First-time Group Research Articles

Patient characteristics influencing knee injury and osteoarthritis outcome scores vary with time from patellar dislocation and number of dislocations

ObjectivesDemographic characteristics of the patient population influence patient reported outcome measures (PROMs) following patellar dislocations. The time from injury and number of dislocations can also vary within the patient population. The hypothesis of the study is that characteristics of the patient population influencing Knee injury and Osteoarthritis Outcome Score (KOOS) measures of pain, function, and quality of life vary with time from patellar dislocation and number of dislocations. MethodsOutcome scores were evaluated for subjects in four groups: within five months of a first patellar dislocation (first-time group, n ​= ​24), within five months of a recurrent dislocation (multiple group, n ​= ​15), five to twelve months after a first dislocation (post-acute group, n ​= ​14), and two years or longer after a first dislocation (two-year group, n ​= ​14). For each group, KOOS pain, physical function, and quality of life scores were compared between males and females. KOOS scores were also correlated against age, body mass index (BMI), and time since first and most recent dislocation. ResultsFor the first-time dislocation group, physical function, and quality of life scores were higher for men than women (p ​< ​0.05). For the multiple dislocation group, pain and physical function improved as BMI decreased (p ​< ​0.025), while quality of life improved as age decreased (p ​= ​0.014). For the post-acute group, all three scores improved as BMI decreased (p ​< ​0.05). For the two-year group, all three scores worsened as time since first dislocation increased (p ​< ​0.01). ConclusionsFollowing patellar dislocation, relationships between characteristics of the patient population and PROMs vary with time from injury and number of dislocations. In the acute phase following a first dislocation, PROMs likely reflect the traumatic injury. Based on relationships with BMI, outcomes likely reflect functional capacity of the knee in the acute phase of multiple dislocations and post-acute phase of a first dislocation. After multiple years, progressive degradation of the knee over time seems to influence PROMs. Level of evidenceRetrospective study with more than one negative criterion (Level 4).

The impact of prior cardiac surgery on patients undergoing surgical repair for acute type A aortic dissection.

To determine the impact of reoperative versus first-time sternotomy for emergent open repair of acute Type A aortic dissection (ATAAD). This was an observational study of consecutive aortic surgeries from 2007 to 2021. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of reoperative versus first-time sternotomy upon survival after ATAAD repair. A total of 601 patients with ATAAD were identified, of which 72 (12%) underwent reoperative sternotomy. The reoperative group had a higher prevalence of baseline comorbidities, including hypertension, diabetes, peripheral vascular disease, atrial fibrillation, and coronary artery disease. Central cannulation of the aorta was achieved at a similar rate across each group (81.9% vs. 81.5%, p = .923), and cardiopulmonary bypass (CPB) time was similar across each group (204 ± 84.8 vs. 203 ± 72.4 min, p = .923). Postoperative outcomes were similar across both groups, including in-hospital mortality, stroke, pulmonary complications, renal failure, and reexploration for excessive bleeding. Five-year survival was 74.5% (70.5, 78.3) for the first-time group and was 71.6% (60.0, 81.9) for the reoperative group. After multivariable Cox regression, reoperative sternotomy was not significantly associated with an increased hazard of death compared to first-time sternotomy (hazards ratio: 0.90, 95% confidence interval: 0.56, 1.43, p = .642). These findings suggest that re-sternotomy can be safely performed with similar outcomes as first-time sternotomy. Central initiation of CPB after sternal reentry limits CPB time and may therefore represent a protective strategy that enhances outcomes for patients presenting with ATAAD and prior cardiac surgery.

Sudden Cardiac Death Risk over Time in HCM Patients with Implantable Cardioverter-Defibrillator.

Background: In patients with HCM at high risk of SCD, an ICD should be considered as a standard of care. Current risk approximation algorithms recommended by ESC 2014 criteria indicate that SCD risk is not stable. The aim of the study was to investigate how the calculated SCD risk in HCM patients with an ICD implanted in the past changed over time. Methods: We analyzed 64 HCM patients with ICD for primary prevention, referred for ICD re-implantation, and 32 HCM patients referred for a first-time ICD placement during the same period. The 5-year-SCD risk was assessed for suitable patients using the recommended ESC calculator. Results: The first-time group had a higher 5-year-SCD risk than those referred for ICD re-implantation: 7.50 (IQR 5.98–10.46) vs. 4.88 (IQR 3.42–7.25), p < 0.05. Out of the patients with an initial calculated risk below 4%, the risk increased in 22% of cases, reaching the 4–6% range. In 78% of patients, the risk remained stable and low. In 31% of patients with an initial calculated SCD risk ≥ 6%, the risk decreased over time to below 6%, and in 14% of the cases, below 4%. Conclusions: SCD risk in HCM patients is usually stable or gets lower. Our data suggest it is important to re-evaluate the risk profile for patients with HCM when ICD re-implantation is considered.

Re-operative Parathyroidectomy in Patients With Mild Primary Hyperparathyroidism

BackgroundSurgery is the definitive management of primary hyperparathyroidism and the only curative therapy. However, many surgeons are hesitant to operate on individuals with mild primary hyperparathyroidism, with an even greater reluctance to operate on those who underwent a previous parathyroidectomy. We hypothesize that patients with mild primary hyperparathyroidism who undergo a re-operation have equivalent outcomes compared with those who undergo a first-time (FT) operation. MethodsWe reviewed a prospective database of 459 patients with mild primary hyperparathyroidism who underwent surgery by one endocrine surgeon. Of these patients, 59 had a re-operative (RE-OP) parathyroid surgery. We compared these patients to those with mild primary hyperparathyroidism who had FT surgery (n = 400) using either the Pearson chi-square, Fisher's exact test, or Student's t-test where appropriate. ResultsThe mean age of our cohort was 60 ± 14 y, with 86% females. Patients in the RE-OP group had similar preoperative calcium and parathyroid hormone levels compared with those in the FT group. Most patients who underwent a RE-OP surgery had four gland hyperplasia on pathology (49.2%). Patients in the RE-OP and FT groups both had high and similar cure rates (100% versus 99.8%, P = 0.70). RE-OP patients had a higher rate of recurrent hyperparathyroidism (10.3% versus 3.3%, P = 0.025). ConclusionsIn patients with mild primary hyperparathyroidism, those who undergo RE-OP parathyroidectomy have a high cure rate that is similar to FT surgery. Therefore, we recommend that these patients with recurrence of mild hyperparathyroid disease be considered for parathyroidectomy.

Efficacy of Nasal Airflow-Inducing Maneuver in Laryngectomy Patients: A Retrospective Cohort Study.

To evaluate the effectiveness of the nasal airflow-inducing maneuver (NAIM) using the Sniffin' Sticks (Burghart, Wedel, Germany) olfactory threshold test, Open Essence (OE, FUJIFILM Wako Pure Chemical Corporation, Osaka, Japan) olfactory identification test, and self-administered odor questionnaire (SAOQ) for olfactory perception in NAIM experienced and NAIM first-time groups. For NAIM first-time group, the relationships between time from laryngectomy to first NAIM, olfactory threshold, and identification ability were also evaluated. Retrospective cohort study. Sixty-six patients who had undergone laryngectomy (NAIM experienced group: 23; NAIM first-time group: 43) underwent the threshold test, OE, and SAOQ. Mean results of the threshold test were 2.7 (±2.3) and 2.5 (±3.0) for the NAIM experienced and NAIM first-time groups, respectively, indicating no significant differences (P = .35). The mean number of correct responses in OE was 4.5 (±2.7) and 3.2 (±3.0) in the NAIM experienced and nonrehabilitation groups, respectively, indicating a higher number in the NAIM experienced group (P = .06). Mean result of SAOQ was 47.9% (±30.9%) and 25.5% (±27.0%) in the NAIM experienced and NAIM first-time groups, respectively, indicating a significantly higher result in the NAME experienced group (P = .003). There were no correlations of threshold test and identification test scores with time from laryngectomy to the first NAIM (threshold test: r = 0.03, P = .87; OE: r = -0.03, P = .87). NAIM enabled odor perception in patients who underwent laryngectomy, and SAOQ was an effective method for evaluating this. Further, olfactory tests in both groups showed that NAIM might restore olfaction irrespective of time elapsed since laryngectomy. 4. Laryngoscope, 130: 2013-2018, 2020.

Identification of new urinary risk markers for urinary stones using a logistic model and multinomial logit model.

Risk assessment for urinary stones has been mainly based on urinary biochemistry. We attempted to identify the risk factors for urinary stones by statistically analyzing urinary biochemical and inflammation-related factors. Male participants (age, 20-79years) who visited Nagoya City University Hospital were divided into three groups: a control group (n = 48) with no history of stones and two stone groups with calcium oxalate stone experience (first-time group, n = 22; recurring group, n = 40). Using 25-µL spot urine samples, we determined the concentrations of 18 candidate urinary proteins, using multiplex analysis on a MagPix® system. In univariate logistic regression models classifying the control and first-time groups, interleukin (IL)-1a and IL-4 were independent factors, with significantly high areas under the receiver operating characteristic curve (1.00 and 0.87, respectively, P < 0.01 for both). The multivariate models with IL-4 and granulocyte-macrophage colony-stimulating factor (GM-CSF) showed higher areas under the receiver operating characteristic curve (0.93) compared to that for the univariate model with IL-4. In the classification of control, first-time, and recurrence groups, accuracy was the highest for the multinomial logit model with IL-4, GM-CSF, IL-1b, IL-10, and urinary magnesium (concordance rate 82.6%). IL-4, IL-1a, GM-CSF, IL-1b, and IL-10 were identified as urinary inflammation-related factors that could accurately distinguish control individuals from patients with urinary stones. Thus, the combined analysis of urinary biochemical data could provide an index that more clearly evaluates the risk of urinary stone formation.

Serial Tissue Expansion at the Same Site in Pediatric Patients: Is the Subsequent Expansion Faster?

BackgroundSerial tissue expansion is performed to remove giant congenital melanocytic nevi. However, there have been no studies comparing the expansion rate between the subsequent and preceding expansions. In this study, we analyzed the rate of expansion in accordance with the number of surgeries, expander location, expander size, and sex.MethodsA retrospective analysis was performed in pediatric patients who underwent tissue expansion for giant congenital melanocytic nevi. We tested four factors that may influence the expansion rate: The number of surgeries, expander location, expander size, and sex. The rate of expansion was calculated by dividing the ‘inflation amount’ by the ‘expander size’.ResultsThe expansion rate, compared with the first-time group, was 1.25 times higher in the second-or-more group (P=0.04) and 1.84 times higher in the third-or-more group (P<0.01). The expansion rate was higher at the trunk than at other sites (P<0.01). There was a tendency of lower expansion rate for larger expanders (P=0.03). Sex did not affect the expansion rate.ConclusionsThere was a positive correlation between the number of surgeries and the expansion rate, a positive correlation between the expander location and the expansion rate, and a negative correlation between the expander size and the expansion rate.

Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): Preliminary results

Conclusions: Our preliminary results indicate that mastoidectomy by reconstruction of the posterior wall and obliteration (MAPRO) avoided the disadvantages of a canal-wall-down mastoidectomy. MAPRO effectively prevented cholesteatoma recurrence, provided an excellent basis for hearing restoration, and was generally water-safe. Objective: To evaluate the authors’ experience with the MAPRO technique for eradication of cholesteatomas requiring canal-wall-down mastoidectomy. Methods: The medical files of all the patients who underwent MAPRO for cholesteatoma between 2008 and 2011 at the Sheba Medical Center were retrospectively reviewed. Results: This series included 49 patients (31 children and 18 adults). The index operation was the first procedure for 30 patients and repeat surgery for 19 patients. Eight patients underwent ossiculoplasty. The mean postoperative follow-up was 28 months. Water tolerance and absence of inflammation were achieved in 93.3% of the first-time group and in 73.7% of the repeat group. (Recurrent cholesteatoma was found on the postoperative non-echo planar base diffusion-weighted magnetic resonance imaging in six (12.2%) patients: three (10%) in the first-time group and three (15.8%) in the repeat group).

Efficacy of abduction bracing in the management of total hip arthroplasty dislocation

A retrospective review of total hip arthroplasty (THA) dislocations was performed to determine the effectiveness of abduction bracing following closed reduction. Patients were grouped as a first-time dislocation (n = 91) or recurrent dislocation (n = 58) and whether or not they received an abduction brace; re-dislocation defined failure of treatment. The mean follow-up was 4.0 years in the first-time group and 3.7 years in the recurrent group. Among patients treated for first-time dislocations, 61% re-dislocated with a brace and 64% of nonbraced patients re-dislocated. In the recurrent group, 55% re-dislocated with a brace, whereas 56% re-dislocated without a brace. Chi-square analysis revealed that observed differences were not significant. There was no significant difference among groups with regards to age, sex, operative side, or significant surgical parameters. Abduction bracing following closed reduction of THA dislocation is ineffective in preventing re-dislocation.

Flaming among first-time group support system users

Numerous benefits, including increases in efficiency, effectiveness, and participant satisfaction, have been noted in the literature when electronic meetings are used in place of traditional, oral meetings. However, several costs, or process losses, have also been observed, including an increase in ‘flaming’ characterized by insults or even obscenities. This paper describes how flaming may be correlated with numerous task and group member characteristics. Results of a case study show that a large number of flames are unrelated to the topic and that a small minority of those writing comments are responsible for the majority of flames. No variables were found to be significant predictors, but its incidence was exclusively among males.

Understanding Abusive Families: An Ecological Approach to Theory and Practice • Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment • Women Survivors of Childhood Sexual Abuse: Healing Through Group Work: Beyond Survival

Understanding Abusive Families: An Ecological Approach to Theory and Practice • Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment • Women Survivors of Childhood Sexual Abuse: Healing Through Group Work: Beyond Survival

Serum pregnancy-specific beta1-glycoprotein before embryo transfer is related to endometrial thickness and to outcome prognosis in women undergoing in-vitro fertilization treatment.

We have previously observed the repeated presence of low but detectable amounts of the trophoblast marker pregnancy-specific beta1-glycoprotein (SP1) in the serum of some women undergoing in-vitro fertilization (IVF) treatment around the time of oocyte retrieval. The occurrence of these signals seemed to be restricted to a defined group of patients which also showed a lower pregnancy success rate in a preliminary study. To test our hypothesis we have analysed 173 consecutive cycles leading to an embryo transfer. Fifty-four cycles (31%) had a serum SP1 level of at least 0.1 ng/ml between days embryo transfer -5 and embryo transfer (group A). Five pregnancies were obtained in this group (pregnancy rate = 9.3%), while in group B, defined by the absence of detectable SP1 before embryo transfer (119 cycles), 36 ongoing pregnancies were achieved (30.3%). Ten of the 41 pregnancies were achieved in 33 first-time non-pregnant patients undergoing further attempts during the study period. Again the pregnancy rate was higher in the first-time group B women (9/23 versus 1/10 for group A). Patients tended to remain in their groups A or B, the latter being associated with a better immediate as well as subsequent chance for pregnancy. Group A cycles had a significantly lower endometrial thickness two days before oocyte retrieval than group B (P = 0.0011). We postulate that the presence of an unknown, maternal and progesterone- or follicle stimulating hormone-independent factor in some patients could stimulate tonic ectopic SP1 synthesis and at the same time negatively influence endometrial development.

Treatment of Recurrent Carotid Disease

The purpose of this study was to determine whether repeat carotid endarterectomy (CEA) poses a greater risk than first-time CEA. The authors analyzed data from 893 consecutive CEA cases (1981-1993). Thirty-three patients (3.7%) had repeat CEA, and 860 (96.3%) had first-time CEA. There were statistically significantly higher incidences of hypertension (60.6% vs 44.6%), smoking (84.8% vs 55%), hypertriglyceridemia (33.3% vs 16.2%), and coronary artery disease (66.6% vs 36%) in the repeat CEA group than in the first-time CEA group. Symptomatic disease was present in 25 (75.8%) patients in the repeat group and in 576 (67%) patients in the first-time group (P&gt;0.05). The cause of recurrence was atherosclerosis in 25 patients (76%), myointimal hyperplasia in seven patients (21.2%), and intraluminal thrombus without an underlying lesion in one patient (3%). Redo CEA with vein patch angioplasty was performed in 27 patients (82%), vein patch angioplasty alone in five patients (15%), and interposition vein graft in one patient (3%). The hospital operative mortality was 0% (n=0) in the repeat CEA group and 0.6% (n=5) in the first-time CEA group (P&gt;0.05). The incidence of postoperative stroke was 0% (n=0) in the repeat group and 1.2% (n= 10) in the first-time group (P&gt;0.05). There was one case (3%) of transient ischemic attack (TIA) in the repeat group, and two cases (0.2%) of TIA in the first-time group. There was no difference in the incidence of cranial nerve dysfunction between the repeat group (n=2, 6%) and the first-time group (n=41, 4.8%; P&gt;0.05). Late follow-up data were obtained for 30 patients (mean: 61.4 months, range: 5-158 months) in the repeat CEA group and 501 patients (mean: 55.8 months, range: 17-168 months) in the first-time CEA group. The incidence of late failure (ipsilateral stroke or TIA) was 3.3% (n= 1) in the repeat group and 3.2% (n= 16) in the firsttime CEA group; P&gt;0.05. The overall late mortality was 20% (n=6) in the repeat CEA group and 14.6% (n=73) in the primary CEA group; P&gt;0.05. Repeat CEA can be performed safely in individuals with severe recurrent carotid stenosis, and perioperative and long-term mortality and neurologic morbidity rates are similar to those for patients undergoing first-time carotid endarterectomy.

The certification examination. Viewpoints of past candidates.

Almost half the candidates of the 1976-77 certification examination in psychiatry answered a questionnaire seeking their opinions about the examination after they had experienced it. Opinions varied markedly depending upon whether the candidates were taking the examination for the first time or whether they were repeating it. The first-time group had the highest passing rate. This group also tended to feel adequately trained towards the examination and to like its present format. Those candidates who were repeating the examination tended to feel inadequately prepared and disliked the present format. Half the candidates in this sample had negative comments about this experience. A high level of anxiety and preoccupation with the examination were most often commented upon. A number of candidates did however find it easier and more fair than they had expected. The candidates, after taking the examination, tended as a group to feel better prepared and more positive toward the examination than the fourth year residents about to take the examination. The recommendations suggested focused on changing the task and image of the Board of Examiners, improving the examination and improving examination passing skills.