Comparison of clinical and radiographic outcomes of arthroscopic-assisted percutaneous fixation versus open reduction internal fixation of lateral tibial plateau fractures.

PURPOSE: Treatment for tibial plateau fractures continues to evolve but maintains primary objectives of anatomic reduction of the joint line and a rapid recovery course. Arthroscopic-assisted percutaneous fixation (AAPF) has been introduced as an alternative to traditional open reduction internal fixation (ORIF). The purpose of the study is to compare clinical and radiographic outcomes in patients with low-energy Schatzker type I-III tibial plateau fractures treated with AAPF versus ORIF. METHODS: A retrospective chart review was performed at a level 1 trauma centre to compare outcomes of 120 patients (57 AAPF, 63 ORIF) with low-energy lateral Schatzker type I-III tibial plateau fractures who underwent tibial plateau fixation between 2009 and 2018. Demographic information, injury characteristics, and surgical treatment were recorded. The main outcome measurements included reduction step-off, joint space narrowing, time to weight bearing, and implant removal. RESULTS: There was no difference in age, gender distribution, BMI, ASA, Schatzker classification distribution, initial displacement, blood loss, and reduction step-off between the two groups (p > 0.05). Shorter tourniquet time (74.1 ± 21.7 vs 100.0 ± 21.0 min; p < 0.001), shorter time to full weight bearing (47.8 ± 15.2 vs. 69.1 ± 17.2 days; p < 0.001), and lower rate of joint space narrowing (3.5% vs. 28.6% with more than 1 mm, p < 0.001) were associated with the AAPF cohort, with no difference in pain, knee range of motion, or implant removal rate between the two cohorts. CONCLUSION: AAPF may be a viable alternative to ORIF for the management of low-energy tibial plateau fractures with outcomes not inferior compared to the traditional ORIF method.

Examining heterogeneity in mentoring: Associations between mentoring discussion topics and youth outcomes.

The current study aims to apply a staged approach to document heterogeneity in discussions in mentoring relationships, chiefly, discussion topics from weekly mentoring sessions with undergraduate women mentors (n = 40), then link each of the eight topics (relationships with friends, family, teachers, and romantic relationships, as well as goals, academic skills, academic problems, and hopes for the future) to developmental outcomes for middle school girls (n = 41) who participated in a school-based mentoring program. In doing so, the authors hope to better understand the mechanisms that influence variability in mentoring treatment effects. Mentoring dyads engaged in unstructured one-on-one sessions and structured group meetings across the 2018-2019 academic year. The primary predictors for this study are weekly mentor-reported discussion topics and activities addressed during unstructured one-on-one mentoring sessions, with 11 social-emotional, academic, and behavioral outcomes measured via pre- and postsurveys administered by research assistants to mentees during the fall and spring. A series of 11 path analyses indicate small to moderate associations, both beneficial and negative, between key discussion topics, such as hopes for the future, family relationships, and goals, and several mentee-reported outcomes of interest at the end of the intervention, including extrinsic motivation, life satisfaction, and self-esteem. Study findings provide information about heterogeneity in mentoring practices to inform how various mechanisms of mentoring (e.g., discussions focused on relationships, goals and skills, and strengths) influence developmentally-relevant effects for youth.

Leptospirosis in the Air: A Case Review Series During Air Medical Transport in Haiti.

Leptospirosis is an infectious illness encountered mostly in tropical climates and has been of particular concern in Haiti after natural disasters. Heavy rainfalls and natural disasters in combination with scarce resources to control and identify clusters of infections make certain populations and countries vulnerable. In some cases, patients who contract this disease may need air medical transport to hospitals that have a higher level of care. In this case report, a trio of cases is highlighted from an outbreak that required air transport to transfer patients to a facility with the availability of an intensive care unit. The goal of highlighting these cases is to increase the awareness of physicians and air transport providers to the manifestation and treatment of this disease and to provide pearls to stabilize patients during transport.

Complications in the 2-Year Postoperative Period Following Pediatric Syndactyly Release.

PURPOSE: Syndactyly surgical release is one of the most common congenital hand surgeries performed by pediatric hand surgeons. The purpose of our study was to evaluate the complications associated with syndactyly release and determine factors that correlate with higher complication rates within the 2-year postoperative period. METHODS: A retrospective chart review was completed for patients who underwent syndactyly release at a single pediatric center between 2005 and 2018. Patients were included if they had a diagnosis of syndactyly and underwent surgical release, and excluded for a diagnosis of cleft hand, incomplete surgical documentation, surgery performed at an outside institution, or follow-up care that did not extend beyond the first postoperative visit. Complications were classified using the Clavien-Dindo (CD) system. RESULTS: Fifty-nine patients met the inclusion criteria, which included 143 webs released in 85 surgeries. A total of 27 complications occurred for the 85 surgeries performed. The severity of complications was CD grade I or II in 23% of surgeries, most commonly unplanned cast changes, and CD grade III in 8% of surgeries. No CD grade IV or V complications occurred. The CD grade III complications included 6 reoperations. The complication rate was higher when performing >1 syndactyly release per surgery. It also was higher for patients undergoing >1 surgical event. Rates of complication per surgery were similar between patients with multiple surgeries compared with those with a single surgery. Concomitant diagnoses and complexity of syndactyly was not associated with a higher complication rate. CONCLUSIONS: Syndactyly release was associated with a complication rate of 31% per surgical event with 44% of these complications related to unplanned cast changes and 8% of complications that required admission or reoperation. Risk factors for complications following syndactyly release include >1web operated on per surgery and undergoing >1 surgical event. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.

Strategies for monitoring mentoring relationship quality to predict early program dropout.

We examined data from a nationally implemented mentoring program over a 4-year period, to identify demographic and relationship characteristics associated with premature termination. Data were drawn from a sample of 82,224 mentor and mentees. We found matches who reported shared racial or ethnic identities were associated with lower likelihood of premature termination as was mentee's positive feelings of the relationship. We also found that, if data were used as a screening tool, the data were suboptimal for accuracy classifying premature closure with sensitivity and specificity values equal to 0.43 and 0.75. As programs and policymakers consider ways to improve the impact of mentoring programs, these results suggest programs consider the types of data being collected to improve impact of care.

Improving the school environment: School staff perceptions of school climate data and reporting practices.

School climate surveys have become widely used in U.S. schools, but there is little information on whether school leaders engage teachers and other staff in the process of reviewing and making use of survey results. This mixed-methods study examined staff interest, viewing, and use of survey results in a state that administers a school climate survey. Semistructured interviews with 15 staff members were conducted to gain insight into quantitative results from 16,525 staff members in 318 high schools. Survey data showed that although 84% of school staff were interested in seeing the results of their school climate survey, fewer than one-third reported seeing the results or using them for school planning or improvement. Administrators were more likely than teachers and other staff to have seen and used survey results. Content coding of the qualitative data elaborated on staff interest in reviewing and using climate data. These findings highlight the need for school leaders to collaborate with school staff on interpreting and using survey results for school climate improvement efforts.

Small Sets of Novel Words Are Fully Retained After 1-Week in Typically Developing Children and Down Syndrome: A Fast Mapping Study.

OBJECTIVES: Down syndrome (DS) is a population with known hippocampal impairment, with studies showing that individuals with DS display difficulties in spatial navigation and remembering arbitrary bindings. Recent research has also demonstrated the importance of the hippocampus for novel word-learning. Based on these data, we aimed to determine whether individuals with DS show deficits in learning new labels and if they may benefit from encoding conditions thought to be less reliant on hippocampal function (i.e., through fast mapping). METHODS: In the current study, we examined immediate, 5-min, and 1-week delayed word-learning across two learning conditions (e.g., explicit encoding vs. fast mapping). These conditions were examined across groups (twenty-six 3- to 5-year-old typically developing children and twenty-six 11- to 28-year-old individuals with DS with comparable verbal and nonverbal scores on the Kaufman Brief Intelligence Test - second edition) and in reference to sleep quality. RESULTS: Both individuals with and without DS showed retention after a 1-week delay, and the current study found no benefit of the fast mapping condition in either group contrary to our expectations. Eye tracking data showed that preferential eye movements to target words were not present immediately but emerged after 1-week in both groups. Furthermore, sleep measures collected via actigraphy did not relate to retention in either group. CONCLUSIONS: This study presents novel data on long-term knowledge retention in reference to sleep patterns in DS and adds to a body of knowledge helping us to understand the processes of word-learning in typical and atypically developing populations. (JINS, 2018, 24, 955-965).

From patients to partners: participant-centric initiatives in biomedical research.

Advances in computing technology and bioinformatics mean that medical research is increasingly characterized by large international consortia of researchers that are reliant on large data sets and biobanks. These trends raise a number of challenges for obtaining consent, protecting participant privacy concerns and maintaining public trust. Participant-centred initiatives (PCIs) use social media technologies to address these immediate concerns, but they also provide the basis for long-term interactive partnerships. Here, we give an overview of this rapidly moving field by providing an analysis of the different PCI approaches, as well as the benefits and challenges of implementing PCIs.

Association of antidiabetic medication use, cognitive decline, and risk of cognitive impairment in older people with type 2 diabetes: Results from the population-based Mayo Clinic Study of Aging.

OBJECTIVE: To determine the cross-sectional and longitudinal associations between diabetes treatment type and cognitive outcomes among type II diabetics. METHODS: We examined the association between metformin use, as compared to other diabetic treatment (ie, insulin, other oral medications, and diet/exercise) and cognitive test performance and mild cognitive impairment (MCI) diagnosis among 508 cognitively unimpaired at baseline type II diabetics enrolled in the Mayo Clinic Study of Aging. We created propensity scores to adjust for treatment effects. We used multivariate linear and logistic regression models to investigate the cross-sectional association between treatment type and cognitive test z scores, respectively. Mixed effects models and competing risk regression models were used to determine the longitudinal association between treatment type and change in cognitive test z scores and risk of developing incident MCI. RESULTS: In linear regression analyses adjusted for age, sex, education, body mass index, APOE ε4, insulin treatment, medical comorbidities, number of medications, duration of diabetes, and propensity score, we did not observe an association between metformin use and cognitive test performance. Additionally, we did not observe an association between metformin use and cognitive test performance over time (median = 3.7-year follow-up). Metformin was associated with an increased risk of MCI (subhazard ratio (SHR) = 2.75; 95% CI = 1.64, 4.63, P < .001). Similarly, other oral medications (SHR = 1.96; 95% CI = 1.19, 3.25; P = .009) and insulin (SHR = 3.17; 95% CI = 1.27, 7.92; P = .014) use were also associated with risk of MCI diagnosis. CONCLUSIONS: These findings suggest that metformin use, as compared to management of diabetes with other treatments, is not associated with cognitive test performance. However, metformin was associated with incident MCI diagnosis.

Performance of the CogState computerized battery in the Mayo Clinic Study on Aging.

INTRODUCTION: The feasibility and validity of brief computerized cognitive batteries at the population-level are unknown. METHODS: Nondemented participants (n = 1660, age 50-97 years) in the Mayo Clinic Study on Aging completed the computerized CogState battery and standard neuropsychological battery. The correlation between tests was examined and comparisons between CogState performance on the personal computer (PC) and iPad (n = 331), and in the clinic vs. at home (n = 194), were assessed. RESULTS: We obtained valid data on greater than 97% of participants on each test. Correlations between the CogState and neuropsychological tests ranged from -0.462 to 0.531. Although absolute differences between the PC and iPad were small and participants preferred the iPad, performance on the PC was faster. Participants performed faster on Detection, One Card Learning, and One Back at home compared with the clinic. DISCUSSION: The computerized CogState battery, especially the iPad, was feasible, acceptable, and valid in the population.

What really matters? A multi-view perspective of one patient's hospital experience.

BACKGROUND: 'Patient experience' is both recognised and solicited as a means of assessing healthcare delivery and a method for gauging patient centredness. Research comparing healthcare recipient and provider perceptions regarding the same episode of care is lacking. AIM: To identify what mattered to a patient and family member (healthcare recipients) during the patient's hospital experience and to examine the healthcare provider's awareness of what mattered. METHODS: A qualitative descriptive investigation was undertaken using semi-structured interviews designed to compare multiple perceptions of one patient's hospital experience. Interviews were undertaken with the patient, family member, and healthcare providers. A definition of hospital experience was sought from each participant. Additional phrases as presented by the patient and family member were coded and grouped into categories and then salient themes. Phrases as presented by the healthcare providers were coded, and then allocated to the previously identified themes. FINDINGS: One patient, his wife and seven healthcare providers (doctors (2), registered nurses (4) and a patient care orderly (1)) were interviewed. Definitions of 'hospital experience' differ between participants. Recipients include pre and post hospital admission periods, whereas providers limit hospital experience to admission. Three salient themes emerged from recipient data suggesting; medication management, physical comfort and emotional security are what mattered to the recipients. Awareness was dependent upon theme and differed between the providers. CONCLUSION: Hospital experience as a term is poorly defined, and definitions differ between recipients and providers of care. Healthcare providers are not always aware of what matters to the patient and family during their hospital admission.

How Scoring Approaches Impact Estimates of Growth in the Presence of Survey Item Ceiling Effects.

Survey scores are often the basis for understanding how individuals grow psychologically and socio-emotionally. A known problem with many surveys is that the items are all "easy"-that is, individuals tend to use only the top one or two response categories on the Likert scale. Such an issue could be especially problematic, and lead to ceiling effects, when the same survey is administered repeatedly over time. In this study, we conduct simulation and empirical studies to (a) quantify the impact of these ceiling effects on growth estimates when using typical scoring approaches like sum scores and unidimensional item response theory (IRT) models and (b) examine whether approaches to survey design and scoring, including employing various longitudinal multidimensional IRT (MIRT) models, can mitigate any bias in growth estimates. We show that bias is substantial when using typical scoring approaches and that, while lengthening the survey helps somewhat, using a longitudinal MIRT model with plausible values scoring all but alleviates the issue. Results have implications for scoring surveys in growth studies going forward, as well as understanding how Likert item ceiling effects may be contributing to replication failures.

How survey scoring decisions can influence your study's results: A trip through the IRT looking glass.

Though much effort is often put into designing psychological studies, the measurement model and scoring approach employed are often an afterthought, especially when short survey scales are used (Flake & Fried, 2020). One possible reason that measurement gets downplayed is that there is generally little understanding of how calibration/scoring approaches could impact common estimands of interest, including treatment effect estimates, beyond random noise due to measurement error. Another possible reason is that the process of scoring is complicated, involving selecting a suitable measurement model, calibrating its parameters, then deciding how to generate a score, all steps that occur before the score is even used to examine the desired psychological phenomenon. In this study, we provide three motivating examples where surveys are used to understand individuals' underlying social emotional and/or personality constructs to demonstrate the potential consequences of measurement/scoring decisions. These examples also mean we can walk through the different measurement decision stages and, hopefully, begin to demystify them. As we show in our analyses, the decisions researchers make about how to calibrate and score the survey used has consequences that are often overlooked, with likely implications both for conclusions drawn from individual psychological studies and replications of studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What patients value when oncologists give news of cancer recurrence: commentary on specific moments in audio-recorded conversations.

PURPOSE: Recommendations for communicating bad or serious news are based on limited evidence. This study was designed to understand patient perspectives on what patients value when oncologists communicate news of cancer recurrence. STUDY DESIGN AND METHODS: Participants were 23 patients treated for a gastrointestinal cancer at a tertiary U.S. cancer center within the past 2 years, who had semistructured qualitative interviews in which they listened to audio recordings of an oncology fellow discussing news of cancer recurrence with a standardized patient. Participants paused the audio recording to comment on what they liked or disliked about the oncologist's communication. RESULT: Three themes were identified that refine existing approaches to discussing serious news. The first theme, recognition, described how the oncologist responded to the gravity of the news of cancer recurrence for the patient. Participants saw the need for recognition throughout the encounter and not just after the news was given. The second theme, guiding, describes what participants wanted after hearing the news, which was for the oncologist to draw on her biomedical expertise to frame the news and plan next steps. The third theme, responsiveness, referred to the oncologist's ability to sense the need for recognition or guidance and to move fluidly between them. CONCLUSION: This study suggests that oncologists giving news of cancer recurrence could think of the communication as going back and forth between recognition and guidance and could ask themselves: "Have I demonstrated that I recognize the patient's experience hearing the news?" and "Have I provided guidance to the next steps?"

Patient-centered discussions about prostate cancer screening: a real-world approach.

National guidelines recommend that primary care providers discuss the risks and benefits of prostate cancer screening with their patients but give little guidance on how to fit such a complex discussion into a busy clinic encounter. The authors propose a process-oriented approach (Ask-Tell-Ask) that promotes tailored conversations and value-based recommendations. The Ask-Tell-Ask approach includes diagnosing a patient's informational needs, providing targeted education based on those needs, and making a shared decision about testing. This time-efficient model emphasizes the provider's role as an interactive guide rather than a one-way supplier of information. Although there is no way to make these discussions simple, this streamlined strategy can help patients and providers efficiently negotiate the complex and important decision of screening for prostate cancer.

Promoting mentoring relationships through joint decisions: Evidence from a national mentoring program.

School-based mentoring programs are one of the most popular types of prevention programs offered to support students' social-emotional and academic success. Because a high-quality mentoring relationship is thought to be a mechanism for improving youth outcomes, we investigated how mentor- and mentee-relationship quality develops over time. In addition, we examined how relationship development varied as a function of three approaches to selecting mentoring activities (i.e., mentor-directed, program-directed, or jointly determined). We used a random-intercepts crossed-lagged panel model to test how mentor and mentee reports of relationship quality developed over three time points across one school year. Data were gathered from 2014 to 2018 and included 47,699 youth (56% female; 51% Black or Hispanic) who participated in Big Brothers Big Sisters-which provides school-based mentoring services to youth across the U.S. Results indicated that mentors' positive appraisals of the mentoring relationships led to positive appraisals from the mentee at the subsequent time point. In addition, when mentors and mentees jointly determined activities, we found evidence that mentors' and mentees' positive appraisals at one time point led to positive appraisals at the following time point. These results suggest that school-based mentoring programs should consider ways to support joint decision-making among mentors and mentees participating in school-based mentoring programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promoting social emotional development during the paediatric well-child visit: a demonstration project.

Supporting social emotional development, beginning at birth, can improve lifelong health. The American Academy of Paediatrics recommends 12 well-child visits between birth and age 3 years. Each well-child visit provides a unique opportunity to interact with and support families to promote social emotional development of children. Eighteen US paediatric practices joined a learning community to use improvement science to test and implement evidence-informed strategies that nurture parent-child relationships and promote the social emotional development of young children.Quality improvement methods were used to integrate 11 strategies into well-child visits between birth and age 3 years and measure the improvements with a set of outcome, process and balancing measures. Participation among the 18 paediatric practices was high with 72% of teams attending monthly webinars and 97% of teams attending the three learning sessions. Over 12 months, the percentage of children receiving age-appropriate social emotional development screens at participating practices' well-child visits increased from a baseline median of 83% to 93%.Current paediatric practice in the USA focuses primarily on cognitive and physical development, and paediatric providers are less familiar with established practices to screen for social emotional development and promote the caregiver-child relationship. This project suggests that improvement methods show promise in increasing the number of children who receive age-appropriate social emotional development screens or assessments at well-child visits.

Population description and its role in the interpretation of genetic association.

Despite calls for greater clarity and precision of population description, studies have documented persistent ambiguity in the use of race/ethnicity terms in genetic research. It is unclear why investigators tolerate such ambiguity, or what effect these practices have on the evaluation of reported associations. To explore the way that population description is used to replicate and/or extend previously reported genetic observations, we examined articles describing the association of the peroxisome proliferator-activated receptor-gamma-gamma Pro12Ala polymorphism with type 2 diabetes mellitus and related phenotypes, published between 1997 and 2005. The 80 articles identified were subjected to a detailed content analysis to determine (1) how sampled populations were described, (2) whether and how the choice of sample was explained, and (3) how the allele frequency and genetic association findings identified were contextualized and interpreted. In common with previous reports, we observed a variety of sample descriptions and little explanation for the choice of population investigated. Samples of European origin were typically described with greater specificity than samples of other origin. However, findings from European samples were nearly always compared to samples described as "Caucasian" and sometimes generalized to all Caucasians or to all humans. These findings suggest that care with population description, while important, may not fully address analytical concerns regarding the interpretation of variable study outcomes or ethical concerns regarding the attribution of genetic observations to broad social groups. Instead, criteria which help investigators better distinguish justified and unjustified forms of population generalization may be required.

Why don't patients enroll in hospice? Can we do anything about it?

BACKGROUND: United States hospice organizations aim to provide quality, patient-centered end-of-life care to patients in the last 6 months of life, yet some of these organizations observe that some hospice-eligible patients who are referred to hospice do not initially enroll. PRIMARY OBJECTIVE: To identify reasons that eligible patients do not enroll in hospice (phase 1). SECONDARY OBJECTIVE: To identify strategies used by hospice providers to address these reasons (phase 2). DESIGN: Semi-structured interviews analyzed using content analysis. PARTICIPANTS: In phase 1, we interviewed 30 patients and/or family members of patients who had a hospice admissions visit, but who did not enroll. In phase 2, we interviewed 19 hospice staff and national experts. APPROACH: In phase 1, we asked participants to describe the patient's illness, the hospice referral, and why they had not enrolled. We performed a content analysis to characterize their reasons for not enrolling in hospice. In phase 2, we enrolled hospice admissions staff and hospice experts. We asked them to describe how they would respond to each reason (from phase 1) during an admissions visit with a potential new hospice patient. We identified key phrases, and summarized their recommendations. RESULTS: Reasons that patients hadn't enrolled fell into three broad categories: patient/family perceptions (e.g., "not ready"), hospice specific issues (e.g., variable definitions of hospice-eligible patients), and systems issues (e.g., concerns about continuity of care). Hospice staff/experts had encountered each reason, and offered strategies at the individual and organizational level for responding. CONCLUSIONS: In hopes of increasing hospice enrollment among hospice-eligible patients, non-hospice and hospice clinicians may want to adopt some of the strategies used by hospice staff/experts for talking about hospice with patients/families and may want to familiarize themselves with the differences between hospice organizations in their area. Hospices may want to reconsider their admission policies and procedures in light of patients' and families' perceptions and concerns.