Risk Factors For Injury Research Articles

Prevalence and Risk Factors of Acute Kidney Injury After Colorectal Cancer Surgery.

Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients. Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves. Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001). AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.

Psychosocial factors and running-related injuries: unraveling the connection, based on a one-year prospective study.

Although runners are healthier than most of the population, they can incur a risk of injury. Literature shows a strong evidence of risk factors for running-related injuries (RRIs) based on characteristics of running. This study aimed to assess differences in psychosocial factors between injured and uninjured recreational runners. The study was designed as a 1-year prospective study with 108 participants (age 36.3±8.4y). The primary outcome was the incidence of RRIs at 1-year follow-up. The primary exposure variables were running-related characteristics and psychosocial factors assessed upon entry into the study. The differences between injured and uninjured runners were assessed using Mann-Whitney U Test, independent samples t-test and the effect size was assessed by Cohen's d. No statistically significant differences were observed between injured and uninjured runners in relation to the psychosocial factors examined. However, it is noteworthy that we identified medium-sized effects for the amount of sleep (d=0.46) and restless sleep (d=0.43), providing a basis for future research with larger sample sizes and more refined measures of sleep patterns to elucidate the potential role of sleep in RRIs.

Age, creatinine, and ejection fraction score is a risk factor for acute kidney injury after surgical aortic valve replacement

Background The incidence of acute kidney injury (AKI) increases after surgical aortic valve replacement (SAVR). This study aimed to characterize the risk factors of AKI after SAVR. Methods and Results We conducted a retrospective registry study based on data from 299 consecutive patients undergoing SAVR. At 48 h after SAVR, 41 patients developed AKI. There was a significantly higher prevalence of older age, higher body mass index (BMI), and diabetes mellitus in the AKI group. Previous use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) and β-blocker, intake and output volumes within 24 h, mechanical ventilation time, length of intensive care unit and hospital stay, baseline creatinine, baseline, 24 h, and 48 h estimated glomerular filtration rate were strongly associated with the incidence of AKI. BMI >24, history of hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Univariate logistic regression indicated that overweight, hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Notably, the ACEF score was an independent predictor of AKI. The receiver operating characteristic curve was employed to assess the ACEF score for predicting AKI and the best cutoff was 1.1. After dividing ACEF into quartiles, each one-unit increment in ACEF led to a 2.27-fold risk in the incidence of AKI among patients. Conclusions AKI is a generalizable phenomenon occurring frequently after SAVR. The ACEF score is an independent predictor of AKI among patients undergoing SAVR.

Impact of expressive intentions on upper-body kinematics in two expert pianists

IntroductionExpression is a key aspect of music performance. Studies on pianists’ gestures and expression have mainly documented the impact of their expressive intentions on proximal segments and head linear kinematics. It remains unclear how pianists’ expressive intentions influence joint angular kinematics as well as exposure to risk factors of injury, such as poor overall posture and distal jerky movements, two kinematic factors linked to injury. The first objective of this exploratory case study was to analyze the influence of pianists’ expressive intentions on proximal and distal joint range of motion (ROM) across different musical contexts. The second objective was to evaluate the impact of expressive intentions on the posture of joints that are commonly injured in pianists, as well as distal joint angular jerk. Methods: Two expert pianists (P1 and P2) performed six musical excerpts (E1–E6) in two experimental conditions: normal condition (including expressive intentions) and the control condition (strictly playing the composer’s notations written in the score with no subjective interpretation). An inertial measurement unit system recorded upper body kinematics.MethodsTwo expert pianists (P1 and P2) performed six musical excerpts (E1–E6) in two experimental conditions: normal condition (including expressive intentions) and the control condition (strictly playing the composer’s notations written in the score with no subjective interpretation). An inertial measurement unit system recorded upper body kinematics.Results and discussionBoth proximal and distal joint ROM increased when pianists incorporated expressive intentions. Participants exhibited more static, non-neutral wrist postures when incorporating expressive intentions (right and left wrist for P1 and P2, respectively), suggesting an increased risk of distal injury. On the contrary, the thorax exhibited more dynamic, neutral flexion postures, suggesting a reduced risk of proximal injury. These results suggest that expressive intentions may impact proximal and distal postures differently. Incorporating expressive intentions also led to jerkier, less smooth wrist movements in lyrical, non-virtuosic musical excerpts (E1–E4). However, in more virtuosic excerpts (E5–E6), there were generally no differences between conditions. Spatiotemporal constraints might explain these discrepancies between non-virtuosic and virtuosic musical excerpts. These results provide evidence of the impact of expressive intentions on the entire kinematic chain, while highlighting the implications of the subjective dimension of music expression in relation to exposure to risk factors of injury.

Serum C-Reactive Protein-to-Albumin Ratio as a Clinical Risk Factor for Traumatic Spinal Cord Injury.

To evaluate the effects of admission serum C-reactive protein-to-albumin ratio (CAR) in traumatic spinal cord injury (TSCI) severity evaluation and prognosis. We included 402 TSCI patients from 2 hospitals and collected relevant clinical and laboratory data. The effects of CAR on the prognosis of TSCI were explored using univariate and multivariate logistic regression analyses. The predictive values of different indicators were compared by evaluating the areas under the receiver operating characteristic curve. We classified 224 (55.7%) patients as severe TSCI (American spinal injury association Impairment Scale [AIS] grades A-B) and 178 (44.3%) patients as nonsevere TSCI (AIS grades C-E) according to the American Spinal Cord Injury Society Impairment Scale (AIS). Further investigation into the correlation among C-reactive protein (CRP), CAR, and serum albumin with the AIS grade showed that the admission CRP and CAR decreased in an AIS grade-dependent manner, while serum albumin increased in an AIS grade-dependent manner. Of the total patients, 226 (56.2%) were categorized as having a good clinical outcome based on AIS grade at the 1-year follow-up. Serum CAR decreased as follow-up AIS grade decreased. Serum CAR was more strongly correlated with follow-up AIS grade than serum CRP and serum albumin alone. Multivariate logistic regression analyses showed that injury severity and CAR were independent risk factors for poor prognosis. The area under the curve (AUC) of serum CAR was 0.749 higher than that of serum CRP (AUC= 0.736) and serum albumin (AUC= 0.719). Serum CAR is a readily available biomarker for assessing the severity of TSCI and predicting prognosis, which is clinically relevant for the functional recovery of patients with TSCI.

The Protective Role of the FIFA 11+ Training Program on the Valgus Loading of the Knee in Academy Soccer Players Across a Season.

Background: Improper neuromuscular control with excessive dynamic valgus loading of the knee has been identified as one of the main anterior cruciate ligament injury risk factors. This study aimed to analyze the impact of the FIFA 11+ training program on the valgus loading of the knee in academy soccer players over a competitive season. Methods: A prospective study was conducted on 85 players. The drop vertical jump test was carried out before the match and at the end of the same match at the beginning and at the end of the season over a period of 11 months. Results: An increase of the varus angle on the right limb was noted between the start and the end of the season at the beginning of the match (-4.7 ± 8.9 versus -6.9 ± 6, p = 0.003) and between the start and the end of the match in values measured at the beginning of the season (-4.7 ± 8.9 versus -7.7 ± 9, p < 0.001). An increase of the flexion angle of both limbs was noted between the start and the end of the season in values measured at the start of the match (left limb 76.8 ± 32.8 versus 98.6 ± 17.2, p < 0.001; right limb 76.4 ± 32.8 versus 96.1 ± 16.1, p < 0.001) and between the start and the end of the season in values measured at the end of the match (left limb 92.8 ± 19.1 versus 98.5 ± 16.3, p = 0.002; right limb 92.6 ± 19.2 versus 96.7 ± 14.5, p = 0.013). Conclusions: A decrease in dynamic valgus angle and an increase in knee flexion angle measured with the DVJ test were noted between the start and the end of the season, suggesting a protective role of the FIFA 11+ training program.

Incidence and risk factors of recurrent ocular injuries: A multicenter retrospective cohort study in four community hospitals, central Thailand

Incidence and risk factors of recurrent ocular injuries: A multicenter retrospective cohort study in four community hospitals, central Thailand

Genetic and Genomic Approaches to the Study of Drug-Induced Liver Injury.

Idiosyncratic hepatotoxicity induced by prescribed drugs has been known since the early 20th century. Identifying risk factors, including genetic factors, that trigger this drug-induced liver injury (DILI) has been an important priority for many years, both to prevent drugs that cause liver injury being licensed and as a potential means of preventing at-risk patients being prescribed causative drugs. Improved methods for genomic analysis, particularly the development of genome-wide association studies, have facilitated the identification of genomic risk factors for DILI, but, to date, there are only two main examples, liver injury caused by amoxicillin-clavulanate (AC) and by flucloxacillin, where genetic risk factors causing the injury have been identified and replicated with understanding of the underlying mechanism. There has also been progress on identifying genetic risk factors for liver injury caused by other anti-infective agents, herbal remedies and nonsteroidal anti-inflammatory drugs. The majority of genetic risk factors identified to date are specific human leucocyte antigen (HLA) alleles and evidence that these alleles preferentially present self-peptides inappropriately to T cells in the liver has been obtained. Non-HLA genes also contribute to genetic susceptibility, both as co-factors in T-cell responses and, in the case of isoniazid-only, drug metabolism. Polygenic risk scores to predict DILI have been developed, both a simple score that predicts AC injury and complex scores that may be applied to DILI more generally and provide evidence that additional risk factors other than HLA genes exist.

Frequency, Etiology and Risk Factors of Infant Burn Injuries

Background: Pediatric population in Pakistan is exposed to alarming consequences of burn injuries. Infants have a higher risk of fatality from burns than adolescents and adults. Merely few burn centers across the country are equipped with the resources and trained doctors/paramedical staff who can cater well to the neonatal and infant burn patients. We studied the frequency, etiology and risk factors of infant burn injuries to call attention and bring in public policy for its prevention and awareness among public. Methods: This was a cross-sectional study conducted in the Department of Pediatric Surgery and Pediatric Burn Unit, Mayo Hospital, Lahore, Pakistan from September 2023 to August 2024. All patients being admitted with burn injuries who were 12 months old or younger were included in the study. A structured questionnaire was filled by the duty doctor after interviewing the parents/guardians. Results: Total 2638 children presented with burns. Out of 867 admissions 75 were infants with male predominance. Mean age was 9.4+3.4 months ranging from 11 days to 12 months. 62 were scalds, 12 flame burns and one electric burn. Mothers were primary caretakers in 89% cases and 97% mothers were house wives. 71% lived in nuclear families. 64 out of 75 were kitchen accidents. All families faced major disruption in natural gas supply in their homes. Majority accidents occurred in winters and 62.6% in January and February alone. Conclusion: Infant burns can be prevented by close surveillance, keeping infants away from kitchen, support system for mothers at home and keeping stove and hot items on shelves away from reach. Provision of hot running water and infrastructure for adequate power and gas supply along with awareness/prevention campaigns by government bodies are needed to save vulnerable infants from this adversity.

Development and validation of a predictive model for acute kidney injury in patients with ureterolithiasis

Objectives This study aims to identify risk factors for acute kidney injury (AKI) in patients with ureterolithiasis and to develop a predictive model for early AKI detection in this population. Methods A retrospective analysis was conducted on data from 1,016 patients with ureterolithiasis who presented to our outpatient emergency department between January 2021 and December 2022. Using multifactorial logistic regression, we identified independent risk factors for AKI and constructed a nomogram to predict AKI risk. The predictive model’s efficacy was assessed through the area under the ROC curve, calibration curves, Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA). Results AKI was diagnosed in 18.7% of the patients. Independent risk factors identified included age, fever, diabetes, hyperuricemia, bilateral calculi, functional solitary kidney, self-medication, and prehospital delay. The nomogram demonstrated excellent discriminatory capabilities, with AUCs of 0.818 (95% CI, 0.775–0.861) for the modeling set and 0.782 (95% CI, 0.708–0.856) for the validation set. Both calibration curve and HL test results confirmed strong concordance between the model’s predictions and actual observations. DCA highlighted the model’s significant clinical utility. Conclusions The predictive model developed in this study provides clinicians with a valuable tool for early identification and management of patients at high risk for AKI, thereby potentially enhancing patient outcomes.

Risk factors of acute kidney injury, septic shock and acute respiratory distress syndrome in patients with blood culture‑positive sepsis.

Sepsis, a condition characterized by a dysregulated host response to infection, can progress to septic shock and lead to various complications. The present study aimed to identify risk factors for the early clinical identification of sepsis patients at heightened risk of complications. In the present study, a total of 383 hospitalized patients with sepsis and positive blood cultures were enrolled. Demographic characteristics, laboratory findings at admission and treatment outcomes were collected and analyzed. Among the 383 sepsis patients, 165 were diagnosed with acute kidney injury (AKI). Patients with AKI exhibited significantly lower platelet counts, elevated procalcitonin levels and higher Sequential Organ Failure Assessment (SOFA) scores. Logistic regression analysis identified the SOFA score [odds ratio (OR)=1.269, 95% confidence interval (CI): 1.067-1.510, P=0.007) as an independent predictor of AKI. Furthermore, patients with septic shock had lower platelet counts and higher white blood cell counts at admission. Multivariable analysis revealed that age (OR=1.024, 95% CI: 1.001-1.047, P=0.039), procalcitonin (OR=1.018, 95% CI: 1.003-1.032, P=0.015), SOFA score (OR=1.465, 95% CI: 1.248-1.719, P<0.001) and Pitt bacteremia score (OR=1.437, 95% CI: 1.204-1.716, P<0.001) were independently associated with septic shock. In addition, sepsis patients with acute respiratory distress syndrome (ARDS) were observed to have lower platelet counts, higher body weight and elevated alanine aminotransferase levels. Multivariable analysis identified the SOFA score (OR=1.177, 95% CI: 1.095-1.265, P<0.001) and body weight (OR=1.030, 95% CI: 1.007-1.054, P=0.010) as independent predictors of ARDS. The present study highlights the risk factors associated with AKI, ARDS and septic shock in sepsis patients with positive blood cultures. Early identification and close monitoring of these factors are crucial for improving outcomes in sepsis management.

High incidence of anterior cruciate ligament injuries in professional men's handball: Analysis of the ‘ACL registry in German Sports’ over seven consecutive seasons

AbstractPurposeThe purpose of this study was to generate knowledge about the epidemiology and risk factors for anterior cruciate ligament (ACL) injuries in handball. It was hypothesised that the incidence of ACL injuries is high and comparable to other pivoting sports like football.MethodsThis study is based on the prospective ‘ACL registry in German Sports’ implemented in the 2016–2017 season. Professional (first and second leagues) male handball players were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double‐checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2016–2017 to the 2022–2023 season.ResultsA total of 84 ACL injuries were registered. 46.3% of ACL injuries were re‐ruptures. This represents a total incidence of 0.044 ACL injuries per 1000 h of exposure in training and matches per player over the study period. An increased incidence rate of 0.064/1000 h in the first league compared to 0.031/1000 h in the second league was reported (p ˂ 0.001). The mean number of injuries in the first division was 8.3, and in the second division, 6.6 ACL ruptures per season. Risk factors for ACL injury include previous knee injury and increased match exposure.ConclusionThe incidence of ACL injuries in professional handball is high and comparable to football with an increased risk in the first league compared to the second league in Germany. There was a high incidence of re‐injury. Other risk factors for ACL injuries include previous injuries to the affected knee in general as well as increased match exposure.Level of EvidenceLevel II prospective cohort study.

The Association of Salivary Estradiol Levels with Anterior Cruciate Ligament Stiffness and Laxity

BACKGROUND: Females are three to six times more likely to sustain an anterior cruciate ligament (ACL) injury than males. Researchers have previously identified hormonal fluctuations as a possible intrinsic factor related to the higher incidence of ACL injuries among female athletes. Whether hormonal levels, with or without use of oral contraceptives (OC), influence ligamentous mechanical properties resulting in increased ACL injury risk remains unclear. Furthermore, previous studies have mainly focused on anterior tibial translatory (ATT) laxity, with limited research on changes in ATT tissue compliance/stiffness. The purpose of this study is to investigate the influence of estradiol levels, menstrual cycle phases, with and without use of OC on ATT tissue compliance/stiffness and laxity. METHODS: Fifty-two female participants (age 24-30 years), divided into two groups of 26 each (Group OC using oral contraception, and Group NOC not using oral contraceptive). Data collection was performed on two different dates corresponding to two menstrual cycle phases: follicular or inactive phase (days 1-3) and the ovulation or active pill phase (days 12-14). Estradiol levels via saliva sampling, ATT tissue compliance/stiffness and laxity measures via the GNRB knee arthrometer were collected each testing session. Spearman’s rank-order correlation product-moment correlations were run to determine the relationship between follicular and ovulation phase estradiol and GNRB outputs related to translation and compliance. RESULTS: Estradiol levels showed a significant change between follicular and ovulation phases across both groups combined (p = 0.01). There were weak non-significant correlations between measured estradiol levels and GNRB measures of anterior translation and compliance, (p&gt; 0.05). No significant relationships were found across subjects whether they were on oral contraceptive or not using hormone regulated birth control. CONCLUSION: Estradiol level changes in the follicular and ovulation phases and oral contraceptive use did not significantly influence ACL laxity (anterior tibial translation) or compliance/stiffness. Additional studies on hormonal fluctuations as a potential risk factor for higher female ACL injury are indicated.

Analysis of imaging risk factors for prognosis in children with spinal cord injury without radiologic abnormalities

This study aimed to identify imaging risk factors for spinal cord injury without radiologic abnormalities (SCIWORA) in children. We retrospectively analyzed the medical records and magnetic resonance imaging (MRI) findings of children with SCIWORA admitted to our hospital between January 1, 2012, and September 30, 2022. Univariate and binary logistic regression analyses were used to evaluate the prognostic impact of various factors including MRI type, maximum cross-sectional area of spinal cord injury, injury length, injury signal intensity ratio. The American Spinal Injury Association (ASIA) impairment scale (AIS) was used to assess neurological improvement of spinal cord injury. A total of 39 patients met the inclusion criteria, comprising three males and 36 females aged 6.38 ± 1.7 years. The injuries were predominantly dance-related (25 patients), followed by car accidents (4 patients), and falls/sprains (10 patients). Seventeen patients showed improvement in the AIS grade, while 22 did not. Binary logistic regression analysis revealed that the maximum cross-sectional area and length of the damaged segment were significant prognostic factors. Receiver operating characteristic curve analysis demonstrated an area under the curve (AUC) of 0.91, with a maximum cutoff value, sensitivity, and specificity of 0.12, 81.80%, and 88.20%, respectively, for the maximum damage cross-sectional area. For the damaged segment length, the AUC, maximum cutoff value, sensitivity, and specificity were 0.78, 6.50, 50%, and 41%, respectively. Whole-spine MRI plays a crucial role in the diagnosis and prognosis of pediatric patients with SCIWORA. The cross-sectional area and length of spinal cord injury are risk factors for poor prognosis.Level of evidence: IV

The course of plasma alpha-1-microglobulin and haemolysis during cardiac surgery and the relationship to acute kidney injury, a pilot study

Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO (Kidney Disease, Improving Global Outcome) criteria. The plasma concentration of free haemoglobin during CPB was found to be significantly higher in patients with postoperative AKI at 60 min after start of CPB [mean 1379 µg/mL (95% CI: 1037–1721)]; compared to [820 µg/mL (622–1018)]; p = 0.034, in patients without AKI, and at one hour post-CPB [2600 µg/mL (969–4230)] vs [1037 µg/mL (722–1353)]; p = 0.044]. There was no significant difference found for pA1M levels between the groups with and without postoperative AKI development. Haemolysis during cardiac surgery with CPB increases the risk of postoperative AKI. Levels of pA1M did not differ for patients who developed postoperative AKI compared with those who did not. The data did not allow conclusions regarding the hypothesis that pA1M has a reno-protective effect.

Traumatic dental injuries in permanent teeth among Arab children: prevalence, and associated risk factors-a systematic review and meta-analysis.

There is no clear literature present till date assessing the prevalence of traumatic dental injuries and associated factors in children living in Arab countries. The purpose of this study was to systematically assess the prevalence, trends, and potential risk factors of traumatic dental injury (TDI) in permanent teeth among children and adolescents in Arab countries. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The researchers conducted a comprehensive literature search in various databases, including PubMed, Cochrane library of systematic reviews, Directory of Open Access Journals (DOAJ), Google Scholar, and gray literature sources such as MDS dissertations and manuscripts. To analyze the collected data, the researchers used a random effects model for conducting meta-analyses. Pooled estimates of prevalence and odds ratios were derived, along with 95% confidence intervals (CI), to provide a measure of statistical precision and variability in the findings. For the studies that were considered, trend analysis was done. The risk of bias assessment of included studies was done using Newcastle-Ottawa tool for cross-sectional studies. A total of 545 articles were identified, of which 23 articles fulfilled the inclusion criteria. Quality assessment of included studies showed that twenty studies were of high quality and three studies showed low quality. The frequency of dental trauma in Arab children was 26% (95% CI [10-43]). Children with overjet of more than 3.5 mm were shown to be 1.78 times more likely to have dental injury than children with normal overjet (pooled odds ratio 1.78; 95% CI [1.17-2.70]). Males had a 2.06 times odds of TDI compared to females. Children with insufficient lip coverage had an odds ratio of 2.57, indicating a higher likelihood of oral injuries compared to those with appropriate lip coverage. Significant correlations were obtained between the prevalence of dental trauma and other variables such as male gender, increased overjet, inadequate lip coverage, etc. Future population-based analytical research should concentrate on documenting the incidence and/or prevalence of TDI among marginalized communities in order to better understand the primary causes of TDI.

Moral injury and mental health in healthcare workers are linked to organizational culture and modifiable workplace conditions: Results of a national, mixed-methods study conducted at Veterans Affairs (VA) medical centers during the COVID-19 pandemic

Using mixed methods, we examined drivers of risk for moral injury, mental health symptoms, and burnout among frontline healthcare workers in high-risk Veterans Affairs (VA) clinical settings during the COVID-19 pandemic. Across 21 VA medical centers, 2,004 healthcare workers completed an online survey assessing potential risk factors for moral injury, posttraumatic stress, depression, and burnout. Assessed risk factors included: pandemic exposures; individual worker characteristics; aspects of workplace/organizational culture; and facility performance on standardized measures of care quality, patient satisfaction, and employee satisfaction (extracted from VA administrative data). Among surveyed workers, 39% were at risk for moral injury, 41% for posttraumatic stress, 27% for depression, and 25% for persistent burnout. In generalized linear mixed models, significant predictors of moral injury risk included perceived lack of management support for worker health/safety, supervisor support, coworker support, and empowerment to make job-related decisions—all modifiable workplace factors. Pandemic-related risk factors for moral injury included prolonged short-staffing, denying patient-family visits, and high work-family conflict. Predictors of posttraumatic stress, depression, and burnout were similar. Forty-six surveyed workers completed a follow-up qualitative interview about experiences of moral distress in the workplace, and interview themes aligned closely with survey findings. Rapid qualitative analysis identified protective factors that may reduce moral injury risk, including a collaborative workplace community, engaged leadership, empowerment to make changes in the workplace, and opportunity to process distressing events. We conclude with recommendations to mitigate moral injury risk in healthcare organizations. These include involving workers in discussions of high-stakes decisions that will affect them, creating consistent and clear channels of communication between the frontlines and leaders of the organization, practicing leadership rounding to improve leaders’ understanding of the daily work of frontline teams, and collaborating to understand how existing processes and policies may contribute to safety risks and moral conflict.

Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes.

Shoulder pain is one of the most common musculoskeletal complaints in overhead athletes. This study investigated the prevalence of the main risk factors and sex differences related to the development of shoulder pain in a cohort of amateur overhead athletes. The external rotation/internal rotation (ER/IR) isometric strength ratio <0.75% is the most prevalent risk factor associated to overuse shoulder injuries in both sexes. Cohort study. Level 3. A total of 296 (147 male and 149 female) amateur overhead athletes from handball, volleyball, and water polo participated in this cross-sectional study. Isometric strength, rotational range of motion, and scapular control were analyzed bilaterally. The measurements and motions were randomized between sides. The ER/IR isometric strength ratio deficit among the disciplines was presented in 264 and 229 out of 296 athletes in the dominant and nondominant sides, respectively. Normalized isometric strength showed significant differences for dominant (P < 0.01; ε² = 0.47) and nondominant IR (P < 0.01; ε² = 0.60). No significant differences were observed between dominant (P = 0.44; ε² = 0.05) and nondominant ER (P = -0.24; ε² = 0.07). The prevalence of glenohumeral IR deficit (GIRD) (P = 0.81) and total arc of motion differences (TAMD) (P = 0.39) was low, with no difference between sexes. Male (16.3%) and female (12.1%) athletes had low rate of obvious scapular dyskinesis in their dominant shoulders. Muscle strength was the most prevalent risk factor. The ER/IR ratio imbalance was present in both sides, without sex differences. Risk factors such as scapular dyskinesis, GIRD, and TAMD were present in low percentages, without sex differences. It is advisable to implement shoulder exercises to strengthen ER muscles to decrease differences between internal and external rotators and prevent injuries in overhead athletes.

Risk Factors for Postoperative Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery.

Background: Postoperative acute kidney injury (AKI) in patients undergoing heart valve surgery is a common complication requiring special treatment, including renal replacement therapy (RRT). Effective prevention remains the most effective tool to reduce this important clinical problem. The aim of the study was to evaluate the predictive abilities of selected perioperative parameters in predicting AKI requiring RRT in the early postoperative period in patients undergoing cardiac valve surgery. Methods: Prospective study on a group of patients undergoing cardiac valve surgery. The primary endpoint was postoperative AKI requiring RRT. The secondary endpoint was death in the RRT group. Logistic regression analysis was used to assess which variables predicted the primary and secondary endpoints. Results: 603 patients were included in the study. The primary endpoint occurred in 43 patients. At multivariable analysis, age (p < 0.001), preoperative CRP level (p = 0.007), troponin T measured one day after surgery (TnT II) (p < 0.001) and prolonged postoperative use of catecholamines (p = 0.001) were independent predictors of the primary endpoint. In turn, death in the group of patients requiring RRT occurred in 32 patients. Age (p < 0.001), preoperative CRP level (p = 0.002), TnT II (p = 0.009), and prolonged postoperative use of catecholamines (p = 0.001) remained independent predictors of the secondary endpoint. Conclusions: The results of this study indicate that older age, elevated values of preoperative levels of CRP, as well as increasing levels of postoperative troponin T and the need for a prolonged supply of catecholamines, are independent predictors of postoperative AKI requiring RRT as well as death. Accurate identification of patients at increased postoperative risk of AKI could facilitate preoperative patient informed consent and optimize the process of qualification and cardiac surgical treatment.

A study on the relationship between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in neurosurgery and the occurrence and prognosis of progressive hemorrhagic brain injury (PHI) in patients with traumatic brain injury

ObjectiveTo investigate the correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in neurosurgery and their impact on the occurrence and prognosis of acute traumatic progressive hemorrhagic brain injury (PHI) among traumatic brain injury patients.MethodA retrospective analysis encompassed 220 traumatic brain injury patients treated between 2019 and 2022. Patients were categorized into two groups: those experiencing progressive hemorrhagic brain injury (PHI) and those without PHI. The levels of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were examined within each group. Within the PHI cohort, patients were further stratified based on their Glasgow Outcome Scale (GOS) scores into good and poor prognosis groups, with corresponding observations of NLR and PLR levels. Logistic regression was used to identify factors influencing both the occurrence and poor prognosis of PHI. Additionally, Pearson’s linear analysis was utilized to investigate the correlation between serum NLR and PLR levels among PHI patients and the occurrence and prognosis of the disease.ResultWe found no statistically significant differences were observed between the PHI group and the non-PHI group in terms of gender, age, history of hypertension, smoking history, types of intracranial lesions, heart rate (HR), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), pupillary reflex status, mean arterial pressure (MAP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) (P > 0.05). However, there were significant differences in GCS scores, PaO2, and Hb levels (P < 0.05). Furthermore, the non-PHI group had higher NLR and PLR than the PHI group (P < 0.05). Multiple Logistic regression analysis showed that neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were independent risk factors for progressive hemorrhagic brain injury (PHI) in TBI patients (P < 0.05). Kendall analysis showed that there was a significant negative correlation between GOS score PHI (r=-0.458, P = 0.000). Additionally, Pearson linear correlation analysis showed a notable positive correlation between serum NLR and PLR levels in PHI patients and the occurrence of the disease (r = 0.377, P = 0.000). Evaluation based on the Glasgow Outcome Scale (GOS) score demonstrated no significant differences in gender, age, history of hypertension, smoking, types of intracranial lesions, heart rate (HR), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), pupillary reflex status, mean arterial pressure (MAP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) between the good and poor prognosis groups but significant differences in GCS score, PaO2, and Hb levels (P < 0.05). In addition, the NLR and PLR of the poor prognosis group were higher than those of the good prognosis group (P < 0.05). Multiple Logistic regression analysis showed that NLR and PLR were independent risk factors for poor prognosis in PHI patients (P < 0.05). Pearson linear correlation analysis showed a statistically significant positive correlation between serum NLR and PLR levels in PHI patients and the likelihood of poor prognosis (r = 0.307, P = 0.000).ConclusionElevated NLR to PLR ratios in TBI patients significantly elevate the risk of PHI occurrence. Moreover, higher NLR to PLR ratios correlate with poorer prognostic outcomes among PHI patients.