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Background. There are many different haematological malignancy subtypes. Most follow chronic pathways that are uncertain and unpredictable, which may lead to feelings of anxiety and distress. The provision of information can ameliorate such difficulties, but patients are known to have unmet needs in this regard. The aim of this study is to explore experiences of information sharing among patients with chronic blood cancers and the factors impacting this process. Methods. The study is set within a UK cohort of blood cancer patients, where care is provided across 14 hospitals according to national clinical guidelines. Purposive sampling was used to identify expert participants (based on experience), and in-depth qualitative interviews were conducted with 35 patients, 10 with a relative present. The study was intended to inform practice and utilised qualitative description, with thematic content analysis and systematic data coding. Results. Experiences of information sharing varied. Most patients described this positively, but not all. Several barriers and facilitators were identified, which are discussed within five themes: (1) shock affects ability to process information, (2) the importance of time to facilitate information exchange, (3) personal relationships have an impact on meeting information needs, (4) HCP interpersonal skills are central to good information sharing, and (5) communication skills and terminology. Conclusions. Patients with chronic blood cancers prefer to engage in information sharing when they are not in a state of shock, and when they have adequate time to process material that is effectively and sensitively delivered, by HCPs they know and trust. [ABSTRACT FROM AUTHOR]

Background: Self-perception is an important internal resource, and violence exposure can negatively impact children's view of themselves. Although camp interventions can enhance self-perception, research has not yet examined whether camp interventions improve self-perception among children affected by family violence. Camp-based interventions promote health equity by addressing common barriers to service engagement. Objective: Using a non-masked, parallel randomized controlled design, this pilot study evaluated whether a camp-based intervention (i.e., Camp HOPE) enhanced self-perception among youth exposed to family violence. Method: Participants included 47 children aged 7–12 (M = 9.55, SD = 1.63; 79% Black/African American) and one of their adult caregivers seeking services from a Family Justice Center. Children were assigned to the camp (n = 23) or waitlist control (n = 24) condition using block randomization. Caregiver-child dyads completed evaluations at baseline, 2-month follow-up, and 5-month follow-up. Children reported on three self-perception domains: Social Competence, Behavioral Conduct, and Global Self-Worth (GSW). Piecewise latent growth curve models evaluated between-group differences in self-perception at 2- and 5-month follow-up. Results: Findings from intent-to-treat analyses indicated that Camp HOPE may have a temporary, negative impact on children's GSW (Diff. = − 2.65; SE = 1.22; p = 0.029; g = 0.63). Supplemental "as-treated" analyses revealed no significant differences between children who attended and did not attend the camp. Conclusions: Results are inconsistent with previous findings that camp interventions enhance self-perception, raising important questions about the unique experiences of youth exposed to family violence. Given these findings, Camp HOPE America might consider modifications to enhance effectiveness. [ABSTRACT FROM AUTHOR]

Objective. To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods. Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results. The database and secondary searches identified 516 articles. After removing duplicates and assessing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions. Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population. [ABSTRACT FROM AUTHOR]

The original 26‐item Self‐Compassion Scale (SCS; Neff, 2003) and 12‐item Short‐Form Self‐Compassion Scale (SF‐SCS; Raes et al., 2011) are scales commonly used in cross‐sectional and longitudinal research to assess the global self‐compassion construct and its six facets. We introduce the Single‐Item Self‐Compassion Scale (SISC; 'I have high self‐compassion') to measure the global self‐compassion construct in time‐, space‐ and resource‐limited contexts (e.g., daily diaries, experience sampling and nationally representative surveys). Additionally, the SISC will expand knowledge about self‐compassion by providing researchers whose primary interest is not self‐compassion with a convenient, face‐valid option to measure self‐compassion. Across 10 samples (four cross‐sectional, four longitudinal and two 7‐day daily diary; N = 2,477), we demonstrated that the SISC has acceptable psychometric properties. Specifically, the SISC was temporally consistent, correlated adequately with the SCS and SF‐SCS, exhibited nearly identical correlational patterns when compared with the SCS and SF‐SCS with a wide range of criterion measures (e.g., self‐esteem, personality, affective and social functioning, mental health and demographic variables) and saved 12 min over a 7‐day diary. Results replicated among students, community samples and across the United States, Turkey and Malaysia. Thus, we provide the field with an alternative measure of the global self‐compassion construct that complements the SCS and SF‐SCS. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems. Design: Longitudinal test–retest. Setting: Sports medicine clinic. Participants: Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury. Independent Variables: We grouped patients based on whether they reported sleep disturbances within 14 days of injury. Main Outcome Measures: Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits. Results: Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80). Conclusions: Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery. [ABSTRACT FROM AUTHOR]

To decrease opioid overdose mortality, prisons and jails in the US are increasingly offering medications for opioid use disorder (OUD) to incarcerated people. It is unknown how receipt of these medications in a correctional setting affects health services use after release. In this article we analyze changes in postrelease health care use after the implementation of a statewide medications for OUD program in the unified jail and prison system of the Rhode Island Department of Corrections. Using Medicaid claims data, we examined individual health care use in the community before and after receipt of medications for OUD while incarcerated. We found that inpatient admissions did not change, emergency department visits decreased, and both nonacute outpatient services and pharmacy claims increased after people received medications for OUD while incarcerated. There was no change in total health care costs paid by Medicaid. Our findings provide evidence that people's use of health care services paid for by Medicaid did not increase after they started medications for OUD in correctional settings. Given the frequent interaction of people with OUD with the criminal justice system, offering evidence-based treatment of OUD in correctional settings is an important opportunity to initiate addiction treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. Study design: Prospective repeated measures. Participants: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. Setting: Sport concussion clinic. Interventions: N/A. Main outcome measures: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. Results: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ² = 14.1, P = 0.001). Conclusions: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making. [ABSTRACT FROM AUTHOR]

11-17 Health outcomes research findings have had a major influence on changes in paediatric cancer therapy and have informed health-screening strategies of childhood cancer survivors. 7-10 Current understanding of late health outcomes in adult survivors of childhood cancer has largely been the result of a number of cohort studies that have been instrumental in identifying, quantifying and characterizing cancer treatment-related health risks. Robust characterization of health outcomes and cancer-, cancer treatmentand health behaviour-related exposures provide an unparalleled opportunity to identify novel associations and to refine our understanding of the effects of cancer and its treatment on the health of aging survivors. Whereas SJLIFE does not specify age at cancer diagnosis, SJCRH generally restricts acceptance to children<25 years of age at the time of cancer diagnosis. [Extracted from the article]

Background: The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame.Methods: We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls.Results: A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable.Conclusion: Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials. [ABSTRACT FROM AUTHOR]

Objective: To determine the test-retest correlation of an objective eye-tracking device among uninjured youth athletes. Design: Repeated-measures study. Setting: Sports-medicine clinic. Participants: Healthy youth athletes (mean age = 14.6 ± 2.2 years; 39% women) completed a brief, automated, and objective eye-tracking assessment. Independent variables: Participants completed the eye-tracking assessment at 2 different testing sessions. Main outcome measures: During the assessment, participants watched a 220-second video clip while it moved around a computer monitor in a clockwise direction as an eye tracker recorded eye movements. We obtained 13 eye movement outcome variables and assessed correlations between the assessments made at the 2 time points using Spearman's Rho (rs). Results: Thirty-one participants completed the eye-tracking evaluation at 2 time points [median = 7 (interquartile range = 6-9) days between tests]. No significant differences in outcomes were found between the 2 testing times. Several eye movement variables demonstrated moderate to moderately high test-retest reliability. Combined eye conjugacy metric (BOX score, rs = 0.529, P = 0.008), the variance of the ratio for both eye movements in the horizontal (rs = 0.497, P = 0.013) and vertical (rs = 0.446; P = 0.029) movement planes along the top/bottom of the computer screen, and the variance of the left and right eye movement along the bottom segment of the computer screen (rs = 0.565; P = 0.004) each demonstrated moderate between-test correlations. Conclusions: Automated and quantitative eye movement and conjugacy metrics provide relatively stable measurements among a group of healthy youth athletes. Thus, their inclusion as a visual tracking metric may be complementary to other visual examination techniques when monitoring concussion recovery across time. [ABSTRACT FROM AUTHOR]

Background: Concussion prognosis is a challenging clinical task. Identification of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to offer appropriate anticipatory guidance.Research Question: Can a multifaceted single/dual-task postural control assessment within one week of a diagnosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)?Methods: We conducted a prospective cohort study of youth and young adult athletes who were evaluated within 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prognostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI).Results: Sixty-six participants completed the study: 24% reported PPCS (mean age = 16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age = 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step variability (5.1 ± 1.4 vs. 4.0 ± 1.2 cm; p = 0.003) for the PPCS group relative to the no PPCS group. After multivariable modeling, dual-task transverse plane COM ROM (adjusted odds ratio = 1.34, 95% CI = 1.07, 1.68) and lateral step variability (adjusted odds ratio = 1.85, 95% CI = 1.13, 3.05) were significantly associated with PPCS.Significance: Dual-task transverse plane movement and lateral step variability demonstrate viable prognostic ability for PPCS among youth and young adult athletes and, along with other established factors, may add incremental value to PPCS prognosis models. [ABSTRACT FROM AUTHOR]

Context: The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective: To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design: Descriptive laboratory study. Setting: Sports injury-prevention center. Patients or Other Participants: Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s): Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s): Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results: Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single- task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r= .627; dual-task r= 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions: Tandem gait outcome measures demonstrat¬ed high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time. [ABSTRACT FROM AUTHOR]

Aims: This study reports on the Exeter-Trident total hip arthroplasty (THA) using an alumina ceramic-on-ceramic bearing with 10-year clinical and radiographic follow-up. Patients and methods: Between January 2001 and January 2006, 275 THAs were performed. Mean age at surgery was 52.7 (17–86) years, with 84 patients (33.6%) aged <50 years. The primary outcome was all-cause construct survival at minimum 10 years. Secondary outcomes included functional and noise scores. Radiographs were compared between baseline and latest follow-up and assessed for component loosening, migration and lysis. Results: No patient was lost to follow-up. Mean follow-up for surviving patients was 12.5 (9.5–15.6) years. Kaplan-Meier survival for all-cause revision was 94.0% (95% CI, 90.5–97.5) at 14.3 years. 2 patients had a femoral component fracture. All scores improved significantly at latest follow-up. HSS-NQ for 247 hips (90.2%) at mean 9.1 (7.0–14.4) years post implantation showed most hips (93.1%) reported no more than occasional noise. At minimum 5 years, radiolucency around the acetabular component was observed in 2 hips (0.8%), and lysis at the interface in 1 hip (0.4%). On the femoral side, endosteal lysis was observed in 7 hips. Conclusions: The Exeter-Trident THA with alumina ceramic-on-ceramic bearings performed well in this population. Patients are at low risk of revision in the first decade. However, there is a small risk of stem fracture as a late complication and some patients experience significant noise. [ABSTRACT FROM AUTHOR]

Background: Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control.Methods: Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we used logistic regression models adjusted for sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications.Results: Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated.Conclusions: Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).Methods: Using the 2015-2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate.Results: 269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16% vs. 0.43%; P < 0.001) and strictures (0.19% vs. 0.33%; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64% vs. 1.16%; P = 0.004) with no statistically different results for the other's outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52% vs. 0.92%; P = 0.01), renal complications (0.16% vs. 0.38%; P = 0.004), and venous thromboembolism (0.24% vs. 0.52%; P = 0.02).Conclusions: Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB. [ABSTRACT FROM AUTHOR]

Research in the USA provides evidence that neighbourhood conditions affect intergenerational mobility. However, what remains unclear is the extent to which the US context is unique in producing this influence. To examine this question, the present study directly compares neighbourhood effects on intergenerational mobility in the USA versus those in Germany – a country whose housing market and social welfare policies differ significantly from those in the USA. Results provide a blueprint for conducting cross-national neighbourhood effects studies and illuminate how the nature and severity of neighbourhood effects are nationally specific. These findings underscore the importance of considering how broader political contexts shape neighbourhood effects on intergenerational mobility – a consideration that has implications for proposed policy interventions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the time required for antimicrobial stewardship (AS) activities at a small community hospital (SCH) as well as barriers to remote AS to satisfy The Joint Commission (TJC)'s AS standard. Methods: This was a prospective chart review and time study conducted in patients identified by a clinical decision support application as potential opportunities for antimicrobial therapy modification at a SCH between December 12, 2016, and March 31, 2017. Potential interventions were communicated electronically to the clinical pharmacy specialist, who would then communicate the recommendations to the patient's provider. The primary endpoint was a time study for stewardship activities. Secondary endpoints included describing barriers encountered to remote AS as well as a cost-benefit analysis of remote AS. Results: The time study revealed an average of 11 alerts per day, 9 chart reviews per day, 8 interventions per day, and 5 minutes per chart. Seven hundred twenty-four alerts were evaluated with the most common alerts constituting opportunities for de-escalation (29%), targeted drugs (22%), positive blood cultures (18%), Intravenous (IV) to oral (PO) (17%), and antimicrobial renal monitoring (8%).Interventions were accepted (11%), accepted modified (6%), rejected (35%), or undetermined (48%). Barriers to implementation included workflow and indirect communication. For patients with accepted interventions, there was an average savings of $279.82 per patient in pharmacy charges. Conclusion: Through remote AS, a SCH can have an antimicrobial stewardship program that is in compliance with the basic elements of the TJC standard MM.09.01.01, performs daily chart review by an infectious diseases trained pharmacist to increase the quality of patient care, and achieves a mean savings of $279.82 in pharmacy charges and $1,126.26 in hospital charges per patient with accepted interventions. [ABSTRACT FROM AUTHOR]

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 ±2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL. We assessed QOL using patient-reported Pediatric Quality of Life Inventory 4.0, and symptoms using the Health and Behavior Inventory (HBI). Acute (<2 days post-injury) HBI ratings demonstrated a low correlation (R2 = 0.08) with physical health QOL and a moderate correlation with psychosocial health QOL (R2 = 0.21) 30 days post-concussion. HBI ratings 30 days post-concussion demonstrated a moderately high correlation with physical health QOL (R2 = 0.35) and psychosocial health QOL (R2 = 0.57). Age was not significantly associated with physical or psychosocial QOL ratings. Impairments in QOL following concussion may identify children and adolescents who need additional referral to address persistent symptoms at this time. [ABSTRACT FROM AUTHOR]

Purpose: We report the six year implant survivorship, tibial component alignment and knee and limb function measured by the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index ((WOMAC) score after kinematically aligned total knee arthroplasty (TKA) and tested the hypothesis that varus alignment of the tibial component, knee, or limb does not adversely affect implant survival and function.Methods: We prospectively followed 214 consecutive patients (219 knees) treated with a kinematically aligned TKA in 2007. Kaplan-Meier survival analysis and revision rate per 100 component years determined implant failure. The Oxford Knee Score (0 worst, 48 best) and WOMAC score (0 worst, 100 best) were used to measure function. We categorised tibial component alignment as in-range (≤ 0°) or varus (>0°), knee alignment as in-range (between -2.5° and -7.4°), varus (>-2.5°), or valgus (<-7.4°), and limb alignment as in-range (0° ± 3°), varus (>3°) or valgus (<-3°).Results: At a mean of 6.3 years (range, 5.8-7.2), implant survivorship was 97.5 % and revision-rate per 100 component years 0.40. Three implants had been revised (deep infection one, loose tibial component one and patella instability [1); two loose patella components were pending revision and considered failures. The average Oxford Knee Score was 43 and WOMAC 91. Function of tibial components (80 %), knees (31 %) and limbs (7 %) that were aligned in varus was similar to patients aligned in-range.Conclusions: At a mean of 6.3 years after kinematically aligned TKA, varus alignment of the tibial component, knee and limb did not adversely affect implant survival or function, which supports the consideration of kinematic alignment as an alternative to mechanical alignment for performing primary TKA. Level of evidence, III; therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: The QuickDASH is a valid and reliable outcome measure widely used to assess the function and pain in arm, shoulder, and hand disabilities. A recent study introduced a QuickDASH 80% cut point test to gauge patients at risk of poor outcomes. However, the utility of this test has not been validated.Purpose: To determine typical QuickDASH scores for three upper limb conditions and to test the sensitivity and specificity of the QuickDASH 80% cut point test in predicting patients at risk of poor outcomes.Methods: This is a retrospective study with a total of 406 patient records for whom QuickDASH scores were examined. The sensitivity and specificity of the QuickDASH 80% cut point test was investigated for three acute upper limb conditions seen in hand therapy: surgical distal radius fracture, nonsurgical lateral epicondylitis, and carpal tunnel release.Results: Typical scores were determined for three upper limb conditions. The QuickDASH 80% cut point test per upper limb condition returned poor sensitivity between 28.57% and 41.67%.Conclusion: The results did not support the QuickDASH 80% cut point test as a predictor of final outcome in these three patient populations. Patients with the worse initial 20% scores were not correctly classified as worse 20% final scores. This study provides summary data from three upper limb conditions to provide clinicians with comparison data to establish goals and educate patients. [ABSTRACT FROM AUTHOR]

Introduction: Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). Methods: We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup. Recommended workup included brain imaging, vascular imaging, cardiac monitoring, and observation. Patients were included if clinical providers determined the need for workup for TIA. We included consecutive patients presenting during a six-month period prior to protocol implementation, and those presenting between 6-12 months after implementation. Outcomes included ED length of stay (LOS), hospital LOS, use of neuroimaging, and 90-day risk of stroke or TIA. Results: From 01/2012 to 06/2012, 130 patients were evaluated for TIA symptoms in the ED, and from 01/2013 to 06/2013, 150 patients. The final diagnosis was TIA or stroke in 45% before vs. 41% after (p=0.18). Following the intervention, the inpatient admission rate decreased from 62% to 24% (p<0.001), median ED LOS decreased by 1.2 hours (5.7 to 4.9 hours, p=0.027), and median total hospital LOS from 29.4 hours to 23.1 hours (p=0.019). The proportion of patients receiving head computed tomography (CT) went from 68% to 58% (p=0.087); brain magnetic resonance (MR) imaging from 83% to 88%, (p=0.44) neck CT angiography from 32% to 22% (p=0.039); and neck MR angiography from 61% to 72% (p=0.046). Ninety-day stroke or recurrent TIA among those with final diagnosis of TIA was 3% for both periods. Conclusion: Implementation of a TIA protocol significantly reduced ED LOS and total hospital LOS. [ABSTRACT FROM AUTHOR]

To better understand factors influencing spiritual care during critical illness, we examined the use of spiritual care in patients hospitalized with intracerebral hemorrhage (ICH), a frequently disabling and fatal disease. Specifically, the study was designed to examine which demographic and clinical characteristics were associated with chaplain visits to critically ill patients. The charts of consecutive adults (>18) with spontaneous ICH presenting to a single academic medical center between January 2014 and September 2015 were reviewed. Chaplains visited 86 (32%) of the 266 patients. Family requests initiated the majority of visits (57%). Visits were disproportionately to Catholic patients and those with more severe injury. Even among Catholics, 28% of those who died had no chaplaincy visit. Standardized chaplaincy screening methods and note templates may help maximize access to spiritual care and delineate the religious and spiritual preferences of patients and families. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to prospectively examine the association between intracortical inhibition and functional recovery after mild traumatic brain injury (mTBI). Methods: Twenty individuals with mTBI and 20 matched control participants were assessed using transcranial magnetic stimulation, the Attentional Network Test, and gait analysis. Hierarchical linear modeling was used to longitudinally examine potential differences between groups and relationships in the pattern of recovery in cortical silent period (CSP) duration, cognitive reaction time, and single- and dual-task walking speeds across five testing time points. Individuals with mTBI were assessed within 72 h of injury, and again at 1 wk, 2 wk, 1 month, and 2 months postinjury. After initial testing, control participants followed a similar timeline. Results: At the 72-h time point, the group with mTBI had longer reaction time (b = -91.76, P = 0.01), similar single-task walking speed (b = 0.055, P = 0.10), and slower dual-task walking speed (b = 0.10, P = 0.012) compared with control participants. The CSP duration also tended to be longer in individuals with mTBI than controls at the 72-h time point (b = -16.34, P = 0.062). The change is CSP duration over time was not significantly associated with the change in reaction time (b = -0.19, P = 0.47), single-task walking speed (b = 0.0001, P = 0.53), or dual-task walking speed (b < 0.001, P = 0.68). Conclusion: Although cognitive and motor functions were significantly impaired in the mTBI group acutely after injury, levels of intracortical inhibition were not associated with recovery in either functional domain. [ABSTRACT FROM AUTHOR]

Objectives. To assess the impact of CVS Health's discontinuation of tobacco sales on cigarette purchasing. Methods. We used households' purchasing data to assess rates at which households stopped cigarette purchasing for at least 6 months during September 2014 to August 2015 among 3 baseline groups: CVS-exclusive cigarette purchasers, CVS+ (CVS and other retailers), and other-exclusive (only non-CVS retailers). In state-level analyses using retailers' point-of-sale purchase data, an interrupted time series compared cigarette purchasing before (January 2012 to August 2014) and after (September 2014 to April 2015) tobacco removal in 13 intervention states with CVS market share of at least 15% versus 3 control states with no CVS stores. Results. Compared with other-exclusive purchasers, CVS-exclusive purchasers were 38% likelier (95% confidence interval = 1.06, 1.81) to stop cigarette purchasing after tobacco removal. Compared with control states, intervention states had a significant mean decrease of 0.14 (95% confidence interval = 0.06, 0.22) in packs per smoker per month. Conclusions. After CVS's tobacco removal, household- and population-level cigarette purchasing declined significantly. Private retailers can play a meaningful role in restricting access to tobacco. This highlights one approach to reducing tobacco use and improving public health. (Am J Public Health. [ABSTRACT FROM AUTHOR]

People differ in their openness to different types of information and some information may evoke greater avoidance than does other information. We developed an 8-item measure of people's tendency to avoid learning information. The flexible instrument can function as both a predictor and outcome measure. The results from 4 studies involving 7 samples and 4,393 participants reveal that scores on the measure are generally internally consistent, remain relatively stable across time, and correlate modestly with measures of similar constructs and with avoidance behavior. The measure is adaptable to a variety of types of information (e.g., health outcomes, attractiveness feedback) and is internally consistent in several distinct populations (e.g., high school students, college students, U.S. adults, low-socioeconomic-status adults). Discussion centers on potential uses for the scale and an online supplement discusses a 2-item version of the scale. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Matched control data are commonly used to examine recovery from concussion. Limited data exist, however, examining dual-task gait data consistency collected over time in healthy individuals. The study purposes were to: 1) assess the consistency of single-task and dual-task gait balance control measures, 2) determine the minimal detectable change (MDC) of gait balance control measures, and 3) examine the extent to which age and task complexity affect dual-task walking costs in healthy adolescents and young adults. Twenty-four adolescent (mean age=15.5±1.1years) and 21 young adult (mean age=21.2±4.5years) healthy participants completed 5 testing sessions across a two-month period, which involved analyses of gait balance control and temporal-distance variables during single-task and dual-task walking conditions in a motion analysis laboratory. Cronbach's α and MDCs were used to determine the consistency of the gait balance control variables and the smallest amount of change required to distinguish true performance from change due to the performance/measurement variability, respectively. Dual-task costs were evaluated to determine the effect of task complexity and age across time using 3-way ANOVAs. Good to excellent test-retest consistency was found for all single-task and dual-task walking (Cronbach's α range: 0.764-0.970), with a center-of-mass medial-lateral displacement MDC range of 0.835-0.948cm. Greater frontal plane dual-task costs were observed during more complex secondary tasks (p<0.001). The results revealed good-excellent consistency across testing sessions for all variables and indicated dual-task costs are affected by task complexity. Thus, healthy controls can be effective comparators when assessing injured subjects. [ABSTRACT FROM AUTHOR]

Background: Kinematically aligned TKA restores function by aligning the femoral and tibial components to the normal or prearthritic joint lines of the knee. However, aligning the components to the joint lines of the normal knee also aligns the tibial component in varus, creating concern that varus alignment might result in poor function and early catastrophic failure. Questions/Purposes: We therefore determined whether function and the incidence of catastrophic failure were different when the tibial component, knee, and limb alignment were in a specified normal range, varus outlier, or valgus outlier. Methods: We prospectively followed all 198 patients (214 knees) who underwent TKAs between February and October 2008. We treated each knee in this cohort of patients with a kinematically aligned, cruciate-retaining prosthesis implanted using patient-specific guides. From a long-leg scanogram, we measured and categorized alignment of the tibial component as in range (≤ 0°) or a varus outlier (> 0°), alignment of the knee as in range (between −2.5° to −7.4° valgus) or a varus (> −2.5°) or valgus (< −7.4°) outlier, and alignment of the limb as in range (0° ± 3°) or a varus (> 3°) or valgus (< −3°) outlier. We assessed function using the Oxford Knee Score and WOMAC™ score, and reported catastrophic failure as the incidence of revision attributable to loosening, wear, and instability of the femoral or tibial components. The minimum followup was 31 months (mean, 38 months; range, 31-43 months). Results: The mean Oxford Knee Score of 43 and WOMAC™ score of 92 were similar between the three alignment categories. The incidence of catastrophic failure in each alignment category was zero. Conclusions: Kinematically aligned TKA restores function without catastrophic failure regardless of the alignment category. Because 75% of patients had their tibial component categorized as a varus outlier and also had high function and a zero incidence of catastrophic failure, the concern that kinematic alignment compromises function and places the components at a high risk for catastrophic failure is unfounded and should be of interest to surgeons committed to cutting the tibia perpendicular to the mechanical axis of the tibia. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. Purpose: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. Study Design: Cohort study; Level of evidence, 2. Methods: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. Results: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. Conclusion: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms. [ABSTRACT FROM AUTHOR]

Objective:Self-affirming – such as by reflecting on one’s strengths and values – reduces defensiveness to threatening information, reduces negative effects of stereotype threat and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts. Design:Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2731 respondents. Main Outcome Measures:Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking and engagement in medical research. Results:Spontaneous self-affirmation was associated with more positive perceptions of communication with one’s provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself and multiple indices of surrogate information seeking (i.e. seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient–provider relationship were not modified by factors likely to be associated with stereotype threat (e.g. race or BMI). Conclusion:Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations. [ABSTRACT FROM PUBLISHER]

Objective: There is a considerable body of research linking elements of Leventhal's Common Sense Model (CSM) to emotional well-being/distress outcomes among people with physical illness. The present study aims to consolidate this literature and examine the evidence for the role of coping strategies within this literature.Methods: A systematic review was conducted where the outcomes of interest were: depression, anxiety and quality of life. A total of 1050 articles were identified and 31 articles were considered eligible to be included in the review.Results: Across a range of illnesses, perceptions of consequences of the illness and emotional representations were consistently the illness perceptions with the strongest relationship with the outcomes. Coping variables tend to be stronger predictors of outcomes than the illness perception variables. The evidence for the mediating effect of coping was inconsistent.Conclusions: Illness perceptions and coping have an important role to play in the explanation of distress outcomes across a range of physical health conditions. However, some clarity about the theoretical position of coping in relation to illness perceptions, and further longitudinal work is needed if we are to apply this information to the design of interventions for the improvement of psychological health among people with physical health conditions. [ABSTRACT FROM AUTHOR]

Recent work has identified deficits in dual-task gait balance control for up to 2 months after adolescent concussion; however, how resumption of preinjury physical activities affects recovery is unknown. Purpose: The objective of this study is to examine how return to activity (RTA) affects recovery from concussion on measures of symptom severity, cognition, and balance control during single-task and dual-task walking. Methods: Nineteen adolescents with concussion who returned to preinjury activity within 2 months after injury and 19 uninjured, matched controls completed symptom inventories, computerized cognitive testing, and single-task and dual-task gait analyses. Concussion participants were assessed at five time points: within 72 h, 1 wk, 2 wk, 1 month, and 2 months postinjury. Control participants were assessed at the same time points as their matched concussion counterparts. RTA day was documented as the postinjury day in which physical activity participation was allowed. The effect of returning to physical activity was assessed by examining the percent change on each dependent variable across time before and directly after the RTA. Data were analyzed by two-way mixed effects ANOVAs. Results: After the RTA day, concussion participants significantly increased their total center-of-mass medial/lateral displacement (P = 0.009, ƞp2 = .175) and peak velocity (P = 0.048, ƞp2 = 0.104) during dual-task walking when compared with pre-RTA data, whereas no changes for the concussion group or between groups were detected on measures of single-task walking, forward movement, or cognition. Conclusions: Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA, suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery. [ABSTRACT FROM AUTHOR]

Background: Age has been described as a factor that affects recovery after concussion. The recommended management protocol is to treat adolescents in a more cautious manner than adults. However, few studies have prospectively and longitudinally assessed the way these age groups perform on motor tasks after concussion. Purpose: To examine dual-task gait balance control deficits after concussion in a group of adolescents and young adults in reference to matched control subjects within 72 hours of injury and throughout 2 months after injury. Study Design: Cohort study; Level of evidence, 2. Methods: Adolescents and young adults who sustained a concussion and individually matched controls completed a whole-body motion gait analysis while simultaneously performing a cognitive task. Subjects with concussion reported to the laboratory within 72 hours after injury and at the following time points: 1 week, 2 weeks, 1 month, and 2 months after injury. Control subjects completed the same protocol at similar time points. Gait balance control measurements included whole-body center-of-mass (COM) medial-lateral displacement/velocity and anterior velocity. Results: A total of 38 subjects with concussion, 19 young adults (mean ± SD age, 20.3 ± 2.4 years) and 19 adolescents (mean ± SD age, 15.1 ± 1.1 years), and 38 individually matched control subjects were tested. Within 72 hours of injury, adolescents displayed significantly greater COM medial-lateral displacement (P = .001) and peak velocity (P = .001) relative to their control group, and the young adult concussion group displayed significantly less peak COM anterior velocity than their control group (P = .01). Across the 2 months of testing, adolescents with concussion displayed significantly greater total COM medial-lateral displacement than did adolescent controls (P = .001), while young adults with concussion did not significantly differ from their matched controls (P = .07). Conclusion: An examination of gait balance control during dual-task walking revealed that after concussion, in reference to matched controls, adolescents demonstrated greater gait balance control deficits than did young adults initially and throughout the 2-month postinjury period, supporting the recommendation of conservative management for adolescents after concussion. [ABSTRACT FROM AUTHOR]

Little research has examined the developmental course of posttraumatic stress symptoms (PTSS) in children. The current study aimed to identify developmental trajectories of PTSS in childhood and to examine predictors of symptom presentation in 1,178 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a consortium of studies focusing on the causes and effects of child maltreatment. Most children had a history of documented reports with Child Protective Services (CPS) and all were identified as living in high-risk environments. Using group-based trajectory modeling, 3 unique developmental trajectories were identified: Resilient, Clinical-Improving (PTSS in the clinical range at baseline then declining over time), and Borderline-Stable (chronically subclinical PTSS). Children in the Clinical-Improving group were more likely than children in the Resilient group to have reports of physical abuse (RRR = 1.76), emotional abuse (RRR = 2.55), neglect (RRR = 1.57), and exposure to violence at home and in the community (RRR = 1.04). Children in the Borderline-Stable group were more likely than children in the Resilient group to have a CPS history of neglect (RRR = 2.44) and exposure to violence at home and in the community (RRR = 1.04). Many children living in high-risk environments exhibit resilience to PTSS, but exposure to witnessed violence and neglect appear to put children at chronic risk for poor adjustment. These children may require more intensive, integrated clinical services that attend to multiple adverse experiences. [ABSTRACT FROM AUTHOR]

The current study examined psychosocial predictors of change in intercourse frequency and number of sexual partners among youth within a socio-ecological framework and assessed whether these determinants vary by stage of adolescent development. Longitudinal data were derived from a large, community study of adolescent risky behavior among predominantly high-risk, African American youth. Significant predictors of intercourse frequency for early adolescents included age, gender, self-worth, and familial factors; for older youth, age, gender, self-worth, curfews, and sense of community exerted significant effects. Among early adolescents, age, gender, self-worth, familial factors, and sense of community predicted change in the number of sexual partners in the previous year, while age, gender, self-worth, parental knowledge, curfews, and sense of community were predictive of change in the number of sexual partners in the previous year among older youth. Study implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Varus alignment of the tibial baseplate and limb > 3° might adversely affect baseplate fixation after total knee arthroplasty (TKA), especially for unrestricted kinematically aligned (KA) TKA which aligns a majority of baseplates in varus. The purposes of this study were to determine whether baseplate migration at 1 year (1) was significantly less than a stability limit of 0.5 mm, (2) increased over time, and (3) was related to varus alignment of the baseplate and limb after unrestricted KA TKA. Methods: Thirty-five patients underwent unrestricted KA TKA using a fixed-bearing, cemented, medial conforming tibial insert with posterior cruciate ligament retention. Using model-based radiostereometric analysis, maximum total point motion (MTPM) (i.e., largest displacement on the baseplate) was computed at 6 weeks, 3 months, 6 months, and 1 year postoperatively relative to the day of surgery. Baseplate and limb alignment were measured postoperatively on long-leg CT scanograms. Results: At 1 year, mean MTPM of 0.35 mm was significantly less than the 0.5 mm stability limit (p = 0.0002). Mean MTPM did not increase from 6 weeks to 1 year (p = 0.3047). Notably, 89% (31/35) of tibial baseplates and 46% (16/35) of limbs were > 3° varus. Baseplate and limb alignment had no relationship to MTPM at 1 year (|r|≤ 0.173, p ≥ 0.3276). Conclusion: Low and non-progressive tibial baseplate migration 1 year after unrestricted KA TKA with a medial conforming design should allay any concern that unrestricted KA TKA increases risk of baseplate loosening due to varus alignment of the baseplate and limb. Level of evidence: Level II, therapeutic prospective cohort study. [ABSTRACT FROM AUTHOR]

In spite of the experiential advantage, people consume material items in the pursuit of happiness. We conducted three studies to determine if people commit forecasting errors when deciding between purchasing life experiences and material items. Study 1a showed that people expect life experiences to result in more well-being, whereas material items are forecasted to be a better use of money. However, Study 1b demonstrated that people enjoy greater well-being from life experiencesandconsider them to be a better use of money. Study 2, a four-week longitudinal study, corroborated this economic misforecast. Study 3 demonstrated that seeking to make good use of one’s money, compared to prioritizing happiness, is more important during material consumption, and when people attempt to maximize economic value, instead of their happiness, they are more likely to consume material items. We suggest that prioritizing value may encourage people to prefer material items instead of life experiences. [ABSTRACT FROM PUBLISHER]

The presence of threat and self-blame in children exposed to violence in the home has been linked to a number of negative behavioral and emotional consequences across developmental periods. Little research, however, has examined self-reported attributions of threat and self-blame in children under the age of 6. The current study evaluated the developmental trajectories of appraisals of threat and self-blame in preschool-aged children recently exposed to intimate partner violence. It was hypothesized that (a) children’s appraisals of threat and self-blame would naturally decrease over time and (b) there would be a main effect of child sex on appraisals of self-blame but not threat, such that girls would report higher levels of self-blame than boys. Participants included 68 preschool-aged children (ages 4-6) who were interviewed at two time points over the course of 1 year. Multilevel modeling was employed to examine the effects of violence exposure, child age, and child sex over time. Children’s attributions of threat were stable over the course of 1 year, but greater child age was related to lower appraisals of threat. Children’s appraisals of self-blame increased over time, and there was a trend for girls to report more self-blame than did boys. It appears that without intervention, young children may be at risk of developing relatively stable maladaptive cognitive patterns, thereby heightening their risk of subsequent developmental psychopathology. Furthermore, girls may need additional intervention targeted at addressing attributions of self-blame. [ABSTRACT FROM PUBLISHER]

Objective. The aim of the present study was to assess the suitability of emergency department (ED) discharge diagnosis for identifying patient cohorts included in the definitions of key performance indicators (KPIs) that are used to evaluate ED performance. Methods. Hospital inpatient episodes of care with a principal diagnosis that corresponded to an ED-defined KPI were extracted from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) for the year 2010-2011. The data were then linked to the corresponding ED patient record and the diagnoses applied in the two settings were compared. Results. The asthma and injury cohorts produced favourable results with respect to matching the QHAPDC principal diagnosis with the ED discharge diagnosis. The results were generally modest when the QHAPDC principal diagnosis was upper respiratory tract infection, poisoning and toxic effects or a mental health diagnosis, and were quite poor for influenza. Conclusions. There is substantial variation in the capture of patient cohorts using discharge diagnosis as recorded on Queensland Hospital Emergency Department data. [ABSTRACT FROM AUTHOR]

OBJECTIVES Prediction of operative risk in adult patients undergoing cardiac surgery remains a challenge, particularly in high-risk patients. In Europe, the EuroSCORE is the most commonly used risk-prediction model, but is no longer accurately calibrated to be used in contemporary practice. The new EuroSCORE II was recently published in an attempt to improve risk prediction. We sought to assess the predictive value of EuroSCORE II compared with the original EuroSCOREs in high-risk patients. METHODS Patients who underwent surgery between 1 April 2006 and 31 March 2011 with a preoperative logistic EuroSCORE ≥10 were identified from prospective cardiac surgical databases at two European institutions. Additional variables included in EuroSCORE II, but not in the original EuroSCORE, were retrospectively collected through patient chart review. The C-statistic to predict in-hospital mortality was calculated for the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II models. The Hosmer–Lemeshow test was used to assess model calibration by comparing observed and expected mortality in a number of risk strata. The fit of EuroSCORE II was compared with the original EuroSCOREs using Akaike's Information Criterion (AIC). RESULTS A total of 933 patients were identified; the median additive EuroSCORE was 10 (interquartile range [IQR] 9–11), median logistic EuroSCORE 15.3 (IQR 12.0–24.1) and median EuroSCORE II 9.3 (5.8–15.6). There were 90 (9.7%) in-hospital deaths. None of the EuroSCORE models performed well with a C-statistic of 0.67 for the additive EuroSCORE and EuroSCORE II, and 0.66 for the logistic EuroSCORE. Model calibration was poor for the EuroSCORE II (chi-square 16.5; P = 0.035). Both the additive EuroSCORE and logistic EuroSCORE had a numerically better model fit, the additive EuroSCORE statistically significantly so (difference in AIC was −5.66; P = 0.017). CONCLUSIONS The new EuroSCORE II does not improve risk prediction in high-risk patients undergoing adult cardiac surgery when compared with original additive and logistic EuroSCOREs. The key problem of risk stratification in high-risk patients has not been addressed by this new model. Future iterations of the score should explore more advanced statistical methods and focus on developing procedure-specific algorithms. Moreover, models that predict complications in addition to mortality may prove to be of increasing value. [ABSTRACT FROM PUBLISHER]

Context: Early physical activity (PA) after concussion may promote symptom resolution. Prior studies have investigated exercise frequency/duration, yet precise PA intensity or volume required for optimal recovery requires further investigation. moderate to vigorous physical activity (MVPA) is beneficial for physical health. We investigated whether sedentary time, light activity time, MVPA time, or activity frequency in the weeks following concussion are associated with time to symptom resolution among adolescents. Design: Prospective cohort study. Methods: Adolescents 10–18 years of age were tested ≤14 days of concussion and followed until symptom resolution. At the initial visit, participants rated symptom severity and were provided wrist-worn activity trackers to monitor PA for the following week. PA behavior was categorized each day based on heart rate: sedentary (resting), light PA (50%–69% age-predicted max heart rate), and MVPA (70%–100% age-predicted max heart rate). Symptom resolution was defined as the date when participants reported cessation of concussion-like symptoms. Patients were not given specific PA instructions, though some may have received instructions from their physician. Results: Fifty-four participants were included in the study (54% female; mean age = 15.0 [1.8] y; initially assessed 7.5 [3.2] d after concussion). Female athletes recorded more sedentary time (900 [46] vs 738 [185] min/d; P =.01; Cohen d = 0.72), and less time in light PA (194.7 [64.5] vs 224 [55] min/d; P =.08; Cohen d = 0.48) and MVPA (23 [17] vs 38 [31] min/d; P =.04; Cohen d = 0.58) than male athletes. After adjusting for sedentary time, hours per day with >250 steps, sex, and initial symptom severity, more MVPA time was associated with faster symptom resolution time (hazard ratio = 1.016; 95% confidence interval, 1.001–1.032; P =.04). Conclusion: Our findings offer preliminary insight into how varying PA intensities affect concussion recovery, as MVPA may be a higher intensity than what is typically prescribed in concussion care. [ABSTRACT FROM AUTHOR]

Background: Head trauma in adolescents has been linked with deficits in attention and executive function that can compromise the performance of everyday tasks. Although previous research has examined this issue using computerized neuropsychological testing, little work has been done using laboratory-based measurements of attention and executive function in this population. A longitudinal analysis of recovery patterns of these measures among adolescents is central to understanding the effects of concussions across the age spectrum. Purpose: This study prospectively and longitudinally examined laboratory-based measures of attention and executive function in concussed adolescents sequentially during a 2-month period after injury. Methods: Two measures of attention and executive function, the Attentional Network Test and the Task-Switching Test, were administered to 20 concussed adolescents within 72 h post-injury as well as at 1 wk, 2 wk, 1 month, and 2 months post-injury. Twenty healthy, matched control subjects were similarly assessed at the same time intervals. Data were analyzed by two-way, mixed-effects ANOVA to determine the effect of group and time on the dependent variables. Results: Compared with control subjects, the concussed group exhibited a significantly greater switch cost on the Task-Switching Test (P = 0.038, mean difference value = 38 ms) and a significantly greater reaction time for the Attentional Network Test conflict effect component (P = 0.015, mean difference value = 34 ms) for up to 2 months after injury. Conclusions: Concussed adolescents have difficulty recovering executive function after injury and may require extended recuperation time before full recovery is achieved. Evaluations focusing on attention and executive function can be useful additions in the assessment and follow-up after head injury. [ABSTRACT FROM AUTHOR]

Empirical data support the benefits of physical activity for women who have been diagnosed with breast cancer. However, the experience of exercising during or after breast cancer treatment has not been fully documented. The purpose of the researchers in this study was to provide an in-depth description of women's experiences with exercising during or after their breast cancer treatments, specifically, their perceptions of the benefits they experienced as a result of participation in an individualized exercise program that included cardiovascular and resistance activities. Forty-five women who had been diagnosed with breast cancer within the previous two years were recruited from two oncology practices after electing to enroll in an exercise program. Data were collected between September 2006 and August 2007 through in-depth interviews at various stages in the exercise program and analyzed simultaneously using thematic analysis methods. Whether in treatment or post-treatment, women attributed psychological, physical, and social benefits to their participation in the exercise program. Participants credited the program with helping them to feel better, regain control over their bodies and their lives, manage their emotions, and prepare them to live healthfully going forward. These results provide insight into the specific ways women experience exercise during and after their breast cancer treatments. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: To determine whether slow processing speed is associated with risk of sport-related concussion. Design: We conducted a retrospective cohort study using computerized neurocognitive assessments (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT]) from the Massachusetts Concussion Management Coalition. Slow processing speed was defined as 2 SD below the sample mean (n = 131) and fast processing speed as 2 SD above the sample mean (n = 259). We used a binary logistic regression model to determine the odds of sustaining a concussion with our main predictor being processing speed (high or low) adjusted for the effects of age, sex, and prior number of concussions. Setting: Massachusetts Concussion Management Coalition, Institutional care. Participants: Three hundred ninety junior high soccer players ages 10 to 15 with a baseline score for ImPACT. Independent Variables: Processing Speed. Main Outcome Measures: Risk of sustaining a concussion. Results: Those with slow processing speed had a visual motor composite score of ≤19.92, those with fast-processing speed had a score of ≥46.20. Athletes with slow processing speed were younger (13 vs 14 years; P < 0.001) and more likely to be male (57% vs 49%; P = 0.014). After adjusting for the effects of age, sex, and prior concussions, there was no significant difference in the odds of sustaining a concussion between groups (aOR 1.01; 95% CI, 0.99-1.04). Conclusions: Despite previous research showing that slow processing speed is a risk factor for musculoskeletal injuries during sports, our study suggests that processing speed is not associated with the risk of sustaining a concussion among junior high school soccer players. [ABSTRACT FROM AUTHOR]

Purpose: To explore changes in daily activities associated with high-intensity volunteering, this study assessed activities in a sample of 180 new Experience Corps (EC) volunteers serving low reading students in urban schools.Methods: Level of activity in 15 areas (visiting friends, reading, watching TV, etc.) was obtained at the beginning of this high-commitment volunteer experience and after 9 months of service. Latent class analyses were used to identify activity patterns, and regression analyses were used to identify factors associated with changes in activities.Results: At pre-test, 37% were classified in the low-activity group and were more likely to be first time volunteers, older, non-White, and have less education. At post-test, only 17% were classified as low activity. An increase in activity was more likely to occur for those who were low activity before joining the volunteer program.Implications: These findings demonstrate that increase in activity does occur for less active older adults who join a volunteer program. [ABSTRACT FROM PUBLISHER]

Factors that may contribute to preschool-aged children’s appraisals of their parent’s violent conflicts in families experiencing recent intimate partner violence (IPV) were evaluated for 116 mother–child dyads. Mothers and children were interviewed using empirically-validated measures to assess level of violence, maternal and child mental health, and children’s appraisals of conflict. Results suggest that preschool-aged children are able to meaningfully respond to statements about their parents’ conflicts. Both mothers’ and children’s reports of violence were significantly associated with children’s appraisals of Threat, but not with appraisals of Self-blame. Girls reported significantly higher levels of Self-blame than did boys. Children’s cognitive appraisals of Threat and Self-blame did not vary by age or ethnicity. These findings suggest that interventions designed for young children might specifically target their cognitive appraisals to help them regulate their feelings of being threatened and to provide for their safety. [ABSTRACT FROM AUTHOR]

Abstract: Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n =95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7–10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. [Copyright &y& Elsevier]

Background: The determinants of Queensland’s rising caesarean section (CS) rate remain poorly understood because of the historical absence of standard classification methods. Aims: We applied the Robson Ten Group Classification System (RTGCS) to population-based data to identify the main contributors to Queensland’s rising CS rate. Method: The RTGCS was applied retrospectively to the Queensland Perinatal Data Collection. CS rates were described for all ten RTGCS groups using data from 2006. Trends were evaluated using data for the years 1997–2006. Public and private sector patients were evaluated separately. Results: In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. Multiparous women with a previous caesarean birth (Group 5) made the greatest contribution to the CS rate in both sectors, followed by nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2) and nulliparous women in spontaneous labour (Group 1). CS rates have risen in all RTGCS groups between 1997 and 2006. The trend was pronounced among multiparous women with a previous caesarean delivery (Group 5), among women with multiple pregnancies (Group 8) and among nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2). Conclusions: The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland’s CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans. [ABSTRACT FROM AUTHOR]

Objective: To determine, in the early stages of suspected clinically significant infection, the independent relationship of the presenting venous lactate level to 28-day in-hospital mortality.Design: Prospective, observational cohort study.Setting: Urban, university tertiary-care hospital.Patients: One thousand two hundred and eighty seven adults admitted through the emergency department who had clinically suspected infection and a lactate measurement.Measurements and Results: Seventy-three [5.7% (95% CI 4.4-6.9%)] patients died in the hospital within 28 days. Lactate level was strongly associated with 28-day in-hospital mortality in univariate analysis (p<0.0001). When stratified by blood pressure, lactate remained associated with mortality (p<0.0001). Normotensive patients with a lactate level >or=4.0 mmol/l had a mortality rate of 15.0% (6.0-24%). Patients with either septic shock or lactate >or=4.0 mmol/l had a mortality rate of 28.3% (21.3-35.3%), which was significantly higher than those who had neither [mortality of 2.5% (1.6-3.4%), p<0.0001. In a model controlling for age, blood pressure, malignancy, platelet count, and blood urea nitrogen level, lactate remained strongly associated with mortality. Patients with a lactate level of 2.5-4.0 mmol/l had adjusted odds of death of 2.2 (1.1-4.2); those with lactate >or=4.0 mmol/l had 7.1 (3.6-13.9) times the odds of death. The model had good discrimination (AUC=0.87) and was well calibrated.Conclusions: In patients admitted with clinically suspected infection, the venous lactate level predicts 28-day in-hospital mortality independent of blood pressure and adds significant prognostic information to that provided by other clinical predictors. [ABSTRACT FROM AUTHOR]