Assessing the Impact of the COVID-19 Pandemic on Emergency Department Use for Patients Undergoing Cancer-Directed Surgeries

Emergency department (ED) use is a concern for surgery patients, physicians and health administrators particularly during a pandemic. The objective of this study was to assess the impact of the pandemic on ED use following cancer-directed surgeries. This is a retrospective cohort study of patients undergoing cancer-directed surgeries comparing ED use from 7 January 2018 to 14 March 2020 (pre-pandemic) and 15 March 2020 to 27 June 2020 (pandemic) in Ontario, Canada. Logistic regression models were used to (1) determine the association between pandemic vs. pre-pandemic periods and the odds of an ED visit within 30 days after discharge from hospital for surgery and (2) to assess the odds of an ED visit being of high acuity (level 1 and 2 as per the Canadian Triage and Acuity Scale). Of our cohort of 499,008 cancer-directed surgeries, 468,879 occurred during the pre-pandemic period and 30,129 occurred during the pandemic period. Even though there was a substantial decrease in the general population ED rates, after covariate adjustment, there was no significant decrease in ED use among surgical patients (OR 1.002, 95% CI 0.957–1.048). However, the adjusted odds of an ED visit being of high acuity was 23% higher among surgeries occurring during the pandemic (OR 1.23, 95% CI 1.14–1.33). Although ED visits in the general population decreased substantially during the pandemic, the rate of ED visits did not decrease among those receiving cancer-directed surgery. Moreover, those presenting in the ED post-operatively during the pandemic had significantly higher levels of acuity.     

Disproportionate loss of thin filaments in human soleus muscle after 17-day bed rest

Previously we reported that, after 17-day bed rest unloading of 8 humans, soleus slow fibers atrophied and exhibited increased velocity of shortening without fast myosin expression. The present ultrastructural study examined fibers from the same muscle biopsies to determine whether decreased myofilament packing density accounted for the observed speeding. Quantitation was by computer-assisted morphometry of electron micrographs. Filament densities were normalized for sarcomere length, because density depends directly on length. Thick filament density was unchanged by bed rest. Thin filaments/μm² decreased 16–23%. Glycogen filled the I band sites vacated by filaments. The percentage decrease in thin filaments (Y) correlated significantly (P < 0.05) with the percentage increase in velocity (X), (Y = 0.1X + 20%, R² = 0.62). An interpretation is that fewer filaments increases thick to thin filament spacing and causes earlier cross-bridge detachment and faster cycling. Increased velocity helps maintain power (force × velocity) as atrophy lowers force. Atrophic muscles may be prone to sarcomere reloading damage because force/μm² was near normal, and force per thin filament increased an estimated 30%. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:1280–1289, 1998.     

The assessment of cervical sensory motor control: A systematic review focusing on measuring methods and their clinimetric characteristics

BackgroundCervical sensorimotor control (CSMC) becomes increasingly important in the assessment and treatment of patients with neck pain. This review aims to compare commonly used CSMC measuring methods in terms of required tasks, measuring device and clinimetric properties.Search methodsA systematic review of two databases, followed by methodological quality assessment (CBO guidelines).ResultsThe methodological quality of 34 included articles was generally good (five to seven out of eight), the inter-rater agreement was excellent (κ_w = 0.966, p < 0.01). Following tasks were found: head repositioning accuracy to the neutral head position (HRA-to-NHP) and to a target position (HRA-to-target), a virtual reality test, a continuous linear movement technique (CLMT) and an object following non-linear movement technique (NLMT) (The Fly?). Test–retest reliability was fair to excellent (ICC 0.35–0.87) for the HRA-to-NHP, very bad to excellent (ICC 0.01–0.90) for the HRA-to-target, fair to good (ICC 0.25–0.77) for the virtual reality test and moderate to excellent (ICC: 0.60–0.86) for The Fly?. The reliability of the CLMT was not documented. The HRA-to-NHP, The Fly? and the CLMT can discriminate between patients with neck complaints and controls (discriminant validity). Currently, only The Fly? can discriminate between different patient populations (post-traumatic and non-traumatic neck pain). The sensitivity, specificity and responsiveness of the methods have to be assessed in future research.ConclusionsThe dynamic method The Fly? appears to be more reliable than the HRA-to-NHP and is able to discriminate between different patient populations. The diagnostic potential is to be confirmed in future research.