Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

Context: The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function. Objective: To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain. Design: Cross-sectional Setting: Academic medical center. Patients: A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated. Intervention: None. Main Outcome Measures: Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. Results: Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion. Conclusions: Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

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Ankle Dorsiflexion Among Healthy Men With Different Qualities of Lower Extremity Movement

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.14 ◽

2014 ◽

Vol 49 (5) ◽

pp. 617-623 ◽

Cited By ~ 12

Author(s):

Alon Rabin ◽

Zvi Kozol ◽

Elad Spitzer ◽

Aharon Finestone

Keyword(s):

Lower Extremity ◽

Weight Bearing ◽

Movement Patterns ◽

Movement Pattern ◽

Ankle Dorsiflexion ◽

Healthy Male ◽

Cross Sectional ◽

Quality Of Movement ◽

Step Down

Context: Lower extremity movement patterns have been implicated as a risk factor for various knee disorders. Ankle-dorsiflexion (DF) range of motion (ROM) has previously been associated with a faulty movement pattern among healthy female participants. Objective: To determine the association between ankle DF ROM and the quality of lower extremity movement during the lateral step-down test among healthy male participants. Design: Cross-sectional study. Setting: Training facility of the Israel Defense Forces. Patients or Other Participants: Fifty-five healthy male Israeli military recruits (age = 19.7 ± 1.1 years, height = 175.4 ± 6.4 cm, mass = 72.0 ± 7.6 kg). Intervention(s): Dorsiflexion ROM was measured in weight-bearing and non–weight-bearing conditions using a fluid-filled inclinometer and a universal goniometer, respectively. Lower extremity movement pattern was assessed visually using the lateral step-down test and classified categorically as good or moderate. All measurements were performed bilaterally. Main Outcome Measure(s): Weight-bearing and non–weight-bearing DF ROM were more limited among participants with moderate quality of movement than in those with good quality of movement on the dominant side (P = .01 and P = .02 for weight-bearing and non–weight-bearing DF, respectively). Non–weight-bearing DF demonstrated a trend toward a decreased range among participants with moderate compared with participants with good quality of movement on the nondominant side (P = .03 [adjusted P = .025]). Weight-bearing DF was not different between participants with good and moderate movement patterns on the nondominant side (P = .10). Weight-bearing and non–weight-bearing ankle DF ROM correlated significantly with the quality of movement on both sides (P < .01 and P < .05 on the dominant and nondominant side, respectively). Conclusions: Ankle DF ROM was associated with quality of movement among healthy male participants. The association seemed weaker in males than in females.

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Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.196460 ◽

2016 ◽

Vol 07 (S 01) ◽

pp. S037-S040 ◽

Cited By ~ 1

Author(s):

Suruliraj Karthikbabu ◽

Mahabala Chakrapani ◽

Sailakshmi Ganesan ◽

Ratnavalli Ellajosyula

Keyword(s):

Pelvic Tilt ◽

Pearson Correlation ◽

Weight Bearing ◽

Tertiary Care ◽

Chronic Stroke ◽

Community Dwelling ◽

Stroke Survivors ◽

Cross Sectional ◽

Affected Side ◽

Anterior Pelvic Tilt

ABSTRACT Background and Purpose: Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. Materials and Methods: This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA. Results: Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P < 0.001) than anterior pelvic tilt (r = 0.44; P < 0.001). Conclusion: Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.

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Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

10.2196/preprints.36140 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline Richardson ◽

Iulia Dobrin ◽

Rodica Pop-Busui ◽

Gretchen Piatt ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Interactive Voice Response ◽

Medical Center ◽

Academic Medical Center ◽

Text Messages ◽

Management Support ◽

Cross Sectional Survey ◽

Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

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A Study on Knowledge Towards Brain Death among Residents in Indonesia

Folia Medica Indonesiana ◽

10.20473/fmi.v56i2.21235 ◽

2020 ◽

Vol 56 (2) ◽

pp. 140

Author(s):

Asra Al Fauzi ◽

Christrijogo Sumartono Waloejo ◽

Abdulloh Machin ◽

Muhammad Ja'far Shodiq

Keyword(s):

Brain Death ◽

Medical Center ◽

Academic Medical Center ◽

Cross Sectional Study ◽

Research Subjects ◽

Cross Sectional ◽

Academic Medical ◽

Center Hospital ◽

Level 3 ◽

Level 2

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

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Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

10.2196/preprints.32451 ◽

2021 ◽

Author(s):

Landon Arensberg ◽

Jessica Kalender-Rich ◽

Jaehoon Lee ◽

Cheryl Gibson

Keyword(s):

Medical Care ◽

Baby Boomers ◽

Medical Center ◽

Academic Medical Center ◽

Age Groups ◽

Online Reviews ◽

Online Resources ◽

Cross Sectional ◽

Academic Medical ◽

Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

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Development of an Abstraction Tool to Assess Palliative Care Components

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211061724 ◽

2021 ◽

pp. 104990912110617

Author(s):

Meredith A. MacMartin ◽

Amber E. Barnato

Keyword(s):

Palliative Care ◽

Qualitative Content Analysis ◽

Medical Center ◽

Clinical Care ◽

Academic Medical Center ◽

Physical Symptoms ◽

Future Research ◽

Clinical Documentation ◽

Cohen’S Kappa ◽

Cohen's Kappa

Background: Little is known regarding the fidelity of delivery of guideline-recommended components of palliative care in “real world” encounters. Objective: To develop a qualitative coding framework to identify components of clinical palliative care in clinical documentation across care settings. Design: Retrospective review of palliative care clinical documentation from medical providers, with directed qualitative content analysis to identify components of clinical care documented. Setting/Subjects: Purposively sampled deceased patients seen by palliative care at a US academic medical center between 7/1/2011–7/1/2018. Main Outcomes and Measures: The outcome of this work is a coding framework for use in future research. We assessed the robustness of the framework using Cohen’s kappa. Results: We reviewed sixty-two encounters from twenty-six patients. We identified 7 major themes in documentation: (1) addressing physical symptoms, (2) addressing psychological symptoms, (3) establishing illness understanding, (4) supporting decision making, (5) end-of-life planning, (6) understanding psychosocial context, and (7) care coordination. Interrater reliability varied widely between components, with Cohen’s kappa ranging from −.51 to 1. Conclusions: This pilot study provides a coding framework to measure documentation of clinical palliative care components. Several components could not be reliably identified using this framework, suggesting the need for additional measurement strategies.

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An overview of radiological manifestations of acquired dental developmental disturbances in paediatric head and neck cancer survivors

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20190275 ◽

2020 ◽

Vol 49 (3) ◽

pp. 20190275

Author(s):

Reinier C. Hoogeveen ◽

Marinka L.F. Hol ◽

Bradley R. Pieters ◽

Brian V. Balgobind ◽

Erwin W.E.R. Berkhout ◽

...

Keyword(s):

Radiation Therapy ◽

Cancer Survivors ◽

Head And Neck ◽

Developmental Disorders ◽

Medical Center ◽

Academic Medical Center ◽

Future Research ◽

Dental Development ◽

Radiographic Findings ◽

Anterior Teeth

Objectives: In paediatric cancer survivors treated with chemotherapy and radiotherapy therapy, late effects on dental development are quite common. Oral radiologists are not familiar with the radiographic images of these specific dental consequences of chemotherapy and radiotherapy. With the goal of educating colleagues, to raise awareness of the needs of survivors, and to identify directions for future research, we present dental radiographs of survivors treated for head and neck rhabdomyosarcoma with chemotherapy and radiotherapy. Also, based on the survivors reviewed, a radiographic inventory of commonly found late dental developmental effects seen in conjunction with treatment is presented. Methods: Panoramic radiographic findings of five illustrative cases are presented, from a group of 42 survivors of head and neck rhabdomyosarcoma treated at the Academic Medical Center Amsterdam, The Netherlands over the past 25 years. Results: Five cases showing dental developmental disorders are presented. These cases show an association of the location of the radiation field and the developmental stage of the teeth with the severity of the effect on dental development. We also report an inventory of severe and moderate effects of chemotherapy and radiotherapy on the development of molars and anterior teeth. Conclusions: This paper presents five cases and a radiographic inventory to illustrate disturbances of dental development associated with chemotherapy and radiotherapy in children. Medical and dental professionals involved in the treatment of cancer survivors are relatively unaware of the dental consequences of radiation therapy and the age dependency of specific regional effects. These effects can be severe, with great impact on quality of life. Further research in this area could help improve planning of radiation therapy for children, potentially preventing or limiting dental or maxillofacial sequelae.

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Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz018 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 8

Author(s):

Sophia Jung ◽

Mary Elizabeth Sexton ◽

Sallie Owens ◽

Nathan Spell ◽

Scott Fridkin

Keyword(s):

Antibiotic Prescription ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Clinic ◽

Multivariable Logistic Regression Analysis ◽

Comorbid Condition ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Care Clinic ◽

The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

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Essential Oil Olfactory Test: Comparison of Affordable Rapid Olfaction Measurement Array (AROMA) to Sniffin’ Sticks 12

OTO Open ◽

10.1177/2473974x20962464 ◽

2020 ◽

Vol 4 (4) ◽

pp. 2473974X2096246

Author(s):

Jennifer Li ◽

Gracie Palmer ◽

Suraj Shankar ◽

Mark R. Villwock ◽

Alexander G. Chiu ◽

...

Keyword(s):

Essential Oil ◽

Medical Center ◽

Low Cost ◽

Academic Medical Center ◽

Cross Sectional Study ◽

Moderate Correlation ◽

Cross Sectional ◽

Percent Correct ◽

Olfactory Testing ◽

Snot 22

Objectives To further demonstrate the validity of Affordable Rapid Olfaction Measurement Array (AROMA), an essential oil−based smell test, and compare it to the Sniffin’ Sticks 12 Test (SST12). Study Design Prospective cross-sectional study. Setting Academic medical center. Methods Fifty healthy individuals without sinonasal disease were recruited to the study. AROMA has been previously validated against the University of Pennsylvania Smell Identification Test. The current study tests 2 additional higher concentrations to increase the ability to detect olfactory reserve. Healthy participants completed AROMA, SST12, Sino-Nasal Outcome Test (SNOT-22), and Questionnaire of Olfactory Disorders (QoD). Spearman correlations were used to evaluate AROMA, SST, SNOT-22, and QoD. Results AROMA demonstrated strong test-retest reliability ( r = 0.757, P < .01). AROMA showed a moderate correlation to SST12 (ρ = 0.412, P < .01). Age and SNOT-22 were significantly correlated ( P < .05) with AROMA (ρ = −0.547, −0.331, respectively), and age was weakly correlated with SST (ρ = −0.377, P < .01). Median percent correct scores were as follows: SST12 identification, 92%; AROMA detection, 90%; and AROMA identification, 81%. Median correct odor identification of AROMA concentrations at 1×, 2×, 4×, and 8× were 64%, 75%, 92%, and 92%, respectively. Conclusion AROMA has a moderate correlation with SST12. AROMA is more strongly correlated than SST12 to age and SNOT-22. AROMA’s stronger correlation with subjective olfactory status, low cost, and adaptability may help remove barriers to routine olfactory testing in the clinic.

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Trimethylamine-N-oxide is present in human follicular fluid and is a negative predictor of embryo quality

Human Reproduction ◽

10.1093/humrep/dez224 ◽

2020 ◽

Vol 35 (1) ◽

pp. 81-88 ◽

Cited By ~ 1

Author(s):

R A Nagy ◽

I Homminga ◽

C Jia ◽

F Liu ◽

J L C Anderson ◽

...

Keyword(s):

Follicular Fluid ◽

Embryo Quality ◽

Conflicts Of Interest ◽

Medical Center ◽

Academic Medical Center ◽

Gut Bacteria ◽

Human Follicular Fluid ◽

Cross Sectional ◽

Oocyte Fertilization ◽

Negative Predictor

Abstract STUDY QUESTION Are levels of trimethylamine-N-oxide (TMAO) in human follicular fluid (FF) related to IVF outcomes? SUMMARY ANSWER Higher levels of TMAO are a negative predictor of oocyte fertilization and embryo quality. WHAT IS KNOWN ALREADY TMAO is a metabolic product of dietary choline and l-carnitine produced via subsequent enzymatic modifications by the intestinal microbiota and hepatocytes. TMAO promotes inflammatory and oxidative stress pathways and has been characterized as a causative biomarker for the development of cardiometabolic disease. STUDY DESIGN, SIZE, DURATION For the present cross-sectional study, samples (FF and plasma) from 431 modified natural cycle (MNC)-IVF cycles of 132 patients were collected prospectively between October 2014 and March 2018 in a single academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS TMAO and its precursors (choline, l-carnitine and gamma-butyrobetaine) were measured by ultra-high-performance liquid chromatography/mass spectrometry in (i) matched FF and plasma from 63 MNC-IVF cycles, in order to compare metabolite levels in the two matrices and (ii) FF from 232 MNC-IVF cycles in which only one oocyte was retrieved at follicular puncture. The association between metabolite levels and oocyte fertilization, embryo fragmentation percentage, embryo quality and the occurrence of pregnancy was analyzed using multilevel generalized estimating equations with adjustment for patient and cycle characteristics. MAIN RESULTS AND THE ROLE OF CHANCE The level of choline was higher in FF as compared to matched plasma (P < 0.001). Conversely, the levels of TMAO and gamma-butyrobetaine were lower in FF as compared to plasma (P = 0.001 and P = 0.075, respectively). For all metabolites, there was a positive correlation between FF and plasma levels. Finally, levels of TMAO and its gut-derived precursor gamma-butyrobetaine were lower in FF from oocytes that underwent normal fertilization (TMAO: odds ratio [OR] 0.66 [0.49–0.90], P = 0.008 per 1.0-μmol/L increase; gamma-butyrobetaine: OR 0.77 [0.60–1.00], P = 0.047 per 0.1-μmol/L increase) and developed into top-quality embryos (TMAO: OR 0.56 [0.42–0.76], P < 0.001 per 1.0-μmol/L increase; gamma-butyrobetaine: OR 0.79 [0.62–1.00], P = 0.050 per 0.1-μmol/L increase) than in FF from oocytes of suboptimal development. LIMITATIONS, REASONS FOR CAUTION The individual contributions of diet, gut bacteria and liver to the metabolite pools have not been quantified in this analysis. WIDER IMPLICATIONS OF THE FINDINGS More research on the contribution of diet and the effect of gut bacteria on FF TMAO is warranted. Since TMAO integrates diet, microbiota and genetic setup of the person, our results indicate potential important clinical implications for its use as biomarker for lifestyle interventions to improve fertility. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this project. The Department of Obstetrics and Gynecology of the University Medical Center Groningen received an unrestricted educational grant of Ferring Pharmaceutical BV, the Netherlands. The authors have no other conflicts of interest. TRIAL REGISTRATION NUMBER Netherlands Trial Register number NTR4409.

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