Strengthening the relationship between intractable plantar keratosis and human papillomavirus.

The aim of the study was to determine the presence of human papillomavirus (HPV) in patients with intractable plantar keratosis (IPK) by comparing the histopathological findings of biopsies. A prospective, observational, and concordance study was carried out. Three different specimens were taken from each IPK. A first punch was sent for histopathological examination, and a second punch and a superficial skin scraping were both sent for HPV  polymerase chain reaction (PCR) and type determination. A total of 51 patients were included. From the histopathological examination, it was determined that 35 (68.6%) samples were diagnosed as warts and 16 (31.3%) as keratosis. However, the presence of HPV was confirmed by PCR in 49 (96.1%) and in 42 (82.4%) samples obtained by punch and superficial scraping, respectively. In the 49 PCR-positive samples, the most common HPV types were HPV1, HPV2, HPV27, HPV57, and HPV65, accounting for 81.6% of the samples. In conclusion, this study demonstrates that HPV infection and IPK lesions are very closely related. Although we cannot confirm that HPV is the cause of the development of IPK, the high prevalence of HPV observed in these lesions calls for a change to the procedures for managing IPK.

Fit factor compliance of masks and FFP3 respirators in nurses: A case-control gender study.

AIMS: To determine the fit factor and compliance with American Industrial Hygiene Association (AIHA) and Occupational Safety and Health Administration (OSHA) requirements of surgical masks and filtering respirators in male versus female nurses. DESIGN: A case-control gender study performed from 2016 to 2019. METHODS: A gender and age matched-paired sample of 74 nurses was recruited and divided into men (n = 37) and women (n = 37). FFP3 filtering respirators and surgical masks fit factors were compared between male and female nurses by Mann-Whitney U tests. These measurements were tested to pass or fail according to the OSHA (≥100) and AIHA (≥50) criteria by Fisher exact tests for a 95% confidence interval. RESULTS: Global fit factor mean (standard deviation) was 2.86 (2.73) and 3.55 (6.34) for male and female nurses wearing surgical masks (p = .180), respectively, and nobody passed neither OSHA nor AIHA criteria (p = 1.00). Nevertheless, global fit factor were 30.82 (28.42) and 49.65 (43.04) for male and female nurses wearing FFP3 respirators, respectively, being significantly lower and worse in male nurses (p = .037). According to OSHA criteria, only 2.70% and 13.51% of male and females nurses, respectively, passed with non-significant difference (p = .199), meanwhile 21.62% and 48.64% of male and female nurses, respectively, passed AIHA criteria showing significant differences (p = .027) wearing FFP3 respirators. CONCLUSIONS: All male and female nurses wearing surgical masks failed to pass OSHA and AIHA criteria. Global fit factor of the proposed FFP3 filtering respirators was decreased and worse in male than female nurses. IMPACT: Our recommendation is to avoid surgical masks use for protective purposes and use the proposed FFP3 filtering respirators among nurses. Each nurse should be fit tested for its own respirator with special caution in male nurses due to their lower fit factor achieved and most of them failed to pass OSHA and AIHA criteria, especially during COVID-19 pandemic.

Braden Scale and Norton Scale modified by INSALUD in an acute care hospital: validity and cutoff point.

OBJECTIVE: The objective of this article was to determine the most suitable cutoff point (CP) for the Braden Scale and Norton Modified Scale by INSALUD Scale (Norton-MI) in an acute care hospital. DESIGN: The authors have designed a prospective, descriptive study of patients from their hospital. From December 2008 to March 2009, a nurse collected and recorded adult patient data daily, including the appearance of pressure ulcers. PATIENTS: Adult patients in medical and surgical wards. MAIN OUTCOMES MEASURE: The parameters used in both scales are sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) of receiver operating characteristic (ROC). MAIN RESULTS: In the end, the authors have evaluated a total of 1001 patients and obtained 4486 measurements with both the Norton-MI and the Braden scales. The rates for the recommended CP of the Norton-MI scale (CP 14) are as follows: sensitivity: 67.91% (62.42-73.39), specificity: 78.66% (77.41-79.92), PPV: 18.36%, NPV: 97.20%. Those for Braden (CP 16) are as follows: sensitivity: 65.69% (64.19-75), specificity: 79.62% (78.39-80.85), PPV: 19.43%, NPV: 97.37%. The Norton-MI scale offers an AUC-ROC of 0.828 with a 95% confidence interval of 0.811-0.854, and the Braden Scale presents an AUC-ROC of 0.832 with a 95% confidence interval of 0.807 to 0.849. CONCLUSION: Both scales show good validity data. If the CP is raised: MI-Norton (CP 15): sensitivity: 77.36 (72.43-82.30), specificity 74.27 (72.94-75.61), PPV: 17.52 (15.42-19.62), NPV: 97.89 (97.38-98.41). The Braden scale with a CP of 17 presents sensitivity: 78.38 (73.52-83.24), specificity: 73.44 (72.09-74.79), PPV: 17.25 (15.19-19.31), NPV: 97.96 (97.45-98.47). These CPs improved the predictive capacity of both scales in the authors' hospital environment.

Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review.

AIM: This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. BACKGROUND: An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. DATA SOURCES: A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. REVIEW METHODS: Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. FINDINGS: People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. CONCLUSION: Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.

Living with life insurance: a qualitative analysis of the experience of male implantable defibrillator recipients in Spain.

BACKGROUND AND OBJECTIVES: The implantation of defibrillators should not be studied simply on the basis of clinical improvement or quality of life: it is also important to understand the significance, which the recipients attach to the defibrillator and their experiences with it. The aim of this work was, therefore, to determine the experience of Spanish implantable defibrillator recipients. DESIGN: A qualitative phenomenological study. METHODS: Purposeful sampling of male implantable defibrillator recipients older than 18 years of age attended at the defibrillator consultancy at the Hospital Fuenlabrada or belonging to the Heart Patients' Association (Asociación de Pacientes Coronarios, APACOR). A secondary, theoretical sampling was also carried out to gain a more in-depth understanding of certain aspects identified in the first sampling, such as living with the discharges and difficulties during sexual activity. Data were collected using unstructured and semi-structured questionnaires and applying a question guide, field notes and the recipients' personal diaries/letters. Data collection was terminated once theoretical saturation was reached. Data were analysed using the Giorgi method. Finally, the seven themes, which showed what it means to be an implantable cardioverter-defibrillator recipient, were described. RESULTS: The defibrillator is perceived positively and is considered to be a form of life insurance, whereas the discharges are a limiting factor. The recipient's outlook on life changes. Acceptance of the changes resulting from the implant leads to the development of strategies to facilitate everyday life. CONCLUSIONS: An understanding of the significance attached by recipients to their disease, diagnosis and treatment allows their behaviour and expectations to be understood. RELEVANCE TO CLINICAL PRACTICE: Provide the basis for nursing assessment after discharge, understand the effects of the device in the recipient and track the process of adapting the recipient to daily life.

The Relationship Between Burnout and Health Professionals' Creativity, Method, and Organization.

BACKGROUND: This research focuses on problems relating to creativity and problem-solving capacity faced by a specific group of professionals, as they relate to worker burnout, which is prevalent in a large number of work environments. OBJECTIVES: Our hypothesis was that creative people who follow method and order are less likely to suffer from burnout. Our objective was to demonstrate that health professionals working in surgery who are creative, methodical, and orderly have lower levels of burnout compared to others. DESIGN: A correlational, analytical, and cross-sectional study with 70 health professionals working in surgery. METHODS: A random sample of health professionals who worked in surgery at the Hospital Universitario de La Princesa in Madrid, Spain from 2011 to 2014 were studied. The variables considered in the study were: gender, age, profession, creativity score, method and order score, and burnout score. Measurement tools were CREA: creative intelligence (Corbalán & Martinez, 2003), MO2: method and order (Seisdedos, 1994), and the Maslach Burnout Inventory (MBI), a test of emotional exhaustion, depersonalization, and personal accomplishment (Maslach, 1981), all of which were validated for the Spanish population. RESULTS: Our data indicate that a worker's age influences his/her capacity to work with method and order, and that workers with emotional exhaustion (a basic feature of burnout) have lower scores in method and order. Greater emotional exhaustion and greater depersonalization were related to lower personal accomplishment and greater burnout. CONCLUSION: people who work with method and order are less likely to suffer from burnout. We did not find a direct relationship between creativity and method and order or between creativity and burnout.

Mechanical Stress Redistribution in the First Metatarsal Bone After Autologous Bone Harvesting.

BACKGROUND: The first metatarsal bone is a viable source for autologous bone grafting in foot and ankle surgery and may serve as another convenient graft site to correct a flail toe deformity. We aimed to determine how progressive bone removal from the first metatarsal affects the mechanical redistribution of the foot and whether this bone removal increases the risk of fracture. METHODS: A three-dimensional finite element model developed from computed tomographic images obtained from a healthy man were used to evaluate traction stresses on the first metatarsal bone as a function of applied loads on the talus and Achilles tendon at two phases of the gait cycle (and according to the depth of bone removal). RESULTS: Simulations indicated that when maximum load was applied to the Achilles tendon, tensile stress increased from 2.049 MPa in the intact foot to 5.941 MPa in the area of maximum bone harvest during the stance phase. Furthermore, as the volume of bone extracted from the first metatarsal increased, there was a redistribution of stress that differed significantly from that of the intact foot. CONCLUSIONS: Although the maximum stress on the first metatarsal was not significantly affected by increasing the volume of bone harvested, the ankle should be splinted in plantarflexion during the postoperative period to eliminate the stance phase of gait and reduce the risk of metatarsal fracture.

The QardioArm App in the Assessment of Blood Pressure and Heart Rate: Reliability and Validity Study.

BACKGROUND: Self-measurement of blood pressure is a priority strategy for managing blood pressure. OBJECTIVE: The aim of this study was to evaluate the reliability and validity of blood pressure and heart rate following the European Society of Hypertension's international validation protocol, as measured with the QardioArm, a fully automatic, noninvasive wireless blood pressure monitor and mobile app. METHODS: A total of 100 healthy volunteers older than 25 years from the general population of Ciudad Real, Spain, participated in a test-retest validation study with two measurement sessions separated by 5 to 7 days. In each measurement session, seven systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between the two devices. The test device was the QardioArm and the previously validated criterion device was the Omron M3. Sessions took place at a single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. RESULTS: The QardioArm displayed very consistent readings both within and across sessions (intraclass correlation coefficients=0.80-0.95, standard errors of measurement=2.5-5.4). The QardioArm measurements corresponded closely to those from the criterion device (r>.96) and mean values for the two devices were nearly identical. The QardioArm easily passed all validation standards set by the European Society of Hypertension International Protocol. CONCLUSIONS: The QardioArm mobile app has validity and it can be used free of major measurement error.

Evaluation of Depression in Subacute Low Back Pain: A Case Control Study.

BACKGROUND: Low back pain (LBP) is the most common musculoskeletal disorder affecting the general population and it is believed to be associated with depression. OBJECTIVE: The study aim was to describe and compare the impact in a sample of people with subacute LBP (SLBP) and patients without LBP with normalized reference values in the light of the scores obtained with regard using the Beck Depression Inventory (BDI). STUDY DESIGN: This was a case-control study. SETTINGS: Physiotherapist area at a care center. METHODS: A sample of 164 participants of a mean age of 41.45 ± 0.97 came to a physical therapy clinic where self-reported data were registered, informants' professional activity was determined, and the scores obtained were compared in the BDI. RESULTS: Total BDI scores at SLBP and their controls were 21.52 ± 6.93 (11 - 43) and 17.30 ± 5.09 (11 - 30), respectively (P < 0.001). The SLBP patient has 2.12 times more likely to have moderate depression (OR 2.12 (1.07 - 4.18) and 18.82 times more likely to have serious depression (OR 18.82 (1.06 - 331.81) compared to their controls (P < 0.05). LIMITATIONS: The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. CONCLUSIONS: People with SLBP also have a significant increase in depression based on BDI scores, regardless of gender.

Static and dynamic plantar pressures in children with and without sever disease: a case-control study.

BACKGROUND: Calcaneal apophysitis (Sever disease) has been reported to be the most common cause of heel pain in athletic children. OBJECTIVE: The study aim was to compare plantar pressure, plantar surface contact area, distribution of body weight across the lower extremities, and prevalence of gastrocnemius ankle equinus and gastrocnemius-soleus ankle equinus (which can cause decreases in ankle dorsiflexion range of motion) in children with and without Sever disease. DESIGN: This was a case-control study. METHODS: Participants were 56 male students enrolled in a soccer academy. Twenty-eight participants had Sever disease (Sever disease group), and 28 participants were healthy (control group). Dynamic and static peak plantar pressures, plantar surface contact area, and body weight distribution were assessed with pedobarography. A goniometer was used to assess gastrocnemius and gastrocnemius-soleus ankle dorsiflexion range of motion. RESULTS: Both maximum and average peak pressures and percentages of body weight supported by each heel were significantly higher in the symptomatic feet of participants in the Sever disease group than in the control group. Twenty-six participants with Sever disease but only 8 participants in the control group exhibited bilateral gastrocnemius ankle equinus. LIMITATIONS: A limitation of the study is that measurements were obtained from participants who were symptomatic. CONCLUSIONS: Higher heel plantar pressures under dynamic and static conditions appear to be associated with Sever disease. It is unclear, however, whether these higher pressures are a predisposing factor contributing to the disease or a result of the condition. Gastrocnemius ankle equinus also may be a predisposing factor for Sever disease. Further research is needed to identify other biomechanical factors associated with the disease to enhance prevention and treatment strategies.

Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities.

BACKGROUND: Transfer of the flexor digitorum longus tendon is one of the surgical techniques described to treat lesser toe deformities. A global analysis of the benefits of this procedure has not been presented in the literature to date. The aim of this meta-analysis was to evaluate the clinical benefit of transfer of the flexor digitorum longus tendon regarding patient satisfaction. METHODS: A reviewer formally trained in meta-analysis abstraction techniques searched several databases to identify relevant published studies. Initially, 203 citations were identified and evaluated for relevance. Abstract screening produced 112 articles to be read in their entirety, of which 17 articles studying 515 procedures with a mean ± SD follow-up of 54.21 ± 20.64 months met all of the inclusion criteria necessary for analysis. RESULTS: Overall crude patient satisfaction after flexor digitorum longus tendon transfer was 86.7% (95% confidence interval, 81.7%-90.5%). A low grade of heterogeneity across studies (Q = 24.458, I(2) =34.583, P = .080) and no influence of the individual studies on overall estimation were found. When adjusting for higher-quality prospective studies, overall patient satisfaction increased to 91.8%, although it did not reach statistical significance. Additional a priori sources of heterogeneity (age, sex, studies with <3 years of follow-up, percentage of patients lost to follow-up, and year of publication) were evaluated by subgroup analysis and meta-regression, but no statistical significance was found. This adjustment also significantly decreased heterogeneity across studies (crude Q = 24.458, high-quality studies Q = 1.504). CONCLUSIONS: Regarding patient satisfaction, this comprehensive analysis provides supportive evidence of the clinical benefit of flexor digitorum longus tendon transfer.