University of Kansas Medical Centerhttps://hdl.handle.net/1808/1972024-03-27T01:18:14Z2024-03-27T01:18:14ZOculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain InjuryD’Silva, Linda J.Chalise, PrabhakarObaidat, SakherRippee, MichaelDevos, Hanneshttps://hdl.handle.net/1808/318442021-07-27T08:00:43Z2021-07-26T00:00:00ZOculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury
D’Silva, Linda J.; Chalise, Prabhakar; Obaidat, Sakher; Rippee, Michael; Devos, Hannes
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
2021-07-26T00:00:00ZInfection risks in multiple myeloma: A systematic review and meta-analysis of randomized trials from 2015 to 2019Balmaceda, NicoleAziz, MuhammadChandrasekar, Viveksandeep ThoguluvaMcClune, BrianKambhampati, SumanShune, LeylaAbdallah, Al-OlaAnwer, FaizMajeed, AneelaQazilbash, MuzaffarGanguly, SiddharthaMcGuirk, JosephMohyuddin, Ghulam Rehmanhttps://hdl.handle.net/1808/317112021-06-29T08:00:36Z2021-06-26T00:00:00ZInfection risks in multiple myeloma: A systematic review and meta-analysis of randomized trials from 2015 to 2019
Balmaceda, Nicole; Aziz, Muhammad; Chandrasekar, Viveksandeep Thoguluva; McClune, Brian; Kambhampati, Suman; Shune, Leyla; Abdallah, Al-Ola; Anwer, Faiz; Majeed, Aneela; Qazilbash, Muzaffar; Ganguly, Siddhartha; McGuirk, Joseph; Mohyuddin, Ghulam Rehman
Background
Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments.
Methods
We performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs).
Results
The risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection.
Conclusions
This is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.
A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.
2021-06-26T00:00:00ZDifferences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysisVopat, Matthew L.Coda, Reed G.Giusti, Nick E.Baker, JordanTarakemeh, ArminSchroeppel, John P.Mullen, ScottRandall, JeffreyProvencher, Matthew T.Vopat, Bryan G.https://hdl.handle.net/1808/317032021-06-25T08:00:41Z2021-05-25T00:00:00ZDifferences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis
Vopat, Matthew L.; Coda, Reed G.; Giusti, Nick E.; Baker, Jordan; Tarakemeh, Armin; Schroeppel, John P.; Mullen, Scott; Randall, Jeffrey; Provencher, Matthew T.; Vopat, Bryan G.
Background:
The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults.
Purpose:
To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed.
Results:
Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; P = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; P < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; P = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; P < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; P = .999).
Conclusion:
Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability.
A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.
2021-05-25T00:00:00ZHospitalization at the end of life in patients with multiple myelomaAbbasi, SaqibRoller, JohnAbdallah, Al-OlaShune, LeylaMcClune, BrianSborov, DouglasMohyuddin, Ghulam Rehmanhttps://hdl.handle.net/1808/317012021-06-24T08:00:55Z2021-03-31T00:00:00ZHospitalization at the end of life in patients with multiple myeloma
Abbasi, Saqib; Roller, John; Abdallah, Al-Ola; Shune, Leyla; McClune, Brian; Sborov, Douglas; Mohyuddin, Ghulam Rehman
Background
Despite advances in treatment, multiple myeloma (MM) remains incurable and results in significant morbidity and mortality. Further research investigating where MM patients die and characterization of end-of-life hospitalizations is needed.
Methods
We utilized the National Inpatient Sample (NIS) to explore the hospitalization burden of MM patients at the end of their lives.
Results
The percent of patients dying in the hospital as a percent of overall MM deaths ranged from 54% in 2002 to 41.4% in 2017 (p < 0.01). Blood transfusions were received in 32.7% of these hospitalizations and infections were present in 47.8% of patients. Palliative care and/or hospice consultations ranged from 5.3% in 2002 to 31.4% in 2017 (p < 0.01).
Conclusion
Our study demonstrates that patients with MM dying in the hospital have a significant requirement for blood transfusions and have a high infection burden. We also show that palliative care and hospice involvement at the end of life has increased over time but remains low, and that ultimately, inpatient mortality has decreased over time, but MM patients die in the hospital at a higher rate than the general population.
A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.
2021-03-31T00:00:00Z