Differences In Average Scores Research Articles

Do Patients With Chronic Diabetes Have Worse Motor Outcomes After Cervical ASIA C Traumatic Spinal Cord Injury?

This was a level IV retrospective prognostic study. The objective of this study was to determine if patients with chronic diabetes have worse functional outcomes and motor recovery after cervical traumatic spinal cord injury (TSCI). Diabetes mellitus has multiple deleterious neurological effects and has been shown to worsen elective cervical spine surgery outcomes. Prior literature has scarcely characterized the impact of chronic diabetes on motor and functional outcomes after TSCI. The National Spinal Cord Injury Statistical Center (NSCISC) database was utilized to retrospectively collect data on cervical American Spinal Injury Association (ASIA) C TSCI between 2011 and 2016. Patients were divided into diabetes and nondiabetes groups. Primary outcomes included wheelchair requirement and ambulatory status 1 year after injury. Secondary outcomes were motor score collected at the time of rehab admission, rehab discharge, and 1-year follow-up. All outcome variables were analyzed using univariate and multivariate regression to assess for differences between diabetes and nondiabetes groups and possible confounders. A total of 219 patients met the inclusion criteria for the study: 193 without diabetes and 26 with diabetes (12.0%). After controlling for confounders, patients with diabetes had had significantly increased wheelchair requirement (83.3% vs. 51.8%, relative risk=1.63, 95% confidence interval: 1.20-1.83, P =0.009 multivariate) and decreased ambulatory rates (50% vs. 67.9%, relative risk=0.55, 95% confidence interval: 0.25-0.98, P =0.042 multivariate) at 1 year. They also had no difference in average total motor scores at rehab admission but significantly worse total motor scores at rehab discharge (50.6±23.3 vs. 60.3±21.4, P =0.033 univariate, P =0.002 multivariate). Patients with diabetes have increased wheelchair requirement and decreased ambulatory ability at 1 year after the injury as well as diminished recovery in motor scores after motor-incomplete cervical TSCI. These patients may be targets for aggressive diabetic screening and intervention to minimize negative outcomes.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study

BackgroundProperly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies.ObjectiveTo investigate dental students’ learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method.MethodsA crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively.ResultsThere was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions.ConclusionHealth professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment.Trial registrationNCT04692142, 31/12/2020.

University Education Management Model Based on Artificial Intelligence Programming and Analysis Technology Foundation for Building Models and Applications

The reform and development of university education management are operating according to their own laws with the changes of the internal environment of education and the social external environment such as politics, economy, science and technology, and culture. As a branch of the mechanism of university education management, the operation mechanism of university education management supports the reform and development of university education management. This article studies the construction of a university education management model based on an intelligent programming analysis method. The research shows that the average score of the control class before the experiment is 63.7748 and the average score of the experimental class is 63.8954. It can be seen that the average score difference between the two classes is only 0.1206. Understand the performance changes of various dynamic forces by gradually contacting complex structures. Through building + intelligent programming, we can preliminarily understand programming and increase children’s interest in programming; strengthen programming ability; learn various complex structures; and lay a good foundation for later intelligent programming. This article studies the intelligent programming education of university education management and solves the problems existing in University Programming Education by formulating relevant policies, changing teaching methods and using after-school time, so as to optimize the teaching effect.

Dietary Restraint Constructs Are Associated With Diet Quality and Nutrient Intake

ObjectivesTo examine and compare reported food and nutrient intake in men and women who differ in cognitive restraint (CR) and disinhibition (D) scores. We hypothesize that average intake of sodium, total sugar, saturated fat, and Healthy Eating Index (HEI) scores of diet quality will differ between low and high D groups. Methods330 adults from a cross-sectional study who completed 3 dietary recalls and the three-factor eating questionnaire (TFEQ) were included in this analysis. Participants were classified into 4 groups based on TFEQ scores for CR and D: high CR + high D (CRD, n = 46); high CR + low D (CR, n = 104); low CR + high D (D, n = 42); and low CR + low D (LL, n = 138). The Automated Self-Administered 24-hour (ASA24) tool was used to obtain dietary recalls on 2 weekdays and 1 weekend day. Nutrient intakes were averaged for the 3 recalls, and HEI scores were calculated using the HEI-2015 scoring standards. Differences in average calories, sodium, total sugar, saturated fat, and HEI scores between groups were analyzed using analysis of covariance with age, sex, and BMI as covariates. ResultsThere were differences in average sodium and saturated fat intake, with CR group reporting lower sodium intake (p = 0.041) and lower saturated fat (p = 0.007) intake compared to the LL group only. There were no differences in calorie or total sugar intake between groups. Interestingly, added sugar intake based on HEI-2015 scoring showed group differences, with CR reporting lower added sugar intake than LL group (p = 0.042). HEI subscore for refined grain intake was also higher in LL group compared to CR (p = 0.002) and CRD (p = 0.023). Total HEI score was lower in LL (59.5 ± 1.0) compared to CR (65.1 ± 1.15, p = 0.002) and CRD (65.6 ± 1.75, p = 0.017). ConclusionsHigh cognitive restraint was associated with a more “healthful” diet with lower sodium and saturated fat intakes compared to groups with low restraint. While there were no associations between total sugar intake and cognitive restraint, reduced consumption of added sugar and refined grains were reported by the cognitively restrained participants, regardless of disinhibition status. Contrary to our hypothesis, high cognitive restraint was the predominant behavior associated with diet quality, not disinhibition. Funding SourcesFunding was provided through the USDA.

Assessment of vaccination service delivery and quality: a cross-sectional survey of over 1300 health facilities from 29 districts in Sindh, Pakistan conducted between 2017–18

BackgroundRoutine childhood immunization coverage in Pakistan remains sub-par, in part, due to suboptimal utilization of existing vaccination services. Quality of vaccine delivery can affect both supply and demand for immunization, but data for immunization center quality in Pakistan is sparse and in Sindh province in Southern Pakistan, no comprehensive health facility assessment has ever been conducted at a provincial level. We assessed health facilities, specifically immunization centers, and their associated health workers throughout the province to summarize quality of immunization centers. MethodsAn exhaustive list of health facilities obtained from Sindh’s provincial government was included in our analysis, comprising a total of 1396 public, private, and public-private health facilities. We adapted a health facility and health worker assessment survey developed by BASICS and EPI-Sindh to record indicators pertaining to health facility infrastructure, processes and human resources. Using expert panel ranking, we developed critical criteria (the presence of a cold box/refrigerator, vaccinator and vaccination equipment at the immunization center) to indicate the bare minimum items required by immunization centers to vaccinate children. We also categorized other infrastructure, process, and human resource items to determine high, low and moderate function requirements to ascertain quality. We evaluated presence of critical criteria, calculated scores for high, moderate and low function requirements, and displayed frequencies of infrastructure, process and human resource indicators for all immunization centers across Sindh. We analyzed results at the division level and utilized a two-sample independent clustered t-test to test differences in average function requirement scores between facilities that met critical criteria and those that did not.ResultsOut of the 1396 health facilities assessed across Sindh province from October 2017 to January 2018, 1236 (88.5%) were operational while 1209 (86.6%) offered vaccination services (immunization centers). Only 793 (65.6%; 793/1209) immunization centers met the critical criteria of having all the following items: vaccinator, a cold box or refrigerator and vaccine supplies. Of the 416 (34.4%; 416/1209) immunization centers that did not meet the critical criteria, most of the centers did not have a cold box or refrigerator (28.3%; 342/1209), followed by lack of vaccines (19.9%; 240/1209), and a vaccinator (13.0%; 157/1209). Of the 2153 healthcare workers interviewed, 1875 (87.1%) were vaccinators, of which 1745 (81.0%; 1745/2153) were male, and had an average of 12.4 years of schooling. A total of 1805 (96.3%; 1805/1875), 1655 (88.3%; 1655/1875) and 1387 (74.0%; 1387/1875) of the vaccinators were trained in vaccination, cold chain and inventory management respectively.ConclusionOne out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. While the majority of health workers (>80%) were trained on vaccination and cold chain management, the proportion trained on inventory management was comparatively low. Our findings therefore suggest that suboptimal immunization center quality is partly due to inadequate infrastructure and inefficient processes contributed to an extent, by low levels of inventory management training among vaccinators. Our study presents critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within a low-middle income country setting.

Toward Zero Prescribed Opioids for Outpatient General Surgery Procedures: A Prospective Cohort Trial

IntroductionAchieving satisfactory post-operative pain control for common elective general surgical procedures, while minimizing opioid utilization, remains challenging. Utilizing pre-operative educational strategies, as well as multimodal analgesia, we sought to reduce the post-operative opioid use in elective general surgery cases. MethodsBetween November 2019 and July 2021, patients undergoing elective inguinal hernia repair or cholecystectomy were enrolled in the study. Patients were divided into three cohorts: Control, opioid sparing (OS), or zero-opioid (ZO). Control patients did not have any intervention; OS patients had an opioid reduction intervention protocol applied (patient education and perioperative multimodal analgesia) and were provided an opioid prescription at discharge; the ZO had the same protocol, however, patients were not provided opioid prescriptions at discharge. Two weeks after discharge, patients were interviewed to record opioid consumption, pain scores, and level of satisfaction since discharge. ResultsA total of 129 patients were recruited for the study. Eighty-eight patients underwent inguinal hernia repair and 41 patients underwent cholecystectomy. Median post-operative morphine equivalents consumed in the Control cohort (n = 58); 46 (37.5-75) were significantly reduced when the OS protocol was enacted (n = 42); 15 (11-22.5) and further reduced to zero for every patient in the ZO cohort (n = 29) (P = 0.0001). There were no differences in patient-reported average pain scores after discharge (P = 0.08) or satisfaction levels with experience (P = 0.8302). ConclusionsOur study demonstrates that patient education and preoperative interventions can result in zero opioids prescribed after common general surgery procedures with equivalent patient satisfaction and pain scores.

The Validity of MCAT Scores in Predicting Students' Performance and Progress in Medical School: Results From a Multisite Study.

This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school. Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status. Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females. These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum.

Multifocal contact lens vision simulated with a clinical binocular simulator

PurposeThe purpose of this study is to compare the binocular visual perception of participants wearing multifocal contact lenses and these same lens designs viewed through a temporal multiplexing visual simulator. MethodsVisual performance and perceived visual quality at various distances were obtained in 37 participants wearing soft M−CLs and through the SimVis Gekko programmed with the same lenses. In a pilot study (n = 10) visual performance was measured in terms of LogMAR visual acuity (VA) at far (4 m), intermediate (64 cm) and near (40 cm) distances and through-focus VA (TFVA) curves with the simulated M−CLs. In the follow-up study (n = 27), LogMAR VA at far, intermediate and near distances were measured both with the actual and simulated M−CLs. Perceived visual quality was measured in both studies using the Multifocal Acceptance Score (MAS-2EV), and a Participants Reported Outcomes Vision questionnaire. Differences between the metrics obtained with simulated and actual lenses were obtained. ResultsBoth actual and simulated M−CLs increased depth-of-focus by a similar amount. Mean LogMAR VA differences with actual and simulated M−CLs ranged between 4 and 6 letters (0.08 ± 0.01, 0.12 ± 0.01 and 0.10 ± 0.01, for far, intermediate and near distances, respectively). MAS-2EV average score differences with actual and simulated M−CLs ranged between −1.00 and + 4.25. Average MAS-2EV scores were not correlated significantly with VA. However, MAS-2EV (average and individual scores) were highly correlated to visual quality questionnaire responses (p < 0.005). ConclusionsA simultaneous vision simulator accurately represented vision with M−CLs both VA at various distances and perceived visual quality, as measured in a clinical setting. The MAS-2EV metric accurately captured participant reported outcomes of standard vision questionnaires. The combination of SimVis Gekko and MAS-2EV has the potential to largely reduce chair time in M−CLs fitting.

LBA02-01 EFFECT OF CANNABIDIOL OIL ON POST-URETEROSCOPY PAIN FOR URINARY CALCULI: A RANDOMIZED DOUBLE-BLIND PLACEBO CONTROLLED TRIAL

You have accessJournal of UrologyCME1 May 2022LBA02-01 EFFECT OF CANNABIDIOL OIL ON POST-URETEROSCOPY PAIN FOR URINARY CALCULI: A RANDOMIZED DOUBLE-BLIND PLACEBO CONTROLLED TRIAL Gopal Narang, Olufunmilola Adeleye, Kevin Wymer, Mitchell Humphreys, and Karen Stern Gopal NarangGopal Narang More articles by this author , Olufunmilola AdeleyeOlufunmilola Adeleye More articles by this author , Kevin WymerKevin Wymer More articles by this author , Mitchell HumphreysMitchell Humphreys More articles by this author , and Karen SternKaren Stern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002670.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-ureteroscopy stent placement carries significant morbidity and pain which can interfere with daily life. This discomfort unfortunately leads many to opioid pain medications, which have a known risk of addiction. Cannabidiol (CBD) oil represents an alternative analgesic that has proven anti-inflammatory and antinociceptive effects. We sought to evaluate the effect of an FDA-approved CBD oil (Epidiolex) on pain control and opioid usage in the post-ureteroscopy setting. METHODS: This was a prospective, placebo-controlled, double-blind, randomized controlled trial at a tertiary care center. 90 patients undergoing ureteroscopy with stent placement for urinary stone disease were randomized 1:1 to placebo or 20 milligrams of CBD oil daily for 3 days post-operatively. Both groups were prescribed a rescue narcotic, tamsulosin, oxybutynin and phenazopyridine. Daily pain scores, medication usage and ureteral stent symptoms using the validated USSQ questionnaire were recorded for 3 days post-operatively. RESULTS: Both the placebo and CBD group were similar in pre- and peri-operative characteristics. We found no difference in average pain scores or opioid usage between groups post-operatively. Both groups endorsed similar discomfort with ureteral stents that affected their physical activity, sleep, urination, and daily life. Lastly, the majority of patients would have either mixed feeling or would be unhappy if they had to have a stent placed in the future. CONCLUSIONS: CBD oil showed no difference compared to placebo in minimizing post-ureteroscopic stent discomfort or opioid usage. Despite the availability of numerous analgesic agents, patient experienced notable stent related symptoms and would be unhappy to have a stent placed in the future. Source of Funding: Institutional © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1041 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gopal Narang More articles by this author Olufunmilola Adeleye More articles by this author Kevin Wymer More articles by this author Mitchell Humphreys More articles by this author Karen Stern More articles by this author Expand All Advertisement PDF DownloadLoading ...

Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study

ObjectiveTo describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.DesignCross sectional survey and retrospective cohort study.Setting140 US medical schools accredited by the Association of...

A cross-sectional study: comparison of public perceptions of adverse drug reaction reporting and monitoring in eastern and western China

BackgroundAdverse drug reactions (ADRs) cause a substantial clinical and economic burden. Spontaneous reporting of ADRs by the public is crucial. In some developed countries like the United States, Canada, consumers have been allowed to directly report ADRs, however, convenient channels for direct ADR reporting by the public are lacking in China.ObjectiveWe aimed to compare the knowledge, attitudes, and practice(KAP) regarding monitoring and reporting of adverse drug reaction (ADR) among the general public in eastern and western China.MethodsA questionnaire-guided cross-sectional study was administered to participants in Nanjing and Xi’an during April–July 2019. A descriptive statistical analysis was used to describe respondents’ demographic information and other results. The t-test and analysis of variance were used to test the differences in knowledge and attitudes among respondents with different demographic characteristics. P < 0.05 was considered statistically significant. Binary logistic regression analysis was used to examine factors associated with knowledge and attitudes.ResultsA total of 1085 questionnaires were distributed in this survey, 869 valid questionnaires were returned, the recovery rate was 80.09%. Respondents showed poor knowledge of the definition of ADRs and reporting criteria, with a significant difference in average knowledge scores according to education level, gender, and age group. Most respondents had positive attitudes toward ADR monitoring and reporting, with no significant differences in knowledge and attitude scores between the two cities. In total, 68.93% of respondents said they would feedback information to health care professionals, most (84.35%) would take the initiative to report ADRs if there were a convenient method. More than half (58.57%) of respondents were more likely to report ADRs by telephone.ConclusionThe findings of our study indicated that health care professionals should encourage patients to actively report ADR. China should also explore ways to facilitate direct public reporting of ADRs by improving relevant laws and regulations.

Correlation of the rate of metastasis-free survival with the presence of pathogenic germline genetic mutations in patients with prostate cancer at a community practice.

70 Background: Loeb et al. recently highlighted that academic physicians were statistically more likely to recommend genetic testing to prostate cancer patients per NCCN guidelines compared to physicians at community practices. Several articles have outlined the rate of pathogenic mutations and metastasis free survival (MFS) for prostate cancer patients treated at academic institutions. However, there is a relative paucity of equivalent data regarding patients treated at community urology clinics. We felt it was important to retrospectively review data from our large community based uro-oncology practice and present our findings in an effort to clarify this topic. Methods: We collected data on 562 prostate cancer patients treated at our multidisciplinary uro-oncology clinic between 2016 and 2018. We found 363 patients that satisfied the inclusion criteria of having germline genetic mutation testing and at least 1 year of follow-up. Patients were stratified into three categories based on the results of their germline genetic test: negative for germline mutations, positive for germline pathogenic mutations, or positive for VUS (variant of uncertain significance) mutations. Analysis of variances (ANOVA) was conducted to assess for any differences in age, Gleason score, metastasis rate, and MFS across the groups. A significance level of.05 was used. Results: All patients were treated according to guideline recommendations as was standard for the practice. There was no statistically significant difference in average age or Gleason score between the groups. There was also no statistically significant difference between the MFS across the three groups. Although the metastasis rate and MFS in the group without any mutations (9.8%, 18.3 months) was clinically significant compared to the groups with pathogenic mutations (7.5%, 16.5 months) and VUS mutations (7%, 16.6 months), the differences were not statistically significant (p=.754 and.127 respectively). Conclusions: In our community based uro-oncology practice, we found no statistically significant difference in MFS between patients with pathogenic germline mutations, patients without germline mutations, and patients with VUS mutations at 1 year of follow-up. This does not exclude the possibility of an impact of germline mutations on MFS as the data matures to reach 5 or more years of follow-up.[Table: see text]

Offline Context Affects Online Reviews: The Effect of Post-Consumption Weather

Abstract This empirical study investigates whether unpleasant weather—a prominent aspect of a consumer’s offline environment—influences online review provision and content. It uses a unique dataset that combines 12 years of data on hotel bookings and reviews, with weather condition information at a consumer’s home and hotel address. The results show that bad weather increases review provision and reduces rating scores for past consumption experiences. Moreover, 6.5% more reviews are written on rainy days and that these reviews are 0.1 points lower, accounting for 59% of the difference in average rating scores between four- and five-star hotels in our data. These results are consistent with a scenario in which bad weather (i) induces negative consumer mood, lowering rating scores, and (ii) makes consumers less time-constrained, which increases review provision. Additional analyses with various automated sentiment measures for almost 300,000 review texts support this scenario: reviews on rainy days show a significant reduction in reviewer positivity and happiness, yet are longer and more detailed. This study demonstrates that offline context influences online reviews, and discusses how platforms and businesses should include contextual information in their review management approaches.

Gauging the impact of Pediatric education on Paramedics’ knowledge

Background: A high level of emergency medical care is now expected from paramedics dealing with the sick and injured, including pediatric patients.1,2 Very little is known of the paramedics’ perception of competency and of pediatric prehospital education and training, which is so critical to improve a paramedics’ knowledge and performance of important skills.2,3 The purpose of this study was to determine if pediatric training resulted in a change in knowledge among paramedics from Hamad Medical Corporation Ambulance Service (HMCAS). Methods: A mixed-methods research approach was adopted to explore diverse perspectives. A comparison of all pre and post-test results for a pediatric Continuing Professional Development (CPD) course was conducted during the study period to determine whether knowledge was gained by paramedics. A survey was also used to conduct a retrospective analysis of the paramedics’ perception of pediatric training and to review their perceived level of competency. Results: The pediatric CPD course (Table 1) was conducted 33 times between January and November 2019. The average score difference between the pre and post-test indicates a gain in knowledge post-training across the participants (n = 51). The survey results (n = 33) revealed that there was an overall positive perception of the CPD course by paramedics and the impact it had on their learning and learning styles. Active learning strategies and hands-on practice were the recommended modalities by participants. The key findings are presented in Figure 1. Conclusion: HMCAS paramedics provided positive feedback on their pediatric training opportunities. Evaluating the effectiveness of all training provides valuable insight towards the improvement of the activity. Educators should have a fair knowledge and understanding of adult learning principles and the application of effective teaching and learning strategies when developing any CPD activity. Lastly, continual advances in patient care need to be reflected in all training programs.

High Prevalence of Sleep Disturbance Is Associated with Femoroacetabular Impingement Syndrome

PurposeThe purpose of this study was to identify an association between Patient-Reported Outcomes Measurement Information System (PROMIS) sleep scores and other PROMIS domains in patients with femoroacetabular impingement syndrome (FAIS).MethodsPatients were retrospectively identified for FAIS pathology, and PROMIS outcomes were assessed at multiple visits. Individual generalized linear mixed-effects models were fit with PROMIS sleep score as the predictor variable, and each subsequent PROMIS metric as the response variable. Additionally, models were fit using a clinically significant dichotomization of PROMIS sleep score to assess differences in average PROMIS scores between those with disrupted sleep (>55) and those with normal sleep (≤55).ResultsPROMIS scores at baseline differed between those with and without sleep disturbance. Specifically, higher PROMIS sleep scores were associated with higher anxiety, depression, fatigue, pain intensity, and pain interference scores and lower physical function, and social participation.ConclusionsAn association between PROMIS sleep score and other PROMIS outcomes does exist. Sleep disturbance is associated with increased anxiety, depression, fatigue, pain intensity, pain interference and decreased physical function, and social participation when analyzing PROMIS score, as both a continuous and dichotomized variable. Because of the observational design of this study, no causal inference can be made on these results.Level of EvidenceLevel III, retrospective comparative trial.

Elective Foot &amp; Ankle Procedures in the Geriatric Populations: Worth the Mobility Gains

Category:Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. Given increased rates of perioperative comorbidities and the heightened risks of intraoperative complications, physicians may be more inclined to manage elderly patients with longer periods of conservative treatment for similar pathologies. However, previous work has shown that decreased mobility of elderly patients affects longevity and is linked to increased rates of all-cause and non- cancerous morbidity and mortality. Currently, little is known about the effect of elective foot and ankle procedures on mobility in patients of all ages. Therefore, the objective of this study was to compare posteroperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following foot and ankle surgery.Methods:A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by a single surgeon between September 1, 2015 and August 31, 2019 was undertaken following IRB approval. Patient-reported LSA scores were collected at preoperative and routine 6-month and 12-month follow-up clinic appointments. Patient demographic and surgical data were recorded, and they were divided into groups by age over and under 65 years. Demographics and surgical characteristics were compared utilizing an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer's exact test for categorical data. Alpha and beta were assumed to be 0.05 and 0.8, respectively.Results:The younger (<65) group included 140 patients (mean age 44.1, SD 13.2), while 44 patients were observed in the elderly (>=65) age group (mean age 70.4 years, SD 8.4 (p<0.0001). The elderly group had significantly more patients with hypertension requiring medical management (p=0.012), but no other differences in perioperative comorbidities or demographics were observed. A higher proportion of elderly patients underwent surgery for conditions of osteoarthric origin, while younger patients underwent surgery more frequently for soft tissue pathology (p=0.033). The average LSA score of elderly patients at the preoperative visit was 58.3 (SD 38.0) versus 79.3 (SD 38.8) in the younger cohort (p=0.041). Both the young and elderly patient cohorts regained and surpassed their preoperative mobility scores by 6 months and 1-year postop. No difference in average mobility score was observed between young (85.6, SD 36.1) and elderly (90.1, SD 34.3) cohorts at 1-year follow-up.Conclusion:This study demonstrates that while elderly patients may begin with lower mobility than younger patients with foot and ankle pathology, operative treatment can improve their mobility dramatically up to comparable levels of operatively-treated younger patients. Our results, in tandem with literature showing the drastic deleterious effects of decreased mobility in the elderly, suggest that the discussion to pursue or hold on surgical correction of chronic foot and ankle disease in the patients over the age of 65 must take into account the mobility benefits of surgery.

Efficacy of Opioid Spinal Analgesia for Postoperative Pain Management after Pancreatoduodenectomy

Background: Efficacy of opioid spinal analgesia for pain management after pancreatoduodenectomy remains understudied and lacks comparison to thoracic epidural analgesia (TEA). Methods: Pancreatoduodenectomy patients who underwent TEA or opioid spinal for postoperative pain management between May 2015 and June 2020 were included in this observational cohort study. Primary outcome was patient-reported daily pain scores. Secondary outcomes included postoperative morphine milligram equivalents (MMEs) and length of stay (LOS). Multivariable linear regression models were constructed to compare risk-adjusted outcomes between groups. Results: 180 patients were included: 56 (31%) TEA and 124 (69%) spinal. Compared to TEA patients, spinal patients were older (67.0 vs. 64.6, p = 0.045), had a greater body mass index (26.5 vs. 24.4, p = 0.02), and were less frequently smokers (19.4% vs. 41.1%, p = 0.002). Spinal, compared to TEA, was associated with lower intraoperative MMEs (0.25 vs. 22.7, p < 0.001) and postoperative daily MMEs (7.9 vs. 10.3, p = 0.03). Adjusted analyses demonstrated spinal patients had significantly lower pain scores on POD0 (3.4 vs. 5.9, p < 0.001) but greater pain scores on POD3 (4.2 vs. 3.2, p = 0.03) (Figure). There was no difference in average pain score across the entire postoperative period (spinal vs. epidural: 4.18 vs. 4.14, p=0.93), daily MMEs (p=0.50), or LOS (p=0.23). Conclusion: There was no overall difference in postoperative pain scores, opioid use, or LOS between TEA or spinal patients after pancreatoduodenectomy. Opioid spinal analgesia should be considered as part of multimodal analgesic regimens for patients undergoing pancreatoduodenectomy.

Is Drinking Water Hardness Associated With Elevated Coronary Artery Calcium Scores? A Comparison Between Sydney Water and Mudgee Water Drinkers

Coronary artery calcium (CAC) is a marker of atherosclerosis and predicts the risk of future cardiac events. It is often higher in rural populations compared to metropolitan ones. We hypothesise that rural patients may have higher CAC scores than city dwellers due to increased calcium intake from drinking water. 126 patients were included in the study (Sydney water n=51, Mudgee bore water n=37, Mudgee tank water n=38). Patients must have consumed this water for >10 years and received a CAC score in the allocated timeframe (April 2021–December 2021, inclusive). Cardiovascular risk data and CAC data were collected from hard copy patient records and retrospectively analysed. The mean cardiovascular risk score was 4%, 10%, and 5.5% respectively for Sydney, bore water, and tank water groups. Sydney water drinkers had the highest proportion of ‘zero’ CAC scores; 39.2% versus 27.0%, and 21.1% in bore and tank water drinkers, respectively (see Figure 1). Among non-zero scores, Sydney water drinkers had a statistically significant lower average CAC score [192.5, 95%CI 95.8 - 289.1], compared to Mudgee groups (p<0.05). There was no statistically significant difference in average non-zero CAC scores between the Mudgee bore water [745.6, 95%CI 442.4 - 1048.8] and tank water [635.3, 95%CI 371.6 - 899.0] groups (p=0.11). Mudgee patients have higher CAC and cardiovascular risk scores than Sydney patients. After adjusting for cardiovascular risk factors, however, there is not sufficient evidence to suggest an association between drinking water hardness and CAC scores.

Effect of Nursing Instructions on Reducing Selected Functional Gastrointestinal Disorders among Elderly Patients

Aim of the study: To evaluate the effect of the nursing instructions on reducing the selected functional gastrointestinal disorders among elderly patients. Research design: Quasi-experimental (Pre–posttest). A consecutive sample of one hundred elderly patients was included in this study. Setting: The current study was carried out at a Geriatric home, Geriatric club, and Gastrointestinal clinic at Qena two tools were utilized to collect data, First Tool: A Structured interviewing questionnaire sheet, personal data (age, gender, marital status level, etc.)Second Tool: The Patient Assessment of Constipation-Symptoms questionnaire. Results: there was a highly statistically significant difference in total mean average score and SD (20.4 ±8.3, 10.8 ±8.3) of constipation symptoms severity during pre and post-nursing instructions implementation p value≤0.05. Conclusion implementing the nursing instructions regarding selected functional gastrointestinal disorders among elderly patients reflected a significant impact on patient's outcomes of constipation this significant difference justified the research hypothesis. Recommendations: A continuous education and training are offered on regular basis for elderly patients regarding gastrointestinal disorders, in addition to educational classes for elderly people about age-related changes that affect their gastrointestinal tract and elimination pattern without a feeling of shame or embarrassment to prevent complications. Encouraging to improve the elderly home foods menu to contain high fiber foods such as vegetables and fruits to over com constipation problems

Improving Student’s Communication Skills in Social Science Learning Through a Scientific Approach

The goal of this study is to see if using a scientific approach might help students enhance their communication abilities in social studies classes. A one-group pretest-posttest research design was adopted in this research. The research participants were students from SMP Negeri 46 Kerinci, with a total population of 95 students and a sample of 30 students from class VIII. The sampling approach used in this research was a random sample technique. Observation sheets and a communication skills assessment were used to collect data. IBM SPSS version 25 software was used to statistically analyze the research data. The findings imply that teaching social studies using a scientific approach has a significant influence on students’ communication skills. This is confirmed by the difference in average scores between the pretest and posttest tests. Also suggestive is a t-test significance value of 0.000 or less than 0.05.