ABSTRACT
Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever, tachycardia, tachypnea, and/or leukocytosis. We hypothesize this diagnostic modality is low-yield in the postoperative period when surgery-related sequelae are more probable. Methods This is a single-center retrospective cohort study of patients who underwent trauma laparotomy and had subsequent CT for CD from March 19, 2019 to June 30, 2022. Descriptive statistics and multiple logistic regression were performed. The primary outcome was saddle and lobar PE incidence. Results 1032 adult patients underwent trauma laparotomy with 434 undergoing CT for CD: 137 CT abdomen and pelvis only, 30 CTPE, 265 both. The majority (80.2 %) was male, age 33[interquartile range (IQR) 24-45], suffered penetrating mechanism (57 %), and had ISS 23[IQR16-30]. Injuries at laparotomy included 47 % solid organ, 62 % GI tract, 7 % biliary, 11 % vascular, and 42 % other. 176 (41 %) required damage control laparotomy. Median time to CT post-laparotomy was 174 h [111-235] with saddle and lobar PE in 3 (1 %), peripheral PE 18 (5 %), and abdominal abscess, leak, fluid, or pseudoaneurysm in 222 (51 %). Clinical management was altered (40 %) by antibiotics, therapeutic anticoagulation, drainage, aspiration, filter, thrombectomy, or surgical operation. Patients for whom CT findings changed management were more likely to have had GI tract surgery (69% vs 57 %, p = 0.021), higher white blood cell (WBC) (16.4 [13.1-20.5] vs 15.1 [9.9-19.5], p = 0.002), more hours between CT and laparotomy (184 [141-245] vs 162 [89-230], p = 0.002), and lower mortality (2% vs 8 %, p = 0.008). In-hospital mortality was 5 %; none were PE-related. Predictors of clinical intervention required based on CT imaging were GI tract injury (AOR: 1.65, p = 0.0182), and elevated WBC (AOR: 1.038, p = 0.010 Conclusion Saddle and lobar PE incidence post-trauma laparotomy is low. SIRS-type symptoms prompting postoperative CT commonly have no procedural or antibiotic requirement. Postoperative decompensation is more likely related post-operative complications, and less likely a PE.
Subject(s)
Laparotomy , Pulmonary Embolism , Tomography, X-Ray Computed , Humans , Male , Pulmonary Embolism/etiology , Pulmonary Embolism/diagnostic imaging , Female , Retrospective Studies , Adult , Middle Aged , Postoperative Complications , Abdominal Injuries/complications , Abdominal Injuries/surgery , Abdominal Injuries/diagnostic imaging , Incidence , Tachycardia/etiologyABSTRACT
The search for alternatives to live animal sentinels in rodent health monitoring programs is fundamental to the 3Rs (Reduction, Replacement, and Refinement) of animal research. We evaluated the efficacy of a novel battery-operated tumbler device that rotates soiled bedding in direct contact with sample media against the use of exhaust sample media and soiled bedding sentinel (SBS) mice. Four rodent racks were used, each with 3 test cages: a cage with a tumbler device that rotated for 10min twice a week (TUM10), a cage with a tumbler device that rotated for 60min twice a week (TUM60), and a cage housing 2 female Crl:CD1(ICR) mice. Every 2 wk, each test cage received soiled bedding collected from all cages on each respective rack. In addition to soiled bedding, the tumbler device contained various sample collection media: a contact Reemay filter (3mo-cRF) that remained in the tumbler for the duration of the study, a contact Reemay filter (1mo-cRF) that was replaced monthly, adhesive swabs (AS) that were added at every biweekly cage change, and an exhaust Reemay filter located at the exhaust outlet of the cage. All analyses were performed by direct PCR for both sample media in the animal-free methods, and fecal pellet, body swab, and oral swabs were collected from sentinel mice. Out of 16 total pathogens detected, assessment of 1mo-Crf from both TUM10 and TUM60 cages detected 84% and 79% of pathogens, respectively, while SBS samples detected only 47% of pathogens. AS in TUM60 and TUM10 cages detected the fewest pathogens (24% and 13%, respectively). These results indicate that the novel tumbler device is an effective and reliable tool for rodent health monitoring programs and a suitable replacement for live animal sentinels. In this study, 1mo-cRF in TUM10 cages detected the highest number of pathogens.
Subject(s)
Housing, Animal , Animals , Mice , Female , Mice, Inbred ICR , Rodent Diseases/diagnosis , Electric Power Supplies , Sentinel Surveillance/veterinaryABSTRACT
OBJECTIVE: Ankylosing Spondylitis (AS) is a chronic inflammatory condition that affects the axial skeleton. Recent studies have shown that mortality risk is higher in AS patients and that it is possibly related to disease activity and duration. Our aim was to investigate the leading causes and factors associated with mortality in hospitalized AS patients in the USA. METHODS: This is a case-control study using the Cerner Health Facts® database between 2015 and 2017. The search was done using ICD codes and administrative claims. Cases were hospitalized AS patients who died during that hospitalization, while controls were patients who survived. In addition to demographics, we collected data on the inpatient use of medications such as NSAIDs, as well as different comorbidities and systemic disease manifestations. The discharge diagnoses for deceased patients were collected to infer causes of mortality. Analysis of association was performed using chi-square tests, t-tests, Wilcoxon rank-sum tests, and logistic regression methods. RESULTS: The leading causes of death were cardiovascular, infectious, respiratory, and traumatic. The Elixhauser comorbidity index was the factor most associated with mortality (p-value < 0.0001), with congestive heart failure and renal disease the most contributing. Drug use disorder was associated with mortality (adjusted OR = 10.9; p = 0.001). Inpatient NSAIDs use was not associated with increased odds for mortality (p-value 0.33). CONCLUSION: Cardiovascular and renal comorbidities are associated with mortality and need to be targeted early on to lower the odds of mortality as patients age. Strategies to prevent opioid and drug abuse should be strengthened in the AS population. Key Points ⢠Cardiovascular and renal comorbidities are associated with mortality and need to be screened for and targeted early on to lower the odds of mortality as patients age. ⢠Drug use disorder including opioid dependence is associated with mortality, and strategies to prevent opioid and drug abuse should be strengthened in the AS population.
Subject(s)
Opioid-Related Disorders , Spondylitis, Ankylosing , Humans , Spondylitis, Ankylosing/epidemiology , Spondylitis, Ankylosing/drug therapy , Case-Control Studies , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic useABSTRACT
BACKGROUND: Early neurologic deterioration (END) following ischemic stroke is a serious event and is associated with poor outcomes. However, the incidence and predictors of END after stroke thrombectomy for emergent large vessel occlusion are largely unknown. METHODS: The baseline characteristics of patients enrolled in the COMPASS trial (NCT02466893) were analyzed. The primary outcome was worsening of ≥4 National Institutes of Health Stroke Scale (NIHSS) points 24 hours post thrombectomy (4+ END24) and the secondary outcome was deterioration of ≥2 points (2+ END24). RESULTS: Among 270 patients, 27 (10%) developed 4+ END24 and 42 (16%) had 2+ END24. Those with 4+ END24 were older (76.4±12.9 vs 70.9±12.9 years; p=0.04), had a higher prevalence of hypertension (96% vs 69%; p=0.003), diabetes (41% vs 27%; p=0.13) and higher pretreatment systolic blood pressure (SBP) (170.4±32.6 vs 157.6±28.1 mmHg; p=0.03). More 4+ END24 patients had failed reperfusion: Thrombolysis in Cerebral Infarction ≤2a (26% vs 8%; p=0.003). In unadjusted analysis, older patients and those with hypertension, diabetes, elevated SBP and failed reperfusion had higher odds of 4+ END24. In adjusted analysis, age increase by 5 years led to an increase in 4+ END24 of 28%, diabetes increased odds of 2.6 and failed reperfusion increased odds of 4.5. In the multivariable analysis for the secondary outcome, age (OR 1.33; 95% CI 1.109 to 1.593), diabetes (OR 2.7; 95% CI 1.247 to 5.764) and failed reperfusion (OR 7.2; 95% CI 0.055 to 0.349) were also significant predictors of 2+ END24. CONCLUSIONS: Older patients with acute ischemic stroke who have a history of diabetes or hypertension, with elevated pretreatment SBP and failed reperfusion are at a higher risk of END following stroke thrombectomy for emergent large vessel occlusion.
Subject(s)
Brain Ischemia , Endovascular Procedures , Hypertension , Ischemic Stroke , Stroke , Humans , Child, Preschool , Ischemic Stroke/complications , Treatment Outcome , Retrospective Studies , Stroke/surgery , Stroke/complications , Thrombectomy/adverse effects , Brain Ischemia/surgery , Brain Ischemia/complicationsABSTRACT
BACKGROUND: Community collaboration is a founding principle of the Early Success Coalition (ESC), a collaborative of over 74 agencies, engaging over 200 participants. The ESC aims to develop a comprehensive neighborhood young-child-wellness system model to better foster cognitive, physical, and social-emotional development of young children. The Wilder Collaborative Factors Inventory (WCFI) was used, as part of a participatory mixed-methods evaluation, to collect annual measures of collaboration. OBJECTIVE: To reflect on lessons learned, resulting from 4 years of ESC WCFI data. METHODS: ESC members completed the WCFI standardized survey tool, encompassing 40 questions grouped into 20 factors associated with successful collaboration, annually. LESSONS LEARNED: Community collaborations are naturally slow to establish, with funding/staffing concerns standing out as primary fears within the membership. CONCLUSIONS: Participation in the ESC provided leadership, structure, and concrete goals, which bolstered local collaborative efforts. Overall, the WCFI is proposed as an insightful tool for evaluating community collaboratives.
Subject(s)
Community-Based Participatory Research , Leadership , Child, Preschool , Community-Based Participatory Research/methods , Humans , Residence Characteristics , Surveys and QuestionnairesABSTRACT
Kidney transplants (KT) from hepatitis C (HCV) viremic donors to HCV negative recipients has shown promising renal outcomes, however, high incidence of cytomegalovirus (CMV) viremia were reported. We performed a prospective cohort study of 52 HCV negative KT recipients from Methodist University Hospital including 41 receiving transplants from HCV aviremic donors and 11 from HCV viremic donors. CMV specific CD4+ and CD8 + T cell immunity was measured by intracellular flow cytometry assay. Primary outcome was the development of positive CMV specific CD4+ and CD8 + T cell immune response in the entire cohort and each subgroup. The association between donor HCV status and CMV specific CD4+ and CD8 + T cell immune response was analyzed by Cox proportional hazard models. Mean recipient age was 48 ± 13 years, with 73% male and 82% African American. Positive CMV specific CD4+ and CD8 + T cell immune response was found in 53% and 47% of the cohort at 1 month, 65% and 70% at 2 months, 80% and 75% at 4 months, 89% and 87% at 6 months, and 94% and 94% at 9 months post-transplant, respectively. There was no significant difference in the incidence of positive CMV specific T cell immune response between recipients of transplants from HCV aviremic donors compared to HCV viremic donors in unadjusted (for CD8+: HR = 1.169, 95%CI: 0.521-2.623; for CD4+: HR = 1.208, 95%CI: 0.543-2.689) and adjusted (for CD8+: HR = 1.072, 95%CI: 0.458-2.507; for CD4+: HR = 1.210, 95%CI: 0.526-2.784) Cox regression analyses. HCV viremia in donors was not associated with impaired development of CMV specific T cell immunity in this cohort.
Subject(s)
Cytomegalovirus Infections , Hepatitis C , Kidney Transplantation , Adult , Antiviral Agents , Cytomegalovirus Infections/epidemiology , Female , Hepacivirus , Humans , Immunity , Kidney Transplantation/adverse effects , Male , Middle Aged , Prospective Studies , T-Lymphocytes , Tissue Donors , Transplant Recipients , ViremiaABSTRACT
Cancer survivors who have undergone hematopoietic cell transplantation (HCT) are at risk for myocardial dysfunction. Children who receive allogenic HCT encounter systemic inflammation resulting in tachycardia and hypertension. The effect of these abnormalities on myocardial function is not known. The aim of this study was to determine whether cardiac dysfunction early after HCT can be predicted by tachycardia or hypertension, within a retrospective single-center sample of pediatric HCT recipients. Early tachycardia or hypertension was defined as a majority of values taken from infusion date to 90 days post-infusion being abnormal. Ejection fraction <53% determined systolic dysfunction. A composite score of accepted pediatric diastolic abnormalities determined diastolic dysfunction. Among 80 subjects (median age 8 years), early tachycardia, systolic dysfunction, and diastolic dysfunction were present in 64%, 25%, and 48% of the sample, respectively. In multivariable models, early tachycardia was an independent predictor of early systolic dysfunction (OR = 12.6 [1.4-112.8], p = 0.024) and diastolic dysfunction (OR = 3.9 [1.3-11.5], p = 0.013). Tachycardia and cardiac dysfunction are common and associated with one another in the early period after pediatric HCT. Future studies may elucidate the role of tachycardia and myocardial dysfunction early after HCT as important predictors of future cardiovascular dysfunction.
Subject(s)
Cardiomyopathies , Hematopoietic Stem Cell Transplantation , Child , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Retrospective Studies , Tachycardia/etiology , Transplant RecipientsABSTRACT
BACKGROUND: The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. PURPOSE: To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. METHODS: We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. RESULTS: MRI-PDFF values showed a strong positive correlation (Pearson's correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57-0.89, p<0.0001). The correlation appeared much stronger when macro plus micro-steatosis were included (r = 0.87, 95% confidence interval 0.72-0.94, p<0.0001). EAD was noted in 7(25%) subjects. AUC (Area Under the Curve) for macro steatosis (histology) predicted EAD in 73% (95% CI: 48-99), micro plus macro steatosis in 76% (95% CI: 49-100). AUC for PDFF values predicted EAD in 67(35-98). Comparison of the ROC curves in a multivariate model revealed, adding MRI PDFF values to macro steatosis increased the ability of the model in predicting EAD (AUC: 79%, 95% CI: 59-99), and addition of macro plus micro steatosis based on histology predicted EAD even better (AUC: 90%: 79-100, P = 0.054). CONCLUSION: In this pilot study, MRI-PDFF imaging showed potential utility in quantifying hepatic steatosis ex-vivo donor liver evaluation and the ability to predict EAD related to severe allograft steatosis in the recipient.
Subject(s)
Liver/diagnostic imaging , Magnetic Resonance Imaging , Non-alcoholic Fatty Liver Disease/pathology , Aged , Area Under Curve , Bilirubin/analysis , Biomarkers/metabolism , Female , Humans , International Normalized Ratio , Liver/pathology , Liver Transplantation , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Pilot Projects , ROC Curve , Transaminases/metabolism , Transplantation, HomologousABSTRACT
AIMS: Elder abuse, defined as emotional, physical, or sexual abuse, financial exploitation, or neglect, is a growing problem. Dental professionals have the unique opportunity to identify elder abuse. However, elder abuse awareness training, targeting dental students, is insufficient and research is limited. This knowledge gap prompted the research team at the University of Tennessee Health Science Center (UTHSC) to develop, implement, and evaluate an online Elder Abuse Awareness Professional Education Training (EAAPET) program, designed to educate dental and other health professionals to recognize, respond to, and report elder abuse. METHODS AND RESULTS: Ninety-six dental students, attending the UTHSC College of Dentistry during the fall semester of 2018, were enrolled. Pre- and post-assessments, designed to assess changes in students' perceived and actual knowledge, were conducted. Paired sample t-test results indicate that the EAAPET program significantly improved students' perception of their abilities to identify, respond to, and report elder abuse. Improvement was also demonstrated within students' actual knowledge of how to appropriately interact with suspected elder abuse victims. Qualitative assessment suggested the training was well received by the students. CONCLUSIONS: Based on these findings, the authors recommend that dental schools integrate elder abuse awareness education into their curriculums.
Subject(s)
Elder Abuse , Students, Dental , Aged , Curriculum , Health Personnel , Humans , Schools, DentalABSTRACT
OBJECTIVE: Shunt-related adverse events are frequent in infants after modified Blalock-Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock-Taussig. METHODS: In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock-Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose. RESULTS: There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2-23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3-71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7-10), p=0.16] was not associated with decrease in these events. CONCLUSIONS: High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock-Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock-Taussig.
Subject(s)
Aspirin/administration & dosage , Blalock-Taussig Procedure/adverse effects , Heart Defects, Congenital/surgery , Postoperative Care/methods , Postoperative Complications/prevention & control , Thrombosis/prevention & control , Administration, Oral , Computed Tomography Angiography , Dose-Response Relationship, Drug , Echocardiography, Doppler , Female , Follow-Up Studies , Humans , Infant , Male , Platelet Aggregation Inhibitors/administration & dosage , Postoperative Complications/diagnosis , Prognosis , Retrospective Studies , Thrombosis/diagnosisABSTRACT
Although significant progress has been made in improving breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. The goal of this investigation is to quantify racial disparities in the context of breast cancer care, examining the outcomes of recurrence and mortality in the city of Memphis. Patients with a biopsy-proven diagnosis of breast cancer from January 1, 2002, through December 31, 2012, were obtained from the tumor registry. Black patients were more likely to have advanced (II, III, or IV) clinical stage of breast cancer at diagnosis versus white patients. Black breast cancer patients had a two times higher odds of recurrence (95% confidence interval: 1.4, 3.0) after adjusting for race and clinical stage. Black breast cancer patients were 1.5 times more likely to die (95% confidence interval: 1.2, 1.8), after adjusting for race; age at diagnosis; clinical stage; ER, PR, HER2 status; and recurrence. Black women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery than white women. Black patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus white patients on a citywide level in Memphis. Black breast cancer patients have higher odds of recurrence and mortality when compared with white breast cancer patients, after adjusting for appropriate demographic and clinical attributes. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.
Subject(s)
Black or African American , Breast Neoplasms/ethnology , Health Status Disparities , Healthcare Disparities/ethnology , White People , Adolescent , Adult , Aged , Aged, 80 and over , Breast Carcinoma In Situ/diagnosis , Breast Carcinoma In Situ/ethnology , Breast Carcinoma In Situ/mortality , Breast Carcinoma In Situ/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/ethnology , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/surgery , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Carcinoma, Intraductal, Noninfiltrating/ethnology , Carcinoma, Intraductal, Noninfiltrating/mortality , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Lobular/diagnosis , Carcinoma, Lobular/ethnology , Carcinoma, Lobular/mortality , Carcinoma, Lobular/surgery , Female , Follow-Up Studies , Health Services Accessibility , Humans , Logistic Models , Middle Aged , Neoplasm Recurrence, Local/ethnology , Neoplasm Recurrence, Local/mortality , Registries , Retrospective Studies , Tennessee , Young AdultABSTRACT
BACKGROUND: Intussusception is uncommon in children older than 3 years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted. METHODS: The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014. Patients were followed for 6 months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures. RESULTS: A total of 7,412 patients were identified: 6,681 were <3 years old, 731 patients were >3 years old. In those >3 years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3 years old and patients >3 years old (5% vs 6%, P = .07). The rate of a Meckel's diagnosis was greater in patients >3 years old (2% vs 14%, P < .0001). In patients >3 years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4 days vs 4 days, P = .06). Older age was not associated with increased risk of recurrent admission for intussusception (P = .45). CONCLUSION: Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3 years.
Subject(s)
Digestive System Surgical Procedures/methods , Enema/methods , Ileal Diseases/therapy , Intussusception/therapy , Age Factors , Analysis of Variance , Child , Child, Preschool , Cohort Studies , Confidence Intervals , Databases, Factual , Follow-Up Studies , Health Information Systems , Humans , Ileal Diseases/diagnosis , Infant , Intussusception/diagnosis , Pediatrics , Recurrence , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: The Southern United States has low breastfeeding rates, particularly among African Americans. Breastfeeding rates are influenced by community attitudes and norms. OBJECTIVE: This study aimed to examine changes in breastfeeding attitudes and demographic factors related to these attitudes. METHODS: Cross-sectional data from a community-based survey, repeated annually from 2004 to 2008, were analyzed. Univariable analysis examined trends over time and log binomial regression estimated the strength of the association between year of the survey, demographic factors, and outcome responses related to the survey questions. RESULTS: After adjusting for sex, race, marital status, age, and education, compared to 2004, 2008 respondents were 26% more likely to rate breastfeeding as extremely important compared to formula feeding (prevalence ratio [PR] = 1.26; 95% confidence interval [CI], 1.10-1.43). Similarly, 2008 respondents were 29% more likely to rate the importance of breastfeeding for long-term health as extremely important (PR = 1.29; 95% CI, 1.14-1.46). Comfort levels with breastfeeding outside the home also increased. Respondents to the 2008 survey were more likely to report that they were comfortable with a mother breastfeeding in their workplace (PR = 1.20; 95% CI, 1.11-1.31) and in a mall or restaurant (PR = 1.15; 95% CI, 1.06-1.26). After controlling for demographic factors, there were no significant differences in responses between African Americans and other races. CONCLUSION: Despite significantly lower breastfeeding rates among African Americans, this analysis revealed significant positive changes in attitudes regarding breastfeeding between 2004 and 2008, regardless of race. These changes in attitude coincided with increased breastfeeding initiation rates, suggesting that federal, state, and local breastfeeding promotion efforts had an effect.
Subject(s)
Black or African American/psychology , Breast Feeding/psychology , Health Knowledge, Attitudes, Practice/ethnology , Urban Health/ethnology , Adult , Breast Feeding/ethnology , Breast Feeding/trends , Cross-Sectional Studies , Female , Humans , Male , Multivariate Analysis , Tennessee , Urban Health/trendsABSTRACT
This study measured intimate partner violence (IPV) curriculum content exposure; knowledge, attitudes, beliefs, and self-reported behaviors; and IPV prevalence within doctor of nursing practice and doctor of philosophy nursing programs at a university in the southern United States. The survey instrument was an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey modified with language that focused on students in the health care arena. Three summary scales-Perceived Preparedness, Perceived Knowledge, and Actual Knowledge-were also created. Mann-Whitney U tests and exploratory multivariable and logistic regression analyses were employed to analyze the data. Results indicated that nursing students who received IPV training prior to graduate school had significantly higher perceived preparation and perceived knowledge ratings than those reporting no IPV training prior to graduate school. Results also showed that 40% of nursing students surveyed had personally experienced some type of domestic violence including IPV. Identifying and responding to curricular shortcomings and ascertaining student IPV prevalence are critical steps in strategizing and implementing comprehensive curriculum revision, enabling students to enter the nursing profession with the capacity to directly impact the care and treatment of IPV victims.
Subject(s)
Curriculum , Domestic Violence , Sexual Partners , Students, Nursing , Adult , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: To date, work-hour restrictions have not been imposed on attending surgeons in the United States. The purpose of this study was to investigate the impact of working an overnight trauma shift on outcomes of general surgery operations performed the next day by the post-call attending physician. STUDY DESIGN: Consecutive patients over a 3.5-year period undergoing elective general surgical procedures were reviewed. Procedures were limited to hernia repairs (inguinal and ventral), cholecystectomies, and intestinal operations. Any operations that were performed the day after the attending surgeon had taken an overnight trauma shift were considered post-call (PC) cases; all other cases were considered nonpost-call (NP). Outcomes from the PC operations were compared with those from the NP operations. RESULTS: There were 869 patients identified; 132 operations were performed PC and 737 were NP. The majority of operations included hernia repairs (46%), followed by cholecystectomies (35%), and intestinal procedures (19%). Overall, the PC operations did not differ from the NP operations with respect to complication rate (13.7% vs 13.5%, p = 0.93) or readmission within 30 days (5% vs 6%, p = 0.84). Additionally, multivariable logistic regression failed to identify an association between PC operations and the development of adverse outcomes. Follow-up was obtained for an average of 3 months. CONCLUSIONS: Performance of general surgery operations the day after an overnight in-hospital trauma shift did not affect complication rates or readmission rates. At this time, there is no compelling evidence to mandate work-hour restrictions for attending general surgeons.
Subject(s)
Medical Staff, Hospital , Personnel Staffing and Scheduling , Surgical Procedures, Operative , Adult , Female , Humans , Male , Treatment Outcome , Wounds and Injuries/surgeryABSTRACT
BACKGROUND: Complementary and Alternative Medicine (CAM) use is on the rise in both the US and Europe, despite questions about its safety and effectiveness, and lack of national standards. We aimed to determine the prevalence and predictors of CAM and integrative medicine use (CAM-I) and perceived effectiveness compared to the standard treatment of botulinum toxin injections in patients with adult-onset primary dystonia. METHODS: This was a retrospective questionnaire study of 389 dystonia patients examining the effects age, gender, education level and number of affected anatomical regions on botulinum toxin and CAM-I use and their perceived effectiveness. RESULTS: 53% (208) of patients reported CAM-I use, while 90% (349) used the standard treatment (botulinum toxin), and 48% used both. Education was the only significant predictor of CAM-I use - individuals with bachelor's degrees were more likely to try CAM-I whereas those with high school diplomas were less likely. The mean effectiveness rate for botulinum toxin injections (59%) significantly exceeded that for CAM-I (28%, p < 0.0001). CONCLUSIONS: Our work highlights the need for scientifically sound studies to determine the safety, effectiveness and expense of CAM-I treatments for dystonia and other neurological disorders given that CAM-I use is steadily increasing, there is great variability in what is classified as CAM-I, and the effectiveness of some modalities may be significantly less than conventional medical treatments.
Subject(s)
Complementary Therapies/methods , Dystonic Disorders/epidemiology , Dystonic Disorders/therapy , Integrative Medicine/methods , Patient Satisfaction , Aged , Complementary Therapies/trends , Dystonic Disorders/diagnosis , Female , Humans , Integrative Medicine/trends , Male , Middle Aged , Predictive Value of Tests , Prevalence , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVES: Previous studies examined the prevalence and efficacy of intimate partner violence (IPV) education in medical school. We documented IPV content exposure shortage in medical school curriculum at a southern university health science center and measured personal IPV experience among medical students. METHODS: Responses were gathered from a 67-item survey adapted from the Physician Readiness to Manage Intimate Partner Violence Survey. Our survey measured IPV knowledge and attitudes, along with sufficiency of IPV education that students received before and during medical school. Three summary scales were created to examine students' perceived preparedness to deal with IPV survivors and their perceived and actual knowledge about IPV. RESULTS: Across summary scales, differences were higher but not significant between medical students who received IPV education either before or during medical school and those with no IPV education. Of all of the medical students surveyed, 28.7% (n = 33) had experienced some type of domestic violence including IPV. Gaps in knowledge also were identified. CONCLUSIONS: Student IPV experience (whether directly by way of personal exposure to IPV or indirectly through family members or acquaintances who were victims of IPV) can be applicable in classrooms, clinics, and students' careers, but it may not necessarily increase perceived or actual IPV knowledge; however, our results show that any IPV education that students receive can be effective in increasing confidence and perceived preparedness to address IPV with patients. Comprehensive approaches to teaching IPV should be integrated fully into medical school curricula.
Subject(s)
Curriculum/standards , Education, Medical/standards , Spouse Abuse , Demography , Health Knowledge, Attitudes, Practice , United StatesABSTRACT
Our study documents the shortage of intimate partner violence (IPV) content exposure within one dental school curriculum, with an eye toward utilizing this information to revise an existing comprehensive family violence curriculum that will be fully integrated into required university coursework to improve competence and help overcome knowledge gaps. IPV is defined by the Centers for Disease Control and Prevention as physical and sexual violence, threats of physical and sexual violence, or psychological/emotional abuse including coercive tactics that adults or adolescents use against current or former intimate partners. We report on the results of a four-part (background, IPV knowledge, opinions, and personal experience), sixty-seven-item validated survey instrument used to measure knowledge, attitudes, beliefs, and self-reported behaviors among dental students preparing to become health care professionals working in the field. Survey responses from the nearly 80 percent of fourth-year dental students who completed the survey were examined within the context of students' actual IPV knowledge, as well as opinions and attitudes that could directly or indirectly influence patients. Our findings indicate that a sizeable number of students received no IPV training prior to or during dental school, leading to perceptions that they lack knowledge about IPV and are not well prepared to address IPV with patients. A notable percentage of students (20 percent) also reported personal experience with IPV.
Subject(s)
Curriculum , Education, Dental , Health Knowledge, Attitudes, Practice , Spouse Abuse/psychology , Students, Dental , Adult , Clinical Competence , Female , Humans , Male , Self-Assessment , Sexual Partners/psychology , Spouse Abuse/statistics & numerical data , Students, Dental/psychology , Students, Dental/statistics & numerical data , Surveys and Questionnaires , TennesseeABSTRACT
BACKGROUND: Children in developing country suffer the highest burden of pneumonia. However, few studies have evaluated associations between poverty and pneumonia. METHODS: A prospective population-based study on pneumonia was carried out as part of the Latin America Epidemiological Assessment of Pneumococcus (LEAP study). Chest x-rays were obtained for children one to 35 months old with suspected pneumonia presenting to emergency care centers and hospital emergency rooms in Goiania, Brazil. Chest radiographs were evaluated according to WHO guidelines. Clustering of radiologically-confirmed pneumonia were evaluated using a Poisson-based spatial scan statistic. Associations between census socioeconomic indicators and pneumonia incidence rates were analyzed using generalized linear models. RESULTS: From May, 2007 to May, 2009, chest radiographs were obtained from 11 521 children with clinical pneumonia; 3955 episodes were classified as radiologically-confirmed. Incidence rates were significantly higher in very low income areas (4825.2 per 105) compared to high income areas (1637.3 per 105). Spatial analysis identified clustering of confirmed pneumonia in Western (RR 1.78; p=0.001) and Southeast (RR 1.46; p=0.001) regions of the city, and clustering of hospitalized pneumonia in the Western region (RR 1.69; p=0.001). Lower income households and illiteracy were associated with pneumonia incidence. CONCLUSIONS: In infants the risk of developing pneumonia is inversely associated with the head of household income and with the woman educational level. Areas with deprived socioeconomic conditions had higher incidence of pneumonia and should be targeted for high vaccination coverage.