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Postoperative physical therapy (PT) following lumbar spinal fusion is an effective form of postoperative rehabilitation. However, it is unknown when a postoperative PT protocol should be optimally initiated. This study sought to compare lengths of stay between patients on a day zero PT protocol and those on a day one PT protocol. Retrospective chart review. Patients who underwent lumbar spinal surgery at a large midwestern tertiary medical care center from January 1, 2018 through April 30, 2019 were eligible for their medical record's inclusion. Length of hospital stay following surgery. Patients were stratified by having started postoperative PT on the same day as surgery (day zero) or having started postoperative PT on the day following surgery (day one). A total of 164 patients were included in the study, 69 in the day zero group and 95 patients in the day one group. Most patients were female (59%, n = 98), and patients' average age was 62 years (SD = 13). Average length of stay was 61 hours (SD = 20) for those on the day zero protocol and 75 hours (SD = 32) for those on the day one protocol. This study suggests that a postoperative physical therapy protocol initiated on day zero is associated with patients experiencing a shorter length of hospital stay compared to a similar PT protocol initiated on postoperative day one. [ABSTRACT FROM AUTHOR]

• Readmitted patients were more likely to have a feeding tube during their index stay. • Being infection-free was a protective factor against readmission. • Patients unable to receive fluid intake by mouth was a risk factor for readmission. The objective was to identify risk and protective factors associated with post-stroke pneumonia readmission. A retrospective chart review was conducted on 365 stroke patients who were admitted to Ascension Via Christi St. Francis Hospital in Wichita, Kansas from January 1, 2015 through January 30, 2020. This case control study used matching by age at a proportion of four control patients to one post-stroke pneumonia patient. Patients with and without post-stroke pneumonia readmission within 90 days of discharge were included in this study. Of the 3,952 patients diagnosed with stroke, 1.8% (n=73) patients were readmitted with post-stroke pneumonia. Compared to patients who were not readmitted for post-stroke pneumonia, patients with post-stroke pneumonia readmission were more likely to: have used a nasogastric tube during index admission, have used mechanical ventilation during index admission, or have been placed on a nothing-by-mouth diet at discharge. Being placed on nothing-by-mouth for fluids was also a predictor of post-stroke pneumonia readmission. Lack of acquired infection during the index admission was a protective factor for post-stroke pneumonia readmission. The pathophysiology of post-stroke pneumonia is multifactorial and includes consideration of dysphagia severity, bacterial colonization of the oropharynx and feeding tube, and an altered immune system. During the index admission, patients on nothing-by-mouth were more likely to be readmitted, and infection-free patients were less likely to be readmitted with post-stroke pneumonia. By identifying at-risk patients, clinicians may be able to use this information to tailor future medical interventions to prevent post-stroke pneumonia readmissions. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The purpose of this study was to assess compliance with American Diabetes Association screening recommendations at Salina Family Healthcare (SFHC) in Salina, Kansas, a large rural town, and to evaluate the impact of point-of-care (POC) dilated eye exams for uninsured patients. POC exams are those performed in the location where patients are treated. Methods: There were 462 type II diabetic (DM2) patients seen at SFHC in 2009 and 537 DM2 patients seen in 2010. A chart review of all patients with DM2 was done to assess rates of recommended screening exams, including dilated eye exams and foot exams. Results: In 2009/2010 urine microalbumin was checked in 57%/75% of DM2 patients. HbA1c and low density lipoprotein (LDL) levels at goal were 46%/48% and 58%/58%, respectively. 47%/67% of DM@ patients received foot exams and 21%/30% received eye exams. In 2009, 23% of the 155 uninsured diabetic patients at SFHC received a dilated eye exam. The following year, after implementation of on-site ophthalmologic services, rates of dilated eye exams increased 1.6 fold to 37% of the 196 uninsured patients. Conclusions: SFHC performed similarly to national rates on some diabetic screening exams, but there is room for improvement in all recommended screening exams. The implementation of a novel approach to increasing dilated eye exam rates indicates that expanded POC services can improve outcomes for diabetic patients. [Copyright &y& Elsevier]

The likelihood of persons working while ill, a practice known as “presenteeism,” must be assessed when making preparations for pandemic influenza. A questionnaire was distributed to evaluate various health care professionals'' past presenteeism, future intent to work with an influenza-like illness (ILI), and vaccination status. Of the respondents who reported that they would call in sick, 47% reported previously working with an ILI. Overall, males were more likely than females to have been vaccinated, to haved stayed at work when ill, and to have previously worked with an ILI. Because limiting the spread of influenza depends on community action, knowing a community''s attitudes and behaviors can help target educational and preparedness efforts. [Copyright &y& Elsevier]

Introduction: Funding increases after September 11, 2001 have provided impetus to improve public health emergency preparedness plans. Training of local health department staff and coordination between counties are important components of these plans. Electronic media have been used to facilitate dissemination of training, and a need for evaluation has been identified. Methods: Public Health Investigation (PHI) was conducted in 6 Kansas counties during February 2005 in an electronic, in-office format. The quantitative evaluation consisted of pre- and postsurveys. Questions measured self-reported improvements in 4 areas: surge capacity, coordination between counties, risk communication, and protocols and procedures. Results: Although all 4 areas showed improvement, 2 showed statistically significant improvement. At the postsurvey, participants reported significantly improved abilities to (1) participate in a coordinated, multidisciplinary response to an infectious disease outbreak (P = .003) and (2) identify the need for and implement surge capacity (P = .017). Conclusions: Increased collaboration between counties and partner agencies may be the greatest strength of PHI, a multi-county, real-time exercise. This format strengthens regional bonds and is cost-effective. The PHI may be a useful model for other states wishing to use a regional approach for training, thereby strengthening regional bonds. [Copyright &y& Elsevier]

Abstract: Objective: To determine if applying chilled solution to exposed cerebral cortex can reduce interictal epileptiform activities in patients during surgery. Methods: Electrocorticography was used to record the epileptiform activity of 12 patients (ages 18–53) undergoing cortical mapping and resection surgery. Interictal spikes were counted at baseline and compared with spikes after applying room temperature and chilled Lactated Ringer''s or normal saline solution. Results: Cortical irrigation with 150-cm3, chilled (4°C) normal saline solution reduced the mean number of interictal spikes from 11.46 to 4.87 spikes per minute (p =0.04). There was no significant reduction in the epileptic spike frequency when room temperature normal saline was used. Conclusion: The application of chilled solution directly to the cortex can reduce interictal epileptiform activities, suggesting that seizure potential can be suppressed to avoid evoked seizures during intraoperative surgery. [Copyright &y& Elsevier]

Objective: To quantify the yearly prostate cancer incidence per 100,000 men, comparing consecutive years from 2010 through 2016. In the years immediately following the 2011/2012 U.S. Preventive Services Task Force update to prostate specific antigen (PSA) screening guidelines, PSA screening, biopsy, and subsequent prostate cancer diagnosis and definitive local treatment have declined. We performed an analysis of stage and grade at diagnosis for prostate cancer in the US, in the years following the 2011/2012 update.Methods/materials: This was a retrospective study performed using the Surveillance, Epidemiology, and End Results Program data. Inclusion criteria were men ≥ 40 years with prostate cancer diagnosed between the years 2010 and 2016.Results: In total, 370,865 cases of prostate cancer were analyzed. Overall, the incidence of prostate cancer decreased from 522 to 327 cases per 100,000 persons from 2010 to 2016. Conversely, the rate of metastatic disease increased over this duration from 29 to 37 cases per 100,000 persons (P< .05). In patients ≥70 years, this increase was from 21 to 27 cases per 100,000 persons over the 7 years (P < .05). High-grade disease incidence did not change significantly over the study period, though low-grade disease incidence, (Grade Groups 1 and 2) decreased from 204 and 155 to 116 and 115 cases per 100,000 persons, respectively (P < .05).Conclusions: In the years following the 2011/2012 recommendation against PSA screening, fewer localized prostate cancers and more distantly metastatic prostate cancers were diagnosed. Most increases in metastatic disease was among men ≥70 years. [ABSTRACT FROM AUTHOR]