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Hip abductor deficiency is a common cause of lateral hip pain in middle-aged patients. Identifying upstream muscle denervation originating in the lumbo-sacral spine could potentially impact the management of patients who have abductor deficiency. The purpose of this study was to estimate the prevalence of lumbo-sacral pathology (L4 to S1) in patients undergoing hip abductor tendon repair. All cases of primary hip abductor repair performed at a tertiary care center between January 2010 and December 2021 were reviewed. Patients were classified into the following groups: A) confirmed L4 to S1 disease based on preoperative or perioperative L4 to S1 interventions (ie, surgery, epidural injections, and/or positive electromyography findings); B) radiographic evidence on lumbar spine magnetic resonance imaging demonstrating nerve compression at L4 to S1; and C) no evidence of L4 to S1 disease. There were 131 cases of primary hip abductor repair that were included. Over 80% of patients were women, who had a mean age of 64 years (range, 20 to 85). There were thirteen patients (9.9%) who underwent concomitant total hip arthroplasty (THA). Of the included patients, 29% (n = 38) were categorized into group A, 12% (n = 16) into group B, and 59% (n = 77) into group C. Patients who had L4 to S1 pathology were older than patients who did not have L4 to S1 pathology (67 versus 61 years, P =.004). Of the patients undergoing concomitant THA and hip abductor repair, 54% demonstrated evidence of lumbo-sacral spine pathology. Over 40% of patients undergoing isolated hip abductor tendon repair and >50% of patients undergoing concomitant hip abductor tendon repair and THA demonstrated evidence of L4 to S1 disease perioperatively. Patients demonstrating symptomatic hip abductor deficiency should be screened for concomitant lower lumbo-sacral spine pathology. [ABSTRACT FROM AUTHOR]

• Levetiracetam (LEV) is a 1st line anti-seizure medication (ASM) in the UK. • There is no high-quality evidence comparing PwID to those without ID prescribed LEV. • Concerns exist regarding LEV's behavioural & psychological side-effects in PwID. • This is the largest study of PwID trialled on LEV & compared to non-ID controls. • Findings largely support prescribing of LEV for PwID as a first line ASM. People with Intellectual Disabilities (PwID) are twenty times more likely than general population to have epilepsy. Guidance for prescribing antiseizure medication (ASM) to PwID is driven by trials excluding them. Levetiracetam (LEV) is a first-line ASM in the UK. Concerns exist regarding LEV's behavioural and psychological adverse effects, particularly in PwID. There is no high-quality evidence comparing effectiveness and adverse effects in PwID to those without, prescribed LEV. Pooled casenote data for patients prescribed LEV (2000–2020) at 18 UK NHS Trusts were analysed. Demographics, starting and maximum dose, adverse effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed. 173 PwID (mild 53 M/P 120) were compared to 200 without ID. Mean start and maximum dose were similar across all groups. PwID (Mild & M/P) were less likely to withdraw from treatment (P = 0.036). No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in LEV's efficacy i.e. >50 % seizure reduction. Significant association emerged between ID severity and psychiatric adverse effects (P = 0.035). More irritability (14.2 %) and aggression (10.8 %) were reported in M/P PwID. PwID and epilepsy have high rates of premature mortality, comorbidities, treatment resistance and polypharmacy but remain poorly researched for ASM use. This is the largest studied cohort of PwID trialled on LEV compared to general population controls. Findings support prescribing of LEV for PwID as a first-line ASM. [ABSTRACT FROM AUTHOR]

The American Society for Metabolic and Bariatric Surgery (ASMBS) Fellowship Certificate was created to ensure satisfactory training and requires a minimum number of anastomotic cases. With laparoscopic sleeve gastrectomy becoming the most common bariatric procedure in the United States, this may present a challenge for fellows to obtain adequate numbers for ASMBS certification. To investigate bariatric fellowship trends from 2012 to 2019, the types, numbers, and approaches of surgical procedures performed by fellows were examined. Academic training centers in the United States. Data were obtained from Fellowship Council records of all cases performed by fellows in ASMBS-accredited bariatric surgery training programs between 2012 and 2019. A retrospective analysis using standard descriptive statistical methods was performed to investigate trends in total case volume and cases per fellow for common bariatric procedures. From 2012 to 2019, sleeve gastrectomy cases performed by all Fellowship Council fellows nearly doubled from 6,514 to 12,398, compared with a slight increase for gastric bypass, from 8,486 to 9,204. Looking specifically at bariatric fellowships, the mean number of gastric bypass cases per fellow dropped over time, from 91.1 cases (SD = 46.8) in 2012–2013 to 52.6 (SD = 62.1) in 2018–2019. Mean sleeve gastrectomy cases per fellow increased from 54.7 (SD = 31.5) in 2012–2013 to a peak of 98.6 (SD = 64.3) in 2015–2016. Robotic gastric bypasses also increased from 4% of all cases performed in 2012–2013 to 13.3% in 2018–2019. Bariatric fellowship training has seen a decrease in gastric bypasses, an increase in sleeve gastrectomies, and an increase in robotic surgery completed by each fellow from 2012 to 2019. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (SG) is a widely performed bariatric surgery, but it is associated with an increased risk of gastroesophageal reflux (GERD) in the long term. The addition of fundoplication to laparoscopic SG may improve lower oesophageal sphincter function and reduce postoperative GERD. This systematic review and meta-analysis aims to compare the efficacy and safety of SG plus fundoplication (SG + F) versus SG alone for the treatment of patients with severe obesity (≥35 kg/m2). Meta-analysis. Three electronic databases were searched from inception until January 2023. Studies were included if they compared outcomes of SG + F versus SG in patients with severe obesity (≥35 kg/m2). The primary outcome was remission of GERD postoperatively. Secondary outcomes were the percentage of excess weight loss, percentage of total weight loss, postoperative complication rate, operative time, and length of stay. A total of 5 studies with 539 subjects (212 SG + F and 327 SG alone) were included. The mean preoperative body mass index was 42.6 kg/m2. SG + F achieved higher remission of GERD compared with laparoscopic SG (odds ratio [OR] = 13.13; 95% CI, 3.54–48.73; I 2 = 0%). However, the percentage of total weight loss was lower in the SG + F group (mean difference [MD] = –2.75, 95% CI, –4.28 to –1.23; I 2 = 0%), whereas there was no difference in the percentage of excess weight loss (MD = –0.64; 95% CI, –20.62–19.34; I 2 = 83%). There were higher postoperative complications in SG + F (OR = 2.56; 95% CI, 1.12–5.87; I 2 = 0%) as well. There was no difference in operative time or length of stay between the 2 groups. SG + F achieved better GERD remission but is associated with lesser weight loss and increased postoperative complications compared with SG alone. Further studies are required to ascertain the overall clinical benefit of SG + F for patients with severe obesity. • Meta-analysis evaluated the role of sleeve gastrectomy plus fundoplication • Sleeve plus fundoplication reduces postoperative GERD, de novo GERD and esophagitis • However, sleeve plus fundoplication results in poorer weight loss • Sleeve plus fundoplication has increased postoperative morbidity [ABSTRACT FROM AUTHOR]

This study investigated changes in suicidal ideation, attempts, and nonsuicidal self-injury (NSSI)-related ambulance attendances among adolescents during the COVID-19 pandemic. An interrupted time series analysis using data from the National Ambulance Surveillance System, a globally unique mental health and suicide surveillance system. Patients aged 12–17 years from the state of Victoria, Australia who were attended by ambulance for suicide attempts, suicide ideation, and NSSI between January 2016 and October 2021 were included. Monthly ambulance attendances during the pre-COVID period (January 2016–March 2020) were compared to those in the peak period of COVID-19 (April 2020–October 2021). There were 20,125 ambulance attendances for suicide ideation, suicide attempt, and NSSI in adolescents over the study period. During the pre-COVID period, the number of suicide ideation, attempts, and NSSI attendances was increasing by 1.1% per month (incidence rate ratio [IRR]:1.011; 95% confidence interval [1.009–1.013], p <.001). There was no change in the rate of all suicide ideation, attempt, and NSSI for all adolescents during the period of COVID-19. However, when disaggregated by gender, there was a 0.7% increase in the monthly rate of attendances for females (IRR: 1.007 [1.001–1.013], p =.029), and a 3.0% decrease for males (IRR: 0.970 [0.964–0.975], p <.001). Adolescent female suicide ideation, attempt, and NSSI attendances increased during the COVID-19 period, compared with males in the same time period. These findings suggest tailored intervention strategies may be needed to address the increasing trends of self-harm among young people. [ABSTRACT FROM AUTHOR]

Tapered, fluted titanium (TFT) femoral stems have become the gold standard in revision total hip arthroplasty (rTHA). However, there is a paucity of data on TFT stem subsidence rates following aseptic rTHA. Subsidence can lead to instability, mechanical failure, leg-length discrepancy, and may require revision surgery. This study evaluated the incidences and predictors of TFT subsidence in aseptic rTHA. A total of 102 TFT femoral stems of 4 designs were retrospectively reviewed. Stem subsidence was measured on digital radiographs taken immediately after surgery and at standard clinical follow-up. Patient characteristics, risk factors for subsidence, revision etiologies, and implant characteristics were recorded. Patient-reported outcome measures were also evaluated for a subset of cases. Overall, 12% of stems subsided >1 cm, and subsidence was minimal (<3 mm) in ≥64% of cases. From immediate postoperative to 1-month radiographic follow-up, 79% of stems subsided a mean of 2.9 mm (range, 0.1 to 12 mm). Beyond 1 month, subsidence was minimal for ≥77% of cases. In multivariate analyses, women and less femoral implant canal fill were associated with greater subsidence (P ≤.034). The TFT stem design was not associated with early subsidence (P =.816). There were no modular junction fractures. There were 2 fractures and 2 subsidence-related revisions for aseptic loosening that occurred postoperatively. The amount of subsidence in TFT stems was low and was detectable in the early (less than 1 year) postoperative period. Maximizing TFT stem fill within the femoral canal appears to reduce the risk of subsidence without increasing femoral fracture rates and should be the goal with implantation of these devices. IV–Case Series, No Control Group. [ABSTRACT FROM AUTHOR]

• Guidelines have been created to improve the reporting of clinical trials of biofield therapies. • These healthcare practices include External Qigong, Healing Touch, Reiki, and Therapeutic Touch. • The main focus of the guidelines is a set of items that call for details of the intervention procedure. • Guidelines can help to strengthen the evidence base for biofield therapies and increase their usage in mainstream healthcare. A set of guidelines has been developed to help improve reporting of clinical trials of biofield therapies. The need for enhanced transparency when reporting trials of this family of integrative health practices, e.g., External Qigong, Healing Touch, Reiki and Therapeutic Touch, has been advocated in systematic reviews of these studies. The guidelines, called Bi o fi eld Therapies: Re porting E vidence G uidelines (BiFi REGs), supplement CONSORT 2010 by including details of the intervention protocols relevant to biofield therapy trials. BiFi REGs evolved through a draft document created by a core group, two rounds of a Delphi process with an international group of subject matter experts and two panels, meeting via Zoom, which included editors of complementary and integrative medicine journals. BiFi REGs comprises a 15-item Intervention checklist. Modifications of two other CONSORT topic areas are also proposed to enhance their relevance to trials of biofield therapies. Included for each item are an explanation, and exemplars of reporting from peer-reviewed published reports of biofield therapy trials. When used in conjunction with all other items from CONSORT 2010, we anticipate that BiFi REGs will expedite the peer review process for biofield therapy trials, facilitate attempts at trial replication and help to inform decision-making in the clinical practice of biofield therapies. [ABSTRACT FROM AUTHOR]

To assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. Retrospective cohort study of consecutive patients over a 5-year period (2018–2022). Sixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n = 28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer 'challenge' and 19 (31.2%) were self-harm, of whom 5 (26.3%) were inpatients on a mental health ward at the time of injury. All 'challenge' and self-harm injuries were caused by aerosol. Patients with 'challenge' injury were younger than those with self-harm (p =.007) and non-intentional injuries (p <.001). A greater proportion of self-harm injuries were in female patients compared with non-intentional injuries (p <.001). Median total body surface area (TBSA) was 0.35% (IQR: 0.3). Most burns were superficial partial thickness (n = 35, 56.5%), followed by deep dermal (n = 18, 29.0%), full-thickness (n = 8, 12.9%), and superficial (n = 1, 1.6%). The upper limb was most frequently affected (n = 35, 56.5%). Aetiology and a non-intentional, 'challenge' or self-harm injury did not affect TBSA (p = 0.776 and p = 0.364) or depth (p = 0.353 and p = 0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range: 7–45, IQR: 22.75). Follow-up ranged from 1 to 173 weeks. The incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or because of social media or peer 'challenges'. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use. [ABSTRACT FROM AUTHOR]

The designation of health care providers is limited to physicians, physician assistants, nurse practitioners, certified nurse midwives, nurse anesthetists, clinical psychologists, dietitians, and social workers. Pharmacists are not federally recognized health care providers and, therefore, are not eligible for cognitive service reimbursements. This commentary explains the intentions of adding pharmacists as Medicare Part B providers, evaluates current state pharmacist provider status, and calls pharmacists, technicians, and other key stakeholders to advocate on behalf of the profession of pharmacy. If federal provider status is granted to pharmacists, patients will gain better access to care, health spending will decline, and physician lead care teams will have an expert in medications readily available for consultation or other medication-related needs. Reimbursement would provide more resources to administer these needed services to more patients in areas with limited access to health care resources. [ABSTRACT FROM AUTHOR]

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history. [ABSTRACT FROM AUTHOR]

There is a disparity in access, quality, and sustainability of cleft care in low and middle income countries, where burden of disease is greatest. CLEFT-Bridging the Gap (registered charity number: 1194581) is a UK-based charity that aims is to solve this through teaching, empowerment and development of sustainable cleft services. A Student Section, composed of medical, dental and speech and language therapy students, was established to support these endeavours through fundraising. 1) examine effectiveness of the Student Section, 2) explore students' perception of cleft care, 3) provide a framework for similar groups. Cross-sectional survey study design. Likert-Scale responses to questions regarding organisation and experience of the section were collected. Data was analysed using Chi statistical test, ordinal data assessed using Wilcoxon-Signed Rank test. 40/64 ambassadors responded to the survey. 90% had a positive perception on the organisation of the section, this correlated with group size (p = 0.012) and number of fundraising events organised (p = 0.032). 85% had an overall positive experience, scores for consideration of a career in cleft significantly improved from 2.25 (95%CI: 1.95–2.55) to 3.30 (95%CI: 3.03–3.57) (p < 0.001). This study presents the first example of a nationwide student group involved with a charitable cleft organisation. [ABSTRACT FROM AUTHOR]

• Empathy is essential to patient safety/outcomes, but often lacking in nurses/students. • Role-play patient simulations allow students to experience the patient condition. • Experiencing the patient point of view improves empathic concern. Empathic care by nurses improves patient safety and outcomes. Nursing educators are responsible for training students to provide empathic care. This study explored the impact of role-play patient simulation on nursing students' empathic state. Participants completed the Comprehensive State Empathy Scale (CSES) questionnaire before and after completion of a role-play simulation. A statistically significant increase was seen in the CSES scores. The findings support the use of role-play simulations to impact state empathy. [ABSTRACT FROM AUTHOR]

With the regulatory prohibition for using Halon 1301 (CF 3 Br) in fire suppression systems onboard newly certified aircraft, significant research efforts have been undertaken to develop suitable halon replacements with comparable suppression performance that are also eco-friendly with low Ozone Depletion Potential (ODP) and Global Warming Potential (GWP). This paper determined the fire suppression effectiveness for mixtures of trifluoroiodomethane (CF 3 I) with carbon dioxide (CO 2) under development as a drop-in halon replacement for onboard aircraft fire suppression systems. Through both experimental measurements and flame simulations using detailed chemical kinetics, we demonstrated that the extinguishment performance of CF 3 I-CO 2 blends can be superior to that of the individual components alone. The extinction concentrations were determined for different CF 3 I-to-CO 2 ratios introduced into ambient air using a heptane cup burner. The extinction concentrations for pure CF 3 I in air (3.36 ± 0.13% vol.) and CO 2 in air (20.74 ± 0.64% vol.) are in close agreement with previously reported values, and first-time extinction concentration data for CF 3 I-CO 2 blends are reported. To elucidate important reaction pathways, detailed chemical mechanisms have been compiled for modeling methane-, propane- and heptane-air flame inhibition at ambient conditions. These mechanisms were constructed from published sub-mechanisms for C 7 and C 1 -C 3 hydrocarbons and hydrofluorocarbons with additional oxidation chemistry developed for trifluoroiodomethane. The latter sub-mechanism contains 14 species and 91 reactions. Using the CANTERA software package, critical concentration values of CF 3 I-CO 2 mixtures in air for extinguishing methane, propane, and n-heptane counterflow flames were determined and compared against experimental non-premixed flame extinction data. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) is a well-evidenced therapeutic model for the treatment of chronic pain. While there is substantial data that indicates improvement in the cognitive and behavioral aspects of pain (e.g., pain acceptance, pain inflexibility, pain interference), significantly less research has explored changes in physiological variables following acceptance-based interventions. In particular, heart rate variability (HRV) is a physiological marker of pain and reflects the time elapsed between heart beats. The current study examined whether HRV changed following a randomized-controlled trial of ACT for individuals with neurofibromatosis type 1 and chronic pain (N = 62). Repeated measures analyses of covariance assessed change following ACT. In addition, hierarchical linear regression models examined pain-related predictors of HRV at follow-up. The results suggest that HRV improves following ACT, although given the small sample and limited analytical model, the findings should be considered preliminary. Further, improvements in HRV over the course of the intervention predicted improvements in pain intensity at follow-up suggesting a relationship between these two variables. Taken together, these data provide modest evidence of the relationships between ACT and HRV within a chronic pain population. Additional implications and future directions are discussed. • Acceptance and Commitment Therapy is an efficacious treatment for pain. • Heart rate variability is associated with pain inflexibility. • Preliminary analyses suggest heart rate variability improves following ACT. • Improvements in HRV during the course of ACT are associated with longer-term improvements in pain interference. [ABSTRACT FROM AUTHOR]

Successful anastomotic healing is critical to preventing complications after intestinal surgery. We aimed to compare the early healing of end-to-end small bowel anastomosis by self-forming magnets with surgical stapling in a porcine model. Six Yorkshire pigs underwent 2 simultaneous small bowel anastomoses using a circular stapler and self-forming magnet technique. The primary outcome was healing quality, measured by 4 histologic features: inflammatory cell infiltration, collagen formation, grade of inflammation, and bacterial infiltration at the anastomosis. The samples were evaluated at days 1, 3, and 7. Gross evaluation of anastomotic integrity was a secondary outcome. The self-forming magnet group displayed significant differences at each time point. On day 1, the stapled group displayed dense inflammatory cell infiltration and extensively ulcerated intestinal layers with significant edema. The self-forming magnet group showed less inflammatory infiltrate, and all intestinal layers remained compressed in direct apposition. By day 3, the self-forming magnet group already exhibited neovascularization with scant bacterial colonies. By contrast, stapled anastomoses had large areas of inflammation separating collagen fibers with prevalent bacterial infiltrations. On day 7, self-forming magnet anastomoses were characterized by robust neovascularization, maturing granulation tissue, and mucosal re-epithelization without significant inflammation. Meanwhile, stapled samples had persisting dense inflammation, tissue cavities with hemorrhage, and immature fibrous tissue. Grossly, the self-forming magnet created a patent lumen without defect, whereas stapled anastomoses demonstrated focal areas of serosal separation. Bowel anastomosis by self-forming magnets is associated with superior early histologic healing metrics, including early seal generation through mechanical compression, decreased inflammation, early neovascularization, lower bacterial infiltration, and faster re-epithelization. [Display omitted] [ABSTRACT FROM AUTHOR]

Retro-odontoid pseudotumor (ROP) is a benign proliferation of soft tissues posterior to the odontoid process. It can be associated with both inflammatory and noninflammatory arthritis. Altered biomechanics and atlantoaxial instability are the major contributing factors. There are no characteristic clinical findings. In the majority of cases, ROP is detected as an incidental finding in imaging. Early diagnosis of the lesion is important because of its proximity to the spinal canal and spinal cord. Clinical signs and symptoms range from pain to paralysis depending on the presence and level of spinal cord compression. In very rare cases, the lesion might cause sudden death of the patient. We report a case of ROP detected as an incidental finding in cone beam computed tomography of a patient examined for implant treatment planning. [ABSTRACT FROM AUTHOR]

Immune recovery uveitis (IRU) is an ocular form of immune reconstitution inflammatory syndrome, which is rare in the pediatric population. We report a case of IRU in an 11-year-old girl with a history of cytomegalovirus (CMV) retinitis in the setting of acute leukemia, who developed uveitis, vitritis, retinitis, and vasculitis during immune reconstitution. She was found to have negative CMV antigenemia, and the disease occurred during concurrent systemic antiviral therapy. Anterior chamber tap confirmed the absence of the CMV in the eye, and recurrent blood samples continued to reveal absent CMV viral particles systemically while her lymphocyte count was steadily increasing. The patient responded to oral steroids, leading to resolution of active retinitis. Tapering the steroids caused a mild reactivation of the ocular immune response. [ABSTRACT FROM AUTHOR]

We developed and tested a dichoptic treatment designed for younger children that can be viewed freely and involves a dichoptic manipulation of a popular animation series that enables contrast-rebalancing without disrupting fusion. Our aim was to assess whether this novel amblyopia treatment is superior to patching in children aged 3-5 years. A total of 34 children with amblyopia were randomly assigned to contrast-rebalanced dichoptic cartoons (4 hours/week) or patching (14 hours/week) for 2 weeks. Children in the cartoon group continued watching cartoons for an additional 2 weeks. Designed to target the youngest and most treatable children, the dichoptic cartoons presented the entire scene to the amblyopic eye at 100% contrast, while the fellow eye view was presented at reduced contrast with the main character omitted. Best-corrected visual acuity (BCVA), stereoacuity, suppression, and manual dexterity were measured at each visit. After 2 weeks, improvement in amblyopic eye BCVA was greater for dichoptic treatment than for patching, with a mean improvement of 0.11 ± 0.08 versus 0.06 ± 0.09 logMAR, respectively (P = 0.04). Stereoacuity, suppression, and manual dexterity did not improve significantly more in the dichoptic group than the patching group at 2 weeks. After 4 weeks of dichoptic cartoon treatment, mean visual acuity improvement in the dichoptic group was 0.16 logMAR (95% CI, 0.10-0.21). In our study cohort, a contrast-rebalanced dichoptic cartoon was more effective than patching in treating childhood amblyopia after 2 weeks. Dichoptic cartoons that rebalance contrast to overcome suppression provide an additional treatment option for amblyopia in young children. [ABSTRACT FROM AUTHOR]

The biodiversity of fire-dependent woodlands is of great importance and interest throughout the eastern United States but is especially integral to longleaf pine (Pinus palustris) savannahs and woodlands. Longleaf pine communities are widespread throughout the southeastern United States with a dominant understory vegetation of wiregrass (Aristida spp.) in much of its range. Some portions of the longleaf pine range, however, are naturally free of wiregrass including an area in central South Carolina called the "Wiregrass Gap". Here, the understory vegetation is dominated by bluestem grasses (Andropogon spp. and Schizachyrium spp.) which, along with pine (Pinus spp.) and oak (Quercus spp.) litter, drive the disturbance regime of frequent low-intensity fire. The successful establishment of these grasses is key for longleaf pine woodland restoration efforts in this region. We investigated the woodland vegetation response to three slash manipulation treatments that resulted from a restoration harvest in 2020. These consisted of (1) a "conventional" treatment in which the slash was distributed across the treatment area, (2) a "biomass" treatment simulating a timber harvest that removes the whole tree from the site including the slash, and (3) a "mastication" treatment during which the slash and any regenerating woody stems were mulched shortly after the harvest. The biomass treatment generally resulted in a positive herbaceous response with significantly greater graminoid (p = 0.012, 1.5x greater) and non-woody perennial (p = 0.006, 1.5x greater) richness. This herbaceous response was likely driven by greater combined duff and mineral soil exposure yielding more opportunity for herbaceous species to establish. The benefits to the herbaceous layer were likely suppressed by large amounts of woody 100-h fuels in the conventional treatment and 1- to 10-hour fuels in the mastication treatment. While exposed duff and mineral soil had a favorable effect on the herbaceous response, it also benefitted the regeneration of loblolly pine seedlings (39 % of all woody seedling stems on site) with significantly more (p = 0.004, 5.0x as many) in the biomass than the mastication treatment. This complicates restoration efforts as poor continuity of herbaceous fuel in the mastication and biomass treatments could impede the swift re-introduction of prescribed fire. With better fuel continuity to carry a prescribed burn, the conventional treatment could most effectively reduce loblolly pine regeneration. Thus, accepting an initial muted herbaceous response in the conventional treatment could eventually lead to a more robust herbaceous response post-burn. Fire will ultimately determine the treatments' effectiveness. • The manipulation of logging slash influenced pre-fire vegetation. • Slash removal resulted in greater graminoid and non-woody perennial richness. • Slash removal resulted in more loblolly pine seedlings, complicating restoration. • Unreliable fuel continuity with slash removal may complicate swift restoration by fire. [ABSTRACT FROM AUTHOR]

Rotator cuff repair has a substantial failure rate despite various attempts to improve outcome and prevent a retear. Patch augmentation is an intuitively appealing approach to seek to reduce failure rate and improve outcomes for patients. Two main augmentation approaches are used: "on-lay" and "bridging." The literature is heterogeneous, and the best approach is uncertain. The evidence on patch augmentation for rotator cuff repair is both disparate and weak. Large randomized trials and registry data are required to move the field, ensure patient safety, and avoid wasting precious resources. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare the patient-reported bleeding outcomes and complication rates with the use of the 52-mg levonorgestrel-releasing intrauterine system (52-LNG-IUS) for treatment of heavy menstrual bleeding (HMB) among adolescents with and without a diagnosed inherited bleeding disorder (BD) within the first 12 months after insertion. Retrospective chart review was conducted of adolescents ages 14–21 years, with and without an inherited BD, who underwent 52-LNG-IUS insertion between September 2013 and February 2020 for the treatment of HMB. One hundred forty-four 52-LNG-IUS insertions among 139 subjects were evaluated. Fifty-nine (41%) of these were among adolescents with a diagnosed inherited BD, and 85 (59%) were among those without a BD. Among subjects with follow-up, documentation of patient-reported bleeding outcome, and a retained IUS (92/144), both groups subjectively reported improvement in bleeding outcome, with 91.7% (33/36) of those with a BD and 94.6% (53/56) of those without a BD reporting that bleeding outcome was better than prior to IUS insertion (p =.675). There was no statistically significant difference in the rate of spontaneous expulsion (p =.233), with the rate of expulsion in the first 12 months after placement among those with a BD of 13.7% (7/51) and 6.8% for those without a BD (5/72). Adolescents with HMB both with and without an inherited BD benefit from the 52-LNG-IUS for the treatment of HMB. Rates of spontaneous IUS expulsion are not statistically different regardless of the presence of a BD and are similar to rates found in other studies of intrauterine device use in adolescents. [ABSTRACT FROM AUTHOR]

Nursing leaders have recognized the need for consistent mechanisms to promote and sustain nursing professionalism. Peer-to-peer feedback and peer review are widely effective for nurse professionalism and self-regulation, patient care outcomes, and retention. Unprofessional behavior has been noted as widespread in health care and the effects on patients, clinicians, and organizations have been well-documented. Approximately 10% of the registered nurses in the United States belong to a collective bargaining unit (CBU) or union. This article will describe how a peer feedback program to address unprofessional behavior was implemented in a Magnet nursing practice with CBU representation. • Collaboration with collective bargaining units can result in shared goals. • Collaboration and discussion can produce an effective peer feedback program. • Peer feedback is important to create a culture of safety and respect. [ABSTRACT FROM AUTHOR]

Theta burst stimulation (TBS) is an efficient noninvasive neuromodulation paradigm that has been widely adopted, clinically. However, the efficacy of TBS treatment remains similarly modest as conventional 10 Hz repetitive transcranial magnetic stimulation (rTMS). To develop a new TBS paradigm that enhances the effects of TMS administration while maintaining high time-efficiency. We describe here a new TMS paradigm, named High-Density Theta Burst Stimulation (hdTBS). This paradigm delivers up to 6 pulses per burst, as opposed to only 3 in conventional TBS, while maintaining the inter-burst interval of 200 ms (or 5 Hz) – a critical parameter in inducing long-term potentiation. This paradigm was implemented on a TMS stimulator developed in-house; its physiological effects were assessed in the motor cortex of awake rats using a rodent specific focal TMS coil. Microwire electrodes were implanted into each rat's limb muscles to longitudinally record motor-evoked potential (MEP). Four different TBS paradigms (3, 4, 5 or 6 pulses per burst, 200 s per session) were tested; MEP signals were recorded immediately before (baseline) and up to 35 min post each TBS session. We developed a stimulator based on a printed-circuit board strategy. The stimulator was able to deliver stable outputs of up to 6 pulses per burst. Animal experiments (n = 15) revealed significantly different aftereffects induced by the four TBS paradigms (Friedman test, p = 0.018). Post hoc analysis further revealed that, in comparison to conventional 3-pulse TBS, 5- and 6-pulse TBS enhanced the aftereffects of MEP signals by 56% and 92%, respectively, while maintaining identical time efficiency. A new stimulation paradigm is proposed, implemented and tested in the motor cortex of awake rats using a focal TMS coil developed in the lab. We observed enhanced aftereffects as assessed by MEP, with no obvious adverse effects, suggesting the translational potentials of this paradigm. • Proposed and implemented a new paradigm, named high-density theta burst stimulation (hdTBS). • Assessed the aftereffects of hdTBS in rat motor cortex. • Developed a rat model to record MEP longitudinally. • hdTBS induced more prominent aftereffects than conventional intermittent TBS. • MEP recoding further confirmed the focality of the rat TMS coil to be 2 mm. [ABSTRACT FROM AUTHOR]

To provide a comprehensive characterization of verbal learning and memory (VLM) abilities in youth with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) and to evaluate disease severity as a predictor of VLM functioning over time. As part of a longitudinal natural history study, youth with NF1 and PNs were administered repeat neuropsychological assessments, including measures of VLM and ratings of NF1 disease severity completed by a medical professional. This sub-study analyzed data from 89 patients (M age baseline = 13.1, SD = 4.3 years, range 6–24 years) who had completed tests of VLM abilities and verbal attention at either baseline and/or 36 months. VLM scores across the sample fell predominantly within the average range of functioning at both time points. However, relative to peers with mild NF1 disease severity, youth with moderate/severe NF1 disease showed lower functioning across multiple VLM domains at 36 months, even after controlling for the effects of verbal attention. Exclusive use of overall domain scores does not fully characterize VLM functioning in youth with NF1 and PNs. Additionally, children and adolescents with more severe NF1 disease should be monitored more closely for verbal memory challenges and targeted for interventions. • VLM appears to be relatively intact in youth with NF1. • Overall memory scores may not fully represent VLM in youth with NF1. • Youth with moderate/severe NF1 disease have lower VLM functioning over time. [ABSTRACT FROM AUTHOR]

Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion. [ABSTRACT FROM AUTHOR]

The article focuses on addressing the risks posed by electronic health record (EHR) transparency, mandated by the 21st Century Cures Act, to the confidentiality of adolescent healthcare. The topics include the design and implementation of an innovative curriculum for medical students to navigate EHR-mediated communication, emphasizing strategies to protect adolescent confidentiality and enhance patient- and family-centered written communication skills.

Background: There are an abundance of commercially available lateral flow assays (LFAs) that detect antibodies to SARS-CoV-2. Whilst these are usually evaluated by the manufacturer, externally performed diagnostic accuracy studies to assess performance are essential. Herein we present an evaluation of 12 LFAs.Methods: Sera from 100 SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) positive participants were recruited through the FASTER study. A total of 105 pre-pandemic sera from participants with other infections were included as negative samples.Results: At presentation sensitivity against RT-PCR ranged from 37.4 to 79% for IgM/IgG, 30.3-74% for IgG, and 21.2-67% for IgM. Sensitivity for IgM/IgG improved ≥ 21 days post symptom onset for 10/12 tests. Specificity ranged from 74.3 to 99.1% for IgM/IgG, 82.9-100% for IgG, and 75.2-98% for IgM. Compared to the EuroImmun IgG enzyme-linked immunosorbent assay (ELISA), sensitivity and specificity ranged from 44.6 to 95.4% and 85.4-100%, respectively.Conclusion: There are many LFAs available with varied sensitivity and specificity. Understanding the diagnostic accuracy of these tests will be vital as we come to rely more on the antibody status of a person moving forward, and as such manufacturer-independent evaluations are crucial. [ABSTRACT FROM AUTHOR]

This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatments and personal protective equipment. New advice and recommendations are provided on: workload management; staff health, including vaccination; providing clinical education; personal protective equipment; interventions, including awake proning, mobilisation and rehabilitation in patients with hypoxaemia. Additionally, recommendations for recovery after COVID-19 have been added, including roles that physiotherapy can offer in the management of post-COVID syndrome. The updated guidelines are intended for use by physiotherapists and other relevant stakeholders caring for adult patients with confirmed or suspected COVID-19 in the acute care setting and beyond. [ABSTRACT FROM AUTHOR]

Spine infection is both a clinical and diagnostic imaging challenge due to its relatively indolent and nonspecific clinical presentation. The diagnosis of spine infection is based upon a combination of clinical suspicion, imaging evaluation and, when possible, microbiologic confirmation performed from blood cultures or image-guided percutaneous or open spine biopsy. With respect to the imaging evaluation of suspected spine infection, MRI without and with contrast of the affected spine segment is the initial diagnostic test of choice. As noncontrast MRI of the spine is often used in the evaluation of back or neck pain not responding to conservative medical management, it may show findings that are suggestive of infection, hence this procedure may also be considered in the evaluation of suspected spine infection. Nuclear medicine studies, including skeletal scintigraphy, gallium scan, and FDG-PET/CT, may be helpful in equivocal or select cases. Similarly, radiography and CT may be appropriate for assessing overall spinal stability, spine alignment, osseous integrity and, when present, the status of spine instrumentation or spine implants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Radiation therapy effectively palliates bone metastases, although variability exists in practice patterns. National recommendations advocate against using extended fractionation (EF) with courses greater than 10 fractions. We previously reported EF use of 14.8%. We analyzed practice patterns within a statewide quality consortium to assess EF use in a larger patient population after implementation of a quality measure focused on reducing EF. Patients treated for bone metastases within a statewide radiation oncology quality consortium were prospectively enrolled from March 2018 through October 2020. The EF quality metric was implemented March 1, 2018. Data on patient, physician, and facility characteristics; fractionation schedules; and treatment planning and delivery techniques were collected. Multivariable binary logistic regression was used to assess EF. Twenty-eight facilities enrolled 1445 consecutive patients treated with 1934 plans. The median number of treatment plans per facility was 52 (range, 7-307). Sixty different fractionation schedules were used. EF was delivered in 3.4% of plans. Initially, EF use was lower than expected and remained low over time. Significant predictors for EF use included complicated metastasis (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.04-4.02; P =.04), lack of associated central nervous system or visceral disease (OR, 2.27; 95% CI, 1.2-4.2; P =.01), nonteaching versus teaching facilities (OR, 8.97; 95% CI, 2.1-38.5; P <.01), and treating physicians with more years in practice (OR, 12.82; 95% CI, 3.9-42.4; P <.01). Within a large, prospective population-based data set, fractionation schedules for palliative radiation therapy of bone metastases remain highly variable. Resource-intensive treatments including EF persist, although EF use was low after implementation of a quality measure. Complicated metastases, lack of central nervous system or visceral disease, and treatment at nonteaching facilities or by physicians with more years in practice significantly predict use of EF. These results support ongoing efforts to more clearly understand and address barriers to high-value radiation approaches in the palliative setting. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic. Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. Overall, 556 patients – 'Pre-COVID-19' (n = 310) and 'During COVID-19' (n = 246) – were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00–6.37 and p < 0.05). The absolute risk of SSI in the 'Pre-COVID-19' group was 2.3% and 5.3% in the 'During COVID-19' group. The relative risk of developing an SSI in the 'During COVID-19' group was 2.34 (95% CI, 0.95–5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups. The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3–5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma. [ABSTRACT FROM AUTHOR]

Neurofibromatosis type 1 (NF1) is a genetic syndrome associated with multiple complications that cause chronic pain, including plexiform neurofibroma (PN) tumors. However, no randomized studies have examined non-pharmacological interventions for pain specifically targeting individuals with NF1 and PNs. In the current randomized controlled trial, an Acceptance and Commitment Therapy intervention was conducted with older adolescents and adults ages 16–59 years with NF1, PNs, and chronic pain. We hypothesized that pain interference would decrease from pre-to post-intervention compared to a wait-list control group. We also examined potential mediators, including pain acceptance and inflexibility. The intervention consisted of two 2-h in-person sessions followed by 8 weeks of online training including weekly email assignments and biweekly video chats. Outcome measures evaluating pain interference, pain intensity, pain anxiety, and depression and process measures evaluating pain acceptance and pain inflexibility were administered at baseline and after the 8-week intervention. Sixty-two participants (M age = 30.7 ± 11.5 years, 61.3% female) completed the intervention. Results indicated that the ACT intervention significantly reduced how much pain interfered with daily functioning. Improvements in pain acceptance and, separately, pain inflexibility, mediated the treatment benefit for individuals in the ACT group. No improvements in pain intensity, pain anxiety, or depression were noted following the intervention. Durable treatment benefits were seen at 6 months albeit only among those who improved more during the 8-week intervention. While the immediate post-intervention effects were seen after 4 h of in-person training and limited online sessions, more support is likely needed to maintain these effects long-term. Results indicate that remote ACT interventions have promise and could make this treatment accessible to more patients with NF1, PNs and chronic pain. • This is the first randomized trial to show that ACT treatment reduces pain interference in NF1. • Mediation models showed that acceptance and inflexibility mediated treatment benefit. • The mixed-methods intervention (in-person and remote) increases treatment accessibility. [ABSTRACT FROM AUTHOR]

Unlike medullary thyroid carcinoma in adults, the vast majority of pediatric medullary thyroid carcinoma is hereditary. Pediatric medullary thyroid carcinoma is known to have different genetic alterations driving tumorigenesis, but it is not known if pediatric medullary thyroid carcinoma has different clinicopathologic features. This study aims to identify which pediatric medullary thyroid carcinoma patients might warrant elective neck dissection. We selected all patients ages 0 to 19 diagnosed with clinically evident medullary thyroid carcinoma in the National Cancer Database between 2004 to 2016. Clinicopathologic factors, treatments, and outcomes were analyzed and compared between this cohort and adults (ages ≥20) with medullary thyroid carcinoma. One hundred twenty-five pediatric medullary thyroid carcinoma (median age: 13) and 5,086 adult medullary thyroid carcinoma (median age: 57) patients were identified. Pediatric patients had smaller tumors (median diameter: 1.2 cm vs 2.0 cm; P <.001), lower rates of nodal metastases (n = 31, 36.9% vs 1,689, 50.4%; P =.02) but double the incidence of multifocal tumors (n = 70, 59.3%, vs 1,412, 29.9%; P <.001) compared with adults. Multifocal tumors conferred a significantly increased risk of nodal metastases in adult medullary thyroid carcinoma (64.4% vs 43.2%; P <.001) but not pediatric medullary thyroid carcinoma (37.7% vs 35.7%; P =.85). Nodal metastases were more frequent among older children (0–5 years: 0.0%, 6–12: 40.7%, 13–19: 41.7%; P =.04). However, rates of occult nodal metastases were similar between older children (6–19 years: n = 12, 21.4%) and adults (557, 25.8% P =.56). Pediatric medullary thyroid carcinoma has lower rates of lymph node metastases compared with adults. The risk of nodal disease was low among the youngest children, but older children ages 6 to 19 were at considerable risk for occult metastases. These findings could guide clinicians in selecting pediatric patients considered for elective lymph node dissection. [ABSTRACT FROM AUTHOR]

Patients with a new diagnosis of attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication need regular follow-up. Guidelines recommend follow-up within 30 days of stimulant initiation or change but this goal is seldom achieved. This quality improvement (QI) study in an urban academic outpatient practice aimed to: 1) assess whether use of school-based telemedicine increases rates of follow-up within 30 days and decreases the number of days to follow-up for ADHD, and 2) compare rates of 30-day follow-up via in-person vs telemedicine visits. We performed three Plan-Do-Study-Act cycles over a 12-month period: QI interventions included clinic wide education, paper prompts for clinicians, and creation of a database to track ADHD patients. We measured days from the index visit to the follow-up visit, and the mode of both visits (in-person or telemedicine). Data were collected for 6 months pre-intervention and 12 months post-intervention. Follow-up within 30 days increased from 19% (of 191 visits) to 33% (of 661 visits) (P <.001). The time to follow-up decreased from 67 to 34 days (P <.001). Follow up visits by telemedicine were more also more likely to be within 30 days (62% vs. 32%, P <.001). A QI intervention for ADHD care increased rates of follow-up within 30 days, particularly when telemedicine was used, and decreased the number of days to follow-up. This intervention could serve as a model to improve follow-up for ADHD in other settings. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the magnitude of an independent association between bullying victimization and self-harm and suicide attempt in adolescence after adjusting for unmeasured and measured confounding factors. Using the Child and Adolescent Twin Study in Sweden, we examined twins born between 1994 and 1999 (n = 13,852). Twins self-reported bullying victimization at age 15 years and self-harm and suicide attempt at age 18 years. We created a factor score of 13 bullying items, on which self-harm and suicide attempt items were regressed in three models: (1) among unrelated individuals; (2) among co-twins, in which a twin exposed to more bullying was compared with his/her co-twin who was exposed to less; and (3) among co-twins while adjusting for indicators of childhood psychopathology. Among unrelated individuals, a one standard deviation increase in bullying victimization was associated with increased odds for self-harm (odds ratio [OR], 1.29 [95% confidence interval, 1.23–1.36]) and suicide attempt (OR, 1.68 [1.53–1.85]). Among co-twins, the odds attenuated for self-harm (OR, 1.19 [1.09–1.30]) and suicide attempt (OR, 1.39 [1.17–1.66]). Finally, when accounting for childhood psychopathology, there was a 14% (1.04–1.25) and 25% (1.03–1.52) relative increase in odds of self-harm and suicide attempt, respectively. The results suggest that bullying victimization was uniquely associated with self-harm and suicide attempt over and above the confounding because of unmeasured and measured factors (i.e., familial vulnerability and pre-existing psychopathy). However, magnitudes were small, suggesting that additional interventions and screenings are needed to address suicidality apart from bullying interventions. [ABSTRACT FROM AUTHOR]

Malnutrition is estimated to affect over three million people in the UK resulting in serious consequences on both the individuals' health and healthcare system. While dietitians are uniquely qualified to provide nutritional interventions, they have one of the lowest workforce numbers in the NHS making it difficult to tackle the malnutrition burden alone. Thus, innovative ways of working are needed. Non-dietetic health care professionals are often involved in the identification, assessment and treatment of malnutrition and research has shown benefits of their involvement in identification and management of nutritional issues, however their role in delivering nutritional interventions has not yet been evaluated. The aim of this systematic review is to collate evidence on the potential roles and effectiveness of non-dietetic healthcare professionals in providing nutritional interventions and their impact on patient-centred outcomes in malnourished or at-risk individuals. Three electronic databases were searched on 10th October 2019. Titles and abstracts were initially screened, followed by full texts, against inclusion criteria and included/excluded studies by two authors independently. Data were extracted and tabulated where possible and grouped according to type of intervention and outcomes. Risk of bias and quality of evidence was assessed using the GRADE approach. Data were combined in the form of a narrative synthesis. Eighteen eligible studies were included; five involved feeding assistance, 10 involved implementing individualised nutrition monitoring or care plans and three were multi-factorial interventions. Interventions took place in a range of settings including hospital and long term care facilities. Very low and low quality evidence suggests that non-dietetic HCP interventions may improve weight, percent of patients reaching estimated energy requirements, quality of life, falls and frailty rate and patient satisfaction. Very low quality evidence suggests that non-dietetic HCP interventions may not improve mid-arm circumference, energy or protein intake, activities of daily living, handgrip strength or length of hospital stay. Low quality evidence suggests that non-dietetic HCP interventions have no effect on mortality. A lack of good quality evidence on the effectiveness of non-dietetic HCP delivered interventions on the management of malnutrition in adults makes it difficult to draw conclusions. However, this review has highlighted the types of interventions and potential roles of non-dietetic HCPs, providing a groundwork for further high-quality research such as feasibility studies in this area, for the effective management of malnutrition within clinical and community practice. [ABSTRACT FROM AUTHOR]

• Experienced registered nurses who are employed as nurse navigators provide effective co-ordinated care to people living with multiple chronic conditions. • Nurse navigators effectively use value-based care to help reconnect patients who have lost trust in the health service, to reconnect with their interdisciplinary teams. • Nurse navigators provide individualized, authentic care, which is more than the sum of hospital avoidance. Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of the McKenzie Method of Diagnosis and Treatment (MDT) as an evaluation and treatment paradigm in adult patients with neck pain to improve patient outcomes. A systematic review and meta-analysis was performed using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar. Full search terms included "McKenzie method" OR "McKenzie approach" OR "McKenzie treatment" AND "neck pain" in each database. Inclusion criteria was use of McKenzie MDT, Level I randomized control trials (RCTs), adults, and outcomes of pain (0-10 scale) and disability (Neck Disability Index). Exclusion criteria included lower level of evidence studies, articles without full text, concurrent thoracic symptoms, and non-English text. Article screening was performed by multiple authors. Articles were examined for full text and relevance by multiple authors. Data extraction included first author, year of publication, intervention, control group, number of patients, average pain scores with standard deviations, average Neck Disability Index score with standard deviations, and follow-up time. A total of 11 RCTs met final selection criteria from 1,955 articles on initial search with 289 patients receiving McKenzie MDT out of 677 total patients. For meta-analysis, there was a small but statistically significant improvement in pain (1.14/10 points) in patients receiving McKenzie MDT versus control (p< 0.02). There was no significant improvement in NDI score between McKenzie MDT versus control (p=0.19). For severity of pain, there was a significant improvement in moderate or severe pain (2.06/10 points; p< 0.01), but not in mild to moderate pain (p=0.84) when comparing McKenzie MDT to controls. McKenzie MDT has small but statistically significant improvement in neck pain compared to controls, especially in patients with moderate to severe neck pain. Use of McKenzie MDT did not provide any significant improvement in disability compared to control. This study is the first systematic review with meta-analysis on the effectiveness of McKenzie MDT for adult patients with neck pain. The authors have no relevant disclosures to make known. [ABSTRACT FROM AUTHOR]

To investigate the impact of patient specific scoliosis exercises (PSSE) on outcomes in patients with adolescent idiopathic scoliosis (AIS) to improve patient care. A systematic review with meta-analysis was performed using PubMed, CINAHL, MEDLINE, Cochrane, and ScienceDirect with search terms "adolescent idiopathic scoliosis" AND "schroth" OR "scoliosis specific exercise" from October 2022 to database inception. Inclusion criteria included use of PSSE, patient population of AIS, patient outcomes, and English full text. Multiple reviewers participated in article screening and final selection. A total of 628 articles were retrieved from the initial search with 26 articles meeting final inclusion criteria (10 Level I articles,16 Level IV articles). Data extraction was performed by multiple authors. Article bias and quality was assessed via the Physiotherapy Evidence Database (PEDro) for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) for observational studies. A total of 18 articles (n=1927 total patients) were used for Cobb angle assessment with 3.20 degrees of improvement in Cobb angle in patients receiving PSSE at 18 months follow up as compared to 1.4 degrees of worsening in controls (p < 0.001). Meta analysis of eight randomized controlled trials revealed a statistically significant difference of Cobb angle delta between treatment (n=644 patients) and control groups (n=782 patients) with an overall mean improvement of 2.6 degrees (0.91,4.30; p=0.018). For subgroup analysis, there was significant improvement in small curves (less than 30 degrees)(p< 0.001) with no significant improvement in larger curves (greater than 30 degrees)(p=0.565) in patients treated with PSSE. No significant improvement was seen in ATR (p=0.07) or SRS-22 scores (p=0.16) after PSSE. PSSE demonstrates a small but statistically significant improvement in Cobb angle in patients with AIS. When stratified based on curve size, improvement was seen for smaller curves, but not for larger curves. Patrick Cahill has affiliations with Dynamic Lung MRI and Pediatric Deformity System. John Flynn has affiliations with Biomet and Wolters Kluwer. No other authors have any disclosures. [ABSTRACT FROM AUTHOR]

To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness. A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions to generate items for the core domains research. In rounds 2-4, participants were invited to use a Likert scale (1-9) to rate the importance of each core domain for research studies of physical activity and/or sedentary behavior in hospitalized older adults with an acute medical illness. Online surveys. A total of 49 participants were invited to each round (international researchers, clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%, 88%, 83% and 81%, respectively. None. Consensus was defined a priori as ≥70% of respondents rating an item as "critical" (score≥7) and ≤15% of respondents rating an item as "not important" (score≤3). In round 2, a total of 9 of 25 core domains reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional 8 reached consensus (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality, economic). Round 4 participants provided further review and a final rating of all 17 core domains that met consensus in previous rounds. Four core domains were rated as "critically important" to evaluate: physical functioning, social functioning, emotional functioning, and hospital outcomes. This preliminary work provides international and expert consensus-based core domains for development toward a core-outcome set for research, with the ultimate goal of fostering consistency in outcomes and reporting to accelerate research on effective strategies to address physical activity and/or sedentary behavior in older adults while hospitalized. • This research determined core domains (important types of outcomes). • Findings are for studies of physical activity in hospitalized older adults. • Findings may also improve outcome reporting in studies of sedentary behavior. • Use of a consensus approach with researchers, clinicians, policymakers, and patients. • Core domains provide the starting point for developing a core outcome set. [ABSTRACT FROM AUTHOR]