Significant Differences In Use Research Articles

Perioperative Management of Spinal Arteriovenous Malformation Embolization: Delayed Venous Thrombosis and Implications for Severe Back Pain.

The prognosis of untreated spinal arteriovenous malformations (SAVMs) is poor. Embolization plays an important role in the management of intramedullary SAVMs. Delayed aggravation due to spinal venous thrombosis following successful embolization has been reported; however, perioperative management strategies to prevent thrombosis have not been explored. We present our single-center experience of SAVM embolization and perioperative management, including anticoagulation. We retrospectively evaluated 18patients with SAVMs who underwent transarterial embolization. Perioperative anticoagulation therapy was administered to selected patients. We compared the characteristics of the patients, including perioperative management procedures, between those with and without postoperative worsening following embolization. Acute postoperative worsening within 1week occurred in 4 (22.2%) patients. Of these, immediate worsening was observed in one patient as aprocedure-related complication. Delayed worsening after 24 h was observed in 3 patients, caused by delayed venous thrombosis with severe back pain. Rescue anticoagulation for delayed worsening improved symptoms in two patients. Acomparison between patients with and without acute postoperative worsening revealed significant differences in age (median 46.5 vs. 26.5 years, p = 0.009) and the presence of postoperative back pain (75.0% vs. 0%, p = 0.005); however, there was no significant difference in use of selective anticoagulation (p = 0.274). The results of this study suggest that SAVM embolization can cause acute worsening due to postoperative venous thrombosis with severe back pain, which may be reversed by anticoagulation therapy. Back pain is an important finding that suggests venous thrombosis, and anticoagulation should be urgently administered.

Comparison of preoperative retrobulbar bupivacaine and postoperative subcutaneous liposome-encapsulated bupivacaine on postoperative analgesia in dogs undergoing enucleation.

To compare the effectiveness of preoperative bupivacaine inferotemporal retrobulbar blocks to postoperative liposome-encapsulated bupivacaine (Nocita) line blocks for analgesia following enucleation. 39 client-owned dogs (40 eyes) presenting to the Ophthalmology Service for enucleation. Dogs were randomly assigned to receive either a preoperative inferotemporal retrobulbar block with 0.5% bupivacaine or a peri-incisional line block with liposome-encapsulated bupivacaine (Nocita) at closure. Patients underwent unilateral enucleation and were hospitalized for 24 hours after surgery. Pain scores were performed by a masked observer with the Glasgow Composite Measure Pain Scale and the University of Wisconsin Ocular Pain Scale at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours following surgery. Intraoperative use of blood pressure and anesthetic support mediations as well as need for rescue pain control were recorded and compared between groups. There was no significant difference in rescue rates between treatment groups. When comparing the use of medical intraoperative heart rate, blood pressure, or anesthetic plane support, there were no significant differences in use between groups. Use of preoperative bupivacaine retrobulbar blocks and postoperative Nocita line blocks were equally effective at postoperative pain control with similarly low complication rates.

Social Media Use among Orthopedic Trauma Fellowship-trained Surgeons.

Objective:  To quantify the use of social media platforms by orthopedic traumatologists with an emphasis on demographic, practice-based, and regional differences. Materials and Methods:  Using the Orthopaedic Trauma Association (OTA) membership database, online searches were performed to identify professional profiles on numerous social media platforms. This presence was then quantified by a cumulative social media score which was correlated to the demographic information collected. Results:  In total, 1,262 active fellowship-trained orthopedic traumatologists were identified. Surgeons practicing in an academic setting were found to be more likely to use numerous social media platforms and to present an overall greater social media score than those in private practices. No significant differences in use were found based on practice region. Conclusion:  Social media platforms are currently underused by orthopedic traumatologists. Level of Evidence:  IV.

Use of antibiograms and changes in bacterial resistance patterns in the Ross Tilley Burn Centre

BackgroundInfection is a leading cause of death in burn patients and increasing antimicrobial resistance has made management difficult. Antibiograms are a useful tool to guide empiric treatment of infections, however, inappropriate prescribing may influence resistance. The objective of this study is to describe trends in antibiotic susceptibilities and use in a Canadian burn population pre- (PrA) and post-introduction (PoA) of antibiograms. MethodsWe performed a retrospective review of patients admitted to an ABA-verified Burn Centre for two years pre- (2013–2014) and post-introduction (2016–2017) of institutional antibiograms receiving empiric broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, and/or vancomycin). ResultsA total of 864 patients were admitted during the study period with 257 patients PrA and 239 patients PoA included. Average age, % total body surface area (%TBSA), and length of stay were similar between cohorts. Administration of empiric meropenem increased (43.2 % vs. 56.8 %) and piperacillin-tazobactam decreased (60.6 % vs. 39.4 %), which was significant (p = 0.002). There was a significant decrease in the overall use of empiric antibiotics (p = 0.002) and sepsis (p = 0.008) since the inception of antibiograms. There was no significant difference in use of targeted antibiotics pre- or post-antibiogram introduction. ConclusionsOur study demonstrates that since the introduction of antibiograms, there has been a decrease in overall use of empiric antibiotics, a significant decrease in administration of piperacillin-tazobactam, and improvement in sepsis rates. However, these antibiotics were not routinely targeted to the appropriate organism and therefore may contribute to multi-drug resistant organisms in a burn population.

Ecological perspectives on virtual community engagement among university students during and after COVID-19

This research, conducted at Hail University, explores how university students interact with online communities during and after the COVID-19 pandemic using an ecological perspective. It aims to understand the increased role of these platforms in education and socialization during the pandemic. The study focuses on examining students' views, activities, and motivations in online interactions. A detailed electronic questionnaire was used to investigate students' understanding, use, and application of online communities. It also looked at ecological methods to improve involvement, such as increasing awareness, assessing risks, providing support, and tackling challenges in online communities. Various methods, including content analysis, surveys, case studies, and detailed interviews, were used to test these approaches. The results show that students frequently use online communities, with no significant differences in use based on gender, field of study, or academic level. The research highlights the importance for educational institutions to adopt these findings and methods to create an effective online community environment that supports students' overall growth and academic success. This study is unique in its ecological approach and offers new insights into student engagement in virtual communities.

Daratumumab Combinations in US Veterans: Patient Characteristics and Outcomes

Background: Daratumumab is an anti-CD38 antibody with efficacy both in relapsed and newly diagnosed multiple myeloma (NDMM).Clinical trials evaluating daratumumab have demonstrated improved outcomes when combined with lenalidomide (DRd) or bortezomib (DVd) and with dexamethasone, as well as using all four drugs (D-VRd). We evaluated characteristics and outcomes of veterans treated with daratumumab combination in NDMM. Methods: This retrospective, cross-sectional study analyzed electronic medical record data from the Veterans Affairs (VA) Corporate Data Warehouse (CDW). We identified veterans by evidence of daratumumab administration in prescription records in combination with a second agent within 30 days and who did not receive any anti-myeloma agents prior to 30 days. Age, race, Quan's Charlson Comorbidity Index (CCI), the time to next treatment (TTNT), and overall survival (OS) were assessed. Patient characteristics were compared using ANOVA or chi-square and overall survival was estimated using Kaplan-Meier. Analyses were conducted using SAS 9.x. Results: There were 428 veterans who received daratumumab containing regimens. Mean age was 69.5 years and 36.2% self-identified as African American. There were 147 patients who received DRd, 190 DVd, and 91 D-VRd. Veterans who received DRd were significantly older than veterans receiving DVd (mean 73.0 vs. 69.1 years) and D-VRd(73.0 vs. 64.9 years, p<0.001). Use of daratumumab combinations has increased yearly since FDA approval (see table). There was no significant difference in use of regimens by race or comorbidity, measured by CCI. TTNT displayed distinct variations among the regimens, with DRd showing the most extended duration at a median of 316 days, followed by D-VRd at 231 days, and DVd at 40 days. These observed differences in TTNT may be attributed to changes in regimen, such as starting lenalidomide after 1-2 cycles of DVd. Median overall survival with DRd at 45 months (95% CI 38-not reached (NR)) and with DVd was 28 months (95% CI 20-39). Median survival in D-VRd was not reached. Conclusion: Daratumumab combinations are increasingly used to treat multiple myeloma in the VHA. DRd is used more commonly in older veterans and D-VRd in younger veterans. DVd is used more frequently than other combinations and veterans may transition or other treatments.

Progress and Persistent Disparities in Patient Access to Electronic Health Information

Patient access to electronic health information (EHI) available via online medical records and through patient portals has been shown to help individuals make informed health decisions, which are associated with better health outcomes. To assess progress in patient engagement with EHI and to identify racial or ethnic disparities in access to patient portals. This was a repeated cross-sectional study using data from the US Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals' access and use of their health information. Six cycles of HINTS were included (2014, 2017-2020, 2022); data for the disparities analysis came from the 2022 HINTS. Data analyses were performed in April 2023. Patient reports of (1) being offered portal access by a health care provider (HCP); (2) being encouraged by the HCP to use the portal; (3) accessing their portal; and (4) using the portal for various purposes. Additional key measures included methods used to access portals and self-reported ease of understanding information contained in the online medical records or portals. The total study population included 22 266 individuals (mean [SE] age, 49.9 [0.15] years) of whom 13 348 (54%) were female; 909 (5%) self-identified as Asian, 3523 (12%) as Black, 3178 (14%) as Hispanic, 13 555 (66%) as White, and 785 (3%) as another or more than 1 race. Nationally, patient portal access increased each year from 2014 through 2022, with a 46% increase observed between 2020 (n = 3319) and 2022 (n = 5437). However, in 2022, Black and Hispanic individuals reported being offered access to a portal by their HCP at significantly lower rates compared with White individuals (73% vs 81%; χ21 = 22.24; P < .001; and 62% vs 81%; χ21 = 135.57; P < .001, respectively) as well as accessing a patient portal at lower rates (60% vs 70%; χ21 = 23.80; P < .001; and 57% vs 70%; χ21 = 49.02; P < .001, respectively). The findings of this repeated cross-sectional study of US adult respondents to the HINTS suggest that access to and engagement with patient portals increased significantly from 2014 through 2022, but racial and ethnic disparities in patient access persisted in 2022. However, there were no significant differences in use or understanding of information available in the online medical records among those who accessed them, which suggests that efforts to promote equitable opportunities to access EHI would likely be associated with increased patient access.

Impact Analysis of ICT on Women in Agriculture: A Study Conducted in Jorhat District of Assam, India

ICT led extension system is capable of changing farmers’ lives by improving access to information and sharing knowledge through click of a button. Such approaches are far more important and essential for women farmers who are overburdened and hard pressed for time. Realizing the ever increasing role of women in agriculture and the need for empowering them in technological domain, the present study was conducted to study the level of knowledge of Farm Women Knowledge Group (FWKG) members on different aspects of selected ICT tool, to find out the level of use of ICT tool by the FWKG members and to study the impact of intervention programmes on knowledge and use of selected ICT tool among the FWKG members. Rural women having farming as an occupation were selected purposively. Six Farm Women Knowledge Group (FWKG) comprising ten members each were formed for the study. Intervention programmes were conducted for the members of FWKG including awareness programme, training and workshop which were home based, farm based and community based Programmes. The study reveals that post intervention levels of knowledge and use of selected ICT were better than pre intervention level among the FWKG members. High level of knowledge increased from 20.00 per cent to 48.33 per cent whereas low level of knowledge decreased from 45.00 per cent to 6.66 per cent. Similarly in case of high level of use increased from 6.66 per cent to 48.33 per cent. Knowledge and use of selected ICT tool was positively related in both pre and post-intervention phase. Paired ‘t’ test implies that there was gain in knowledge after the intervention programmes. Similarly significant difference in use of selected ICT tool between the pre and post intervention was also found. It may be concluded that such interventions may increase the level of knowledge and use of selected ICT tool and such model may be replicated in other areas at micro level.

A comparative study of atropine and atropine plus pralidoxime in the management of organo-phosphorous poisoning

Background: Poisoning with organophosphorus compounds (OP) is a common problem throughout the world particularly in developing countries. Standard treatment involves resuscitation, administration of the anti-muscarinic agent atropine, an acetylcholinesterase reactivator (pralidoxime) and assisted ventilation if necessary. In this study we compared the efficacy of add-on pralidoxime therapy over therapy with atropine alone in OP poisoning. Methods: The study included 103 patients, out of 103 OP poisoning cases, 54 patients received both atropine and PAM (group A) and 49 received only atropine (group B). Main outcome parameters of the study were total hospital stay and mortality. The data was compared using ‘t’ test while mortality was compared using Fisher’s exact test. Data was tabulated, analysed, reviewed and evaluated. Results: There was no difference in duration of hospital stay between the two group. The mean hospital stay in group A was 3.71±1.92 days and in group B was 3.14±2.01 days (p value &gt;0.05). No difference in mortality was seen between the two group. Out of 54 in group A, 8 died and in group B out of 49, 7 died (p value &gt;0.05). Importantly cost burden is very high in the pralidoxime added group. Conclusions: There is no significant difference in use of atropine alone or atropine-pralidoxime combination in terms of morbidity and mortality in OP poisoning rather the later incurs more economic burden which may not be practicable in poor countries like India. However, a larger multicentric prospective study needs to be conducted, to be able to draw a definitive conclusion.

Peroperative administration of tranexamic acid in sleeve gastrectomy to reduce hemorrhage: a double-blind randomized controlled trial

IntroductionIn metabolic surgery, hemorrhage is the most common major complication. This study investigated whether peroperative administration of tranexamic acid (TXA) reduced the risk of hemorrhage in patients undergoing laparoscopic sleeve gastrectomy (SG).MethodsIn this double-blind randomized controlled trial, patients undergoing primary SG in a high-volume bariatric hospital were randomized (1:1) to receive 1500-mg TXA or placebo peroperatively. Primary outcome measure was peroperative staple line reinforcement using hemostatic clips. Secondary outcome measures were peroperative fibrin sealant use and blood loss, postoperative hemoglobin, heart rate, pain, major and minor complications, length of hospital stay (LOS), side effects of TXA (i.e., venous thrombotic event (VTE)) and mortality.ResultsIn total, 101 patients were analyzed and received TXA (n = 49) or placebo (n = 52). There was no statistically significant difference in hemostatic clip devices used in both groups (69% versus 83%, p = 0.161). TXA administration showed significant positive changes in hemoglobin levels (millimoles per Liter; 0.55 versus 0.80, p = 0.013), in heart rate (beats per minute; -4.6 versus 2.5; p = 0.013), in minor complications (Clavien–Dindo ≤ 2, 2.0% versus 17.3%, p = 0.016), and in mean LOS (hours; 30.8 versus 36.7, p = 0.013). One patient in the placebo-group underwent radiological intervention for postoperative hemorrhage. No VTE or mortality was reported.ConclusionThis study did not demonstrate a statistically significant difference in use of hemostatic clip devices and major complications after peroperative administration of TXA. However, TXA seems to have positive effects on clinical parameters, minor complications, and LOS in patients undergoing SG, without increasing the risk of VTE. Larger studies are needed to investigate the effect of TXA on postoperative major complications.Graphical abstract

Assesment of Use of Performance-Enhancing Substances and Methods among Wrestlers, Boxers, and Bodybuilders in Kenya

Measuring prevalence of usage of performance enhancing drugs in Boxing, wrestling, and bodybuilding is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers so that their scarce resources are not wasted. The purpose of this study was to establish knowledge levels, attitudes towards the use of performance enhancing substances (PES), among athletes from boxing, wrestling, and bodybuilding federations in Kenya. The study utilized cross-sectional analytical research design. The study population comprised of 1900 athletes from the three sports disciplines with a sample size of 384 athletes. Close ended questionnaires were used as the data collection instrument. Data obtained from the respondents was coded and organized for analysis by use of SPSS version 25. Hypotheses were tested using one-way ANOVA and t-test at confidence level of 0.05. Post hoc analysis was carried out using Duncan Multiple Range Test where differences were found to be significant. Results on usage showed that majority of the respondents (74.2%) never used food supplements (FS) to improve sports performance. Many of the respondents (93.8%) had never used traditional herbs (TH) to improve sports performance. 91.9% never used PES to improve sports performance. Majority of the respondents (96.6%) indicated as never having been given food supplements by a coach, doctor, or physiotherapist to enhance performance. On supply of PES, 91.7% of the respondents had no information of if medical practitioner, local chemist, or sports agents supplied PES and methods. The results of one-way ANOVA showed that there was a significant difference in the use of FS, TH, PES, and Methods by athletes from the three sports disciplines, [F (2, 381) = 24.050, p &lt; 0.000]. In conclusion and in light of the limitations of this study generally majority of the respondents did not use PES and methods. There were also significant differences in use of PES and methods across the different sports. The study recommended that sports federation officials from boxing, wrestling and bodybuilding should have a put proper structures for imparting knowledge and proper attitude on use of performance enhancing substances among athletes.

Racial and ethnic differences in patients enrolled in the national bronchiectasis and nontuberculous mycobacteria research registry

Demographic and socioeconomic factors are recognized to contribute to disparities in healthcare outcomes. Originally, bronchiectasis was described in a population of predominantly White ethnic group of patients in which racial disparity could not be identified. The U.S. Bronchiectasis Research Registry (BRR), a centralized database of adult patients with bronchiectasis and/or NTM from 18 clinical institutions across the U.S., was created to support the research of this condition. The aim of this study is to describe the racial and ethnic distribution of patients enrolled in the BRR and evaluate factors associated with healthcare disparities within manifestations of and/or the care delivered to this population.At the time of this study, 3600 patients with bronchiectasis and/or NTM were enrolled in the BRR. Of those, 3510 participants were included in these analyses. The population was predominantly non-HispanicWhite (n = 3143, 89.5%), followed by Hispanic or Latino (n = 149, 4.3%), Asian (n = 130, 3.7%) and non-Hispanic Black (n = 88, 2.5%) participants. Testing for cystic fibrosis, immunoglobulin deficiency, and mycobacteria was not different between races, but non-Hispanic Black patients were tested less frequently for alpha-1 antitrypsin (A1AT) deficiency compared to other groups (P = 0.01). The four groups did not differ in the proportion of Pseudomonas aeruginosa or Hemophilus influenzae. There was no statistically significant difference in use of high-frequency chest wall oscillation, pulmonary rehabilitation services, or suppressive macrolide treatment across the groups (P > 0.05).There is a disproportionately high percentage of non-Hispainc White patients compared to non-Hispanic Black patients and Hispanic or Latino patients in the BRR. However, we found an overall similarity of care of BRR patients, regardless of racial and ethnic group.

Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema.

The purpose of this study is to describe practice patterns of physical therapists (PT) and physical therapist assistants (PTA) who treat patients with breast cancer-related lymphedema and determine if they are adherent to best evidence recommendations for lymphedema diagnosis and intervention. An electronic survey to collect practice pattern data of PTs and PTAs who treat patients with BCRL was distributed. A descriptive and quantitative statistical analysis was performed. Twenty-six percent of respondents read the American Physical Therapy Association sponsored lymphedema diagnosis clinical practice guideline (CPG) and 20% read the lymphedema intervention CPG. Lymphoscintigraphy was the only diagnosis or intervention tool with a significant difference in use between therapists who read versus did not read the CPGs. Adherence to "should do" recommendations was variable: bioimpedance (18.2%), volume calculation (49.3%), ultrasound (0%), patient reported outcome tools (64.9%), compression garments (43.9%), exercise (87.2%), and compression bandaging (56.8%). There is variability in adherence to recommendations for both the lymphedema diagnosis and intervention CPGs. Interventions to improve implementation and adherence to CPG recommendations are warranted.

142. Loss of sagittal correction >3 years after adult spinal deformity surgery

<h3>BACKGROUND CONTEXT</h3> The durability of adult spinal deformity (ASD) surgery is key for cost-effective treatment. Malalignment is one of the main reasons for revision surgery. <h3>PURPOSE</h3> To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study of a prospective database. <h3>PATIENT SAMPLE</h3> This study included 321 ASD patients with minimum 3 -year follow-up. <h3>OUTCOME MEASURES</h3> L1-S1, L4-S1 and L1-L4 lumbar lordosis. <h3>METHODS</h3> A total of 321 patients who underwent fusion of the lumbar spine (=5 levels, LIV S1/ilium) with a revision-free follow-up =3 years were identified. Patients were stratified by the change in PI-LL from 6 weeks to 3 years postop as Maintained vs Loss > 5°. Those with a loss due to instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Changes in regional and focal lordosis over time were investigated with repeated measures ANOVA and factor comparison. <h3>RESULTS</h3> Mean age 64 yrs, BMI 28 kg/m², 80% female. The baseline alignment (PI-LL=21±19°, T1PA=26±12°) was corrected to PI-LL=3±13°, and T1PA=18±10° at 3 yrs (mean 3Y follow-up: 45±11m, with 44±11 mo between early and late follow-up). Eighty-two patients (25.5%) lost >5° of PI-LL correction (mean loss 10±5°). After exclusion of patients with instrumentation failure, 52 patients (Loss) with a mean loss of correction of 8.6±2.9 were compared to 222 controls with maintained LL correction. Demographics were similar between groups (age: 63 vs 61 p=0.15; Sex: 78.4% F vs 88.5% p=0.10). There were no significant differences in use of osteotomy, 3CO, and IBF between Loss and Maintained LL (all p >0.1). There was no significant difference in number of levels fused (11 vs 12 p=0.39), rod material (CoCr 59.4% vs 58.8% p=0.34), and BMP use (88.7% vs 84.6% p=0.41) but Loss had less supplemental rod use (5.8% vs 23.4% p=0.004). Comparison between Maintained and Loss revealed a similar PI-LL mismatch at pre-op (16.7±18.7 vs 20.9±18.3 p=0.14) and final postop (1.8±12.5 vs 5.1±14.5 p=0.11) but a significantly smaller PI-LL for Loss at early postop (0.6±12.8 vs -3.5±13.7 p=0.41). Distally, Maintained had a significant improvement in L4-S1 lordosis from preop to early postop (p=0.013), with no significant difference from early to final follow-up. In contrast, patients in the Loss group had no difference in L4-S1 from preop to early postop (p=0.14), but showed a significant loss of correction at 3 years (p <0.001). Proximally, significant increase between pre and early postop in L1-L4 (all p <0.001), with Loss and Maintained reaching similar early postop value (p=0.34). However, from early postop to final follow up, Loss showed a significant decrease in proximal lordosis (p <0.001) while Maintained did not (p=0.08), corresponding with a smaller absolute L1-L4 in the Loss cohort at 3 yrs (p=0.002). Screw orientation showed a significant decrease from early to late follow-up between the L1 and S1 screws for Loss (1.3±4.1 p=0.031), without any changes across the L4-S1 segment (-0.1±2.9 p=0.97). <h3>CONCLUSIONS</h3> Approximately a quarter of patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (ie, tulip/shank angle shifts and/or rod bending), but lost distally through bone "settling" through the instrumentation itself. The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Diabetes mellitus is associated with increased risk of positive qSOFA score but not with increased ICU admission in patients undergoing ureteral stent placement for ureteral stone and suspected infection.

Patients presenting with an obstructing ureteral stone and urinary tract infection (UTI) are at risk for severe infectious complications. Historically, diabetes mellitus (DM) was considered a risk factor for the development of septic shock in these patients. This study aimed to evaluate DM's impact on risk of septic shock in ureteral stent placement for ureteral stone and presumed UTI. An institutional review board-approved, retrospective review was performed at two institutions. All patients who met the following criteria from July 2016 to April 2020 were included in the study: emergency department visit with obstructing ureteral stone, concern for UTI, and ureteral stent placement. The primary outcome of interest was the development of postoperative septic shock defined by sepsis with hypotension requiring vasopressor support for at least one hour. The study cohort was made up of 187 patients. Median age was 61 (range 16-91). Males represented 40.1% (n=75) of the population, while DM was present in 26.2% (n=49). Thirty-five of 143 patients (18.7%) met the criteria for postoperative septic shock. Quick Sequential Organ Failure Assessment (qSOFA) criteria were met by 11 (22.4%) patients with DM compared to 13 (9.5%) of patients without DM (p=0.026). This difference did not translate into significant differences in use of vasopressors, with DM cohorts requiring pressors in 11 (22.4%), and 241 (17.5%) in non-DM (p=0.523). Purulent urine was more frequently described in patients with DM (22 [44.9%] vs. 342 [4.8%], p=0.011). Intensive care unit (ICU) admissions were similar between DM and non-DM at 13(27.1%) vs. 29 (21.2%), respectively (p=0.543). ICU stay and length of stay were similar between cohorts. In this multicenter study of patients who underwent ureteral stenting for ureteral stone and presumed UTI, DM was not associated with an increased risk of development of septic shock but was associated with an increased risk of positive qSOFA score.

Police, ambulance and psychiatric co-response versus usual care for mental health and suicide emergency callouts: A quasi-experimental study.

Mental health-related calls to emergency services made via 111 (New Zealand) or 000 (Australia) often represent critical junctures for the person in crisis. Traditionally, police, ambulance and mental health services work separately to manage such emergencies. Sequential agency responses may be protracted and cause escalation. This study tests multi-agency co-response aiming for more integrated, faster, safer and less coercive management of mental health crises. Immediate and 1-month outcomes of mental health emergency calls made to police and ambulance were compared according to whether they occurred on days with co-response availability. Outcomes measured included emergency department admission and waiting times, psychiatric admissions, compulsory treatment, use of force, detention in police cells and the time to resolution of the event. Relative risk estimates were constructed. A total 1273 eligible mental health emergency callouts occurred between March 2020 and March 2021 (38% coded 'mental health' emergencies, 48% suicide risk and 14% as 'other'), 881 on days with co-response availability and 392 on days without. Co-response interventions were resolved faster and were more likely to be community-based. Fewer than one-third (32%) led to emergency department admissions, compared with close to half (45%) on days without co-response (risk ratio: 0.7 [0.6, 0.8]). In the following month, the number of emergency department and mental health admissions reduced (p < 0.01 and 0.05, respectively). There were no statistically significant differences in use of force and few people were detained in police custody. Co-response intervention increased the likelihood of mental health crises being resolved in the community and reduced hospitalisations. Benefits were sustained at 1 month.

Psychometric properties of the French and English short form of the Protective Behavioural Strategies for Marijuana Scale in Canadian university students

BackgroundThe Protective Behavioural Strategies for Marijuana (PBSM-17) scale serves to identify and measure strategies employed by young adults before, during or after cannabis use. After the adaptation and translation of...

700 Use of Antibiograms and Changes in Bacterial Resistance Patterns

IntroductionInfection is a leading cause of death in burn patients. With an increase in resistance patterns, management of these infections has become progressively difficult. Antibiograms, a summary of susceptibilities to bacteria in a given institution or area, are often used to guide empiric treatment of infections. However, inappropriate prescribing and use of empiric antimicrobials may greatly impact the incidence of resistance. Currently, we do not know the patterns of antibiotic use since the introduction of institutional antibiograms or associated changes in antibiotic resistance. The objective of this study is to describe trends in antibiotic susceptibilities in burn patients in Canada pre- (PrA) and post-introduction (PoA) of antibiograms.MethodsWe performed a retrospective review of patients admitted to an ABA-verified Burn Centre 2 years pre- (2013-2014) and post-introduction (2016-2017) of institutional antibiograms and started on broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, and/or vancomycin).ResultsA total of 864 patients were admitted during the study period (n=420 PrA and n=444 PoA). Average age, % total body surface area (%TBSA), and length of stay were similar between cohorts. Administration of empiric meropenem increased (43.2% vs. 56.8%) and piperacillin-tazobactam decreased (60.6% vs. 39.4%), which was significant (p=0.002). The use of vancomycin was unchanged. There was a significant decrease in the overall use of empiric antibiotics (p=0.002) since the inception of antibiograms, with a significant improvement in culture and sensitivity (C&S) testing within 5 days of starting empiric antibiotics (p=0.002). There was no significant difference in use of targeted antibiotics pre- or post-antibiogram introduction.ConclusionsOur study demonstrates that since the inception of antibiograms, there has been a significant decrease in overall use of empiric antibiotics and improvement in acquiring C&S within 5 days. However, these antibiotics were not always targeted to the appropriate organism and therefore may contribute to multi-drug resistant organisms in a burn population.

Hypofractionated Radiotherapy for Breast Cancer: Findings From an International ESTRO-GIRO Survey

Hypofractionated radiotherapy (HF) for early breast cancer has been found to be equivalent to conventional fractionation (CF) in several large studies. More recently, accelerated HF regimens and HF in more advanced disease has been evaluated and adopted. Using data from the European Society of Radiation Oncology' (ESTRO) Global Impact of Radiotherapy in Oncology (GIRO) initiative survey on HF, this study aims to identify patterns, facilitators and barriers to uptake of breast cancer HF across World Bank income groups.The ESTRO-GIRO initiative administered an anonymous, electronic survey to radiation oncologists from January 2018 to January 2019. Details on physician demographics, clinical practice, preferred HF regimen for specific breast cancer clinical scenarios (curative and palliative), and justifications for HF practices were collected. Curative scenarios included: node-negative (N0) following breast-conserving surgery (BCS) and mastectomy, and node-positive (N+) following BCS and mastectomy. Palliative scenarios evaluated HF for symptom control. Factors associated with HF were assessed using multivariate logistic regression models.A total of 1,434 physicians responded to the breast survey scenarios, with 1251 (87%) from high-income (HICs) and upper middle-income countries (UMICs) and 183 (13%) from lower middle-income countries (LMICs). The most common HF fraction size was between 2.5 and 2.9 Gy delivered in a total of 15 fractions for curative indications (30%); only 1% of respondents reported using a 5-fraction regimen. For palliative indications, the most common HF fraction size was between 3 Gy and 3.5 Gy in 10 fractions (23%). In N0 disease following BCS, there was no significant difference in use of hypofractionation in LMICs compared to HICs and UMICs. Respondents in Africa were less likely to hypo fractionate compared to Europe (OR = 0.29 (0.12,0.69), P = 0.006) and those using Cobalt-60 were less likely to hypo fractionate (OR = 0.55 (0.37,0.84), P = 0.005). In the other curative scenarios, those in LMICs were more than twice as likely to hypo fractionate compared to those in HICs and UMICs. There were no differences in use of HF across income groups for palliative symptom control. Published evidence was the most cited justification for HF (89%) across income groups. Lack of advanced technology was cited as a barrier by 14% in LMICs, compared to 5% in HICs and UMICs.Patterns of HF for breast cancer varied across income groups for curative indications, with minimal uptake of accelerated regimens. Targeted interventions are needed to address barriers to HF and support evidence-based utilization.

Parental approaches for educating preschool children at home: evidence from Vietnam

ABSTRACT The role of parents in educating preschool children at home is inarguable. However, the strength or lightness of parents’ role in educating their child depends a lot on the way they used to educate him. The aim of this study was to explore the usage of parental education methods for preschool children at home. The cluster random sampling technique was used to select 586 survey participants. This study confirmed four groups of educational methods that were used by parents, including Group of verbal methods, Group of action-based methods, Group of motivation-making methods, and Group of disciplinary methods. Most of the method groups were practiced on the often level or more. Three out of four method groups were found to have significant differences in use among parents with different characteristics. The parental education level was a significant predictor of all method groups used for educating preschool children at home, whereas parental age was not a significant predictor for any of them.