Browsing by Author "Palma, Samantha"

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    Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty
    (Sage, 2023) Patel, Purva V.; Giannoudis, Vasileios P.; Palma, Samantha; Guy, Stephen P.; Palan, Jeya; Pandit, Hemant; Van Duren, Bernard H.; Graduate Medical Education, School of Medicine
    Background/objective: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively. Methods: A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis. Results: 14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant (p < 0.05).Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients (n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days). Conclusions: The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.
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    The Heart of Maternal Mortality: Postpartum Cardiomyopathy and Its Upstream Determinants of Health
    (2020) Campbell, Meredith; Lee, Deborah; Marks, Claire; Palma, Samantha; Yang, Caroline
    CASE: A 25-year-old obese African American female presented with dyspnea 6 weeks after a full-term vaginal delivery complicated by pre-eclampsia. Further work up showed LV enlargement without hypertrophy and globally decreased contractility consistent with postpartum cardiomyopathy as well as endocarditis with vegetations on the aortic and tricuspid valves. In the setting of poor patient compliance, patient progressed to worsening systolic heart failure as LVEF dropped from 45% to 25% within a year. Despite further management including valve replacement, ICD placement and a continuous milrinone treatment, LVEF continued to decline, with the lowest value at 12%. During one of her recurrent acute respiratory failures, the patient and team made the difficult decision to transition to palliative care, where she expired. BACKGROUND: Postpartum cardiomyopathy (PPCM) is a life-threatening disease that arises between the last month of pregnancy and four months after delivery, where patients present with dyspnea, dizziness, or lower extremity edema. Although it is rare with an incidence of 1 case per 2187 live births, it has a high mortality rate in the US ranging from 6% to 10%, mostly in the first 30 days. DISCUSSION: Multiple recent studies have demonstrated the significance of early diagnosis of PPCM and its strong association with more favorable outcomes, including greater LVEF recovery and lower rates of morbidity and mortality. This evidence suggests the need for pre-discharge screening, in order to diagnose patients earlier and give them the greatest opportunity for a full recovery. Additionally, patient noncompliance, largely influenced by socioeconomic status and medical literacy of the patient, is another crucial factor that affects the prognosis of PPCM. Effective strategies to increase compliance include educating the patient, using an inter-professional healthcare team, and working with the psychological and socioeconomic barriers to compliance.
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    Injury Patterns and Demographics in Child and Adolescent Assault Victims Presenting to US Emergency Departments
    (Hindawi, 2020-10) Loder, Randall T.; Palma, Samantha; Smith, Maddie; Orthopaedic Surgery, School of Medicine
    Objective: To correlate injury patterns with patient demographics in child and adolescent assault victims. Methods: The National Electronic Injury Surveillance System-All Injury Program data for the years 2005 through 2015 was used. Injuries due to assault were identified and analyzed with SUDAAN 11.0.01™ software to account for the weighted, stratified nature of the data. Results: There were an estimated 4,407,009 ED visits for assault in patients ≤ 19 years of age. With increasing age, the percentage of females decreased. Sexual assaults were more common in females (87.4%), and robbery/burglary was more common in males (79.8%). When the perpetrator was a spouse/partner, the assault victim was most commonly female (88.8%), and when a stranger, the assault victim was most commonly male (71.5%). With increasing age, the percentage of sexual assaults decreased while the reason for the assault being unknown increased. The assault occurred in the home in 59.6% of those ≤ 4 years of age, decreasing to 18.7% in those 15 to 19 years of age. The anatomic location was the head/neck in 32.8% of those ≤ 4 years of age, increasing to 60.6% in those 15-19 years old. Those ≤ 4 years old had the highest hospital admission rate (8.3%). The main diagnoses were concussion (3.0%), contusion/abrasion (33.3%), fracture (11.5%), laceration (11.5%), internal organ injury (11.5%), puncture (2.8%), and strain/sprain (20.7%). The number of assaults from 2005 to 2015 decreased for all age groups except for those ≤ 4 years old. Conclusions: These data provide a comprehensive overview of child and adolescent assault victims presenting to the ED in the USA and can be used as background data for further study. The decreasing numbers of assaults over the 11 years of the study are encouraging, and challenges still exist in decreasing the number for those ≤ 4 years old.
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    Patients Generally May Return to Driving 4 Weeks After Hip Arthroscopy and 6 Weeks After Knee Arthroscopy: A Systematic Review and Meta-analysis
    (Elsevier, 2021-10-06) Palma, Samantha; Giannoudis, Vasileios; Patel, Purva; Palan, Jeya; Guy, Stephen; Pandit, Hemant; Van Duren, Bernard; Medicine, School of Medicine
    Purpose: To consolidate the evidence from the available literature and undertake a meta-analysis to provide a reference for physicians to make evidence-based recommendations to their patients regarding the return to driving after hip or knee arthroscopic procedures. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The OVID, Embase, and Cochrane databases were searched through June 2020 for articles containing keywords and/or MeSH (Medical Subject Headings) terms "hip arthroscopy" and "knee arthroscopy" in conjunction with "total brake response time" or "reaction time" in the context of automobile driving. A title review and full article review were performed to assess quality and select relevant articles. A meta-analysis of qualifying articles was undertaken. Results: Eight studies met the inclusion criteria for meta-analysis of brake reaction time (BRT). Meta-analysis of all knee BRTs showed times slower than or equal to baseline BRTs through 5 weeks, with a trend of improving BRTs from 6 to 10 weeks (weeks 8 and 10 were significant, P < .05). Among all hip BRTs, week 2 showed times slower than baseline BRTs, but after week 4, a trend toward faster BRTs was observed through week 8 (week 8 was significant, P < .05). Conclusions: BRTs met baseline or control values and continued to improve after 6 weeks after knee arthroscopy and after 4 weeks after hip arthroscopy. On the basis of these results, it would be safe to recommend a return to driving at 6 weeks after knee arthroscopic procedures and 4 weeks after hip arthroscopic procedures. Clinical relevance: These results can be used by surgeons to base their recommendations on to provide guidance for their patients on the resumption of driving. Although BRT is an important aspect of driving ability, there are additional factors that need to be taken into consideration when making these recommendations, including cessation of opioid analgesics, strength of the surgical limb, and range of motion.