scholarly journals Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture

2021 ◽  
Author(s):  
Anne Eva J. Bulstra ◽  
Tom J. Crijns ◽  
Stein J. Janssen ◽  
Geert A. Buijze ◽  
David Ring ◽  
...  
Keyword(s):  
The United States ◽  
Clinical Factors ◽  
Cast Immobilization ◽  
Radiographic Appearance ◽  
Factors Associated ◽  
Included Patient ◽  
Elbow Surgery ◽  
Mixed Regression ◽  
Fracture Consolidation ◽  
The Impact

Abstract Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient sex, age, a description of radiographic fracture consolidation, fracture tenderness and duration of cast immobilization completed (8 versus 12 weeks). To assess the impact of clinical factors on recommendation to continue immobilization we calculated posterior probabilities and determined variable importance using a random forest algorithm. Multilevel logistic mixed regression analysis was used to identify surgeon characteristics associated with recommendation for additional cast immobilization. Results Unclear fracture healing on radiographs, fracture tenderness and 8 (versus 12) weeks of completed cast immobilization were the most important factors influencing surgeons’ decision to recommend continued cast immobilization. Women surgeons (OR 2.96; 95% CI 1.28–6.81, p  =  0.011), surgeons not specialized in orthopedic trauma, hand and wrist or shoulder and elbow surgery (categorized as ‘other’) (OR 2.64; 95% CI 1.31–5.33, p  =  0.007) and surgeons practicing in the United States (OR 6.53, 95% CI 2.18–19.52, p  =  0.01 versus Europe) were more likely to recommend continued immobilization. Conclusion Adoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P < .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

Socioeconomic, Psychosocial, and Clinical Factors Associated With Employment in Women With HIV in the United States

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenni M. Wise ◽  
Andres Azuero ◽  
Deborah Konkle-Parker ◽  
James L. Raper ◽  
Karen Heaton ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Clinical Factors ◽  
Factors Associated ◽  
Women With Hiv

Abstract 12789: Clinical Factors Associated With Mortality Among Patients Hospitalized for Heart Failure in Egypt

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmed Hassanin ◽  
Mahmoud M Hassanein ◽  
Madiha F Abdel-maksoud
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
The United States ◽  
Clinical Factors ◽  
Clinical Variables ◽  
Factors Associated ◽  
The Us ◽  
One Year

Introduction: Heart failure (HF) is a growing public health burden in many low and middle-income countries (LMIC). However, most HF registries were conducted in high income countries, which often have different ethnic and cultural backgrounds from that of LMIC. Hypothesis: Independent clinical variables associated with mortality in patients hospitalized for HF in Egypt are different from those established in the United States (US). Methods: Between 2011 and 2014, 1,660 patients hospitalized for HF were enrolled from 20 centers across Egypt as part of the European Society of Cardiology HF long-term Registry. Deceased patients were compared to survivors, to identify demographic, clinical and biochemical variables associated with in-hospital and one-year mortality. Variables associated with mortality on univariate analysis, and independent variables identified in the Acute Decompensated Heart Failure National Registry (ADHERE) and in the Seattle Heart Failure Model, both based in the US, were entered into the multivariate logistic regression model. Results: In-hospital mortality was 5%. Only two independent clinical factors associated with in-hospital mortality were identified: elevated serum creatinine (sCr), OR=1.47 [95% CI: 1.23, 1.74] for every point increases above one mg/dl; and low admission systolic blood pressure (SBP), OR=1.54; [95% CI: 1.43, 1.65] for every 10 points decrease in SBP below 140 mmHg. At one-year follow up, mortality was 27%. Independent predictors of one-year mortality were: age, OR=1.47; [95% CI: 1.23,1.75] for every 10-year increase above 40; low discharge SBP, OR=1.30 [95% CI: 1.08, 1.52] for every 10 points decrease below 140 mmHg; low ejection fraction, OR=1.51 [95% CI: 0.59,0.73] for every 5 points decrease from 65%; chronic liver disease, OR=3.0 [95% CI: 1.51,5.88]; history of stroke, OR=3.2 [95% CI: 1.52,6.65]. These variables overlapped with those identified in US registries. Conclusions: Independent clinical variables associated with mortality after HF hospitalization in Egypt are similar to those reported in HF registries in the US.

scholarly journals Decoding the Risk of Accepting Online Misinformation Using Intelligence Quotient and Income

2021 ◽  
Author(s):  
Azad Kabir ◽  
Raeed Kabir ◽  
Jebun Nahar ◽  
Ritesh Sengar
Keyword(s):  
United States ◽  
Low Income ◽  
Intelligence Quotient ◽  
The United States ◽  
Demographic Groups ◽  
Factors Associated ◽  
The Us ◽  
Surrogate Measure ◽  
Lower Intelligence ◽  
The Impact

Abstract: The object of the study was to evaluate the risk factors associated with accepting online misinformation about COVID-19 vaccination in the United States. The percentages of fully vaccinated people, with regards to COVID-19, were considered as a surrogate measure of accepting online misinformation. The study evaluated the impact of the US state's average intelligence quotient (IQ) and per capita income on accepting misinformation. The study found that socio-demographic groups with lower income along with lower intelligence quotient (IQ) are more vulnerable to online misinformation theories surrounding COVID-19. Further study is needed to evaluate how to increase the intelligence quotient among low-income individuals and whether such an effort will reduce the acceptance of misinformation among the vulnerable population in the United States.

Regional variation in high-resource utilization among lung cancer-related emergency department visits in the United States.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20038-e20038
Author(s):  
Cynthiya Ruban ◽  
Marc Kowalkowski ◽  
Christopher Michael Blanchette
Keyword(s):  
Lung Cancer ◽  
Emergency Department ◽  
Regional Variation ◽  
The United States ◽  
Emergency Department Visits ◽  
Factors Associated ◽  
High Resource ◽  
Ed Visits ◽  
Hospital Factors ◽  
The Impact

e20038 Background: Regional variation is common in oncology care but is not defined for emergency department (ED) care for cancer patients, particularly patients with lung cancer (LC) who regularly utilize EDs for management of acute cancer or treatment related illness. This study analyzed regional variation and other factors associated with high total episodic charge (≥75th percentile; HTC) among LC patients evaluated in the ED in relation to discharge or admission. Methods: A retrospective study of LC-related ED visits in the US was conducted using the 2013 Nationwide ED Sample. LC-related ED visits among adults were identified by LC-specific Clinical Classification Software codes (CCS = 19; mapping to ICD-9 = 162.x, 209.21, 231.2, V10.11). Multivariable logistic regression analyzed the association between patient and hospital factors and HTC, weighted to represent ED visits nationwide. Results: Among 373,761 LC-related ED visits, 134,838 (36%) were treated and discharged and 238,923 (64%) were admitted (ranging from 51% (West [W]) to 76% (South [S]). HTC was ≥$5,655 (median = $2,993) for ED discharges and ≥$54,760 (median = $29,590) for admissions. The proportion of visits with HTC differed by region and admission status (discharged: 7% [W] to 27% [S]; admitted: 20% [Midwest] to 39% [W]). After adjusting for clinical and hospital factors associated with increased HTC odds (metastases, common acute comorbid disorder [chest and abdominal pain, pneumonia, sepsis, respiratory failure], diagnostic radiology use, thoracic/other surgery, chemo/radiotherapy, length of stay, primary payer, and hospital ownership, location and teaching status), significant HTC variation remained by hospital region with opposing relative HTC odds among discharged and admitted patients (discharged: W v S OR = 0.3 95%CI = 0.2-0.6, Northeast v S OR = 0.5 95%CI = 0.3-0.7; admitted: W v S OR = 3.8 95%CI = 2.5-5.7). Conclusions: Regional variation in HTC suggest differences in ED use and management patterns for LC and may reflect quality of care concerns. Clinical outcome linkage (including ED revisit tracking) is needed to better define the impact of variation and develop strategies to improve care for patients with LC.

scholarly journals Prevalence and factors associated to contamination from porcine epidemic diarrhea virus during the transportation of pigs to slaughterhouses in Colombia

2020 ◽  
Author(s):  
Maria del Pilar Pineda Ortiz ◽  
Johanna Paola Corrales Morales ◽  
Gilma Hernández Herrera ◽  
Carlos Enrique Trillos Pena ◽  
Diana Corina Zambrano Moreno
Keyword(s):  
Porcine Epidemic Diarrhea Virus ◽  
Animal Feed ◽  
The United States ◽  
The Body ◽  
Swine Industry ◽  
Pressurized Water ◽  
Diarrhea Virus ◽  
Factors Associated ◽  
Porcine Epidemic Diarrhea ◽  
The Impact

Abstract Porcine epidemic diarrhea virus (PEDV) causes acute diarrhea, dehydration, and high mortality in newborn piglets and has caused high economic impact in the swine industry in the United States and Asia. Until March 2014, PED was an exotic disease in Colombia. This study was carried out at the beginning of the spread of PEDV in the country, and its main objective was to determine the prevalence and factors associated to the contamination of PEDV in the transportation of pigs to the slaughterhouses in Colombia through environmental samples analyzed by RT-PCR. 518 pig trucks in the 32 main slaughterhouses, were sampled and the drivers of the trucks fulfilled a questionnaire. The prevalence of PEDV at the entrance of the slaughterhouses was 71.8% (CI 95%: 70.8-72.8) versus 70.5% (CI 95%: 69.5-71.5) at the slaughterhouse exit, and there was no evidence of significant differences between both rates. (McNemar value p: 0.375). The factors that increased the possibility of truck contamination were: vehicles that visit national slaughterhouses (OR 15.9 95% CI: 4.9–51.85) and that visit national –export type (OR 9.0 95% CI: 2.20–36.91), trucks with mobility in area of ​​greatest slaughter (OR 9.05 95% CI: 2.9-27.63), the non-exclusive use of vehicles to transport pigs (OR 3.75 95% CI: 1.55-9.08) and visit animal feed mills (OR 13.5 95% CI: 4.1– 44.12). The factors identified that reduce the possibility of contamination were cleanliness of the body truck (OR 0.089 95% CI: 0.03-0.23) and the cabin (OR 0.16 95%CI: 0.08-0.31), use of disinfectant (OR 0.32 95% CI:0.16-0.62), pressurized water (OR 0.38 95% CI:0.15-0.95), and back pump (OR 0.17 95% CI:0.08-0.35) and the exclusive use of the vehicle for pig transportation (OR 0.36 95% CI: 0.19-0.70). The results showed that the high grade of mobilization of the trucks to points of concentration, failures in biosecurity and virus survival characteristics, enabled the spread of PEDV, turning it into an endemic disease in Colombia; however, the measures implemented by the farmers mitigated the impact of the disease. We evidenced the need of standardizing and regulating biosecurity protocols for slaughterhouses, pig transportation and farms.

Disparities in Trial of Labor among Women with Twin Gestations in the United States

2021 ◽  
Author(s):  
Gina N. Mo ◽  
Yvonne W. Cheng ◽  
Aaron B. Caughey ◽  
Lynn M. Yee
Keyword(s):  
United States ◽  
Vaginal Delivery ◽  
Maternal Age ◽  
Demographic Factors ◽  
The United States ◽  
Clinical Factors ◽  
Factors Associated ◽  
Trial Of Labor ◽  
Hispanic White ◽  
Second Twin

Objective The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery. Study Design This was a population-based cohort study of women giving birth to twin gestations in the United States (2012–2014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed. Results Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age >35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater. Conclusion In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL. Key Points

An update on penile cancer: Evaluating management trends and clinical outcomes using the National Cancer Data Base.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 492-492 ◽  
Author(s):  
Matthew Mossanen ◽  
Sarah Holt ◽  
John L. Gore ◽  
Daniel W. Lin ◽  
Jonathan L. Wright
Keyword(s):  
Data Base ◽  
Metastatic Disease ◽  
Penile Cancer ◽  
The United States ◽  
National Cancer Data Base ◽  
Clinical Factors ◽  
Cancer Data ◽  
Factors Associated ◽  
Partial Penectomy ◽  
To Receive

492 Background: Penile cancer remains a rare disease in the United States and may be associated with substantial morbidity and even mortality. Though the understanding of penile cancer is limited by the uncommon nature of the disease, the use of large volume datasets may help reveal recent management trends and clinical factors associated with treatment. We sought to describe penis cancer management over the past several years using the National Cancer Data Base. Methods: We performed a retrospective review of data obtained from the National Cancer Data Base from 1998-2012. We analyzed patient characteristics, demographic information, and therapeutic approaches within two clinical scenarios: 1) use of partial penectomy for early stage (clinical Ta-T2 disease); and 2) use of chemotherapy for metastatic disease. We performed multivariate logistic analysis to determine factors associated with these treatments. Results: A total of 2,677 patients presented with cTa-T2 penile carcinoma. Of these, the proportion receiving partial penectomy increased from 73.9% in 1998-2000, to 80.4% in 2010-2012 (p < 0.001). Compared to those aged 50-59, partial penectomy was more common in the old (age > 80, OR 1.52, 95% CI 1.05 – 2.20) and young (age < 50, OR 1.47, 95% CI 1.04 – 2.07). Treatment at academic centers and those without insurance were less likely to receive partial penectomy (both p < 0.01), as were patients with cT2 and node positive disease (both p < 0.001). Of those presenting with metastatic disease (n = 817), use of chemotherapy increased over the time period from 39% receiving chemotherapy in 1998-2000, to 49% in 2010-2012 (p <0.03). Patients least likely to receive chemotherapy were older and with higher Charlson Comorbidity score (both p < 0.05), African American (OR 0.46, 95% CI 0.29 – 0.70), and those living > 50 miles from the nearest treatment hospital (OR 0.37, 95% CI 0.25 – 0.55). Conclusions: Penile sparing surgery and use of chemotherapy are becoming more commonly utilized over the last several years. Multiple factors appear to be associated with these trends, and further work is needed to define both clinical and non-clinical factors associated with treatment.

Clinical Factors and Outcomes Associated With Immune Non-response Among Virally Suppressed Adults With HIV From Africa and the United States

2021 ◽  
Author(s):  
Adi Noiman ◽  
Allahna Esber ◽  
Xun Wang ◽  
Emmanuel Bahemana ◽  
Yakubu Adamu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Age Groups ◽  
The United States ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Clinical Factors ◽  
Factors Affecting ◽  
Factors Associated ◽  
Hazard Ratios ◽  
Before And After

Abstract Background: A significant minority of people living with HIV (PLWH) achieve viral suppression (VS) on antiretroviral therapy (ART) but do not regain healthy CD4 counts. Clinical factors affecting this immune non-response (INR) and its effect on incident serious non-AIDS events (SNAEs) have been challenging to understand due to confounders that are difficult to control in many study settings. Setting: The U.S. Military HIV Natural History Study (NHS) and African Cohort Study (AFRICOS). Methods: PLWH with sustained VS (<400 copies/mL for at least two years) were evaluated for INR (CD4 < 350 cells/µl at the time of sustained VS). Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with INR. Cox proportional hazards regression produced adjusted hazard ratios (aHRs) for factors associated with incident SNAE after sustained VS. Results: INR prevalence was 10.8% and 25.8% in NHS and AFRICOS, respectively. Higher CD4 nadir was associated with decreased odds of INR (aOR=0.31 [95% CI: 0.26, 0.37] and aOR=0.50 [95% CI: 0.43, 0.58] per 100 cells/µl in NHS and AFRICOS, respectively). After adjustment, INR was associated with a 61% increase in relative risk of SNAE [95% CI: 1.12, 2.33]. Probability of "SNAE-free" survival at 15 years since sustained VS was approximately 20% lower comparing those with and without INR; nearly equal to the differences observed by 15-year age groups. Conclusion: CD4 monitoring before and after VS is achieved can help identify PLWH at risk for INR. INR may be a useful clinical indicator of future risk for SNAEs.

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