Still Scholarworks (A.T. Still University)
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Interpreting patient-rated outcome measures in adolescent patients following concussion
No full textObjective: To estimate scale scores for patient-reported outcome (PRO) measures that classify patients as improved or unimproved at days 3 and 10 post-concussion. Methods: Data from 187 adolescent patients who sustained a concussion (150 males, 32 females, 5 not reported) were analyzed. Patients completed the Pediatric Quality of Life Inventory (PedsQL), PedsQL Multidimensional Fatigue Scale (MFS), Headache Impact Test (HIT-6), and Global Rating of Change (GROC) on days 3 and 10 post-concussion. Dependent variables: PedsQL total score, 3 MFS subscale scores [general (MFS-GF), sleep (MFS-SLF), cognitive (MFS-CF) fatigue], and HIT-6 total score. Higher scores on PedsQL and MFS indicate better health; lower scores on HIT-6 indicate less impact on headache-related health. GROC ascertained patient-perceived magnitude of change in health status since concussion. Receiver Operating Characteristic Curve analyses estimated PRO cut-point scores that classified patients as improved or unimproved. Results: Day 3 PRO cut-points: PedsQL total = 90; MFS-GF = 73; MSF-CF = 85; MFS-SLF = 81; and HIT-6 total = 54. Day 10 PRO cut-points: PedsQL total = 91; MFS-GF = 85; MFS-CF = 85; MFS-SLF = 90; and HIT-6 total = 51. Conclusions: Our results define PedsQL, MFS, and HIT-6 scores as they relate to perceived improvement following concussive injuries. Cut-point scale scores help clinicians interpret concussion PROs and make informed decisions during the management of patients with concussion
Parents and coaches as transformational leaders: Motivating high school athletes’ intentions to report concussion symptoms across socioeconomic statuses
No full textPurpose: Studies demonstrate that parents and coaches play a role in an athlete\u27s concussion reporting decision primarily through their influence on the decision environment. Little work, however, has explored how a given parenting/coaching style operates to promote intentions and much less work has examined whether the impact of parenting/coaching on concussion reporting differs by socioeconomic status. Transformational parenting/coaching (i.e., a focus on building autonomy and self-efficacy in athletes) represents one promising approach given its effects on other outcomes (e.g., health, burnout, aggression). We hypothesize that athlete perceptions of transformational parenting/coaching will be associated with their reporting intentions directly and through the athlete\u27s motivation for playing their sport regardless of household income. Methods: A national survey of 1023 high-school athletes measured athlete perceptions of transformational parenting/coaching, sport motivation, and reporting intentions. Structural Equation Modeling was used to examine hypotheses. Results: Transformational parenting was directly associated with reporting intentions (β: Reporting Intentions = .265; Scenario 1 = 0.206; Scenario 2 = 0.260) and indirectly through increased autonomous/decreased controlled motivation. Transformational coaching was not directly associated with Reporting Intentions (β = 0.008, p = .816) or Scenario 2 (β = 0.046, p = .198) but was for Scenario 1 (β = 0.077, p = .003). Transformational coaching was also associated with reporting intention indirectly through increased autonomous, but not controlled motivation. Athletes with household income of $50,000+ were more likely to report transformational parenting/coaching; however, the effects of transformational parenting/coaching did not differ for athletes from higher versus lower-income households. Conclusions: Transformational parenting/coaching may encourage greater concussion reporting intentions primarily through increased autonomous (i.e., self-directed) sport motivation regardless of socioeconomic status. Cultivating transformational leadership in parents/coaches can have a positive impact on the athlete\u27s intention to report concussion-like symptoms
Types and prevalence of adverse skin reactions associated with prolonged N95 and simple mask usage during the COVID-19 pandemic
No full textBackground: As the coronavirus 2019 (COVID-19) pandemic persists on a global level, the chronic daily use of face masks within the healthcare system remains an important component of disease prevention and transmission. Increased use of personal protective equipment (PPE) may result in increased rates of occupational dermatoses and adverse skin reactions. Objectives: The purpose of this study is to explore how chronic, prolonged use of N95 masks or simple surgical masks affects the prevalence of adverse skin reactions in Healthcare Workers (HCWs). Methods: An optional, quantitative, web-based survey was administered to patient-facing HCWs across six network hospitals in a large metropolitan city. Data were analysed to assess the types and sites of adverse skin reactions, and to evaluate correlations between single mask use duration and adverse skin reactions. Results: A total of 230 HCWs responded with 192 endorsing occupational dermatoses. Among the healthcare responders, (n = 192, 83.5%) experienced at least one adverse skin reaction. The most common occupational adverse skin reactions were acne (n = 133, 57.8%), dryness (n = 108, 47.0%) and redness (n = 105, 45.7%). Anatomical areas most commonly affected included the nasal bridge (n = 92, 40.0%), cheeks (n = 92, 40.0%) and chin (n = 91, 39.6%). Acne (P = 0.002), dryness/scaling (P = 0.002), increased pore size (0.003), itch (P = 0.003), nasal bridge scarring (P \u3c 0.001), redness (P \u3c 0.001), frictional erosions (P = 0.001) and ulcerations (P = 0.002) showed a positive correlation to duration of mask use. Conclusions: Prolonged, daily usage of PPE is associated with numerous adverse skin reactions among HCWs with acne being the most commonly seen adverse reaction. Many adverse reactions are associated with prolonged use of single mask
Online medical education in Egypt during the COVID-19 pandemic: a nationwide assessment of medical students’ usage and perceptions
No full textBackground: The coronavirus (COVID-19) pandemic required a transformation of medical education in Egypt. Public health measures necessitated a rapid shift from traditional face to face lectures to largely online platforms following campus closures. The aim of this study is to characterize medical student use and perception of online medical education in Egypt as well as exploring the efficacy of different e-learning modalities. Additionally, many barriers and opportunities as perceived by students are reviewed to inform future educational improvements. Methods: A 29-item online survey was created on google forms and distributed by social media to medical students across 26 Egyptian medical schools. The survey was administered from August 20th, 2021, to September 5th, 2021. The survey consisted of a mixture of questions style. The medical students were asked about their experiences with online medical education during the COVID-19 pandemic as well as medical students’ anxiety, perceived academic performance, and obstacles related to online education. Results: Of the 4935 responses collected, 43.4% (n = 2140) of respondents were women; 56.6% (n = 2795) were men. Medical students from private medical schools were 13.0% (n = 644), whereas 87.0% (n = 4291) were from public medical schools. 54.6% of students reported that online education is not as effective as face-to-face education. There was a significant rise in hours spent by medical students on online medical education compared to before COVID-19 pandemic. More than half of students (63%) agreed that online recorded video tutorials (e.g., YouTube) were the most effective form of online medical education. Conclusion: The shift to online education has significantly impacted medical students in Egypt. Medical students reported various limitations and challenges of online medical education, which must be addressed considering the potential benefits of online platforms over traditional face to face learning. The results of this nationwide study provide a framework for potential areas to implement change to improve the accessibility and structure of online medical education in Egypt
Differential affinity chromatography reveals a link between Porphyromonas gingivalis–induced changes in vascular smooth muscle cell differentiation and the type 9 secretion system
No full textPorphyromonas gingivalis is implicated in adverse pregnancy outcome. We previously demonstrated that intrauterine infection with various strains of P. gingivalis impairs the physiologic remodeling of the uterine spiral arteries (IRSA) during pregnancy, which underlies the major obstetrical syndromes. Women diagnosed with IRSA also have a greater risk for premature cardiovascular disease in later life. The dysregulated plasticity of vascular smooth muscle cells (VSMCs) is present in both IRSA and premature cardiovascular events. We hypothesized that VSMCs could serve as a bait to identify P. gingivalis proteins associated with dysregulated VSMC plasticity as seen in IRSA. We first confirmed that dams with P. gingivalis A7UF-induced IRSA also show perturbed aortic smooth muscle cell (AoSMC) plasticity along with the P. gingivalis colonization of the tissue. The in vitro infection of AoSMCs with IRSA-inducing strain A7UF also perturbed AoSMC plasticity that did not occur with infection by non-IRSA-inducing strain W83. Far-Western blotting with strain W83 and strain A7UF showed a differential binding pattern to the rat aorta and primary rat AoSMCs. The affinity chromatography/pull-down assay combined with mass spectrometry was used to identify P. gingivalis/AoSMC protein interactions specific to IRSA. Membrane proteins with a high binding affinity to AoSMCs were identified in the A7UF pull-down but not in the W83 pull-down, most of which were the outer membrane components of the Type 9 secretion system (T9SS) and T9SS cargo proteins. Additional T9SS cargo proteins were detected in greater abundance in the A7UF pull-down eluate compared to W83. None of the proteins enriched in the W83 eluate were T9SS components nor T9SS cargo proteins despite their presence in the prey preparations used in the pull-down assay. In summary, differential affinity chromatography established that the components of IRSA-inducing P. gingivalis T9SS as well as its cargo directly interact with AoSMCs, which may play a role in the infection-induced dysregulation of VSMC plasticity. The possibility that the T9SS is involved in the microbial manipulation of host cell events important for cell differentiation and tissue remodeling would constitute a new virulence function for this system
Textbook typologies: Challenging the myth of the perfect obstetric pelvis
No full textMedical education\u27s treatment of obstetric-related anatomy exemplifies historical sex bias in medical curricula. Foundational obstetric and midwifery textbooks teach that clinical pelvimetry and the Caldwell–Moloy classification system are used to assess the pelvic capacity of a pregnant patient. We describe the history of these techniques—ostensibly developed to manage arrested labors—and offer the following criticisms. The sample on which these techniques were developed betrays the bias of the authors and does not represent the sample needed to address their interest in obstetric outcomes. Caldwell and Moloy wrote as though the size and shape of the bony pelvis are the primary causes of “difficult birth”; today we know differently, yet books still present their work as relevant. The human obstetric pelvis varies in complex ways that are healthy and normal such that neither individual clinical pelvimetric dimensions nor the artificial typologies developed from these measurements can be clearly correlated with obstetric outcomes. We critique the continued inclusion of clinical pelvimetry and the Caldwell–Moloy classification system in biomedical curricula for the racism that was inherent in the development of these techniques and that has clinical consequences today. We call for textbooks, curricula, and clinical practices to abandon these outdated, racist techniques. In their place, we call for a truly evidence-based practice of obstetrics and midwifery, one based on an understanding of the complexity and variability of the physiology of pregnancy and birth. Instead of using false typologies that lack evidence, this change would empower both pregnant people and practitioners
Long-Term CBCT Evaluation of Mandibular Third Molar Changes after Distalization in Adolescents
No full textIntroduction: This study aimed to evaluate mandibular molar changes after distalization using Class III elastics and modified C-palatal plates (MCPPs) in the maxilla and to use CBCT to specifically analyze the third-molar position after long-term retention in adolescents. Methods: The sample consisted of 65 mandibular third molars from 35 subjects, divided into two groups. Twenty-six of the third molars were from fourteen adolescent patients with Class I bimaxillary protrusion (mean age, 12.8 years) who had undergone bilateral maxillary distalization using an MCPP and mandibular distalization with Class III elastics with non-extraction treatment. For the control group, 39 third molars from 21 Class I normal-occlusion subjects were used. In the treated group, CBCT images were taken before distalization (T1), after molar distalization (T2), and at a long-term observation point (6.1 ± 2.7 years) (T3). Repeated measures ANOVA and a post hoc test with Bonferroni correction were used to analyze significant differences in the positions at the three points in time. Results: There were 2.3 and 1.7 mm of distal movement at the crown of the mandibular first and second molars, with distal tipping of 5.2◦ and 5.3◦, respectively, and 3.0◦ of distal tipping of the third molars. Comparing the treated group with the control group at T3, there was a significant change in the angulation of the third molars (p \u3c 0.001). In the long-term, the third molars from the treated group showed a downward and buccal position after distalization. Conclusions: In the long term, the developing mandibular third molar buds had downward and buccal positional changes after total arch distalization. These findings suggest the need for clinicians to consider the possibility of the impaction of developing third molars after mandibular total arch distalization in adolescents
CRANIOFACIAL INJURIES FOR NONSPECIALISTS
No full textSpecialists from around the world have contributed to this unique textbook on the surgical skills essential for the urgent treatment of craniofacial injuries caused by war and terrorist incidents. It explores a wide range of considerations including how to work with limited resources and logistical problems, preparation for terror attacks, preservation of sight and cosmetic appearance, and also features a simulation training module proven to be academically successful and economical to run. The content is ideal for all nonspecialist clinicians and students of medicine, dentistry and nursing, and also for teaching programmes involving the psychopathology of trauma
