Aspirus Wausau Hospital

Spinal surgeries have become common procedures due to greater life expectancy and the increasing elderly population. Failed fusion, or nonunion, may be influenced by patient risk factors and can lead to a myriad of complications. Pulsed electromagnetic field (PEMF) stimulation is a noninvasive post-operative adjunct therapy that has been shown to influence underlying cellular processes that may improve osteogenesis to promote successful fusion following spinal surgery. The aim of the study was to evaluate the effect of PEMF on lumbar fusion in patients with risk factors for nonunion. The current study employed a prospective, multicenter study to investigate PEMF as an adjunct therapy following lumbar spinal fusion procedures in subjects with risk factors for failed fusion. A retrospective control arm was used as a comparator. Subjects were enrolled with at least one of the following risk factors: prior failed fusion, multi-level fusion, nicotine use, osteoporosis, advanced age (>65 years), body mass index >30 kg/m2, and diabetes. PEMF was delivered for 6-months following surgery. Overall fusion status and influence of risk factors were assessed. Successful fusion was determined by radiographic imaging. Fusion status was compared at a 12-month follow-up in subjects treated with PEMF (n=142) vs. control (n=47). Successful fusion was observed in 88.0% (n=125/142) of PEMF subjects and 68.1% (n=32/47) of control subjects. PEMF therapy resulted in statistically improved fusion rates in subjects with prior failed fusion (P=0.04), multi-level fusion surgery (P<0.001), and advanced age (P<0.001) when compared to control. PEMF therapy resulted in statistically improved fusion rates in subjects who had at least one risk factor (P=0.002), ≥2 risk factors (P<0.001), and ≥3 risk factors (P=0.003) compared to control. Linear regression analyses showed a significant treatment effect of PEMF across all risk factors and presentations (P=0.003). A favorable safety profile was observed with PEMF therapy. PEMF therapy improved fusion success in subjects following lumbar spinal surgery and represents a beneficial adjunct treatment resulting in significant improvements in subjects having risk factors for nonunion.

Background: Quality-of-life (OQL) is recognized as a proven benefit of atrial fibrillation (AF) ablation. The DEEP trial (NCT02393885) showed safety (6.7%) and efficacy (71.8%) of an epicardial-endocardial hybrid ablation (HA) approach with left atrial appendage exclusion (LAAE) for non-paroxysmal AF; results were consistent with two randomized trials comparing HA+LAAE to catheter ablation (CA). Limited data exist on QOL after HA+LAAE. Goal: To evaluate QOL changes from baseline to 12-months post-HA+LAAE in the DEEP trial. Methods: DEEP is a 17-site prospective, international, single arm trial. Key eligibility: adults with non-paroxysmal AF, left atrial diameter ≤5.5cm, failed class I/III anti-arrhythmic drugs, and ≤2 prior failed CA. Stage 1 was thoracoscopic radiofrequency epicardial ablation to isolate the pulmonary veins and left atrial posterior wall, and LAAE. Stage 2 was endocardial mapping and touchup ablation. QOL was measured via the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 12-months post-HA+LAAE. AFEQT yields scores from 0 to 100 (0 as complete disability and 100 as no disability) and includes an overall and four subscale scores. A 5-point AFEQT change is clinically important. Mean differences with 95% CIs were calculated; p-values are from paired t-tests. Results: Of 85 patients, 82 completed both baseline and 12-month AFEQT. The mean change in overall score was 30.1 ± 19.8 (95% CI: 25.8-34.5; median 29.5, min, max: -15.4, 78.2; p&lt;0.0001) (Figure). The greatest improvement was in the Treatment Satisfaction subscale with a mean score of 53.2 ± 29.9 (95% CI: 46.6-59.7; median 58.3, min, max: 0.0, 100.0; p&lt;0.0001), followed by Treatment Concern, Daily Activities, and Symptoms subscale scores. All mean improvements from baseline exceeded a clinically meaningful 5-point change. Conclusion: In the DEEP trial, HA+LAAE resulted in patient-reported QOL improvements at 12-months post-procedure.

Background and ObjectivesInternational evidence shows that patients treated at nonurban hospitals experience poorer access to key stroke interventions. Evidence for whether this results in poorer outcomes is conflicting and generally based on administrative or voluntary registry data. The aim of this study was to use prospective high-quality comprehensive nationwide patient-level data to investigate the association between hospital geography and outcomes of patients with stroke and access to best-practice stroke care in New Zealand.MethodsThis is a prospective, multicenter, nationally representative observational study involving all 28 New Zealand acute stroke hospitals (18 nonurban) and affiliated rehabilitation and community services. Consecutive adults admitted to the hospital with acute stroke between May 1 and October 31, 2018, were captured. Outcomes included functional outcome (modified Rankin Scale [mRS] score shift analysis), functional independence (mRS score 0–2), quality of life (EuroQol 5-dimension, 3-level health-related quality of life questionnaire), stroke/vascular events, and death at 3, 6, and 12 months and proportion accessing thrombolysis, thrombectomy, stroke units, key investigations, secondary prevention, and inpatient/community rehabilitation. Results were adjusted for age, sex, ethnicity, stroke severity/type, comorbid conditions, baseline function, and differences in baseline characteristics.ResultsOverall, 2,379 patients were eligible (mean [SD] age 75 [13.7] years; 51.2% male; 1,430 urban, 949 nonurban). Patients treated at nonurban hospitals were more likely to score in a higher mRS score category (greater disability) at 3 (adjusted odds ratio [aOR] 1.28, 95% CI 1.07–1.53), 6 (aOR 1.33, 95% CI 1.07–1.65), and 12 (aOR 1.31, 95% CI 1.06–1.62) months and were more likely to have died (aOR 1.57, 95% CI 1.17–2.12) or experienced recurrent stroke and vascular events at 12 months (aOR 1.94, 95% CI 1.14–3.29 and aOR 1.65, 95% CI 1.09–2.52). Fewer nonurban patients received recommended stroke interventions, including endovascular thrombectomy (aOR 0.25, 95% CI 0.13–0.49), acute stroke unit care (aOR 0.60, 95% CI 0.49–0.73), antiplatelet prescriptions (aOR 0.72, 95% CI 0.58–0.88), ≥60 minutes of daily physical therapy (aOR 0.55, 95% CI 0.40–0.77), and community rehabilitation (aOR 0.69, 95% CI 0.56–0.84).DiscussionPatients managed at nonurban hospitals experience poorer stroke outcomes and reduced access to key stroke interventions across the entire care continuum. Efforts to improve access to high quality stroke care in nonurban hospitals should be a priority.

Medical physicists can be exposed to significant liability risks when performing clinical duties. The nature and extent of such exposure is not always as clear to physicists as it is to physicians. The legal questions involved in resolving a case or claim involving patient harm are complex and are seldom governed according to common sense expectations. Whether a physicist is employed by a hospital or healthcare provider or functions independently as a contractor or consultant, the first line of defense against liability risk is contract negotiation. In this process, the physicist has the opportunity to establish a respectful, collaborative relationship with an employer or client while laying out clear rules and expectations for the handling of any incidents. Much legal, financial, and professional trouble can be avoided by handling this process carefully. This session explores methods and principles for establishing good relationships and contracts. Should a lawsuit occur, it is important to have a basic understanding of civil procedure and the “anatomy” of a professional liability case. This session will review common legal terminology and present examples from seminal cases that are used as the basis of many liability and malpractice cases today. In the event that a physicist is named as a defendant in a lawsuit, he or she should be well‐informed about the expected sequence of events and how they relate to the overall outcome of the case. Professional liability insurance is a useful tool to provide protection to an individual physicist's personal assets and income in the event of a lawsuit, and especially after an adverse legal decision or settlement. The choice of the appropriate amount and type of protection is an individual and complicated decision. Some employers of physicists also provide coverage to their employees, and the nature and extent of this coverage can be challenging to understand fully. This session discusses the common features and aspects of professional liability insurance products to enable the clinical medical physicist to evaluate their own situation and to choose an appropriate product for their needs.Learning Objectives:1. Describe a strategy for medical physicists to minimize liability risk by establishing and negotiating healthy contract relationships with employers or clients.2. Recognize the common elements of civil procedure and explain how they are impacted by typical clinical medical physics activities, such as quality control and recordkeeping.3. Evaluate commercial professional liability insurance offerings in the context of a physicist's personal asset and income protection needs and practice type and setting.

This article describes the development of a tailored family-centered approach to genetic counseling following abnormal newborn screening (NBS) for cystic fibrosis (CF). A genetic counseling consortium reviewed research literature, selected theoretical frameworks, and incorporated counseling psychology micro skills. This innovative intervention integrated theories and empirically validated techniques. Pilot testing and parent feedback confirmed satisfaction with and feasibility of the approach designed to (a) minimize parents' distress, (b) facilitate parents' understanding, (c) increase parents' capacities to use genetic information, and (d) enhance parents' experiences with genetic counseling. Counselors engage in a highly interactive process of evaluating parents' needs and tailoring assessments and interventions that include a therapeutic environment, the family's emotional needs, parents' informational needs, and a follow-up plan. This promising new model is the first to establish a theory-driven, evidence-based standard for genetic counseling in the context of NBS for CF. Additional research will evaluate the model's efficacy in clinical practice.

Pituitary adenomas comprise approximately 10% to 20% of all central nervous system neoplasms whereas autopsy series have suggested that the incidence of pituitary adenoma in the general population may approach 25%. Several treatment modalities are used in the treatment of pituitary adenomas, including observation, surgery, medical intervention, and radiotherapy. The treatment modality employed depends greatly on the type of pituitary adenoma and presenting symptoms. This review will discuss the biology of pituitary adenomas and the current management principles for the treatment of prolactinomas, Cushing disease, acromegaly, and nonsecretory adenomas, with an emphasis on the published radiotherapeutic literature.

RUGBY UNION FOOTBALL IS A SPORT THAT IS EXPERIENCING AN INCREASED NUMBER OF PARTICIPANTS AT THE HIGH SCHOOL AGED LEVEL. THE GAME IS UNIQUE IN THAT IT COMBINES ELEMENTS OF STRENGTH, POWER, SPEED, AGILITY, AND ENDURANCE INTO A GAME OF CONTACT AND COLLISION WITH MINIMAL USE OF PROTECTIVE PADDING. THIS CONTACT CAN PRECIPITATE CERTAIN INJURIES THAT COULD CUT A PLAYER'S CAREER SHORT. OVERALL, THE INJURY RATE FOR RUGBY UNION FOOTBALL IS NO HIGHER THAT THOSE FOR AMERICAN FOOTBALL, SOCCER, OR BASKETBALL. THIS ARTICLE WILL DISCUSS EXERCISES TO STRENGTHEN THE CERVICAL SPINE MUSCULATURE TO HELP REDUCE THE RISK OF INJURY AND AID PERFORMANCE IN THE HIGH SCHOOL AGED RUGBY PLAYING ATHLETE.

In Brief Get inside intra-aortic balloon pump therapy. Initiation of intra-aortic balloon pump therapy is a relatively safe and easy procedure, allowing a wide range of hospitals to take advantage of its lifesaving effects. In the United States alone, it's used on approximately 100,000 patients per year and plays an important part in helping to mend “broken” hearts.