly lower in the EBHC (2/42, 4.8%) than in the OBHC (11/31, 35.5%) group (p = .0121). At 30 days, mortality did not differ between groups. Significantly more patients treated with EBHC were alive at 6 months than were those with OBHC. No patient died as a consequence of the operative procedure in the both groups. A discharge GCS of 15 was recorded in more participants with EBHC than in those with OBHC. Gross neurological deficit was significantly less frequent in those with EBHC than in those with OBHC at first postoperative day and discharge, but did not differ at 6 month follow-up. The mean placement time of drainage tube was significantly less in those with EBHC (27.2 h) than in those with OBHC (52.0 h, p = .0055). The mean length of hospital stay for neurosurgery was 4 days in the EBHC group, while it was 5 days in the OBHC group (p = .0015). The mean hematoma reduction rate was significantly higher in those with EBHC than in those with OBHC at first postoperative day (85.3% vs 72.5%, p = .0037) and discharge (90.3% vs 85.1%, p = .0127). ConclusionComparing two minimally invasive procedure protocols for treatment of SCSH, EBHC is a safe and effective surgical technique. It significantly surpasses the results obtained in OBHC in lowering recurrence rate, morbidity rate, placement time of drainage tube, and length of hospital stay for neurosurgery. We recommend EBHC technique to be widely used in the treatment of SCSH, even common chronic subdural hematoma (CSH), subacute and acute subdural hematomas, acute epidural hematomas and empyemas to avoid large craniotomies, particularly in elderly patients, so that patients can receive the best treatment on the basis of minimal trauma.

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study.

Background:The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications.Purpose:To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures.Study Design:Cohort study; Level of evidence, 3.Methods:Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks.Results:There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively).Conclusion:Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.

Comparison of Stent-Assisted Coil Embolization and the Pipeline Embolization Device for Endovascular Treatment of Ophthalmic Segment Aneurysms: A Multicenter Cohort Study.

Stent-assisted coil embolization and flow diversion with the Pipeline embolization device (PED) are both effective endovascular treatment options for ophthalmic segment aneurysms (OSAs) of the internal carotid artery. Here we present a large comparative cohort study. A multicenter, retrospective cohort comparison study of consecutively treated OSAs was conducted at 2 academic institutions in the United States comparing stent-coiling (between 2007 and 2015) and PED (between 2011 and 2016). A total of 62 of OSAs were treated with stent-coiling and 106 were treated with the PED. The stent-coiling-treated aneurysms were larger, although the maximum diameter was not significantly different between the 2 groups (P= 0.05). The median duration of follow-up was 22.5 months for the stent-coiling group and 8.7 months for the PED group (P= 0.0002). Complete occlusion at last follow-up was achieved in 75.9% of aneurysms in the stent-coiling group and in 81.1% of aneurysms in the PED group (P= 0.516). The retreatment rate was higher with stent-coiling, but the difference did not reach statistical significance (P= 0.062). A good functional outcome was achieved in 96.6% of patients in the stent-coiling group and in 94.7% of those in the PED group (P= 0.707). The rate of neurologic complications was 4.8% in the stent-coiling group and 9.4% in the PED group (P= 0.376). Stent-coiling and the PED were equally effective for treating OSAs. There were no significant differences in terms of procedural complications, angiographic, functional, and visual outcomes. PED may be more favorable for multiple adjacent OSAs.

The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting

ObjectiveOpioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. MethodsWe conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (<25% appointments by telemedicine), mixed (25–75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records. ResultsA total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14–1.41; p<0.001). Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08–1.47; p=0.001) and had a retention rate of 47% at one year. ConclusionTelemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions.

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8–33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13–15 or Markwalder’s Grading Scale (MGS) Grade 0–2. They were retrospectively compared with GCS- and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p = 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p = 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021–0.958), which favours the use of Atorvastatin in CSDH (p = 0.0451). The Number needed to treat (NNT) was 2.4 (p = 0.0447; 95%CI: 1.31–14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.

Managing older medical patients in hospital: a study of the outcomes from a shift of resources to the ‘front door’

We performed a retrospective cohort comparison study to look at the processes for concentrating geriatric resources in the acute admissions area in a general hospital in the UK and compare key outcomes. The number of consultant geriatricians and other staff working at the 'front door' - acute medical unit (AMU) and short stay ward (SSW) - was increased. We compared 'front door' outcomes with whole department outcomes in 2013 and 2014, looking at the proportion of patients discharged within 3 and 5 days of admission, the proportion discharged from the 'front door', mean lengths of stay (LOS) and readmissions within 28 days of discharge. There were 1,147 and 1,381 discharge episodes in 2013 and 2014, respectively. 'Front door' discharges rose from 36% to 46% (p<0.001) between 2013 and 2014, and the proportion of 'front door' discharges occurring within 3 days rose from 56% (2013) to 68% (2014), compared with 35% and 33% for the department as a whole (p=0.006). The mean LOS at the 'front door' fell from 6.1 to 3.8 days (p=0.007). Readmissions from 'front door' discharges rose from 12% to 14% (p=0.004). The change in the configuration of the acute geriatric service was associated with more favourable discharge performance outcomes at the 'front door' but modest improvements in discharge performance for the geriatric service as a whole.

Ten year maturation period in a level-I trauma center, a cohort comparison study

PurposeMany changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation.MethodsA cohort comparison, between June 2004–July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome.ResultsFrom June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25.ConclusionAn increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.

Temporal and spectral contributions to musical instrument identification and discrimination among cochlear implant users

ObjectiveTo investigate the contributions of envelope and fine-structure to the perception of timbre by cochlear implant (CI) users as compared to normal hearing (NH) listeners.MethodsThis was a prospective cohort comparison study. Normal hearing and cochlear implant patients were tested. Three experiments were performed in sound field using musical notes altered to affect the characteristic pitch of an instrument and the acoustic envelope. Experiment 1 assessed the ability to identify the instrument playing each note, while experiments 2 and 3 assessed the ability to discriminate the different stimuli.ResultsNormal hearing subjects performed better than CI subjects in all instrument identification tasks, reaching statistical significance for 4 of 5 stimulus conditions. Within the CI population, acoustic envelope modifications did not significantly affect instrument identification or discrimination. With envelope and pitch cues removed, fine structure discrimination performance was similar between normal hearing and CI users for the majority of conditions, but some specific instrument comparisons were significantly more challenging for CI users.ConclusionsCochlear implant users perform significantly worse than normal hearing listeners on tasks of instrument identification. However, cochlear implant listeners can discriminate differences in envelope and some fine structure components of musical instrument sounds as well as normal hearing listeners. The results indicated that certain fine structure cues are important for cochlear implant users to make discrimination judgments, and therefore may affect interpretation toward associating with a specific instrument for identification.