No Humans Here

Many research communities routinely conduct activities that fall outside the bounds of traditional human subjects research, yet still frequently rely on the determinations of institutional review boards (IRBs) or similar regulatory bodies to scope ethical decision-making. Presented as a U.S. university-based fictional memo describing a post-hoc IRB review of a research study about social media and public health, this design fiction draws inspiration from current debates and uncertainties in the HCI and social computing communities around issues such as the use of public data, privacy, open science, and unintended consequences, in order to highlight the limitations of regulatory bodies as arbiters of ethics and the importance of forward-thinking ethical considerations from researchers and research communities.

Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.

What Did We Miss? Analysis of Military Personnel Responses to an Open-Ended Question in a Post-Deployment Health Survey

ABSTRACT Introduction Post-deployment health surveys completed by military personnel ask about a range of deployment experiences. These surveys are conducted to determine if there are links between experiences and poor health. Responses to open-ended questions in these surveys can identify experiences that might otherwise go unreported. These responses may increase knowledge about a particular deployment and inform future surveys. This study documented deployment experiences described by Australian Defence Force personnel who were deployed to the Middle East. Materials and Methods A survey completed by 14,032 personnel examined health outcomes and over 100 experiences relating to their Middle East deployment. Responses to two open-ended questions captured additional experiences. Descriptive statistics reveal the characteristics of those who did and did not describe additional experiences, and a content analysis details the nature and frequency of the experiences reported. The study was approved by an Institutional Review Board. Results Five percentage (n = 692) of personnel who completed the survey described additional deployment experiences. The most frequently reported experiences were specific Navy experiences; experiences of poor leadership; administrative or organizational issues; the anthrax vaccine; and traumatic events/potentially morally injurious experiences. Conclusions The findings suggest that post-deployment health surveys should have questions about certain deployment experiences tailored by military service (i.e., Air Force, Army, and Navy). Researchers could consider including questions about personnel experiences of leadership for its impact on health and about potentially morally injurious experiences that may help explain adverse mental health. Clear wording of open-ended questions and participant instructions may improve response rates and reduce response biases.

Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon

Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for “normalization of deviance” phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex (p = 0.19), age (p = 0.46), or referral diagnosis (p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) (p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

In Grenada, West Indies, What Is the Degree of Bat-human Interaction in Households and Is It Associated to Arboviral Disease?

Background: Bats are reservoirs for several zoonotic pathogens, making human-bat interactions particularly concerning. Recent studies documented that Grenadian bats can be infected with Zika, dengue and Chikungunya viruses and Leptospira bacteria among other pathogens. The objective of this study was to estimate the number of homes in Grenada that have a bat infestation, and to determine whether there is a correlation between the number of bat infested homes with the type of roofing or the presence of arbovirus infections of human inhabitants. Methods: An institutional review board (IRB) approved questionnaire delivered through a semi-structured interview was administered at the central bus stop in St. George, Grenada to recruit participants from all six parishes and the island of Carriacou. Results determined the percentage of individuals that had bat roosts in their households, whether this was of concern to them, whether they had taken any steps to keep bats out of their residence, and whether they had confirmed or suspected cases of dengue, Zika or Chikungunya virus infections. Information on the type of roofing and presence of window screens were also documented. Bat type (fruit vs insect eating bats) was attempted by guano description. Results: Results from 210 individual responses provided data showing all six parishes were represented although not equally. Having bats at the household was not associated with parish of residence, roof type or presence or absence of window screens. The results showed 60% of homes in Grenada are bat-infested and 51% of people self-reported recent arbovirus infection; but no correlation between the two. Also, no correlation to a specific type of roof or type of bat was found.Conclusions: A statistically significant number of inhabitants had attempted to remove bats from their homes, indicating that bats are perceived as pest to homes in Grenada, and justifying further research into relocating bats through the use of construction changes, awareness, and the creation of bat houses.

The role of community advisory boards in community-based HIV clinical trials: a qualitative study from Tanzania

Background Community Advisory Boards (CAB) have become essential organs of involving communities in HIV clinical trials especially in developing countries. However, limited empirical evidence exists on the role of CABs in low and middle-income countries including Tanzania. This study aims at exploring the role of CABs in community-based HIV clinical trials conducted in Tanzania. Methodology We adopted a phenomenological approach to purposefully select HIV clinical trial stakeholders. These included CAB members, researchers and Institutional Review Board (IRB) members in Tanzania. We conducted In-depth Interviews (IDIs) with ten participants and three Focus Group Discussions (FGDs) with eighteen participants. The data were thematically analyzed with the aid of MAXQDA software version 20.2.1. Results The findings indicate that at every stage of implementation of a community-based HIV clinical trial, a functioning CAB is important for its success. This importance is based on contextualization of the informed consent process and protocol, managing rumours in the community, weighing trial risks and benefits, sensitizing the community, assisting participant recruitment, tracing and retention. However, being perceived as financial beneficiaries than community representatives emerged as a challenge to CAB members. Conclusion The study empirically indicates the need for functioning CABs in every stage of implementation of community-based HIV clinical trials. The roles of which are interwoven in serving research goals and protecting the interests of the community and that of trial participants.

Acute Basilar Artery Occlusion Presenting With Convulsive Movements: A Systematic Review

Background and Purpose: Convulsive seizures related to posterior circulation stroke are considered rare. However, some patients with acute basilar artery occlusion (BAO) can present with convulsive movements. Misdiagnosed as seizures may delay the reperfusion therapy for acute BAO. In this study, we have summarized the clinical features and possible mechanisms of BAO presenting with convulsive movements.Methods: We performed an Institutional Review Board-approved institutional database query from 2015 to 2020 and a literature search of the online database PubMed. Clinical data were collected and analyzed.Results: In total, 14 patients with acute BAO presented with convulsions. There were 10 men and 4 women, with a mean age of 53 (range, 23–77) years. All of these patients had different degrees of impaired consciousness (100.0%, 14/14). Convulsive movements were the initial symptoms in 78.6% (11/14) of patients. Further, 64.3% (9/14) of patients presented with paralysis or cranial nerve abnormalities, and 85.7% (12/14) of patients were treated with reperfusion therapy (thrombolysis, 35.7% [5/14]; endovascular thrombectomy, 64.3% [9/14]). The BAO etiology and mechanism were related to embolism, vessel dissections, and severe stenosis of the right vertebral artery in 57.1% (8/14), 21.4% (3/14), and 7.1% (1/14) of patients, respectively; they were undefined in 14.3% (2/14) of patients. Moreover, 42.9% (6/14) of patients had a 90-day modified Rankin Scale score of 0–2, and the mortality rate was 21.4% (3/14).Conclusions: Acute BAO, especially that related to embolism or vessel dissection, may present with convulsive movements. Acute BAO is a devastating, but treatable disease if diagnosed in time. Considering the possibility of BAO is important when dealing with patients presenting with acute-onset convulsive movements. Prompt diagnosis and reperfusion therapy may help achieve a better prognosis.

Can Peer Assessment Impact Self-efficacy During Small-Group Learning?

Introduction: While studies report positive correlations between students’ perceptions of the learning environment and their reported self-efficacy, the role of peer assessment is poorly understood in this context. This study examines the process and impact of peer assessment on self-efficacy and perceptions of the learning environment during a small-group discussion-based course required of first-year medical students. Methods: After spending time in small-group learning, students completed three peer assessments and reviewed three assessments of themselves. Analysis of the peer assessments included thematic coding of comments and word counts. Prior to and following the assessment period, students completed a survey including the Generalized Self-efficacy (GSE) Scale, and six locally-developed questions regarding the learning environment and perceptions of peer assessment. We performed paired-sample t tests to determine whether there were differences between the pre- and post-peer assessment surveys. The SUNY Upstate Institutional Review Board reviewed the study and determined it to be exempt. Results: Peer assessment narratives referred most commonly to students’ participation style and the need for greater participation. Word counts ranged widely. A paired sample t test indicated that the difference between pre and post peer assessment GSE scores was significant (P=.009), but the effect size was small (d=0.32). Perceptions of the learning environment did not change after the peer assessments. Conclusion: Peer assessment offers a potential strategy for enhancing self-efficacy in medical school small-group learning environments and requires few resources to implement, relative to the potential benefits.

Enhanced Recovery After Surgery: Standardized Postoperative Instructions in Hand Surgery

Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.

Outcomes of Operative Treatment of Forearm Deformity in Children with Osteogenesis Imperfecta: 18 Cases

Osteogenesis imperfecta (OI) often results in recurrent fractures and/or progressive bowing of the long bones, including the arms. Upper extremity deformity has been shown to negatively impact function. The objective of this retrospective case series is to assess the ability to correct deformity, improve function and evaluate the complications and revision rates in our patients with OI who have undergone forearm deformity correction. A retrospective study, approved by The University of Nebraska Medical Center Institutional Review Board, was conducted with OI patients who underwent forearm osteotomy and fixation of one or both forearm bones between December 2011 and August 2018. There were no exclusion criteria. The electronic medical records were reviewed for patient demographics, surgical details, revisions and complications. A total of 48 procedures on 27 forearms in 18 patients were performed during the study. Surgery was performed in children with forearm deformity and recurrent fractures that were interfering with function. Half of the patients had surgery on one forearm and half had surgery on both forearms. The majority of the patients have Type III OI. There were multiple complications, the most common being wire migration which required either replacement or advancement of the wire. In conclusion, forearm deformity in OI is possible, with good healing of osteotomies and fractures, although many patients may require multiple surgical interventions.