Difference In Mean Time Research Articles

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate for the Treatment of Adult Diaphyseal both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones. Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures. Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded. Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection. Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

Impact of Electronic Procedural Protocoling on the Timeliness of Pre-operative Breast Localization Procedures

ObjectiveTo evaluate the impact of a new electronic procedural protocol on start times of pre-operative breast localization procedures. MethodsThis HIPAA-compliant, Institutional Review Board-exempted, quality improvement initiative was performed at a large tertiary academic center. In May 2018, an electronic version of the pre-procedure protocol for breast localizations was created within the electronic health record; prior to this time, the protocol was completed manually on a paper form. Mean time between: (1) appointment time and procedure start time, (2) procedure begin-to-end time, and (3) arrival to appointment time were compared for all female patients undergoing pre-operative breast localization procedures during 4-month periods pre-implementation of the electronic procedural protocol (January-April 2018), and post-implementation (June-September 2018), excluding the May 2018 implementation month. Statistical analysis was done by two tailed t-test and statistical process control charting. ResultsPre-implementation, 427 procedures were performed, and post-implementation 409 procedures were performed. Three pre-implementation cases performed more than 3 hours prior to appointment time were excluded (presumed to be rescheduled cases). Mean time between appointment time and procedure start time decreased from 2.7 minutes after to 5.6 minutes before appointment start time, an 8.3-minute improvement (P = 0.0001), with sustained improvement by statistical process control analysis. Mean time for procedure length increased by 4.7 minutes (P = 0.001). There was no significant difference in mean time of patient arrival to appointment time pre- and post-implementation. ConclusionImplementation of an electronic protocol process for pre-operative breast localizations was associated with a significant and sustained reduction in time between appointment time and procedure start time.

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate For the Treatment of Adult Diaphyseal Both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones.
 Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures.
 Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded.
 Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection.
 Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

Evaluation of Time Consumption for Debonding Brackets Using Different Techniques: A Hospital-Based Study.

Materials and Methods A total of 80 human premolars were included in this study. The samples were first arranged following a standard protocol for bracketing and then debonded using the ultrasonic scaler (US), debonding plier (DP), ligature cutter (LC), and thermal method (TM). Depending on the technique applied for debonding, the specimens were randomly divided into four groups with 20 samples, each keeping a 1 : 1 ratio. During the debonding process, the time taken for each bracket removal was recorded using a stopwatch. To assess the difference in mean time required for debonding among the four techniques, one-way ANOVA test was applied along with Tukey's HSD to compare the two methods. Results The time range and the mean time required for the four techniques analyzed show that the DP method has the highest range of time needed for debonding with 0.97–2.56 seconds, while LC methods have the least time range taking 0.46 to 1.79 seconds. TM's mean time to debond is the highest at 1.5880 seconds. LC method has the lowest mean debonding time of 0.9880 seconds. The one-way ANOVA test has shown the mean debonding time required by the four techniques to be significantly different (p < 0.001). Tukey's HSD multiple comparisons also show that the mean time to debond using the LC method is substantially less than the other three methods (p < 0.001). Conclusion The mean debonding time for the TM was substantially the highest, followed by the US and DP. Debonding with the LC technique required the least time. This study shows some limelight towards the effectiveness of the LC method as it is the least time-consuming technique.

A National Assessment of the Association Between Patient Race and Physician Visit Time During New Outpatient Urology Consultations

ObjectiveTo determine if there is an association between patient race and physician time spent with the patient during outpatient urology consultations. MethodsWe identified all adult urology new outpatient visits in the National Ambulatory Medical Care Survey dataset for 2012-2016. Patient race was dichotomized as White or non-White. Our primary outcome was time spent during the visit between the patient and urologist. Using population-level weighting, we compared differences in mean time spent during visits with White and non-White patients. Mixed-effects linear regression was used to adjust for confounding factors and to account for clustering among individual physicians. Secondary outcomes included number of services provided and if ancillary providers were seen. ResultsOver the 5 year period, 1668 raw visits met criteria and were used to estimate 21million new outpatient urology visits nationwide. 80% of all visits were with White patients. Mean physician time spent among visits with white patients was 23.9 minutes and 24.4 minutes for non-White patients. There was no difference in number of services provided but visits with non-white patients were less likely to include an ancillary provider. After adjustment, there was no significant difference in mean time spent with the urologist among visits with White and non-White patients (difference 0.9 minutes, 95% CI: -0.6-2.4). There were also no differences in adjusted mean time spent among return visits or new visits for hematuria, urologic cancers, or BPH. ConclusionWe found no statistically significant difference in time spent with a urologist during outpatient office consultations between White and non-White patients.

Combination Therapy with Favipiravir for Treatment of Hospitalized COVID-19 Adults

Background: The optimal treatment for coronavirus disease 2019 (COVID-19) remains unclear. Favipiravir, an RNA polymerase inhibitor, has been used for COVID-19 but its clinical role and safety have not been established. Methods: We evaluated the outcomes of hospitalized adults with COVID-19 on favipiravir as part of combination therapy between March 1 and June 1, 2020. Favipiravir was given at a loading dose of 1600 mg orally every 12 hours for 2 doses, followed by a maintenance dose of 600 mg orally every eight hours. We performed a retrospective assessment of virologic clearance, improvement in oxygenation, clinical improvement and possible adverse effects. Results: One hundred and nine patients received favipiravir for a mean duration of 5.32 days. Mean time from symptom onset to initiation of favipiravir (day 0) was 4.89 days. Quick Sequential Organ Failure Assessment score was &lt;2 in 83 patients (76.1%), and 17 patients (15.6%) were on invasive mechanical ventilation at day 0. All patients received at least one additional antiviral, 50 patients (45.9%) received tocilizumab and 14 patients (12.8%) received convalescent plasma. Mean clinical and oxygenation improvement at day 28 were 79.8% and 81.6%, respectively, including 10/17 patients (58.8%) who were extubated. There was no statistically significant difference in mean viral RNA clearance time between patients that received &gt;7 days and those receiving &lt;7 days of favipiravir. Mortality was 9.2%. Main adverse events leading to early favipiravir discontinuation were QTc interval prolongation (11%) and hypertriglyceridemia (8.3%). Conclusion: Early use of favipiravir as part of combination therapy was associated with improved outcomes, a low mortality rate and a high rate of clinical and oxygenation improvement in patients with mild, moderate, and severe COVID-19. There was no impact on virologic clearance. No severe adverse effects were recorded. The effect of favipiravir as monotherapy and as part of early combination therapy need to be elucidated further in randomized clinical trials.

A comparison of hand function in Colles and scaphoid casts using a modified Jebsen Hand Function Test.

This study investigates the impact of Colles versus scaphoid casts on hand function in modern day activities using the Jebsen Hand Function Test with additional modified subtests including texting on a mobile phone, using a computer mouse and typing on a computer keyboard. Twenty healthy volunteers were recruited for the study. Study participants performed worse in a scaphoid cast compared to a Colles cast; most evident in tasks involving fine motor movements such as writing, picking up small objects and stacking checkers (mean time difference 2.3 seconds, 1.5 seconds and 1.2 seconds, respectively) and tasks involving forearm rotation such as card turning and picking up large light objects (mean time difference 1.6 seconds and 1.1 seconds, respectively). This study highlights the importance of careful consideration when assessing the need for thumb immobilization, due to its impact on hand function when performing both traditional and modern-day activities of daily living.

Innovation in low-cost video-laryngoscopy: Intubator V1-Indirect compared with Storz C-MAC in a simulated difficult airway

BackgroundVideo laryngoscopy has directly impacted airway management, with numerous studies demonstrating its utility in clinical management of anatomically difficult airways. However, availability of video laryngoscopes in all clinical areas has been limited by the relatively high cost. We used smartphone technology, miniature cameras and three-dimensional printing to design and create an innovative low-cost hyperangulated video laryngoscope. This has the potential to make the technique more widely available. The aim of this study was to determine if time to intubation with the novel device was clinically equivalent to an existing gold-standard video laryngoscope (Storz CMAC with Dörges blade). MethodsWe conducted a randomised, controlled, cross-over equivalence study with 100 skilled practitioners who had previous video laryngoscopy experience. Participants received instruction on the new device, and adequate opportunity to practice. Intubations were then performed in a randomised order on a mannikin simulating a difficult airway. Video recordings of each intubation were analysed by two independent investigators to determine time to intubation. A mean difference in intubation time of less than 10 s was determined a priori to denote clinical equivalence. ResultsMean difference in intubation time between the devices was 4.9 s, (two one-sided test 95%CI: 2.3–7.5 s). The innovative low-cost VL was thus clinically equivalent to the industry standard in a simulated difficult airway. Further testing in vivo in a clinical environment is needed. ConclusionThe results of this study show that a low-cost disposable hyperangulated video laryngoscope is clinically equivalent to the industry standard in a simulated difficult airway. In the context of the current global pandemic, video laryngoscopy has been advised in nearly all airway guidelines. Access to a low-cost VL which does not require reprocessing may be of great value.

Clinical Outcomes in Burns Patients with Early Venous Thromboembolism Prophylaxis Compared with Late-Anticoagulated Patients: A Retrospective Study

The aim of this study was to describe the timing of venous thromboembolism diagnosis in patients with severe burns and determine the relationship between venous thromboembolism prophylaxis and venous thromboembolism development in a large trauma hospital. A retrospective cohort study over 10 years from 2009 to 2019 was conducted. Records of 226 patients with &gt;20% total body surface area burns were surveyed, and 20 patients with symptoms suggestive of venous thromboembolism had a diagnosis of VTE confirmed on imaging. Enoxaparin was the most common primary thromboprophylaxis (85%, n = 192), followed by heparin (13.71%, n = 31) and sequential compression devices (0.88%, n = 2). Compared with patients who did not develop a venous thromboembolism, patients who developed a venous thromboembolism had a mean difference in time from admission to thromboprophylaxis prescription of 1.72 days (95% CI = −1.50 to 4.92, p &gt; 0.05) and 10.51 days in those who developed a pulmonary embolus (mean difference = 10.51, 95% CI = 3.73 to 17.32, p = 0.0006). A threshold of 4 days was identified by which 96% of patients who never developed venous thromboembolism during admission were prescribed prophylaxis, compared with 32% of those who developed a pulmonary embolus. No bleeding or adverse events were recorded. Timely prescription of thromboprophylaxis in patients with severe burns is critical in reducing venous thromboembolism incidence. Avoidance of delay post injury is especially critical in preventing venous thromboembolism development. Guidelines on thromboprophylaxis must be considered on an individualised patient basis, considering likely surgical requirements and obesity.

Treatment of temporomandibular dysfunction with jaw functional orthopedics: a retrospective study

What are my chances of getting better?” And “How long will it take for the discomfort to improve?” are the two basic questions asked by individuals after they know about the influence of the stomatognathic system (SS) on their discomfort. Despite the biological unpredictability and variation, these individuals need some information. When searching in MEDLINE, some parameters may be found, but there are none about Jaw Functional Orthopedics (JFO). This study sample was composed of 146 patients with TMD and/or headache/neck pains, who were treated with JFO and divided into three groups. Group 1 exclusively with TMD; Group 2 with head and/or neck pain without symptoms of TMD (pain on palpation or movement); and Group 3 with TMD and head/neck pain. The symptoms monitored were arthralgia, and myalgia of the temporal, masseter or suprahyoid muscles, neck pain on movement or palpation, headache and cervicalgia reported. Odontogenic pain and headache originating from other sources (sinusitis, flu, pre-menstrual period, photophobia, hangover, etc.) were excluded from the study. The sample was aligned with the literature relative to prevalence of age and sex. Results showed that JFO treatment was effective in patients of the three groups. There was no statistical difference in mean time for remission among the groups. The results and conclusions should be analyzed with caution since there was no control group, and long term follow up is needed to check the behavior of the symptoms. However, the data from this study suggested that JFO was an efficient tool for treatment of patients with occlusal and biomechanical alterations of the SS, with chronic TMD, head and/or neck pain in a short period of time.

Surgical approach for management of Pertrochanteric fractures of proximal femur or hip in patients with COVID-19

Background: Since the onset of the COVID-19 pandemic, adverse outcomes in patients with orthopaedic surgery have become a major concern for surgeons. In other words, the question remains whether surgery should be postponed until the patient is fully recovered or whether early surgery should be performed. Objectives: The present study sought to answer the above questions by examining the consequences of pertrochanteric fractures of the proximal femur or hip surgery in CVOID-19 patients and comparing the findings with non-COVID-19 patients. Methods: The present study reports the experience of orthopaedic surgeons on patients with pertrochanteric fractures of the proximal femur or hip candidates for surgery admitted between May and July 2020, who were divided into two groups of patients with COVID-19 (n=12) and non- COVID-19 patients (n=24). The outcomes of the surgery were determined based on the duration of surgery, time interval between surgery to complete recovery, and duration of hospitalization in the intensive care unit (ICU). Results: Comparing the postoperative outcomes across the two groups with and without COVID-19 showed no significant difference in mean time required for the patient to recover after surgery (p=0.160) or mean operation time (p=0.648). However, the length of ICU stay in those who were infected with SARS-CoV-2 was significantly longer than that observed in the non-COVID-19 group (p = 0.018) due to the need for more care and not because of postoperative complications. Conclusion: Surgical approach on fractures in patients with COVID-19 can be performed with high confidence and safety, and therefore, such surgeries should not be delayed in these patients.

Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial

People with type 1 diabetes can continuously monitor their glucose levels on demand (intermittently scanned continuous glucose monitoring [isCGM]), or in real time (real-time continuous glucose monitoring [rtCGM]). However, it is unclear whether switching from isCGM to rtCGM with alert functionality offers additional benefits. Therefore, we did a trial comparing rtCGM and isCGM in adults with type 1 diabetes (ALERTT1). We did a prospective, double-arm, parallel-group, multicentre, randomised controlled trial in six hospitals in Belgium. Adults with type 1 diabetes who previously used isCGM were randomly assigned (1:1) to rtCGM (intervention) or isCGM (control). Randomisation was done centrally using minimisation dependent on study centre, age, gender, glycated haemoglobin (HbA1c), time in range (sensor glucose 3·9-10·0 mmol/L), insulin administration method, and hypoglycaemia awareness. Participants, investigators, and study teams were not masked to group allocation. Primary endpoint was mean between-group difference in time in range after 6 months assessed in the intention-to-treat sample. This trial is registered with ClinicalTrials.gov, NCT03772600. Between Jan 29 and Jul 30, 2019, 269 participants were recruited, of whom 254 were randomly assigned to rtCGM (n=127) or isCGM (n=127); 124 and 122 participants completed the study, respectively. After 6 months, time in range was higher with rtCGM than with isCGM (59·6% vs 51·9%; mean difference 6·85 percentage points [95% CI 4·36-9·34]; p<0·0001). After 6 months HbA1c was lower (7·1% vs 7·4%; p<0·0001), as was time <3·0 mmol/L (0·47% vs 0·84%; p=0·0070), and Hypoglycaemia Fear Survey version II worry subscale score (15·4 vs 18·0; p=0·0071). Fewer participants on rtCGM experienced severe hypoglycaemia (n=3 vs n=13; p=0·0082). Skin reaction was more frequently observed with isCGM and bleeding after sensor insertion was more frequently reported by rtCGM users. In an unselected adult type 1 diabetes population, switching from isCGM to rtCGM significantly improved time in range after 6 months of treatment, implying that clinicians should consider rtCGM instead of isCGM to improve the health and quality of life of people with type 1 diabetes. Dexcom.

Test-retest Reliability and Construct Validity of the Satisfaction with Treatment Result Questionnaire in Patients with Hand and Wrist Conditions: A Prospective Study.

A patient's satisfaction with a treatment result is an important outcome domain as clinicians increasingly focus on patient-centered, value-based healthcare. However, to our knowledge, there are no validated satisfaction metrics focusing on treatment results for hand and wrist conditions. Among patients who were treated for hand and wrist conditions, we asked: (1) What is the test-retest reliability of the Satisfaction with Treatment Result Questionnaire? (2) What is the construct validity of that outcomes tool? This was a prospective study using two samples: a test-retest reliability sample and a construct validity sample. For the test-retest sample, data collection took place between February 2020 and May 2020, and we included 174 patients at the end of their treatment with complete baseline data that included both the primary test and the retest. Test-retest reliability was evaluated with a mean time difference of 7.2 ± 1.6 days. For the construct validity sample, data collection took place between January 2012 and May 2020. We included 3742 patients who completed the Satisfaction with Treatment Result Questionnaire, VAS, and the Net Promotor Score (NPS) at 3 months. Construct validity was evaluated using hypothesis testing in which we correlated the patients' level of satisfaction to the willingness to undergo the treatment again, VAS scores, and the NPS. We performed additional hypothesis testing on 2306 patients who also completed the Michigan Hand Outcomes Questionnaire (MHQ). Satisfaction with the treatment result was measured as the patients' level of satisfaction on a 5-point Likert scale and their willingness to undergo the treatment again under similar circumstances. We found high reliability for level of satisfaction measured on Likert scale (intraclass correlation coefficient 0.86 [95% CI 0.81 to 0.89]) and almost-perfect agreement for both level of satisfaction measured on the Likert scale (weighted kappa 0.86 [95% CI 0.80 to 0.91]) and willingness to undergo the treatment again (kappa 0.81 [95% CI 0.70 to 0.92]) of the Satisfaction with Treatment Result Questionnaire. Construct validity was good to excellent as seven of the eight hypotheses were confirmed. In the confirmed hypotheses, there was a moderate-to-strong correlation with VAS pain, VAS function, NPS, MHQ pain, and MHQ general hand function (Spearman rho ranged from 0.43 to 0.67; all p < 0.001) and a strong to very strong correlation with VAS satisfaction and MHQ satisfaction (Spearman rho 0.73 and 0.71; both p < 0.001). The rejected hypothesis indicated only a moderate correlation between the level of satisfaction on a 5-point Likert scale and the willingness to undergo the treatment again under similar circumstances (Spearman rho 0.44; p < 0.001). The Satisfaction with Treatment Result Questionnaire has good-to-excellent construct validity and very high test-retest reliability in patients with hand and wrist conditions. This questionnaire can be used to reliably and validly measure satisfaction with treatment result in striving for patient-centered care and value-based healthcare. Future research should investigate predictors of variation in satisfaction with treatment results.

VMAT-like plans for magnetic resonance guided radiotherapy: Addressing unmet needs.

VMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique. First, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of±5mm. In phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is -1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2min and 3.1min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and -0.6min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn't increase plan robustness. VMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.

Author Response: Exosomal Neurofilament Light: A Prognostic Biomarker for Remote Symptoms After Mild Traumatic Brain Injury?

We thank Dr. Kawada for his comments and inquiry on our article.1 Our report of plasma and exosomal axonal, inflammatory, and vascular biomarkers is part of a discovery project studying candidate biomarkers of remote mild TBI (mTBI) outcomes among service members and veterans with combat-related mTBI enrolled in the Chronic Effects of Neurotrauma Consortium longitudinal study. This study complemented our previous report that evaluated biomarkers associated with neurodegeneration tau, hyperphosphorylated tau, and beta amyloid-40 and beta amyloid-42.2 The samples in this analysis were obtained a mean of 8 years after the most severe combat-related mTBI. By contrast, the specimens in the earlier study by Gill et al.3 were obtained much earlier from service members who had sustained an mTBI within the previous 3 years. In addition to the difference in mean time since injury, there were other methodological differences between the studies. All results are preliminary and require validation in a larger cohort.

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19.

Objectives: Patients with comorbidities are at increased risk for poor outcomes in COVID-19, yet data on patients with prior neurological disease remains limited. Our objective was to determine the odds of critical illness and duration of mechanical ventilation in patients with prior cerebrovascular disease and COVID-19.Methods: A observational study of 1,128 consecutive adult patients admitted to an academic center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. We tested the association between prior cerebrovascular disease and critical illness, defined as mechanical ventilation (MV) or death by day 28, using logistic regression with inverse probability weighting of the propensity score. Among intubated patients, we estimated the cumulative incidence of successful extubation without death over 45 days using competing risk analysis.Results: Of the 1,128 adults with COVID-19, 350 (36%) were critically ill by day 28. The median age of patients was 59 years (SD: 18 years) and 640 (57%) were men. As of June 2nd, 2020, 127 (11%) patients had died. A total of 177 patients (16%) had a prior cerebrovascular disease. Prior cerebrovascular disease was significantly associated with critical illness (OR = 1.54, 95% CI = 1.14–2.07), lower rate of successful extubation (cause-specific HR = 0.57, 95% CI = 0.33–0.98), and increased duration of intubation (restricted mean time difference = 4.02 days, 95% CI = 0.34–10.92) compared to patients without cerebrovascular disease.Interpretation: Prior cerebrovascular disease adversely affects COVID-19 outcomes in hospitalized patients. Further study is required to determine if this subpopulation requires closer monitoring for disease progression during COVID-19.

587 Methadone and Morphine for Outpatient CO2 Laser Pain Management

Abstract Introduction Burn reconstruction with CO2 laser is now very popular. Providing adequate analgesia is imperative for large total body surface area (TBSA) resurfacing. CO2 lasers’ cause significant pain during the procedure and pain similar to that of a severe sunburn post-operatively. Thus, adequate analgesia that provides peri-operative and post discharge management without delaying discharge is beneficial. At our institution, we use a multimodal analgesic preoperative and intra-operative approach to deal with this issue. The preoperative intervention utilizes a novel approach of oral methadone for older children and avoids the use of intra-operative morphine as a preemptive measure for pain management. The purpose of this outcomes review was to determine if our peri-operative analgesic practices were effective in controlling peri-operative pain. Methods After corporate IRB review, this project was undertaken as a quality improvement initiative and was not formally supervised by an institutional review board. A chart review of all patients who received CO2 laser treatment (CLT) was conducted. Using a Donabedian model for outcomes measure, postoperative and pre-discharge observational pain scores (scale 1–10), peri-operative analgesics, demographics, percent burn treated, incidents of rescue medication before discharge home, time to discharge and adverse reactions were collected. Results 74 patients were reviewed (47 male, 27 female), ages 4 to 30, average age 17. Average percent body surface area treated was 17.5%. Out of 74 cases, 18 received intra-operative morphine and 56 received oral methadone pre-operatively. All patients received routine intra-operative ketorolac and lidocaine/prilocaine cream, based on weight. In the PACU there were 2 recorded rescue doses of morphine in the morphine group and 0 in the methadone group. There was one post- operative recorded observational pain score of 5 in the methadone group and one each of 3 and 8 in the morphine group, both of which received rescue morphine. There were no differences in mean times to discharge between groups. Observational pain scores were 0 for both groups at discharge. Chi square analysis showed no statistical difference between groups. No adverse outcomes (respiratory arrest or readmission for pain) were recorded in either group. Conclusions Both pre-operative oral methadone and intra-operative morphine are effective in controlling peri-operative pain in our children undergoing laser surgery. Categorical age differences and low group sizes may have contributed to outcomes and should be considered in the next review.

A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

PurposeNew energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study.MethodsThis prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate.ResultsFor the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85–130) minutes versus 150 (IQR 130–199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261).ConclusionThe Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter.Trial registrationUMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017

Risk Factors for Prolonged Hospital Stay after Endoscopy.

Background/AimsThe recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unit is desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay among outpatients. MethodsWe retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at the Toyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depression during endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100 minutes) were identified using multiple logistic regression analysis. ResultsWe enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested without sedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and non-sedation group was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.014−1.036), female sex (OR, 1.657; 95% CI, 1.220−2.249), and midazolam dose (OR, 1.019; 95% CI, 1.013−1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results for colonoscopy. ConclusionsOld age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.

Association of ABO blood group with postoperative total bleeding volume in patients undergoing total hip arthroplasty.

As individuals with blood types A, B and AB have approximately 25% higher levels of vWF than those with type O, the risk of developing venous thrombotic events has been investigated in a number of clinical studies, but whether individuals with type O blood experience increased bleeding remains to be clarified. The purpose of this study was to evaluate an association of ABO blood group with intraoperative bleeding and postoperative total bleeding in patients undergoing total hip arthroplasty. We prospectively recruited 84 women who were undergoing total hip arthroplasty. The differences between blood groups in mean age, body weight, preoperative and postoperative Hct levels, and postoperative/preoperative Hct ratio, intraoperative bleeding volume (IBV), and total bleeding volume (TBV) were evaluated. Twenty-six patients had type A blood, 17 had type B, 9 had type AB, and 30 had type O. There were no significant differences in mean age, body weight or operating time between the different ABO blood groups. While there was no significant difference in these Hct levels or IBV among the different blood groups, there was a significant difference in TBV between type O and type AB, and between type O and non-type O. Our study in patients undergoing total hip arthroplasty suggests that patients in blood group O tend to have large amounts of bleeding.