Haagensenkirk3746
These findings suggest that provisional mini-fragment plates do not need to be removed prior to definitive fixation.
To report the progression of radiographic healing after intramedullary nailing of tibial shaft fractures using the Radiographic Union Score for Tibial fractures (RUST) and determine the ideal timing of early post-operative radiographs.
Retrospective case series.
Urban academic Level 1 trauma center.
303 acute tibial shaft fractures underwent intramedullary nailing between 2006-2013, met inclusion criteria, and had at least three months of radiographic follow-up.
Baseline demographic, injury, and surgical data were recorded for each patient. Each set of post-operative radiographs were scored using RUST and evaluated for implant failure.
Post-operative time distribution for each RUST score, RUST score distribution for four common follow-up time points, and the presence and timing of implant failure.
The 5th percentile and median times, respectively for reaching "any radiographic healing" (RUST= 5) was 4.0 weeks and 8.4 weeks, "radiographically healed" (RUST=9) was 12.1 and 20.9 weeks, and "healed and remodeled" (RUST=12) was 23.5 weeks and 47.7 weeks. At six weeks, 84% of radiographs were scored as RUST≤6 (two or fewer cortices with callus). No implant failure occurred within the first eight weeks after surgery and the indication for all seven reoperations within this period was apparent on physical examination or immediate post-operative radiographs.
The median time to radiographic union (RUST=9) after tibial nailing was approximately twenty weeks and little radiographic healing occurred within the first eight weeks after surgery. Routine radiographs in this time period may offer little additional information in the absence of clinical concerns such as new trauma, malalignment, or infection.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.Focus groups are a standard method of qualitative data collection and an excellent method for data collection in nursing professional development. Advances in technology, virtual health care, and the COVID-19 pandemic increase the opportunities to use virtual focus groups for rich data collection. In this perspective article, the authors promote virtual focus groups as an answer to challenging data collection, while exploring ways that privacy and confidentiality can be maintained in an online environment.
Sexual and gender minorities (SGMs) experience unique challenges when accessing sexuality and gender-affirming, safe health care services in the rural, southern United States. An identified gap in the literature is an intersectional, community-based approach to assessing the obstacles SGM individuals with intersecting identities experience when navigating comprehensive health services in rural southern communities in the United States; therefore, the present study used qualitative inquiry with an intersectional lens to describe these obstacles. The authors analyzed qualitative data from in-depth, semi-structured individual interviews with SGM individuals (N = 12). Common themes emerged that highlighted the compounding effects of the sociopolitical climate of the geographical area, religious attitudes toward SGMs, and the experience of racism. this website Findings of this study can inform health professions' academic curriculum, provider and support staff training, and implementation of policy that focuses on creating and implementation of policy that focuses on creating a diverse and inclusive health care delivery experience.
Until recently, guidelines recommended a 3-year surveillance colonoscopy for persons with 3 to 10 nonadvanced adenomas (NAA). In this study, we quantify yield for metachronous advanced neoplasia (AN); attempt to identify risk factors for AN; and measure colorectal cancer (CRC) incidence and mortality.
We used natural language processing to screen an existing data set for Veterans with 3 to 10 NAA. We manually reviewed colonoscopy and pathology reports to verify baseline findings and determine results of subsequent colonoscopy (sCY). Baseline features were extracted from the electronic medical record (EMR) and a national data set, CRC incidence was obtained from the Veterans Affairs cancer registry, and CRC mortality from the National Death Index through September 30, 2017. CRC incidence and mortality were compared between Veterans who did versus did not have sCY.
Natural language processing identified 3673 Veterans who potentially had 3 to 10 NAA, of which 1672 were excluded after EMR review. In the analytical cohort of 2001 subjects, 1178 (59%) had sCY at a mean (SD) follow-up of 4.3 (2.2) years. The sCY group was younger (mean age 61 vs. 67 y; P<0.01) and were less likely to have diabetes (27% vs. 31%; P=0.02) and congestive heart failure (4% vs. 9%; P<0.01). sCY showed AN in 182 subjects (15.5%). Baseline features were no different between those with versus without metachronous AN. Subjects with sCY had a greater CRC incidence (n=7 vs. n=0; P=0.046), but there was no difference in CRC mortality (0 for both subgroups).
Among patients with 3 to 10 NAA on index colonoscopy who underwent sCY, AN was present in 15.5% at mean follow-up of 4.3 years. No risk factors for AN were identified. CRC incidence, but not CRC mortality, was higher among those with sCY.
Among patients with 3 to 10 NAA on index colonoscopy who underwent sCY, AN was present in 15.5% at mean follow-up of 4.3 years. No risk factors for AN were identified. CRC incidence, but not CRC mortality, was higher among those with sCY.
The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety.
Disruptive physicians can damage team morale by creating a psychologically unsafe working environment. Healthcare organizations must be committed to ensuring that all team members can function effectively in their work environments. The leaders of healthcare organizations must be acutely aware of what constitutes disruptive behavior and act proactively to eliminate such behaviors. Disruptive physicians should be made acutely aware that their behavior is deemed unacceptable and efforts at correcting such behavior are imperative.
The practice of medicine is multifaceted. It is imperative that the assurance of psychological safety is met to meet the standards of high quality and safe care for patients.
