Evaluation of CPS compliance with legally required review of investigations by CAPs.

BACKGROUND: There is significant variability in Child Protective Services (CPS) utilization of medical-forensic experts. In 2016, Missouri legislation (HB 1877) mandated that CPS investigators submit screening forms to a Child Abuse Pediatrician (CAP) to review children < 4 years investigated for abuse. Compliance with this mandate is unknown. OBJECTIVE: To measure compliance with HB 1877, hypothesizing that urban counties would have better compliance than rural counties. PARTICIPANTS AND SETTING: This retrospective study included evaluation of screening forms completed by Missouri CPS and submitted to Missouri CAPs during February, July and September of 2017. METHODS: Compliance was measured in three ways. Compliance Measure 1 (CM1) was the number of screening forms versus the number of eligible CPS investigations. Compliance Measure 2 (CM2) was the average number of days from an abuse report until form submission, and Compliance Measure 3 (CM3) was the percentage of forms with complete information. Urban and rural counties were classified by 2010 census data. t-Tests were used to compare compliance measures between urban and rural counties. RESULTS: Overall compliance with CM1 was 69% with 1496 screening forms submitted and 2170 child maltreatment investigations for children less than 4 years of age. For CM2, mean days from abuse report to form submission was 30 days. For CM3, 60.5% of statewide forms were complete. There was no significant difference between rural and urban county compliance. CONCLUSIONS: Limited compliance with HB 1877 demonstrates the necessity of continued monitoring and improvement for optimal efficacy of legal mandates.

Gender differences in academic surgery, work-life balance, and satisfaction.

BACKGROUND: An increasing number of women are pursuing a career in surgery. Concurrently, the percentage of surgeons in dual-profession partnerships is increasing. We sought to evaluate the gender differences in professional advancement, work-life balance, and satisfaction at a large academic center. MATERIALS AND METHODS: All surgical trainees and faculty at a single academic medical center were surveyed. Collected variables included gender, academic rank, marital status, family size, division of household responsibilities, and career satisfaction. Student t-test, Fisher's exact test, and chi-square test were used to compare results. RESULTS: There were 127 faculty and 116 trainee respondents (>80% response rate). Respondents were mostly male (77% of faculty, 58% of trainees). Women were more likely than men to be married to a professional (90% versus 37%, for faculty; 82% versus 41% for trainees, P < 0.001 for both) who was working full time (P < 0.001) and were less likely to be on tenure track (P = 0.002). Women faculty were more likely to be primarily responsible for childcare planning (P < 0.001), meal planning (P < 0.001), grocery shopping (P < 0.001), and vacation planning (P = 0.003). Gender-neutral responsibilities included financial planning (P = 0.04) and monthly bill payment (P = 0.03). Gender differences in division of household responsibilities were similar in surgical trainees except for childcare planning, which was a shared responsibility. CONCLUSIONS: Women surgeons are more likely to be partnered with a full-time working spouse and to be primarily responsible for managing their households. Additional consideration for improvement in recruitment and retention strategies for surgeons might address barriers to equalizing these gender disparities.

Improving Investigative Site Contact Options on Clinical Trial Registries:: Making It Easier for Patients to Find Clinical Trials.

BACKGROUND: Survey data has suggested a gap between individuals willing to participate in a clinical trial and those who enroll. Clearer research must be done to better understand this discrepancy and the accessibility of patient-desired information, such that steps can be identified to assist sponsors in empowering patients to drive their own clinical trial search journey. METHODS: Patients, sponsors, and health care professionals were engaged through surveys and advisory boards to determine the ideal information for sponsors to provide during a clinical trial search. Public registries were analyzed to assess availability of basic investigator and site contact location information. RESULTS: Data reiterated the need for patients to have easy and unambiguous methods of connecting with the clinical trial site. Analysis of data on registries prove that sponsors have the opportunity to better utilize contact information on databases to enable a patient's clinical trial search journey. CONCLUSIONS: More robust disclosure of site location and contact details on public registries could lay the foundation for a more user-friendly clinical trial search. Allowing sites autonomy in site contact methods while promoting accessibility will facilitate the connection of interested patients with appropriate trial opportunities.

Infectious complications in obese patients after trauma.

BACKGROUND: Obesity is a public health concern in the United States due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under aged 40 y. The purpose of this study is to determine the association between obesity and specific infectious complications after traumatic injury. MATERIALS AND METHODS: A retrospective analysis was conducted using data from the 2012 National Trauma Data Bank. The National Trauma Data Bank defined obesity as having a body mass index of 30 or greater. Descriptive statistics were calculated and stratified by obesity status. A hierarchical regression model was used to determine the odds of experiencing an infectious complication in patients with obesity while controlling for age, gender, diabetes, number of comorbidities, injury severity, injury mechanism, head injury, and surgical procedure. RESULTS: Patients with a body mass index of 30 or greater compared with nonobese patients had increased odds of having an infectious complication (Odds Ratio, 1.59; 1.49-1.69). In addition to obesity, injury severity score greater than 29, age 40 y or older, diabetes, comorbid conditions, and having a surgical procedure were also predictive of an infectious complication. CONCLUSIONS: Our results indicate that trauma patients with obesity are nearly 60% more likely to develop an infectious complication in the hospital. Infection prevention and control measures should be implemented soon after hospital arrival for patients with obesity, particularly those with operative trauma.

The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads.

BACKGROUND: Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay. OBJECTIVE: We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants. METHODS: Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization). RESULTS: Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47). CONCLUSION: Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.

Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure.

BACKGROUND AND PURPOSE: We examined blood pressure 1 year after stroke discharge and its association with treatment intensification. METHODS: We examined the systolic blood pressure (SBP) stratified by discharge SBP (≤140, 141-160, or >160 mm Hg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP >160 mm Hg or repeated SBPs >140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range, 0%-100%, where 100% indicates that each elevated SBP always resulted in medication change). RESULTS: Among 3153 patients with ischemic stroke, 38% had ≥1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP ≤140 mm Hg, and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty-seven percent of patients discharged with SBP 141 to160 mm Hg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty-three percent of the patients discharged with an SBP >160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits. CONCLUSIONS: Patients with discharge SBP >160 mm Hg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on initiation and review of antihypertensives before acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.

Concurrent validity of the TIMP and the Bayley III scales at 6 weeks corrected age.

PURPOSE: Examine agreement between the Test of Infant Motor Performance (TIMP) and the Bayley III. METHODS: One hundred forty-five infants born at 29 to 34 weeks gestation with socioenvironmental risk factors were tested on the TIMP and Bayley III at 6 weeks corrected age (CA). Scores were correlated to assess convergence/divergence of content. Decision analysis using a cutoff of the mean on the Bayley Motor Composite and -0.5 and -1 SD from the mean on the TIMP assessed agreement on delay/nondelay. RESULTS: The TIMP-Bayley Motor Composite correlation was 0.546, with Cognitive was 0.310, and with Language was 0.281. Nine percent of infants scored less than -1.0 SD on the TIMP, while no child scored less than -1 SD on the Bayley Motor scale (sensitivity, 31%). CONCLUSIONS: Convergent validity between the TIMP and the Bayley Motor scale was demonstrated, but no infant showed delay on any Bayley scale. The TIMP is preferred for early assessment of infants.