Purpose
This paper reports on an investigation of spatial patterns of out-of-hospital cardiac arrest (OHCA) incidence in a large American city. The purpose of this paper is to identify neighborhoods and public occupancies with highest risk in order to develop an evidence-based strategy to promote cardiac health and improve survival.
Design/methodology/approach
Two-tailed bivariate analysis was conducted using a Spearman correlation coefficient to check the covariance of census variables that were expected to relate to OHCA incidence. A principal component analysis was conducted on the remaining variables that statistically correlated with OHCA. Local indicators of spatial analysis was conducted to test the OHCA risk index and assess how well it predicts the observed OHCA incidence.
Findings
Clusters of OHCA events were found in neighborhoods with socially isolated older persons, as well as low-income minority populations. However, while past research has documented high-risk OHCA locations, these were not the case in this community.
Originality/value
The results highlight the importance of using local data to develop public health policies. Understanding neighborhood-level risks invariably guides resource allocation, service provision, and policy decisions to improve community public health and safety outcomes.
Background
Traumatic amputees commonly experience residual limb pain (RLP) and phantom limb pain (PLP) which present major barriers to rehabilitation. An evolving treatment, targeted muscle reinnervation (TMR), shows promise in reducing these symptoms. While initial data is encouraging, existing studies are low power, and more research is needed to assess the long-term outcomes of TMR. We present the results of self-reported outcome surveys distributed to major-limb amputees >1-year post-TMR which were compared to similar data from a landmark randomized control trial for context.
Methods
Data was obtained from 17 adult traumatic amputees who were >1-year post-TMR using a numerical rating scale (NRS) and The Patient-Reported Outcomes Measurement Information System (PROMIS) survey tool. Results were compared to a 2019 randomized control trial by Dumanian et. al. which assessed TMR vs standard care (SC) after major limb amputation and demonstrated improvement in pain scores 1-year post-TMR.
Results
There was a statistically significant reduction in this cohort of TMR amputees’ RLP worst-pain scores relative to the comparison study’s SC amputees (without TMR). In general, there was no significant difference in outcomes between TMR cohorts. However, PLP worst-pain was significantly higher in this cohort relative to the comparison study’s TMR group.
Conclusions
These findings support the use of TMR for reducing RLP in traumatic amputees. Relative to a similar group treated without TMR in the comparison study, this cohort’s RLP was significantly improved. Future studies should aim to recruit more amputees to allow for analysis of functional outcomes, especially in upper limb amputees.
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