• The Effect of Two Surgeons on Operative Time, Anesthesia Time, and Blood Loss in Pediatric Patients with Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion Surgery

      Cowan, Kirsten; The University of Arizona College of Medicine - Phoenix; Shrader, M. Wade (The University of Arizona., 2014-04)
      Objective The goal of this study was to investigate the effect of using a two attending surgeon approach on operative time, anesthesia time, and estimated blood loss in patients with neuromuscular scoliosis undergoing posterior spinal fusion surgery. Methods This was a retrospective chart review study of patients with neuromuscular scoliosis who underwent posterior spinal fusion surgery at Phoenix Children’s Hospital in 2011 and 2012. Results Results from 70 patients showed a significant reduction in operative and anesthesia times for patients with two attending surgeons as opposed to one. Mean operative time for the two surgeon group was 3 hours 30 minutes (SD = 49 minutes) and was significantly shorter than 4 hours 26 minutes (SD = 1 hour 22 minutes), the mean operative time for the one surgeon group, t (56) =3.44, p = .001. Mean anesthesia time for the two surgeon group was 5 hours 28 minutes (SD = 55 minutes) and was significantly shorter than 6 hours 9 minutes (SD = 1 hour 28 minutes), the mean anesthesia time for the one surgeon group, t (57) = -2.34, p = .023. There was no significant difference in estimated blood loss found between the groups. The mean blood loss for the two surgeon group was 1202.1 ml( SD = 1033.1) versus 1042.1 ml (SD = 959.41) for the one surgeon group, t(68) = .671, p = .50. This pattern of results remained the same in subgroup analysis designed to compare cases with similar severity of presentation. Significance Patients with neuromuscular scoliosis may benefit from a two attending surgeon approach to posterior spinal fusion. More studies are needed to determine modifiable risk factors for excessive blood loss in neuromuscular scoliosis patients as well as to investigate the effect of using a two surgeon approach on specific post-operative complications.
    • The Effects of Parent Training in Pivotal Response Treatment (PRT) and Continued Support through Telemedicine on Gains in Communication in Children with Autism Spectrum Disorder

      Singh, Namrata; The University of Arizona College of Medicine - Phoenix; Melmed, Raun (The University of Arizona., 2014-04)
      Introduction: With the increase in children diagnosed with autism spectrum disorders (ASD) each year comes the need for individualized interventions necessary for children with autism. Many of the treatments currently available are time consuming, costly, and rely heavily on behavioral interventionists despite the lack of qualified interventionists to provide these services. Therefore, there is a growing recognition of the need for efficient, cost-effective treatment models that involves families in the intervention. This study examined the effects of continuous parent training and feedback for 3 months in Pivotal Response Treatment (PRT) through telemedicine on responsivity to language opportunities in children with ASD versus a control group of parents receiving one week of PRT training alone. We hypothesized that with telemedicine support, the child’s verbal communication would increase. Methods: 30 child-parent dyads from Tucson, AZ were enrolled in this randomized control trial. Subjects were 24-60 months of age and met DSM-IV criteria for autism at the time of enrollment. All subjects received one week of intensive parent training at the Southwest Autism Research and Resource Center (SARRC) in PRT. The support group received telemedicine feedback three times weekly for three months. Data was analyzed using two sample t-tests and Wilcoxon rank sum tests. Results: The control group had a mean responsivity in function verbal utterances of 64.3% and the telemedicine group had a 62.7% verbal responsivity rate prior to initiation of telemedicine support. At three month follow-up, the control group had a mean responsivity rate of 58.6% and the telemedicine group had a mean responsivity of 64.3%. A two sample t-test showed a no significant difference between the two groups with a p-value of 0.51. Conclusions: This study did not find any significant difference between the telemedicine and control groups. However, there is a trend towards increased verbal communication in the telemedicine group. We therefore recommend further studies to determine the utility of telemedicine and parent training in PRT in the treatment of children with ASD.