2313 research outputs found
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Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies
No full textBackground: Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach.
Methods: Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed.
Results: Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient.
Conclusions: Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months
Moderating Effects of Leader Narcissism on the Relationships Between Leader Political Skill and Follower LMX and Affective Commitment
No full textRecent research identifies political skill and narcissism as leader characteristics of practical and scholarly interest. Studies to date, however, have examined these features in isolation, resulting in an incomplete picture hindering subsequent research. We address this gap by examining the leader political skill x narcissism interaction, and its implications for work outcomes including organizational commitment (OC) and leader-member exchange (LMX). Specifically, we explore whether political skill can be useful alone, or whether some motivation is necessary (e.g., narcissism) for its activation and influence on work outcomes. Accordingly, we also address whether narcissism can be a positive workplace trait when combined with political skill. We used a multi-wave, supervisor (narcissism and political skill) and subordinate (OC and LMX) matched pair data collection. Results indicate that the leader political skill x leader narcissism interaction was significant for organizational commitment and LMX. We also found support for the moderated mediation model, where narcissism influenced the mediated relationship between political skill and organizational commitment via LMX. We discuss contributions to theory and practice, limitations, and directions for future research
Finding Possibilities, Determining Student Abilities, and What That Looks Like in an Inclusive Classroom during COVID-19
No full textShining a Light on the Challenging Behaviors of Adolescents with Comorbid Diagnoses: Use of Pictorial Concurrent Operant Preference Assessment
Full text linkCurrently, there are no published studies that have used the concurrent operant preference assessment procedure to identify functions of challenging behaviors displayed by individuals with comorbid diagnoses. Four participants (aged 11–16 years) with comorbid diagnoses who displayed multiple challenging behaviors were referred to this study. We modified the standard concurrent operant preference assessment and used the new modified version, the pictorial concurrent operant preference assessment, to identify the functions of the challenging behaviors. Utilizing the triangulation mixed-methods design, we compared the indirect functional behavioral assessment (FBA) and the direct FBA with the pictorial concurrent operant preference assessment. The results obtained successfully demonstrated the concordance among these assessments in identifying the behavioral function for each participant. The results further showed that (1) the preferences served the same functional effects on both the challenging behaviors and the adaptive behaviors and (2) the pictorial concurrent operant preference assessment can be used independently to identify potential behavioral function and to specify the reinforcing potency of each behavioral function. The significance of the study results, limitations of this study, and directions for future research and clinical practice are discussed
Is There Anything Else You Would Like Me to Know? : Applying a Trauma-Informed Approach to the Administration of the Adverse Childhood Experiences Questionnaire.
No full textNearly ubiquitous agreement exists regarding the potentially negative impact of adverse childhood experiences (ACEs) on health and well‐being across the lifespan. This has propelled a movement across the nation for consistent screening of ACEs. Despite agreement regarding the consequences of ACEs, little research related specifically to the administration of the ACE questionnaire exists. Using data from a mixed‐methods study of first‐time mothers as means of illustration, this paper examines shortcomings of the ACE questionnaire. Participant responses revealed ambiguity with item structure, limited breadth of included events, and failure to capture the gravity of the experience. These shortcomings underscore inadequacies of the measure in accurately understanding individuals\u27 lived experiences and call for the application of trauma‐informed (TI) values, both in its content and administration. We apply the main tenets of a TI framework to the ACE questionnaire and make recommendations for its administration, translating theoretical underpinnings of a TI approach into action
Under the Radar: Everyday Sadism Predicts Both Passive-Aggressive Harms and Beneficial Actions After Accounting for Prosocial Tendencies
No full textTwo studies examined the predictive value of everyday sadism in determining participants\u27 choices to cause frustration to a hypothetical other, controlling for prosocial characteristics (cognitive and affective empathy, helpfulness). In Study 1 (n = 154), forward-stepwise multiple regression analyses indicated direct physical sadism levels predicted participants\u27 assignment of easy and difficult math items after levels of prosocial characteristics were statistically controlled. In Study 2 (n = 110), forward-stepwise multiple regression analyses indicated participants\u27 levels of direct physical sadism predicted the assignment of easy and difficult math items across two math tasks (a replication of study one and a second math task related to the first). Study 2 analyses also revealed both direct verbal and physical sadism predicted the assignment of moderately difficult math items. Additional analyses further suggest direct verbal sadism predicted choosing to frustrate others in a more common, everyday experience. These findings suggest levels of direct physical and verbal sadism are important independent predictors of individuals\u27 decisions to inflict non-physical forms of frustration on others
Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database
No full textPURPOSE: The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented.
DESIGN: Observational, cross-sectional cohort study.
SUBJECTS AND SETTING: An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients).
METHODS: Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed.
RESULTS: Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel.
CONCLUSIONS: Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development
