Educating Patients on Screening Guidelines and Expectations for Well-Woman Examinations

Female patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.https://scholarworks.uvm.edu/fmclerk/1494/thumbnail.jp

Impact of Deferral for Low Hemoglobin on Donor Return

Introduction. A consistent blood supply to support life-saving transfusions relies on regular and repeat volunteer blood donations. In this study, we focused on donors previously deferred for low-hemoglobin (Hb) levels to better understand the value of supplying post-deferral educational information, and the actions donors took based on their deferral. Methods. An anonymous national survey of active and inactive donor groups (10,000 each) was conducted. The survey questions assessed post-deferral donor actions, preferences regarding post deferral education, understanding of their deferral, and demographic information. Chi-square analysis was performed to compare categorical survey results between donor groups with p \u3c 0.05 denoting statistical significance. Results. The survey resulted in 722 and 103 active and inactive donor respons- es, respectively. Active donors were more likely to recall receiving educational materials post-deferral (52% vs. 35%, p=003), take iron and vitamin supplements (54% vs. 39%, p=0.009), lived within 30 min of a donor site (94% vs. 84%, p=0.006), and more likely to be older than 45 yr (62% vs. 42%, p=0.002) than their inactive donor counter- parts. Active and inactive donors were similar (p\u3e0.05) with anemia history frequency, female-gender predominance, low-prevalence of vegans, and mixed interest in receiving information about raising hemoglobin levels. Conclusion. While active donors more frequently recalled receiving educational materials for their low hemoglobin deferral, and were more likely to take action to improve their hemoglobin, an alternative method of post-deferral recruitment should be considered given the uncertain value of post-deferral information when comparing active vs. inactive donors.https://scholarworks.uvm.edu/comphp_gallery/1253/thumbnail.jp

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVE: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. METHODS: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (\u3c6 \u3eweeks), and postoperatively (\u3e6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. RESULTS: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( CONCLUSION: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes

Supplemental Material, Appendix_A - Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery

<p> Supplemental Material, Appendix_A for Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery by Peter G. Passias, Gregory W. Poorman, Edward Delsole, Peter L. Zhou, Samantha R. Horn, Cyrus M. Jalai, Shaleen Vira, Bassel Diebo, and Virginie Lafage in Global Spine Journal </p

Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery.

OBJECTIVE: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. METHODS: Inclusion: radiographic CD, age \u3e18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. RESULTS: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. CONCLUSIONS: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes.

Study designRetrospective review of prospective database.ObjectiveComplication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.MethodsComplications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (&lt;6 weeks), and postoperatively (&gt;6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores.ResultsOf 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL (P &lt; .001) and LOS (P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation (P &lt; .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores (P &lt; .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes (P &lt; .05).ConclusionThe Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes

Development of New-Onset Cervical Deformity in Nonoperative Adult Spinal Deformity Patients With 2-Year Follow-Up.

PurposeEvaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes.MethodsRetrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors.ResultsA total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P &gt; .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P &gt; .05).ConclusionsCervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years