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Zogg CK, Runquist EB, Amick M, Gilmer G, Milroy JJ, Wyrick DL, Grimm K, Tuakli-Wosornu YA. Experiences of Interpersonal Violence in Sport and Perceived Coaching Style Among College Athletes. JAMA Netw Open 2024; 7:e2350248. [PMID: 38227316 PMCID: PMC10792469 DOI: 10.1001/jamanetworkopen.2023.50248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Importance Concern about interpersonal violence (IV) in sport is increasing, yet its implications remain poorly understood, particularly among currently competing college athletes. Objective To document the self-reported prevalence of IV in college sports; identify associated risk factors; examine potential consequences associated with athletes' psychosocial well-being, emotional connection to their sport, and willingness to seek help; and explore the associations between IV reporting and perceived variations in coaching styles. Design, Setting, and Participants This survey study analyzes results of the 2021 to 2022 National Collegiate Athletic Association (NCAA) myPlaybook survey, which was administered from July to December 2021 to 123 colleges and universities across the US. Participants were NCAA athletes aged 18 to 25 years who were current players on an NCAA-sanctioned team. Exposures Self-reported demographic characteristics (eg, athlete gender identity and sexual orientation) and perceived differences in supportive vs abusive coaching styles (eg, athlete autonomy, team culture, and extent of abusive supervision). Main Outcomes and Measures The primary outcome was self-reported experiences of IV in sport during the college sports career of currently competing college athletes. Types of IV considered were physical abuse, financial abuse, sexual abuse, psychological or emotional abuse, and neglect or abandonment. Outcomes potentially affected by IV were assessed with 4 questionnaires. Results A total of 4119 athletes (mean [SD] age, 19.3 [1.5] years; 2302 males [55.9%]) completed the survey (response rate, 21.2%). One in 10 athletes (404 of 4119 [9.8%]) reported experiencing at least 1 type of IV during their college sports career, of whom two-thirds (267 [6.5%]) experienced IV within the past 6 weeks. On multivariable analysis, female gender identity (odds ratio [OR], 2.14; 95% CI, 1.46-3.13), nonheterosexual sexual orientation (OR, 1.56; 95% CI, 1.01-2.42), increasing age beyond 18 years (OR, 1.13; 95% CI, 1.01-1.30), increasing year of NCAA eligibility beyond the first year (OR, 1.19; 95% CI, 1.02-1.39), and participation in select sports (eg, volleyball: OR, 2.77 [95% CI, 1.34-5.72]; ice hockey: OR, 2.86 [95% CI, 1.17-6.95]) were independently associated with IV. When exposed to IV, college athletes reported experiencing consistently worse psychosocial outcomes, including increased burnout (mean difference on a 5-point Likert scale, 0.75; 95% CI, 0.63-0.86; P < .001) and an expressed desire to consider quitting their sport (mean difference, 0.81; 95% CI, 0.70-0.92; P < .001). They were not, however, less willing to seek help. Differences in coaching style were associated with differences in IV reporting. In risk-adjusted linear regression models, having a more supportive coach was associated with a 7.4 (95% CI, 6.4-8.4) absolute percentage point decrease in athletes' probability of reporting experiencing IV. In contrast, having a more abusive coach was associated with up to a 15.4 (95% CI, 13.8-17.1) absolute percentage point increase in athletes' probability of reporting experiencing IV. Conclusions and Relevance Results of this survey study suggest that IV is associated with marked changes in the psychosocial health and emotional well-being of college athletes, particularly those who identify as female and with nonheterosexual sexual orientations. Variations in coaching style have the potential to alter these associations. Ongoing efforts are needed to leverage the unique position that coaches hold to help reduce IV and create safe places where all college athletes can thrive.
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Affiliation(s)
- Cheryl K Zogg
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Edward B Runquist
- Department of Sports Medicine, Drexel School of Medicine, Philadelphia, Pennsylvania
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Gabrielle Gilmer
- Cellular and Molecular Pathology Graduate Program, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffery J Milroy
- Institute to Promote Athlete Health & Wellness, University of North Carolina Greensboro, Greensboro
| | - David L Wyrick
- Institute to Promote Athlete Health & Wellness, University of North Carolina Greensboro, Greensboro
| | | | - Yetsa A Tuakli-Wosornu
- Sports Equity Lab, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Ottesen TD, Amick M, Kirwin DS, Mercier MR, Brand J, Frumberg DB, Grauer JN, Rubin LE. Increasing Value in Subspecialty Training: A Comparison of Variation in Surgical Complications for Pediatric Versus Other Fellowship-trained American Board of Orthopaedic Surgery Candidates in the Treatment of Supracondylar Fractures. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00006. [PMID: 38252550 PMCID: PMC10805463 DOI: 10.5435/jaaosglobal-d-22-00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The effect of orthopaedic fellowship subspecialization on surgical complications for patients with supracondylar fracture is unknown. This study seeks to compare the effect of subspecialty training on supracondylar fracture complications. METHODS The American Board of Orthopaedic Surgery Part II Examination Case List database was reviewed for all supracondylar fractures from 1999 to 2016. Procedures were divided by fellowship subspecialty (trauma, pediatric, or other) and case volume and assessed by surgeon-reported surgical complications. Predictive factors of complications were analyzed using a binary multivariate logistic regression. RESULTS Of 10,961 supracondylar fractures identified, 53.47% were done by pediatric fellowship-trained surgeons. Pediatric-trained surgeons had fewer surgical complications compared with their trauma or other trained peers (4.54%, 5.67%, and 6.24%; P = 0.001). Treatment by pediatric-trained surgeons reduced surgical complications (OR = 0.79, 95% CI: 0.66 to 0.94; P = 0.010), whereas increased case volume (31+ cases) showed no significant effect (OR = 0.79, 95% CI: 0.62 to 1.02; P = 0.068). Patient sex, age, and year of procedure did not affect complication rates, while those treated in the Southeast region of the United States and those with a complex fracture type were at increased odds. DISCUSSION Treatment of supracondylar fractures by pediatric-trained surgeons demonstrates reduced surgeon-reported complications compared with their other fellowship-trained counterparts, whereas case volume does not. This suggests the value of fellowship training beyond pertinent surgical caseload among pediatric-trained surgeons and may lie in targeted education efforts.
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Affiliation(s)
- Taylor D Ottesen
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Dr. Ottesen, Dr. Amick, Dr. Kirwin, Dr. Mercier, Dr. Brand, Dr. Frumberg, Dr. Grauer, and Dr. Rubin), and the Harvard Combined Orthopaedic Residency Program, Boston, MA (Dr. Ottesen)
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Amick M, Ottesen TD, O'Marr J, Frenkel MY, Callahan B, Grauer JN. Effects of anode position on pedicle screw testing during lumbosacral spinal fusion surgery. Spine J 2022; 22:2000-2005. [PMID: 35843532 DOI: 10.1016/j.spinee.2022.07.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/11/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
OF BACKGROUND DATA Pedicle screws are commonly placed with lumbar/lumbosacral fusions. Triggered electromyography (tEMG), which employs the application of electrical current between the screw and a complementary anode to determine thresholds of conduction, may be utilized to confirm the safe placement of such implants. While previous research has established clinical thresholds associated with safe screw placement, there is variability in clinical practice of anode placement which could lead to unreliable measurements. PURPOSE To determine the variance in pedicle screw stimulation thresholds when using four unique anode locations (ipsilateral/contralateral and paraspinal/gluteal relative to tested pedicle screws). STUDY DESIGN Prospective cohort study. Tertiary medical center. PATIENT SAMPLE Twenty patients undergoing lumbar/lumbosacral fusion with pedicle screws using tEMG OUTCOME MEASURES: tEMG stimulation return values are used to assess varied anode locations and reproducibility based on anode placement. METHODS Measurements were assessed across node placement in ipsilateral/contralateral and paraspinal/gluteal locations relative to the screw being assessed. R2 coefficients of correlation were determined, and variances were compared with F-tests. RESULTS A total of 94 lumbosacral pedicle screws from 20 patients were assessed. Repeatability was verified using two stimulations at each location for a subset of the screws with an R2 of 0.96. Comparisons between the four anode locations demonstrated R2 values ranging from 0.76 to 0.87. F-tests comparing thresholds between each anode site demonstrated all groups not to be statistically different. CONCLUSION The current study, a first-of-its-kind formal evaluation of anode location for pedicle screw tEMG testing, demonstrated very strong repeatability and strong correlation with different locations of anode placement. These results suggest that there is no need to change the side of the anode for testing of left versus right screws, further supporting that placing an anode electrode into gluteal muscle is sufficient and will avoid a sharp ground needle in the surgical field.
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Affiliation(s)
- Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA
| | - Taylor D Ottesen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA; Harvard Combined Orthopaedic Residency Program, 55 Fruit St, Boston, MA, 02114, USA
| | - Jamieson O'Marr
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA
| | - Mikhail Y Frenkel
- Nuvasive Clinical Services 10275 Little Patuxent Pkwy Ste 300 Columbia, MD 21044, USA; UConn Main Campus 2131 Hillside Road, Unit 3088 Storrs, CT 06269-3088
| | - Brooke Callahan
- Nuvasive Clinical Services 10275 Little Patuxent Pkwy Ste 300 Columbia, MD 21044, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA.
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Ottesen TD, Shultz BN, Munger AM, Amick M, Toombs CS, Friedaender GE, Grauer JN. Chondrosarcoma patient characteristics, management, and outcomes based on over 5,000 cases from the National Cancer Database (NCDB). PLoS One 2022; 17:e0268215. [PMID: 35901087 PMCID: PMC9333210 DOI: 10.1371/journal.pone.0268215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chondrosarcoma, although relatively uncommon, represents a significant percentage of primary osseous tumors. Nonetheless, there are few large-cohort, longitudinal studies of long-term survival and treatment outcomes of chondrosarcoma patients and none using the National Cancer Database (NCDB). METHODS Chondrosarcoma patients were identified from the 2004-2015 NCDB datasets and divided on three primary tumor sites: appendicular, axial, and other. Demographic, treatment, and long-term survival data were determined for each group. Multivariate Cox analysis and Kaplan-Meier survival curves were generated to assess long-term survival over time for each. RESULTS In total, 5,329 chondrosarcoma patients were identified, of which 2,686 were appendicular and 1,616 were axial. Survival was higher among the appendicular cohort than axial at 1-year, 5-year, and 10-year (89.52%, 75.76%, and 65.24%, respectively). Multivariate Cox analysis identified patients in the appendicular cohort to have significantly greater likelihood of death with increasing age category, distant metastases at presentation, and male sex (p<0.001 for each). Best outcomes for seen for those undergoing surgical treatment (p<0.001). Patients in the axial cohort were with increased likelihood of death with increasing age category and distant metastases (p<0.001), while surgical treatment with or without radiation were associated with a significant decrease (p<0.001). Kaplan-Meier survival analysis showed worst survival for the axial cohort (p<0.001) and patients with distant metastases at presentation (p<0.001). Survival was not significantly different between older (2004-2007) and more recent years (2012-2016) (p = 0.742). CONCLUSIONS For both appendicular and axial chondrosarcomas, surgical treatment remains the mainstay of treatment due to its continued superiority for the long-term survival of patients, although advancements in survival over the last decade have been insignificant. Presence of distant metastases and axial involvement are significant, poor prognostic factors perhaps because of difficulty in surgical excision or extent of disease.
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Affiliation(s)
- Taylor D. Ottesen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- Harvard Combined Orthopaedics Residency Program, Boston, MA, United States of America
| | - Blake N. Shultz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Alana M. Munger
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Courtney S. Toombs
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Gary E. Friedaender
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
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Ottesen TD, Amick M, Kapadia A, Ziatyk EQ, Joe JR, Sequist TD, Agarwal-Harding KJ. The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States. J Bone Joint Surg Am 2022; 104:e47. [PMID: 35104253 DOI: 10.2106/jbjs.21.00512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Historic and present-day marginalization has resulted in a high burden of disease and worse health outcomes for American Indian and Alaska Native (AI/AN) communities in the United States. Musculoskeletal disease is the leading cause of disability for the general population in the U.S. today. However, few have examined musculoskeletal disease burden and access to orthopaedic surgical care in the AI/AN communities. A high prevalence of hip dysplasia, arthritis, back pain, and diabetes, and a high incidence of trauma and road traffic-related mortality, suggest a disproportionately high burden of musculoskeletal pathology among the AI/AN communities and a substantial need for orthopaedic surgical services. Unfortunately, AI/AN patients face many barriers to receiving specialty care, including long travel distances and limited transportation to health facilities, inadequate staff and resources at Indian Health Service (IHS)-funded facilities, insufficient funding for referral to specialists outside of the IHS network, and sociocultural barriers that complicate health-system navigation and erode trust between patients and providers. For those who manage to access orthopaedic surgery, AI/AN patients face worse outcomes and more complications than White patients. There is an urgent need for orthopaedic surgeons to participate in improving the availability of quality orthopaedic services for AI/AN patients through training and support of local providers, volunteerism, advocating for a greater investment in the IHS Purchased/Referred Care program, expanding telemedicine capabilities, and supporting community-based participatory research activities.
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Affiliation(s)
- Taylor D Ottesen
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Massachusetts General Hospital/Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Michael Amick
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Yale University School of Medicine, New Haven, Connecticut
| | - Ami Kapadia
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Q Ziatyk
- Department of Family Medicine, Chinle Comprehensive Healthcare Facility, Chinle, Arizona
| | - Jennie R Joe
- Department of Family and Community Medicine, University of Arizona Health Sciences, Tucson, Arizona
- Native American Research and Training Center, University of Arizona Health Sciences, Tucson, Arizona
| | - Thomas D Sequist
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts
| | - Kiran J Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Department of Orthopaedic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Amick M, Bentivegna K, Hunter AA, Leventhal JM, Livingston N, Bechtel K, Holland ML. Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut. Child Abuse Negl 2022; 128:105619. [PMID: 35364466 PMCID: PMC8958138 DOI: 10.1016/j.chiabu.2022.105619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous studies of national emergency department (ED) data demonstrate a decrease in visits coded for physical abuse during the pandemic period. However, no study to date has examined the incidence of multiple child maltreatment types (physical abuse, sexual abuse, and neglect), within a single state while considering state-specific closure policies. Furthermore, no similar study has utilized detailed chart review to identify cases, nor compared hospital data to Child Protective Services (CPS) reports. OBJECTIVE To determine the incidence of child maltreatment-related ED visits before and during the COVID-19 pandemic, including characterizing the type of maltreatment, severity, and CPS reporting. PARTICIPANTS AND SETTING Children younger than 18 years old at two tertiary-care, academic children's hospitals in X state. METHODS Maltreatment-related ED visits were identified by ICD-10-CM codes and keywords in chief concerns and provider notes. We conducted a cross-sectional retrospective review of ED visits and child abuse consultations during the pre-COVID (1/1/2019-3/15/2020) and COVID (3/16/2020-8/31/2020) periods, as well as state-level CPS reports for suspected maltreatment. RESULTS Maltreatment-related ED visits decreased from 15.7/week in the matched pre-COVID period (n = 380 total) to 12.3/week (n = 296 total) in the COVID period (P < .01). However, ED visits (P < .05) and CPS reports (P < .001) for child neglect increased during this period. Provider notes identified 62.4% of child maltreatment ED visits, while ICD-10 codes identified only-CM captured 46.8%. CONCLUSION ED visits for physical and sexual abuse declined, but neglect cases increased during the COVID-19 pandemic in X state.
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Affiliation(s)
| | | | - Amy A Hunter
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Nina Livingston
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kirsten Bechtel
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
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Adeclat GJ, Hayes M, Amick M, Kahan J, Halim A. Acute forearm compartment syndrome in the setting of acquired hemophilia A. Case Reports in Plastic Surgery and Hand Surgery 2022; 9:140-144. [PMID: 35601981 PMCID: PMC9116254 DOI: 10.1080/23320885.2022.2071274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with acquired or congenital hemophilia are at risk for Acute Compartment Syndrome (ACS) and pose a diagnostic challenge and a treatment risk with post-fasciotomy hemostasis of critical importance. We present the case of a woman with ACS of the forearm in the setting of newly diagnosed acquired hemophilia A.
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Affiliation(s)
- Giscard Joel Adeclat
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hayes
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph Kahan
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Halim
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
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Leviter J, Auerbach M, Amick M, O'Marr J, Battipaglia T, Amendola C, Riera A. Point-of-Care Ultrasound Curriculum for Endotracheal Tube Confirmation for Pediatric Critical Care Transport Team Through Remote Learning and Teleguidance. Air Med J 2022; 41:222-227. [PMID: 35307147 DOI: 10.1016/j.amj.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/30/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) is used to manage patients in real time. This study aimed to teach pediatric critical care team members to use POCUS for endotracheal tube (ETT) placement confirmation. A secondary aim was to assess the feasibility of a remote curriculum for this purpose. METHODS The Kern 6-step approach was used. The curriculum involved virtual didactics, asynchronous learning modules, and remote hands-on sessions using teleguidance with the Butterfly IQ+ probe, Butterfly Network, Inc, Guilford, CT. Participants learned direct and indirect methods of ETT placement confirmation and were directed to practice independently. Outcomes included attitudes and satisfaction, knowledge and skills acquisition and retention, and the use of POCUS on shift. RESULTS Ten participants completed the curriculum. The average knobology and quiz scores improved by 29.3% and 20.8%, respectively. Improvement was sustained at re-evaluation. Seven of 10 participants performed independent scans. At the 3-month reassessment, most demonstrated mastery of thoracic scans. All required prompting for satisfactory tracheal scans. All felt positively toward POCUS and the remote curriculum. CONCLUSION Pediatric critical care team members acquired and retained knowledge and skills for POCUS basics and ETT placement confirmation through a remote curriculum. Participants were satisfied with the course. Further studies are needed to reassess longer-term knowledge and skill retention and the effects on patient outcomes.
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Affiliation(s)
- Julie Leviter
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
| | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
| | | | | | - Tracie Battipaglia
- Yale Pediatric Critical Care Transport Team, Yale New Haven Children's Hospital, New Haven, CT.
| | - Christopher Amendola
- Yale Pediatric Critical Care Transport Team, Yale New Haven Children's Hospital, New Haven, CT.
| | - Antonio Riera
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
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Rutland EA, Suttiratana SC, da Silva Vieira S, Janarthanan R, Amick M, Tuakli-Wosornu YA. Para athletes' perceptions of abuse: a qualitative study across three lower resourced countries. Br J Sports Med 2022; 56:561-567. [PMID: 35012930 DOI: 10.1136/bjsports-2021-104545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Interpersonal violence is an increasingly recognised risk of sport participation and causally linked to negative physical and mental health outcomes. Para athletes from low- and middle-income countries may be at highest risk of physical, psychological, sexual and neglect-related violence due to various factors; however, their perceptions of these abusive behaviours are unknown. This study examined the perceptions and experiences of abuse in para athletes from three lower resourced countries: Ghana, India and Brazil. METHODS Qualitative data from semistructured focus group interviews conducted with 26 individuals were collected to explore characteristics of abuse observed, navigated and experienced by para athletes. The framework method for multidisciplinary qualitative research guided data analysis. RESULTS Athletes identified a wide range of abusive behaviours they experienced within and outside of sport, including psychological, emotional, physical, sexual and neglect-related violence, which operated on both interpersonal and systemic levels. Most athletes described three less easily recognised forms of abuse in greater detail and more frequently than others: financial abuse, neglect and disability stigma. CONCLUSION It is important to hear directly from athletes with diverse experiences and backgrounds and to integrate their insights and priorities into sport safeguarding policies, programmes and interventions. Understanding the requirements and challenges of para athletes and para sport is needed to achieve safe, equitable and inclusive sport. As new insights from diverse sport settings are added to the evidence base, globally balanced, athlete-generated and locally relevant preventative strategies can better protect all athletes.
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Affiliation(s)
- Emily Anne Rutland
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sakinah C Suttiratana
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | | | - Michael Amick
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA .,Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Tuakli-Wosornu YA, Amick M, Guiora AN, Lowe SR. Athlete abuse hurts everyone: vicarious and secondary traumatic stress in sport. Br J Sports Med 2021; 56:119-120. [PMID: 34610913 DOI: 10.1136/bjsports-2021-104715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Yetsa A Tuakli-Wosornu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA .,Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael Amick
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Amos N Guiora
- S.J. Quinney College of Law, The University of Utah College of Law, Salt Lake City, Utah, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
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Amick M, O'Marr JM, Schuster KM. Evaluation of MRSA surveillance nasal swabs for predicting MRSA infection in SICU patients. J Surg Res 2021; 268:712-719. [PMID: 34487964 DOI: 10.1016/j.jss.2021.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We aimed to examine the clinical value of serial MRSA surveillance cultures to rule out a MRSA diagnosis on subsequent cultures during a patient's surgical intensive care unit (SICU) admission. MATERIAL AND METHODS We performed a retrospective cohort study to evaluate patients who received a MRSA surveillance culture at admission to the SICU (n = 6,915) and collected and assessed all patient cultures for MRSA positivity during their admission. The primary objective was to evaluate the transition from a MRSA negative surveillance on admission to MRSA positive on any subsequent culture during a patient's SICU stay. Percent of MRSA positive cultures by type following MRSA negative surveillance cultures was further analyzed. MEASUREMENTS AND MAIN RESULTS 6,303 patients received MRSA nasal surveillance cultures at admission with 21,597 clinical cultures and 7,269 MRSA surveillance cultures. Of the 6,163 patients with an initial negative, 53 patients (0.87%) transitioned to MRSA positive. Of the 139 patients with an initial positive, 30 (21.6%) had subsequent MRSA positive cultures. Individuals who had an initial MRSA surveillance positive status on admission predicted MRSA positivity rates for cultures in qualitative lower respiratory cultures (64.3% versus. 3.1%), superficial wound (60.0% versus 1.6%), deep wound (39.0% versus 0.8%), tissue culture (26.3% versus 0.6%), and body fluid (20.8% versus 0.7%) cultures when compared to MRSA negative patients on admission. CONCLUSION Following MRSA negative nasal surveillance cultures patients showed low likelihood of MRSA infection suggesting empiric anti-MRSA treatment is unnecessary for specific patient populations. SICU patient's MRSA status at admission should guide empiric anti-MRSA therapy.
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Affiliation(s)
- Michael Amick
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jamieson M O'Marr
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Kevin M Schuster
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Rutland EA, Suttiratana SC, Vieira SDS, Janarthanan R, Amick M, Tuakli-Wosornu YA. Athletes’ Perceptions Of Intentional Injury (abuse): The Impact Of Sociocultural Context On Prevention And Reporting. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764984.05707.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Weininger G, Mori M, Shang M, Degife E, Amick M, Yousef S, Assi R, Milewski R, Geirsson A, Vallabhajosyula P. Patterns of Surveillance Imaging for Incidentally Detected Ascending Aortic Aneurysms. Ann Thorac Surg 2021; 113:125-130. [PMID: 33609548 DOI: 10.1016/j.athoracsur.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ascending aortic aneurysms (AsAA) remain a silent killer for which timely intervention and surveillance intervals are critical. Despite this, little is known about the follow-up care patients receive after incidental detection of an AsAA. We examined the pattern of surveillance and follow-up care for these high-risk patients. METHODS We identified patients at our institution with incidentally detected AsAAs (≥37 mm) between 2013 and 2016. We collected information on patients' aneurysms and clinical follow-up. Logistic regression models related aneurysm size and demographics to whether patients received follow-up imaging or referral. RESULTS From 2013 to 2016, 261 patients were identified to have incidentally detected AsAAs among the 21,336 computed tomography scans performed at our institution. The median aneurysm size was 4.2 cm (interquartile range, 4 to 4.4). Only 18 (6.9%) of the identified patients were referred to a cardiac surgeon for evaluation, and only 37.9% of the identified patients had a follow-up chest computed tomography scan within 1 year of detection; 34% had an echocardiogram. The median follow-up duration for the study was 5 years. Logistic regression models showed that aneurysm size and family history were significant predictors of whether a patient was referred to a cardiac surgeon (odds ratio 10.34; 95% confidence interval, 2.3 to 47.9), but not whether the patients received follow-up imaging. CONCLUSIONS Among 261 patients with incidentally detected AsAAs, only a third received any follow-up imaging within 1 year after detection, with very low clinical penetrance for expert referral. Surveillance of this high-risk patient population appears insufficient and may require standardization.
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Affiliation(s)
- Gabe Weininger
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Makoto Mori
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New-Haven Hospital, New Haven, Connecticut
| | - Michael Shang
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ellelan Degife
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Amick
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Sameh Yousef
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Roland Assi
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Rita Milewski
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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