Still Scholarworks (A.T. Still University)
Not a member yet
2228 research outputs found
Sort by
Comments on “Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University”
No full textThe fragility of statistical findings in distal biceps tendon repairs: a systematic review of randomized controlled trials
No full textBackground: The purpose of this present study was to perform a fragility analysis to assess the robustness of randomized controlled trials (RCTs) evaluating the distal biceps tendon repairs. We hypothesize that the dichotomous outcomes will be statistically fragile, and higher fragility will exist among statistically significant outcomes comparable to other orthopedic specialties. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), randomized controlled trials from 4 orthopedic journals indexed on PubMed from 2000 to 2022 reporting dichotomous measures relating to distal biceps tendon repairs were included. The fragility index (FI) of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The fragility quotient (FQ) was calculated by dividing each fragility index by study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. Results: Of the 1038 articles screened, 7 RCTs containing 24 dichotomous outcomes were included for analysis. The fragility index and fragility quotient of all outcomes was 6.5 (IQR 4-9) and 0.077 (IQR 0.031-0.123), respectively. However, statistically significant outcomes had a fragility index and fragility quotient of 2 (IQR 2-7) and 0.036 (IQR 0.025-0.091), respectively. The average number of patients lost to follow-up was 2.7 patients, with 28.6% of the included studies reporting loss to follow-up (LTF) greater than or equal to 6.5. Conclusions: The literature surrounding distal biceps tendon repair may not be as stable as previously thought and presents a similar fragility index to other orthopedic subspecialties. We therefore recommend triple reporting the P value, fragility index, and fragility quotient to aid in the interpretation of clinical findings reported in biceps tendon repair literature
The statistical fragility of the distal fibula fracture literature: A systematic review of randomized controlled trials
No full textBackground: The purpose of this study was to apply both the fragility index (FI) and fragility quotient (FQ) to evaluate the degree of statistical fragility in the distal fibular fracture (DFF) literature. We hypothesized that the dichotomous outcomes within the DFF literature are statistically fragile. Methods: We performed a PubMed search for distal fibular fractures clinical trials from 2000 to 2022 reporting dichotomous outcomes. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. Results: Of the 1158 articles screened, 23 met the search criteria, with six RCTs included for analysis. Forty-five outcome events with 5 significant (p \u3c 0.05) outcomes and 40 nonsignificant (p ≥ 0.05) outcomes were identified. The overall FI and FQ was 5 (IQR 4–6) and 0.089 (IQR 0.061–0.107), respectively. Conclusions: The randomized controlled trials in the peer-reviewed distal fibular fracture literature may not be as robust as previously thought, as incorporating statistical analyses solely on a P value threshold is misleading. Standardized reporting of the P value, FI and FQ can help the clinician reliably draw conclusions based on the fragility of outcome measures
Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic
No full textBackground: The coronavirus 2019 (COVID-19) pandemic resulted in rapid implementation of telemedicine. Little is known about the impact of telemedicine on both no-show rates and healthcare disparities on the general primary care population during the pandemic. Objective: To compare no-show rates between telemedicine and office visits in the primary care setting, while controlling for the burden of COVID-19 cases, with focus on underserved populations. Design: Retrospective cohort study. Setting: Multi-center urban network of primary care clinics between April 2021 and December 2021. Participants: A total of 311,517 completed primary care physician visits across 164,647 patients. Main Measures: The primary outcome was risk ratio of no-show incidences (i.e., no-show rates) between telemedicine and office visits across demographic sub-groups including age, ethnicity, race, and payor type. Results: Compared to in-office visits, the overall risk of no-showing favored telemedicine, adjusted risk ratio of 0.68 (95% CI 0.65 to 0.71), absolute risk reduction (ARR) 4.0%. This favorability was most profound in several cohorts with racial/ethnic and socioeconomic differences with risk ratios in Black/African American 0.47 (95% CI 0.41 to 0.53), ARR 9.0%; Hispanic/Latino 0.63 (95% CI 0.58 to 0.68), ARR 4.6%; Medicaid 0.58 (95% CI 0.54 to 0.62) ARR 7.3%; Self-Pay 0.64 (95% CI 0.58 to 0.70) ARR 11.3%. Limitation: The analysis was limited to physician-only visits in a single setting and did not examine the reasons for visits. Conclusion: As compared to office visits, patients using telemedicine have a lower risk of no-showing to primary care appointments. This is one step towards improved access to care
Acuity Tools for the Antepartum and Neonatal Intensive Care Units
No full textPurpose:To evaluate content validity and interrater reliability for acuity tools developed for the antepartum and neonatal intensive care unit (NICU) patient population.Study Design and Methods:Antepartum and NICU acuity tools were developed to better evaluate nurse staffing assignment equity and patient needs. Following several iterations with staff nurses and nurse leaders, content validity of the acuity tools was established via a panel of experts in each substantive area using the Content Validity Index. The final tools were then evaluated for interrater reliability using Intraclass Correlation.Results:Content validity for the Antepartum Acuity Tool was S-CVI/Ave = 0.87 and for the NICU Acuity Tool was S-CVI/Ave = 0.98. Interrater Reliability for the Antepartum Acuity tool was ICC = 0.88, and the NICU Acuity Tool was ICC = 0.95.Clinical Implications:These tools have established content validity and interrater reliability and are appropriate for use in the antepartum and NICU settings to determine patient acuity and promote appropriate nurse-to-patient assignments
Mannosylated preactivated hyaluronic acid-based nanostructures for bacterial infection treatment
No full textSalmonella Typhi is an intracellular bacterium causing a variety of enteric diseases, being typhoid fever the most common. Current modalities for treating S. typhi infection are subjected to multi-drug resistance. Herein, a novel macrophage targeting approach was developed via coating bioinspired mannosylated preactivated hyaluronic acid (Man-PTHA) ligands on a self-nanoemulsifying drug delivery system (SNEDDS) loaded with the antibacterial drug ciprofloxacin (CIP). The shake flask method was used to determine the drug solubility in the different excipients (oil, surfactants and co-surfactants). Man-PTHA were characterized by physicochemical, in vitro, and in vivo parameters. The mean droplet size was 257 nm, with a PDI of 0.37 and zeta potential of − 15 mV. In 72 h, 85 % of the drug was released in a sustained manner, and the entrapment efficiency was 95 %. Outstanding biocompatibility, mucoadhesion, muco-penetration, anti-bacterial action and hemocompatibility were observed. Intra-macrophage survival of S. typhi was minimal (1 %) with maximum nanoparticle uptake, as shown by their higher fluorescence intensity. Serum biochemistry evaluation showed no significant changes or toxicity, and histopathological evaluation confirmed the entero-protective nature of the bioinspired polymers. Overall, results confirm that Man-PTHA SNEDDS can be employed as novel and effective delivery systems for the therapeutic management of S. typhi infection
How COVID-19 changed frontline healthcare workers’ experiences: a narrative inquiry into the impact of chronic burnout on a surgical physician assistant’s wellness
No full textBurnout is an occupational phenomenon resulting from unmanaged chronic workplace stress. Since COVID-19 started, burnout among healthcare workers has worsened and become a public health crisis. Wellness is about leading a physically, mentally, and spiritually healthy lifestyle to achieve one’s full potential through positive affirmations. Its multiple dimensions include (1) physical, (2) emotional, (3) intellectual, (4) occupational, (5) social, and (6) spiritual. Extant empirical literature lacked regarding surgical physician assistants and how chronic burnout affected their wellness. This longitudinal narrative inquiry thus aimed to explore the perceived impact of a surgical physician assistant’s chronic burnout during the COVID-19 pandemic on her physical, mental, and emotional wellness through her lived work experiences from the onset to the major surges of COVID-19 positive cases (2020, 2021, 2022). The study participant provided the researcher with her self-recorded personal journals of lived work experiences. The researcher organized and re-presented the narratives, applied thematic analyses to identify key dimensions from the narratives, and grouped them into positive-effect and negative-effect dimensions. Three positive-effect dimensions were (1) resilience and healthcare leadership competencies, (2) work support system, and (3) family-and-friend support system. Six negative effect dimensions were (1) lack of federal leadership and coordination, (2) unhealthy work conditions, (3) caring for the critically ill, (4) inequity in work-location arrangements, (5) frustrated and angry patients and families, and (6) increased workload. Healthcare policymakers and industry leaders must pay immediate attention to the Quintuple Aim’s 4th and 5th aims to address healthcare workers’ burnout and wellness, and inequity within the healthcare workforce
Periodontal and systemic health: shaping the future of our knowledge.
No full textNumerous studies have shown the existence of a close relationship between oral and systemic health, and a two-way interaction is likely to exist in some instances; however, as of today, the mechanisms involved in such an interaction are not completely understood. The scientific evidence demonstrating that people suffering from periodontal infections are more susceptible to metabolic endotoxemia, inflammation, obesity, type 2 diabetes, and other related systemic complications allows to conclude that periodontal diseases represent a risk factor for a wide array of clinically important systemic diseases. Research on the effects of endocrine-disrupting chemicals (EDCs) on obesity, type 2 diabetes, and associated metabolic disorders is a relatively new discipline; nevertheless, a growing number of epidemiological studies reveals associations between EDCs body burdens and a variety of diseases. Future research goals might be aimed at exploring the diverse mechanisms that hint to a certain connection between periodontal infections and EDCs
A case of dulaglutide-induced vaginal bleed
No full textType 2 diabetes mellitus (T2DM) is a growing challenge across the globe. The disease process is amendable to lifestyle modifications in the early stages. If those changes fail to correct endocrine dysfunction, medical therapy is initiated. Initially, therapy for type 2 diabetes consisted of biguanides and sulfonylureas. With modern medicine, we have developed dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide 1 (GLP-1) receptor agonists. Dulaglutide is a GLP-1 receptor agonist that is sold under the brand name Trulicity. The most common side effect associated with Dulaglutide is gastrointestinal discomfort. We present a case of severe vaginal bleeding due to a rare side effect of Dulaglutide.
A 44-year-old perimenopausal female with a past medical history of type 2 diabetes mellitus presented to the clinic after experiencing significant vaginal bleeding. The patient was unable to tolerate Metformin and Semaglutide in the past. The abnormal vaginal hemorrhage started one week after receiving the second dose of Dulaglutide. Her hemoglobin concentration fell significantly. Dulaglutide was immediately discontinued, and her vaginal bleeding stopped.
This case documents the necessity of post-market surveillance to oversee the safety of recently approved medications by the Food and Drug Administration (FDA). Rare side effects can emerge in the general population that were not seen during clinical trials. Physicians should consider the possibility of adverse medication reactions when determining whether to start a new medication or a conventional one
The effects of platelet rich plasma as a treatment modality for the “unhappy triad”—a multisystemic review
No full textThe “Unhappy Triad” traditionally identifies an injury that affects the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the medial meniscus (MM). It occurs in an estimated twenty-five percent (25%) of acute knee injuries [1]. Due to a recent increased prevalence of lateral meniscus (LM) tears the “Unhappy Triad” may be more accurately described as an injury that consists of tears of the ACL, MCL, and the LM [2,3]. Acute simultaneous rupture in the “unhappy triad” of the knee is a rare but severe injury