Rejected

To identify potential areas for intervention and gain insight on current practice in patients who are tapered to zero morphine equivalent daily doses (MEDD) through the Pharmacy Pain E-Consult at a Veterans Healthcare System. This was done by describing the types of follow-up care and resources utilized by patients. This project is a retrospective chart review of Veterans with non-cancer pain on chronic-opioid therapy consulted to the pharmacy e-consult service and tapered to 0 MEDD. Descriptive statistics are collected one year pre-taper and one year post-taper. One year post-taper, approximately one-third of the patients were re-started on opioid therapy. However, average MEDD overall was significantly decreased one year post-taper compared to pre-taper. Average pain scores were not significantly different pre-taper compared to post-taper. Non-opioid medications generally increased post-taper. Follow-up with mental health and pain management clinical pharmacy specialists decreased post-taper. Tapering to zero MEDD did not lead to a significant increase in pain one-year post-taper; however, approximately 33% of patients were re-started on opioids within one year post-taper. Average MEDD scores decreased post-taper as expected but with effects on mental health being largely unknown, we believe that further study in this area will help us better support patients.

A 49-year-old man presented with new onset headache and diplopia, with right ptosis and limitation of extraocular movements consistent with a third nerve palsy. He had a known diagnosis of a non-functioning pituitary adenoma, and his presentation and neuroimaging were consistent with ischaemic pituitary apoplexy. The patient was otherwise stable with no signs of optic neuropathy or endocrine abnormality. He was observed with close interval follow-up and reported resolution of symptoms within 4 days after onset. Pituitary apoplexy is a potentially life-threatening condition often managed with initial medical stabilisation followed by neurosurgical decompression. The guidelines regarding the utility of surgery in patients with isolated ocular motility disorders are unclear, and recent retrospective studies suggested that outcomes may be similar in patients managed conservatively. This case demonstrates that rapid resolution of an isolated third nerve palsy may occur in this setting, and that observation is a reasonable initial management strategy.

: The lateral step-down test is used to appraise movement quality in patients with patellofemoral pain (PFP), however, it is unclear if reliability of the test is affected by physical therapist experience. Determine if there is a difference in reliability between 'experienced' and 'novice' physical therapists appraising movement quality of patients with PFP during the lateral step-down test. Three 'experienced' and 3 'novice' physical therapists analyzed movement quality of 22 participants [mean age (SD) 28.25 (6.5) years] with PFP. Physical therapists viewed two-dimensional videos of participants performing the lateral step-down test and appraised the quality with a score (0-1 = 'good'; 2-3 = 'fair', and 4-5 = 'poor') at baseline and 1 week. Inter- and intra-rater reliability were calculated with kappa and percent agreement. Differences between the groups were assessed with the chi-square test with an a priori alpha level of < 0.05. Inter- and intra-rater reliability ranged from fair to moderate (ĸ = 0.40-0.65). There was no difference in reliability between 'experienced' and 'novice' physical therapists at baseline ( = .13) or 1 week post testing ( = .94). There was no difference in reliability between 'experienced' and 'novice' physical therapists using categories to appraise movement quality during the lateral step-down test for patients with chronic PFP.

Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery. This procedure consists of the withdrawal of 20 to 50 mL of cerebrospinal fluid (CSF) through a lumbar puncture (LP) after which the symptoms of the triad are tested. Improvement in the quality and speed of gait are already recognized but cognitive improvement depends on several factors such as tests used, the time elapsed after LP for re-testing, and the number of punctures. Serial punctures may trigger similar conditions as external lumbar drainage (ELD) to the organism.

Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus.

Chronic Achilles tendon rupture is commonly defined as a rupture presenting 6 weeks after the time of injury and operative management is recommended. This research aims to describe a novel modified surgical technique in the repair of chronic Achilles tendon rupture and to report the result of this technique.

Thoracic epidural analgesia has long been a common method of postoperative analgesia for major open abdominal surgeries and is frequently used within enhanced recovery after surgery programs. An alternative postoperative analgesia method is the single shot transversus abdominis plane block, which has shown promising outcomes with respect to total length of stay, cost, pain scores, and decreased opioid usage. However, far less is known regarding continuous transversus abdominis plane analgesia using catheters. We evaluated the total cost-effectiveness of transversus abdominis plane catheter analgesia compared to thoracic epidural analgesia for patients undergoing open colorectal surgeries within the enhanced recovery after surgery program at our institution.

Topical photodynamic therapy (PDT) is a widely used effective treatment for actinic keratoses (AKs). However, cure rates are significantly reduced for AKs on acral sites. We compared the sequential regimen of topical calcitriol and methyl aminolevulinate (MAL) daylight-PDT (CAL-DL-PDT) versus placebo and MAL-DL-PDT (P-DL-PDT) on acral AKs in an intra-individual, randomized trial.

This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia.