Nonoccupational Postexposure Human Immunodeficiency Virus Prophylaxis: Acceptance Following Sexual Assault.

BACKGROUND: Nonoccupational postexposure prophylaxis (nPEP) for HIV following sexual assault may decrease the likelihood of HIV transmission. OBJECTIVE: The purpose of this exploratory chart review study was to examine factors associated with patients accepting post-sexual assault nPEP at three forensic nurse examiner programs in urban settings. METHODS: Forensic nursing charts of patients presenting for acute sexual assault care were reviewed as part of a mixed-methods study. RESULTS: Patients assaulted by more than one or an unknown number of assailants were over 12 times more likely to accept the offer of nPEP (adjusted odds ratio [aOR] = 12.66, 95% CI [2.77, 57.82]). In cases where no condom was used (aOR = 8.57, 95% CI [1.59, 46.10]) or when any injury to the anus or genitalia was noted (aOR = 4.10, 95% CI [1.57, 10.75]), patients were more likely to accept nPEP. Patients with any injury to the face or head were less likely to initiate nPEP (aOR = 0.32, 95% CI [0.11, 0.97]). DISCUSSION: This study is an important first step in understanding factors associated with nPEP acceptance after sexual assault.

Assessing stimulus preference using response force in a conjugate preparation: A replication and extension.

The current study examined 98 participants' preferences for five pictorial stimuli. The researchers used a verbal multiple-stimulus-without-replacement (VMSWO) preference assessment with each participant to identify high-preference and low-preference pictorial stimuli. Next, participants viewed each pictorial stimulus in a randomized order on a computer while using a hand dynamometer that measured the amount of force they exerted to increase or maintain the visual clarity of each image. The results indicate that over 75% of participants' force response ranks corresponded with participants' VMSWO high-preference stimuli, VMSWO low-preference stimuli, or both. The results of the current study provide further evidence for the use of conjugate schedules in the assessment of stimulus preference with potential for use as a reinforcer assessment. Implications along with directions for future research and limitations of the findings are discussed.

Evaluating change in bruise colorimetry and the effect of subject characteristics over time.

UNLABELLED: Forensic clinicians are routinely asked to estimate the age of cutaneous bruises. Unfortunately, existing research on noninvasive methods to date bruises has been mostly limited to relatively small, homogeneous samples or cross-sectional designs. PURPOSE: The purpose of this prospective, foundational study was to examine change in bruise colorimetry over time and evaluate the effects of bruise size, skin color, gender, and local subcutaneous fat on that change. METHOD: Bruises were created by a controlled application of a paintball pellet to 103 adult, healthy volunteers. Daily colorimetry measures were obtained for four consecutive days using the Minolta Chroma-meter(®). The sample was nearly equal by gender and skin color (light, medium, dark). Analysis included general linear mixed modeling (GLMM). RESULTS: Change in bruise colorimetry over time was significant for all three color parameters (L*a*b*), the most notable changes being the decrease in red (a*) and increase in yellow (b*) starting at 24 h. Skin color was a significant predictor for all three colorimetry values but sex or subcutaneous fat levels were not. Bruise size was a significant predictor and moderator and may have accounted for the lack of effect of gender or subcutaneous fat. CONCLUSION: Study results demonstrated the ability to model the change in bruise colorimetry over time in a diverse sample of healthy adults. Multiple factors, including skin color and bruise size must be considered when assessing bruise color in relation to its age. This study supports the need for further research that could build the science to allow more accurate bruise age estimations.

Sex differences in interpersonal problems: does sexual orientation moderate?

Sexual orientation was examined as a moderator in the relation between biological sex and interpersonal problems. Participants were 60 lesbians, 45 heterosexual women, 37 gay men, and 39 heterosexual men, who completed the Inventory of Interpersonal Problems-Circumplex. Sexual orientation was found to moderate one of the eight interpersonal problems under study. Heterosexual women scored significantly higher than lesbian women in Non-assertive. Although hypothesized, gay men did not differ from heterosexual men along the Dominant-Cold quadrant. Implications of these results are discussed.

Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: a review.

Although available for over a decade, use of nonoccupational postexposure prophylaxis (nPEP) remains controversial in the United States. There are concerns over sexual assault survivors' adherence, or lack thereof, leading to increased costs without an appreciable decrease in human immunodeficiency virus (HIV) transmission. This review examines and synthesizes the available literature from the past 10 years to determine the true rates of provision and adherence to nPEP regimens in sexual assault survivors in low HIV prevalence, industrialized nations. Findings suggest that further prospective research is necessary to better understand the process of post-assault nPEP evaluation and subsequent follow-up and adherence.

Female genital injury following consensual and nonconsensual sex: state of the science.

INTRODUCTION: Nurses who evaluate patients following sexual assault are often faced with the task of identifying genital injuries and providing legal testimony regarding the nature of the injuries. Following a 2000 Virginia State court decision, sexual assault nurse examiners have had to struggle to answer the questions, "Are the genital injuries consistent with the patient's history?" and "Are the genital injuries consistent with sexual assault?" METHODS: A search of the relevant scientific literature was conducted. Sources were examined and reviewed to identify what is presently known about adult female genital injuries associated with either consensual or nonconsensual sexual intercourse. RESULTS: Female genital injuries occur with both consensual and nonconsensual sexual contact. Although some studies suggest that differences in injury patterns, types, or locations may exist, the data do not unequivocally confirm these findings. DISCUSSION: Currently, the presence or absence of genital injury should not be used to render an opinion regarding consent to sexual intercourse. Further research is necessary to determine if injury patterns can indeed distinguish consensual from nonconsensual sex.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

"Reclaiming Control" Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault.

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.

Predictors for Telephone Outreach Post-hospital Discharge.

PURPOSE OF STUDY: The specific aims of this study were to examine whether sociodemographic variables and medical-surgical diagnoses were associated with telephone follow-up (TFU) reach rates, emergency department visits, and hospital readmissions. PRIMARY PRACTICE OF SETTING: Acute care inpatient units in an academic medical center. METHODOLOGY AND SAMPLE: A correlational design was utilized, and a prospective medical record review of patients was conducted while implementing face-to-face prehospital discharge meeting interventions. The study sample (N = 176) included adult patients in two neurosurgical wards who were admitted between June 2016 and September 2016. Parametric and nonparametric tests were used to explore the balance between the intervention group receiving a face-to-face prehospital discharge meeting and comparison group receiving standard prehospital discharge care. Bivariate statistics were employed to determine associations between variables. RESULTS: A total of 15 sociodemographic and medical-surgical variables were used to correlate TFU reach rates, emergency department (ED) visits, and readmission rates. Educational attainment (p = .002), employment status (p = .014), parental status (p = .010), and hospital service (p = .039) had significant differences between the intervention and comparison groups. Results demonstrated an improved reach rate for the intervention group but despite the differences in the groups, phi and Cramer's V coefficients did not correlate any associations with TFU reach rate, ED visits, and readmission rates with sociodemographic and surgical variables. This outcome affirmed that despite the similarities and differences in the sample, a face-to-face meeting prehospital discharge is an effective intervention to improve telephone outreach. IMPLICATIONS TO CASE MANAGEMENT PRACTICE: There is a need to determine the most cost-effective way to increase TFU reach rates to prevent subsequent ED visits and hospital readmissions. There is also a need to develop a tool that can predict the hardest-to-reach patients posthospital discharge, so that case managers can meet those patients before leaving the hospital. In addition, it is important to identify alternative methods of "face-to-face" interactions during the COVID-19 pandemic crises. Case managers must explore ways with caution to leverage secured digital technology to bridge the gap of communicating with patients and family members when hospital visitations are limited.

Alternate Light Source Findings of Common Topical Cosmetics and Three Removal Methods.

INTRODUCTION: Alternate light sources (ALSs) are a tool used by forensic nurses to aid in the physical examination of patients. Prior research has shown some topical makeup products absorb alternate light similar to the absorption noted in bruises. Therefore, the purposes of this study were (a) to further examine the ALS findings of multiple brands and types of makeup products and (b) to compare the efficacy of three methods of makeup removal. METHODS: Fourteen makeup products were applied to the forearms of 100 healthy adult volunteers with varying skin tones and then assessed under white light, six alternate light wavelengths, and three color filters, producing 19 total wavelength-and-filter combinations. The results were recorded before and after removal procedures by forensic nurse examiners who were blinded to the removal method. A three-arm randomized controlled trial of makeup removal methods (soap and water, isopropyl alcohol swab, makeup removal wipe) was conducted with the participants. RESULTS: All 14 makeup products produced absorption in at least 10% of the observations. Fluorescence was observed in more than 10% of the observations for only two products. After product removal, four products continued to produce statistically significant absorption findings when viewed under an ALS. One product produced significant fluorescence after removal procedures. There were no statistically significant differences between the removal methods noted in any of these analyses. CONCLUSION: Our findings support the importance of using alternate light as one component of a comprehensive forensic examination, including history taking and physical examination.

Quantifying the Degree of Bruise Visibility Observed Under White Light and an Alternate Light Source.

BACKGROUND: Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS). METHODS: Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales. RESULTS: Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values. IMPLICATIONS FOR PRACTICE: Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial.

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350-535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35-6.56; 450 nm: OR = 4.08, 95% CI: 3.36-4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37-3.70; fat: OR = 1.21, 95% CI: 1.09-1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.

Face-to-Face Meetings with Neurosurgical Patients Before Hospital Discharge: Impact on Telephone Outreach, Emergency Department Visits, and Hospital Readmissions.

The Johns Hopkins Community Health Partnerships (JCHiP) was developed in 2010 within the Johns Hopkins Health Systems. As part of JCHiP, the Patient Access Line call center was created. The average telephone reach rate at The Johns Hopkins Hospital in 2014 was only 53%. In a population of adult neurosurgical patients, this study aimed to: determine the impact of face-to-face meetings with neurosurgical patients before hospital discharge on telephone follow-up (TFU) reach rates, and determine the association between TFU reach rates and subsequent emergency department (ED) visits and hospital readmission rates. This quasi-experimental study used a posttest-only research design with a comparison group. Two adult inpatient neurosurgical units at the Johns Hopkins Hospital were selected as the intervention and comparison groups. A convenience sampling technique was used. Face-to-face meetings pre hospital discharge resulted in a TFU reach rate of 97.7% on the intervention unit while the comparison unit had only a 76.1% TFU reach rate (P < .001). Reached patients had fewer ED visits (7.8%) than not reached patients (17.4%); however, the difference was not statistically significant (P = .138). Reached patients also had fewer hospital readmissions (3.3%) than not reached patients (8.7%); this also was not statistically significant (P = .214). This study demonstrated that face-to-face meetings with neurosurgical patients prior to discharge increased TFU rates. Results were statistically significant. ED visits and hospital readmissions were also reduced in reached patients and the findings were clinically significant.

The Best Practice for Increasing Telephone Outreach: An Integrative Review.

PURPOSE OF STUDY: Many hospitals established telephone follow-up (TFU) programs to improve care transitions and reduce hospital readmissions. However, there is a lack of knowledge on how to increase the outreach of TFU programs. This integrative review aims to answer the clinical practice question, "What is the best practice for increasing telephone follow-up reach rates post-hospital discharge?" PRIMARY PRACTICE SETTING: The primary setting evaluated in this review was hospital-based phone call programs that are conducting post-hospital discharge TFU. METHODOLOGY: In this integrative review, we searched studies published between January 2003 and November 2017. We searched 5 electronic databases including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane. The Johns Hopkins Nursing Evidence-Based Practice model was used to critically analyze and synthesize the selected articles. RESULTS: Nine articles were reviewed, and this study uncovered that pre-hospital face-to-face meeting might increase TFU reach rates. However, most studies calculated reach rates using only frequencies/percentages. This contributed to our low-quality rating on most of the reviewed studies. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This review identified that TFU, as a component of a care coordination program, may reduce hospital readmissions and control health care utilization. However, few studies (n = 2) used TFU reach rates as a major study outcome to determine the impact of face-to-face meetings on phone outreach. Therefore, the evidence is limited to inform case management practice to increase phone outreach post-hospital discharge. It is recommended to conduct further research and test different methods that may increase phone outreach.

Acute injury patterns of intimate partner violence victims.

Although millions of women receive injuries from intimate partner violence (IPV) each year in the United States alone, there has been only limited research of acute injury patterns and the types, locations, and mechanisms of IPV injuries. The mechanism of being punched to the face with a fist resulting in blunt trauma-related injuries is most commonly reported. Strangulation, especially manual strangulation, is a frequently cited mechanism of injury; however, less is known about the types of injuries that result from strangulation. In general, clinicians should assess all patients who present for treatment of head, neck, and face injuries for IPV. There is little consistency between and much inaccuracy with medical terms used to describe types of injuries. To increase the accuracy and generalizability of findings from studies of acute IPV injuries, researchers need to use more standardized medical forensic terminology.