Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals.

BACKGROUND: Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques. METHODS: This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups. RESULTS: Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P<0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P<0.01. CONCLUSION: The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population. LEVEL OF EVIDENCE: Level III-Case control or retrospective comparative study.

Impact of the COVID-19 Pandemic on the Overall Health of Patients With Pre-diabetes and Diabetes.

Coronavirus disease 2019 (COVID-19) impacted those with chronic diseases worldwide, especially those with diabetes. Very few studies have explored the effect of COVID-19 on diabetic patients' health markers. The present retrospective study compared various health markers of diabetic patients before and during the COVID-19 pandemic. Patients (N = 511) displayed a significant increase in systolic blood pressure, hemoglobin A1c (HbA1c), diabetic medications, and dose of insulin (p < 0.05) as well as a decrease in low density lipoprotein (LDL) levels (p = 0.04). When patients were stratified by body mass index (BMI), those in higher BMI categories were more negatively impacted during the pandemic than those in lower categories. Results display the impact that COVID-19 had on the general well-being of diabetic patients, and should encourage providers to increase telehealth visits when in-person visits are not possible.

Evaluating an urban pediatric hospital's scald burn prevention program.

BACKGROUND: Over 450,000 individuals are hospitalized with burns annually and roughly 35% are scald burns. Children younger than 5 years of age are at the greatest risk of scald burn injury. Caregiver burn prevention programs have been found to reduce the prevalence of injuries in young children; however, low-income and underserved populations seldomly have access to these programs. The impact of scald burn prevention programs in underserved populations remains unexplored. The objective of the current study was to evaluate the efficacy of a scald burn prevention program at a Level One Pediatric Trauma Center in a low-income, underserved community. METHODS: Our hospital developed a one-hour scald burn prevention program for caregivers with children 5 years of age or younger. The program educated caregivers on ways to prevent scald burns and create safeguards in their home. Caregivers completed a pre-post survey to measure their ability to identify hot or cold objects, as well as respond to items about their perceptions of the program's utility, their willingness to share it with others, and the likelihood that they would use the information in the future. Data was analyzed using a paired t-test. RESULTS: Two-hundred and sixty-nine (N = 269) caregivers participated in the program. Before the program, caregivers could identify potentially hot objects 83.17% of the time, and after the program, they were able to identify these items 92.31% of the time: t (268) = 12.46, p < .001, d = 1.07. Additionally, 95% of caregivers indicated that the program was helpful, 99% stated that they were likely to share this information with others, and 100% indicated that they would use the information from the program. CONCLUSIONS: Education is a critical component to prevent scald burns. Results indicate that a hospital-led scald burn prevention program can positively impact a caregiver's ability to identify possible scald-burn risks. Providing education to caregivers who typically do not receive this information could lower the prevalence of scald burns not only institutionally, but in communities that are disproportionately impacted by this mechanism of injury.

Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center.

BACKGROUND: Motor vehicle collisions (MVCs) are a significant safety issue in the United States. Young children are disproportionally impacted by car accidents and suffer high rates of injuries and mortality. When used properly, car seats have been found to reduce the severity of injuries. However, individuals from low-income areas often do not have access to education or car seats compared to those in suburban or higher income areas. Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge. METHODS: Caregivers (N = 200) attended a single, one-hour car seat educational program with a Child Passenger Safety Technician (CPST). The sessions included educational and hands-on components, where caregivers were asked to complete a seven-item pre-post knowledge assessment. For completion of the course, caregivers received a car seat for their child. RESULTS: A paired t-test revealed that the workshop significantly increased caregiver knowledge from pre-post: t (199) = - 12.56, p < .001; d = 1.27. McNemar's Chi-Square analyses displayed that caregivers increased in all knowledge categories (p < .001). CONCLUSIONS: While caregivers in urban areas or in low-income areas may have less access to resources, hospital-led car seat courses can increase knowledge of proper car seat usage in these communities. These findings should be used to establish programs in hospitals in areas where these resources are not readily available to caregivers.

Using Weather, Lunar Cycles, and Time of Year to Predict Trauma Incidents in an Urban, Level I Pediatric Trauma Center.

BACKGROUND: Trauma patterns in adults are influenced by weather conditions, lunar phases, and time of year. The extent to which these factors contribute to pediatric trauma is unclear. OBJECTIVE: The present study aimed to review patients from a single Level I pediatric trauma center to determine the influence of weather, the lunar cycle, and time of year on trauma activity. METHODS: A retrospective review of trauma activations (n = 1,932) was conducted from 2015 to 2017. Injury type and general demographics were collected. Weather data and lunar cycles were derived from historical databases. RESULTS: Days with no precipitation increased the total number of injuries of all types compared with those with precipitation (p < .001). Blunt and penetrating injuries were more likely to occur during full moons, whereas burn injuries were significantly higher during new moons (p < .001). Blunt trauma was significantly higher in September than all other months, F(11, 1,921) = 4.25, p < .001, whereas January had a significantly higher number of burns than all other months (p < .001). CONCLUSIONS: Pediatric trauma trends associated with external factors such as weather, lunar cycles, and time of year can inform hospital staffing decisions in anticipation of likely injuries and help direct injury prevention efforts.

Growing into "Us": Trajectories of Social Identification with College Sport Teams Predict Subjective Well-Being.

BACKGROUND: Groups are often a source of social identification that may elicit subjective well-being. When joining and maintaining membership of groups such as sport clubs, it is anticipated that members will experience varying trajectories of identification strength, but it is unclear how these trajectories may relate to well-being. METHOD: Participants were 697 college students (64% female), nested within 35 club-level sport teams. The current study longitudinally assessed students' social identification with sport teams at three timepoints (3-month lags) across a school year to examine the extent that growth trajectories in identification strength predicted indices of well-being (i.e. life satisfaction, happiness, and subjective health) at the end of the school year. RESULTS: Multilevel latent growth modeling revealed that end-of-year well-being was positively predicted by social identification intercepts (b = .24, p = .010) and growth trajectories (b = .75, p < .001). Accounting for baseline identification, steeper increases in social identification (upward trajectories) predicted greater well-being. CONCLUSIONS: Findings support established theory that social identification relates to well-being, while adding novel insights that students may experience unique benefits when their social identity strengthens over the course of a school year. Considering recent declines in college student well-being, groups like sport teams represent a source for social identification that should be fostered throughout the course of one's group membership.

Stop the Bleed: The Impact of a Basic Bleeding Control Course on High School Personnel's Perceptions of Self-Efficacy and School Preparedness.

Background: Uncontrolled bleeding is the leading cause of preventable death from trauma. The Stop the Bleed (STB) initiative provides basic education about bleeding to potential immediate responders. The present study aimed to assess the perceptions of self-efficacy and school preparedness related to responding to a life-threatening bleeding emergency in school personnel at an urban high school. Methods: High school personnel from an urban high school (N = 156) completed a 1-hour STB course that included a didactic and hands-on component. Participants rated their agreement with statements about self-efficacy and school preparedness on a 5-point Likert-type scale, responded to items regarding how school personnel could be better prepared for life-threatening emergencies, and had the option to provide written responses pre- and post-course. Findings: Independent samples t tests revealed that perceptions of self-efficacy and school preparedness increased after the course (p < .001). Before the course, 87% of participants felt they needed training, 80% felt the school needed clearer procedures, and 74% felt the school required more equipment for a life-threatening bleeding incident compared with 63%, 69%, and 78% post-course, respectively. Thematic analysis of written responses revealed that participants desired higher frequencies of STB training, more equipment, clearer school procedures, and realistic training scenarios with students. Conclusions/Application to Practice: The STB course increased both perceptions of self-efficacy and school preparedness in a sample of high school personnel. Qualitative analyses provided insight to personnel's opinion of STB's effectiveness and what is necessary to maintain or follow through with this knowledge after completion of the course.

Exploring Predictors of Moral Disengagement in Collegiate Athletic Trainers.

CONTEXT: Considering recent high-profile reports of malpractice and negligence by National Collegiate Athletic Association (NCAA) athletic trainers (ATs), it is prudent to investigate the psychological mechanisms that may influence ATs' ability to justify unethical behaviors. When treating injured student-athletes, ATs may undergo a cognitive process known as moral disengagement, which involves convincing oneself that ethical standards do not apply in a particular context. OBJECTIVE: To explore the psychological factors and traits among ATs that may predict moral disengagement pertaining to allowing athletes to play through injuries. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 187 Division I, II, and III ATs from 100 NCAA universities. MAIN OUTCOME MEASURE(S): In addition to the primary outcome variable of moral disengagement, the survey captured the AT's demographic background, sport and athletic training histories, and measures of sport ethic, contesting orientations, commitment, and social identity. RESULTS: Cluster analysis was used to identify homogeneous subgroups of participants based on these variables. A 2-cluster solution emerged, with cluster 1 (n = 94) scoring higher in the sport-ethic and sport-contesting orientations but lower in commitment and social identity compared with cluster 2 (n = 93). An independent-samples t test revealed that moral disengagement was highest (t185 = 19.59, P < .001, d = 0.69) among ATs in cluster 1. CONCLUSIONS: These findings advance our understanding of the psychological processes that may predict moral disengagement of ATs in allowing student-athletes to play through injury. Although additional research is needed to test whether moral disengagement influences return-to-play decisions, we provide initial evidence that ATs who conform to sport norms (eg, "no pain, no gain") and who tend to view sport competition with a "war-like" orientation are more likely to morally disengage.

Are all sport activities equal? A systematic review of how youth psychosocial experiences vary across differing sport activities.

OBJECTIVE: Models of sport development often support the assumption that young athletes' psychosocial experiences differ as a result of seemingly minor variations in how their sport activities are designed (eg, participating in team or individual sport; sampling many sports or specialising at an early age). This review was conducted to systematically search sport literature and explore how the design of sport activities relates to psychosocial outcomes. DESIGN: Systematic search, followed by data extraction and synthesis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were applied and a coding sheet was used to extract article information and code for risk of bias. DATA SOURCES: Academic databases and manual search of peer-reviewed journals. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Search criteria determined eligibility primarily based on the sample (eg, ages 7 through 17 years) and study design (eg, measured psychosocial constructs). RESULTS: 35 studies were located and were classified within three categories: (1) sport types, (2) sport settings, and (3) individual patterns of sport involvement. These studies represented a wide range of scores when assessed for risk of bias and involved an array of psychosocial constructs, with the most prevalent investigations predicting outcomes such as youth development, self-esteem and depression by comparing (1) team or individual sport participants and (2) youth with varying amounts of sport involvement. SUMMARY/CONCLUSION: As variations in sport activities impact youth sport experiences, it is vital for researchers to carefully describe and study these factors, while practitioners may use the current findings when designing youth sport programmes.