bluuebunny/crossref_metadata_2025 huggingface dataset:
Demographic Differences in Satisfaction and Work-Life Balance of Prelicensure Nursing Faculty
Authors: Crawford Ryan P. , Barbé Tammy , Randolph Justus
Published: February 2023

Background:

A need exists to recruit and retain nursing faculty of differing generations, races/ethnicities, and genders.

Purpose:

The purpose of this study was to examine whether generational cohort, race/ethnicity, and gender predicted job satisfaction, life satisfaction, or work-life balance for full-time faculty teaching in prelicensure, baccalaureate nursing programs.

Methods:

Faculty (N = 363) from multiple schools of nursing in the United States completed a survey that included demographics, the Job Satisfaction Scale, the Satisfaction with Life Scale, and the Work-Life Balance Self-Assessment.

Results:

Significant relationships and differences were noted for nursing faculty. Faculty of color reported lower job and life satisfaction than their White counterparts.

Conclusions:

As calls to increase diversity among nursing faculty increase, continued research should focus on differences in the experience of faculty of color.
Nurse Educators' Perceptions and Self-efficacy in Response to COVID-19
Authors: Riess Dawn , Mersiovsky Amy , Gruhn Carole
Published: February 2023

Background:

During the COVID-19 pandemic, nurse educators had to adapt quickly to required changes in nursing education following isolation mandates. Educators worked diligently to provide a quality remote/online educational experience with limited resources.

Purpose:

The purpose of this review was to explore nurse educators' perceptions and self-efficacy toward the transformation from the traditional face-to-face teaching to remote/online teaching and simulation/laboratory modifications in response to the COVID-19 pandemic.

Methods:

A scoping review, informed by PRISMA-SCR guidelines, was performed in PubMed, Web of Science, CINAHL Complete, OVID MEDLINE, and Google Scholar.

Results:

There were 34 articles included in the final review, with 7 themes identified: teaching pedagogy, technology challenges, online teaching role, learning environment, leadership, clinical education, and well-being.

Conclusions:

The review is relevant to nursing faculty across the globe. Planning for future pandemics should include self-care, use of evidence-based practices, protocols, and increased communication.
Strategies to Evaluate and Enhance Accelerated Second-Degree Nursing Pathways
Authors: Jones Kim Dupree , Hayes Rose , McCauley Linda
Published: February 2023

Background:

Health systems are facing historic staffing crises, and they require efficient pipelines of qualified students into practice. Accelerated second-degree students are helping to address pressing health care market needs.

Problem:

Few publications have assessed the second-degree program landscape or offered comparisons of second-degree pathways.

Approach:

This article discusses the second-degree program landscape, including challenges in second-degree education; compares graduate-level second-degree entry against other pathway options; and presents strategies to optimize and sustain second-degree student pipelines based on these insights.

Findings:

The second-degree program landscape is characterized by variability. Challenges include inconsistent program nomenclature and limited national data collection. Graduate-level second-degree pathways offer financial and career advantages compared with other pathways.

Conclusion:

Nursing education should standardize second-degree nomenclature, refine national data capture mechanisms, standardize program scope and requirements, and encourage second-degree pathways at the graduate level or above.
Exploring the Use of Common Strict Search Criteria in Nursing Literature Searches
Authors: Truex Eleanor Shanklin , Spinner Emily , Hillyer Jean , Ettien A'Llyn , Wade Sarah , Calhoun Courtney , Wolf Grace , Hedreen Rebecca , Heimlich Layla , Nickum Annie , Vonderheid Susan C.
Published: February 2023

Background:

Health sciences librarians and nursing journal contributors have expressed concern about the impact of using strict parameters when searching the literature.

Purpose:

The purpose of this study was to explore the use of strict search criteria (eg, 5-year rule, “nurse as author”) by direct care nurses and nursing students.

Methods:

Fourteen online focus groups were conducted with 54 participants: direct care nurses, health sciences librarians, nursing faculty, and nursing students. Nursing faculty and health sciences librarians were included as participants to add perspective to the origins and effects of the use of stringent search criteria.

Results:

The majority of the nurses viewed the 5-year rule and nurse as author search limits favorably, while noting that a strict date range may hamper successful searching. Librarians viewed these search criteria more unfavorably but recognized the value of topic-appropriate search limits.

Conclusion:

Reliance on strict limits can be detrimental to pertinent results; however, appropriate use is essential for relevant results. Pedagogy focused on searching the nursing literature needs to emphasize that limits are tools to be used judiciously.
Factors Associated With Willingness to Use Daily Antibiotics as Sexually Transmitted Infection Prophylaxis Among HIV Preexposure Prophylaxis–Experienced Gay and Bisexual Men in Australia
Authors: Arapali Tyson , Grulich Andrew E. , Heywood Anita E. , Chan Curtis , Fraser Doug , Zablotska Iryna B. , Holt Martin , Vaccher Stefanie J. , Bavinton Benjamin R.
Published: February 2023

Background

Gay and bisexual men (GBM) who use HIV preexposure prophylaxis (HIV-PrEP) have high rates of bacterial sexually transmitted infections (STIs). The use of daily antibiotics as STI preexposure prophylaxis (STI-PrEP) may be appealing to GBM who are using or have previously used HIV-PrEP (HIV-PrEP–experienced) for the prevention of bacterial STIs.

Methods

We examined willingness to use daily STI-PrEP among a cross-sectional sample of HIV-PrEP–experienced GBM in Australia who participated in an observational online cohort study from August 2018 to March 2020. Factors associated with willingness to use daily STI-PrEP were determined using bivariate and multivariate logistic regression.

Results

Of the 1347 participants, half (54.3%) were willing to use daily STI-PrEP. Factors independently associated with greater willingness to use daily STI-PrEP included having >10 sexual partners in the last 6 months, using methamphetamine in the last 6 months, being more conscious about avoiding STIs, having a greater number of STIs since commencing HIV-PrEP, being willing to take HIV-PrEP for as long as they were at risk of acquiring HIV, and only using condoms when a sexual partner requested them. Conversely, factors associated with less willingness to use daily STI-PrEP included being university educated, using nondaily dosing regimens of HIV-PrEP, preferring event-driven HIV-PrEP, and being concerned about long-term HIV-PrEP adverse effects.

Conclusions

Sexually transmitted infection PrEP is likely to be appealing to many HIV-PrEP–experienced GBM, especially those who engage in activities associated with a higher risk of STI transmission. However, they are less likely to be willing to use STI-PrEP unless it aligns with their HIV-PrEP dosing regimen, suggesting that research into the safety and efficacy of alternative STI prophylaxis dosing options should be prioritized.
Testing Technologies as Enhancers of Disease Intervention Specialist Activities: Applying Lessons From COVID-19
Authors: Van Der Pol Barbara
Published: February 2023

Disease intervention specialists are often at the forefront of adoption of new technologies in support of sexually transmitted infection (STI) contact tracing efforts. Newer technology for detection of treatable STI includes point-of-care molecular tests for detection of chlamydia, gonorrhea, and trichomonas and syphilis serology point-of-care tests. Other additions to our case finding toolbox are the use of telemedicine and the proliferation of direct-to-consumer offerings, both of which rely on remote sample collection involving self-collection of specimens in nonclinical settings. Finally, on the near horizon are over-the-counter tests that will support self-testing without the involvement of a medical professional. Each of these new developments is discussed and contextualized in experiences resulting from the COVID-19 pandemic response. Many options are now available, or will be soon, for detection of STIs in nontraditional settings, and we need to consider the processes involved as we move toward adoption of these new tools.
HIV Testing Preferences and Characteristics of Those Who Have Never Tested for HIV in the United States
Authors: Patel Shilpa N. , Emerson Brian P. , Pitasi Marc A. , Tripp Natalie E. , Marcus Ruthanne , Delaney Kevin P. , Chavez Pollyanna R.
Published: February 2023

Background

The initial phase of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative prioritized efforts in 57 geographic areas. The US Centers for Disease Control and Prevention recommends persons aged 13 to 64 years be tested for HIV at least once as part of routine health care; however, it is unclear how effectively these testing recommendations have been implemented in EHE priority areas.

Methods

In 2021 to 2022, we analyzed data from a Web-based, nationally representative survey of adults fielded in 2021. HIV testing preferences were compared by testing history, demographic characteristics, behaviors, and geography.

Results

An estimated 72.5% of US adults had never tested for HIV. Never testing was most prevalent among those aged 18 to 29 or those 50 years or older, non-Hispanic White persons, and those living in the Midwest. Among persons living in EHE priority areas and persons reporting at least one behavior that increases risk of HIV transmission, 69.1% and 48.0%, respectively, had never tested for HIV. The top 3 HIV testing preferences among never testers were as follows: testing for HIV during a routine health care visit (41.2%), testing at an urgent care or walk-in clinic (9.6%), and self-testing (8.1%).

Conclusions

Most adults had not been tested for HIV, confirming that US Centers for Disease Control and Prevention recommendations are not being fully implemented, even in EHE priority areas. Moreover, most adults who never tested preferred testing in clinical settings, highlighting missed opportunities. As the EHE initiative continues to advance, it is critical to leverage preferred HIV testing modalities, such as routine testing in clinical settings or HIV self-testing.
The PrEP Care Continuum Among Mexican Men Who Have Sex with Men and Transwomen: a Qualitative Study
Authors: Aguilera-Mijares Santiago , Martínez-Davalos Araczy , Bautista-Arredondo Sergio , Vermandere Heleen
Published: February 2023

Background

This article describes perceptions and experiences related to the pre-exposure prophylaxis (PrEP) care continuum of Mexican men who have sex with men (MSM) and transwomen (TW).

Methods

Between June and July 2020, we applied 24 online semi-structured interviews regarding PrEP use with 10 PrEP users, six ex-users, and eight potential users (at risk, not enrolled).

Results

Awareness: TW did not always receive the information they needed from trusted people. Acceptability: Potential users were reluctant to use PrEP due to fear of side effects, and only a few participants worried about stigma. Uptake: Potential users missed their enrollment visit and did not know how to reschedule. Adherence: Barriers included routine changes interfering with PrEP-taking habits (arriving home later, traveling, etc.) while feeling protected was reported as a facilitator. Retention: Ex-users quit PrEP services, mostly without reducing their HIV risk, because of difficulties keeping appointments and fearing long-term effects.

Conclusion

Inclusive awareness activities, tackling misbeliefs regarding side effects, and more flexible services may improve PrEP usage and enhance its impact.
Economic Evaluation of a Point-of-Care Test for Bacterial Vaginosis Among Women With Vaginal Symptoms
Authors: Jiao Boshen , Fredricks David N. , Srinivasan Sujatha , Hansen Ryan
Published: February 2023

Background

There is an unmet need for a clinical diagnostic technology to detect bacterial vaginosis (BV) rapidly and accurately. Novel point-of-care (POC) tests have the potential to fulfill this gap. Our objective was to determine the cost-effectiveness of a hypothetical clinician-administered POC test for diagnosing BV in the United States.

Methods

We developed a state-transition microsimulation model to evaluate the cost-effectiveness of using the POC test versus usual care among women of reproductive age with vaginal symptoms. We adopted a healthcare sector perspective that included relevant healthcare costs and a societal perspective that further incorporated productivity costs. Model parameters were empirically estimated based on commercial insurance claims data or derived from published literature. The primary model outcome was incremental cost-effectiveness ratio. We started with analyzing a hypothetical POC test with a sensitivity and specificity of 0.9 and a cost of $40, followed by extensive sensitivity analyses.

Results

Using the hypothetical POC test to diagnose BV increased costs by $16 and quality-adjusted life-years by 0.0005 per person compared with the usual care, leading to an incremental cost-effectiveness ratio of $31,108 per quality-adjusted life-year gained. When also capturing the productivity costs, the POC test resulted in an average cost savings of $57. The sensitivity analyses showed that the POC test's sensitivity was more influential on its cost-effectiveness than specificity.

Conclusions

Using the POC test to diagnose BV is likely to be cost-effective relative to usual care, especially with a high sensitivity or a substantial positive effect on productivity.
Two Models for Increasing the Scope and Activities of Human Immunodeficiency Virus Partner Services Programs: Preliminary Findings From the Fast Track Project
Authors: Golub Sarit A. , Price Devon M. , Starbuck Lila , Kim Christine , Strock Leah , Misra Kavita , Mikati Tarek , Udeagu Chi-Chi
Published: February 2023

Background

We sought to develop a novel strategy for expanding an existing human immunodeficiency virus (HIV) partner services (PS) model to provide comprehensive sexual health services, including sexually transmitted infection testing, a virtual telemedicine visit, and access to immediate start medication (antiretroviral treatment, preexposure or postexposure prophylaxis). Fast Track was a National Institutes of Health–funded implementation science trial in New York City to pilot and refine the new strategy, and examine its feasibility, acceptability, and impact.

Methods

Over the course of 1 year, health department staff collaborated with the academic research team to develop Fast Track protocols and workflows, create a cloud-based database to interview and track patients, and train disease intervention specialists to deliver the new program. The initial field-based program (Fast Track 1.0) was piloted March to December 2019. A modified telephone-based program (Fast Track 2.0) was developed in response to COVID-19 pandemic constraints and was piloted August 2020 to March 2021.

Results

These 2 pilots demonstrate the feasibility and acceptability of integrating comprehensive sexual health services into HIV PS programs. Disease intervention specialists were successfully trained to conduct comprehensive sexual health visits, and clients reported that the availability of comprehensive sexual health services made them more willing to engage with PS. Key lessons for scale-up include managing collaboration with a licensed provider, navigating technical and technological issues, and challenges in client engagement and retention.

Conclusions

The success of this integrated strategy suggests that telehealth visits may be a critical gateway to care engagement for PS clients. This model is an innovative strategy for increasing engagement with HIV testing, prevention, and treatment for underserved populations.
Immunotherapy in Genitourinary Cancers: Role of Surgical Pathologist for Detection of Immunooncologic Predictive Factors
Authors: Bahlinger Veronika , Hartmann Arndt , Eckstein Markus
Published: February 2023

Genitourinary malignancies include a broad spectrum of distinct tumor entities occurring in the kidney, the urinary tract, the prostate, the adrenal glands, the penis, and testicles. Each tumor entity presents with unique biological characteristics, especially in terms of immunobiology. The immune landscape of genitourinary malignancies differs between immunoreactive tumors like urothelial carcinoma or carcinomas of the kidney, for which several immunotherapeutic treatment options have been approved in the past years. In contrast, prostate cancer presents with low immunogenicity and previous trials exploring immune checkpoint inhibitors and other immunotherapeutic agents did not proof substantial survival benefits. In this review, we are presenting a streamlined overview on the role of surgical pathologists within the contemporary practice of immune oncology. It includes current indications for pathologic programmed death-ligand 1 (PD-L1) assessment and important pathologic considerations on PD-L1 testing harmonization including interassay and algorithm variabilities. In addition, we will discuss emerging biomarkers beyond PD-L1 and their potential to predict immunotherapy responses including tumor mutational burden, microsatellite instability, gene expression signatures, and histologic factors.
Peritoneal Mesothelioma—An Update
Authors: Malpica Anais
Published: February 2023

A remarkable amount of new information has been generated on peritoneal mesothelioma (PeM), ranging from nomenclature changes, including the removal of “malignant” when referring to this neoplasm and the use of the term “tumor” rather than “mesothelioma” to designate the neoplasm formerly known as “well-differentiated papillary mesothelioma”, to the acknowledgment that PeMs can be associated with tumor predisposition syndromes or germline mutations. Although the disease is still more frequently seen in caucasian males, PeM is not uncommon in women. In addition, it can represent a diagnostic challenge when it has an uncommon presentation (ie, paraneoplastic syndrome or incidental finding) or when it has confounding histologic features. Ancillary testing, including immunohistochemical stains, in situ hybridization for CDKN2A or NF2, and molecular studies, in selected cases, allows its correct diagnosis. The molecular landscape of PeM is still a work in progress; however, some findings, such as ALK gene rearrangements and EWSR1/FUS-ATF1 fusions, are specifically seen in PeM of young patients. The biological behavior of PeM is variable; however, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have markedly improved the survival of patients affected by this disease.
Multiple Organ Dysfunction and Critically Ill Children With Acute Myeloid Leukemia: Single-Center Retrospective Cohort Study
Authors: Gaugler Mary , Swinger Nathan , Rahrig April L. , Skiles Jodi , Rowan Courtney M.
Published: February 2023

OBJECTIVES:

To describe the prevalence of multiple organ dysfunction syndrome (MODS) and critical care utilization in children and young adults with acute myeloid leukemia (AML) who have not undergone hematopoietic cell transplantation (HCT).

DESIGN:

Retrospective cohort study of MODS (defined as dysfunction of two or more organ systems) occurring any day within the first 72 hours of PICU admission.

SETTING:

Large, quaternary-care children’s hospital.

PATIENTS:

Patients 1 month through 26 years old who were treated for AML from 2011–2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Eighty patients with AML were included. These 80 patients had a total of 409 total non-HCT-related hospital and 71 PICU admissions. The majority 53 of 71 of PICU admissions (75%) were associated with MODS within the first 72 hours. MODS was present in 49 of 71 of PICU admissions (69%) on day 1, 29 of 52 (56%) on day 2, and 25 of 32 (78%) on day 3. The organ systems most often involved were hematologic, respiratory, and cardiovascular. There was an increasing proportion of renal failure (8/71 [11%] on day 1 to 8/32 [25%] on day 3; p = 0.02) and respiratory failure (33/71 [47%] to 24/32 [75%]; p = 0.001) as PICU stay progressed. The presence of MODS on day 1 was associated with a longer PICU length of stay (LOS) (β = 5.4 [95% CI, 0.7–10.2]; p = 0.024) and over a six-fold increased risk of an LOS over 2 days (odds ratio, 6.08 [95% CI, 1.59–23.23]; p = 0.008). Respiratory failure on admission was associated with higher risk of increased LOS.

CONCLUSIONS:

AML patients frequently require intensive care. In this cohort, MODS occurred in over half of PICU admissions and was associated with longer PICU LOS. Respiratory failure was associated with the development of MODS and progressive MODS, as well as prolonged LOS.
Primary Intensivists and Nurses for Long-Stay Patients: A Survey of Practices and Perceptions at Academic PICUs*
Authors: Williams Erin P. , Madrigal Vanessa N. , Leone Tina A. , Aponte-Patel Linda , Baird Jennifer D. , Edwards Jeffrey D.
Published: February 2023

Objectives:

To determine the prevalence of the utilization of primary intensivists and primary nurses for long-stay patients in large, academic PICU and ascertain how these practices are operationalized and perceived.

Design:

A cross-sectional survey.

Setting:

U.S. PICUs with accredited Pediatric Critical Care Medicine fellowships.

Subjects:

One senior physician and one senior nurse at each institution.

Intervention:

None.

Measurements and Main Results:

Separate but largely analogous questionnaires for intensivists and nurses were created using an iterative process to enhance content/face validity and readability. Sixty-seven intensivists (representing 93% of the 72 institutions with fellowship programs and their PICUs) and 59 nurses (representing 82%) responded. Twenty-four institutions utilize primary intensivists; 30 utilize primary nurses; and 13 utilize both. Most institutions use length of stay and/or other criteria (e.g., medical complexity) for eligibility. Commonly, not all patients that meet eligibility criteria receive primaries. Primary providers are overwhelmingly volunteers, and often only a fraction of providers participate. Primary intensivists at a large majority (>75%) of institutions facilitate information sharing and decision-making, attend family/team meetings, visit patients/families regularly, and are otherwise available upon request. Primary nurses at a similar majority of institutions provide consistent bedside care, facilitate information sharing, and attend family/team meetings. A large majority of respondents thought that primary intensivists increase patient/family satisfaction, reduce their stress, improve provider communication, and reduce conflict, whereas primary nurses similarly increase patient/family satisfaction. More than half of respondents shared that these practices can sometimes require effort (e.g., time and emotion), complicate decision-making, and/or reduce staffing flexibility.

Conclusions:

Primary practices are potential strategies to augment rotating PICU care models and better serve the needs of long-stay and other patients. These practices are being utilized to varying extents and with some operationalization uniformity at large, academic PICUs.
Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study
Authors: Cleveland Melissa , Baute Rebecca , Clindaniel Casey , Hertz Leesa , Pond Rachel , Centers Gabriela I.
Published: February 2023

OBJECTIVES:

To determine the inter-rater reliability (IRR) of the Cornell Assessment for Pediatric Delirium (CAP-D) in infants admitted to a cardiac ICU (CVICU) and to explore the impact of younger age and mechanical ventilation on IRR.

DESIGN:

Prospective cross-sectional study of delirium screening performed by bedside CVICU nurses. We collected data from September 2020 to April 2021. We evaluated IRR with intraclass correlation coefficient (ICC) one-way random effects and Fleiss kappa for multiple raters.

SETTING:

Eighteen-bed academic pediatric CVICU.

PARTICIPANTS:

Subjects: Infants 1 day to 1 year old admitted to the CVICU, stratified in two age groups (≤ 9 wk and 9 wk to < 1 yr). Exclusion criteria were patients’ immediate postoperative day, State Behavioral Scale score less than or equal to –2, or at risk for hemodynamic instability with assessment. Raters: CVICU nurses working in the unit during study days.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Groups of four raters performed 91 assessments, a total of 364 CAP-D screens. Forty-five of 91 (49%) were in patients less than or equal to 9 weeks old and 43 of 91 (47%) in mechanically ventilated patients. Sixty-eight of 81 nurses (81%) participated. In infants less than or equal to 9 weeks old, ICC was 0.59 (95% CI 0.44–0.71), poor to moderate reliability, significantly lower than the ICC in infants greater than 9 weeks and 0.72 (95% CI 0.61–0.82), moderate to good reliability. In mechanically ventilated infants, ICC was 0.5 (95% CI 0.34–0.65), poor to moderate reliability, significantly lower than the ICC in nonmechanically ventilated infants and 0.69 (95% CI 0.57–0.8), moderate to good reliability. Fleiss kappa for all infants was 0.47 (95% CI 0.34–0.6), slight to fair agreement. Use of anchor points did not improve reliability.

CONCLUSIONS:

In the youngest, most vulnerable infants admitted to the CVICU, further evaluation of the CAP-D tool is needed.
Is HbA1c an Indicator of Diabetic Ketoacidosis Severity in the Pediatric Population?
Authors: Lamsal Riwaaj , Klyachman Leslie , Adeyinka Adebayo , Kondamudi Noah , Pierre Louisdon
Published: February 2023

Glycosylated hemoglobin (HbA1c) reflects how well blood glucose is controlled and is one of the strongest predictors of chronic complications of diabetes mellitus. The degree of acidosis helps determine the severity of diabetic ketoacidosis (DKA) (mild: pH 7.2–7.3; moderate: pH 7.1–7.2; severe: pH <7.1) and guides the level of care and predicts outcome. Many studies have implicated that higher HbA1c levels lead to recurrent DKA. However, there is no description of the association of higher HbA1c with the severity of DKA. One hundred thirty-eight electronic medical records of patients aged 1 to 21 years admitted to the pediatric intensive care unit with DKA between 2011 and 2015 were analyzed. We excluded 50 patients because the HbA1c level was not available. Spearman correlation analyzed the data for 88 patients included in the study. The mean HbA1c was 13.3, with female patients having more admissions compared with male patients (58% vs 42%). The age group from 13 to 21 years accounted for 77.3% of the patients. The duration of type 1 diabetes mellitus did not affect the HbA1c level. Likewise, the blood glucose and serum creatinine level did not show a statistical correlation with blood pH levels. Mean HbA1c for mild, moderate, and severe DKA groups were 11.4%, 12.2%, and 14.8%, respectively. Blood pH and HbA1c returned a negative correlation (correlation coefficient, −0.557; P = 0.005). The HbA1c level correlated positively with the 3 groups of DKA (correlation coefficient, 0.595; P = 0.01). A higher A1c was associated with more severe DKA.
The Effect of 3 Methods (Buzzy, ShotBlocker, and DistrACTION Cards) Used While Taking Blood Samples From Children with Pain and Anxiety
Authors: Sivri Birsen Bilgen , Balci Serap , Dolgun Gülümser
Published: February 2023

Objectives

The aim of this study was to compare the effectiveness of 3 methods (Buzzy, ShotBlocker, and DistrACTION Cards) in reducing pain and anxiety while taking venous blood samples in children.

Methods

The study population consisted of children aged 9 to 12 years admitted to the Child Health and Diseases Department in a Faculty of Medicine in Turkey. The sample of the study consisted of 242 children (Buzzy = 60, ShotBlocker = 61, DistrACTION Cards = 60, control = 61) who met the patient selection criteria and agreed to participate in the study. The data were obtained using an Information Form, the State-Trait Anxiety Inventory for Children, visual analog scale, and the Faces Pain Scale–Revised.

Design

This article is an experimental randomized controlled study.

Results

During venous blood collection, the scores of visual analog scale were significantly lower in ShotBlocker, Buzzy, and DistrACTION Cards groups than the control group. It was also observed that the control group experienced more anxiety than the other groups.

Conclusions

Methods such as Buzzy, ShotBlocker, and DistrACTION Cards can be used to reduce the anxiety and pain of children during painful procedures such as blood collection and vascular access. Among these methods, “Buzzy” and “DistrACTION Cards” can be preferred as it is equally effective, and then ShotBlocker can be preferred.
Validation of a Clinical Decision Rule for Ultrasound Identification of MRSA Skin Abscesses in Children
Authors: Gutierrez Christie M. , Malia Laurie , Ng Lorraine K. , Dayan Peter S. , Rabiner Joni E.
Published: February 2023

Objective

The aim of this study was to validate an adult-derived clinical decision rule for ultrasound identification of methicillin-resistant Staphylococcus aureus (MRSA) skin abscesses in a pediatric cohort.

Methods

We conducted a retrospective study of skin and soft tissue infections in patients <21 years presenting to the emergency department who had radiology performed ultrasounds completed and wound cultures obtained. Ultrasound scans were reviewed for edge definition, volume, and shape by 2 pediatric emergency physicians with expertise in point-of-care ultrasound, with approximately 25% of scans reviewed by both experts to evaluate interrater reliability. A third, blinded expert weighed in for discrepancies before analysis. Test performance characteristics were calculated for the clinical decision rule in children.

Results

Two hundred nine patients were enrolled, with mean age of 9.8 (±6.7) years; 87 (42%) were male. Sixty-nine (33%) patients had a wound culture positive for MRSA. The clinical decision rule had a sensitivity of 86% (95% confidence interval [CI], 75%–93%), specificity of 32% (95% CI, 25%–41%), positive predictive value of 38% (95% CI, 35%–42%), negative predictive value of 82% (95% CI, 71%–89%), positive likelihood ratio of 1.26 (95% CI, 1.08–1.46), negative likelihood ratio of 0.45 (95% CI, 0.24–0.84), and an odds ratio of 2.8 (95% CI, 1.31–5.97).

Conclusions

This clinical decision rule for ultrasound identification of MRSA abscesses had moderately high sensitivity and negative predictive value in pediatric patients, with similar sensitivity compared with the original adult validation group. Ultrasound may help identify MRSA abscesses, allowing for improved antibiotic choices and outcomes for children with MRSA abscesses.
Thoracic Imaging in Pediatric Trauma
Authors: Lynch Peter , Samoilov Lucy , Brahm Gary
Published: January 2023

Objectives

Imaging algorithms for assessment of thoracic trauma in pediatric patients remain controversial, attempting to balance radiation dose and its associated risk with the need for thorough assessment of patients' injuries. This study reviewed the value of chest radiography in detecting traumatic injuries, and the impact that computed tomography (CT) had on clinical management.

Methods

A retrospective review of pediatric trauma patients undergoing chest radiography and thoracic CT over a 2-year period at a level 1 trauma center was performed. The incidence of various traumatic injuries was documented, with measures of sensitivity and specificity on radiography. Clinical notes were reviewed to identify any changes in care based on CT findings.

Results

Eighty-one pediatric trauma patients underwent thoracic CT over a 2-year period, with 60 patients meeting the inclusion criteria. Radiographs identified 47 traumatic injuries out of 117 seen on the subsequent CT examinations for a sensitivity of 41% and specificity of 91%. Radiographs were most sensitive in detecting osseous injuries with a sensitivity of 54%. Additional CT findings changed management in 2 of 60 cases, or 3.3% of the time.

Conclusions

Use of thoracic CT in pediatric trauma patients identifies a significantly greater number of injuries compared with than radiography but significantly increases radiation dose while changing management in only a very small proportion of cases. Despite the relatively small sample size, the findings reflect 2 years of experience at a level 1 trauma center, and this study suggests that it may be reasonable to decrease the frequency of cross-sectional imaging.
Accidental and Abusive Mandible Fractures in Infants and Toddlers
Authors: Koti Ajay S. , Vega Sarah , Johnson Katie L. , Schlatter Adrienne , Ayson Nicole , Menashe Sarah J. , Feldman Kenneth W.
Published: February 2023

Objective

Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident.

Methods

Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination.

Results

Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries.

Conclusions

Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities
Authors: Ater Abraham Deng , Kurella Sushma , Shah Gulzar H. , Waterfield Kristie C.
Published: February 2023

Context:

Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources.

Objective:

To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics.

Design:

The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures.

Results:

LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities—had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers.

Conclusions:

Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.
Benefits and Impacts of Public Health Accreditation for Small Local Health Departments
Authors: Heffernan Megan , Melnick Meghan , Siegfried Alexa L. , Papanikolaou Malina
Published: February 2023

Objective:

This study sought to identify accreditation benefits and impacts among local health departments (LHDs) stratifying by size of population served to determine differences between small, medium, and large LHDs.

Background:

The Public Health Accreditation Board operates the national accreditation program for public health departments, through which 306 LHDs have been accredited as of August 2022. Benefits of accreditation for LHDs are well documented, despite potential challenges and barriers to seeking accreditation. Research on the benefits of accreditation for small LHDs, specifically, is more limited.

Methods:

All health departments that completed the accreditation process between December 2013 and May 2022 were surveyed following receipt of the accreditation decision. The analytic sample included 266 LHDs (response rate of 93.7%). Data for LHDs were analyzed for specific variables related to experiences, challenges, and benefits, and stratified by size to compare small LHDs with medium and large LHDs. Bivariate analyses were conducted to identify statistical significance.

Results:

Generally, small LHDs reported similar outcomes of accreditation to medium and large LHDs. These included improvements in staff competencies, capacity to provide high-quality services, and relationships with partners. Small LHDs were significantly more likely than medium and large LHDs to report that accreditation increased their use of evidence-based practices. LHDs of all sizes reported an increase in quality improvement activities due to accreditation. Challenges for small LHDs included limited staff time or staff turnover and limited funding.

Conclusions:

The public health accreditation program has offered numerous benefits to LHDs of all sizes, including small LHDs. These accreditation benefits may be particularly important for small LHDs because of their critical role in the public health system and the ongoing need to support performance improvement, strengthen infrastructure, and increase resilience.
Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program
Authors: Lane-Barlow Christi , Thomas Isabel , Horter Libby , Fleurence Rachael , Green Jamilla , Juluru Krishna , Byrkit Ramona , Weitz Andrew , Ricaldi Jessica N. , Valencia Diana
Published: February 2023

Context:

Health departments (HDs) work on the front lines to ensure the health of their communities, providing a unique perspective to public health response activities. Say Yes! COVID Test (SYCT) is a US federally funded program providing free COVID-19 self-tests to communities with high COVID-19 transmission, low vaccination rates, and high social vulnerability. The collaboration with 9 HDs was key for the program distribution of 5.8 million COVID-19 self-tests between March 31 and November 30, 2021.

Objective:

The objective of this study was to gather qualitative in-depth information on the experiences of HDs with the SYCT program to better understand the successes and barriers to implementing community-focused self-testing programs.

Design:

Key informant (KI) interviews.

Setting:

Online interviews conducted between November and December 2021.

Participants:

Sixteen program leads representing 9 HDs were purposefully sampled as KIs. KIs completed 60-minute structured interviews conducted by one trained facilitator and recorded.

Main Outcome Measures:

Key themes and lessons learned were identified using grounded theory.

Results:

Based on perceptions of KIs, HDs that maximized community partnerships for test distribution were more certain that populations at a higher risk for COVID-19 were reached. Where the HD relied predominantly on direct-to-consumer distribution, KIs were less certain that communities at higher risk were served. Privacy and anonymity in testing were themes linked to higher perceived community acceptance. KIs reported that self-test demand and distribution levels increased during higher COVID-19 transmission levels.

Conclusion:

HDs that build bridges and engage with community partners and trusted leaders are better prepared to identify and link high-risk populations with health services and resources. When collaborating with trusted community organizations, KIs perceived that the SYCT program overcame barriers such as mistrust of government intervention and desire for privacy and motivated community members to utilize this resource to protect themselves against COVID-19.
Patient Decision Making for Management of Style 410 Anatomic Implants in Breast Reconstruction
Authors: Boyd Carter J. , Salibian Ara A. , Bekisz Jonathan M. , Karp Nolan S. , Choi Mihye
Published: February 2023

Background:

In July of 2019, the Food and Drug Administration (FDA) recalled the Allergan Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Textured Breast Implants (Allergan, Santa Barbara, CA) because of a heightened risk of developing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The objective of this study was to describe patient decision-making in management of preexisting 410 textured implants.

Methods:

A single-institution retrospective chart review was conducted to determine all patients who received 410 anatomic implants from two surgeons. Patients who received these implants were contacted in July-September of 2019 regarding the FDA recall and requested to schedule a consultation to discuss explant/exchange versus surveillance. Outcomes analyzed included decision of surveillance versus explanation and subsequent reconstructive operations.

Results:

89 patients had received 410 implants from 2013-2017. Of the 147 breasts that were reconstructed, 58.5% were oncologic mastectomies and 41.5% were prophylactic. The majority of patients (71.9%) cited BIA-ALCL as the predominant influencing factor in their decision for management. Others factors included cosmesis, implant concerns unrelated to BIA-ALCL, and other medical conditions. 20 (22.5%) patients underwent explantation of the Style 410 implants. The remaining 77.5% of patients have elected for monitored surveillance. There was a significant association between a history of breast cancer and explantation of the Style 410 implants (p=0.0335).

Conclusions:

The majority of patients with Style 410 textured implants elected to undergo surveillance for BIA-ALCL. When deciding to explant or exchange the Style 410 implants, plastic surgeons should work in conjunction with their patients to carefully outline management options.
“Impact of Health Insurance Contract Timing on Breast Reconstruction Completion”
Authors: Jones Kaitlin D. , Wen Yuan E. , Teotia Sumeet S. , Haddock Nicholas T.
Published: February 2023

Introduction:

Cost of breast reconstruction can create a substantial burden for patients. As patients hope to maximize insurance plan benefits, it is crucial to receive efficient, cost-reducing care. This study analyzes the impact of insurance cycle (calendar-based insurance (CBI) vs. non-calendar-based insurance (NCBI)) on breast reconstruction.

Methods:

Between January 2014-2018, patients undergoing post-mastectomy breast reconstruction by two senior surgeons at a single academic institution (N.T.H. and S.S.T.) were retrospectively evaluated. Data were collected on Insurance Contract Timing (CBI vs. NCBI) and Insurance payor.

Result:

A total of 514 patients were included: 136 patients on NCBI and 378 patients on CBI. Individuals enrolled in CBI were more likely than NCBI patients to have their last surgery towards the end of the calendar year (p<0.0005). Additionally, individuals on private CBI’s are more likely to have their last surgery closer to the end of the year than those on public CBI’s (p<0.0001). Individuals enrolled in CBI were less likely to receive autologous reconstruction than individuals on NCBI (p=0.011). Among patients on private CBI’s, patients with all major revisions were more likely to start their reconstructive journey earlier in the year than patients that did not finish major revisions (p=0.011). Lastly, individuals on private insurance also receive more revisionary procedures than those on public insurance (p< 0.0001).

Conclusions:

Insurance contract cycle and payor impact the timing of breast reconstruction. This study emphasizes the importance of both patient and provider working towards maximizing health insurance plan benefits.
D.a.C.i. (Double asymmetric Circular incision), a new skin-sparing mastectomy technique: results and outcomes of first 46 procedures.
Authors: Casella Donato , Cassetti Dario , Marcasciano Marco , Lo Torto Federico , Fusario Daniele , Miccoli Simone , Fausto Alfonso , Restaino Valeria , Ribuffo Diego , Neri Alessandro
Published: February 2023

Skin-sparing mastectomy (SSM) is a surgical technique that preserves as much of the breast skin as possible. D.a.C.i. - Double asymmetric Circular incision is a novel immediate breast reconstruction technique for immediate prepectoral implant placement using a titanium-coated polypropylene mesh.

The aim of this technique is to optimize the cosmetic benefits of smaller incisions, preserve breast anatomy, avoid breast deformities and reduce negative psychological impact on the patient without increasing local recurrence risk.

D.a.C.i. SSM uses a double circular incision: the external drawing contains the nipple-areola complex (NAC), while the inner circular skin island will be used to provide the skin for the new areola.

We performed D.a.C.i. SSM in patients with tumors located within 2 cm of the NAC, or in cases of patients with multicentric lesions involving areolar tissue.

Forty-six patients underwent D.a.C.i. SSM at the authors’ institutions between February 2014 and July 2019. Two patients developed hematoma and one patient developed seroma. No implant loss was observed. Skin flap necrosis rate was 0%. The BREAST-Q patient-reported outcomes measure was routinely used at our institution and recorded good aesthetic outcomes and high patient satisfaction.

This new technique appears to be safe and easily reproducible in patients with small- to medium-sized breasts and with little to moderate ptosis (up to Regnault classification grade II).