1. In a cohort of patients undergoing head and neck cancer treatment, multimedia patient education platforms were found to enhance patient satisfaction.
Evidence Rating Level: 1 (Excellent)
Recent literature has started to recognize patient education as a vital component of a surgical care plan. Enhancing a patient’s understanding of the disease and treatment has demonstrated improved decision making, patient involvement and health outcomes. However, there is still limited research in this area. Therefore, this randomized clinical trial aimed to evaluate the feasibility of implementing a standardize preoperative multimedia guide for patients undergoing head and neck surgical procedures. Data from 100 participants was analyzed (63 women [63%]), from which 50 were in the treatment group and 50 in the control group. Patients in the intervention group received access to short evidence-based animated videos accessible through a web-based platform. Both groups received the standard in-person preoperative teaching by healthcare staff. All participants were given a questionnaire to complete preoperatively, either after the preoperative visit or after watching the educational video depending on their assigned group. The preoperative questionnaire included demographic characteristics and for the intervention group, questions about the educational video. One month post-operatively, all patients received the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) INFO 25 questionnaire which assesses perceived quality of information given to patients with cancer. The primary outcome was to compare the patient satisfaction scores between the two groups. The study found that the scores in the intervention group ranked higher across all domains, with a cumulative mean score difference of 11.3 (95% CI, 10.1 – 12.5 points). The largest difference between the two groups was noted in the amount of information received about accessible services with a 64-point cumulative difference (95% CI, 60.2 – 68.9 points). There were no significant preoperative differences between the two groups, except for the type of surgery with the control group having fewer thyroidectomy and parathyroidectomy procedures. Overall, the study concluded that multimedia use as a platform for patient education may lead to increased patient satisfaction in patients undergoing head and neck surgery. Further studies are needed address the short and long-term outcomes of such a program.
1. Among a cohort of adults in the United States, immune dysfunction was associated with a higher risk of COVID-19 breakthrough infection despite full vaccination. Evidence
Rating Level: 2 (Good)
Vaccines against SARS-CoV-2 have demonstrated high efficacy and safety around the world. Therefore, breakthrough infections, which occur after an individual has completed all required doses of the vaccine, are rare. Research has demonstrated that people with immune dysfunction have a higher risk for developing severe COVID-19 outcomes. However, there is no research on whether these individuals respond differently to a vaccination against COVID-19. Therefore, this retrospective cohort study aimed to identify whether having immune dysfunction predisposes a patient to having a breakthrough infection. It made use of data from the National COVID Cohort Collaborative partnership. Patients who received at least 1 dose of the vaccine were included in the sample (664 722 patients; 56.9% women; median age = 51 years). The study collected data on vaccination status, COVID-19 diagnosis, immune dysfunction diagnoses (e.g. HIV infection, rheumatoid arthritis, solid organ transplant, etc.), comorbid conditions, and demographics. A breakthrough infection was defined as a COVID-19 infection contracted on or after the 14th day of vaccination. The primary outcome was to identify the incidence rate (IR) for COVID-19 breakthrough infection after vaccination among patients with or without immune dysfunction. It was found that compared to those without immune dysfunction, patients with immune dysfunction had higher rates of breakthrough infection after receiving partial or full vaccinations. The IR of breakthrough infection was 7.1 (95% CI, 7.1-7.2) per 1000 person-months for people without immune dysfunction versus 9.1 (95% CI, 8.8-9.4) per 1000 person-months for people with HIV infection, 8.9 (95% CI, 8.4-9.3) per 1000 person-months for multiple sclerosis, 9.3 (95% CI, 9.1-9.6) per 1000 person-months for rheumatoid arthritis, 15.7 (95% CI, 15.1-16.4) per 1000 person-months for solid organ transplant, and 8.6 (95% CI, 8.0-9.1) per 1000 person-months for bone marrow transplant. Overall, the study concluded that although full vaccination was associated with decreased risk of breakthrough COVID-19 infection, people with immune dysfunction had a substantially higher risk of this complication.
1. In a cohort of women receiving urogynecologic surgery, chlorhexidine was found to be non-inferior to iodine for vaginal antisepsis prior to surgery.
Evidence Rating Level: 1 (Excellent)
The most common complications following urogynecology surgery are urinary tract infections (UTIs) and surgical site infections (SSIs). Surgeries that pass through the vagina are known to increase the risk of postoperative infections. Thus, preoperative antiseptic cleaning of the vaginal surgical field is recommended to decrease this risk. Currently, iodine is the only FDA approved antiseptic agent in such situation, limiting the use of chlorohexidine gluconate (CHG). Therefore, this study aimed to compare the efficacy of the two preoperative vaginal antiseptic solutions prior to urogynecology surgery. The trial analyzed data from 119 participants, from which 58 were allocated to the iodine group (mean [SD] age = 57 years) and 61 to the CHG group (mean [SD] age = 58 years). There were no statistically significant differences in the demographic characteristics amongst the two groups. The primary outcome measured was the rates of symptomatic UTI between the two groups within the first two weeks of surgery. It was found that the risk of symptomatic UTI at 2 weeks was lower in the CHG group (10% versus 17%; RR, 0.57; 95% CI, <1.26). The upper limit of the 95% CI did not exceed the predetermined inferiority margin of RR 1.50. The secondary outcome measured were culture-proven UTIs at 2 and 6 weeks, symptomatic UTI at 6 weeks, any surgical site infection at 2 weeks, and patient reported vaginal irritation. The study also found that chlorohexidine was non-inferior to the iodine for the secondary UTI outcomes, surgical site infection, and presence of vaginal irritation. Overall, the study concluded CHG to be non-inferior to iodine when used for vaginal antisepsis prior to urogynecologic surgery, specifically with respect to UTI risk.
1. In a cohort of patients with osteoarthritis from Uganda, serum vitamin D levels are not associated with severity of symptoms.
Evidence Rating Level: 2 (Good)
Vitamin D is crucial in reducing bone turnover and cartilage degradation. Thus, it is hypothesized to prevent the development and progression of osteoarthritis, a common musculoskeletal disease that leads to significant functional decline. However, there is limited evidence regarding serum vitamin D levels and their relationship to symptom severity. Therefore, this cross-sectional study aimed to fill this gap in literature. It analyzed data from 107 (mean [SD] age 58.1 [12.6] years; 92 females [86%]) patients with knee osteoarthritis from an outpatient rheumatology clinic in Uganda. The patients’ serum vitamin D levels were measured, and they were categorized as sufficient (≥ 30 ng/ml), insufficient (20–29 ng/ml), or deficient (< 20 ng/ml). Assessment of osteoarthritis symptom severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The three subclasses measured through this scale were joint pain, joint stiffness, and physical function From the participants, 38 (35.5%) had sufficient serum vitamin D, 54 (50.5%) had insufficient levels, and 15 (14.0%) had deficient levels. The study found that there was no association between serum vitamin D levels and joint pain, stiffness, and physical function severity. Therefore, the study concluded that serum vitamin D levels are not associated with the progression of severe symptoms in patients with knee osteoarthritis.
1. In a cohort of patients with myocardial infarctions, dual anti-platelet therapy before a coronary artery bypass grafting procedure has no effect on postoperative outcomes.
Evidence Rating Level: 2 (Good)
Coronary artery bypass grafting (CABG) is used as a treatment for some patients with acute coronary syndrome (ACS_. The basis of ACS treatment is dual antiplatelet therapy (DAPT) usually with aspirin and clopidogrel. However, with a CABG, there is increased risk of bleeding after the procedure which contrasts its long-term benefits. Therefore, antiplatelet therapies must be chosen carefully, balancing these two risks. Therefore, this prospective cohort study was designed to evaluate the effects of DAPT on postoperative outcomes in patients with ACS. It included data from 244 patients (mean [SD] age, 60.4 [9.2] years; 70.5% men). 124 of the participants were placed in the aspirin group, who were treated with 80mg of aspirin daily till before surgery. 120 participants were placed in the DAPT group who received 80mg of aspirin daily and 75mg of clopidogrel daily until the day before the surgery; they also received 600mg of clopidogrel as a loading dose at the time of admission. The primary outcome measured was assessment of postoperative bleeding, intraoperative and postoperative blood transfusions, cardio-bypass and cross-clamp There were no statistically significant differences between the two groups in any of the primary outcomes. Secondary outcomes included assessment of mortality, cerebrovascular accident (CVA), length of hospitalization and stay in cardiac surgery intensive care unit, ejection fraction rate, hospital costs and need for readmission, re-angiography, re-PCI and CABG at 6-month follow-up, recurrence, and occurrence of stroke or death. Similarly, after completing multivariate logistic regression tests, there were no significant differences between the two groups for any secondary outcomes. The study concluded that DAPT with aspirin and clopidogrel before CABG does not have any effect on postoperative outcomes when compared to mono antiplatelet therapy with aspirin. Therefore, given the role of DAPT in preventing ischemic events in ACS patients, it recommended utilizing DAPT over monotherapy in patients undergoing CABG.
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