bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuromuscular adaptations to experimentally induced pain in the lumbar region: systematic review and meta-analysis
Authors: Devecchi Valter , Falla Deborah , Cabral Hélio V. , Gallina Alessio
Published: February 2023

Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy individuals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.
Stress biomarkers in individuals with fibromyalgia syndrome: a systematic review with meta-analysis
Authors: Beiner Eva , Lucas Victoria , Reichert Julian , Buhai Diana-Victoria , Jesinghaus Meike , Vock Stephanie , Drusko Armin , Baumeister David , Eich Wolfgang , Friederich Hans-Christoph , Tesarz Jonas
Published: February 2023

Evidence suggests an involvement of hypothalamic–pituitary–adrenal (HPA) axis dysregulation in the development and maintenance of fibromyalgia syndrome (FMS). However, studies on the stress response via the HPA-axis in individuals with FMS show conflicting results. To better understand the relationship between FMS and HPA-axis dysregulation, we (1) systematically summarized the current level of evidence on HPA biomarkers in individuals with FMS compared with individuals without and (2) evaluated whether FMS is associated with a specific pattern of HPA dysregulation. The main outcome measures were cortisol, adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), epinephrine, and norepinephrine. A systematic search of MEDLINE, EMBASE, and PsychMed yielded 47 studies eligible for meta-analysis, including 1465 individuals with FMS and 1192 FMS-free controls. No main effect of FMS was found on altered levels of blood cortisol, ACTH, CRH, and epinephrine. Compared with controls, salivary and urinary cortisol levels were decreased in individuals with FMS, whereas blood levels of norepinephrine were increased. However, heterogeneity of data was high with significant evidence for publication bias. Overall, the data are compatible with association of FMS with adrenocortical hypofunction in the presence of increased sympathetic tone. However, the data are partially contradictory, so it must be assumed that the data are highly dependent on the respective study designs, patient samples, and analytical methods and do not necessarily demonstrate an abnormal HPA-axis function in FMS.
Pain-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain
Authors: Plinsinga Melanie Louise , Vuvan Viana , Maclachlan Liam , Klyne David , Graven-Nielsen Thomas , Vicenzino Bill , Hodges Paul , Bjarke Vaegter Henrik
Published: February 2023

Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
Risk factors for hemorrhagic complications following robotic-assisted partial nephrectomy
Authors: Tsai Cheng-Han , Chung Hsiao-Jen , Huang Eric Y.H. , Lin Tzu-Ping , Huang Tzu-Hao , Huang William J.
Published: February 2023

Background:

The aim of this study was to analyze the risk factors for hemorrhagic complications in patients who underwent robotic-assisted partial nephrectomy.

Methods:

We retrospectively reviewed the records of 260 patients who underwent robotic-assisted partial nephrectomy. Hemorrhagic complications were defined as bleeding, hematoma, or arteriovenous fistula requiring hemostatic medication, blood transfusion, or therapeutic intervention. Hemorrhagic complications were graded according to the modified Clavien classification system, and the hemorrhagic complication group comprised only those complications with Clavien grade II or higher. Thereafter, we investigated the presence of any relevant association between perioperative factors and hemorrhagic complications.

Results:

Of 260 patients included in the study, 32 (12.3%) had hemorrhagic complications. The postoperative hemoglobin level was significantly lower in the hemorrhagic complication group than in the group without complications. The hemorrhagic complication group had significantly more essential blood loss and a significantly longer length of hospital stay. In the univariate analysis, type 2 diabetes mellitus, Radius-scores tumor size as maximal diameter exophytic/endophytic properties of the tumor nearness of the deepest portion of the tumor to the collecting system or renal sinus anterior (a)/posterior (p) descriptor location relative to the polar line., sum of the renal size plus renal sinus involvement in the PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS, prolonged console time (>180 minutes), prolonged warm ischemic time (>25 minutes), and method of pedicle control were statistically significant risk factors. In the multivariate logistic regression analysis, warm ischemic time >25 minutes was the only significant risk factor for hemorrhagic complications (odds ratio, 3.51; 95% confidence interval, 1.28-9.59; p = 0.01).

Conclusion:

Patients who undergo robotic-assisted partial nephrectomy with a warm ischemic time >25 minutes are significantly more likely to have hemorrhagic complications and should hence receive careful perioperative follow-up.
The determinants of health-related quality of life among patients with newly diagnosed lung cancer in Taiwan: A cross-sectional study
Authors: Liao Chia-Hui , Yu Shu , Lin Kuan-Chia , Wu Yu-Chung , Wang Tsae-Jyy , Wang Kwua-Yun
Published: February 2023

Background:

Although considered one of the most important prognostic factors for lung cancer patients, the health-related quality of life (HRQOL) of the newly diagnosed lung cancer population remains scarcely focused on in the literature. Therefore, we aimed to identify the determinants of HRQOL among newly diagnosed lung cancer patients in Taiwan.

Methods:

Two hundred and fifty patients newly diagnosed with lung cancer were recruited from a medical center in northern Taiwan through convenience sampling. Four structured questionnaires, including the Taiwanese version of the MD Anderson symptom inventory (MDASI-T), the Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), were used to collect data. Further, a multivariate stepwise linear regression was conducted to determine the independent risk factors for HRQOL. A p value of less than 0.05 was considered statistically significant.

Results:

The patients (mean age was 61.04 years, 51.2% male, 94.0% non–small-cell lung cancer, 56.4% stage IIIB–IV) had moderate levels of HRQOL among the physical, psychological, social, and environmental domains, as well as overall QOL. HRQOL was not correlated with married status, religion, and comorbidity. Gender, age, family income, smoking status, cancer stage, ECOG PS scores, PA, symptom burden (severity and interference), and PSQI global scores were correlated with HRQOL. Notably, symptom severity was the dominant negative predictor affecting the psychological and environmental domains of QOL (β = −4.313 and −3.500, respectively), accounting for 23.2% and 14.6% of the variance, respectively. On the other hand, symptom interference was the dominant negative predictor affecting the physical and social domains of QOL, as well as overall QOL (β = −3.592, −1.984, and −0.150, respectively), accounting for 44.4%, 15.0%, and 24.1% of the variance, respectively.

Conclusion:

Newly diagnosed lung cancer patients suffered symptom severity and interference that significantly impaired their HRQOL; particularly, symptom interference affected the physical domain of QOL. Healthcare professionals should pay more attention to cancer-related symptom severity, symptom interference, and HRQOL changes when caring for newly diagnosed lung cancer patients.
The Relationship Between Effort-Reward Imbalance and Depressive Symptoms Among Chinese Firefighters
Authors: Yu Yebo , Fu Mingqi , Yang Fan , Guo Jing
Published: February 2023

Objectives

This study aims to examine the association between effort-reward imbalance (ERI) and depressive symptoms among Chinese firefighters and the moderating role of positive and negative coping styles in the above association.

Methods

A cross-sectional study including 1328 male firefighters was conducted in China. We adopted the Center for Epidemiologic Studies Depression Scale to measure depressive symptoms.

Results

Results showed that ERI was associated with depressive symptoms. Individuals with a higher ERI ratio and greater overcommitment were likely to have higher level of depressive symptoms. Furthermore, negative coping style strengthened the relationship between ERI ratio and overcommitment with depressive symptoms, whereas the positive coping style presented none significant moderation.

Conclusions

These findings indicate that reforming the effort-reward system might be helpful for mental health promotion among Chinese firefighters.
The Impact of COVID-19 Pandemic on Physical Activity Levels Among Health Care Workers
Authors: Zare Fariba , Sadeghian Farideh , Chaman Reza , Mirrezaie Seyed Mohammad
Published: February 2023

Objective

The aim of the present study was to investigate physical activity (PA) changes during the COVID-19 pandemic among health care workers.

Methods

In a follow-up study, staff PA was compared before and during the COVID-19 pandemic. Logistic regression model was used to determine the related factors with PA changes.

Results

Total PA (MET minutes a week) among participants (n = 449) showed a statistically significant decrease during the pandemic compared with before the pandemic: 3785.5 ± 2237.09 versus 2363 ± 2452.90, P < 0.0001. Although transport-related PA decreased in medical and administrative department staff (3851 ± 22.83.4 vs 2446.7 ± 2477.6, P < 0.0001 and 3593.8 ± 2094.3 vs 2122.6 ± 2373.8, P < 0.0001, respectively), the decrease was associated with employment in the administrative and nonshift sectors with odds ratios of 2.37 (1.38 to 4.08) and 2.04 (1.28 to 3.26), respectively.

Conclusion

Promoting PA at home and leisure is especially recommended to achieve the recommended PA levels.
Post-Offer Employment Testing and Its Impact on Health Care Costs for Employers
Authors: Hoffman Ben , Schaneman Justin
Published: February 2023

Objective

To quantify the cost benefits associated with Post-Offer Employment Testing (POET).

Methods

Cross-sectional analysis of 5 million individuals/480 million medical, prescription, absence, short- and long-term disability, property and casualty and workers' compensation claims. Individuals who received POET were statistically matched by company, position, age, and gender to candidates who did not.

Results

Significant injury reduction rates and integrated benefits cost savings were found in the cohort screened by POET.

Conclusion

POET is an effective tool for the employer to manage health, disability, motor vehicle crash, at-work injury costs, and reduce turnover.
Orchestra Musicians’ Work Environment and Health Versus General Workforce
Authors: Vastamäki Martti , Heliövaara Markku , Vastamäki Heidi , Ristolainen Leena
Published: February 2023

Objective

Our cross-sectional epidemiological study compared the work-environment harms and job uncertainties of orchestral musicians to those of the general population and their impact on health, work, and quality of life.

Methods

Musicians of all the Finnish domestic symphony orchestras and a population sample from the Finnish work force completed questionnaires, each group answering the same questions on their work environment and on health, ability to work, and quality of life.

Results

Noise disturbed the musicians 8 and poor lighting 22 times as often as these problems disturbed the controls. Musicians experienced mental violence or bullying considerably more often than did controls, with an odds ratio (95% confidence interval) of 3.0 (2.0–4.7).

Conclusions

Noise issues and poor lighting are well-known problems for orchestra musicians, but mental violence or bullying are less well known. Research should focus on such areas.
What Could Highly Engaged Workers Gain From Mental Health Promotion Programs?
Authors: Xie Weiyi , Ng Siu-man , Wang Man , Li Hui Yun , Emery Clifton , Lo Herman H. M. , Yeung Albert , Young Daniel K. W.
Published: February 2023

Objective

The current study aims to examine the effects of mental health programs on well-being among highly engaged workers.

Methods

Participants were randomly allocated to body-mind-spiritual or peer support program. Of the whole sample, we examined participants' work engagement and positive affect from the highest quarter and the lowest quarter of work engagement at baseline. Measures were taken at baseline and 1-month intervals during 3-month programs and 3-month follow-up.

Results

The programs had decreasing effects on work engagement in the HWE subgroup. There is an increasing trend of positive affect on the HWE group only in the body-mind-spiritual program. The trajectories of work engagement in the HWE group moved toward a moderate level.

Conclusion

Our results suggest that the work engagement's decrease in the HWE group could be a sign of recovery and relaxation.
Limited Health Risks in Performing Drug Reconstitution and Handling Tasks in Pharmacies—Results of an Occupational Risk Assessment Study
Authors: Crul Mirjam , Breukels Oscar , Ng Shiwai , Le Feber Maaike , Kuijpers Eelco , Smeets Oscar
Published: February 2023

Objective

Some drugs need processing before they can be administered or dispensed. We measured airborne exposure of pharmacy staff to small particles when performing these tasks.

Methods

Reconstitution of powdered drugs in vials; crushing, splitting, and counting of tablets; and opening of capsules, using different ventilation strategies, were investigated in five pharmacies after in a worst-case approach. Airborne particulate matter was determined for a range of particles sizes.

Results

Mean particle concentrations ranged from not detectable to 1.03 μg/m3 (<1 μm) and 589.7 μg/m3 (<10 μm). Dust exhaust made tasks safer. Most hazardous was pouring out tablets from a bulk supply, and least hazardous was reconstitution of a powder for injection.

Conclusions

Occupational exposure during routine handling of drugs can occur, but the risks vary greatly with the nature and duration of the tasks.
Burn Pit Exposure Assessment to Support a Cohort Study of US Veterans of the Wars in Iraq and Afghanistan
Authors: Woskie Susan R. , Bello Anila , Rennix Christopher , Jiang Lan , Trivedi Amal N. , Savitz David A.
Published: February 2023

Objective

For a cohort study of veterans' health conditions, we conducted an exposure assessment for 109 bases in Iraq and Afghanistan and 17 outside transit site bases.

Methods

The Department of Defense records were used to determine burn pit usage and waste disposal methods for each base in each year during the period of 2001 to 2014.

Results

In the final cohort of 475,326 veterans, who had more than 80% of their deployment time characterized by our exposure matrix, only 14.5% were found to have no burn pit exposure. The 2009 Department of Defense regulations on burn pits did produce changes in waste segregation, as well as adding incineration and local disposal of waste.

Conclusion

Most Iraq and Afghanistan veterans were stationed on bases that had burn pits, although the contents disposed of in the burn pits changed over time.
Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey
Authors: Makovec Knight Jennifer , Mitra Biswadev , McIntosh Andrew , Clifton Patrick , Makdissi Michael , Rosenfeld Jeffrey V. , Harcourt Peter , Howard Teresa S. , Willmott Catherine
Published: February 2023

Objectives:

To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football.

Design:

Online survey.

Setting:

Junior and youth athletes in Australia.

Participants:

Australian football players aged U8 to U18.

Assessment of Variables:

Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity.

Main Outcome Measures:

Rates of padded HG use, and beliefs associated with HG use.

Results:

A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer (P < 0.001) and being able to play harder while wearing HG (P < 0.001). Median responses were “disagree” on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019).

Conclusions:

Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.
Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players?
Authors: Gerschman Tommy , Brooks Brian L. , Mrazik Martin , Eliason Paul H. , Bonfield Stephan , Yeates Keith O. , Emery Carolyn A. , Schneider Kathryn J.
Published: February 2023

Objective:

To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players.

Design:

Secondary analyses of 2 prospective cohort studies.

Setting:

Canadian youth ice hockey teams.

Participants:

Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season).

Assessment of Risk Factors:

Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition.

Main Outcome Measures:

Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression.

Results:

When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRRSELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRRPARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion.

Conclusions:

Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.
High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students
Authors: Whatman Chris , van den Berg Carla , Black Amanda M. , West Stephen , Hagel Brent , Eliason Paul , Emery Carolyn
Published: February 2023

Objective:

To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion.

Design:

Cross-sectional study.

Setting:

High schools, Alberta, Canada.

Participants:

High school students (14-19 years) participating in various sports.

Independent Variables:

Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year).

Main Outcome Measures:

Twelve-month injury history (musculoskeletal and concussion).

Results:

Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39).

Conclusions:

Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.
Bilateral Ischial Tuberosity Stress Fractures in an Adolescent Football Player: A Case Report
Authors: Jones Jared M. , Wallenfelsz Grant M. , Worts Phillip R. , Wong Andrew M.
Published: February 2023

Pelvic stress fractures are rare, making up an estimated 1% to 7% of all stress fractures with the primary locations being the pubic rami, pubic symphysis, and sacrum. Two cases of stress fractures of the ischium have been previously described in the literature, with both occurring in the ischial body. In this case, a 17-year-old high school American football player presented with nonspecific pelvic pain and bilateral point tenderness on deep palpation of the ischial tuberosities. Advanced imaging identified bilateral ischial tuberosity stress fractures. This report outlines the diagnosis and management of the first reported case of bilateral ischial tuberosity stress fractures. We report how ischial tuberosity stress fractures present clinically, potential management strategies, and highlight the use of computed tomography imaging for pelvic stress fractures. Knowledge of unusual stress fracture locations may improve early diagnosis, limit complications, reduce healthcare costs, and promote an accelerated recovery time.
Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review
Authors: Silber Zachary S. , Donnelly Joseph C. , Farias Michael J. , Lama Christopher J. , Luther Lauren I. , Kosinski Lindsay R. , Hoy Austin E. , Gil Joseph A.
Published: February 2023

Objective:

To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair.

Data Sources:

The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases “TFCC,” “return to sport,” “return to work,” and “athlete.”

Results:

Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively.

Conclusion:

Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored.
Evidence-Based Practice Doctor of Physical Therapy Curricular Guideline Utilization: A Convergent Parallel Mixed Methods Study
Authors: Chen Yuping , Selby-Silverstein Lisa , Greenberger Hilary B. , Gobert Denise , Levine David , Kaplan Sandra L.
Published: February 2023

Introduction:

In 2014, an expert panel from the American Physical Therapy Association Academy of Research Evidence-Based Practice (EBP) special interest group created the Doctor of Physical Therapy (DPT) EBP Curricular Guideline (EBP-CG). This study describes faculty awareness of the EBP-CG, DPT curricular alignment with its terminal objectives, EBP-CG uses, and challenges addressing the objectives.

Review of Literature:

DPT educators frequently use core curriculum guidelines (CGs) that articulate entry-level knowledge and skills to determine competencies. No such guidelines existed for EBP in 2012 leading to the EBP-CG development to assist educators. Few CGs have been studied for their impact on content standardization. A mixed methods design was chosen to more completely describe this CG's impact.

Subjects:

Faculty teaching EBP in US accredited DPT programs.

Methods:

A mixed-methods design explored what EBP-CG objectives are addressed, to what expected mastery levels, and how faculty use the document.

Results:

Eighty-three of 252 accredited programs completed the survey; 14 respondents were interviewed. The EBP-CG was valued and viewed as reflecting curricular content. Its 33 objectives were taught by most respondents at knowledge and practice levels with independent mastery expected for 7. Interviewees described EBP as commonly practiced through group over individual projects. More EBP curriculum credits predicted more objectives taught (R = .29, R

2
= .09, P = .03) and expected for mastery (R = .28, R

2
= .08, P = .04). No interviewees shared the EBP-CG with clinical partners or Directors of Clinical Education; EBP carryover from classroom to practice is unknown.

Discussion and Conclusion:

Respondents confirmed that the EBP-CG objectives were useful and consistent with curricular content. Four EBP preparation gaps were identified: 1) limited EBP-CG awareness by faculty who teach EBP, 2) use of group over independent projects to practice EBP, 3) communication gaps between academic and clinical education settings about the EBP-CG, and 4) no consensus on minimum EBP competencies.
Motivational Interviewing Education and Utilization in US Physical Therapy
Authors: Kruger Eric , Granzow Rachel
Published: February 2023

Introduction.

In physical rehabilitation, motivational interviewing (MI) can improve treatment adherence and therapeutic outcomes. The objective of this study was to investigate the relationship between MI education and use of MI skills in physical therapy practice in the United States.

Review of Literature.

Motivational interviewing is an empirically supported technique for facilitating behavior change. Numerous studies have examined its use in physical rehabilitation settings. No research has examined education and utilization of MI in physical therapy in the United States.

Subjects.

Physical therapists (PTs) in the United States (N = 785) responded to an electronic survey distributed through the special interest academies and state chapters of the American Physical Therapy Association.

Methods.

Descriptive, correlational, and group comparisons were used to analyze the survey responses about MI utilization in clinical practice, characteristics of MI training, and self-reported use of MI communication skills.

Results.

Two-thirds of the sample reported using MI and half of the sample received training in MI. Motivational interviewing training was heterogeneous, with interactive elements superior to lecture alone. Interestingly, training received in PT education programs correlated negatively with the use of the MI skills assessed in this study. Use of MI skills significantly correlated with increased perceived patient adherence and decreased struggle with patients.

Discussion and Conclusion.

Incorporation of MI into physical therapy practice has the potential to improve patient care through increased therapeutic rapport, improvement of health outcomes associated with behavior change, and improved job satisfaction. Although MI is becoming more prevalent in physical therapy practice in the United States, the results of this study suggest that MI education should include dynamic components to increase the effective use of MI skills in clinical practice.
Enhanced Thrombin Formation in Patients with Ventricular Assist Devices Experiencing Bleeding: Insights from the Multicenter PREVENT Study
Authors: Jeske Walter , Ransom John , Katz Jason N. , Kilic Ahmet , Lindenfeld Joann , Egnaczyk Gregory , Shah Palak , Brieke Andreas , Uriel Nir , Crandall Daniel , Farrar David J. , Walenga Jeanine M.
Published: February 2023

The aim of this investigation was to characterize the hemostatic status of heart failure patients with implanted left ventricular assist devices (LVADs) to propose a mechanism associated with bleeding. Patients (n = 300) from 23 US hospitals were enrolled in the PREVENtion of HeartMate II Pump Thrombosis through Clinical Management (PREVENT) study. A biobank was established with serum and plasma samples prospectively collected from a cohort of 175 patients preimplant baseline (BL) and 3 months (3M) postimplant. Outcomes were collected for 6 months. Thrombin (prothrombin fragment 1.2 [F1.2], functional thrombin generation [TG]) and fibrinolytic activity (D-dimer, plasminogen activator inhibitor-1 [PAI-1]), but not contact activation (complement C5a), were elevated in heart failure patients at BL. F1.2, TG, and PAI-1 levels decreased 3M after LVAD implantation (p < 0.01) but did not revert to normal in all patients; conversely, D-dimer increased BL to 3M (p < 0.01). Compared with patients without events, thrombin activity (F1.2) was increased in patients with late bleeding (3–4 months postimplant) (p = 0.06) and in those with late gastrointestinal (GI) bleeding (p = 0.01). Patients with 3M F1.2 levels above the cohort mean had a higher incidence of bleeding (p < 0.001) and GI bleeding (p < 0.001) compared with those with below mean F1.2. Patients experiencing multiple bleeding events were more likely to have 3M F1.2 greater than the cohort mean. Despite anticoagulation with aspirin and warfarin, LVAD implanted patients exhibit hemostatic activation. Excess thrombin formation, particularly shown by increased F1.2, was demonstrated in association with bleeding in LVAD implanted patients.
Long-Term Follow-up of Disabled Patients With Chronic Pancreatitis
Authors: Liyen Cartelle Anabel , Shah Ishani , Bocchino Rachel , Ahmed Awais , Freedman Steven D. , Kothari Darshan J. , Sheth Sunil G.
Published: February 2023

Background/Aims:

Patients with chronic pancreatitis (CP) often report a poor quality of life and may be disabled. Our study identifies clinical characteristics, predictors and outcomes in CP patients with disability.

Methods:

A review of established CP patients followed in our Pancreas Center between January 1, 2016 and April 30, 2021. Patients were divided into 2 groups based on disability. Univariate analysis was performed to identify differences in demographics, risk factors, comorbidities, complications, controlled medications, and resource utilization. Multivariate analysis was conducted to identify predictors for disability.

Results:

Out of 404 CP patients, 18% were disabled. These patients were younger (53.8 vs. 58.8, P=0.001), had alcoholic CP (54.1% vs. 30%; P<0.001), more recurrent pancreatitis (83.6% vs. 61.1%; P=0.001), chronic abdominal pain (96.7% vs. 78.2%; P=0.001), exocrine pancreatic insufficiency (83.6% vs. 55.5%; P<0.001), concurrent alcohol (39.3% vs. 23.3%; P=0.001) and tobacco abuse (42.6% vs. 26%; P=0.02), anxiety (23% vs. 18.2%; P<0.001), and depression (57.5% vs. 28.5%; P<0.001). A higher proportion was on opiates (68.9% vs. 43.6%; P<0.001), nonopiate controlled medications (47.5% vs. 23.9%; P<0.001), neuromodulators (73.3% vs. 44%; P<0.001), and recreational drugs (27.9% vs. 15.8%; P=0.036). Predictors of disability were chronic pain (OR 8.71, CI 2.61 to 12.9, P< 0.001), celiac block (OR 4.66, 2.49 to 8.41; P<0.001), neuromodulator use (OR 3.78, CI 2.09 to 6.66; P<0.001), opioid use (OR3.57, CI 2.06 to 6.31; P< 0.001), exocrine pancreatic insufficiency (OR3.56, CI 1.89 to 6.82; P<0.001), non-opioid controlled medications (OR 3.45, CI 2.01 to 5.99; P<0.001), history of recurrent acute pancreatitis (OR 2.49, CI 1.25 to 4.77; P<0.001), depression (OR 2.26, CI 1.79 to 3.01; P <0.001), and active smoking (OR1.8, CI 1.25 to 2.29; P<0.001).

Conclusion:

CP patients with disability have unique characteristics and predictors, which can be targeted to reduce disease burden and health care expenditure in this population.
Disparities in Emergency Department Waiting Times for Acute Gastrointestinal Bleeding
Authors: Aghaie Meybodi Mohamad , Shaikh Amjad , Hashemipour Reza , Ahlawat Sushil
Published: February 2023

Objective:

The primary aim of this study was to assess waiting time (WT) across different racial groups to determine whether racial disparities exist in patients presenting with gastrointestinal bleeding (GIB) to the United States emergency departments (EDs).

Methods:

Using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2009 to 2018, we compared WT of patients with GIB across different racial/ethnic groups, including nonhispanic white (NHW), African American (AA), Hispanic White (HW), and Nonhispanic other. Multinomial logistic regression was applied to adjust the outcomes for possible confounders. We also assessed the trend of the WT over the study interval and compared the WT between the first (2009) and last year (2018) of the study interval.

Results:

There were an estimated 7.8 million ED visits for GIB between 2009 and 2018. Mean WT ranged from 48 minutes in NHW to 68 minutes in AA. After adjusting for gender, age, geographic regions, payment type, type of GI bleeding, and triage status, multinomial logistic regression showed significantly higher waiting time for AA patients than NHW (OR 1.01, P=0.03). The overall trend showed a significant decrease in the mean WT (P value<0.001). In 2009, AA waited 69 minutes longer than NHW (P value<0.001), while in 2018, this gap was erased with no statistically significant difference (P value=0.26).

Conclusion:

Racial disparities among patients presenting with GIB are present in the United States EDs. African Americans waited longer for their first visits. Over time, ED wait time has decreased, leading to a decline in the observed racial disparity.
Plaque Progression Differences Between Apixaban and Rivaroxaban in Patients With Atrial Fibrillation Measured With Cardiac Computed Tomography and Plaque Quantification
Authors: Aldana-Bitar Jairo , Moore Jeff , Manubolu Venkat Sanjay , Dahal Suraj , Verghese Dhiran , Lakshmanan Suvasini , Hussein Luay , Crabtree Tami , Jonas Rebecca , Min James K. , Earls James P. , Budoff Matthew J.
Published: February 2023

Background:

Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.

Study Question:

In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?

Study Design:

This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5–5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.

Measures and Outcomes:

Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).

Results:

Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm3, NCP 69.7 mm3, and LD-NCP 27.2 mm3; rivaroxaban: CP 22.9 mm3, NCP 66.3 mm3, and LD-NCP 11.0 mm3) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban (P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant (P = 0.04).

Conclusions:

In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.
Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review
Authors: Elliott James E.G. , Roldao Pereira Luisa , Bell Kim S. , Barnden Tristan
Published: February 2023

Objective

This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP.

Methods

PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP.

Results

Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications.

Conclusion

This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.
Craniopharyngioma surgery for rhinologists
Authors: Salmon Mandy K. , Kshirsagar Rijul S. , Eide Jacob G.
Published: February 2023

Purpose of review

Craniopharyngiomas are rare tumors that that present with loss of pituitary function in most cases. They present in a bimodal age distribution and the most common treatment paradigms include gross total resection or subtotal resection followed by radiation. Endoscopic transnasal access to intradural tumors has become increasingly common due to improvements in equipment, increased familiarity with the surgical corridor and anatomy, and reconstruction techniques. As such, rhinologists play an increasingly important role in the management of craniopharyngiomas.

Recent findings

Recent years have highlighted our growing experience with pediatric endonasal skull base surgery. Prior concerns including sphenoid pneumatization, midfacial growth restrictions, and intercarotid space limitations have been studied more extensively. It has been found that there are no increased complications with lack of sphenoid pneumatization, no changes to midfacial growth with endonasal techniques, and the inter-carotid distance is stable after around age 5. Advances in surgical and skull base reconstruction techniques and intraoperative monitoring have reduced the risks of complications from surgery.

Rhinologists play an important role in craniopharyngioma surgery. The approach to and reconstruction after tumor removal are vital portions of the procedure that allow for resection and prevent postsurgical complications.
Diagnosis and Treatment of Iron Deficiency and Anemia in Youth With Inflammatory Bowel Disease
Authors: Smith Jennifer , Jacobson‐Kelly Amanda , Donegan Amy , Boyle Brendan , Maltz Ross M. , Michel Hilary K. , Dotson Jennifer L.
Published: February 2023

Objectives:

Iron deficiency (ID) with and without anemia is prevalent in children and adults diagnosed with inflammatory bowel disease (IBD), but often goes unrecognized. We hypothesized, quality improvement (QI) methodology could increase the screening for and treatment of ID in children newly diagnosed with IBD.

Methods:

We developed and implemented an easy‐to‐follow algorithm to facilitate screening for and treatment of ID for patients diagnosed with IBD. Through a series of Plan‐Do‐Study‐Act cycles, the approach was modified to increase screening and treatment of ID. Data between January 2019 and July 2021 were assessed using statistical process control.

Results:

Among patients newly diagnosed with IBD, 298 patients were included (67% Crohn disease, 29% ulcerative colitis, 4% indeterminate colitis, and 56% males). Rates of ID screening increased significantly from a baseline of 20% to >90%. Of the 232 patients screened for ID during the improvement period, 205 (88%) met criteria for either iron deficiency anemia (IDA) or ID at diagnosis, specifically, 151 (65%) met criteria for IDA and 54 (23%) met criteria for ID.

Conclusions:

Use of QI methodology to standardize screening assessments for ID among children newly diagnosed with IBD improved screening rates from a baseline of 20% to >90%, with 88% of patients found to have IDA or ID.