scholarly journals ACL Injuries Aren’t Just for Girls: The Role of Age in Predicting Pediatric ACL Injury

2020 ◽  
Vol 12 (6) ◽  
pp. 559-563
Author(s):  
David A. Bloom ◽  
Adam J. Wolfert ◽  
Andrew Michalowitz ◽  
Laith M. Jazrawi ◽  
Cordelia W. Carter
Keyword(s):  
Female Athletes ◽  
Statistical Significance ◽  
Acl Injury ◽  
Childhood And Adolescence ◽  
Chi Square ◽  
Acl Injuries ◽  
Acl Tear ◽  
Chi Square Analysis ◽  
Age And Sex

Background: Female athletes have a higher rate of anterior cruciate ligament (ACL) injuries than male athletes; however, the role of age in mediating this injury risk has not been explored. The purpose of this study was to characterize the relationship between age and sex in predicting ACL injury in the pediatric population. Hypothesis: Prepubescent boys are more likely to sustain an ACL injury than prepubescent girls. Study Design: Descriptive epidemiological study. Level of Evidence: Level 4. Methods: Data were collected from the Statewide Planning and Research Cooperative System database for the state of New York from 1996 to 2016. The database was queried for patients aged ≤19 years who had been diagnosed with an ACL tear using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 844.2 or the ICD-10 (10th Revision) codes S83.512A/S83.511A/S83.519A. Patient age and sex at time of ACL injury diagnosis were recorded. Chi-square analysis was used to compare the frequency of ACL injury between groups, with statistical significance set at P < 0.05. Results: A total of 20,128 patients aged ≤19 years were diagnosed with an ACL tear (10,830 males, 9298 females; male:female, 1.16:1). In all, 129 patients aged <12 years sustained an ACL tear (85 boys, 44 girls; male:female, 1.93:1), and 19,999 of those patients were aged 12 to 19 years (10,745 males, 9254 females; male:female, 1.16:1). Chi-square analysis demonstrated a significant relationship between sex and age group ( P < 0.006). Additional analysis revealed that female athletes were most at risk for ACL injury from ages 12 to 16 years, with 4025 male and 5095 female athletes sustaining ACL injuries in this group (male:female, 1:1.27; P < 0.0001). Conclusion: Prepubescent boys (aged <12 years) are more likely to sustain an ACL injury than same-aged female peers. Clinical Relevance: This study demonstrates that the risk of ACL injury varies with age and sex throughout childhood and adolescence, further guiding treatment and prevention for these pediatric athletes.

scholarly journals Fibrinonecrotic enteritis of piglets in a commercial farm: a postmortem study of the prevalence and the role of lesion associated agents Isospora suis and Clostridium perfringens

2007 ◽  
Vol 27 (7) ◽  
pp. 297-300 ◽  
Author(s):  
Macarena G. Sanz ◽  
Lucila Venturini ◽  
Ronnie A. Assis ◽  
Francisco Uzal ◽  
Miguel A. Risso ◽  
...  
Keyword(s):  
Clostridium Perfringens ◽  
Statistical Significance ◽  
Toxin Gene ◽  
Pathological Changes ◽  
Chi Square ◽  
The Third ◽  
Isospora Suis ◽  
Chi Square Analysis ◽  
Neutral Formalin

The objectives were to determine the prevalence of fibrinonecrotic enteritis (FNE) on a farrow-to-finish farm of 1,000 sows, to categorize the pathological changes, and to to investigate the lesion associated agents Isospora suis and Clostridium perfringens. Causes of preweaning mortality (PWM) were classified into 8 categories including FNE. Obtained data were evaluated for statistical significance by adjusted Chi-square analysis. Samples of FNE were taken for complementary studies including a PCR technique for genotyping toxin genes of Clostridium perfringens from gut samples fixed in 10% neutral formalin. From 3,153 piglets examined, less than 1% was classified as FNE. FNE prevalence increased progressively from the first to the third week, the last differing statistically from the others. Eighty percent of gut samples with FNE lesions were positive to Isospora suis, when examined by PCR from 9 severe FNE lesions detected 7 positive samples only for a toxin gene, characteristic of C. perfringens type-A.

scholarly journals Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lambert T. Li ◽  
Carlin Chuck ◽  
Steven L. Bokshan ◽  
Brett D. Owens
Keyword(s):  
Emergency Department ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Emergency Department Visits ◽  
Level Of Evidence ◽  
Total Cost ◽  
Acl Tear ◽  
Chi Square Analysis

Background: Patients are commonly evaluated at the emergency department (ED) with acute anterior cruciate ligament (ACL) tears, but providers without orthopaedics training may struggle to correctly diagnose these injuries. Hypothesis: It was hypothesized that few patients would be diagnosed with an ACL tear while in the ED and that these patients would be of lower socioeconomic status and more likely to have public insurance. Study Design: Cohort study; Level of evidence, 3. Methods: The 2017 State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) from the state of Florida were utilized in this study. Cases with Current Procedural Terminology code 29888 (arthroscopically aided ACL reconstruction [ACLR]) were selected from the SASD, and data from the SEDD were matched to patients who had an ED visit for a knee injury within 120 days before ACLR. Chi-square analysis was used to test for differences in patient and surgical variables between the ED visit and nonvisit patient groups. A generalized linear model was created to model the effect of ED visit on total cost for an ACL injury. Results: While controlling for differences in patient characteristics and concomitant procedure usage, a visit to the ED added $4587 in total cost ( P < .001). The ED visit cohort contained a greater proportion of patients with Medicaid (20.2% vs 9.1%), patients who were Black (18.4% vs 10.3%), and patients in the lowest income quartile (34.4% vs 25.0%) ( P < .001 for all). In the ED visit cohort, 14.4% of patients received an allograft versus 10.1% in the non-ED visit cohort ( P = .001) despite having a similar mean age. An ACL sprain was diagnosed in only 29 of the 645 (4.5%) patients who visited the ED. Conclusion: Utilizing the ED for care after an ACL injury was expensive, averaging a $4587 increase in total cost associated with ACLR. However, patients rarely left with a definitive diagnosis, with only 4.5% of patients who underwent ACLR being correctly diagnosed with an ACL tear in the ED. This additional cost was levied disproportionately on patients of low socioeconomic status and patients with Medicaid.

Public Perceptions of a Rural Emergency Medical Services System

1994 ◽  
Vol 9 (4) ◽  
pp. 257-259 ◽  
Author(s):  
Lawrence H. Brown ◽  
N. Heramba Prasad ◽  
Kirk Grimmer
Keyword(s):  
Emergency Medical Services ◽  
Statistical Significance ◽  
Public Perceptions ◽  
Medical Services ◽  
Chi Square ◽  
Telephone Directory ◽  
Emergency Medical ◽  
Chi Square Analysis ◽  
Lay Public

AbstractIntroduction:To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system.Hypothesis:Citizens and physicians are unaware of the capabilities of the EMS system.Methods:Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p <0.01.Results:A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p <0.001).Conclusion:This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.

scholarly journals Associations between Modifiable Health-Risk Behaviors and Personality Types

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Jon C. Schommer ◽  
Paul D. Tieger ◽  
Anthony W. Olson ◽  
Lawrence M. Brown
Keyword(s):  
Health Risk ◽  
Risk Behaviors ◽  
Statistical Significance ◽  
Personality Type ◽  
Health Risk Behaviors ◽  
Personality Types ◽  
Chi Square ◽  
Related Stress ◽  
The Individual ◽  
Chi Square Analysis

Objectives: The first objective for this study was to explore if characteristics of personality type (using the Preferred Communication Style Questionnaire) are associated with the following modifiable health-risk behaviors: smoking, exercise, alcohol consumption, nutrition, sleep, depression-related stress, anxiety-related stress, healthcare professional usage, and self-discipline. The second objective for this study was to explore if characteristics of personality type are associated with (1) the quality of patient-physician relationships, (2) patient-physician communication, and (3) preferred method for receiving information. Methods: Data were collected from 10,500 adult individuals residing in the United States via an on-line, self-administered survey coordinated by Qualtrics Panels from March 14-30, 2016. Chi-square analysis was used for making comparisons between categories of personality types and items related to health-risk behaviors. Statistical significance was set at p < 0.05. However, chi-square analysis with large sample sizes (e.g. 10,500 in this study) readily yields statistical significance. Practical significance was set at four or more percentage points above or below the overall mean. Results: Regarding objective 1, personality type was associated with all nine health-risk behaviors studied. Personality types within the Experiencer temperament (17% of the U.S. population) accounted for 46% of the undesirable scores we computed for health-risk behaviors. The Idealist temperament (17% of population) accounted for 32% of the undesirable scores. Conceptualizers (10% of population) accounted for 17% of the undesirable scores and Traditionalists (46% of population) accounted for 5% of the undesirable scores. Regarding objective 2, the findings showed that personality type was associated with (1) the importance people place on the patient-physician relationship, (2) which characteristics of that relationship are most desirable, (3) desire for more communication with their physician, and (4) the preferred method for receiving information. Discussion and Conclusions: Precision medicine has been proposed as a way to create a new taxonomy of disease that uses individual specific data to develop accurate diagnosis, targeted treatment, and improved health outcomes. Based on the findings of this study, we propose that inclusion of personality type is an important component of these efforts so that the health care system can conform more to the individual patient in order to increase engagement and adherence, reduce errors, minimize ineffective treatment and waste, and can be cost effective. Conflict of Interest Co-author, Paul Tieger is CEO of SpeedReading People, LLC which holds copyright for the Individual Wellness Plan and Adherence Predictive Index tools that are mentioned in this manuscript.   Type: Original Research

scholarly journals RECOGNITION AND PREVENTION OF MEDICATION ERRORS IN PEDIATRIC INPATIENTS: THE ROLE OF CLINICAL PHARMACISTS

2021 ◽  
Vol 3 (2) ◽  
pp. 438-446
Keyword(s):  
Medication Errors ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Dose Calculation ◽  
Medical Setting ◽  
Chi Square ◽  
Proper Action ◽  
Clinical Pharmacists ◽  
Chi Square Analysis

Introduction: Medication errors (MEs) are considered preventable errors that may occur frequently during the treatment process with or without patient harm in addition to their economic consequence. MEs occur during prescribing, dose calculation, dispensing, or administration of medicine which could be made by any healthcare professional as a physician, pharmacist or nurse, or by the patient himself. Objective: To detect and report MEs in pediatric inpatients’ medical records and potentially preventing these MEs by making recommendations/suggestions for healthcare professionals about the proper action needed to be taken. Methods: This was a prospective observational study, in which the medical records of admitted pediatric patients to Ibn Al-Atheer Teaching Hospital, Nineveh were reviewed to detect, report, and prevent MEs between the 1st of January and the 30th of June 2019. Results: Out of 6964 medical records reviewed by clinical pharmacists during the study period, 119 MEs were reported to healthcare professionals and prevented. 83% of detected MEs were dosing errors. The results of the Chi-square analysis showed that the highest percentage of dosing errors were associated with antibiotics (p=0.0493). Furthermore, the results of Chi-square analysis showed that the highest percentage of dosing errors were seen in infants and toddlers (p=0.011). Conclusion: This study highlighted the role of clinical pharmacists in recognizing, reporting and preventing MEs which are still occurring in every medical setting. Dosing errors were the most commonly occurring errors and antibiotics were the most frequent group of medicines involved in MEs.

scholarly journals Anterior Cruciate ligament injuries of the knee:

2018 ◽  
Vol 30 (1) ◽  
pp. 1-6
Author(s):  
G Linde Strauss ◽  
D Janse van Rensburg ◽  
C Grant ◽  
A Jansen van Rensburg ◽  
M Velleman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Mechanism Of Injury ◽  
Mri Scan ◽  
Chi Square ◽  
Valgus Stress ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate

Abstract Background and problem statement Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries. Aim To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries. Methods This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified. Results MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury. Conclusion Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public.  Key words Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.

scholarly journals Autopsy Utilization in Medicolegal Defense of Anesthesiologists

2011 ◽  
Vol 115 (4) ◽  
pp. 713-717 ◽  
Author(s):  
Lorri A. Lee ◽  
Linda S. Stephens ◽  
Corinne L. Fligner ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Statistical Significance ◽  
Chi Square ◽  
Autopsy Findings ◽  
New Information ◽  
Malpractice Claims ◽  
Hospital Deaths ◽  
American Society ◽  
Chi Square Analysis ◽  
Closed Claims

Background The rate of autopsy in hospital deaths has declined from more than 50% to 2.4% over the past 50 yr. To understand the role of autopsies in anesthesia malpractice claims, we examined 980 closed claims for deaths that occurred in 1990 or later in the American Society of Anesthesiologists Closed Claims Project Database. Methods Deaths with autopsy were compared with deaths without autopsy. Deaths with autopsy were evaluated to answer the following four questions: Did autopsy findings establish a cause of death? Did autopsy provide new information? Did autopsy identify a significant nonanesthetic contribution to death? Did autopsy help or hurt the defense of the anesthesiologist? Reliability was assessed by κ scores. Differences between groups were compared with chi-square analysis and Kolmogorov-Smirnov test with P &lt; 0.05 for statistical significance. Results Autopsies were performed in 551 (56%) of 980 claims for death. Evaluable autopsy information was available in 288 (52%) of 551 claims with autopsy. Patients in these 288 claims were younger and healthier than those in claims for death without autopsy (P &lt; 0.01). Autopsy provided pathologic diagnoses and an unequivocal cause of death in 21% of these 288 claims (κ= 0.71). An unexpected pathologic diagnosis was found in 50% of claims with evaluable autopsy information (κ = 0.59). Autopsy identified a significant nonanesthetic contribution in 61% (κ = 0.64) of these 288 claims. Autopsy helped in the defense of the anesthesiologist in 55% of claims and harmed the defense in 27% (κ = 0.58) of claims with evaluable autopsy information. Conclusions Autopsy findings were more often helpful than harmful in the medicolegal defense of anesthesiologists. Autopsy identified a significant nonanesthetic contribution to death in two thirds of claims with evaluable autopsy information.

The Predictive Value of Micrometastasis in Nonsentinel Lymph Nodes

2012 ◽  
Vol 78 (6) ◽  
pp. 669-674 ◽  
Author(s):  
Patrick D. Glasgow ◽  
Nikhil Satchidanand ◽  
Gopal Chandru Kowdley
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Lymph Nodes ◽  
Axillary Dissection ◽  
Statistical Significance ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Node Positive Disease ◽  
Completion Axillary Dissection ◽  
Chi Square Analysis

The rate of micrometastatic disease (MMD) to nonsentinel lymph nodes (NSLNs) has been shown to vary considerably in the literature. We identified patients with breast cancer with MMD (N1mi) and measured the incidence of NSLN involvement. We then compared these patients with those who had no metastasis to the SLN (N0) and those who had macrometastasis to the SLN (N2) in an attempt to better understand the behavior of patients with N1mi positivity. A retrospective analysis was conducted on 574 patients with invasive breast cancer between January 2000 and December 2007. Patients were stratified into three groups: no metastasis (N0), MMD (N1mi), and macrometastasis (N2). Chi square analysis and logistic regression models using SPSS software were applied to determine significance between groups. MMD rate was 7.7 per cent (44 of 574). Of this subset of patients, 33 underwent completion axillary dissection, and only two were found to have NSLN-positive disease. Statistical significance was achieved for NSLN positivity when comparing all three nodal groups against one another (χ22,572 = 337.084, P = 0.000). Logistic regression showed multifocality and lymphovascular invasion to be significant predictors of NSLN metastasis. NSLN positivity in patients with MMD acts similarly to node-positive disease and therefore cannot completely exclude axillary dissection from therapeutic algorithm.

scholarly journals In Vivo Bonding of Orthodontic Brackets to Fluorosed Enamel using an Adhesion Promotor

2008 ◽  
Vol 78 (2) ◽  
pp. 357-360 ◽  
Author(s):  
James Noble ◽  
Nicholas E. Karaiskos ◽  
William A. Wiltshire
Keyword(s):  
Dental Fluorosis ◽  
Statistical Significance ◽  
High Volume ◽  
Aluminum Silicate ◽  
Control Group ◽  
Adhesion Promoter ◽  
Bond Failure ◽  
Chi Square ◽  
Chi Square Analysis

Abstract Objectives: To determine the success of bracket retention using an adhesion promoter with and without the additional microabrasion of enamel. Materials and Methods: Fifty-two teeth with severe dental fluorosis were bonded in vivo using a split-mouth design where the enamel surfaces of 26 teeth were microabraded with 50 μm of aluminum silicate for 5 seconds under rubber dam and high volume suction. Thirty-seven percent phosphoric acid was then applied to the enamel, washed and dried, and followed by placement of Scotchbond Multipurpose Plus Bonding Adhesive. Finally, precoated 3M Unitek Victory brackets were placed and light cured. The remaining teeth were bonded using the same protocol but without microabrasion. Results: After 9 months of intraoral service, only one bond failure occurred in the control group where microabrasion was used. Chi-square analysis revealed P = .31, indicating no statistical significance between the two groups. Conclusions: Bonding orthodontic attachments to fluorosed enamel using an adhesion promoter is a viable clinical procedure that does not require the additional micro-mechanical abrasion step.

Effects of Quadriceps and Hamstrings Ratio on ACL Strain During Landing Activities

2012 ◽  
Author(s):  
Carmen E. Quatman ◽  
Ata M. Kiapour ◽  
Ali Kiapour ◽  
Jason W. Levine ◽  
Samuel C. Wordeman ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
The United States ◽  
Implant Design ◽  
Reconstruction Technique ◽  
Fe Model ◽  
Acl Injuries

Over 100,000 anterior cruciate ligament (ACL) injuries occur annually in the United States [1]. Of these, 70% are classified as non-contact, many of which occur subsequent to a landing from a jump [2]. While most agree that quadriceps (Q) and hamstrings (H) have a significant contribution in knee biomechanics, the role of quadriceps and hamstrings muscle loads and their ratio (Q/H) in ACL injury remains controversial. Understanding muscle recruitment in high risk activities may improve our knowledge of ACL injury mechanisms. Such insight may improve current prevention strategies to decrease the risk of ACL injury and damage to secondary anatomical structures, all of which may in turn minimize associated posttraumatic knee osteoarthritis. As in vivo quantification of muscle loads remains challenging, especially under dynamic conditions, validated finite element (FE) models of the knee can be used to characterize the role of muscle loads in ACL injury. FE analysis has provided considerable insight into knee joint biomechanics, including ligament function, ligament reconstruction technique and implant design. This study utilized a validated FE model of the knee joint to study the effects of quadriceps to hamstrings ratio (Q/H) on ACL strain during a simulated landing from a jump. We hypothesized that both the ratio and magnitude of muscle loads are critical determinants of ACL loading. Further, a threshold may be reached as the magnitude of quadriceps load exceeds hamstrings load.

Sign in / Sign up

Export Citation Format

Share Document