bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrograde Intramedullary Nailing of Pediatric Femoral Shaft Fractures Does Not Result in Growth Arrest at the Distal Femoral Physis—A Retrospective Cases Series
Authors: Benedick Alex , Bazar Batzorig , Zirkle Lewis G. , Liu Raymond W.
Published: May 2021

Objective:

To evaluate femoral growth after placement of retrograde intramedullary nails in the treatment of pediatric femoral shaft fractures.

Design:

Retrospective case series.

Setting:

Large urban trauma center in Mongolia.

Patients/Participants:

Twenty-nine pediatric patients who sustained a diaphyseal femoral shaft fracture were included in the study.

Intervention:

Retrograde intramedullary nail fixation with the standard, fin, or pediatric fin Surgical Implant Generation Network nail across an open distal femoral physis.

Main Outcome Measures:

The main outcome measure was the distance traveled by the intramedullary nail with respect to the distal femoral condyles and distal femoral physis from initial surgery to follow-up.

Results:

The mean age of patients was 10.7 years (range: 7–14 years). Follow-up occurred at a mean of 292 days (range: 53–714 days). Both condyle distance and physis distance were significantly positively correlated with follow-up days, with Pearson R values of 0.90 (P < 0.001) and 0.84 (P < 0.001), respectively. Multiple regression analysis revealed that follow-up days was the only significant predictor of physis distance, whereas age, sex, percent growth plate violation, and nail fully traversing physis were not significant predictors. The nail completely crossed the physis in 5 patients and no growth arrests were found.

Conclusions:

This is the first study, to our knowledge, to evaluate treating femoral shaft fractures with a retrograde nail across an open distal femoral physis. In the pediatric population, the use of a retrograde femoral intramedullary nails does not seem to cause growth arrest of the injured femur during the postoperative period and may be a reasonable treatment option when other surgical options are not available. Additional study is necessary to further evaluate the safety profile.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Is the Iliac Cortical Density Similarly Positioned in the Developing Pediatric Pelvis?
Authors: Watzig Benjamin F. , Peterson Danielle F. , Thompson Austin R. , Friess Darin M. , Working Zachary M. , Yang Scott S.
Published: May 2021

Objectives:

The iliac cortical density (ICD) is a critical fluoroscopic landmark for pelvic percutaneous screw placement. Our purpose was to evaluate the ICD as a landmark in pediatrics and quantify the diameter of osseous pathways for 3 screw trajectories: iliosacral (IS) at S1 and transiliac–transsacral (TSTI) at S1 and S2.

Methods:

Two hundred sixty-seven consecutive pelvic CT scans in children 0–16 years of age were analyzed. ICD and S1 vertebral heights were measured at multiple regions along S1. Their height and corresponding ratios, as well as osseous screw corridor dimensions were compared between age groups and by the dysmorphic status.

Results:

In the nondysmorphic pelvises, S1 height, ICD height, and the ICD to S1 height ratio increased across age groups for all locations (P < 0.001). All 3 screw pathway diameters increased with age (P < 0.001). In the dysmorphic group, there was no increase in ICD to S1 height ratio with age. Except for the age 0–2 group, the ICD to S1 height ratios were significantly larger in the nondysmorphic group. In the dysmorphic group, S1 TSTI pathway remained narrow with age, whereas IS at S1 and TSTI at S2 had a significant increased diameter with age (P < 0.001).

Conclusion:

The ICD is a useful fluoroscopic landmark for percutaneous screw placement in the pediatric pelvis. For nondysmorphic pelvises, the ICD to S1 height ratio, as well as osseous corridors for IS, TSTI at S1, and TSTI at S2 screw trajectories increase significantly with age. The margin for safe screw placement in S1 is smaller for younger and dysmorphic pelvises.
Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review
Authors: Rubinger Luc , Khalik Hassaan Abdel , Gazendam Aaron , Wolfstadt Jesse , Khoshbin Amir , Tushinski Daniel , Johal Herman
Published: May 2021

Objectives:

To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR).

Data Sources:

MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines.

Study Selection:

Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III.

Data Extraction:

Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery.

Data Synthesis:

Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9–88.3 years) and 209 knees in the DFR group (mean age range: 71.0–84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized.

Conclusions:

vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%–45% vs. 0%–77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Fracture and Patient Characteristics Associated With Early Conversion Total Hip Arthroplasty After Acetabular Fracture Fixation
Authors: Cichos Kyle H. , Spitler Clay A. , Quade Jonathan H. , McGwin Gerald , Ghanem Elie S.
Published: May 2021

Objectives:

To determine risk factors for early conversion total hip arthroplasty (THA) after operative treatment of acetabular fractures.

Design:

Retrospective cohort.

Setting:

Level I trauma center.

Patients and Intervention:

We reviewed 685 operative acetabular fractures at our institution from 2011 to 2017, with a median follow-up of 12 months (range, 4–105 months).

Main Outcome Measure:

Multivariable regression analysis was performed after univariate analysis to identify independent risk factors for conversion THA. Sensitivity analysis was performed with minimum follow-up set at 6 and 12 months.

Results:

One hundred eight patients (16%) underwent conversion THA, with 52% of conversions occurring within 1 year, an additional 27% within 2 years, and the remaining 21% within 6 years of the index acetabular open reduction internal fixation. The median time to conversion THA was 11.5 months (range, 0.5–72 months). The risk of conversion THA by fracture pattern was 53 of 196 (27%) for transverse posterior wall (TPW), 12 of 52 (23%) for T shaped, 10 of 68 (15%) for posterior column with posterior wall, and 25 of 207 (12%) for posterior wall. Independent risk factors for early conversion included the following: TPW fracture, protrusio, hip dislocation, increased body mass index, increased age, infection, and dislocation after open reduction internal fixation. Independent risk factors for early conversion THA specific to patients with TPW fractures include only increased age and body mass index. Sensitivity analysis showed no change in results using either 6 or 12-month minimum follow-up.

Conclusion:

Transverse posterior wall fractures have a high risk of early conversion THA compared with other acetabular fracture patterns, especially when in combination with other significant risk factors. Consideration for different and novel management options warrants further study in this subset of acetabular fracture patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Prospective Clinical Trial Comparing Surgical Fixation Versus Nonoperative Management of Minimally Displaced Complete Lateral Compression Pelvis Fractures
Authors: Slobogean Gerard P. , Gaski Greg E. , Nascone Jason , Sciadini Marcus F. , Natoli Roman M. , Manson Theodore T. , Lebrun Christopher , McKinley Todd , Virkus Walter W. , Sorkin Anthony T. , Brown Krista , Howe Andrea , Rudnicki Joshua , Enobun Blessing , O'Hara Nathan N. , Gill Jeff , O'Toole Robert V.
Published: May 2021

Objective:

To compare the early pain and functional outcomes of operative fixation versus nonoperative management for minimally displaced complete lateral compression (LC; OTA/AO 61-B1/B2) pelvic fractures.

Design:

Prospective clinical trial.

Setting:

Two academic trauma centers.

Patients:

Forty-eight adult patients with LC pelvic ring injuries with <10 mm of displacement were treated nonoperatively and 47 with surgical fixation. Sixty percent of participants were randomized. Seventy-three percent of the fractures were displaced <5 mm, and 71% were LC-1 patterns.

Intervention:

Operative fixation versus nonoperative management.

Main Outcome Measurements:

The primary outcome was patient-reported pain using the 10-point Brief Pain Inventory. Functional outcome was measured using the Majeed pelvic score. Outcomes were analyzed using hierarchical Bayesian models to compare the average treatment effect from injury to 12 and 52 weeks postinjury. The probability of the mean treatment benefit exceeding a clinically important difference was determined.

Results:

The 3-month average treatment effect of surgery compared with nonoperative management was a 1.2-point reduction in pain [95% credible interval (CrI): 0.4–1.9] and an 8% absolute improvement in the Majeed score (95% CrI: 3%–14%). Similar results persisted to 1 year. Patients with initial fracture displacement ≥5 mm experienced a larger reduction in pain (2.2, 95% CrI: 0.9–3.5) compared with those patients with less initial displacement (0.9, 95% CrI: 0.1–1.8).

Conclusion:

On average, surgical fixation likely provides a small improvement in pain and functional outcome for up to 12 months. Patients with ≥5 mm of posterior pelvic ring displacement are more likely to experience clinically important improvements in pain.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Evaluation of a Mobile Application for Heart Failure Telemonitoring
Authors: Achury Saldaña Diana Marcela , Gonzalez Rafael A. , Garcia Angel , Mariño Alejandro , Aponte Luisa , Bohorquez Wilson Ricardo
Published: May 2021

Adequate adherence to treatment is indispensable in preventing adverse consequences in heart failure patients. Such adherence can be managed through heart failure clinics and various methods of follow-up. In recent years, the use of telemonitoring has shown promising benefits in supporting clinicians' follow-up, as well as contributing to patients' self-care. This article presents the development and evaluation of a telemonitoring application for heart failure, through a Web-based interface for clinicians and a mobile application for patients. The application was evaluated through a 6-month pilot observational descriptive study in 20 outpatients with reduced ejection fraction and two nurses, in the context of a heart failure clinic. A technological acceptance questionnaire was applied to all patients and nurses at the end of the study period. In use, the application generated 64 real-time alerts for early decision-making to prevent complications, and 91% of patients did not present hospital readmissions. Such results, along with high user acceptance, show potential utility of the application as an effective complementary strategy for follow-up of patients with heart failure.
Robotics for Cochlear Implantation Surgery: Challenges and Opportunities
Authors: Panara Kush , Shahal David , Mittal Rahul , Eshraghi Adrien A.
Published: May 2021

Objectives:

Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI.

Data Sources:

MEDLINE, PubMed, and EMBASE databases.

Study Selection:

A search was conducted using the keywords “robotics otolaryngology,” “robotic cochlear implant,” “minimally-invasive cochlear implantation,” “minimally-invasive mastoidectomy,” and “percutaneous cochlear implant” with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present.

Results:

The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics.

Conclusions:

The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.
Clinical Prevalence of Enhanced Vestibulo-Ocular Reflex Responses on Video Head Impulse Test
Authors: Vargas-Alvarez Aitor , Ninchritz-Becerra Elisabeth , Goiburu Miren , Betances Frank , Rey-Martinez Jorge , Altuna Xabier
Published: May 2021

Objective:

To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases.

Study Design:

Cross-sectional clinical study.

Setting:

Tertiary hospital.

Participants:

Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit.

Intervention:

Diagnostic.

Main Outcome Measures:

Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods.

Results:

All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001).

Conclusion:

There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.
Reliability of Postsurgical Soft Tissue Reaction Grading Scales for Bone-anchored Hearing Implants
Authors: Bezdjian Aren , Nathoo-Khedri Nabil , Strijbos Ruben M. , Sewitch Maida , Thomeer Hans G.X.M. , Daniel Sam J.
Published: May 2021

Objective:

This study aims to assess and compare the reliability of the Holgers, the IPS, and the Tullamore scales for skin tolerability assessment of postoperative bone-anchored hearing implant images.

Study Design:

A survey study and retrospective review of percutaneous osseointegrated auditory implant images for scoring using three skin classification scales.

Setting:

McGill University Health Center, Montreal, Quebec, Canada.

Participants:

Healthcare workers experienced and inexperienced with osseointegrated auditory implant skin classification scales.

Main Outcome Measures:

Participation involved completing: 1) survey questionnaires assessing experience with osseointegrated auditory implants and related skin reactions and 2) scoring postoperative osseointegrated auditory implant with surrounding skin images using the Holgers Classification, the IS (of the IPS) scale, and the Tullamore Classification. Participants were asked to rate 12 images of postoperative osseointegrated auditory implant and surrounding soft tissue. This process was repeated until participants scored all images using the three scales; each rater graded 36 images in total. The order in which scales were presented occurred at random. Intraclass correlation coefficients were calculated to assess reliability.

Results:

Thirty-one participants were recruited to the study. Fourteen (45.2%) had experience with at least 1 osseointegrated auditory implant skin classification scale, while 17 (54.8%) did not have experience. The wide and overlapping 95% confidence intervals of the intraclass correlation coefficients results do not provide us with enough evidence to define a well-established degree and hierarchy of reliability when comparing the scales. Among experienced raters, all scales presented moderate to good reliability.

Conclusions:

The Holgers Classification, the IPS scale, and the Tullamore Classification all present moderate to good reliability when used by experienced raters to assess skin reactions following surgical implantation of an osseointegrated hearing device. As a result, clinicians should use these scales with a degree of caution. The findings of this study do not provide us with enough evidence to single out one of the scales as a standard to follow, but more extensive studies are required to assess the reliability of the scales.
Management of dermatofibrosarcoma protuberans
Authors: Badhey Arvind K. , Tikhtman Raisa , Tang Alice L.
Published: May 2021

Purpose of review

Provide an up to date review of the diagnosis, workup and treatment of dermatofibrosarcoma protuberans (DFSP). DFSP can be a challenging disease to manage and adequate understanding of the most up to date literature can help provide comprehensive treatment strategies.

Recent findings

DFSP is an infiltrative cutaneous sarcoma. It tends to have deep local invasion with a high risk of local recurrence, but a low risk of distant metastasis. It presents typically as a slow growing, asymptomatic skin lesion. It presents rarely in the head and neck, only 15% of the time. Recent data has discussed the role of wide local excision (WLE) vs. Mohs surgery. In addition, for unresectable disease the role of systemic therapy and immunomodulatory agents such as Imatinib has shown success.

Typically, surgical management is the first line for DFSP, however the risk for local recurrence still remains high with negative margins. Due to this risk, lifelong surveillance is required after initial diagnosis and management. Similar to other head and neck tumors, most recurrences happen within the first 3 years after treatment. DFSP can be treated with WLE or Mohs. For aggressive disease that is considered unresectable systemic therapy does exist, including molecular targeted therapies.
God Representation Types Are Associated With Levels of Personality Organization and Christian Religious Orthodox Culture
Authors: van der Velde Nathan , Schaap-Jonker Hanneke , Eurelings-Bontekoe Elisabeth H.M. , Corveleyn Jozef M.T.
Published: May 2021

This exploratory study shows that God representation types are associated with levels of personality organization. Among two Dutch samples of psychiatric patients (n = 136) and nonpatients (n = 161), we found associations between the psychotic, borderline, and neurotic personality organizations, and passive-unemotional, negative-authoritarian, and positive-authoritative God representation types, respectively. Both patients and nonpatients reported positive God representations, but only nonpatients and higher-level functioning patients reported an integrated God-object relation. For persons with personality pathology, the relationship with God can be a struggle and might have a defensive and/or compensating function. In addition to personality organization, Christian religious orthodox culture is a statistical predictor of God representations, but not of anger toward God. We offer suggestions for how psychotherapeutic work with God representations might differ for patients with different levels of personality organization.
Who Uses Veterans Mental Health Services?
Authors: Manhapra Ajay , Stefanovics Elina A. , Rhee Taeho Greg , Rosenheck Robert A.
Published: May 2021

Mental health (MH) research among veterans receiving services from the Veterans Health Administration (VHA) is extensive and growing and informs many clinical practice guidelines. We used nationally representative survey data to examine the generalizability of this extensive body of research by comparing sociodemographic and clinical characteristics of male veteran veterans health service (VHS) users (n = 491) with veteran non-VHS users (n = 840) and nonveteran (n = 6300) MH service users. VHS users were older, more often reported Black race, and less likely to have private or Medicaid insurance, but had similar prevalence of psychiatric or substance use disorder diagnoses but with a greater prevalence of posttraumatic stress disorder (PTSD). VHS users reported higher rates of medical diagnoses, pain interference, and poorer physical and MH status. These results suggest that VHA MH research may be reasonably generalizable to US mental health service users with caveats regarding age, PTSD diagnosis, pain, and racial distribution.
Costs of Identifying Cases of Syphilis Using Rapid Syphilis Tests in Multiple Nonclinical Settings in the United States
Authors: Williams Austin M. , Berruti Andrés A.
Published: May 2021

Background

Outreach screening is a common strategy for detecting cases of syphilis in high-risk populations. New rapid syphilis tests allow for quicker response times and may alter the costs of detecting and treating syphilis in nonclinical settings.

Methods

Between May and October of 2017, we collected detailed retrospective cost data from 2 outreach screening programs engaging people experiencing homelessness and LGBTQ populations. Comprehensive and retrospective cost information, disaggregated by cost category, programmatic activity, and source of support, was collected during and after the testing period.

Results

Across all sites, rapid syphilis tests were conducted on 595 people at an average cost of $213 per person. Twenty-three cases of syphilis were confirmed and treated for an average cost of $5517 per case, ranging from $3604 at a rehabilitation facility to $13,140 at LGBTQ venues served by a mobile clinic. Personnel contributed the most to total costs (56.4%), followed by supplies (12.8%) and the use of buildings (10.4%). Expenditures by programmatic activity varied substantially across sites.

Conclusions

Testing costs varied between venues, reflecting differences in the models used and intensity of services provided. Although staff costs are the major driver, buildings and supplies costs are also significant. Our findings suggest that outreach screenings using rapid syphilis tests may be a feasible and cost-effective tool for health departments when targeting known high-prevalence areas and hard-to-reach populations.
Bacterial Vaginosis–Associated Bacteria and Uterine Fibroids: A Nested Case-Control Study
Authors: Moore Kristen R. , Tomar Meena , Umbach David M. , Gygax Scott E. , Hilbert David W. , Baird Donna D.
Published: May 2021

Background

Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis (BV). The literature is currently limited to data using self-report of BV.

Methods

We conducted a nested case-control study of 200 women (100 cases and 100 controls) from a large study of 23- to 35-year-old African American women, 1310 of whom were fibroid-free and prospectively followed up for 5 years to identify incident fibroids with standardized ultrasound examinations. We used quantitative polymerase chain reaction, an objective molecular method, to assess 9 BV-associated and 4 Lactobacillus species from vaginal swab specimens. We used hierarchical logistic regression to compute odds ratios and 95% confidence intervals to examine associations between bacterial species (both individually and grouped as (1) “optimal” Lactobacillus and (2) BV-associated species) with fibroid incidence and number. We also examined vaginal imbalance (quantitatively more BV-associated bacteria than optimal Lactobacilli).

Results

Contrary to our hypothesis, we found no increase in fibroid incidence or number among women with more BV-associated bacteria. High imbalance (only BV-associated bacteria, no optimal Lactobacillus bacteria) was actually inversely associated with fibroid incidence (odds ratio, 0.38; 95% confidence interval, 0.17–0.81).

Conclusions

This is the first study of ultrasound-detected incident fibroids and molecular vaginal bacterial assessment. We found no evidence that BV-associated bacteria increase the risk of fibroid incidence or number.
Modeling the Cost-Effectiveness of Express Multisite Gonorrhea Screening Among Men Who Have Sex With Men in the United States
Authors: Earnest Rebecca , Rönn Minttu M. , Bellerose Meghan , Menon-Johansson Anatole S. , Berruti Andrés A. , Chesson Harrell W. , Gift Thomas L. , Hsu Katherine K. , Testa Christian , Zhu Lin , Malyuta Yelena , Menzies Nicolas A. , Salomon Joshua A.
Published: May 2021

Background

Men who have sex with men (MSM) experience high rates of gonococcal infection at extragenital (rectal and pharyngeal) anatomic sites, which often are missed without asymptomatic screening and may be important for onward transmission. Implementing an express pathway for asymptomatic MSM seeking routine screening at their clinic may be a cost-effective way to improve extragenital screening by allowing patients to be screened at more anatomic sites through a streamlined, less costly process.

Methods

We modified an agent-based model of anatomic site-specific gonococcal infection in US MSM to assess the cost-effectiveness of an express screening pathway in which all asymptomatic MSM presenting at their clinic were screened at the urogenital, rectal, and pharyngeal sites but forewent a provider consultation and physical examination and self-collected their own samples. We calculated the cumulative health effects expressed as gonococcal infections and cases averted over 5 years, labor and material costs, and incremental cost-effectiveness ratios for express versus traditional scenarios.

Results

The express scenario averted more infections and cases in each intervention year. The increased diagnostic costs of triple-site screening were largely offset by the lowered visit costs of the express pathway and, from the end of year 3 onward, this pathway generated small cost savings. However, in a sensitivity analysis of assumed overhead costs, cost savings under the express scenario disappeared in the majority of simulations once overhead costs exceeded 7% of total annual costs.

Conclusions

Express screening may be a cost-effective option for improving multisite anatomic screening among US MSM.
Nugent Score, Amsel's Criteria, and a Point-of-Care Rapid Test for Diagnosis of Bacterial Vaginosis: Performance in a Cohort of Kenyan Women
Authors: Lokken Erica M. , Jisuvei Clayton , Oyaro Brenda , Shafi Juma , Nyaigero Maureen , Kinuthia John , Mandaliya Kishor , Jaoko Walter , McClelland R. Scott
Published: May 2021

There are minimal data on the BVBlue test for diagnosis of bacterial vaginosis (BV) in Africa. Among 701 Kenyan women, compared with Nugent score ≥7, the BVBlue test had moderate sensitivity (81.9%; 95% confidence interval, 76.5%–86.5%) and high specificity (92.4%; 95% confidence interval, 89.5%–94.6%). This test may provide a complimentary approach to syndromic management.
Facilitators and Barriers to Patient-Delivered Partner Therapy Acceptance for Chlamydia trachomatis Among Young African American Men Who Have Sex With Women in a Southern Urban Epicenter
Authors: Lederer Alyssa M. , Hindmarch Grace , Schmidt Norine , Gomes Gérard R. , Scott Glenis , Watson Shannon , Kissinger Patricia J.
Published: May 2021

Background

Chlamydia trachomatis (Ct) disproportionately affects African American young people living in the Southern United States and can have negative consequences if left untreated. Patient-delivered partner therapy (PDPT) is an evidence-based practice in which individuals diagnosed with Ct can provide treatment directly to their sex partners. However, PDPT acceptance rates need improvement. Although reasons for PDPT acceptance have been explored previously, the facilitators and barriers to expedited partner therapy acceptance among young southern African American men who have sex with women have not yet been examined.

Methods

Twenty semistructured interviews were conducted as part of a community-based Ct screening and treatment intervention among African American men aged 15 to 25 years who had female sex partners. Participants were asked about why they did or did not accept PDPT for their sex partners. Data were transcribed and analyzed in NVivo qualitative software using an inductive thematic approach.

Results

Participants' decision making was multifaceted. Facilitators for PDPT acceptance included being able to cure their partner, convenient access to treatment, believing it was the right thing to do, having a close relationship with a partner, concern for the partner's well-being, and the perceived severity of Ct. Barriers to PDPT acceptance were the belief that a partner did not need treatment, not having a close relationship with the partner, being unable to contact the partner, and fear of conflict.

Conclusions

Findings had similarities to other studies, indicating some universal messaging may be warranted alongside culturally tailored interventions for specific patient populations to increase PDPT acceptance. Implications for patient-provider communication are provided.
Genomic Analysis of the Predominant Strains and Antimicrobial Resistance Determinants Within 1479 Neisseria gonorrhoeae Isolates From the US Gonococcal Isolate Surveillance Project in 2018
Authors: Reimche Jennifer L. , Chivukula Vasanta L. , Schmerer Matthew W. , Joseph Sandeep J. , Pham Cau D. , Schlanger Karen , St Cyr Sancta B. , Weinstock Hillard S. , Raphael Brian H. , Kersh Ellen N. , Gernert Kim M. ,   Antimicrobial-Resistant Neisseria gonorrhoeae Working Group
Published: May 2021

Background

The prevalence of Neisseria gonorrhoeae (GC) isolates with elevated minimum inhibitory concentrations to various antibiotics continues to rise in the United States and globally. Genomic analysis provides a powerful tool for surveillance of circulating strains, antimicrobial resistance determinants, and understanding of transmission through a population.

Methods

Neisseria gonorrhoeae isolates collected from the US Gonococcal Isolate Surveillance Project in 2018 (n = 1479) were sequenced and characterized. Whole-genome sequencing was used to identify sequence types, antimicrobial resistance profiles, and phylogenetic relationships across demographic and geographic populations.

Results

Genetic characterization identified that (1) 80% of the GC isolates were represented in 33 multilocus sequence types, (2) isolates clustered in 23 major phylogenetic clusters with select phenotypic and demographic prevalence, and (3) common antimicrobial resistance determinants associated with low-level or high-level decreased susceptibility or resistance to relevant antibiotics.

Conclusions

Characterization of this 2018 Gonococcal Isolate Surveillance Project genomic data set, which is the largest US whole-genome sequence data set to date, sets the basis for future prospective studies, and establishes a genomic baseline of GC populations for local and national monitoring.
Burden of Mycoplasma genitalium and Bacterial Coinfections in a Population-Based Sample in New Mexico
Authors: Hammer Anne , Gravitt Patti E. , Adcock Rachael , Patterson Nicole , Cuzick Jack , Wheeler Cosette M. ,   on behalf of the New Mexico HPV Pap Registry Steering Committee
Published: May 2021

In this population-based US study, the overall prevalence of Mycoplasma genitalium was 1.95% (95% confidence interval [CI], 1.62%–2.34%), declining from 6.12% (95% CI, 4.72%–7.92%) in women aged 21 to 24 years to 0.48% (95% CI, 0.25%–0.94%) in women aged 40 to 64 years. The prevalence of coinfections with Chlamydia trachomatis and Trichomonas vaginalis was low.
Is clinical, musculoskeletal pain associated with poorer logical reasoning?
Authors: Gunnarsson Helena , Agerström Jens
Published: May 2021

Introduction:

It has been hypothesized that pain disrupts system 2 processes (eg, working memory) presumed to underlie logical reasoning. A recent study examining the impact of experimentally induced pain on logical reasoning found no evidence of an effect.

Objectives:

The aim of this study was to examine whether clinical pain, which is qualitatively different from experimental pain, would lower the ability to reason logically.

Methods:

Ninety-six participants completed a questionnaire containing 3 different logical reasoning tasks (the cognitive reflection test, the belief bias syllogisms task, and the conditional inference task), questions about pain variables (present pain intensity, pain intensity during the last 24 hours, the influence of pain on daily activities, pain duration, and pain persistence), questions about other pain-related states (anxiety, depression, and fatigue), and pain-relieving medication. Correlations between the logical reasoning tasks and the pain variables were calculated.

Results:

For 2 of the 3 logical reasoning tasks (the cognitive reflection test and the belief bias syllogisms task), clinical pain was unrelated to logical reasoning. Performance on context-free logical reasoning showed a significant negative correlation with present pain intensity, but not with the other pain variables.

Conclusion:

This finding that logical reasoning ability is largely unrelated to clinical pain is highly consistent with previous research on experimentally induced pain. Pain should probably not constitute a significant barrier to logical reasoning in everyday life.
Construction of a Scale Assessing Patients’ Perceptions Regarding Sanitation and Hygiene in a Clinical Setting
Authors: Asiamah Nestor , Aggrey Mavis , Adu-Gyamfi Kwame , Opuni Frank Frimpong
Published: May 2021

Objective

This study attempted to develop a scale, hereby called HYGIENICCARE, that assesses patients’ perceptions regarding sanitation and hygiene in a healthcare environment. It also evaluated the relationship between the new measure and a previously validated scale measuring healthcare quality.

Methods

This study was a psychometric test in which we constructed a new survey and administered the survey to patients in wards and the outpatient departments of 5 hospitals in Accra North. A robust procedure, including a review of selected questions by an expert panel, was followed to determine the original bank of items of the instrument. Principal component analysis with varimax rotation was used to select items for the scale, whereas confirmatory factor analysis was used to assess construct validity. Multiple linear regression was used to examine the association between the new scale and an existing measure of healthcare quality.

Results

A bank of 10 items was determined through a systematic review of the literature and the engagement of 7 expert reviewers. Through principal component analysis, the items were reduced to 9. Principal component analysis yielded 2 factors: “environment and equipment” and “personnel and process,” which both explained 82% of the total variance and produced Cronbach α coefficients of 0.912 and 0.86, respectively. Confirmatory factor analysis confirmed the 2-factor solution and produced satisfactory discriminant validity and convergent validity indicators. The 2 domains of the new scale were highly correlated with all dimensions of a scale measuring healthcare quality called HEALTHQUAL (r ≥ 0.76, P < 0.001). In multiple linear regression, each of the 2 domains of HYGIENICCARE explained a total variance of 41% or greater in all domains of HEALTHQUAL (P < 0.001).

Conclusions

We developed a brief scale measuring hospital hygiene and sanitation that correlated well with an existing measure of healthcare quality. This effort shows that the new tool is a valid measure of patient-perceived hospital hygiene and sanitation.
Patient Perceptions of Hospital Experiences: Implications for Innovations in Patient Safety
Authors: Butler Jorie M. , Gibson Bryan , Schnock Kumiko , Bates David , Classen David
Published: May 2021

Objective

The purpose of this study was to qualitatively examine safety experiences of hospitalized patients and families.

Methods

We conducted 5 focus groups at 2 sites with patients and family members of patients who had been hospitalized at least once within the preceding 2 years. Using a semistructured focus group script, participants were asked to describe hospital experiences, including any safety risks or problems, and to discuss trust in the hospital care team or members of the care team. All focus groups were audiorecorded and transcribed, and transcriptions were qualitatively analyzed using thematic analysis by experienced qualitative analysts and experts in patient safety.

Results

We collected rich descriptions of safety problems in the hospital. We identified 4 main themes from our focus group data. (1) Experiences with safety problems were not unusual among participants, (2) patients and families develop a structured “care story” about their hospital experiences, (3) there is a spectrum of trust between patients and the hospital care team members that can be diminished or enhanced by experiences, and (4) patients believed having someone who could advocate for them during their hospitalization was important.

Conclusions

Our results suggest that acknowledgment of safety problems, clear communication, building trust, and a role for advocacy are impactful pathways health care providers and health care systems can improve patient experiences. Information technology such as patient- and clinician-facing displays can support each of these actions.
Relationships Between Nurses’ Work System, Safety-Related Performance, and Outcomes: A Structural Equation Model
Authors: Hwang Jee-In , Kim Sung Wan , Park Hyeoun-Ae
Published: May 2021

Objectives

We examined relationships between nurses’ work system, safety-related performance, and outcomes based on a modified Systems Engineering Initiative for Patient Safety model.

Methods

A cross-sectional survey was conducted with 408 nurses from 2 general hospitals. Data on work system factors (person, organization, environment, tools, and task), processes (safety-related performance), and outcomes (staff and clinical outcomes) were collected. Structural equation modeling was used to determine the relationships between nurses’ work system factors, safety-related processes, and outcomes.

Results

Structural equation modeling yielded a comparative fit index of 0.918, standardized root mean square residual of 0.055, and root mean square error of approximation of 0.054, indicating an acceptable model fit. The person factor had a significant positive direct effect on nurses’ safety-related performance, and significant negative direct and indirect effects on the clinical outcome. The organization factor had significant positive direct effects on nurses’ safety-related performance and staff outcome, and a negative indirect effect on the clinical outcome. The task factor had a significant positive direct effect on staff outcome. However, the environment and tools factors had no significant effects on safety-related performance or outcomes.

Conclusions

The findings demonstrated the usefulness of the Systems Engineering Initiative on Patient Safety model to explain safety-related performance and outcomes, indicating differential effects of work system factors. Although the person factor significantly affected safety performance and clinical outcomes, the organization factor was the most influential component for promoting safety-related performance and staff and clinical outcomes. These results can be used to prioritize activities for patient safety.
Neonatal Adverse Events’ Trigger Tool Setup With Random Forest
Authors: Feng Kun , Zhang Li , He Huayun , You Xueqin , Zhang Qiannan , Wei Hong , Hua Ziyu
Published: May 2021

Objective

This study aimed to develop a trigger tool for detection of neonatal adverse events (AEs) and to validate its effectiveness.

Study Design

Random forest (RF) algorithm was used to build the predictive model by analyzing data from the medical records of 782 neonates in our previous study. Thirteen variables for each patient were used to predict neonatal AEs. Next, the critical variables were selected based on recursive elimination of variables to form the list of triggers. Then, a trigger tool with those triggers was established and tested by reviewing medical records. The positive predictive value of individual triggers and of the entire tool was evaluated.

Results

Data from 782 neonates, including 297 patients with and 485 patients without AEs, were collected to build the original RF model. Then, the 6 most important variables, including diarrhea, antibiotic use, fever, death, skin damage, and suspected necrotizing enterocolitis, were selected to establish a neonate-focused trigger tool. The forest with the 6 variables predicted AEs with a sensitivity of 70.7%, a specificity of 92.0%, and an error rate of 16.1%. In a validation study of the trigger tool, 655 neonates with birth weights ≥1500 g were enrolled, and review of their medical records revealed 1709 triggers and 1172 unique AEs. The 3 most common AEs identified were skin damage, iatrogenic diarrhea, and environmental factor–related fever. The total positive predictive value of the trigger tool was 0.686.

Conclusions

The neonate-focused trigger tool developed using the RF algorithm efficiently and reliably identifies AEs among hospitalized neonates with birth weights ≥1500 g.
Quantitative Neuromuscular Monitoring With Train-of-Four Ratio During Elective Surgery: A Prospective, Observational Study
Authors: Azizoğlu Mustafa , Özdemir Levent
Published: May 2021

Objectives

Postoperative residual neuromuscular block (PRNB) is a serious problem that can cause death after surgery. It was aimed to evaluate the adequacy of neuromuscular block (NMB) during endotracheal intubation and the adequacy of neuromuscular recovery during clinically extubation decision and follow-up with the train-of-four ratio (TOFR) using quantitative monitoring.

Methods

This study has a prospective-observational single-blind study design. A total of 205 adult patients who underwent elective surgery, who had American Society of Anesthesiologists physical statuses I to III, and who were intubated with neuromuscular blocking agent under general anesthesia were included in the study. Train-of-four ratio measurements were provided single-blindly by another anesthesiologist outside the team. The TOFRs were measured at the time of intubation (TOFRind), before reversal agent administration (TOFRpre-rev) and after (TOFRpost-rev), at the time of extubation (TOFRext), and on admission to the postoperative care unit (TOFRPACU). If clinical signs of PRNB appeared, the recovery protocol was applied and then TOFRrec was measured. Postoperative respiratory complications were also evaluated for the first 24 hours after surgery.

Results

Endotracheal intubation was performed in 41.5% of the patients (n = 85) without adequate NMB. In 48.8% (n = 100) of the patients, adequate recovery (TOFRext ˂0.9) was not available at the time of extubation. Adequate TOFRPACU rate was found to be significantly higher in those who did not receive additional neuromuscular blocking agent doses (P < 0.001). In the recovery protocol, low-dose sugammadex administered to patients with clinical signs of PRNB significantly increased the TOFRrec rate compared with neostigmine (P ˂ 0.001). The first 24 hours, postoperative respiratory complication rate was 5.4% (n = 11), and the most common hypoxemia was observed.

Conclusions

Approximately half of the patients are intubated without sufficient NMB and extubated without sufficient neuromuscular recovery. This suggests that routine use of quantitative neuromuscular monitoring is necessary for patient safety.
Evaluation of the Efficiency and Safety of a Safe Label System: A Prospective Simulation Study
Authors: Neo Hong Jye , Sim Ming Ann , Ti Lian Kah , Ang Sophia Bee Leng
Published: May 2021

Objectives

Our study aims to investigate the safety and efficiency of the Codonics Safe Label System (SLS) in a prospective simulation study.

Methods

Three sets of simulated experiments involving 82 anesthetists were carried out on patient simulator mannequins. The primary outcome assessed through the simulated experiments was the effectiveness of the SLS in avoiding vial swap errors. Secondary outcomes analyzed included the efficacy of the SLS in preventing syringe swap and the difference in time taken to prepare standardized drugs as compared with conventional methods.

Results

The SLS was associated with a significant reduction in all 4 stages of vial swap error. The incidence of wrong ampoule breakage was significantly lower in the SLS group compared with the conventional group (12.1% versus 38.5%, P = 0.007). The number of staff who drew the wrong ampoule was similarly lower in the SLS group compared with the conventional group (4.9% versus 33.3%, P = 0.001). The proportions of staff who eventually wrongly labeled the loaded syringe were 0% in the SLS group and 17.9% in the conventional group (P = 0.005).

Drug preparation time was longer for the SLS group than for the conventional group (239.6 ± 45.9 versus 160.3 ± 46.5 seconds, P < 0.001).

There was no significant difference in the incidence of syringe swap with the use of the SLS.

Conclusions

The use of the SLS is effective in reducing vial swap error, but not syringe swap errors, and is associated with increased time taken for anesthetic drug preparation.