Objective Thoracoscopic lobectomy is associated with lower rates of adverse events compared to thoracotomy. Despite this, postoperative atrial fibrillation (POAF) occurs in at least 10% of patients. Our objective is to determine if prophylaxis with diltiazem significantly reduced POAF events. Methods Patients without prior history of atrial fibrillation who underwent thoracoscopic lobectomy from 2007 to 2016 at one institution were analyzed in a retrospective cohort study utilizing a prospective database. Patients treated from 2007 to 2012 received no prophylaxis. Patients treated after 2012 received diltiazem postoperatively. All patients were monitored with continuous telemetry postoperatively. Multivariate direct logistic regression was performed to determine independent predictors of POAF. We report adjusted odds ratios and accompanying 95% confidence intervals, with P < 0.05 denoting statistical significance. Results The final regression model included 416 patients (52 with POAF, 364 without). In univariate analysis, the variables of body mass index and history of congestive heart failure, diabetes, or hypertension, and prophylaxis status did not meet inclusion criteria. Age, gender, history of stroke or transient ischemic attack, and vascular disease were included. Only ages 65 to 74 ( P = 0.03) and ≥75 ( P = 0.02), compared to <65, were statistically significant predictors of POAF. Adjusted odds ratios of ages 65 to 74 and ≥75 were 2.88 and 2.62, respectively. Conclusions Diltiazem prophylaxis did not significantly reduce POAF incidence following thoracoscopic lobectomy. Further study is warranted since POAF remains an unwanted source of morbidity and cost for lobectomy patients.

Background: The most recent American Academy of Orthopaedic Surgeons Clinical Practice Guidelines found no high-quality evidence comparing home therapy to no therapy following carpal tunnel release surgery (CTRS). Therefore, this study’s purpose is to compare the outcomes of patients receiving home therapy and patients receiving no therapy following endoscopic CTRS. Methods: A single-blinded prospective randomized controlled trial was performed. Patients were randomized to receive home hand therapy or no therapy postoperatively. Patients were assessed at baseline, 2, 6, and 12 weeks postoperatively. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and Boston Carpal Tunnel Questionnaire (BCTQ) scores were evaluated as primary outcome measures. Grip strength, pinch strength, numerical pain rating scale (NRS), static 2-point discrimination, and hand circumference were also measured. Results: Fifty patients were randomized to home therapy while 55 patients were randomized to no therapy. The QuickDASH, BCTQ functional status scale (FSS), and BCTQ symptom severity scale (SSS) improved over time in both treatment groups. As-treated and intention-to-treat analysis showed no difference in improvement of QuickDASH, BCTQ FSS, or BCTQ SSS between treatment groups. Additionally, there was no significant difference between treatment groups in grip strength, chuck and key strength, NRS, hand circumference, and static 2-point discrimination. Conclusions: This blinded, prospective randomized controlled study shows no significant difference in improvement of QuickDASH, BCTQ SSS, and BCTQ FSS scores between patients receiving no therapy and home therapy following endoscopic CTRS. Consideration should be given to releasing patients without supervised therapy in the postoperative setting. Level of Evidence: Level II Therapeutic

INTRODUCTION: For emergency contraception (EC) to be effective, it has to be readily available. Thus, in 2013 the FDA approved EC Levonorgestrel (LNG) for sale over-the-counter (OTC) without a prescription or age limit. Although requiring a prescription, Ulipristal acetate (UPA) approved in 2010 for EC may be more effective than LNG in certain circumstances. We sought to determine the accessibility of these EC medications at pharmacies in the Lehigh Valley Area of Pennsylvania (population 850,000). METHODS: Phone surveys were conducted of Corporate and Independent pharmacies. Only the pharmacist or pharmacy tech provided information about availability, age requirements and accessibility of EC. Corporate and Independent pharmacies were compared using chi squared test with appropriate correction. RESULTS: The EC survey included 104 Corporate (CorP) and 26 Independent pharmacies (IndP) in the prescribed area. EC was in stock in 95/104 (91%) of CorP and 14/26 (54%) of IndP (p<.001). UPA was in stock at 12/104 (11%) of CorP and none of the IndP (p=.15). Age restriction was noted in 24/104 (23%) of CorP and 8/26 (31%) of IndP (p=.58). LNG over the counter location was found in 75/104 (72%) of CorP and 2/26 (8%) of IndP (p<.001). CONCLUSION: Although regional differences may apply, the availability/accessibly of EC is not ideal. Although the corporate pharmacies appear better than independents, the lack of UPA is a concern. Physicians should be aware of the availability of EC in their area.

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