Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery

BACKGROUND CONTEXTEnhanced recovery (ERAS) pathways can help hospitals maximize the incentives of bundled payment models while maintaining high-quality patient care. A key component of an enhanced recovery pathway is the ability to predictably reduce inpatient length of stay, as this is a critical component of the cost equation.PURPOSETo determine the efficacy of an enhanced recovery pathway on reducing length of stay after thoracolumbar adult deformity surgery.STUDY DESIGNSingle surgeon retrospective review of prospectively-collected data.PATIENT SAMPLEForty adult deformity patients who underwent ≥5 levels of fusion to the pelvis (two to L5) with a single surgeon before and after implementation of an ERAS pathway.METHODSThe pathway involved participation by anesthesiology, hospital medicine, and physical therapy, and was designed to achieve goals previously associated with decreased LOS (eg, EBL<1200 mL, procedure time <4.5 hours, avoidance of ICU postoperatively, and mobilization POD0-1). Patients were propensity-score matched 1:1 to a historical cohort (enhanced recovery [ER] and historical [H] cohorts), based on demographics, medical comorbidities, radiographic alignment parameters, and surgical factors. Outcomes were compared to determine the effect of the enhanced recovery pathway. Primary outcomes included LOS and 90-day complications and readmissions.RESULTSAfter matching, gender, BMI, ASA class, preoperative opioid dependence, day of surgery, sagittal alignment parameters, rate of revision surgery, three-column osteotomies, and interbody fusions were comparable between the cohorts (p>.05). In the ER cohort, there was reduced EBL (920±640 vs. 1437±555, p=.004) and no ER patient went to the ICU immediately following surgery, compared with 30% of H patients (p=.022). The ER cohort also had a greater number of patients ambulating by POD1 compared to the H cohort (100% vs. 55%, p=.010). ER patients had a shorter LOS (4.5±1.3 vs. 7.3±4.4 days, p=.010). A 90-day readmission and complications were comparable between the cohorts (p>.05).CONCLUSIONSThe creation of an ERAS pathway for patients undergoing thoracolumbar adult deformity surgery reduced length of stay without negatively affecting short-term morbidity and complications. Given the specificity of this pathway to a single surgeon and hospital, the resources and staffing changes that were instrumental in creating the pathway may not be generalizable to other centers.     

Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-Analysis

ObjectivesTo conduct a systematic review and meta-analysis of the literature of the factors leading to hospital admission for people with dementia in comparison with (1) people without dementia acutely admitted and (2) people with dementia in the community.ResultsInpatients with dementia are at an increased risk of crisis owing to physical health–related factors, including orthopedic, respiratory, and urologic, than inpatients who do not have dementia. We also reviewed data that compared people with dementia admitted with those who were not and found that behavioral problems, such as agitation and wandering, placed people with dementia at an increased risk of being admitted. Interestingly, we also found that changes in routine and environment and increased dependency problems in several activities of daily living were associated with a higher risk of hospitalization for people with dementia.ConclusionsMany older people’s crisis teams tend to focus on prevention and reducing psychiatric admissions. This review highlights the need for recognition of the physical health risks in these patients and a low threshold for early treatment in the community. This review highlights the importance of integrated working between services for older people’s mental health, primary care, social welfare, intermediate care, and hospital liaison.     

Amplified piezoelectrically actuated on-chip flow switching for a rapid and stable microfluidic fluorescence activated cell sorter

With the potential to avoid cross-contamination, eliminate bio-aerosols, and minimize device footprints, microfluidic fluorescence-activated cell sorting (μ-FACS) devices could become the platform for the next generation cell sorter. Here, we report an on-chip flow switching based μ-FACS mechanism with piezoelectric actuation as a fast and robust sorting solution. A microfluidic chip with bifurcate configuration and displacement amplified piezoelectric microvalves has been developed to build the μ-FACS system. Rare fluorescent microparticles of different sizes have been significantly enriched from a purity of ∼0.5% to more than 90%. An enrichment of 150-fold from ∼0.6% to ∼91% has also been confirmed for fluorescently labeled MCF-7 breast cancer cells from Jurkat cells, while viability after sorting was maintained. Taking advantage of its simple structure, low cost, fast response, and reliable flow regulation, the proposed μ-FACS system delivers a new option that can meet the requirements of sorting performance, target selectivity, device lifetime, and cost-effectiveness of implementation.

With the potential to avoid cross-contamination, eliminate bio-aerosols, and minimize device footprints, microfluidic fluorescence-activated cell sorting (μ-FACS) devices could become the platform for the next generation cell sorter.     

Risk of cardio-respiratory abnormalities in preterm infants placed in car seats: a cross-sectional study

Background  

Little is known about the factors that predispose to the occurrence and severity of cardio-respiratory symptoms during the placement of a prematurely born infant in a car seat. The impact of gestational age, weight at discharge and infant's pre-existing cardio-respiratory status (in the supine position) on cardio-respiratory function during pre-discharge testing in a car seat (semi-upright position) has not been investigated.     

UV-induced DNA repair in leukemic cell differentiation

Ultraviolet light (UV)-induced DNA repair during myeloid leukemic cell differentiation was examined. Human myeloid leukemic cells could be induced to differentiate in vitro into mature cells by various chemical inducers that lost their proliferating potencies. In spite of decrease of proliferation capacity, almost all these terminally differentiated myeloid leukemic cells invariably showed UV-induced unscheduled DNA synthesis (UDS) at low energy of UV irradiation (3-5J/m2). This indicated that the terminally differentiated myeloid leukemic cells are functionally quite different from mature granulocytes in chronic myeloid leukemia (CML) or in normal peripheral blood. In HL-60 cells, UV-survival was enhanced in the process of differentiation induced by 1.25% DMSO or 0.6 mM sodium n-butyrate. The degree of enhancement of UV-survival was correlated with the increased amount of UDS. The process of myeloid leukemic cell differentiation which is completed without loss of capacity performing repair DNA synthesis was one of the characteristics of the terminally differentiated myeloid leukemic cells induced by chemical inducers in vitro and this function may support the hypothesis that DNA breaking and rejoining are involved in a mechanism of cytodifferentiation.