BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk...BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.展开更多
Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychoso...Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multidisciplinary teams delivering holistic care.展开更多
文摘BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.
基金This research was funded by Stanford University School of Medicine。
文摘Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multidisciplinary teams delivering holistic care.
