Law Enforcement and Patient Privacy Among Survivors of Violence: A Nationwide Mixed-Methods Study.

INTRODUCTION: During the emergent treatment of violently injured patients, law enforcement (LE) officers and health care providers frequently interact. Both have duties to protect patient health, rights, and public health, however, the balance of these duties may feel at odds. The purpose of this study is to assess hospital-based violence intervention program (HVIP) representatives' experiences with LE officers among survivors of violence and the impact of hospital policies on interactions with LE officers. MATERIALS AND METHODS: A nationwide survey was distributed to the 35 HVIPs that form the Health Alliance for Violence Intervention. Data regarding respondent affiliation, programs, and perceptions of hospital policies outlining LE activity were collected. Follow-up video interviews were open coded and qualitatively analyzed using grounded theory. RESULTS: Respondents from 32 HVIPs completed the survey (91%), and 22 interviews (63%) were conducted. Common themes from interviews were: police-patient interactions; racism, bias, and victims' treatment as suspects; and training and education. Only 39% of respondents knew that policies existed and were familiar with them. Most representatives believed their hospitals' existing policies were inadequate, ineffective, or biased. Programs that reported good working relationships with LE officers offered insight on how their programs maintain these partnerships and work with LE officers towards a common goal. CONCLUSIONS: Unclear or inadequate policies relating to LE activity may jeopardize the health and privacy of violently injured patients. Primary areas identified for improvement include clarifying and revising hospital policies, education of staff and LE officers, and improved communication between health care providers and LE officers to better protect patient rights.

Examining 5-Year Cervical Cytology Progression Among Minority Women Living With HIV and Baseline Negative Cytology.

OBJECTIVE: Women living with HIV (WLWH) have increased risk of human papillomavirus (HPV) infection, precancers, and invasive cervical cancers. This study aims to determine the rate of cervical cytologic progression and related factors in minority WLWH across 5 years. MATERIALS AND METHODS: We used our HIV clinic database, complemented with a retrospective chart review to identify WLWH with a baseline negative cervical cytology between 2009 and 2012 and 5-year follow-up. Data included race/ethnicity, age, years living with HIV, AIDS status, viral load, history of smoking, drug use, and HPV status. Multivariate logistic regression tested progression of negative cytology to low-grade/high-grade squamous intraepithelial lesions (LGSIL/HGSIL). RESULTS: Among 162 WLWH, 42% were African American, 30% non-Hispanic African Caribbean, and 26% Hispanic. At baseline, 21% had detectable viral load (>200 cp/mL), mean age was 44.8 (±11 years), and mean years living with HIV was 9.6 (±6.9). After 5 years, 19% of the cohort progressed to LGSIL/HGSIL. Human papillomavirus was detected consistently among women with cytologic changes (30% vs 7%, p < .01). Significant factors that predicted higher likelihood of progression to LGSIL/HGSIL were detection of HPV (adjusted odds ratios = 5.11 [1.31-19.93]; p = .02), and Centers for Disease Control and Prevention-defined AIDS status (adjusted odds ratios = 4.28 [1.04-17.63]; p = .04). Of the women who maintained negative cytology at 1 to 2 years (n = 102), 5 women (5%) progressed during the following 3 years before the recommended follow-up. CONCLUSIONS: Human papillomavirus detection and AIDS status were significant factors predicting progression to LGSIL/HGSIL among minority WLWH. Providers screening WLWH for cervical intraepithelial neoplasia should carefully decide screening intervals for minority populations.

Comparison of High Versus Low Eccentric-Based Resistance Training Frequencies on Short-Term Muscle Function Adaptations.

ABSTRACT: Crane, JS, Thompson, BJ, Harrell, DC, Bressel, E, and Heath, EM. Comparison of high versus low eccentric-based resistance training frequencies on short-term muscle function adaptations. J Strength Cond Res 36(2): 332-339, 2022-Eccentric resistance training is beneficial for improving a number of performance and health metrics. However, the recommendations on eccentric training frequency have not been established. This study investigates the effects of volume-matched resistance training frequency comparing 1 vs. 3 training days per week of isokinetic multiple-joint eccentric training on strength and lower-body function adaptations during a 4-week training period. Thirty subjects were assigned to either 3 days per week (high-frequency [HF]) or 1 day per week (low-frequency [LF]) training conditions for 4 weeks. An eccentric dynamometer was used for the training and testing. Eccentric strength and vertical jump (VJ) measures were taken at Pre, Mid (2 weeks), and Post (4 weeks) intervention. Soreness (visual analog scale [VAS]) and rate of perceived exertion (RPE) were taken throughout the training period. There was no group × trial interaction for eccentric strength (p = 0.06) or VJ (p = 0.87). For eccentric strength, all trials were significantly different (p < 0.001) from each other. For VJ, there was a main effect for trial such that VJ increased from Pre to Post (p < 0.001) and Mid to Post (p < 0.01). High frequency reported lower RPE (p < 0.01) and soreness (p = 0.04) compared with LF. Both HF and LF protocols elicited large (36.8 and 27.4% strength increases, respectively) and rapid neuromuscular adaptations for improved strength. Eccentric-based workload may be dispersed across a given period to allow for reduced soreness and perceived exertion levels without compromising neuromuscular adaptations. Some eccentric training transfer to functional (VJ) task may also be observed, independent of training frequency.

Emerging Trends in the Pathological Research of Human Papillomavirus-positive Oropharyngeal Squamous Cell Carcinoma.

Oropharyngeal squamous cell carcinomas (OPSCCs) have shown an alarming rate of increase in incidence over the past several decades, markedly in men. In the United States, transcriptionally-active human papillomavirus (HPV), particularly HPV 16, has become the highest contributive agent of OPSCCs, affecting approximately 16,000 people a year. Compared to patients with HPV-negative OPSCCs, patients with HPV-positive OPSCCs exhibit better health responses to chemoradiotherapy and an overall increase in long-term survival. Despite promising treatment options, many OPSCCs are discovered at an advanced stage, and ~20% of cases will recur after definitive treatment. Therefore, extensive research is ongoing to identify new targets for precision treatment and to stratify tumor prognosis. The aim of this review is to capture the most updated research on HPV-positive OPSCCs, emphasizing their relevance as potential new targets for precision medicine and survival prognosis.

A Comprehensive Update of the Treatment and Management of Bertolotti's Syndrome: A Best Practices Review.

Bertolotti's Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagnosis is made through a combination of clinical presentations and imaging studies and falls into one of four types. The incidence of transitional vertebra has a reported incidence between 4 and 36%; however, Bertolotti's Syndrome is only diagnosed when the cause of pain is attributed to this transitional anatomy. Therefore, the actual incidence is difficult to determine. Initial management with conservative treatment includes medical management and physical therapy. Injection therapy has been established as an effective second line. Epidural steroid injection at the level of the transitional articulation is effective, with either local anesthetics alone or in combination with steroids. Surgery carries higher risks and is reserved for patients failing previous lines of treatment. Options include surgical removal of the transitional segment, decompression of stenosed foramina, and spinal fusion. Recent evidence suggests that radiofrequency ablation (RFA) around the transitional segment may also provide relief. This manuscript is a comprehensive review of the literature related to Bertolotti's Syndrome. It describes the background, including epidemiology, pathophysiology, and etiology of the Syndrome, and presents the best evidence available regarding management options. Bertolotti's Syndrome is considered an uncommon cause of chronic back pain, though the actual incidence is unclear. Most evidence supporting these therapies is of lower-level evidence with small cohorts, and more extensive studies are required to provide strong evidence supporting best practices.

Impact of COVID-19 pandemic on injury prevalence and pattern in the Washington, DC Metropolitan Region: a multicenter study by the American College of Surgeons Committee on Trauma, Washington, DC.

BACKGROUND: The COVID-19 pandemic has had far-reaching effects on healthcare systems and society with resultant impact on trauma systems worldwide. This study evaluates the impact the pandemic has had in the Washington, DC Metropolitan Region as compared with similar months in 2019. DESIGN: A retrospective multicenter study of all adult trauma centers in the Washington, DC region was conducted using trauma registry data between January 1, 2019 and May 31, 2020. March 1, 2020 through May 31, 2020 was defined as COVID-19, and January 1, 2019 through February 28, 2020 was defined as pre-COVID-19. Variables examined include number of trauma contacts, trauma admissions, mechanism of injury, Injury Severity Score, trauma center location (urban vs. suburban), and patient demographics. RESULTS: There was a 22.4% decrease in the overall incidence of trauma during COVID-19 compared with a 3.4% increase in trauma during pre-COVID-19. Blunt mechanism of injury decreased significantly during COVID-19 (77.4% vs. 84.9%, p<0.001). There was no change in the specific mechanisms of fall from standing, blunt assault, and motor vehicle crash. The proportion of trauma evaluations for penetrating trauma increased significantly during COVID-19 (22.6% vs. 15.1%, p<0.001). Firearm-related and stabbing injury mechanisms both increased significantly during COVID-19 (11.8% vs. 6.8%, p<0.001; 9.2%, 6.9%, p=0.002, respectively). CONCLUSIONS AND RELEVANCE: The overall incidence of trauma has decreased since the arrival of COVID-19. However, there has been a significant rise in penetrating trauma. Preparation for future pandemic response should include planning for an increase in trauma center resource utilization from penetrating trauma. LEVEL OF EVIDENCE: Epidemiological, level III.

The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure.

BACKGROUND: Pressures measured during mechanical ventilation provide important information about the respiratory system mechanics and can help predict outcomes. METHODS: The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic information, clinical information, management requirements, and outcomes, such as mortality, ICU length of stay, and hospital length of stay. Mechanical ventilation pressures were recorded on the second full day of hospitalization. RESULTS: This study included 312 adult patients. The mean age is 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7. Some patients had pulmonary infections (46.2%), and some patients had extrapulmonary infections (34.9%). The overall mortality was 42.6%. In a multi-variable model that included age, gender, number of comorbidities, APACHE 2 score, and PaO2/FiO2 ratio, peak pressure, plateau pressure, driving pressure, and PEEP all predicted mortality when entered into the model separately. There was an increase in peak pressure, plateau pressure, and driving pressure across BMI categories ranging from underweight to obese. CONCLUSIONS: This study demonstrates that ventilator pressure measurements made early during the management of patients with acute respiratory failure requiring mechanical ventilation provide prognostic information regarding outcomes, including mortality. Patients with high mechanical ventilator pressures during the early course of their acute respiratory failure require more attention to identify reversible disease processes when possible. In addition, increased BMIs are associated with increased ventilator pressures, and this increases the complexity of the clinical evaluation in the management of obese patients.

Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy.

Purpose of Review: This is a comprehensive literature review of the available for treatment of oral muscle relaxants for cerebral palsy (CP) and associated chronic pain. It briefly describes the background and etiology of pain in CP and proceeds to review and weigh the available evidence for treatment for muscle relaxants. Recent Findings: CP is a permanent, chronic, non-progressive neuromuscular and neurocognitive disorder of motor dysfunction that is diagnosed in infancy and is frequently (62% of patients) accompanied by chronic or recurrent muscular pain. Treatment of pain is crucial, and focuses mostly on treatment of spasticity through non-interventional techniques, surgery and medical treatment. Botulinum toxin injections provide temporary denervation, at the cost of repeated needle sticks. More recently, the use of oral muscle relaxants has gained ground and more evidence are available to evaluate its efficacy. Common oral muscle relaxants include baclofen, dantrolene and diazepam. Baclofen is commonly prescribed for spasticity in CP; however, despite year-long experience, there is little evidence to support its use and evidence from controlled trials are mixed. Dantrolene has been used for 30 years, and very little current evidence exists to support its use. Its efficacy is usually impacted by non-adherence due to difficult dosing and side-effects. Diazepam, a commonly prescribed benzodiazepine carries risks of CNS depression as well as addiction and abuse. Evidence supporting its use is mostly dated, but more recent findings support short-term use for pain control as well as enabling non-pharmacological interventions that achieve long term benefit but would otherwise not be tolerated. More recent options include cyclobenzaprine and tizanidine. Cyclobenzaprine carries a more significant adverse events profile, including CNS sedation; it was found to be effective, possible as effective as diazepam, however, it is not currently FDA approved for CP-related spasticity and further evidence is required to support its use. Tizanidine was shown to be very effective in a handful of small studies. Summary: Muscle relaxants are an important adjunct in CP therapy and are crucial in treatment of pain, as well as enabling participation in other forms of treatments. Evidence exist to support their use, however, it is not without risk and further research is required to highlight proper dosing, co-treatments and patient selection.

Effects of isokinetic eccentric versus traditional lower body resistance training on muscle function: examining a multiple-joint short-term training model.

Early adaptations in eccentric training show several advantages over those in concentric training. The purpose of this study was to quantify the effects of 4 weeks of multiple-joint eccentric versus traditional leg press (TLP) training on muscle strength, rate of torque development (RTD), and jump and sprint performance adaptations. Twenty-six resistance-trained adults performed either an eccentric or a TLP resistance-training program twice per week for 4 weeks. Single-joint isometric maximal and rapid strength (peak torque and RTD, respectively) and isokinetic strength of the knee extensors and flexors, multiple-joint eccentric strength, leg press strength (1-repetition maximum), 40-m sprint, and vertical and long jump were measured before, at the midpoint, and after a 4-week training period. Four weeks of isokinetic multiple-joint eccentric training elicited greater test-specific strength gains (effect size (ES) = 1.06) compared with TLP training (ES = 0.11). The eccentric group also yielded moderate improvements in the middle-late phase RTD (RTD100-200; ES = 0.51 and 0.54 for the knee flexors and extensors, respectively), whereas the TLP group showed small-moderate improvements (ES = 0.37). The majority of the single-joint strength variables showed negligible improvements. Performance tests showed no (broad jump) to small (vertical jump; sprint for the leg press) improvements. Multiple-joint eccentric training induced significant improvements in lower body strength in a short amount of time in a recreationally trained population. These accelerated adaptations along with the lower energy requirements of eccentric exercise, may be useful for clinicians or practitioners when prescribing training programs for those who are injured, sedentary, or elderly as a means to elicit time- and metabolically efficient muscle function improvements.