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The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P =.014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P =.004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation. [ABSTRACT FROM AUTHOR]

Background: Optimal management after posterior cruciate ligament (PCL) injury remains an active area of research, as reconstruction is technically challenging and poses unique risks in the posterior knee. Studies have reported variable rates of complications. Purpose: To describe the rates of readmission, emergency department (ED) visits, and postoperative complications within 90 days of isolated PCL reconstruction (PCLR) in a large, national cohort to better understand the perioperative variables that influence a practitioner's decision of whether to pursue operative versus nonoperative management. Study design: Descriptive epidemiology study. Methods: PCLRs from January 1, 2010, through August 31, 2020, were identified in PearlDiver, a national administrative database. Patients with concomitant ligament surgery and those with fewer than 90 days of postoperative database activity were excluded. Deep vein thromboses, pulmonary embolisms, surgical site infections, compartment syndrome, and vascular events within 90 days of surgery were identified, as were 90-day readmissions and ED visits. Logistic regression models were built in PearlDiver to calculate odds ratios (ORs) for ED utilization. Results: The final cohort consisted of 1154 patients with isolated PCLR (mean age, 34 ± 16 years; 62% male). Most patients were located in the Southern United States (n = 417; 36.1%), and most had commercial insurance (n = 992; 86%). The 90-day rates of adverse events were as follows: deep vein thrombosis (13; 1.1%), pulmonary embolism (19; 1.6%), surgical site infection (<11; <1%), compartment syndrome (<11; <1%), vascular event (<11; <1%), readmission (13, 1.1%), and ED utilization (99; 8.6%). The majority of emergency department visits (52%) occurred in the first 2 weeks postoperatively. Predictive factors for ED utilization included Elixhauser Comorbidity Index score (OR = 1.31 per 2-point increase) and Medicaid insurance (OR = 2.03 relative to commercial insurance). Conclusion: The current study reported rates of adverse events after isolated PCLR in a large, national cohort. The results provide important context for decisions about optimal management of PCL injury. [ABSTRACT FROM AUTHOR]

Purpose: The construct of social participation is still not clearly defined. To reach a better understanding of social participation, the perspectives of adolescents must be taken into account. This study explores the adolescent concept of social participation and expands knowledge of the meaning of subjective components of the term. Methods: Thirty-four semi-structured interviews were conducted with adolescents with and without physical disabilities or chronic diseases between the ages of 12 and 17 and analyzed according to grounded theory. Results: Adolescents describe social participation as involving reflexive interaction with their social environment. Furthermore, forming a social environment plays an important role. All components of the concept are embedded in a context that influences the ways adolescents participate. Adolescents differentiate between active and passive forms of social participation. The concept of reflexive interaction is situated within an interdependent structure of components such as the "feeling of belonging" and the feeling of "well-being" among adolescents. Conclusion: The results expand the current state of knowledge regarding the theoretical differentiation of social participation by exploring subjective components of the term. This offers the possibility of supplementing the theoretical frameworks of social participation and supports the understanding of the critical importance of social participation for adolescents. [ABSTRACT FROM AUTHOR]

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services. [ABSTRACT FROM AUTHOR]

The neonatal intensive care unit (NICU) is a dynamic system with multiple stakeholders and contextual factors impacting the implementation of novel practices. This qualitative study aimed to (a) define health care professionals' perceptions on the feasibility of implementing a sensory intervention to study its efficacy, and (b) elaborate on transactions occurring between NICU health care professionals and the proposed research. Eleven NICU professionals participated in one of three focus groups that were audio-recorded, transcribed, and analyzed thematically in NVivo first descriptively and then interpretively through a transactionalism lens. The health care professionals implied the intervention was feasible, but provided multiple suggestions to enhance implementation. The modification of familiar occupational practices, ingrained habits, and the potential impact on the collective occupational performance of NICU community members arose. Understanding occupations within the NICU as transactional allows for a broader view of occupational engagement and enhances knowledge of the nuances related to implementing clinical changes. [ABSTRACT FROM AUTHOR]

Background: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. Research objective: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. Research design and participants: A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. Ethical considerations: After receiving ethics approval, signed informed consent was obtained from participants before data collection. Results: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. Discussion: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. Conclusion: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice. [ABSTRACT FROM AUTHOR]

Students with disabilities are one student group with elevated risk of sexual violence. Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 students with disabilities who experienced sexual violence focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. Students with disabilities who experienced or expected negative reactions (e.g., judgment) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or sexual violence services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for students with disabilities with sexual violence histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty. [ABSTRACT FROM AUTHOR]

Background: Optimal treatment of meniscal pathology continues to evolve in orthopaedic surgery, with a growing understanding of which patients benefit from which procedure and which patients might be best treated nonsurgically. In 2002, Moseley et al found no difference between arthroscopic procedures, including meniscal debridement and sham surgery, in patients with osteoarthritis of the knee. This called into question the role of routine arthroscopic debridement in these patients. Additionally, an increased interest in understanding and maintaining the function of the meniscus has more recently resulted in a greater focus on meniscal preservation procedures. Study Design: Descriptive epidemiology study. Purpose/Hypothesis: The purpose was to evaluate the trends of arthroscopic meniscal debridement and repair and the characteristics of the patients receiving these treatments, compare the differences in practice between newly trained orthopaedic sports medicine specialists and those of other specialties, and analyze if there are differences in practice by region. It was hypothesized that the American Board of Orthopaedic Surgery (ABOS) database would evaluate practice patterns of recent graduates as a surrogate for current treatment and training and, consequently, demonstrate a decreased rate of meniscal debridement. Methods: Data from ABOS Part II examinees from 2001 to 2017 were obtained from the ABOS Case List. Current Procedure Terminology (CPT) codes related to arthroscopic meniscal treatment were selected. The examination year, age of the patient, practice region, and examinee subspecialty were analyzed. Patient age was stratified into 4 groups: <30, 30 to 50, 51 to 65, and >65 years. Examinee subspecialty was stratified into sports medicine and non–sports medicine. Statistical regression analysis was performed. Results: Between 2001 and 2017, ABOS Part II examinees submitted 131,047 cases with CPT codes 29880 to 29883. Meniscal debridement volume decreased for all age groups during the study period, while repair increased. Sports medicine subspecialists were more likely than their counterparts to perform repair over debridement in patients aged younger than 30 years (P =.0004) and between 30 and 50 years (P =.0005). Conclusion: This study provides insights into arthroscopic meniscal debridement and repair practice trends among ABOS Part II examinees. Meniscal debridement is decreasing and meniscal repair is increasing. Younger patient age and treatment by a sports medicine subspecialty examinee are associated with a higher likelihood of repair over debridement. [ABSTRACT FROM AUTHOR]

Methamphetamine is one of the most frequently used drugs worldwide. In Germany, methamphetamine use has greatly increased in recent years, presenting the rehabilitative treatment system with new challenges. In this study, we identified deficits and possibilities for optimization in the field of medical rehabilitation. A total of 39 interviews and two focus groups with experts along the treatment course of methamphetamine users were conducted. Our analyses indicate that methamphetamine users are more difficult to treat compared with patients who consume other drugs. They are more likely to be associated with problematic characteristics and behaviors than other rehabilitants. Several health care deficits were revealed: too short rehabilitation treatment, no specific or differentiated therapy concepts, lack of capacity for education and vocational training, lack of outpatient options, and insufficient facilities for parents and children. Findings indicate that inadequate rehabilitation is being provided for methamphetamine users in Germany, indicating a need to adapt treatment for this group. [ABSTRACT FROM AUTHOR]

This study investigated key principal leadership skills associated with socially proactive school environments and examined the relationship between School-Wide Positive Behavior Support (SWPBS) implementation and increased evidence of those skills. Findings indicated the following: (a) certified staff members and principals from all schools rated the importance of each of the 31 skills as high; (b) principals in SWPBS schools received significantly higher ratings associated with behavior management effectiveness; and (c) principals from SWPBS and non-PBS schools received relatively equivalent ratings in regard to transformational and managerial skills. SWPBS-certified staff respondents indicated statistically significantly greater rates of job satisfaction than did those in non-PBS schools. Implications for future research are discussed. [ABSTRACT FROM PUBLISHER]

Background: The use of predifferentiated mesenchymal stem cells (MSC) leads to better histological results compared with undifferentiated MSC in sheep. This raises the need for a longer term follow-up study and comparison with a clinically established method.Hypothesis: We hypothesized that chondrogenic in vitro predifferentiation of autologous MSC embedded in a collagen I hydrogel leads to better structural repair of a chronic osteochondral defect in an ovine stifle joint after 1 year. We further hypothesized that resulting histological results would be comparable with those of chondrocyte-seeded matrix-associated autologous chondrocyte transplantation (MACT).Study Design: Controlled laboratory study.Methods: Predifferentiation period of ovine MSC within collagen gel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, 2 osteochondral lesions (7-mm diameter) were created at the medial femoral condyles of the hind legs in 9 sheep. Implantation of MSC gels was performed 6 weeks after defect creation. Thirty-six defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated MSC gels (pre-MSC gels), (2) undifferentiated MSC gels (un-MSC gels), (3) MACT gels, and (4) untreated controls (UC). Histological, immunohistochemical, and radiological evaluations followed after 12 months.Results: After 12 months in vivo, pre-MSC gels showed significantly better histological outcome compared with un-MSC gels and UC. Compared with MACT gels, the overall scores were higher for O’Driscoll and International Cartilage Repair Society (ICRS). The repair tissue of the pre-MSC group showed immunohistochemical detection of interzonal collagen type II staining. Radiological evaluation supported superior bonding of pre-MSC gels to perilesional native cartilage. Compared with previous work by our group, no degradation of the repair tissue between 6 and 12 months in vivo, particularly in pre-MSC gels, was observed.Conclusion: Repair of chronic osteochondral defects with collagen hydrogels composed of chondrogenically predifferentiated MSC shows no signs of degradation after 1 year in vivo. In addition, pre-MSC gels lead to partially superior histological results compared with articular chondrocytes.Clinical Relevance: The results suggest an encouraging method for future treatment of focal osteochondral defects without donor site morbidity by harvesting articular chondrocytes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be ‘stupid’ for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a new wavelet-based computer-assisted detection (CAD) system for detecting and enhancing microcalcifications.Material and Methods: A total of 280 mammograms acquired by full-field digital mammography (Senographe 2000D; G.E. Medical Systems Milwaukee, Wisc., USA) were analyzed with and without a new wavelet-based CAD system for detecting and enhancing microcalcifications. The mammograms comprised roughly equal numbers of cases from each of the BIRADS (Breast Imaging, Reporting and Data System, according to the American College of Roentgenology) categories 1-5. Histologic confirmation was available for all of the 180 cases assigned BIRADS categories 3-5. Four readers interpreted all 280 images for suspicious microcalcifications using a scale of 1-5. The readers alternately assessed 5 images with and 5 without CAD. In a second reading immediately following the first, the readers had to reassess the 280 mammograms. The images that had already been interpreted without CAD were now presented with CAD and vice versa. The images were interpreted as soft copies on a diagnostic mammography workstation (Image Diagnost GmbH, Neufahrn/Munich, Germany). All images interpreted with CAD were presented with enhancement of microcalcifications by wavelet algorithms and prompting of microcalcifications. ROC (receiver operating characteristic) analyses were performed, and image interpretation time with and without CAD was measured.Results: The overall time for interpretation required by all 4 readers together was 483 min with CAD compared to 580 min without CAD. ROC analysis revealed no significant advantage of CAD for the individual readers. Readers 3 (0.811/0.817) and 4 (0.799/0.843) had a slightly improved AUC (area under the curve) with CAD. Readers 1 and 2 had a slightly lower AUC with CAD (0.832 versus 0.861 and 0.818 versus 0.849).Conclusion: The CAD system significantly (P<0.05, t test) speeded up image interpretation with respect to the identification of microcalcifications, while the diagnostic quality remained almost identical under the study conditions. [ABSTRACT FROM AUTHOR]

This study examines predictors of abandonment of evidence-based practices through descriptive analyses of extant state-level training data, fidelity of implementation data, and nationally reported school demographic data across 915 schools in three states implementing school-wide positive behavioral interventions and supports (SWPBIS). Schools included in this study were tracked for a 5-year period after initial training, yet some elected to abandon SWPBIS at various times during implementation. Results showed that a small proportion of schools in the sample abandoned SWPBIS (7%). Logistic regression analysis identified school locale as the only statistically significant predictor of SWPBIS abandonment with schools located in cities being more likely to abandon. Results are discussed in terms of addressing types of schools at greater risk for abandonment and the importance of state-level training and coaching support. [ABSTRACT FROM AUTHOR]