Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy: A Secondary Analysis of the FACET Randomized Controlled Trial

BACKGROUND Short-term neck pain after posterior cervical foraminotomy (posterior surgery) compared with anterior cervical discectomy with fusion (anterior surgery) treating cervical radiculopathy has only been assessed once, retrospectively, to our knowledge. The aim of this study was to prospectively evaluate the course of neck pain for 6 weeks after both treatments. METHODS This is a secondary analysis of the multicenter Foraminotomy ACDF Cost-Effectiveness Trial (FACET), conducted from January 2016 to May 2020. Of 389 patients who had single-level, 1-sided cervical radiculopathy and were screened for eligibility, 265 were randomly assigned to undergo posterior surgery (n = 132) or anterior surgery (n = 133). The primary outcome of the present analysis was neck pain, assessed weekly for 6 weeks using the visual analog scale (VAS), on a scale of 0 to 100. The secondary outcomes were arm pain, neck disability, work ability, quality of life, treatment satisfaction, motor and sensory changes, and hospital length of stay. Data were analyzed with mixed model analysis in intention-to-treat samples using 2-sided 95% confidence intervals (CIs). RESULTS In the first postoperative week, the mean VAS for neck pain was 56.2 mm (95% CI, 51.7 to 60.8 mm) after posterior surgery and 46.7 mm (95% CI, 42.2 to 51.2 mm) after anterior surgery. The mean between-group difference was 9.5 mm (95% CI, 3.3 to 15.7 mm), which gradually decreased to 2.3 mm (95% CI, -3.6 to 8.1 mm) at postoperative week 6. As of postoperative week 5, there was no significant difference between groups. Responder analyses confirmed this result. Secondary outcomes showed small differences between groups. CONCLUSIONS Insight into the course of neck pain during the first 6 weeks after posterior compared with anterior surgery is provided. Despite initially more neck pain after posterior surgery, patients swiftly improved and, as of postoperative week 5, results similar to those after anterior surgery were observed. Our findings should enable improved patient counseling and enhanced shared decision-making between physicians and patients with cervical radiculopathy, where more neck pain in the first postoperative weeks should be balanced against the benefits of posterior surgery. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

PFC: escola bressol i habitatges de protecció oficial a Fabra i Coats

Peer Reviewe

PFC: escola bressol i habitatges de protecció oficial a Fabra i Coats

Peer Reviewe

PFC: escola bressol i habitatges de protecció oficial a Fabra i Coats

Peer Reviewe

Propuesta metodológica de evaluación de impacto sobre la capacidad institucional

El objetivo de esta investigación fue desarrollar una metodología de evaluación de impacto sobre la capacidad institucional de una organización, que fuera sólida en términos conceptuales y lo suficientemente flexible en términos prácticos de manera que resultara fácilmente aplicable a diferentes organizaciones en contextos disímiles. La metodología diseñada propone estimar un Indicador Integral de Impacto (III) que resume los efectos previstos y emergentes, deseados y no deseados que toda intervención puede tener sobre la eficiencia, efectividad y equidad de la organización. Esto permite que las tres dimensiones "compitan" en su contribución al indicador integral, por lo que este resulta un promedio ponderado de los tres indicadores dimensionales. Esta metodología de evaluación admite una multiplicidad de evaluaciones parciales focalizadas en diversos criterios de éxito y por añadidura logra un indicador único de resultados comparable y replicable. La comparación entre proyectos o programas de este indicador permite hacer un ordenamiento de los mismos, independientemente de los objetivos a los que apunten, los montos involucrados, etcétera, lo que posibilita evaluarlos en forma unidimensional.

Cameras, knowledge, action: The potential for participant produced photographs to inform smoking cessation interventions amongst new fathers

Many fathers mitigate the harm of their smoking by physically separating their smoking from their children and child care activities. In this presentation we empirically locate smoking and masculinities to detail the highly gendered nature of the everyday places where fathers smoke. The data (including 308 participant produced photographs drawn from a study of 20 men were analyzed to describe the locations and contexts that facilitate and restrict participants’ smoking. Three thematic findings, smoking on the job, the bifurcated domestic sphere, and solitary confinement were derived to detail when and where smoking does and does not occur. Drawing on these findings, we discuss next steps for developing and disseminating father-centred tobacco reduction interventions. Guided by developments in knowledge exchange, our research activities are now focusing on engaging potential end users (fathers, partners, health care providers, other stakeholders) in knowledge broker (KB) facilitated group consultations to recommend messages/resources for smoking fathers based on research findings. Involving a KB ensures that knowledge exchange activities benefit from mutual learning among interested stakeholders, a full understanding of the intended audiences for the tobacco reduction interventions, and strong relationships with those who can ensure that our interventions reach the intended audience. We discuss the effectiveness of strategies used in this integrated KT project in engaging smoking fathers, a difficult-to-reach group at the intersections of class and changing gendered roles, and potential future directions for new tobacco reduction interventions.Applied Science, Faculty ofNursing, School ofUnreviewedFacultyResearche