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Supplemental Digital Content is Available in the Text. Introduction.: All Doctor of Physical Therapy (DPT) programs in the United States prepare students to demonstrate entry-level clinical performance upon graduation. Clinical residency programs are an option for DPT graduates seeking to specialize in a practice area. Review of Literature.: There is little research published on why DPT graduates decide to pursue residency education (RE) or not. This study aimed to determine factors influencing a Physical Therapist's (PT) decision-making process in choosing to pursue a postgraduate residency. Subjects.: PTs within 3 years of graduation and third-year DPT program students were surveyed. Most respondents were from DPT programs in the northeastern United States. Methods.: A survey was created, piloted, and disseminated to various DPT programs. The survey asked participants their perceptions of motivating factors or barriers to pursuing a RE using multiple choice questions and Likert items. Descriptive statistics and frequencies were reported. One-way analysis of variances, chi-square analysis, and unpaired t tests were used. Results.: Students who considered residency in their second year are 26.5× more likely to apply for a residency (P <.001). Participants strongly agreed with the statements that residency will increase confidence when practicing in their specialty area (1.39 ± 0.48), expand their knowledge as clinicians (1.39 ± 0.051), and expedite proficient practice (1.72 ± 0.057). Participants considered student burnout, the cost of residency, student loan debt, and geographical relocation as the top barriers to pursuing residency. Men were significantly more confident in their ability to apply to residency (F = 8.219, P =.005). Married individuals perceived loans or financial obligations (F = 3.607, P =.029), family obligations (F = 17.170, P <.001), and geographical limitations (F = 3.825, P =.024) as barriers more than single individuals. Discussion and Conclusion.: There are many variables DPT students and recent graduates consider when deciding whether to pursue RE. RPs and entry-level DPT programs should consider these factors to promote increased participation in postprofessional RE. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Children with inflammatory bowel disease (IBD) may respond differently to COVID-19 immunization as compared with healthy children or adults with IBD. Those younger than 12 years receive a lower vaccine dose than adults. We sought to describe the safety and humoral immune response to COVID-19 vaccine in children with IBD. METHODS: We recruited children with IBD, ages 5–17 years, who received ≥ 2 doses of the BNT162b2 vaccine by a direct-to-patient outreach and at select sites. Patient demographics, IBD characteristics, medication use, and vaccine adverse events were collected. A subset of participants had quantitative measurement of anti-receptor binding domain IgG antibodies after 2-part immunization. RESULTS: Our study population included 280 participants. Only 1 participant required an ED visit or hospitalization because of an adverse event. Of 99 participants who underwent anti-receptor binding domain IgG antibody measurement, 98 had a detectable antibody, with a mean antibody level of 43.0 μg/mL (SD 67) and a median of 22 μg/mL (interquartile range 12–38). In adjusted analyses, older age (P = 0.028) and antitumor necrosis factor monotherapy compared with immunomodulators alone (P = 0.005) were associated with a decreased antibody level. Antibody response in patients treated with antitumor necrosis factor combination vs monotherapy was numerically lower but not significant. DISCUSSION: Humoral immune response to COVID-19 immunization in children with IBD was robust, despite a high proportion of this pediatric cohort being treated with immunosuppressive agents. Severe vaccine-related AEs were rare. Overall, these findings provide a high level of reassurance that pediatric patients with IBD respond well and safely to SARS-CoV-2 vaccination. [ABSTRACT FROM AUTHOR]

Background: Measuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution. Methods: Our study included events documented in the electronic health records (EHRs) among hospitalized patients at Denver Health Medical Center during January 1, 2017 to December 31, 2018. Multiple EHR markers (ie, opioid-related diagnostic codes, clinical assessment, laboratory results, and free-text documentation) were used to develop diagnosis-based and extended definitions for OUD, opioid misuse, and opioid poisoning. We used these definitions to estimate number of hospitalized patients with these conditions. Results: During a 2-year study period, 715 unique patients were identified solely using opioid-related diagnostic codes; OUD codes accounted for the largest proportion (499/715, 69.8%). Extended definitions identified an additional 973 unique patients (~136% increase), which includes 155/973 (15.9%) who were identified by a clinical assessment marker, 1/973 (0.1%) by a laboratory test marker, and 817/973 (84.0%) by a clinical documentation marker. Conclusions: Solely using diagnostic codes to estimate prevalence of clinically relevant ORHPs missed most patients with ORHPs. More inclusive estimates were generated using additional EHR markers. Improved methods to estimate ORHPs among a health care system's patients would more fully estimate organizational and economic burden to more efficiently allocate resources and ensure capacity to provide clinical services. [ABSTRACT FROM AUTHOR]

This manuscript will review intensive care management considerations for pregnant patients with severe COVID-19 disease. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Introduction: Infectious complications are common after pancreatoduodenectomy, which in turn are associated with preoperative biliary drainage. Current guidelines recommend a first-generation cephalosporin as perioperative antibiotic prophylaxis. However, some studies support the use of targeted antibiotics. The aim of this systematic review and meta-analysis is to evaluate the role of prophylactic targeted antibiotics compared to standard antibiotics in reducing postoperative infections after pancreatoduodenectomy. Methods: A search from MEDLINE, EMBASE, and Cochrane library from 1946 to July 2020 was conducted. Studies were included if they compared targeted antibiotics with standard perioperative antibiotics while including outcome data on surgical site infections (SSI). Targeted therapy was defined as perioperative antibiotics targeting organisms prevalent in bile instrumentation or by culture data obtained from the patient or institution. Outcomes assessed were the rate of SSIs and their microbiology profile. Analyses included demographic data, perioperative antibiotics, postoperative outcomes including microbiology data, and meta-analysis was performed where applicable. Results: Seven studies were included, with a total of 849 patients undergoing pancreatoduodenectomy. Targeted antibiotics were associated with a significantly lower rate of postoperative SSI compared to standard antibiotic therapy [21.1% vs 41.9%; risk ratios (RR) 0.55, 95% confidence interval 0.37–0.81]. Wound/incisional site infections and organ space infections were lower in patients receiving targeted antibiotic prophylaxis (RR 0.33, P = 0.0002 and RR 0.54, P = 0.0004, respectively). Enterococcus species were the most common bacteria reported. Conclusion: There was a significant reduction in overall SSI rates when targeted antibiotics was used. Current standard antibiotic prophylaxis is inadequate in covering microbes prevalent in postoperative infections developing after pancreatoduodenectomy. [ABSTRACT FROM AUTHOR]