Purpose This study aimed to develop and examine the acceptability, feasibility and usability of a text messaging, or Short Message Service (SMS), system for improving the receipt of survivorship care for adolescent and young adult (AYA) survivors of childhood cancer. Methods Researchers developed and refined the text messaging system based on qualitative data from AYA survivors in an iterative 3-stage process. In stage 1, a focus group (n=4) addressed acceptability; in stage 2, key informant interviews (n=10) following a 6-week trial addressed feasibility; and in stage 3, key informant interviews (n=23) following a 6-week trial addressed usability. Qualitative data were analyzed using a constant comparative analytic approach exploring in-depth themes. Results The final system includes programmed reminders to schedule and attend late effects screening appointments, tailored suggestions for community resources for cancer survivors, and messages prompting participant feedback regarding the appointments and resources. Participants found the text messaging system an acceptable form of communication, the screening reminders and feedback prompts feasible for improving the receipt of survivorship care, and the tailored suggestions for community resources usable for connecting survivors to relevant services. Participants suggested supplementing survivorship care visits and forming AYA survivor social networks as future implementations for the text messaging system. Conclusions The text messaging system may assist AYA survivors by coordinating late effects screening appointments, facilitating a partnership with the survivorship care team, and connecting survivors with relevant community resources. Implications for Cancer Survivors The text messaging system has the potential to improve the receipt of survivorship care.
Introduction: Rapid recovery protocols (RRPs) for total joint arthroplasty (TJA) can reduce hospital length of stay (LOS) and improve patient care in select cohorts; however, there is limited literature regarding their utility in marginalized patient populations. This report aimed to evaluate the outcomes of an institutional RRP for TJA at a safety net hospital. Methods: A retrospective review of 573 primary TJA patients was done, comparing the standard recovery protocol (n = 294) and RRP cohorts (n = 279). Measured outcomes included LOS, 90-day complications, revision surgeries, readmissions, and emergency department visits. Results: The mean LOS reduced from 3.0 6 3.1 days in the standard recovery protocol cohort to 1.6 6 0.9 days in the RRP cohort (P , 0.001). The RRP cohort had significantly fewer 90-day complications (11.1% versus 21.4%, P = 0.005), readmissions (1.4% versus 5.8%, P = 0.007), and revision surgeries (1.4% versus 4.4%, P = 0.047). Conclusion:A RRP for primary TJA can be successfully implemented at a safety net hospital with a shorter LOS and fewer acute adverse events. Such protocols require a coordinated, multidisciplinary effort with strict adherence to evidence-based practices to provide highquality, value-based surgical health care to an underserved cohort. P rimary total knee arthroplasty (TKA) and total hip arthroplasty (THA) are among the most effective, quality of life-improving procedures available to patients. 1 Most patients reach the long-term goals of pain relief and restoration of function after total joint arthroplasty (TJA) 2 ; however, these long-term outcomes may be overlooked by some patients because of acute postoperative pain and surgery-related morbidities. 3 Because the demand for THA and TKA continues to increase, 4 enchaining short-term outcomes has been a target of many surgeons through the use of rapid recovery protocols (RRPs), which aim to expedite recovery and reduce complications while maintaining the highest level of patient care.
Level-1 diagnostic study.Objective. The purpose of this study was to evaluate the sensitivity and specificity of combined motor and sensory intraoperative neuromonitoring (IONM) for cervical spondylotic myelopathy (CSM). Summary of Background Data. Intraoperative neuromonitoring during spine surgery began with sensory modalities with the goal of reducing neurological complications. Motor monitoring was later added and purported to further increase sensitivity and specificity when used in concert with sensory monitoring. Debate continues, however, as to whether neuromonitoring reliably detects reversible neurologic changes during surgery or simply adds set-up time, cost, or mere medicolegal reassurance. Methods. Neuromonitoring data using combined motor and sensory evoked potentials for 540 patients with CSM undergoing anterior or posterior decompressive surgery were collected prospectively. Patients were examined postoperatively to determine the clinical occurrence of new neurologic deficit which correlated with monitoring alerts recorded per established standard criteria.Results. The overall incidence of positive IONM alerts was 1.3% (N ¼ 7) all of which were motor alerts. All were false positives as no patient had clinical neurological deterioration post-operatively. The false-positive rate was 1.4% (N ¼ 146) for anterior surgeries and 1.3% (N ¼ 394) for posteriors with no statistical difference between them (P ¼ 1.0, Fisher exact test). There were no false-negative alerts, and all negatives were true negatives (N ¼ 533). The overall sensitivity of detecting a new neurologic deficit was 0%, overall specificity 98.7%. Conclusion. Combined motor and sensory neuromonitoring for CSM patients created a confusing choice between the motor or sensory data when in disagreement in 1.3% of surgical patients. Criterion standard clinical examinations confirmed all motor alerts were false positives. Surgical plan was negatively altered by following false motor alerts early on, but disregarded in later cases in favor of sensory data. Neuromonitoring added set-up time and cost, but without clear benefit in this series.
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