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The statistical fragility of outcomes in calcaneus fractures: A systematic review of randomized controlled trials
No full textIntroduction: The purpose of this study was to utilize the fragility index to assess the robustness of randomized controlled trials (RCTs) evaluating the management of calcaneus fractures. We hypothesize that the dichotomous outcomes in calcaneus fracture literature will be statistically fragile and comparable to other orthopedic specialties. Methods: We performed a PubMed search for calcaneus fracture RCTs from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). 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 3003 studies screened, 97 met the search criteria, with 19 RCTs evaluating calcaneus fractures included in the analysis. Seventy-nine dichotomous outcomes with 30 significant (P \u3c 0.05) outcomes and 49 with nonsignificant (P \u3e 0.05) outcomes were identified. The overall FI and FQ of all outcomes were 6 (IQR 3–8) and 0.067 (IQR 0.032–0.100), respectively. Conclusions: The literature surrounding calcaneus fractures may not be as statistically stable as previously thought. The sole reliance on the P value may depict misleading results. We, therefore, recommend reporting the P value in conjunction with the FI and FQ to give a robust contextualization of clinical findings in the calcaneus fracture literature
Knowledge and Attitudes of Lifestyle Medicine-Based Care in a Military Community
No full textAbstract
Introduction: The Department of Defense spends more than $3 billion annually on medical costs of lifestyle-related morbidity. Military service members and veterans engage in unhealthy behaviors at a higher rate than the civilian population. Lifestyle medicine may mitigate lifestyle-related chronic diseases and increase medical readiness in the U.S. Military. However, patients\u27 perspectives in a military community regarding a lifestyle medicine-based approach to health care have not been studied. The purpose of this study was to assess the knowledge and attitudes of and interest in lifestyle medicine-based care within a military community.
Materials and methods: Following exempt study determination from the Madigan Army Medical Center Human Protections Office (Reference No. 220092), a prospective, cross-sectional, mixed-methods survey study was conducted from September 2020 to January 2021. Volunteer subjects, including active duty service members, National Guard/Reserves service members, and military dependents, were recruited to complete the anonymous survey while seeking care at five military clinics on Joint Base Lewis-McChord, Washington. The study\u27s outcome measures were the overall level of awareness of lifestyle medicine, ranked level of importance of seven core lifestyle domains, the level of interest in seeking care from a lifestyle medicine practitioner, and the preferred lifestyle medicine care delivery setting. Kruskal-Wallis analyses of variance were conducted for categorical outcome variables. Mean composite scores were calculated for lifestyle domain rankings.
Results: A total of 623 respondents completed the survey with a 62.3% response rate. The majority of respondents (89.7%) lacked definitive knowledge of the field of lifestyle medicine. Food/nutrition and sleep were ranked the highest of all lifestyle domains to include in a healthcare approach in the overall sample and across all subgroups. Quitting smoking and alcohol use were ranked the lowest of importance overall and across all subgroups. The majority of respondents (65.7%) reported it was extremely or very important that lifestyle is part of the healthcare discussion with their provider. Of 614 responses, 77.6% of respondents expressed interest in a lifestyle medicine-based approach to health care, with 40.1% indicating they were extremely or very interested in this approach. A direct correlation was noted between education levels and level of interest in lifestyle medicine. Many respondents selected their primary care provider (34.6%) or a lifestyle medicine practitioner embedded in their primary care clinic (26.1%) as their preferred method of lifestyle medicine provision. A higher smoking rate was demonstrated in service members in combat arms occupational specialties.
Conclusions: Despite an overall low level of awareness of lifestyle medicine, most respondents expressed interest in a lifestyle medicine approach to health care, with food/nutrition and sleep ranked as the most important domains. Lower levels of education may be a potential barrier to patient willingness to engage in lifestyle medicine care. Service members in combat arms occupational specialties may represent a potential target population for smoking cessation interventions. Further research with a larger sample more proportionately inclusive of all military service branches is needed
Weight stigma: a potential barrier to psychiatric/mental health medication care
No full textAbstract
Weight stigma is pervasive in the United States, and its presence in healthcare settings can lead to an avoidance of healthcare services. This study examined whether experienced weight stigma or weight self-stigma predicted psychiatric/mental health medication visits. A total of 384 self-identified female participants completed an online survey about stigma and utilization of healthcare services. Binary logistic regression analyses indicated that having been discriminated against because of body weight, and weight self-stigma, predicted avoidance. Results suggest weight stigma may have negative implications for psychiatric/mental health medication visits. Implications for social work research, practice, and advocacy are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved
Evaluating patients with vertigo
No full textAbstract
Dizziness and vertigo are among the most common complaints in medicine. Patients often provide vague descriptions of symptoms, making clinicians\u27 jobs challenging. However, a patient with vertigo also can be one of the most rewarding encounters of a clinician\u27s day. In most cases, a focused history and bedside vestibular testing provide enough information to make a diagnosis and identify patients for appropriate referral. Canalith repositioning maneuvers often resolve symptoms, leaving patients and clinicians satisfied
Six tips for successful grant writing
No full textAbstract
Physician associates/assistants (PAs) are poised to be excellent grant writers for local projects that can improve access to quality care and improve the finances of historically underserved, urban, and rural healthcare communities. Because grant writing focuses on the dream of what is possible with funding, it contrasts with other forms of medical writing, which focus on past findings. This article aims to introduce PAs to six steps that can help them with grant writing, with a goal of improving patient care or starting community outreach projects
Caring for nonbinary patients
No full textAbstract
Nonbinary is an umbrella term that encompasses any person whose gender identity is outside the binary construct of man or woman . An estimated 1.2 million people in the United States identify as nonbinary, a number that most likely will continue to increase as the visibility of people who live outside binary gender increases in our society. Healthcare providers are likely to encounter nonbinary patients but may lack confidence in treating these patients appropriately. This article describes terminology, concepts, and suggestions for clinicians to provide basic respectful and competent care for nonbinary patients
Effects of vitamin D deficiency on COVID-19–related mortality and morbidity
No full textMany studies have examined the correlation between vitamin D deficiency and mortality from SARS-CoV-2 infections (COVID-19). This research — conducted across many cultures, ages, and pre-existing conditions — consistently demonstrates that vitamin D deficiency is an indicator of poor health and a statistically significant marker for poor outcomes from COVID-19. Although it is known that people with pre-existing health conditions do less well than their healthier counterparts after becoming infected with COVID-19, the relationship to vitamin D deficiency is believed to be more correlative than causative
Non-Surgical Camouflage Treatment of a Skeletal Class III Patient with Anterior Open Bite and Asymmetry Using Orthodontic Miniscrews and Intermaxillary Elastics
No full textThis case report presents the non-surgical orthodontic camouflage treatment of an 18-year-old male patient with skeletal Class III asymmetry and severe anterior open bite. The anterior open bite was corrected by extrusion of the maxillary and mandibular anterior teeth and clockwise and counterclockwise rotation of the maxillary and mandibular occlusal plane, respectively, using intermaxillary Class III elastics between the maxillary posterior buccal miniscrews and mandibular canines and anterior vertical elastics between the maxillary and mandibular canines. Class III dental relationships and dental asymmetry were corrected via unilateral distalization of the mandibular dentition on the left side using a closed coil spring between the buccal shelf screw and hook. The patient’s smile esthetics and dental relationship were improved with a more favorable facial profile, and facial asymmetry was slightly alleviated after orthodontic camouflage treatment. The total treatment time was 15 months. A modified wraparound retainer with a scalloped labial bow, tongue crib, and tooth positioner was used simultaneously to prevent the potential relapse
A CBCT Evaluation of the Proximity of Mandibular Molar Roots and Lingual Cortical Bone in Various Vertical Facial Patterns and Factors Related to Root-Cortical Bone Contact
No full textThe objective of this study was to assess the proximity of the mandibular molar roots and the lingual cortical bone in patients with various vertical facial patterns and determine factors related to root-cortical bone contact. A total of 145 patients (84 males, 61 females, mean age: 22.0 ± 1.76 years) were assigned to hypodivergent (36 patients), normovergent (80 patients) and hyperdivergent (29 patients) groups based on their facial height ratio. Cone-beam computed tomography (CBCT) images were used to measure the distance between the mandibular molar roots and the lingual cortical bone, and any instances of root-cortical bone contact were identified. The study investigated the correlation between the contact of the mandibular molar roots with the lingual cortical bone and several variables, including sex and cephalometric measurements. The distance between the mandibular molar roots and the lingual cortical bone was significantly shorter in the hyperdivergent group than in the hypodivergent group (p \u3c 0.05). Of the total root-cortical bone contact, 87.6% was observed in the mandibular second molars, and the distal roots of the mandibular second molars had the highest contact rate at 43.1% in the hyperdivergent group (p \u3c 0.05). Among the evaluated variables, only the distance between the distal root apex of the mandibular second molar and the mandibular plane was found to be associated with contact of the mandibular molar roots with the lingual cortical bone. An increase of 1 mm in this distance was associated with a 22% decrease in the likelihood of contact between the mandibular second molar roots and lingual cortical bone (p \u3c 0.001). Given the proximity and high contact ratio between the mandibular molar roots and lingual cortical bone, it is recommended that these structures be evaluated using CBCT before planning molar distalization or intrusion in hyperdivergent patients
Comparison of treatment effects between two types of facemasks in early Class III patients
No full textObjective: To compare the short-term treatment effects between two types of facemasks in skeletal Class III patients. Materials and Methods: This retrospective study included 40 skeletal Class III subjects (mean age: 7.7 years) who had been treated with protraction facemasks with forehead straps (PFFS) or Petit type facemasks (PTF). Lateral cephalograms were analyzed at pretreatment (T1) and posttreatment (T2) with an average interval of 9 months. Results: At T1, PFFS and PTF groups showed similar sagittal, vertical dentoskeletal patterns. From T1 to T2, both groups presented significant forward movement of the maxilla, posterior movement and clockwise rotation of the mandible (all p \u3c.001), labioversion of the maxillary incisors, and linguoversion of the mandibular incisors. They showed increased overjet (p \u3c.001). Although there were no significant differences in the number of changes in most dentoskeletal variables between the two groups, the PFFS group showed more anterior rotation of the palatal plane and backward rotation of the mandible compared to the PTF group, resulting in a significant decrease (−0.42 mm) in overbite (p \u3c.05). Conclusions: Both PFFS and PTF showed no significant differences in most skeletal and dental changes, except for overbite. These findings might be helpful for clinicians in selecting the types of facemasks for growing Class III malocclusion patients