bluuebunny/crossref_metadata_2025 huggingface dataset:
Capacidad funcional y valoración sociofamiliar del adulto mayor del asentamiento humano Tierra Prometida Ica octubre 2019
Authors:   , Rodríguez Figueroa Jennifer Natalia
Published: August 2023

Introducción: El adulto mayor es la persona que por naturaleza presenta una disminución de su capacidad funcional por el proceso normal de envejecimiento, también un gran porcentaje de ellos muchas veces se encuentran abandonados enfrentando serios problemas sociofamiliares. Objetivo: La investigación tiene por objetivo determinar la capacidad funcional y valoración sociofamiliar del adulto mayor del Asentamiento Humano Tierra Prometida Ica octubre 2019. Metodología: La investigación es descriptiva, cuantitativa y transversal; la población-muestra está conformada por 44 adultos mayores seleccionados de manera no probabilística; la técnica de recojo de información fue la entrevista y los instrumentos fueron el Índice de Katz para la primera variable y para la segunda, la escala de Valoración Sociofamiliar. Resultados: En relación a los datos generales de los adultos mayores de Tierra Prometida, se observa que el 59% tienen de 60 a 69 años, el 55% son de sexo femenino, el 36% son convivientes, el 77% provienen de la costa y el 80% poseen el Seguro Integral de Salud; respecto a la capacidad funcional, el 52% son independientes, el 39% tienen dependencia parcial y el 09% tienen dependencia total; con relación a la valoración sociofamiliar, el 52.3% están en riesgo social, el 36.4% tienen problema social mientras que el 11.3% tienen una situación social aceptable. Conclusiones: La capacidad funcional del adulto mayor según el índice de Katz, es de independencia, por lo que se rechaza la hipótesis derivada 1 de la investigación; la valoración sociofamiliar del adulto mayor según situación familiar, situación económica, vivienda, relaciones sociales y apoyo de la red social es de riesgo social, por lo tanto, se acepta la hipótesis derivada 2 de la investigación.
Conductas preventivas frente al cáncer de mamas en mujeres beneficiarias del programa vaso de leche de Grocio Prado Chincha 2021
Authors:   , Saravia Herrera Milagros Melchorita
Published: August 2023

Introducción: En la actualidad los casos de cáncer de mamas siguen liderando las estadísticas, producto de diversos factores conductuales y escasa prevención, colocando a la mujer en un grupo de riesgo y de especial interés en la educación para la salud. Objetivo: Identificar las conductas preventivas frente al cáncer de mamas en mujeres beneficiarias del Programa Vaso de Leche de Grocio Prado Chincha 2021. Metodología: Estudio de tipo cuantitativo, el método empleado es descriptivo de corte transversal, tomando en cuenta el muestreo probabilístico aleatorio. Se trabajó con 92 mujeres beneficiarias del programa Vaso de Leche del distrito de Grocio Prado; la técnica corresponde a la encuesta cuyo instrumento fue un cuestionario de elaboración propia, validado por juicio de expertos (p: 0.03), con una confiabilidad interna moderada (0.66) Resultados: Las conductas preventivas frente al cáncer de mamas fueron inadecuadas en un 62%. De acuerdo a las dimensiones se obtuvo que el 62% de mujeres no se realizan el autoexamen de mamas, el 93% no llevan un control adecuado de la salud, de acuerdo a la alimentación las conductas son inadecuadas en un 56%, en cuanto a la actividad física es inadecuadas en 54% y el 82% inadecuado en educación en salud, sin embargo, e las dimensiones hábitos sociales son adecuadas en el 58% de mujeres.
Práctica de cuidado que brinda y nivel de sobrecarga del cuidador del adulto mayor dependiente atendido en el Hospital Félix Torrealva Gutiérrez, Ica febrero 2018
Authors:   , Uribe Chacaltana Manuel Alberto
Published: August 2023

Introducción: La práctica de cuidado tiene un significado de servicio social debido al cuidado ligado a la satisfacción de sus necesidades en el proceso de enfermedad de la persona. La experiencia de cuidar involucra una gran responsabilidad y esfuerzo el cual si no se logra manejar adecuadamente puede traer repercusiones físicas, psicológicas. Objetivo: de la investigación fue determinar la práctica de cuidado que brinda y el nivel de sobrecarga que presenta el cuidador del adulto mayor dependiente atendido en el Hospital Félix Torrealva Gutiérrez, Ica febrero 2018. Metodología: El estudio es descriptivo, cuantitativo y transversal. La muestra que se consideró fue de 35 cuidadores. Resultados: En la primera variable Práctica de cuidado según ingesta alimentaria y de líquidos es favorable en 63%(22) y desfavorable en 37%(13); higiene es desfavorable en 54%(19) y favorable en 46%(16), movilidad y confort es desfavorable en 60%(21) y favorable en 40%(14); obteniéndose un consolidado global en la práctica de cuidado de desfavorable en 60%(21) y favorable en 40%(14). Los datos generales de los cuidadores: el 54%(19) tienen de 41 y 60 años, 63%(22) de sexo femenino, 57%(20) tienen secundaria y el 46%(16) es el cónyuge del paciente En la segunda variable Nivel de sobrecarga según consecuencias del cuidado es de sobrecarga leve en 74%(26), 17%(6) sobrecarga intensa y 9%(3) con ausencia de sobrecarga; según creencias y expectativas el nivel de sobrecarga es leve en 71%(25), sobrecarga intensa en 23%(8) y ausencia de sobrecarga en 6%(2), en la relación cuidador/cuidado es leve en 54%(19), intensa en 34%(12) y ausencia de sobrecarga en 11%(4). Conclusión: La práctica de cuidado que brinda el cuidador según cuidado nutricional es favorable y es desfavorable en las dimensiones higiene, movilidad, confort y el nivel de sobrecarga del cuidador según consecuencias del cuidado en el cuidador, creencias y expectativa sobre la capacidad para cuidar y relación cuidador/cuidado es leve.
Percepción del estudiante de enfermería hacia la investigación científica en la Universidad Privada San Juan Bautista – Chorrillos mayo – 2019
Authors:   , Adanaque Bastarrachea Edith Verónica
Published: August 2023

Introducción: La investigación es un pilar fundamental en el desarrollo de las disciplinas profesionales, su aplicación en el campo académico implica el desarrollo de competencias relacionadas a la creatividad. Objetivo: Determinar la percepción del estudiante de Enfermería de VIII ciclo hacia la investigación científica en la Universidad Privada San Juan Bautista – Chorrillos mayo 2019. Metodología: El estudio de investigación fue de enfoque cuantitativo, de tipo descriptivo y transversal, la población muestral estuvo constituida por 40 estudiantes del VIII ciclo, la técnica fue la encuesta y el instrumento un cuestionario con escala de respuestas tipo Likert. Resultados: Los estudiantes de Enfermería de VIII ciclo tienen edades de 24 a 26 años 60% (24) y de sexo femenino 90% (36) y su percepción hacia la investigación es desfavorable 75% (30) y favorable 25% (10). Conclusiones: Los estudiantes de VIII ciclo de Enfermería tienen una percepción desfavorable hacia la investigación.
Typical and atypical appearance of microwave ablation zones in the liver
Authors: Maurer Martin
Published: August 2023

Local minimally invasive interventional procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of both primary hepatic malignancy and liver metastases of various origins have become increasingly popular in recent years. After treatment, is then the task of follow-up imaging with computed tomography (CT) and/or magnetic resonance imaging (MRI) to evaluate treatment success and to be aware of possible pitfalls that might give rise to misinterpretation.
Marlowe's Voyage Of Liberation: A Post-Colonial Perspective On Heart Of Darkness
Authors: Waqas Ahmad  , Dr. Ubaid Ullah Ubaid  , Imtiaz Ahmed Afridi  , Dr. Sayyed Rashid Ali Shah  , Khalid
Published: August 2023

This research paper delves into the novel "The Heart of Darkness" by Joseph Conrad, examining it through a post-colonial lens to explore the themes of liberation and the impact of colonialism on various aspects of life. The analysis chapter investigates crucial subtopics such as the dream-like existence and passivity of the colonial settlers, the exploitation of power and the weaknesses of the colonized, the lives of subalterns, the imposition of new systems, and the loss of freedom. Additionally, it examines the darkness of life and the insignificance of native culture, along with the legitimization of invasion and occupation and the voice of resistance. The study adopts a qualitative research methodology, drawing on post-colonial theories presented by scholars such as Edward Said, Gayatri Chakravorty Spivak, Homi K. Bhabha, and Frantz Fanon (Said, 1978; Spivak, 1993; Bhabha, 2008; Fanon, 2008). These theories serve as a theoretical framework, guiding the textual analysis to uncover and interpret post-colonial structures and themes present in the novel. By employing these perspectives, the study seeks to understand the complexities of colonial relationships, encompassing traditions, norms, identity, culture, and experiences depicted in the portrayal of both colonizers and the colonized. The main analytical tool used in this research is Edward Said's theory of Orientalism, supplemented by insights from other post-colonial theorists (Edward, 1978). The data collection process involves a comprehensive study of the novel and the selected theories, and relevant text materials from the novel are carefully chosen based on the elements of the adopted theories. The primary sources of data include Joseph Conrad's "The Heart of Darkness," as well as the works of Spivak, Said, Bhabha, and Fanon (Conrad, 1902; Said, 1978; Spivak, 1993; Bhabha, 2008; Fanon, 2008). The research paper presents a qualitative data analysis technique, focusing on themes such as orientalism, racism, identity, subalternity, and hybridity. After thorough examination and interpretation of the novel's text in light of the selected theories, the paper offers critical insights into the post-colonial elements present in "The Heart of Darkness." This study contributes to the broader understanding of post-colonial literature and highlights the lasting impacts of colonialism on both the colonized and the colonizers.
Context As A Shaper Of EFL Teacher Identity: Mediating Role Of Professional Development
Authors: Hussain Ahmad
Published: August 2023

Generally, professional development initiatives focus mainly on enhancing teachers’ classroom practices. However, teaching practices without being cognizant of students’ culture and teaching contexts rarely have an impact on students’ learning outcomes. With regard to language teaching, teachers’ knowledge of teaching context is a pivotal factor in learners’ language development. This paper reports on a study that explored how the Cambridge English Teacher (CET) professional development program influenced knowledge of teaching context of English as a Foreign Language (EFL) teachers in a Saudi Arabian public university. Utilizing convergent parallel mixed-methods design, survey questionnaire and semi-structured interviews provide the data to explore the CET experiences of 130 EFL teachers. The combined quantitative and qualitative results show that because of the CET, the participants’ knowledge of the Saudi EFL context was enhanced in the following areas: the status of the English language in Saudi society, learners’ culture, adaptation to institutional policies, building rapport with learner, and learning from multicultural colleagues. Specifically, the findings indicated that EFL teachers from different linguistics backgrounds gained an understanding of how the English language is taught through using culturally sensitive methodologies. Finally, the article recommends steps that seek to help institutes provide context-specific PD to teachers as well as offers directions for current practices and future research.
Sources of salinity to the Musselshell River, Musselshell County, Montana
Authors:   Montana Bureau of Mines and Geology, Meredith E. , Kuzara S.
Published: August 2023

Scientific report on the results of the GWIP Musselshell project. Includes groundwater/surface water connection analysis, geochemistry, and isotope analysis of sources of salt to the Musselshell River. The project was proposed by the Musselshell Watershed Coalition.
olhar acurado e a descoberta de um “novo mundo” a partir do microscópio
Authors: Alcantara Marlon Cesar de , Lourenço Guilherme Batista , Mendes Marcelo , Carvalho Adriano Reder de
Published: August 2023

Neste artigo propomos a introdução de atividades de observação com o uso do microscópio nas aulas de física. Para tanto, apresentamos um texto a partir do recorte historiográfico do desenvolvimento dos instrumentos óticos, explorando as relações entre arte, ciência e sociedade na República Holandesa do século XVII. Também abordamos nessas aulas de física a vida e a obra de personalidades como Antoni van Leeuwenhoek e Robert Hooke. Mostramos como esses atores participaram de uma rede de trocas de informações sobre instrumentos óticos, que permearam, com muita propriedade, as relações científicas anglo-holandesas. Inseridos nesse contexto, apresentamos dois microscópios de baixo custo que podem ser fabricados pelo professor: um deles remete à construção e à forma de observação de Leeuwenhoek, e o outro, um tanto mais “moderno” para que os docentes possam mostrar aos seus alunos imagens com melhor definição e qualidade. A apresentação desses instrumentos é amparada por um “guia” de construção e utilização, além de uma pequena explicação para a configuração de lâminas.
Efeito Compton: uma proposta de ensino aprendizagem utilizando sequência didática
Authors: Pinheiro Júlio , Magno Fátima Baraúna
Published: August 2023

O objetivo deste trabalho é verificar a efetividade da aplicação de uma Unidade de Ensino Potencialmente Significativa (UEPS) com relação ao ensino-aprendizagem do Ensino Médio ao tratar da introdução do conceito de efeito Compton no conteúdo de física moderna e contemporânea. A UEPS foi estruturada em oito etapas, divididas em material diversificado, como aulas expositivas de revisão, textos, vídeos, mapas conceituais, autoavaliações etc. Desta forma, houve maior integração em sala de aula entre professor e alunos, o que proporcionou aos discentes condições para a aprendizagem dos fenômenos estudados, melhorando a qualidade e o interesse deles no ensino de física. Quanto à metodologia, o trabalho apresentado caracterizou-se como uma pesquisa qualitativa orientada pelo professor na aplicação da sequência didática. Como resultado, este artigo aponta que, através do estudo feito, foi possível concluir que o tópico efeito Compton tem relevância suficiente para ser introduzido no conteúdo de física moderna, sendo uma ferramenta que pode contribuir para o desenvolvimento do ensino-aprendizagem destes estudantes.
Ensinagem do conceito de força centrípeta através de uma atividade prática utilizando material reciclado
Authors: Freitas Gisele Bosso de , Santos Ana Beatriz Monteiro dos
Published: August 2023

Com o objetivo de levar atividades experimentais para o ensino básico e motivar a ensinagem de física nas escolas, uma vez que muitas não possuem laboratórios didáticos para mostrar aos alunos os conceitos da física fora de figuras e fórmulas dos livros didáticos, realizamos uma oficina utilizando materiais reciclados para a ensinagem do conceito de força centrípeta. Nesta oficina, que pode ser adaptada para uma aula em qualquer escola brasileira, os alunos trabalharam em grupos e cada um produziu seu experimento. Além disso, o conceito foi formalizado através de fichas, em que foram anotados os procedimentos experimentais e as grandezas que puderam ser coletadas por meio do experimento. Com a realização da atividade, foi possível perceber o interesse dos alunos pela física devido à grande interação proporcionada por ela.
Aprender circuitos elétricos com estações laboratoriais para desenvolver competências metacognitivas
Authors: Mota Ana Rita Lopes , Santos João Lopes dos , Rosa Cleci T. Werner da
Published: August 2023

Décadas de investigação confirmam que somente uma pequena percentagem de alunos do Ensino Médio (e ensino superior) desenvolve uma compreensão profunda e significativa de circuitos elétricos. Aprender em equipe através do modelo das estações laboratoriais tem-se revelado promissor no contexto do ensino de física. Neste artigo, são apresentadas oito estações laboratoriais sobre circuitos DC, com a duração de 15 minutos cada, que podem ser utilizadas no ensino fundamental e/ou Ensino Médio. As estações foram construídas a partir de indicadores internacionais sobre o tema e foram concebidas para estimular o desenvolvimento de competências metacognitivas.
Construção de um plano inclinado de baixo custo para o ensino de mecânica nas aulas de física
Authors: Silva Leonardo Ribeiro Goes
Published: August 2023

Diante dos desafios que os docentes encontram no ambiente escolar para o desenvolvimento e o ensino e, consequentemente, na aprendizagem dos objetos de conhecimento de física, em especial os de mecânica, torna-se indispensável à necessidade de adotar novas metodologias e estratégias pedagógicas. Uma metodologia de ensino-aprendizagem que pode ser desenvolvida nas aulas de mecânica são as práticas experimentais, que podem ser executadas através de materiais experimentais pedagógicos. Para isso, este trabalho propõe auxiliar o professor na construção de um plano inclinado de baixo custo para ensinar os objetos de conhecimento sobre movimento retilíneo uniforme, movimento uniformemente variado e decomposição de forças de um corpo através de experimentações de cunho pedagógico que possam ser desenvolvidas em sala de aula.
The effects of simulation-based education on the communication and clinical judgment of nursing students and nurses: A systematic review and meta-analysis
Authors: Park Jung Min , Jun Sangeun
Published: August 2023

Purpose: This study aimed to evaluate the effectiveness of simulation-based education on communication and clinical judgment in nursing students and nurses. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Seven databases were searched to obtain articles published in Korean or English. Of 12,864 articles reviewed, 36 were included in a systematic review and 23 in a meta-analysis. To estimate the size of the effects of simulation-based education, a meta-analysis was performed using the R package meta program. The risk of bias was assessed using RoB 2.0 and ROBINS-I. Results: The effect sizes (ES) of simulation-based education on communication and clinical judgment were ES=0.77, 95% confidence interval (95% CI)=0.43 to 1.12 on communication-related variables and ES=1.84, 95% CI=1.03 to 2.65 on clinical judgment. Conclusion: Simulation-based education for nursing students and nurses is useful for improving their communication and clinical judgment. Thus, it is necessary to develop and apply simulation-based education programs for nursing students and nurses to improve their abilities in communications and clinical judgment.
Factors related to the intention of pre-clinical vaccination among nursing students
Authors: Ahn Kahyung , Jang Minsu , Kang Jihyeon , Kim Yuri , Shin Ahyeon , Park Yeon-Hwan
Published: August 2023

Purpose: The aim of this study was to identify factors related to the vaccination intentions of nursing students before clinical practice. Methods: A descriptive correlational study design was used. The participants were 129 nursing students who were enrolled in one college of nursing in Seoul and were scheduled for clinical training. Data collection was conducted from February 28 to March 7, 2022. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson’s correlation coefficient, and a latitudinal regression analysis using the IBM SPSS statistics version 26.0 program. Results: The intention to vaccinate showed a significant correlation with vaccination attitude (r=.72, p<.001), subjective norms (r=.68, p<.001), and perceived behavioral control (r=.63, p<.001). The influencing factors on three intent to vaccinate were vaccination attitude (β=.36 p<.001), subjective norms (β=.31, p<.001), and perceived behavioral control (β=.36, p<.001). The explanatory power of these variables was 69.6%. Conclusion: The vaccination rate before the clinical training of nursing students was related to economic burden, a lack of time, and transportation problems that nursing college students experienced during the vaccination process. Therefore, administrative and financial support is needed for improving the vaccination rates of nursing students.
Development of a case-based nursing education program using generative artificial intelligence
Authors: Ahn Jeonghee , Park Hye Ok
Published: August 2023

Purpose: This study aimed to develop a case-based nursing education program using generative artificial intelligence and to assess its usability and applicability in nursing curriculums.Methods: The program was developed by following the five steps of the ADDIE model: analysis, design, development, implementation, and evaluation. A panel of five nursing professors served as experts to implement and evaluate the program.Results: Utilizing ChatGPT, six program modules were designed and developed based on experiential learning theory. The experts’ evaluations confirmed that the program was suitable for case-based learning, highly usable, and applicable to nursing education.Conclusion: Generative artificial intelligence was identified as a valuable tool for enhancing the effectiveness of case-based learning. This study provides insights and future directions for integrating generative artificial intelligence into nursing education. Further research should be attempted to implement and evaluate this program with nursing students.
Types of perception toward non-face-to-face clinical practice among nursing students
Authors: Kim Geun Myun , Chang Soo Jung , Kim Jeong Ah
Published: August 2023

Purpose: This study aimed to identify the types of perception toward non-face-to-face clinical practice and to characterize the types of students who experienced online clinical practice during the coronavirus disease 2019 (COVID-19) pandemic.Methods: Q-methodology was used in this study, and 270 Q populations were formed based on in-depth interviews with 10 nursing students who had experienced non-face-to-face clinical practice, as well as related literature. Interviews were performed from August 1 to 31, 2022. A total of 42 Q samples were extracted, and Q sorting was performed on 33 nursing students who had experienced non-face-to-face clinical practice. A Q factor analysis was performed using the PC-QUANL program.Results: The nursing students’ perceptions of non-face-to-face clinical practice were classified into the following five types: “future professional competency-focused type,” “realistic convenience priority type,” “task burden awareness type,” “negative critic type,” and “limited experience dissatisfaction type.”Conclusion: This study revealed non-face-to-face clinical practice’s positive and negative aspects in nursing education. Moreover, it identified the aspects of clinical practice that cannot be replaced by non-face-to-face clinical practice and the elements of non-face-to-face practice that can complement clinical practice. These findings can be used as fundamental data to establish a stable and efficient system for improving the quality of clinical practice in the post-COVID-19 era and to implement effective non-face-to-face clinical practice according to student types.
The effects of political efficacy and nursing professionalism on political participation in nursing students
Authors: Woo Chung Hee , Ha Jiyeon
Published: August 2023

Purpose: This study aimed to assess the factors influencing the political participation of nursing students who, as they become future leaders in the nursing field, will need to increase their participation in health policy decisions.Methods: Data were collected using web-based questionnaires answered by 157 nursing students between March 13 and 27, 2023. Those data were analyzed using t-test, a one-way ANOVA, Pearson’s correlation coefficient, and a multiple linear regression.Results: The average score of political participation was 2.77±0.70 out of 5 points. Political participation showed positive correlations between political efficacy (r=.48, p<.001) and nursing professionalism (r=.27, p<.001). Furthermore, sex (female) and political efficacy were identified as influencing factors on political participation among nursing students, which explained it with 24.0% power.Conclusion: Providing timely nursing education is necessary for enhancing political efficacy, which could promote political participation among nursing students.
Factors related to the organizational silence of Korean nurses: A systematic review and meta-analysis
Authors: Kang Kyungja , Kim Jeong-Hee
Published: August 2023

Purpose: This study aimed to identify the variables related to the organizational silence of Korean hospital nurses and to examine the effect sizes of correlations between the related variables and sub-types of organizational silence.Methods: Relevant studies were searched through a systematic search in six Korean electronic databases (RISS, ScienceON, KCI, DBpia, e-Article, and KISS) using June 2022 as the end date. Thirteen studies were identified through a systematic review and eight of them were meta-analyzed. The correlation effect size r (ESr) for each related variable was calculated.Results: Twenty-two related variables were identified from the systematic review. Of them, organizational culture was the most frequently examined. Seven variables (three organizational, two leader-member exchange, and two consequences of organizational silence) were found eligible for the meta-analysis. The intention of turnover (ESr=.39; 95% confidence interval, 95% CI=.32 to .45) and leader-member exchange (“manager’s leaderships” ESr=-.33, 95% CI= -.43 to -.21; “manager’s inclination to reject negative feedback” ESr=.32, 95% CI=.23 to .39) had larger correlation effect sizes than the other variables that related to organizational silence, in particular, acquiescent silence, which had the largest correlation effect size among the three sub-types of organizational silence.Conclusion: These findings show that the intention of turnover and leader-member exchanges were the main factors that related to the organizational silence. This indicates that it is necessary to develop management and education programs, as well as communication systems that focus on reducing and managing organizational silence, especially acquiescent silence.
Prevalence of workplace violence against registered nurses and their perceptions of relevant management systems in acute care hospitals
Authors: Park Seungmi , Kwak Eunju , Lee Ye-Won , Park Eun-Jun
Published: August 2023

Purpose: This study investigated the prevalence and perceptions of workplace violence against registered nurses (RNs) in hospitals.Methods: One thousand RNs replied to a nationwide survey from November 14 to December 22, 2022. They reported their general characteristics, prevalence of and their responses to different types of workplace violence from patients, family caregivers, physicians, and nurse peers, as well as their perceptions of workplace violence management systems.Results: A total of 71.1% of the RNs reported that they had experienced workplace violence in the last six months. The violence and sexual harassment experienced from patients and family caregivers were 57.3% and 19.1%, respectively. Furthermore, violence, sexual harassment, and workplace harassment from physicians were experienced by 24.6%, 4.0%, and 7.4%, respectively, of the RNs, and those from nurse peers by 21.4%, 3.1%, and 11.3%, respectively. The RNs stated that they often responded to workplace violence with passive and inactive behaviors, which were more serious toward physicians’ workplace violence or sexual harassment from different perpetrators. Only 69.5% were aware of their hospital’s workplace violence management systems, while only 14.7%~27.4%, according to the type of hospital (p=.471), perceived the systems as effective. Multiple important strategies were identified to prevent workplace violence.Conclusion: Critical suggestions are discussed for the prevention of workplace violence, including protecting the human rights of healthcare professionals, inter-organizational collaboration, and a culture of person-centered healthcare, and training nurse managers’ competency in managing workplace violence.
The Effect of Onset Time on In-Hospital Mortality in Patients with Acute Type A Aortic Dissection of Different Gender: A Retrospective Cohort Study
Authors: Peng Yanchun , Ni Hong , Pan Qiong , Lin Lingyu , Li Sailan , Chen Liangwan , Lin Yanjuan
Published: August 2023

Background: Although the research on gender in acute type A aortic dissection (AAAD) patients has increased in recent years, the results are still controversial. The effect of time of onset on in-hospital mortality in patients with AAAD of different gender is unclear. The purpose of this study was to investigate the effect of onset time on in-hospital mortality of patients with AAAD of different gender. Methods: In this retrospective observational study, patients with AAAD were selected from June 2013 to March 2020. Patients' information was extracted from electronic medical records. Based on the onset time, the patients were categorized into four groups: group one (00:00–05:59), group two (6:00–11:59), group three (12:00–17:59), and group four (18:00–23:59). Results: A total of 760 subjects were included in our study. There were 591 (77.8%) males and 169 (22.2%) females. In male patients, 79 cases died, in female patients, 19 cases died (p < 0.05). We conducted subgroup analysis according to gender, univariate Cox regression analysis of male patients showed that compared with the patients at onset time of 0:00–5:59, patients at onset time of 12:00–17:59 and 18:00–23:59 were associated with an increased risk of in-hospital mortality. Multivariate Cox regression analysis of male patients showed that the onset time of 18:00–23:59 remained as the significant risk factor of in-hospital mortality of male patients hazard ratio (HR) = 4.396 (p < 0.05). Conclusions: This analysis demonstrated that in-hospital mortality of AAAD patients was similar in different genders. In male patients, the onset time of 18:00–23:59 was significantly associated with an increased risk of in-hospital mortality.
Molecular Classification Improves Therapeutic Options for Infants and Young Children With Medulloblastoma
Authors: Bagchi Aditi , Dhanda Sandeep K. , Dunphy Paige , Sioson Edgar , Robinson Giles W.
Published: August 2023

Medulloblastoma in infants and young children is a major challenge to treat because craniospinal irradiation (CSI), a cornerstone of therapy for older children, is disproportionately damaging to very young children. As a result, trials have attempted to delay, omit, and replace this therapy. Although success has been limited, the approach has not been a complete failure. In fact, this approach has cured a significant number of children with medulloblastoma. However, many children have endured intensive regimens of chemotherapy only to experience relapse and undergo salvage treatment with CSI, often at higher doses and with worse morbidity than they would have initially experienced. Recent advancements in molecular diagnostics have proven that response to therapy is biologically driven. Medulloblastoma in infants and young children is divided into 2 molecular groups: Sonic Hedgehog (SHH) and group 3 (G3). Both are chemotherapy-sensitive, but only the SHH medulloblastomas are reliably cured with chemotherapy alone. Moreover, SHH can be molecularly parsed into 2 groups: SHH-1 and SHH-2, with SHH-2 showing higher cure rates with less intensive chemotherapy and SHH-1 requiring more intensive regimens. G3 medulloblastoma, on the other hand, has a near universal relapse rate after chemotherapy-only regimens. This predictability represents a significant breakthrough and affords oncologists the ability to properly risk-stratify therapy in such a way that the most curative and least toxic therapy is selected. This review examines the treatment of medulloblastoma in infants and young children, discusses the molecular advancements, and proposes how to use this information to structure the future management of this disease.
DON’T PENALIZE DOCTORS FOR USING NON-OPIOID PAIN TREATMENTS
Authors: Sigman Scott
Published: August 2023

The opioid crisis forced policymakers to acknowledge that people in pain need diverse treatment options. They need safe and effective non opioid treatment plans created thoughtfully with both doctor and patient input. Policymakers can and must do better to prevent opioid addiction
Private Equity Partnerships in Orthopedic Groups: Current State and Key Considerations
Authors: Herschman Gary , Torres Hector
Published: August 2023

The orthopedic physician group sector remains an attractive area of investment for private equity because the demand for orthopedic care is high, yet the supply of orthopedic surgeons in the U.S. is relatively low. This supply and demand imbalance provides for long-term sustainable growth of orthopedic services within a highly fragmented clinical specialty. With an approximate $1.8 trillion dollars of private equity capital ready to be deployed within the healthcare services industry, private equity remains an increasingly more available option to orthopedic practices. While partnerships among and between orthopedic groups and private equity firms can result in significant benefits, in today’s environment, private equity may also serve as an advantageous pathway for independent orthopedic groups to bolster their financial strength and better position themselves to weather the post-COVID-19 storm.
Incidence of Sacroiliac Screw Implant Pain and Results of Screw Removal
Authors: Gurnea Taylor P , Gonzalez Miguel A , Turner Alexander R , Moody Alastair E , Althausen Peter
Published: August 2023

Introduction: Percutaneous sacroiliac(SI) screw fixation of pelvic fractures has become commonplace. Routine removal of SI screws has been recommended by some physicians while others remove only symptomatic implants citing risks associated with this procedure. Few publications exist documenting the incidence of SI screw related hardware pain, rates of SI screw removal, the results of implant removal and the risks and complications associated with this procedure. Our objective is to document the incidence and clinical impact of symptomatic sacroiliac drew removal at a community level II trauma centers over a 12-year period.

Methods: Operative records were queried to identify 250 patients with pelvic ring injuries treated with SI screw placement at our institution. Records were analyzed to identify fracture classification, implant removal, reason for implant removal, analogue pain scales before and after implant removal and complications after implant removal.

Results: During the 12 year study period from 2006-2018, 300 posterior pelvic ring screws were placed in 250 patients. 46/250 (18.4%) patients underwent implant removal, accounting for 66 screws. 43 patients cited painful hardware as the reason for removal and 3 patients cited infection. Average time to removal was 6.7 months. Mean analog pain scales were 4.91 and 0.51 before and after removal respectively. No intra-operative or post-operative complications were encountered. All patients reported improvement in pain with screw removal

Conclusions: Postoperative pain following SI screw placement attributed to retained implant occurs in 18% of patients. Despite the previously documented proximity of neuromuscular structures, no intra-operative or postoperative complications were observed in patients who underwent screw removal. All patients reported significant relief of symptoms following implant removal. In patients experiencing pain following SI screw placement, screw removal 6 months following initial fixation is a safe and effective procedure.
Wound complications, infections and nonunions do not increase with open reduction of tibia shaft fractures treated with intramedullary devices
Authors: Will Ryan
Published: August 2023

Introduction: Tibia shaft fractures on common injuries and commonly treated with intramedullary implants. The effect of open reduction on fracture healing and wound healing is not well described.

Methods: A retrospective chart review of 32 cases of open or closed tibia shaft fractures treated by a single surgeon at a Level 3 trauma center with open reduction and use of an intramedullary implant. Re-operation rates for any reason, deep and superficial infection rate and fracture healing were recorded.

Results: All 32 patients healed their fractures and 4 patients require removal of painful hardware. Two cases superficial infection occurred, and no cases of deep infection occurred.

Conclusion: Open reduction of tibia shaft fractures can be done safely and effectively using appropriate technique in a diverse set of patients that present in a community type setting.
Dual Motor Orthopaedic Drill Reduces Plunge and Provides Data for Safe and Accurate Screw Placement During Clavicle Fracture Fixation
Authors: Perry John , Collins Anthony , Gilmer Brian
Published: August 2023

The D-MOD system (SMARTDrill, Smart Medical Devices, Las Vegas, NV) contains a dual motor drill and a remotely linked tablet (Figure 1). The first drill motor spins a chuck similar to any drill but at a controlled revolution rate determined by the software (rpm). The second motor moves a harp and drill guide parallel to the axis of the drill bit controlling advancement of the bit. The second motor records the linear distance that the drill bit travels and provides continuous data back to the monitor.
Management of a Lateral Meniscus Tear with Bucket-Handle Displacement in a Seven-Year-Old with Lateral Discoid Meniscus Morphology: A Case Report
Authors: Combs Kristen , Soppe Clint , Muffly Matthew
Published: August 2023

Background: Lateral meniscus tears in patients less than ten years old are exceedingly rare. Displaced bucket handle tears of the lateral meniscus are even less commonly encountered.

Hypothesis/Purpose: This case report details the presentation, treatment, and recovery of a seven year old female who presented with a bucket handle lateral meniscus tear and was found to have underlying discoid meniscus morphology.

Methods: This case report details the pre-operative, arthroscopic findings, repair technique, and post-operative outcome of a single patient presenting with a rare injury pattern.

Results: The lateral meniscus was torn along the periphery at the meniscocapsular junction involving zones I-III with displacement into the notch. The meniscal tissue appeared hypertrophied and was noted to be a Wrisberg type discoid variant. A saucerization and repair was performed using sutures utilizing a combination of all-inside and outside-in repair techniques. The patient regained full range of motion and returned to full unimpeded activity at three months post-operatively.

Conclusions: This is a unique case of a pediatric patient less than ten years old presenting with a bucket-handle tear of a discoid lateral meniscus who underwent surgical repair. The case details the saucerization and repair technique with successful recovery of this pediatric patient to date. It highlights a technique for meniscus repair in lieu of partial meniscectomy which is of particular benefit in the pediatric population.
Multicenter Survey of Resident Education in Professional Development and the Business of Orthopaedics: Are Residents Ready for Transition to Practice?
Authors: Vallier Heather , Sagi Henry Claude , Quinnan Stephen , Obremskey William , Meinberg Eric , Mauffrey Cyril , Whiting Paul , Kweon Chris , Only Arthur , Okelana Bandele , Flagstag Ilexa , Vang Sandy , Ghasem Alexander , Friess Darin , Parikh Harsh , Blaschke Breanna , Gorman Tiffany , Bhatt Etasha , Cunningham Brian
Published: August 2023

Background

Systems-based practice is a core competency of orthopaedic residency, yet there is no defined curriculum to address this area, which may leave residents with gaps in knowledge.

Objective

The aim of this study was to assess residents’ understanding of systems-based practice and interest in incorporating these principles into curricula.

Methods

In 2018 a survey was emailed to residents in programs across the United States evaluating comprehension in systems-based practice, and interest in specific domains of curriculum development: personal finance, value of orthopaedics, practice dynamics, transition to practice, work life balance, research, professional development, leadership development, international medical work, and law. Residents were categorized into subgroups based on years of training: junior (1-3) and senior (4-5), and nonparametric chi-squared analysis was performed between the groups.

Results

Of 275 residents surveyed, 151 completed the survey for an overall response rate of 55%. Self-rated understanding of systems-based practice was statistically identical (p=1.00) between junior and senior residents; 91.4% of both groups indicated low comprehension of the systems-based practice competency. There was strong interest by the majority of respondents in further training in many domains. When subcategorized as junior and senior residents, the only significant differences in interest were in professional development (p=0.04) and transition to practice (p = 0.01) domains, with more junior residents expressing strong interest in further training in these topics.

Conclusions

This study indicated that there is a gap in resident education in systems-based practice and that orthopaedic residents are interested in the enhancement of education in this domain.
The Impact of the COVID-19 Pandemic on Physicians’ Perception of Digital Health in Orthopedics
Authors: McGrath Mikayla , Spira Bronwyn , Grady-Benson John , Bruning Paul , Kress Kenneth , Belniak Robert , Golladay Gregory J , Damodar Dhanur
Published: August 2023

Digital health and technology have been growing in healthcare over the past 10 years as they have allowed for health systems to remotely deliver virtual care at scale. Despite this, providers and healthcare systems have traditionally viewed technology as an additional asset, or even a burden in some cases, rather than a necessity. Due to the impact of COVID-19 on in-person treatment options for millions of patients, a rapid adoption of telemedicine and virtual healthcare services has been seen across the country and the globe. A survey (Appendix A) was conducted that included respondents from all roles within leading healthcare organizations - from surgeons to nurses to administrators & more. By analyzing data from various healthcare personas, we aimed to paint a complete picture of the orthopedic healthcare industry. COVID-19 has challenged the healthcare system and physicians to reimagine the ways they have traditionally delivered care to patients.

While barriers to adoption exist – including reimbursement and operational efficiencies – the orthopedic community is on track to have virtual care and telemedicine as a new normal long after the pandemic has come to an end. Forward-thinking healthcare systems and physician groups that rise to the challenge and adapt to this change will continue to make strides in improving patient care and driving this forward momentum, wherein healthcare can be a true hybrid of virtual and in-person care that best suits the needs of all patients.
What Matters? When I Became a Patient - A Surgeons Perspective
Authors: Steele Marshal
Published: August 2023

Many physicians don’t always understand what it’s like to be on the other side of the table. Organizations that are successful often don’t see the need. Some don’t have the architectural map or time to implement the hundreds of changes that must be made. Others have different priorities that they believe are more important.
Immediate Weight Bearing After Fixation of Humeral Shaft Fractures with Small Fragment Hybrid Plating: A Biomechanical Analysis
Authors: Bledsoe J. Gary , Geraud Simone , Cannada Lisa K.
Published: August 2023

Background

This study evaluates the stiffness of both 4.5 mm dynamic compression plates (DCP) and 3.5 mm hybrid locking-compression plates (LCP) for treatment of humeral shaft fractures in a simulated weight bearing model.

Methods

Testing was performed on 16 4th generation Sawbones humeri. Initial axial and torsional stiffness were determined. Plates were placed and a 5 mm defect was produced. Specimens were subjected to 90,000 loading cycles to simulate 90 days of crutch walking and then loaded to failure. Statistical analysis was performed using a t-test with significance at P < 0.05.

Findings

Comparison reveals a significant difference between the intact axial and torsional stiffness of 4.5 mm DCPs and 3.5 mm LCPs. The 3.5 mm plates provided 80% of the axial stiffness and 75% of the torsional stiffness of the 4.5 mm plates. The 3.5 mm plated bones failed at 79% of the mean failure load of the 4.5 mm plated bones. The 3.5 mm plated bones failed due to incidental torsion during axial loading; the 4.5 mm plated bones failed as a result of gap closure.

Interpretation

Our results followed expectations due to differences in plate dimensions. There were no apparent differences between constructs following cyclic loading. Our model includes a fracture gap, which requires the plate to carry the entire load. This does not simulate the actual clinical scenario wherein healing would tend to improve construct performance. While the constructs performed differently, both appear to support loads that are anticipated in the clinical setting.