The coronavirus pandemic highlighted the need for remote patient monitoring to deliver and provide access to patient care and education. A mobile-based app providing interactive tools for patient ...education and monitoring was piloted at Thunder Bay Regional Health Sciences Centre (TBRHSC) in November 2020. We aimed to examine the platform’s impact on postoperative length of stay, hospital readmissions, and emergency department (ED) visits 60 days postsurgery in total hip and knee arthroplasty patients in Northwestern Ontario.
Data were assessed from patients undergoing primary total hip or knee arthroplasties at TBRHSC from March 1, 2020, to February 28, 2022. Patients were divided into 2 cohorts based on enrollment with the mobile-based app (SeamlessMD). Statistical differences in outcomes were determined using Mann-Whitney or χ2 tests. An odds ratio was calculated for ED visits.
Patients enrolled in the mobile-based app had statistically lower length of stay (U = 7779.0, P < .001) and fewer ED visits (χ2(1,212) = 5.570, P = .018) than patients not enrolled in the program. Patients not enrolled had 2.31 times greater odds of visiting the ED postsurgery (odds ratio = 0.432, 95% confidence interval = 0.213-0.877, P = .022). There were no statistical differences found in readmission rates.
The implementation of the mobile-based app at TBRHSC showed its potential value as a tool to reduce costs in the healthcare system and improve patient outcomes. Consequentially, more formal studies are required to elucidate the magnitude of this effect.
This paper describes a reinvestigation of the literature concerning the synthesis and structural characterization of the platinum(IV)-based anticancer drug known as CPA-7 and believed to be the ...compound fac-PtCl3(NO2)(NH3)2. CPA-7 has previously been extensively investigated for its ability to control tumor cell growth by inhibition of Stat3 signaling, but very little information is available concerning its synthesis or spectroscopic properties. A reproducible synthetic route is shown to produce an active material which is characterized by IR and 1H, 14N, 15N, and 195Pt NMR spectroscopy, and single crystal X-ray crystallography. The freshly prepared drug is obtained as a single isomer which may in fact be fac- or mer-PtCl3(NO2)(NH3)2, but recrystallization resulted in a disordered crystal containing approximately equal amounts of the two geometric isomers.
Syntheses of the phosphonium-1-indenylide (PHIN) ligands triphenylphosphonium-1-indenylide (1-C9H6PPh3, I), methyldiphenylphosphonium-1-indenylide (1-C9H6PMePh2, II), and ...dimethylphenylphosphonium-1-indenylide (1-C9H6PMe2Ph, III) are reported, as are syntheses of the corresponding planar chiral ruthenium(II) complexes Ru(η5-C5H5)(η5-1-C9H6PPh3)PF6 (IV), Ru(η5-C5H5)(η5-1-C9H6PMePh2)PF6 (V), and Ru(η5-C5H5)(η5-1-C9H6PMe2Ph)PF6 (VI). The ruthenium complexes have been characterized by 1H, 13C, and 31P NMR spectroscopy, by X-ray crystallography, and by extensive DFT calculations, which produce optimized geometries consistent with the crystallographic data. The PHIN–Ru bond strengths are calculated to be ∼20 kcal/mol greater than the corresponding benzene–Ru bond strength of Ru(η5-C5H5)(η6-C6H6)+ and are compatible with the observed configurational stability of the complexes. That interconversion of enantiomers via interfacial exchange of the η5-bound ligands does not occur is demonstrated by the observation of diastereotopic phenyl groups in the 1H NMR spectrum of V and of diastereotopic methyl groups in the 1H NMR spectrum of VI.
Patients with knee osteoarthritis (OA) in northwestern Ontario are referred by their primary care provider (PCP) to a centralized assessment clinic for evaluation by an advanced practice ...physiotherapist (APP) to determine if they will require surgical management. However, many patients are found to not require surgical management, resulting in delays for patients who do. A decision-support tool was developed to address this issue and to guide treatment options by determining the need for surgical or nonsurgical approaches.
We used a proof-of-concept method to assess the use of the decision-support tool in northwestern Ontario. Data from 100 consecutive patients assessed for knee OA management were collected from the Thunder Bay centralized assessment clinic. Two levels of agreement analyses (calculated using Cohen κ statistic) were performed, between the APP assessment decision (surgical or non-surgical) and the decision-support tool recommendation, and between the surgeon's decision (surgical or non-surgical) and the decision-support tool recommendation.
We found a near-perfect agreement (κ = 0.870,
= 65) between the APP decision and the decision-support tool recommendation, when controlled for patient preference. There was a substantial level of agreement (κ = 0.618,
= 72) between the decision-support tool recommendation and the surgeon's decision.
The decision-support tool recommendation showed considerable agreement with the decisions of the APP and surgeon indicating that it could be a valuable tool to guide PCPs caring for patients with knee OA. The applicability of a decision-support tool in northwestern Ontario displayed promising results, but further research is needed to examine the feasibility in a primary care setting.
Chronic, non-cancer pain affects approximately 20-30% of the population in North America, Europe, and Australia, with surgery and trauma frequently cited as inciting events. Prospective studies of ...fracture patients have demonstrated an association between somatic pre-occupation, poor coping, and low recovery expectations following surgery with persistent pain, functional limitations, and lower rates of return to work. Psychological interventions, such as cognitive behavioural therapy (CBT), that are designed to modify unhelpful beliefs and behaviours have the potential to reduce persistent post-surgical pain and its associated effects among trauma patients.
To determine whether online CBT, versus usual care, reduces the prevalence of moderate to severe persistent post-surgical pain among participants with an open or closed fracture of the appendicular skeleton.
The Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE) protocol will be followed to conduct a multi-centre randomized controlled trial. Participants undergoing surgical repair of a long bone fracture will be randomized to receive either (1) online CBT modules with asynchronous therapist feedback or (2) usual care. The primary outcome will be the prevalence of moderate to severe persistent post-surgical pain over 12 months post-fracture. Secondary outcomes include the Short Form-36 Physical and Mental Component Summary scores, return to function, pain severity and pain interference over 12 months post-fracture, and the proportion of patients prescribed opioid class medications (and average dose) at 6 and 12 months post-fracture. The COPE trial will enroll 1000 participants with open and closed fractures of the appendicular skeleton from approximately 10 hospitals in North America.
If CBT is effective in improving outcomes among patients with traumatic fractures, our findings will promote a new model of care that incorporates psychological barriers to recovery.
ClinicalTrials.gov Identifier: NCT04274530. Registered on 14 February 2020.
Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological ...factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture.
Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery.
Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria.
Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program.
ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258.
To perform static breath-hold fluorine 19 ((19)F) three-dimensional (3D) ultrashort echo time (UTE) magnetic resonance (MR) imaging of the lungs in healthy volunteers by using a mixture of 79% ...perfluoropropane (PFP) and 21% O2.
This study protocol was approved by the local research ethics board and by Health Canada. All volunteers provided written informed consent. Ten healthy volunteers underwent MR imaging at 3.0 T. Fluorine 19 3D UTE MR images were acquired during a 15-second breath hold according to one of two breathing protocols: protocol A, a 1-L inhalation of a mixture of 79% PFP and 21% O2, and protocol B, continuous breathing from a 5-L bag of a mixture of 79% PFP and 21% O2 followed by a 1-L inhalation of the same PFP-O2 mixture from a separate bag and a subsequent breath hold. The signal-to-noise ratio (SNR) was measured in the three most central image sections and was compared between breathing protocols by using an unpaired t test.
Overall, the SNR was significantly greater for breathing protocol B (continuous breathing) than for breathing protocol A (single breath) (P = .018). The mean SNRs were 18 ± 6 (standard deviation) and 32 ± 6 for images acquired by using breathing protocols A and B, respectively. Breathing protocol B improves SNR by "washing out" the air from the lungs and increasing the PFP concentration prior to (19)F imaging.
This study demonstrates the feasibility of (19)F 3D UTE static breath-hold MR imaging of human lungs with inert fluorinated gases.
A class of phosphonium cyclopentadienylide ligands was first reported in 1956 by Ramirez and Levy, who synthesized triphenylphosphonium cyclopentadienylide. They discovered that this ylide was ...unusually inert, for instance being unreactive with ketones; they attributed this unusual stability to its ability to undergo charge delocalization. It was subsequently found that the ylide coordinates to metals in η5 fashion, and thus one might anticipate a rich chemistry involved with these ligands, although surprisingly little research on this fascinating ligand has been reported over the past 50 years. More recently, the coordination chemistry of its analogous compound, methyldiphenylphosphonium cyclopentadienylide, has been investigated, specifically using group six transition metals. As an extension of the latter work, we have now successfully developed a general synthetic route to similar phosphonium 1-indenylide compounds, IndPL 3 (L3 = Ph3, PMePh2, PMe2Ph). The coordination of these compounds is of particular interest given that the compounds that form exhibit planar chirality and, as a result, enantioselective catalytic properties are anticipated. Furthermore, reactions involving two molar equivalents of phosphonium 1-indenylide, where two ligands coordinate, would produce diastereomers. It was our attempt to extend this work to group 4 metal halides, specifically to form coordination compounds of the type TiCl3(IndPL3)Cl and TiCl2(IndPL 3)2Cl2. These compounds could be of great importance as enantioselective polymerization catalysts, or alternatively anti-cancer agents.
