Improved Agreement With American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on Carpal Tunnel Syndrome.

The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines on the diagnosis and management of carpal tunnel syndrome (CTS). Previous versions made controversial recommendations, which failed to yield universal endorsement. Updated guidelines were published in 2016, and we aimed to evaluate agreement with their highest-strength recommendations among members of the American Society for Surgery of the Hand. An online questionnaire was sent to American Society for Surgery of the Hand members. There were 22 questions that inquired about respondents' specialty, experience level, and practice patterns. We sought to determine their level of agreement with 6 of the highest-strength recommendations in the guidelines. We also investigated their awareness of the guidelines and perceived barriers to their use in clinical practice. The response rate was 17%. The typical respondent was a private practice orthopedic surgeon with at least 10 years of practice. The majority of respondents were aware of the AAOS guidelines. Approximately half (55%) felt that there were no significant barriers to their implementation into clinical practice. Overall, our study demonstrated that nearly half of the respondents agreed with the highest-strength recommendations. There is an improved agreement with the current AAOS guidelines on CTS, perhaps because they reflect a more accurate role in assisting physicians with their independent medical judgment, rather than as fixed protocols. We believe that all surgeons managing CTS should be familiar with the AAOS guidelines. [Orthopedics. 2023;46(2):114-120.].

Effectiveness and Safety Comparison for Systemic Corticosteroid Therapy With and Without Inhaled Corticosteroids for COPD Exacerbation Management.

BACKGROUND: Only 1 small, single-center study has evaluated the combination of systemic plus inhaled corticosteroid (ICS) routes for chronic obstructive pulmonary disease (COPD) exacerbation management. This study aims to further improve the existing quantity and quality of evidence regarding the utility for combination therapy in the management of COPD exacerbation. OBJECTIVES: To evaluate length of hospital stay, readmission rate, incidence of infection, and mortality in hospitalized patients who experience a COPD exacerbation and receive systemic corticosteroid therapy with or without concurrent ICS. METHODS: Design: retrospective cohort study. PARTICIPANTS AND SETTING: patients at least 18 years old admitted between May 31, 2015, and May 31, 2016, for an acute COPD exacerbation at any of 7 Indiana University Health system hospitals. INTERVENTIONS: patients who received an oral or intravenous systemic corticosteroid either with or without concurrent ICS therapy. RESULTS: This study included 241 patients. No significant difference was found between rates of 30-day readmission or inpatient mortality. Patients receiving concurrent therapy had longer lengths of stay versus those who only received systemic corticosteroid therapy (6.35 ± 3.98 vs 4.99 ± 2.89 days, P = 0.0039). Differences in the rates of antifungal use and mechanical ventilation did not statistically differ. Conclusion and Relevance: There was no significant benefit demonstrated when adding ICS to systemic corticosteroid therapy for COPD exacerbation management. These preliminary findings build on the limited evidence on how best to manage corticosteroid therapy in the inpatient setting, but a large, prospective trial remains warranted to confirm these findings given the design, size, and concern for selection bias limitations in the present study.