Still Scholarworks (A.T. Still University)
Not a member yet
2228 research outputs found
Sort by
The fragility of statistical findings in the reverse total shoulder arthroplasty literature: a systematic review of randomized controlled trials
No full textBackground: Reverse total shoulder arthroplasty (RTSA) has seen increasing utilization as an effective intervention for a wide variety of shoulder pathologies. The scope and indications for growth are often driven by findings from randomized controlled trials (RCTs) guiding surgical decision-making for RTSA. In this study, we utilized the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the robustness of outcomes reported in RCTs in the RTSA literature. Methods: PubMed, Embase, and MEDLINE were queried for RCTs (Jan. 1, 2010-Mar. 31, 2023) in the RTSA literature reporting dichotomous outcomes. The FI and rFI were defined as the number of outcome reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The FQ was determined by dividing the FI by the sample size of each study. Subgroup analysis was performed based on outcome category. Results: One hundred seventy-six RCTs were screened with 18 studies included. The median FI across 59 total outcomes was 4 (interquartile range [IQR]: 3-5) with an associated FQ of 0.051 (IQR: 0.029-0.065). Thirteen outcomes were statistically significant with a median FI of 3 (IQR: 1-4) and FQ of 0.033 (IQR: 0.012-0.066). Forty-six outcomes were nonsignificant with a median rFI of 4 (IQR: 3-5) and FQ of 0.055 (IQR: 0.032-0.065). The most fragile outcome category was revision/reoperations with a median FI of 2.50 (IQR: 1.00-3.25), followed by clinical score/outcome (median FI: 3.00), complications (median FI: 4.00), “other” (median FI: 4.00), and radiographic findings (median FI: 5.00). Notably, the number of patients lost to follow-up was greater than or equal to the FI for 59% of outcomes. Conclusion: The statistical findings in RTSA RCTs are fragile and should be interpreted with caution. Reversal of only a few outcomes, or maintaining postoperative follow-up, may be sufficient to alter significance of study findings. We recommend standardized reporting of P values with FI and FQ metrics to allow clinicians to effectively assess the robustness of study findings
Relationship between youth cardiometabolic health and physical activity in medical records
No full textBackground Thers is limited research examining modifiable cardiometabolic risk factors with a single-item health behavior question obtained during a clinic visit. Such information could support clinicians in identifying patients at risk for adverse cardiometabolic health. We investigated if children meeting physical activity or screen time recommendations, collected during clinic visits, have better cardiometabolic health than children not meeting recommendations. We hypothesized that children meeting either recommendation would have fewer cardiometabolic risk factors. Methods and findings This cross-sectional study used data from electronic medical records (EMRs) between January 1, 2013 through December 30, 2017 from children (2–18 years) with a well child visits and data for ≥1 cardiometabolic risk factor (i.e., systolic and diastolic blood pressure, glycated hemoglobin, alanine transaminase, high-density and low-density lipoprotein, total cholesterol, and/or triglycerides). Physical activity and screen time were patient/caregiver-reported. Analyses included EMRs from 63,676 well child visits by 30,698 unique patients (49.3% female; 41.7% Black, 31.5% Hispanic). Models that included data from all visits indicated children meeting physical activity recommendations had reduced risk for abnormal blood pressure (odds ratio [OR] = 0.91, 95%CI 0.86, 0.97; p = 0.002), glycated hemoglobin (OR = 0.83, 95%CI 0.75, 0.91; p = 0.00006), alanine transaminase (OR = 0.85, 95%CI 0.79, 0.92; p = 0.00001), high-density lipoprotein (OR = 0.88, 95%CI 0.82, 0.95; p = 0.0009), and triglyceride values (OR = 0.89, 95%CI 0.83, 0.96; p = 0.002). Meeting screen time recommendations was not associated with abnormal cardiometabolic risk factors. Conclusion Collecting information on reported adherence to meeting physical activity recommendations can provide clinicians with additional information to identify patients with a higher risk of adverse cardiometabolic health
Decreasing Stigma Toward People Who Inject Drugs: Harm Reduction Training for First-Year Medical Students
No full textProblem Stigma in health care toward people who inject drugs (PWID) is a well-described, significant barrier to quality care, resulting in poor health outcomes. Harm reduction offers a person-centered counter-framework for minimizing harm for people who use drugs. Despite the evidence in support of harm reduction, medical students typically receive minimal training on harm reduction and the care of PWID. Approach To fill this gap, medical students at the University of California, Los Angeles organized around the principles of harm reduction to improve the medical school curriculum related to PWID. Students screened lectures for stigmatizing language and collaborated with faculty to improve lecture materials. They partnered with a community organizer and hosted a mandatory 1-hour lecture and 30-minute discussion introducing the principles of harm reduction within an overdose prevention, recognition, and response training for first-year medical students during medical school orientation in August 2022. An anonymous online pretest and posttest survey, assessing student attitudes toward PWID, was used to evaluate the effects of the training. Outcomes A total of 156 students completed the pretest survey, and 107 students completed the pretest and posttest survey (68.5% response rate). The overall posttest mean stigma score was 1.8 (standard deviation [SD] = 0.5) and was significantly lower than the pretest mean of 2.1 (SD = 0.7; P \u3c.0001), indicating a reduction in stigma among medical student attitudes after the course. There was statistically significant improvement in attitudes for 7 of 13 component measures. Next Steps This analysis demonstrated that the mandatory class has the capacity to improve medical student attitudes toward PWID. The authors plan to further evaluate the program\u27s effectiveness through measuring and reporting outcomes for future student cohorts. The authors are working with curriculum directors to further incorporate harm reduction principles into other lectures and problem-based learning exercises
Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Response to Letter]
No full textConditional Knockouts of Interphotoreceptor Retinoid Binding Protein Suggest Two Independent Mechanisms for Retinal Degeneration and Myopia
No full textPurpose: Interphotoreceptor retinoid-binding protein\u27s (IRBP) role in eye growth and its involvement in cell homeostasis remain poorly understood. One hypothesis proposes early conditional deletion of the IRBP gene could lead to a myopic response with retinal degeneration, whereas late conditional deletion (after eye size is determined) could cause retinal degeneration without myopia. Here, we sought to understand if prior myopia was required for subsequent retinal degeneration in the absence of IRBP. This study investigates if any cell type or developmental stage is more important in myopia or retinal degeneration. Methods: IBRPfl/fl mice were bred with 5 Cre-driver lines: HRGP-Cre, Chx10-Cre, Rho-iCre75, HRGP-Cre Rho-iCre75, and Rx-Cre. Mice were analyzed for IRBP gene expression through digital droplet PCR (ddPCR). Young adult (P30) mice were tested for retinal degeneration and morphology using spectral-domain optical coherence tomography (SD-OCT) and hematoxylin and eosin (H&E) staining. Function was analyzed using electroretinograms (ERGs). Eye sizes and axial lengths were compared through external eye measurements and whole eye biometry. Results: Across all outcome measures, when bred to IRBPfl/fl, HRGP-Cre and Chx10-Cre lines showed no differences from IRBPfl/fl alone. With the Rho-iCre75 line, small but significant reductions were seen in retinal thickness with SD-OCT imaging and postmortem H&E staining without increased axial length. Both the HRGP-Cre+Rho-iCre75 and the Rx-Cre lines showed significant decreases in retinal thickness and outer nuclear layer cell counts. Using external eye measurements and SD-OCT imaging, both lines showed an increase in eye size. Finally, function in both lines was roughly halved across scotopic, photopic, and flicker ERGs. Conclusions: Our studies support hypotheses that for both eye size determination and retinal homeostasis, there are two critical timing windows when IRBP must be expressed in rods or cones to prevent myopia (P7-P12) and degeneration (P21 and later). The rod-specific IRBP knockout (Rho-iCre75) showed significant retinal functional losses without myopia, indicating that the two phenotypes are independent. IRBP is needed for early development of photoreceptors and eye size, whereas Rho-iCre75 IRBPfl/fl knockout results in retinal degeneration without myopia
Analyzing the training of PAs in ophthalmology
No full textObjective:This study sought to determine the role of physician associates/assistants (PAs) in ophthalmology, the balance between barriers and facilitators in training, and optimal training for PAs in ophthalmology.Methods:In this explanatory qualitative case study, 17 of the 94 PAs in ophthalmology in the United States participated in qualitative, semistructured interviews. Qualitative interviews were conducted using a validated interview guide. Interpretational data analysis methods helped in the development of various themes.Results:Themes suggest that PAs play a unique role in assisting ophthalmologists in surgery, performing procedures autonomously, and evaluating and treating patients autonomously. PAs in ophthalmology reported current training programs as unfavorable, reported satisfaction in their careers, and identified formal postgraduate training programs as optimal training for PAs.Conclusions:Findings of this study suggest that formal postgraduate training programs can help PAs gain the necessary skills to successfully fulfill their roles in ophthalmology
Investigating the Perceived Impact of Surgeons’ Burnout on Surgical Physician Associates’ Wellness in United States Ambulatory Surgery Centers
No full textSurgeons are the de facto leaders of surgical teams with surgical physician associates (SPAs) as integral members who function in all areas of the peri-operative environment. Surgeons often supervise SPAs. Ambulatory surgery centers (ASCs) provide patients with same-day diagnostic and preventive procedures as more convenient alternatives to hospital-based outpatient procedures. This qualitative, national, and cross-sectional study explored the perceived impact of surgeons’ burnout on SPAs’ wellness in U.S. ASCs during global health crises. Primary demographic and qualitative data were collected using a self-developed, three-section survey instrument: (1) information regarding informed consent; (2) 10 short demographic questions; and (3) two open-ended essay questions regarding surgeons’ burnout and SPAs’ wellness. To ensure validity and reliability, we individually reviewed the survey instrument to ensure it be formative of the two study constructs, two retired newspaper editors completed the cognitive interviews, and four subject matter experts critically reviewed it. Demographic data were analyzed using Minitab V21, and qualitative data were analyzed using MAXQDA V2022. The final sample (n = 29) represented 29 unique ASCs across all five U.S. geographic regions. Three main findings emerged from the thematic analyses. First, the SPAs experienced poor and decreased work life balance, decreased exercise, stress, burnout, increased job demand, exhaustion, and decreased job satisfaction when their supervising surgeons’ burnout affected their wellness negatively. Second, the SPAs experienced work-related frustration when their interaction with supervising surgeons decreased as a result of the surgeons’ burnout. Finally, the SPAs reported feeling supported when their supervising surgeons were supportive and affected their wellness positively
The Impact of Vision Training on Visual Perceptual Skills in Male Soccer Players
Get PDFBackground. Athletic performance is one of the most visually demanding activities an individual can participate in. Due to the physically and cognitively demanding nature of soccer, it is imperative to take a deeper look into how visual-perceptual skills impact overall athletic performance. If an athlete’s visual system does not correctly receive messages from environmental stimuli, overall athletic performance may suffer. For an athlete to function at their highest performance possible, it is essential to focus on improving visual-perceptual skills.
Methods. A mixed methods approach was used to determine the impact of vision training on visual perceptual skills in male soccer players over six weeks. The TVPS-4 and Neuro-score were used to see how the vision training program affected the visual performance of an athlete. A post-survey was then used to understand the participant\u27s perspective of the project and how they felt vision training helped them in training or games.
Results. Following the six-week vision training project, the means of TVPS-4 scores and Neuro-scores were not found to be statistically significant. Although most athletes did see an increase in scores, there was a negligible correlation between the time spent in vision training and changed TVPS-4 total scores.
Discussion. The ability to make quick decisions is dependent upon how quickly one can perceive what is happening around them on the field and can differentiate between a skilled athlete and a less-skilled athlete. An athlete may not reach their full athletic potential without the proper vision training interventions
The Impact of Individualized Exercise Programs on Athlete\u27s Perception of Performance in Winter Adaptive Sports
Get PDFBackground: Historically, people with disabilities have faced barriers to participating in meaningful occupations like adaptive sports. Despite the positive effects of adaptive sports, sport-induced injury can impede an individual’s functional independence. This capstone project aimed to evaluate the impact of individualized exercise programs on athletes’ perception of performance in winter adaptive sports, with a focus on injury prevention.
Methods: Two recurring High Country Adaptive Sports athletes participated. They provided consent to engage in a 10-week individualized home exercise program (HEP) prior to the 2024 ski season. They completed a pre-survey at the initial meeting and a post-survey upon completion of the HEP and after their last adaptive ski lesson. Weekly questionnaires were administered to monitor program adherence.
Results: Of the two athletes, only one completed the program in its entirety. Athlete A did not complete the 10-week program due to attrition. Athlete B demonstrated positive outcomes in all areas, including strength, confidence, happiness, and health, although bias may have been a contributing factor in her success.
Discussion: Further research is warranted to assess the impact of individualized exercise programs on the perception of performance in winter adaptive sports as well as the impact of HEPs on sports-induced injury. While the findings of this project are not generalizable, it is clear that the scope of the occupational therapy profession aligns with the goals of adaptive sports and authorizes additional research to be done to further validate how improving physical fitness levels can positively impact adaptive sports performance while simultaneously protect the athlete from sports-induced injury
Provider-Perceived Value of Interprofessional Team Meetings as a Core Element of a Lifestyle Medicine Program: A Mixed-Methods Analysis of One Center’s Experience
No full textInterprofessional care improves outcomes for medically complex patients and may be a valuable addition to standard lifestyle medicine practice, but implementation barriers exist. The purpose of this study was to explore the key features, perceived impact, and implementation considerations related to holding interprofessional team meetings as part of an intensive lifestyle medicine program. In this mixed-methods study, focus groups were conducted with 15 lifestyle medicine clinicians from various healthcare disciplines who had participated in interprofessional team meetings. Quantitative descriptive statistics of the meeting minutes were also calculated. Clinician-perceived benefits from participating in interprofessional team meetings included increased acquisition of knowledge, access to other clinicians, collaborative decision-making, patient satisfaction, and achievement of patient-centered goals. Participants described the importance of preparing an agenda for the interprofessional team meetings in advance, but a major implementation challenge was the time required to prepare for and conduct the meetings. Commitment and financial support by organization and program leadership were reported as key facilitators to implementing the meetings. Clinicians perceive significant value from incorporation of interprofessional team meetings into an intensive lifestyle medicine program, but successful implementation of meetings requires investment from all levels within a healthcare system