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Challenges and outcomes of upper cervical spinal tuberculosis surgery in pandemic-Case series study.International Journal of Surgery Case... Jun 2024Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was...
INTRODUCTION AND IMPORTANCE
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was limited to a mere 6 % of cases of extrapulmonary tuberculosis. Upper cervical spinal TB is an exceptionally uncommon condition, with an incidence rate of approximately 0.3-1 % among all cases of spinal tuberculosis.
CASE DESCRIPTION
Three patients diagnosed with upper cervical spinal tuberculosis who underwent Anterior Cervical Corpectomy Fusion (ACCF) or Occipitocervical fusion surgery were reviewed retrospectively. The data was obtained during the pandemic period in Indonesia. The patients were evaluated using pre-operative and post-operative Cobb's angles, Visual Analog Scale (VAS), Frankel scale, and Neck Pain and Disability (NPAD) scale.
CLINICAL DISCUSSION
The ACCF surgery was more favourable when the compression was extended to the vertebral body; it showed good clinical and radiological outcomes. Multilevel ACCF and pathologies affecting bone quality seemed to be risk factors for material subsidence and instability. In this case, all the patients had performed ACCF surgery. The mean Cobb's angle pre-operative was 15.30, and Cobb's angle post-operative was 6.50. The mean pre-operative VAS value was 6.3, and the post-operative VAS value was 3. Compared to the post-operative scale, the pre-operative Frankel scale experienced an average increase of 2 levels. In contrast, the mean value of good post-operative NPAD is 29.3.
CONCLUSION
Operative procedures on upper cervical spinal tuberculosis cases can improve patient's quality of life significantly, clinically and radiologically.
PubMed: 38875826
DOI: 10.1016/j.ijscr.2024.109858 -
Nursing Open Jun 2024To understand the experiences of individuals who undergo LEA due to DFU after disability.
AIM
To understand the experiences of individuals who undergo LEA due to DFU after disability.
DESIGN
A descriptive research design in qualitative research.
METHODS
Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed.
RESULTS
Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.
Topics: Humans; Qualitative Research; Middle Aged; Male; Female; China; Amputation, Surgical; Diabetic Foot; Disabled Persons; Lower Extremity; Social Support; Interviews as Topic; Self Concept
PubMed: 38875354
DOI: 10.1002/nop2.2213 -
JMIR Research Protocols Jun 2024The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected...
BACKGROUND
The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers.
OBJECTIVE
We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8.
METHODS
The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site.
RESULTS
We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8.
CONCLUSIONS
The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/57341.
Topics: Humans; United States; United States Department of Veterans Affairs; Veterans; Self Care; Program Evaluation; Caregivers
PubMed: 38875003
DOI: 10.2196/57341 -
JAMA Health Forum Jun 2024
Topics: Humans; United States; Disabled Persons; National Institutes of Health (U.S.); Health Status Disparities
PubMed: 38874959
DOI: 10.1001/jamahealthforum.2024.1185 -
Scandinavian Journal of Work,... Jun 2024This study examined the associations between implemented disability-related policies and practices (DPP) and sustained employment among partially disabled employees in...
OBJECTIVES
This study examined the associations between implemented disability-related policies and practices (DPP) and sustained employment among partially disabled employees in The Netherlands.
METHODS
Employer survey data on implemented DPP were linked to register data on employment outcomes of partially disabled employees (N=6103 employees from N=366 employers). DPP included six domains based on 48 elements: sick leave policy, occupational health and safety services (OHS), prevention policy, reintegration policy, reintegration practices within the current employer and reintegration practices towards another employer. DPP domains were standardized on a 0-1 scale. Separate logistic regression models were estimated for DDP domains on one-year sustained employment adjusted for employee characteristics, firm size, and sector.
RESULTS
Almost all organizations implemented at least one element of DPP on prevention policy, OHS, sick leave policy, and reintegration practices within the current employer, and two-thirds on reintegration policy and reintegration practices towards another employer. Implemented DPP on prevention policy [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.3-4.0], OHS (OR 1.9, 95% CI 1.1-3.2), and sick leave policy (OR 1.8, 95% CI 1.0-3.3) were positively associated with sustained employment. No significant results were found for reintegration policy and both reintegration practices domains. Stratified analysis showed that DDP domains were particularly associated with sustained employment in larger organizations and in the private sector.
CONCLUSIONS
Implemented DPP related to sick leave policy, OHS and prevention policy are associated with sustained employment among partially disabled employees, in particular in larger organizations and in the private sector.
PubMed: 38874551
DOI: 10.5271/sjweh.4168 -
Acta Orthopaedica Jun 2024There is conflicting evidence regarding treatment outcomes after minimally invasive sacroiliac joint fusion for long-lasting severe sacroiliac joint pain. The primary...
BACKGROUND AND PURPOSE
There is conflicting evidence regarding treatment outcomes after minimally invasive sacroiliac joint fusion for long-lasting severe sacroiliac joint pain. The primary aim of our cohort study was to investigate change in patient-reported outcome measures (PROMs) after minimally invasive sacroiliac joint surgery in daily practice in the Swedish Spine Registry. Secondary aims were to explore the proportion of patients reaching a patient acceptable symptom score (PASS) and the minimal clinically important difference (MCID) for pain scores, physical function, and health-related quality of life outcomes; furthermore, to evaluate self-reported satisfaction, walking distance, and changes in proportions of patients on full sick leave/disability leave and report complications and reoperations.
METHODS
Data from the Swedish Spine Registry was collected for patients with first-time sacroiliac joint fusion, aged 21 to 70 years, with PROMs available preoperatively, at 1 or 2 years after last surgery. PROMs included Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for low back pain (LBP) and leg pain, and EQ-VAS, in addition to demographic variables. We calculated mean change from pre- to postoperative and the proportion of patients achieving MCID and PASS.
RESULTS
68 patients had available pre- and postoperative data, with a mean age of 45 years (range 25-70) and 59 (87%) were female. At follow-up the mean reduction was 2.3 NRS points (95% confidence interval [CI] 1.6-2.9; P < 0.001) for LBP and 14.8 points (CI 10.6-18.9; P < 0.001) for ODI. EQ-VAS improved by 22 points (CI 15.4-30.3, P < 0.001) at follow-up. Approximately half of the patients achieved MCID and PASS for pain (MCID NRS LBP: 38/65 [59%] and PASS NRS LBP: 32/66 [49%]) and physical function (MCID ODI: 27/67 [40%] and PASS ODI: 24/67 [36%]). The odds for increasing the patient's walking distance to over 1 km at follow-up were 3.5 (CI 1.8-7.0; P < 0.0001), and of getting off full sick leave or full disability leave was 0.57 (CI 0.4-0.8; P = 0.001). In the first 3 months after surgery 3 complications were reported, and in the follow-up period 2 reoperations.
CONCLUSION
We found moderate treatment outcomes after minimally invasive sacroiliac joint fusion when applied in daily practice with moderate pain relief and small improvements in physical function.
Topics: Humans; Patient Reported Outcome Measures; Middle Aged; Sweden; Female; Male; Registries; Adult; Sacroiliac Joint; Minimally Invasive Surgical Procedures; Aged; Cohort Studies; Spinal Fusion; Pain Measurement; Low Back Pain; Disability Evaluation; Quality of Life; Patient Satisfaction; Young Adult; Minimal Clinically Important Difference; Treatment Outcome
PubMed: 38874434
DOI: 10.2340/17453674.2024.40817 -
Eastern Mediterranean Health Journal =... May 2024Adequate supply of rehabilitation health workforce is a prerequisite for enhancing access to rehabilitation care. However, there is a lack of comprehensive data...
BACKGROUND
Adequate supply of rehabilitation health workforce is a prerequisite for enhancing access to rehabilitation care. However, there is a lack of comprehensive data regarding the supply of rehabilitation health workers in Saudi Arabia.
AIMS
To determine the need for, and supply of, rehabilitation workforce, and investigate the relationship between rehabilitation workforce supply and rehabilitation needs in Saudi Arabia.
METHODOLOGY
This cross-sectional study measured the ratio of physiotherapists and occupational therapists per 10 000 population. Data were obtained from the Ministry of Health, family health survey and census data of the General Authority for Statistics and published literature. To assess the need for rehabilitation services, we computed a composite disability index based on 3 variables: count of individuals with physical disabilities, those with chronic diseases, and those aged > 65 years. Determinants of the supply potential were population size, rural population percentage, and physician supply. Data were analysed using descriptive statistics and simple linear regression.
RESULTS
The ratios of physiotherapists and occupational therapists working at the Ministry of Health facilities were 0.69 and 0.03 per 10 000 population, respectively. Overall rehabilitation health workforce ratio was 0.73 per 10 000. Supply varied across regions, from 0.4 for Riyadh to 2.5 for Al Jouf. Nine regions exceeded the overall ratio. Rehabilitation need index ranged from 0.144 in Najran to 0.212 in Aseer. No significant associations were found between rehabilitation workforce supply on one hand, and need and other potential determinants on the other hand.
CONCLUSION
The rehabilitation workforce supply in Saudi Arabia surpassed the regional and global averages, but was lower than the average for high-income countries. Workforce distribution varied by region across the country and was not related to need. It is important to consider the need for rehabilitation services and context-specific factors when determining the optimal size and distribution of the rehabilitation health workforce in Saudi Arabia.
Topics: Saudi Arabia; Humans; Cross-Sectional Studies; Health Services Needs and Demand; Health Workforce; Physical Therapists; Occupational Therapists; Male; Rehabilitation; Female; Workforce
PubMed: 38874293
DOI: 10.26719/2024.30.5.344 -
Turkish Neurosurgery Nov 2023Full-endoscopic lumbar discectomy (FELD) is a successful surgical treatment for lumbar disc herniation. We reported our institutional experience with FELD and analyzed...
AIM
Full-endoscopic lumbar discectomy (FELD) is a successful surgical treatment for lumbar disc herniation. We reported our institutional experience with FELD and analyzed the pertinent literature.
MATERIAL AND METHODS
We retrospectively enrolled 100 patients who had undergone full-endoscopic discectomy for lumbar disc herniation using either an interlaminar (IL) or transforaminal (TF) approach. All patients underwent pre-operative imaging. Before and after surgery, patients\' pain and disability levels were measured using visual analog scale (VAS) and Oswestry disability index (ODI) respectively. Clinical outcomes were assessed using the modified MacNab criteria. Patients were divided into two groups, Group 1 (cases 1-50) and Group 2 (cases 51-100), and their learning curve factors were compared using a Student\'s t-test.
RESULTS
69 cases were operated via an IL approach and the remaining 31 cases using a TF approach. There were 4 early conversions in microdiscectomy. The mean operative time of the 96 procedures was 57 min. In Group 1, the mean operative time was 61.7 minutes (range: 35-110); in Group 2, it was 52.3 minutes (range: 25-75). The difference between the two groups was statistically significant (p=0.009). No significant differences were found in conversions, early operations, and recurrences between Groups 1 and 2. Both groups experienced a significant reduction in postoperative VAS and ODI compared to preoperative scores.
CONCLUSION
Our findings support previously reported information on the safety and effectiveness of the FELD. Herein, we share some practical tips and tricks based on our initial experience and on the review of the available literature, which could facilitate new users. In experienced hands endoscopic techniques make treatment of herniated discs feasible independently of patient age, anatomy, and/or targeted pathology features. Conversely, thoughtful patient selection and careful preoperative planning are highly recommended for new users.
PubMed: 38874251
DOI: 10.5137/1019-5149.JTN.44931-23.4 -
Medycyna Pracy Jun 2024Building law regulations determine designing the built environment recognising the needs of users of different ages and psychophysical abilities. Seniors and their...
BACKGROUND
Building law regulations determine designing the built environment recognising the needs of users of different ages and psychophysical abilities. Seniors and their spatial needs are covered there to a limited extent. The benchmark for design are wheelchair users. Their spatial requirements are greater in relation to independent walkers, including most older people. This makes it difficult to adapt the whole built environment to the needs of people with less mobility dysfunction. This can be considered in terms of spatial design and investment costs.
MATERIAL AND METHODS
The paper analyses the building regulations of 3 countries in terms of legal conditions to shape the architectural movement space of older people and disabled people. Analytical and comparative methods are used. Such research is becoming relevant and necessary. The analyses are conducted in the context of ageing populations. They are justified by statistical data on the age groups of Polish society. This is followed by design analyses of the legal requirements in the wheelchair movement space and proposals for alternatives, e.g., people walking with canes (case study). Their aim is to indicate methods to limit excessive communication spaces in buildings while maintaining functional values for all users.
RESULTS
Research may show the possibility of greater diversification of regulations and alternatives to current laws. They are dedicated to participants in investment processes to shape accessible buildings. They can also be used in legislative work on amendments to the construction law.
CONCLUSIONS
Changes in building regulations and a detailed approach to the mobility needs of older and disabled people (walking independently) are proposed. These decisions can provide benefits (spatial and economic savings). They fall into the "design for all" trend and sustainability of the built environment. These demands are based on no longer valid normative regulations. Med Pr Work Health Saf. 2024;75(3).
PubMed: 38873967
DOI: 10.13075/mp.5893.01512 -
Frontiers in Psychology 2024This study aimed to assess the association of anxiety, headache, and insomnia on the QoL of patients with long COVID-19.
PURPOSE
This study aimed to assess the association of anxiety, headache, and insomnia on the QoL of patients with long COVID-19.
METHODS
We conducted a cross-sectional survey between August 2020 and March 2023. A total of 200 participants were eligible, 53 were excluded and 147 patients with long COVID were included. QoL was evaluated across eight domains using the 36-Item Short Form Health Survey (SF-36). Standardized protocols including the Beck Anxiety Inventory (BAI) ( = 103), Pittsburgh Sleep Quality Index (PSQI) ( = 73), and Migraine Disability Assessment (MIDAS) ( = 67) were also used.
RESULTS
Participants with sleep disorders had significantly lower Vitality ( < 0.001). Participants with anxiety disorders had significantly lower Vitality ( = 0.001), poorer Mental Health ( = 0.008), and more severe Bodily Pain ( = 0.008). Participants with headache had significantly lower Vitality ( = 0.032), poorer Mental Health ( = 0.036), and poorer Physical Functioning ( = 0.016). Participants with both headache and anxiety had significantly lower Vitality ( = 0.005) and Mental Health ( = 0.043) domain scores. Correlation analysis revealed that higher scores for anxiety, sleep disorder, and headache were independently correlated with poorer QoL across various domains. The presence of sleep disorder was associated with a fourfold increase in risk of experiencing diminished Vitality (odds ratio [OR]4.47; 95% CI 1.01-19.69; = 0.048).
CONCLUSION
Participants with anxiety, sleep, and headache disorders tended to have a worse QoL. The Vitality and Mental Health domains were the most adversely affected in patients with long COVID. Sleep disorders were associated with a fourfold increase in the risk of poor Vitality.
PubMed: 38873510
DOI: 10.3389/fpsyg.2024.1394068