Norris C. Talbot

Purpose: Previous studies have shown that early rehabilitation is associated with better long-term outcomes in patients with traumatic spinal cord injury. However, data are still limited regarding which factors are associated with discharge to a rehabilitation facility. This study aims to expand on prior research by identifying factors associated with disposition and by introducing a prediction model for these factors.Methods: The National Trauma Data Bank was queried for patients aged 18 years or older who presented to US trauma centers from 2019 to 2021 with traumatic spinal cord injury. Multivariate logistic regression models were used to determine which patient, injury, and hospital variables were significant factors for disposition to a rehabilitation facility, compared to home and intermediate care facilities. Prediction modeling was then performed using these factors.Results: Overall, 14,597 patients were identified, of whom 6,220 were discharged to a rehabilitation facility, 2,647 to an intermediate care facility, and 5,730 to home. Significant factors associated with discharge to a rehabilitation facility compared to home included age, injury location and severity, insurance type, estimated length of stay, systolic blood pressure at admission, and admission blood alcohol level and drug screen results. Similarly, when comparing discharge to a rehabilitation facility with discharge to an intermediate care facility, sex, age, race, estimated length of stay, systolic blood pressure at admission, drug screen results, and coexisting substance use and metabolic conditions all significantly influenced disposition. Fine tree binary classification achieved a prediction accuracy of 72.5% when comparing discharge to a rehabilitation facility and home, and a prediction accuracy of 70.0% when comparing discharge to a rehabilitation facility and an intermediate care facility.Conclusions: This study demonstrates significant factors associated with discharge to a rehabilitation facility in patients with traumatic spinal cord injury. Further studies are needed to improve prediction accuracy.

Decompressive hemicraniectomy (DHC) is performed in emergent cases of uncontrollable intracranial hypertension in which noninvasive procedures or medications are not able to safely maintain pressure within the cranium, increasing the risk of morbidity and mortality. The native bone flap is then replaced, a procedure referred to as cranioplasty, nearly three to six months after injury to allow time for brain relaxation. However, in cases with persistent cerebral edema at the time of cranioplasty, techniques are often applied intraoperatively, including mannitol, external ventricular drain, or lumbar drain placement. To avoid the risks of delaying the procedure or drain placement, we demonstrate a novel technique of splitting the bone flap to adequately increase the size and flexibility. Three patients with a mean age of 44 underwent this novel technique during cranioplasty due to persistent brain edema following a DHC. The new operative technique was successfully performed to compensate for the lingering edema, and all three patients were monitored postoperatively, showing no complications. In this study we demonstrate a new technique to alter bone flap size and flexibility during cranioplasty cases with persistent brain edema, avoiding the need for invasive drain placement. All patients experienced no complications or new cranial/skull defects postoperatively.

Background This analysis is the first systematic review and meta-analysis assessing occurrences of ICD in PD patients treated with oral DAs: ropinirole (ROP) and pramipexole (PRX). This study compares the two oral DAs to a transdermal patch, rotigotine (RTG). Methods We performed an extensive systematic search for eligible studies from PubMed, Embase, Cochrane Library, and Google Scholar. The data was analyzed by various software, including EndNote, Rayyan, PRISM, and RevMan. Two studies incorporating 658 patients collectively were assessed. Results This meta-analysis shows a significant correlation between the usage of PRX (25.3%) or ROP (21.8%) and the development of ICD in PD patients. Compared to the transdermal patch, RTG, PRX was found to have a significant relative risk (P < 0.0001) of 3.46 (95% CI 2.07–5.76), and ROP was found to have a significant relative risk (P < 0.0001) of 2.98 (95% CI 1.77–5.02). The data collected shows RTG is approximately three times less likely to cause ICDs than oral PRX and ROP. Conclusion The present investigation provides insight into ICD occurrences with PRX, ROP, and RTG to allow physicians to make more informed decisions on risk versus reward when deciding how to treat a PD patient with these drugs. However, related to various disclosed limitations, our conclusion cannot provide definitive practice protocols.

Introduction: The procedure of nasotracheal intubation (NI) has long been performed utilizing the Magill forceps as developed by Sir Ivan Magill in the 1920s. While used for nearly a century, several serious patient safety concerns remain including torn tube cuffs, vocal cord trauma, and inefficient tube placement. The Tylke forceps have been developed as a modification to the largely unchanged form of Magill forceps. Methods: In the present investigation we compared the efficacy, number of clasps, and muscle activation involved in NI using the Tylke forceps versus the Magill forceps in previously untrained individuals. Results: Tylke forceps showed faster successful NI over the standard Magill forceps at an average intubation time of 6.54s vs. 13.73s, respectively. Tylke forceps also had fewer clasps per intubation over the Magill. The trapezius, deltoid, and brachioradialis muscle activation was also compared in Tylke vs Magill forceps intubation trials. Tylke forceps required less lower muscle activation in the brachioradialis and trapezius over the Magill forceps with Tylke forceps resulting in higher deltoid muscle activation. Conclusion: Tylke forceps were more efficacious and reduced the number of clasps over the Magill forceps when used in successful NI with different muscle activation patterns.

Meningiomas are the most diagnosed primary central nervous system tumor. Currently, 15 different subtypes of meningioma exist with various characteristics. One extremely rare subtype is myxoid meningioma, which is a World Health Organization grade 1 benign meningioma. These specific meningiomas have only been reported 12 times in the literature. In this representative case, we present a 46‐year‐old female patient with a left frontal myxoid meningioma, describe the findings on imaging, and provide the histopathological features that are needed for diagnosis. Furthermore, this report discusses the other existing myxoid meningioma case reports found throughout the literature.

Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician–patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the “agent-based system”, which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS’s core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application’s features, which may serve as a useful tool for researchers.

Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.