Is Higher Nurse Aide Retention Associated with Fewer Nursing Home Allegations and Complaints?

Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.

Predictors of postoperative urinary retention after posterior spinal fusion for adolescent idiopathic scoliosis

Purpose To determine predictors for postoperative urinary retention in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. Postoperative urinary retention affects almost every third adolescent after spinal fusion for idiopathic scoliosis. There are limited data regarding the risk factors of postoperative urinary retention in this patient group. Methods A retrospective study with prospectively collected urinary retention data from paediatric spine register with 159 consecutive patients (114 females, mean age 15.6 years, range 10–21 years) undergoing pedicle screw instrumentation for adolescent idiopathic scoliosis at a university hospital between May 2010 and April 2020. Postoperative urinary retention was defined as an inability to void after catheter removal and documented residual over 300 mL as confirmed using an ultrasound or by catheterization. Results Postoperative urinary retention was diagnosed in 33% (53 of 159) of the patients during hospital stay. Opioid amount on the day of catheter removal (OR 6.74 [95% CI: 2.47, 18.36], p < 0.001), male gender (OR 2.26 [95% CI: 1.01, 5.05], p = 0.048), and increasing weight (OR 1.04 [95% CI: 1.01, 1.07], p = 0.014) were associated with postoperative urinary retention. Mean opioid consumption on the day of catheter removal was 0.81 mg/kg (95% CI: 0.66, 0.96) in the retention group vs 0.57 mg/kg (95% CI: 0.51, 0.64) in the non-retention group, p < 0.001. Conclusions Higher total opioid consumption, opioid amount on the day of catheter removal, higher weight, and male gender increases the risk of postoperative urinary retention in adolescents with idiopathic scoliosis undergoing posterior spinal fusion.

Comparison of ACIOL Exchange and Descemet Membrane Endothelial Keratoplasty with ACIOL Retention and Descemet Stripping Automated Endothelial Keratoplasty in the Setting of Pseudophakic Bullous Keratopathy

Objective: To compare the clinical outcomes and complications of anterior chamber intraocular lens (ACIOL) exchange and Descemet membrane endothelial keratoplasty (DMEK) with ACIOL retention and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with PBK.Methods: A multicenter retrospective cohort study. Patients with ACIOL who underwent endothelial keratoplasty procedure due to PBK between 2012-2018 in two tertiary medical centers, were identified. Clinical and demographical data including preoperative and postoperative characteristics were collected.Results: Thirteen eyes in the “DMEK and ACIOL exchange” group and 15 in the “DSAEK and ACIOL retention” group were included in the analysis. Mean BCVA six months postoperatively was 0.51±0.20 LogMAR (Snellen 20/64) and 0.57±0.22 LogMAR (Snellen 20/83) in the “DMEK and ACIOL exchange” group and “DSAEK and ACIOL retention” group, respectively (P=0.38). Graft failure occurred in 6 eyes (40%) in the “DSAEK and ACIOL retention” group; four of them were secondary failures occurring at an average follow-up time of 15±11.9 months. In the “DMEK and ACIOL exchange” group, graft failure occurred in one eye and was a primary failure (P=0.046). In the “DMEK and ACIOL exchange” group, postoperative complications were seen in 4 eyes (30.7%). No postoperative complications were recorded in the “DSAEK and ACIOL retention” group (P=0.035).Conclusion: Despite the lower complication rate, the higher incidence of graft failure and the need for second keratoplasty in the DSAEK group along with the similar visual outcomes, might suggest that in the indication of PBK, ACIOL exchange with DMEK offers a good alternative to ACIOL retention with DSAEK.

Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis

Study Design: Systematic review and meta-analysis. Objectives: To compare biomechanical and functional outcomes between implant removal and implant retention following posterior surgical fixation of thoracolumbar burst fractures. Methods: A search of the MEDLINE, EMBASE, Google Scholar and Cochrane Databases was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 751 articles initially retrieved, 13 published articles pooling 673 patients were included. Meta-analysis revealed there was a statistically significant improvement in sagittal Cobb Angle by 16.48 degrees (9.13-23.83, p < 0.01) after surgical stabilization of thoracolumbar burst fractures. This correction decremented to 9.68 degrees (2.02-17.35, p < 0.01) but remained significant at the time of implant removal approximately 12 months later. At final follow-up, the implant removal group demonstrated a 10.13 degree loss (3.00-23.26, p = 0.13) of reduction, while the implant retention group experienced a 10.17 degree loss (1.79-22.12, p = 0.10). There was no statistically significant difference in correction loss between implant retention and removal cohorts (p = 0.97). Pooled VAS scores improved by a mean of 3.32 points (0.18 to 6.45, p = 0.04) in the combined removal group, but by only 2.50 points (-1.81 to 6.81, p = 0.26) in the retention group. Oswestry Disability Index scores also improved after implant removal by 7.80 points (2.95-12.64, p < 0.01) at 1 year and 11.10 points (5.24-16.96, p < 0.01) at final follow-up. Conclusions: In younger patients with thoracolumbar burst fractures who undergo posterior surgical stabilization, planned implant removal results in superior functional outcomes without significant difference in kyphotic angle correction loss compared to implant retention.

Stability of aligned maxillary anterior teeth after orthodontic treatment: amount of changes with different retention methods and without retention

Well-aligned anterior teeth are the major reason for the patients seeking orthodontic treatment, and keeping teeth aligned and stable afterwards is a goal for the orthodontist and the patient. Relapse after treatment is a common problem, and it is defined as when teeth go back to their previous positions. Removable or fixed retainers have been used to avoid relapse after treatment. It has been common practice to use removable retention to retain anterior teeth in the maxilla. However, in recent decades, it has become increasingly common to retain with bonded retainers. Almost all previous studies on retention devices in the maxilla were based on removable retainers. Consequently, there existed knowledge gaps and lack of short-term and long-term studies on the capability to maintain the stability of the maxillary anterior teeth with bonded retainers. Hence, the reason for the papers in this study. In addition, it is not known if retentionis needed in all orthodontic patients or if there are patients, based on their initial malocclusion and individual variations, who may not need retention after treatment. The research questions addressed in this thesis thus originate from knowledgegaps and clinical needs concerning retention strategies after orthodontic treatments. To provide strong clinical evidence, randomised controlled trials (RCT) as well as intention to treat (ITT) methodology has been assessed. The results are expected to be beneficial for the patients who will be offered the most effective retention strategy for maxillary anterior teeth based on patients’ preferences. In Paper I and II, 45 and 27 adolescents’ patients were collected from the Orthodontic Clinic in Mariestad, Sweden. At the time when Paper Iand II were conducted, there were no studies that had evaluated the longterm effect of bonded retainers in the maxilla. In two RCTs, Paper III and IV, 90 and 63 adolescents’ patients were collected from the Orthodontic Clinic in Växjö, Region Kronoberg, Sweden. Paper I: The aim was to investigate the amount and pattern of relapse of maxillary anterior teeth previously retained with a bonded retainer. Paper II: The aim was to investigate the amount and pattern of changes of maxillary anterior teeth seven years post-retention, which previously were retained with a bonded retainer. Paper III: The aim was to evaluate post-treatment changes in the irregularity of the maxillary six anterior teeth and single tooth Contact Point Discrepancy (CPD) of three different retention methods. Paper IV: The aim was to evaluate whether retention is needed after orthodontic treatment for impacted maxillary canines and with moderate pre-treatment irregularity in the maxilla. Key findings in Paper I • The contact relationship between the laterals and the centrals is the most unstable contact. Canines are the most stable teeth. • There was no difference in the relapse pattern between rotational displacements and labiolingual displacement. Key findings in Paper II • There was a strong correlation between irregularity at one- and seven-years post-retention. Stable cases one-year post-retention were stable and unstable cases deteriorated with time. Key findings in Paper III • All three retention methods showed equally effective retention capacity and all the changes found in the three groups were small and considered clinically insignificant. Thus, the null hypothesis was confirmed. All three methods can be recommended. Key findings in Paper IV • Changes between the retention and the non-retention group were statistically but not clinically significant. Since satisfactory clinical results one-year post-treatment were found in the non-retention group, retention does not appear always to be needed. • Most of the changes occur within the first 10-week period after treatment with no retention. Key conclusions and clinical implications Both removable and bonded retainers are effective for holding teeth inposition and can be used for preventing the relapse. It can be enough toretain with bonded retainer 12-22 instead of 13-23. It might be possibleto avoid retention in selected cases in the short-term, but a longer evaluationperiod is needed.

Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: A retrospective cross-sectional study

Background: Endometrioma is a common high-recurrence gynecological disease that affects infertility. Surgical resection using laparotomy or laparoscopy is applied as a standard treatment. Moreover, sclerotherapy is reported to be effective as a noninvasive method for treating endometrioma. Objective: To evaluate whether the ethanol retention or aspiration after sclerotherapy improve pregnancy outcome in infertile women with endometrioma. Materials and Methods: In a retrospective study, hospital records of 43 women with recurrent or bilateral endometrioma who had been undergone transvaginal ultrasound sclerotherapy were reviewed. They were selected to receive either ethanol for 10 min, ethanol injection, irrigation, and then aspiration or total retention without aspiration based on the surgeon’s decision. The participants were followed-up for 3, 6 and 12 months for natural or artificial conception as well as for cyst recurrence. Results: Chemical pregnancy was positive in 52% of the women in the aspiration group and 53.8% in the retention group. Ongoing pregnancy (44% vs 46.2%, p = 0.584) and live birth (40% vs 46.2%, p = 0.490) were reported marginally higher in the retention group compared with the aspiration group, and the differences were not statistically significant. Moreover, the recurrence rate were found to be 48.1% and 37.5% in the aspiration and retention groups, respectively (p = 0.542). The cysts size in the retention group was significantly correlated to the recurrence rate. Conclusion: Both the aspiration and left in situ of ethanol 95% sclerotherapy have the similar impact on the treatment of ovarian endometrioma regarding pregnancy and recurrence rate. However, larger randomized studies with strict inclusion criteria are needed. Key words: Endometrioma, Ethanol, Sclerotherapy, In vitro fertilization, Pregnancy rate.

Independent Radiographic Review of Joint Space Following First Metatarsophalangeal Synthetic Cartilage Implantation: Is There an Association Between Joint Space and Outcomes?

Category: Midfoot/Forefoot; Other Introduction/Purpose: Synthetic cartilage implants for first metatarsophalangeal osteoarthritis have been used for nearly a decade with Level 1 clinical evidence showing 84.9% of implants remain in place at a mean follow-up of 5.8 years. In contradiction to these positive results, however, some recent publications have shown higher revision rates and attempted to correlate the need for revision with the postoperative joint space interval. Most of these studies performed assessments based off of routine anterior-posterior (AP) radiographs using hand drawn measurements without image calibration or scaling. The purpose of this independent radiographic review was to further explore any relationship between joint space integrity and the need for revision surgery. Methods: An independent radiographic review by two board-certified, fellowship-trained, practicing musculoskeletal radiologists with no competing financial interests was conducted for 15 subjects from a previously concluded Level 1 clinical trial looking at outcomes of a synthetic cartilage implant. Ten (10) subjects with positive outcomes and 5 who required revision were selected at random for evaluation. Weight-bearing AP and lateral radiographs at baseline, 2 weeks, 6, 12, 24, and 60 months were reviewed. Using previously validated Quantitative Motion Analysis software, joint space was measured in the medial, central, and lateral locations on AP radiographs and dorsal, central, and plantar locations on lateral radiographs (Coughlin et al. 2003). Measurements were normalized to the proximal phalanx width in the relevant view (AP or lateral) to adjust for lack of image scaling or calibration. Normalized joint spaces at each interval and changes from the 2-week visit, the earliest with the implant in place, were evaluated. Results: In this pilot study, no relationship between mean normalized joint space and implant removal was found at any time point over the 60-month follow-up. Scatterplots were used to determine if movement in different directions impacted mean values. There was significant overlap for the two groups in joint space at each subject’s final visit with the implant in place and the change from the 2-week visit to the final visit (Figure 1). The majority of subjects in both groups experienced changes in joint space of less than 10% across all measurements. The maximum change from the 2-week visit in the revision group was less than 15%, compared to over 25% for subjects in the retention group. Conclusion: Neither joint space at final follow-up nor joint space change from initial postoperative assessment were associated with revision. The maximum observed decrease in the revision group was less than 15%, or 0.5 mm in a joint space of 3 mm. Both the clinical relevance of this minimal decrease and whether or not it can be reliably assessed remain unclear. Future studies could examine patient factors other than joint space to determine success or failure of this implant. These preliminary results suggest joint space integrity evaluated from plain film is a weak indicator of clinical efficacy with this synthetic cartilage implant.

A controlled intervention to improve freshman retention in a STEM-based physiology major

Using a Scholarship of Teaching and Learning lens, this study systematically examined if a targeted intervention in at-risk students within a science, technology, engineering, and mathematics (STEM)-based physiology program would elicit positive student perceptions and higher retention rates into the second year. Those students who were considered at risk for attrition (retention; n = 82) were compared against a control group (non-retention; n = 165), and outcomes were evaluated with an End-of-Semester Survey and university enrollment data. Students in the retention group reported more favorable responses to questions pertaining to a first-year seminar course and academic advising. By the start of the following (spring 2019) semester, 48 students transferred out of the program (20%) with little difference between groups (non-retention 19%; retention 22%). At the start of fall 2019 term, 55% of the 2018 freshman class were retained within the program (non-retention 66%; retention 39%), and 85% were retained within the university (non-retention 91%, retention 74%). The intervention was successful in eliciting positive student perceptions of the major, but did not improve retention of at-risk students within the physiology major.

The Effects of Continuous Usage of Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis (Preprint)

BACKGROUND The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies based on randomized controlled trials (RCTs), showing steeper decrease of hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. OBJECTIVE To evaluate the effectiveness of digital interventions by tracking HbA1c improvement over one year in real-world clinical settings. METHODS The Health2Sync mobile app was used by patients to track self-measured outcomes and communicate with health care professionals (HCPs). The web-based Patient Management Platform was used by HCPs to monitor patient data, view test results from clinical labs, and communicate with patients. Patients that have been onboarded for at least 13 months and had consecutive HbA1c results for five quarters were included in the analysis. They were then stratified into three groups (high, mid, and low retention) according to their level of use of the mobile app in the first six months after onboarding. A mixed model was built to compare the slopes of HbA1c percentage decreases between the groups. In addition, these patients’ stickiness on the app from the seventh to the twelfth month was verified with multiple comparisons. RESULTS A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage decreases as the passed quarter count increased (t = -9.869, P < .001), and that effectiveness was enlarged in high and mid retention groups as the interaction effects were significantly negative compared with the low retention group (t = -6.620, P < .001 for passed quarter count * mid retention; t = -5.173, P < .001 for passed quarter count * high retention). The low retention group also had the highest average HbA1c value in the end of the 13 months [mean (SD): 7.01 (1.02) %, 6.99 (1.00) %, and 7.17 (1.14) % for high, mid, and low retention groups, respectively, P = .07, .02, and 1.00 for high-low, mid-low, and high-mid difference comparison after Bonferroni correction]. The level of use of the app remained consistent in the seventh to the twelfth month after onboarding [mean (SD): 5.23 (1.37) months, 2.43 (1.68) months, and 0.41 (0.97) months for high, mid, and low retention groups, respectively, P < .001 for all comparison pairs after Bonferroni correction]. CONCLUSIONS Our analysis showed that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies can be performed to reveal the efficacy for specific diabetes types and to observe the effects beyond one year.

Colonic transendoscopic tube-delivered enteral therapy (with video): a prospective study

Background Colonic transendoscopic enteral tubing (TET) refers to colonic transendoscopic tube-delivered enteral therapy. Colonic TET has been successfully used for frequent colonic administration of drugs or multiple fecal microbiota transplantations (FMTs). This prospective observational study aimed to evaluate possible factors affecting methodology, feasibility and safety of colonic TET. Methods Patients who underwent colonic TET at our center from October 2014 to November 2018 were included. The feasibility, efficacy, and safety of TET were evaluated. Results In total, 224 patients were analyzed. The success rate of TET was 100%. The median retention time of TET tube within the colonic lumen was 8.5 (IQR 7–11) days in 158 patients with tube falling out spontaneously, and the maximum retention time was up to 28 days. These patients were divided into the short-retention group (≤ 8.5 days) and the long-retention group (> 8.5 days). Univariate and multivariate analysis demonstrated that the type of endoscopic clip (p = 0.001) was an independent factor for the retention time. The larger clips as well as a greater number of clips significantly affected the retention time (p = 0.013). No severe adverse event was observed during and after TET. Conclusions Colonic TET is a feasible, practical, and safe colon-targeted drug delivery technique with a high degree of patients’ satisfaction. Two to four large endoscopic clips are recommended to maintain stability of the TET tube within the colon for over 7 days.