Review of interruptions in a pediatric subspecialty outpatient clinic.

INTRODUCTION: The objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions. METHODS: An observational study was performed at the Children's Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall. RESULTS: There were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate. CONCLUSION: The effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient's agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.

Multimodal MRI assessment for first episode psychosis: A major change in the thalamus and an efficient stratification of a subgroup.

Multi-institutional brain imaging studies have emerged to resolve conflicting results among individual studies. However, adjusting multiple variables at the technical and cohort levels is challenging. Therefore, it is important to explore approaches that provide meaningful results from relatively small samples at institutional levels. We studied 87 first episode psychosis (FEP) patients and 62 healthy subjects by combining supervised integrated factor analysis (SIFA) with a novel pipeline for automated structure-based analysis, an efficient and comprehensive method for dimensional data reduction that our group recently established. We integrated multiple MRI features (volume, DTI indices, resting state fMRI-rsfMRI) in the whole brain of each participant in an unbiased manner. The automated structure-based analysis showed widespread DTI abnormalities in FEP and rs-fMRI differences between FEP and healthy subjects mostly centered in thalamus. The combination of multiple modalities with SIFA was more efficient than the use of single modalities to stratify a subgroup of FEP (individuals with schizophrenia or schizoaffective disorder) that had more robust deficits from the overall FEP group. The information from multiple MRI modalities and analytical methods highlighted the thalamus as significantly abnormal in FEP. This study serves as a proof-of-concept for the potential of this methodology to reveal disease underpins and to stratify populations into more homogeneous sub-groups.

Consensus on the Role of Antibiotic Use in SSI Following Spinal Surgery.

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.

Wearable Technology in Spine Surgery.

Although patient-reported outcome measures (PROMs) provide valuable insight into the effectiveness of spine surgery, there still remain limitations on measuring outcomes in this manner. Among other deficiencies, PROMs do not always correlate with more objective measures of surgery success. Wearable technology, such as pedometers, tri-axis accelerometer, or wearable cameras, may allow physicians to track patient progress following spine surgery more objectively. Recently, there has been an emphasis on using wearable devices to measure physical activity and limb and spine function. Wearable devices could play an important role as a supplement to PROMs, although they might have to be substantiated through adequate controlled studies to identify normative data for patients presenting with common spine disorders. This review will detail the current state of wearable technology applications in spine surgery and its direction as its utilization expands.

Dinámica plantar durante un circuito de habilidades técnicas básicas en fútbol / Foot dynamics during a basic technical skill circuit in football / Dinâmica plantar durante circuito de habilidades técnicas no futebol

Objetivo: Describir el comportamiento de la dinámica plantar durante la ejecución de un circuito de habilidades técnicas específicas del fútbol. Método: Se diseñó un circuito que incluyó habilidades técnicas específicas en el fútbol, se validó y aplicó a 20 jugadores de las selecciones de fútbol de La Universidad de La Sabana, para la medición de la dinámica plantar, se usaron las plantillas electrónicas Open-Go MOTICON. Resultados: La distribución del centro de presión tuvo tendencia hacia anterior y medial en la mayoría de las fases del circuito, el desplazamiento y velocidad del centro de presión fue mayor en el pie derecho con respecto al pie izquierdo en todas las fases, la fuerza de presión ejercida por los pies, fue mayor en el pie izquierdo con respecto al pie derecho. Conclusión: La presión plantar de los participantes tuvo tendencia hacia anterior y medial siendo indicador de la posición en inversión bilateral de los pies, además, la fuerza de presión fue mayor en el pie izquierdo con respecto al pie derecho (p 0.017) durante todas las fases del circuito

Objective: Describe the food dynamics during the execution of a circuit of specific technical skills of soccer. Method: A circuit was validated it included specific technical skills in soccer, it was applied to 20 players of the soccer selections of the University of La Sabana, for the measurement of the plantar dynamics, the electronic templates Open-Go MOTICON were used Results: The distribution of the center of pressure (COP) had a tendency toward anterior and medial in most phases of the circuit, the trace length and velocity of the center of pressure was greater in the right foot with respect to the left foot in all the phases, the pressure force exerted by the feet was greater in the left foot with respect to the right foot. Conclusion: The plantar pressure of the participants had a tendency towards anterior and medial, being an indicator of the position in bilateral inversion of the feet, in addition, the pressure force was greater in the left foot with respect to the right foot (p 0.017) during all phases of the circuit

Objetivo: Descrever a dinâmica plantar durante a execução do circuito de técnicas específicas do futebol. Métodos: Foi validado um circuito que incluiu habilidades técnicas específicas do futebol, que foi aplicado a 20 jogadores de futebol da selecão da Universidade de Sabana afim de medir a dinâmica plantar através do electronic templates Open-Go MOTICON. Resultados: A distribuição do centro de pressão teve uma tendência anterior e medial na maioria das fases do circuito o comprimento de traço e a velocidade do centro de pressão foram maiores no pé direito em relação ao pé esquerdo em todas as fases, a força de pressão exercida pelos pés foi maior no pé esquerdo em relação ao pé direito. Conclusão: A pressão plantar dos participantes tem uma tendência nas direções anterior e medial sendo um indicador da posição na inversão bilateral dos pés, além disso, a força de pressão foi maior no pé esquerdo em relação ao direito (p 0.017) durante todas as fases do circuito