Articles: function.
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Minerva anestesiologica · May 2023
Randomized Controlled TrialEffect of lidocaine or dexmedetomidine on postoperative recovery in elder patients undergoing colorectal surgery.
Opioid sparing techniques have been shown to promote gastrointestinal recovery, shorten length of stay (LOS), and reduce opioid-related complications. We investigated whether intraoperative intravenous lidocaine or dexmedetomidine infusion could improve gastrointestinal recovery in elderly patients undergoing laparoscopic colorectal surgery. ⋯ Intraoperative intravenous lidocaine infusion accelerated return of the bowel function in elderly patients undergoing elective colorectal surgery.
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Randomized Controlled Trial
A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty.
Pneumatic tourniquet is widely used in lower limb surgery to provide a bloodless operating field. Previous studies on total knee arthroplasty (TKA) in which tourniquets have been applied during surgery have reported some vascular and soft-tissue complications. Nevertheless, it is still not well known exactly how use of tourniquets contributes to hemodynamics of the lower limb and its clinical relevance following TKA. In this prospective study, we wished to determine whether tourniquet affects the hemodynamics and postoperative healing of the lower limb in the first few weeks and its clinical relevancies following TKA. ⋯ Tourniquet use in TKA must be managed very carefully. Not only because of immediate complication resulted from tourniquet but also influence on post-operational functional recovery, especially in quadriceps muscle function. According to this study, TKA without tourniquet use preserves better quadriceps muscle function to provide faster recovery and less transfusion need. It avoids complications from tourniquets as well.
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Randomized Controlled Trial
Trial of Endovascular Thrombectomy for Large Ischemic Strokes.
Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations. ⋯ Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.).
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Randomized Controlled Trial
Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis.
Conventional "1-variable-at-a-time" analyses to identify treatment effect modifiers are often underpowered and prone to false-positive results. This study used a "risk-modeling" approach guided by the Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement framework: (1) developing and validating a multivariable model to estimate predicted future back-related functional limitations as measured by the Roland-Morris Disability Questionnaire (RMDQ) and (2) stratifying patients from a randomized controlled trial (RCT) of lumbar epidural steroid injections (LESIs) for the treatment of lumbar spinal stenosis into subgroups with different individualized treatment effects on RMDQ scores at the 3-week follow-up. Model development and validation were conducted in a cohort (n = 3259) randomly split into training and testing sets in a 4:1 ratio. ⋯ R2 values in the training set, testing set, and RCT were 0.38, 0.32, and 0.34, respectively. There was statistically significant modification ( P = 0.03) of the LESI treatment effect according to predicted risk quartile, with clinically relevant LESI treatment effect point estimates in the 2 quartiles with greatest predicted risk (-3.7 and -3.3 RMDQ points) and no effect in the lowest 2 quartiles. A multivariable risk-modeling approach identified subgroups of patients with lumbar spinal stenosis with a clinically relevant treatment effect of LESI on back-related functional limitations.
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Randomized Controlled Trial
Evaluation of a community health worker home visit intervention to improve child development in South Africa: A cluster-randomized controlled trial.
Effective integration of home visit interventions focused on early childhood development into existing service platforms is important for expanding access in low- and middle-income countries (LMICs). We designed and evaluated a home visit intervention integrated into community health worker (CHW) operations in South Africa. ⋯ While the home visit intervention did not significantly impact linear growth or skills, we found significant improvement in SRT. This study contributes to a growing literature documenting the positive effects of home visit interventions on child development in LMICs. This study also demonstrates the feasibility of collecting markers of neural function like EEG power and SRT in low-resource settings.