Variation in Receipt of Cancer Screening and Immunizations by 10-year Life Expectancy among U.S. Adults aged 65 or Older in 2019.

IMPORTANCE: The likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult's life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit. OBJECTIVE: To examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy. DESIGN: Analysis of 2019 National Health Interview Survey. PARTICIPANTS: 8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults. MAIN MEASURES: Proportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors. KEY RESULTS: Overall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination. CONCLUSIONS: Despite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults' life expectancy may improve care of older adults.

Mini-EDACS: Development of the Eating and Drinking Ability Classification System for young children with cerebral palsy.

AIM: To develop and test Mini-EDACS to describe developing eating and drinking abilities of children with cerebral palsy (CP) aged between 18 and 36 months. METHOD: The existing Eating and Drinking Ability Classification System (EDACS) was modified to define Mini-EDACS content. Mini-EDACS was developed in three stages: (1) EDACS was modified after application to videos of standardized feeding evaluations of children with CP aged 18 to 36 months (n = 130); (2) refined content and validity of Mini-EDACS was established through an international Delphi survey; (3) interobserver reliability was assessed by comparing Mini-EDACS levels assigned by speech and language therapists (SaLTs) from video data and parent report. RESULTS: Mini-EDACS provides age-appropriate descriptions for children aged 18 to 36 months with CP. Eighty-nine stakeholders participated in the Delphi survey; required levels of agreement were met after one round (i.e. >80% agreement). Thirteen SaLTs completed paired ratings from 43 video recordings: absolute agreement was 58% (kappa 0.43; intraclass correlation coefficient 0.78; 95% confidence interval 0.63-0.87). INTERPRETATION: Mini-EDACS provides a valid system for classifying eating and drinking performance of children with CP under 3 years old. Results suggest moderate agreement and good reliability when rating Mini-EDACS levels from video recordings of young children with CP.

Frailty Interdisciplinary Pathway: Compliance and Sustainability in a Level I Trauma Center.

BACKGROUND: Frailty is a state of physiological vulnerability that predisposes many older adult trauma patients to poor health outcomes. Specialized care pathways for frail trauma patients have been shown to improve outcomes, but the compliance and sustainability of these pathways have not been reported (Bryant et al., 2019; Engelhardt et al., 2018). METHODS: We retrospectively measured compliance and sustainability during the first 2 years of a frailty pathway for patients 65 years or older at an urban Level I trauma center. Compliance to 19 pathway elements was collected for 279 pathway patients between October 1, 2016, and September 30, 2018. Compliance was analyzed and reported as a percentage of the total possible times each element could have been completed per pathway guidelines. Benchmark compliance was 75% or more. RESULTS: Retrospective 2-year mean overall compliance to all pathway elements was 68.2% and improved from Year 1 (65.0%) to Year 2 (71.4%). Seven elements achieved a mean 75% or more compliance over the 2-year period: frailty screening on admission (92.8%), consultation requests for physical therapy (97.9%), geriatrics (96.2%), and nutrition (92.3%), consultant care within 72 hr of admission (78.0%), delirium screening 3 times daily (76.3%), and daily senna administration (76.0%). Compliance to 10 elements significantly improved from Year 1 to Year 2 and significantly worsened in 2 elements. CONCLUSION: Many standardized geriatric care processes for frail older adult trauma patients can be successfully integrated into routine daily inpatient practice and sustained over time. Multicenter studies are needed to demonstrate how to improve compliance and to understand better which pathway elements are most effective.

Factors Associated With Burnout in Trauma Nurses.

BACKGROUND: Burnout is a psychological syndrome resulting from repeated stressors experienced in the workplace that centers on emotional exhaustion, detachment from the job, and a sense of ineffectiveness. It has been previously demonstrated that burnout exists in the health care workforce, but there has been limited investigation of burnout in nurses who primarily provide care for patients who have been traumatically injured. The purpose of this study was to explore factors associated with burnout reported by trauma nurses. METHODS: This was a secondary analysis of a cross-sectional survey distributed at a large, academic Level I trauma center that serves both adult and pediatric patients. For this analysis, only the Burnout subscale of the Professional Quality of Life scale Version 5 (ProQOL) was used. Multivariate hierarchical regression was used to determine factors associated with burnout reported by trauma nurses. RESULTS: Protective factors included being female, being married, and better quality of sleep. Risk factors included having a mental health diagnosis and working with adult populations. CONCLUSIONS: These results provide an important contribution to the burnout risk profile for trauma nurses and may provide insight into future investigations as well as development and testing of tailored interventions to mitigate burnout in trauma nurses.

Surgery program directors' knowledge of opioid prescribing regulations: a survey study.

BACKGROUND: Opioid misuse is a public health crisis that stems in part from overprescribing by health-care providers. Surgical residents are commonly responsible for prescribing opioids at patient discharge, and residency program directors (PDs) are charged with their residents' education. Because each hospital and state has different opioid prescribing policies, we sought to assess PDs' knowledge about local controlled substance prescribing polices. METHODS: A survey was emailed to surgery PDs that included questions regarding residency characteristics and knowledge of state regulations. RESULTS: A total of 247 PDs were emailed with 110 (44.5%) completed responses. One hundred and four (94.5%) allow residents to prescribe outpatient opioids; one was unsure. Sixty-three (57.3%) respondents correctly answered if their state required opioid prescribing education for full licensure. Twenty-two (20.0%) were unsure if their state required opioid prescribing education for licensure. Sixty-four (58.2%) respondents answered correctly if a prescription monitor programs use is required in their state. Twenty-nine (26.4%) were unsure if a state prescription monitor programs existed. Seventy-six (69.1%) PDs answered correctly about their state's requirement for an additional registration to prescribe controlled substances; 10 (9.1%) did not know if this was required. Twenty-nine (27.9%) programs require residents to obtain individual drug enforcement agency registration; 5 (4.8%) were unsure if this was required. CONCLUSIONS: Most programs allow residents to prescribe outpatient opioids. However, this survey demonstrated a considerable gap in PDs' knowledge about controlled substance regulations. Because they oversee surgical residents' education, PDs should be versed about their local policies in this matter.

Ultrasonography training and utilization in surgical critical care fellowships: a program director's survey.

BACKGROUND: Intensivist-performed ultrasound (IPUS) is an adjunctive tool used to assist in resuscitation and management of critically ill patients. It allows clinicians real-time information through noninvasive methods. We aimed to evaluate the types of IPUS performed and the methods surgical critical care (SCC) fellows are trained along with challenges in training. METHODS: One hundred SCC fellowship directors were successfully sent an email inviting them to participate in a short Web-based survey. We inquired about program characteristics including hospital type, fellowship size, faculty size and training, dedicated surgical critical care beds, and ultrasound equipment availability. The survey contained questions regarding the program directors' perception on importance on cost effectiveness of IPUS, types of IPUS examinations performed, fellows experience with IPUS, challenges to training, and presence and methods of quality assurance (QA) programs. RESULTS: A total of 38 (38.0%) program directors completed the survey. Using a 100-point Likert scale, the majority of the respondents indicated that IPUS is important to patient care in the SICU and is cost-effective (mean score 85.5 and 84.6, respectively). Most (34, 89.5%) utilize IPUS and conduct a mean of 5.1 different examination types with FAST being the most prevalent examination (33, 86.8%). Thirty-three (86.8%) programs include IPUS in their SCC training with varying amounts of time spent training. Of these programs, 19 (57.6%) have a specific curriculum. The most frequently used modalities for training fellows were informal bedside teaching (28, 84.8%), hands-on lectures (20, 60.6%) and formal lectures (19, 57.6%). The top three challenges program directors cited for IPUS education was time (23, 69.7%), followed by concerns for ongoing QA (19, 57.6%) and lack of faculty trained in IPUS (18, 53.9%). Only 20 (60.6%) programs review images as a part of QA/quality improvement. CONCLUSIONS: Utilization and training of IPUS is common in SCC fellowships. There is varied education type and training time devoted to IPUS which could lead to gaps in knowledge and care. Development of a standard curriculum for SCC fellowships could assist surgical intensivists in achieving a base of knowledge in IPUS to create a more homogenously trained workforce and standards of care.

Low fundamental movement skill proficiency is associated with high BMI and body fatness in girls but not boys aged 6-11 years old.

This study examined differences in children's body mass index (BMI) and body fatness (BF%) as a function of gender and fundamental movement skill (FMS) proficiency. Following ethics approval and parental consent, 248, 6-11 year-old children (112 boys, 136 girls) underwent assessment of 7 FMS: sprint run, side gallop, hop, kick, catch, throw and vertical jump. FMS tertiles ("high", "medium" or "low" FMS) were created based on the summed components of the FMS. Skinfold measures were used to calculate BF%. Physical activity (PA) was assessed using pedometry and maturation predicted using anthropometry. Data were analysed using a 2 (Gender) × 3 (FMS tertile) ways analysis of covariance (ANCOVA), controlling for age, maturation and PA. Age (P = .001) and maturation (P = .006) were associated with BMI. Girls classified as high FMS proficiency had significantly lower BMI compared to girls with low and medium FMS proficiency. Age (P = .0001) and maturation (P = .007) were associated with BF%. BF% was also higher for girls with low FMS compared to those with medium and high FMS. BF% and BMI were not different across FMS tertile in boys. Such findings suggest focusing on FMS may be especially important for healthy weight, particularly in girls.

Epithelial sheath neuroma: evidence supporting a hyperplastic etiology and epidermal origin.

An epithelial sheath neuroma (ESN) is a rare benign process of unknown pathogenesis, which is characterized histologically by multiple enlarged peripheral nerve fibers ensheathed by mature squamous epithelium. The histologic features can elicit concern for carcinomatous perineural invasion. The process is limited to the superficial dermis and is surrounded by a loose myxoid stroma, lymphocytic infiltrate and sometimes prominent infundibular cysts. The etiology of this peculiar entity has been debated and theories include a benign neoplasm, a hamartoma or an unusual reactive hyperplasia. There are only seven prior cases reported of ESN in the literature. Our case presented here is the first report to show connection of the ESN to the overlying epidermis and reactive epidermal hyperplasia. This suggests that ESN is indeed an unusual form of benign reactive hyperplasia. In addition, the clinical setting in this case was of pruritus and scratching in a background of papular urticaria, supporting the previous notion that ESN is probably a response to an external stimulus such as rubbing.

Effective Leadership and Management of an ACS Injury Prevention Program: Current Opinions and Perspectives From Where the Rubber Meets the Road.

The American College of Surgeons (ACS) mandates that each verified trauma center must have an injury prevention coordinator (IPC); however, Chapter 18 in the Resources for Optimal Care of the Injured Patient (2014) provides minimal information on how to effectively lead or manage an injury prevention (IP) program. This opinion article addresses 3 fundamental components of an effective IP program: (1) construction of an innovative vision of IP programming using current technology; (2) intentional investment and involvement; and (3) stakeholder leadership, engagement, and sustainability. This article also provides leadership and management methods from other professions both within and outside of the health care field that can be translated into sustainable IP program planning, implementation, and longevity.

Comparisons in ambulatory physical activity in children from the United Kingdom and Belgium.

AIM: This study sought to examine ambulatory physical activity levels in adolescents from the UK and Belgium. METHODS: Following ethics approval, 2760 children (1247 boys, 1513 girls), aged 9-14 years from Belgium (n = 1614) and the UK (n = 1146), wore a pedometer for 4 days including at least 1 weekend day. Body mass index (BMI) was determined from height and mass. RESULTS: A 2 (gender) × 2 (country) way ANCOVA, controlling for age and BMI, revealed a significant country-by-gender interaction for steps/day (p = 0.0001). In both Belgium and the UK, boys were more physically active than girls (both p = 0.0001), but the difference between boys and girls was greater for Belgian than UK children. CONCLUSION: These results suggest there are differences in the ambulatory physical activity patterns of children in the UK and Belgium.

The effect of acute caffeine ingestion on coincidence anticipation timing in younger and older adults.

OBJECTIVES: This study compared the effect of acute caffeine ingestion on coincidence timing accuracy in younger and older adults. METHODS: Thirteen young (aged 18-25 years, age: 20 ± 2 years, 7 females, 5 males) and 13 older (aged 61-77 years, age: 68 ± 6 years, 9 females, 3 males) adults, all who were habitual moderate caffeine consumers undertook measures of coincident anticipation timing performance pre- and post-acute caffeine (3 mg/kg) or placebo ingestion administered in a double blind, randomized fashion. RESULTS: Results indicated significant pre-to-post X substance (caffeine vs. placebo) interactions for absolute (P = 0.02, Pη(2) = 0.204) and variable error (P = 0.015, Pη(2) = 0.221). In both cases, error (absolute or variable) improved pre-to-post ingestion in the caffeine condition but not in the placebo condition. There were no significant differences due to age (younger vs. older adults, P > 0.05) in any of the analyses. DISCUSSION: The results of this study suggest that acute caffeine ingestion positively influence coincidence anticipation timing performance in both younger and older adults, who are moderate habitual caffeine consumers. Such effects might therefore be useful for older adults in enhancing ability to undertake cognitive-perceptual tasks which involve interceptive actions.

Prediction of habitual physical activity level and weight status from fundamental movement skill level.

Fundamental movement skills (FMS) have been assessed in children in order to investigate the issues of the low proportion of children who meet physical activity (PA) guidelines and rising levels of obesity. The aim of this research was to identify whether previous or current FMS level is a better predictor of PA levels and weight status in children. In January 2012 (year 1), 281 children were recruited from one primary school in the West Midlands, UK. Children performed eight FMS three times, which were videoed and assessed using a subjective checklist. Sprint speed and jump height were measured objectively. Height and mass were measured to calculate the body mass index to determine the weight status. Skinfold calliper readings were used to calculate body fat percentage. One year later, in January 2013, all these tests were repeated on the same children, with the additional collection of PA data via the use of pedometers. Following multiple linear regression, it was identified that prior mastery in FMS was a better predictor of current PA, whereas current FMS was a better predictor of current weight status. Overall, FMS mastery is needed in childhood to be able to participate in PA and maintain a healthy weight status.

Cross-validation of pedometer-determined cut-points for healthy weight in British children from White and South Asian backgrounds.

BACKGROUND: Evidence-based pedometer cut-points for health have not been sufficiently examined in the context of ethnicity. OBJECTIVE: To (1) evaluate previously described steps/day cut-points in a sample of White and South Asian British primary school children and (2) use ROC analysis to generate alternative, ethnic specific, steps/day cut-offs for children. METHODS AND PROCEDURES: Height, body mass and pedometer determined physical activity were assessed in 763 British children (357 boys and 406 girls) from White (n = 593) and South Asian (n = 170) ethnic groups, aged 8-11 years. RESULTS: The Vincent and Pangrazi cut-points significantly predicted BMI in white (p = 0.006, Adjusted R(2 )= 0.08) and South Asian children (p = 0.039, Adjusted R(2 )= 0.078). The Tudor-Locke et al. cut-points significantly predicted BMI in White children (p = 0.0001, Adjusted R(2 )= 0.079) but not South Asian children (p < 0.05). ROC analysis indicated significant alternative cut-points in White and South Asian boys and girls (all p = 0.04 or better, Adjusted R(2 )= 0.091 for White and 0.09 for South Asian children). Subsequent cut-points associated with healthy weight, when translated to steps/day were 13,625 for White boys, 13,135 for White girls, 10,897 for South Asian boys and 10,161 for South Asian girls. CONCLUSIONS: Previously published steps/day cut-points for healthy weight may not account for known ethnic variation in physical activity between White and South Asian children in the UK. Alternative, ethnic-specific, cut-points may be better placed to distinguish British children based on pedometer-determined physical activity.

Can a six-week exercise intervention improve gross motor function for non-ambulant children with cerebral palsy? A pilot randomized controlled trial.

OBJECTIVE: To determine the effect of a six-week exercise intervention on gross motor function for non-ambulant children with cerebral palsy. DESIGN: A parallel arm randomized controlled trial. SETTING: Four special schools. PARTICIPANTS: Thirty-five children aged 8-17 with bilateral cerebral palsy; Gross Motor Function Classification System levels IV-V. METHOD: Participants were randomly allocated to a static bike group, a treadmill group or control group. Participants in the bike and treadmill groups received exercise training sessions, three times weekly for six weeks. The control group received their usual care. Blinded assessments were performed at baseline and six weeks and followed up at 12 and 18 weeks. OUTCOME MEASURES: Gross Motor Function Measures GMFM-66, GMFM-88D and GMFM-88E. RESULTS: At six weeks significant differences were found in GMFM-88D scores between the bike group and the control group, and the treadmill group and the control group (P < 0.05). The mean change (SD) in GMFM-88D score was 5.9 (6.8) for the bike group; 3.7 (4.4) for the treadmill group and 0.5 (1.9) for the control group. No significant differences were found for GMFM-66 or GMFM-88E scores between the bike group and control group, or the treadmill group and control group, although trends of improvement were observed for both exercise groups. The improvements observed declined during the follow-up period. CONCLUSION: This study provides preliminary evidence that exercising on a bike or treadmill may provide short-term improvements in gross motor function for non-ambulant children with cerebral palsy. This needs to be tested in a large-scale randomized trial.

Malignant melanoma in transplant patients: a case report and review of the literature.

The clinical course and outcome of malignant melanoma (MM) are well-established for immunocompetent groups; however, they are not well-documented for immunosuppressed populations. Specifically, the influence of immunosuppression may result in poorer outcomes, especially in more advanced cases of melanoma. We report a 67-year-old woman who had previously undergone a kidney and pancreas transplant and presented with American Joint Committee on Cancer (AJCC) stage IIIA melanoma with subsequent rapid demise. As medicine advances with greater numbers of organ transplant recipients, a multi-institutional prospective study for this at-risk population would be greatly beneficial to help characterize the incidence, progression, and prognosis of melanoma in posttransplant immunosuppressed populations.

The impact of policy and screening on cervical cancer in England.

There has been a significant statistical decrease in the incidence of cervical cancer since screening programmes have been introduced. This article will explore and evaluate the impact of the Cancer Reform Strategy on cervical screening in England, which preceded the Government's policy for cancer care announced in January 2011. The Strategy raised the initial age of screening from 20 to 25 years of age. This left a group of the population who could not access screening while also not being eligible for vaccines against cervical cancer. Although this caused concern for many people, the media coverage and reaction to the human papilloma virus (HPV) vaccine and the death of Jade Goody, for example, encouraged women to consider cervical screening. The barriers to screening have been identified but overall the Cancer Reform Strategy was found have a positive impact both economically and socially. The Strategy has led the way for the Government's policy for cancer care, which needs to continue achieving the same positive outcomes.

First reported case of pregnancy in a patient with ornithine aminotransferase deficiency.

Ornithine aminotransferase deficiency is a rare autosomalrecessive human inborn error of the metabolism resulting in hyperornithinemia and progressive chorioretinal degeneration (gyrate atrophy) with blindness. There are few reports in the literature and none, to our knowledge, that address this condition during pregnancy. We report on a novel case of ornithine aminotransferase deficiency during pregnancy that was managed actively with arginine and protein restriction with serial amino acid and fetal growth monitoring, resulting in an uncomplicated term live birth.

Patient and public involvement in the development of clinical practice guidelines: a scoping review.

OBJECTIVES: Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four questions: (1) who are the patients and publics involved in developing the CPG?; (2) from where and how are the patients and publics recruited?; (3) at what stage in the CPG development process are the patients and publics involved? and (4) how do the patients and publics contribute their views? We also extracted data on the use of PPI reporting checklists by the included studies. DESIGN: We used the methodology developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. We searched PubMed, Embase, CINAHL and PsycINFO, websites of national guideline bodies from the UK, Canada, Australia and the USA, and conducted a forward citation search. No language, date or participant demographics restrictions were applied. Data were synthesised narratively. RESULTS: We included 47 studies addressing 1 or more of the 4 questions. All included studies reported who the patient and publics involved (PPI members) were, and several studies reported PPI members from different groups. Patients were reported in 43/47 studies, advocates were reported in 22/47 studies, patients and advocates reported in 17/47 studies, and general public reported in 2/47 studies. Thirty-four studies reported from where the patients and publics were recruited, with patient groups being the most common (20/34). Stage of involvement was reported by 42/47 studies, most commonly at question identification (26/42) and draft review (18/42) stages. Forty-two studies reported how the patients contributed, most commonly via group meetings (18/42) or individual interviews. Ten studies cited or used a reporting checklist to report findings. CONCLUSIONS: Our scoping review has revealed knowledge gaps to inform future research in several ways: replication, terminology and inclusion. First, no standard approach to PPI in CPG development could be inferred from the research. Second, inconsistent terminology to describe patients and publics reduces clarity around which patients and publics have been involved in developing CPGs. Finally, the under-representation of research describing PPI in the development of screening, as opposed to treatment, CPGs warrants further attention.

A population study of Lesch-Nyhan disease in the UK.

AIM: The aims of this study were to identify all people with Lesch-Nyhan disease (LND) born in the UK between 1988 and 2008, and to obtain a clinical profile including age at diagnosis, genetic background, family history, neurological signs, and medications. METHOD: Potential participants were contacted through the British Paediatric Neurology Surveillance Unit. Questionnaires were sent to each child's paediatric neurologist or primary consultant. Two purine laboratories provided metabolic information. RESULTS: Twenty-three live males with LND in the 0- to 20-year age band and eight live males over the age of 20 years were identified. Thirty-one live people with LND were identified in the UK in 2008, giving a prevalence of 1 in 2 million people. Over the 20 years of study, there was a mean incidence rate of 0.18 per 100 000 live births, range 0 to 0.5. INTERPRETATION: To our knowledge, this study is the first to provide details of the prevalence and incidence of LND in the UK. The data highlight that clinical profiles, at the time of diagnosis, and management of the disease are variable. There is the need for ongoing monitoring of allopurinol dosage and metabolic screening.