Search

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]

The article discusses research which investigated stress levels of hospital employees in Kansas. Topics explored include the use of the Stanford Presenteeism Scale-6 to evaluate workplace presenteeism and health of these employees, factors which encouraged employees to work such as recognition for a job well done, yoga classes, and flexible work schedule, and the effectiveness of stress reduction strategies such as increase in staffing, exercise therapy, and counselling sessions.

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]

Background: Little is known about how the COVID-19 pandemic impacted older adults admitted to the hospital with fall-related injuries. This research sought to determine if there was a difference in patient characteristics and hospital outcomes among older adults with fall-related injuries during the COVID-19 pandemic compared to a non-pandemic period. Methods: A retrospective chart review of patients 65 years or older admitted for traumatic falls before and during COVID-19 was undertaken. Data abstracted included demographics, fall details, injury data, and hospital course. Results: Of 1598 patients, 50.5% presented during COVID-19 (cases), and 49.5% presented pre-pandemic (controls). Fewer cases fell in rural areas (28.6% vs 34.1%, P = .018) and were transferred from outside hospitals (32.1% vs 38.2%, P = .011). More cases experienced alcohol (4.6% vs 2.4%, P = .017) and substance use disorders (1.4% vs .4%, P = .029). Fewer cases had subdural hemorrhages (11.8% vs 16.4%, P = .007), and more had pneumothoraxes (3.5% vs 1.8%, P = .032). More patients admitted during COVID-19 experienced acute respiratory failure (2.0% vs .0%, P < .001), hypoxia (1.5% vs .3%, P = .005), and delirium (6.3% vs 1.0%, P < .001). Fewer cases were discharged to skilled nursing facilities (50.8% vs 57.3%, P = .009) and more to home with services (13.1% vs 8.3%, P = .002). Discussion: This study suggested there was a similar frequency of presentation for falls among older adults during the two study periods. Older adults with fall-related injuries experienced differences in presenting comorbidities, injury patterns, complications, and discharge locations during the study periods. [ABSTRACT FROM AUTHOR]

Development of infrastructure for successful and sustained health initiatives in the workplace has been recommended, yet not all components have been studied together. This paper evaluates these practices as a combined set of recommendations for those interested in improving the health of their worksite. Objective: Workplace health programs can be ineffective, and changes are likely to be temporary without first establishing a wellness infrastructure. This study sought to determine whether attending a WorkWell KS Building the Worksite Wellness Foundation (Foundation) workshop enabled worksites to develop this infrastructure. Methods: Survey data were collected from worksites before attending a workshop and approximately 1 year later. Survey items were designed to assess whether the worksite was implementing best practices. Results: In total, 212 worksites participated in a workshop and completed both a baseline and follow-up assessments. At follow-up, more worksites reported having a wellness committee (89.6% vs 59.7%, P < 0.001) and having wellness committee duties included in position descriptions (26.2% vs 6.4%, P < 0.001). Conclusions: This study suggests that Foundation workshops can support worksites' implementation of best practices to establish worksite wellness infrastructure. [ABSTRACT FROM AUTHOR]

The article focuses on the National Training Strategy (NST) which aimed at extending the training of community-based providers on emergency preparedness in the U.S. The NTS was designed to develop and evaluate a training program for all community-based healhtcare provides in the nation to respond to public health emergency. Seven sites were awarded NTS funding in which awardees conducted monthly meeting to discuss strategies for developing national training methods, competencies, and standards.

A systematic review of topic-specific faith-based health programs determined that health outcomes can be improved though faith-based health interventions. A university research team, in partnership with the Kansas United Methodist Church and a United Methodist philanthropy, facilitated planning and development of a statewide initiative to increase the capacity of laity-led health ministry teams. The purpose of this paper is to describe the processes utilized to design and implement an initiative to increase capacity for laity-led comprehensive health ministry among Kansas United Methodist Church congregations and to share the key elements of the initiative. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine whether individuals who participated in an intervention to reduce sitting at work would report changes in arousal, fatigue, and mood. Methods: Inactive females with full-time sedentary occupations (N=49) were randomly assigned to take short, frequent breaks (sBs) or longer, planned breaks (LBs) from sitting each workday for 8 weeks. At baseline and postintervention, participants completed measures of arousal, fatigue, and mood. Within- and between-group changes were examined. Results: SB participants reduced sitting and reported moderate to large improvements in all affective outcomes except calmness (d = -0.44 to -0.82), whereas effect sizes were small for the LB group (d = 0.01 to -0.28). Only changes in negative affect differed between groups (P = 0.045). Conclusion: This study suggests that taking short, frequent breaks from sitting may be an effective strategy for improving affective outcomes among sedentary female employees. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is one of the most common arrhythmias among hospitalized patients. Among patients admitted with septic shock (SS), the new occurrence of atrial fibrillation has been associated with an increase in intensive care unit (ICU) length of stay and in-hospital mortality. This is partially related to further reduction in cardiac output and thus worsening organ perfusion due to atrial fibrillation. However, there is a paucity of research on the outcomes of patients who have underlying chronic AF (UCAF) and then develop SS. This study aimed to identify the clinical characteristics and outcomes of patients with UCAF admitted with SS compared to patients with SS without UCAF. Methods: This study was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with SS, and these patients were stratified into those with and without UCAF. Propensity matching analyses were performed to compare clinical outcomes and in-hospital mortality between the two groups. Results: A total of 353,422 patients with hospitalization for SS were identified, 5.8% (n = 20,772) of whom had UCAF. After 2:1 propensity matching, 20,719 patients were identified as having SS with UCAF, and 41,438 patients were identified as having SS without UCAF. Patients with SS and UCAF had a higher incidence of ischemic stroke [2.5% versus 2.2%, p = 0.012], length of stay [11.5 days versus 10.9 days, p < 0.001], mean total charges [$154,094 versus $144,037, p < 0.001] compared to those with SS without UCAF. In-hospital mortality was high in both groups, but was slightly higher among those with SS and UCAF than those with SS and no UCAF [34.4% versus 34.1%, p = 0.049]. Conclusions: This study identified UCAF as an adverse prognosticator for clinical outcomes. Patients with SS and UCAF need to be identified as a higher risk category of SS who will require more intensive management. [ABSTRACT FROM AUTHOR]

Introduction: Mortality estimates from sepsis and septic shock ranged from 18% to 35% and 40% to 60%, respectively, prior to 2014. Sepsis patients who experience subsequent cardiovascular events have increased mortality; however, data are limited among septic shock patients. This study reports in-hospital mortality, incident cardiovascular events, and cardiovascular procedures among sepsis patients with and without subsequent septic shock. Methods: Patients with a primary diagnosis of sepsis with and without a secondary diagnosis of septic shock were identified from the 2016 and 2017 National Readmissions Database. These patients were then evaluated for the occurrence of cardiovascular events and procedures. Results: A total of 2,127,137 patients were included in the study, with a mean age of 66 years. Twenty percent of patients (n =420,135) developed subsequent septic shock. In-hospital mortality among patients with a primary diagnosis of sepsis was 5.3%, and it was 31.2% for those with subsequent septic shock. Notable cardiovascular events occurring among sepsis patients with and without subsequent septic shock, respectively, included: acute kidney injury (65.1% vs. 32.8%, P < .0001), acute systolic heart failure (9.8% vs. 5.1%, P < .0001), NSTEMI (8.8% vs. 3.2%, P < .0001), and ischemic stroke (2.3% vs. 0.9%, P < .0001). Similarly, the most common cardiovascular procedures between the two groups were: percutaneous coronary intervention (0.37% vs. 0.20%, P < .0001), intraaortic balloon pump (0.19% vs. 0.02%, P < .0001), and extracorporeal membrane oxygenation (0.18% vs. 0.01%, P < .0001). Conclusions: Sepsis with subsequent septic shock is associated with an increased frequency of in-hospital cardiovascular events and procedures. [ABSTRACT FROM AUTHOR]

Objective. This study explores the decision-making process, including motivating factors, for small and midsized businesses in the Midwest to implement health promotion initiatives. Method. This a replication of a study conducted in the Pacific Northwest. Semistructured qualitative interviews were conducted with key informants from 12 Midwestern metropolitan employers with fewer than 1,000 employees. Informants were interviewed regarding their companies’ policies and practices around workplace health promotion programming adoption and valuation. Results. Workplace health promotion adoption at these small and midsized businesses was motivated by three goals: to lower health care costs, to address human relations objectives, and to improve productivity. Low upfront cost was the most frequently considered criterion in choosing which workplace health promotion program to offer. Barriers to implementation included lack of employee buy-in, prohibitive costs, and personnel or time constraints. Aids to implementation included employee buy-in and affordability. Conclusions. This study suggests that cost considerations predominate in the workplace health promotion decision-making process at small to midsized businesses. Furthermore, employee buy-in cannot be underestimated as a factor in successful program implementation or longevity. Employees, along with executives and human resources management, must be appropriately targeted by health promotion practitioners in workplace health promotion efforts. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: An estimated 24% of patients referred to epilepsy clinics actually have nonepileptic seizures. Various procedures have been used to precipitate nonepileptic events. The goal of this study was to use hypnosis in seizure provocation and differentiation between epileptic and nonepileptic seizure events. Methods: Fifty study participants were enrolled from the Via Christi Comprehensive Epilepsy Center’s video/electroencephalography unit. Patients underwent the Hypnotic Induction Profile (HIP) to assess susceptibility to hypnosis. After completion of the HIP, participants underwent hypnosis by a physician trained to do so. They received a hypnotic suggestion to have a seizure. All seizure-like events were classified as either an epileptic, nonepileptic, or undetermined event based on whether or not the patient had abnormal EEG activity during the event. Results: Of the 50 participants enrolled, 3 withdrew consent, resulting in 47 participants. Seven (15%) participants failed to have an event of any type and were classified as undetermined. Sixteen (34%) participants were classified as having epileptic seizure events, and 24 (51%) participants had nonepileptic events. Most participants were Caucasian (87%), female (57%), and unemployed (55%). HIP scores ranged from 0 to 10. Participants classified with nonepileptic scores had higher mean HIP scores (8.08, SD 2.483) than those diagnosed with epileptic seizures [5.94, SD 3.492, t(25)=2.126, P =0.044]. The sensitivity of eliciting a nonepileptic event during hypnosis was only 0.46, but the specificity was 0.88. Conclusion: Hypnosis may be considered as a method of seizure provocation. Events provoked by hypnotic suggestion were more likely than not to be nonepileptic events. However, the current study has moderate specificity and poor sensitivity. Seizures could not be induced in patients who did not also have spontaneous seizures. Additional methodologies for seizure provocation need to be explored. [Copyright &y& Elsevier]

Objective: To summarize and describe the current US surveillance systems that assess physical activity (PA) for work and commuting. Methods: An expert group conducted an environmental scan, generating a list (n  = 18) which was ultimately reduced to 12, based on the inclusion of PA and/or sedentary behavior data. Results: The 12 surveys or surveillance systems summarized provide nationally representative data on occupational-level PA or individual-level PA at work, data on active commuting, some are scorecards that summarize workplace health best practices and allow benchmarking, and one is a comprehensive nationally representative survey of employers assessing programs and practices in different worksites. Conclusions: The various surveillance systems and surveys/scorecards are disparate and need to be better analyzed and summarized to understand the impact of occupational-level PA and commuting on population health and well-being, life expectancy, and workforce productivity. [ABSTRACT FROM AUTHOR]

Being food insecure is generally defined as the limited or uncertain availability of safe and nutritious foods and is linked to poor nutrition and fully progressed diet-sensitive chronic diseases. However, little is known about the association between food insecurity and preclinical disease such as pre-hypertension and pre-diabetes. Methods: Using data from 2007-2010 NHANES, we examined associations between food security and pre-clinical disease among women 18-65 years. Chi-square tests were used to examine differences in demographic variables. Bivariate and multivariable generalized logistic regressions were used to generate odds ratios (ORs) with 95% confidence intervals (CIs) to assess the magnitude of associations between the presence of pre-clinical disease, sociodemographic characteristics, and food insecurity. Results: Food insecure women with very low food security (OR=2.69; 95% CI= 1.76-4.13) and low food security (OR=1.90; 95% CI= 1.20-3.02) had increased odds of having self-reported pre-hypertension. Food insecure women with very low food security (OR = 3.34; 95% CI= 1.40-7.95), and low food security (OR = 2.81; 95% CI= 1.33-5.93) had increased odds of pre-diabetes and pre-hypertension compared to food secure women. Conclusions: Food insecurity is associated with having pre-hypertension alone or having a comorbidity of pre-hypertension and pre-diabetes among an adult female population. [ABSTRACT FROM AUTHOR]

This study sought to obtain a better understanding of how clergy view their health and to investigate their self-reported health status. Additionally, this study sought to explore personal and professional barriers among clergy to living a healthier life. An electronic 32-item survey was sent to all practicing clergy in Kansas East and West conferences of United Methodist church by the Kansas Area Office of the United Methodist Church. Survey items included participants' demographic information and health conditions (e.g., diabetes, heart disease, high blood pressure, high cholesterol). The self-reported general health, mental health, and physical health data were also collected to compare to the general population in Kansas. Clergy were also asked to identify perceived barriers to health. A total of 150 clergy participated in the survey. The majority (93.7 %) self-reported their health as good, very good, or excellent. Participating clergy self-reported a higher prevalence of chronic diseases (diabetes, heart disease, high blood pressure, and high cholesterol) than the Kansas general population, but those differences were not statistically significant. More than three-fourths (77.4 %) of the participating clergy reported weights and heights that classified them as either overweight or obese. Lack of family time was the most frequently reported personal barrier to achieving a healthier lifestyle. An unpredictable work schedule was reported as the most frequent professional barrier to achieving a healthier lifestyle. This study suggests that Kansas clergy generally view their overall health status favorably despite being overweight or obese. Clergy also self-reported higher prevalence of chronic diseases than the general Kansas population, though the prevalence was not statistically different. This study provides additional insight into clergy health and offers suggestions to address the barriers preventing clergy from working toward better health. [ABSTRACT FROM AUTHOR]

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public nutritional assistance program for low-income women and their children up to age five. This study provides insight into maternal characteristics associated with breastfeeding among urban versus rural women. A secondary analysis was conducted using the Pregnancy Nutrition Surveillance System dataset of women enrolled in the Kansas WIC program in 2011. Geographic residency status was obtained through application of the Census tract-based rural-urban commuting area codes. Descriptive variables included maternal demographics, health, and lifestyle behaviors. A multivariable binary logistic regression was used to obtain adjusted odds ratios with 95 % confidence intervals. The outcome variable was initiation of breastfeeding. A P value of ≤0.05 was considered statistically significant. The total sample size was 17,067 women. Statistically significant differences regarding socio-demographics, program participation, and health behaviors for urban and rural WIC participants were observed. About 74 % of all WIC mothers initiated breastfeeding. Urban women who were Hispanic, aged 18-19, high school graduates, household income >$10,000/year, and started early prenatal care were more likely to breastfeed. Urban and rural women who were non-Hispanic black with some high school education were less likely to breastfeed. Increased breastfeeding initiation rates are the result of a collaborative effort between WIC and community organizations. Availability of prenatal services to rural women is critical in the success of breastfeeding promotion. Findings help inform WIC program administrators and assist in enhancing breastfeeding services to the Kansas WIC population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cesarean patients are commonly prescribed opioids when discharged from the hospital. This study aimed to determine if there were differences in prescribing practices based on the postoperative day opioid prescriptions were written, and before and after the publication of the most recent Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG). METHODS: This retrospective chart review study included women who had a live birth via cesarean at a single institution from July 1, 2017, to February 28, 2021, and excluded those with chorioamnionitis or discharged after more than 4 days. Opioids were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were grouped based on date of delivery relative to the publication of ACOG Committee Opinion 742 (July 2018). Institutional review board approval was obtained for this study. RESULTS: Out of 411 patients, 93.9% (n=386) had opioids prescribed at discharge, 85.5% of whom (330/386) received a prescription written on the day of discharge. There was no difference in the quantity of MMEs in discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients delivering after the new ACOG Opinion (63.9%, n=263) received discharge prescriptions with fewer average MMEs (159.53±61.64) than those who delivered before the publication (36%, n=148) (187.35±53.42), chi-square (1, N=411)=17.71, P <.001. CONCLUSION: Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, but there was no difference between prescriptions written the day of versus before discharge. [ABSTRACT FROM AUTHOR]

Purpose: Early detection of diabetic eye disease by dilated eye exam can limit potential vision loss from diabetic retinopathy. The purpose of this study was to examine what variables contribute to diabetes patients not receiving annual dilated eye examinations. Methods: This study used national 2009 Behavioral Risk Factor Surveillance System survey data. Variables used in the analysis included sociodemographics, insurance status, mentally unhealthy days, receipt of annual dilated eye exams, insulin dependence, a history of diabetes education classes, timely annual diabetic foot exams, and history of cardiovascular disease. Survey proportions were calculated, and survey logistic regression was performed with the consideration of survey strata and weight to correct for biases. Results: The likelihood of receiving annual dilated eye exams was correlated with eight statistically significant variables. These variables included age category, income level, education level, health insurance status, mentally unhealthy days within the past month, insulin dependence, a history of diabetic education classes, and timeliness of annual diabetic foot examinations. Conclusions: This study provides a snapshot of variables that may have a bearing on diabetes patients seeking annual dilated retinal examinations. Eight variables were statistically significant in affecting the timeliness of diabetic eye examinations. Thus, resolutions for these factors could be implemented for future improvement of comprehensive health care provided to those with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Osteosarcoma is the most common primary malignancy in orthopaedic surgery. Studies suggest that expression of VEGF and high vascularity within osteosarcoma may correlate with poor prognosis. The purpose of this study was to determine whether there was a correlation of VEGF expression with clinical tumour stage and metastasis. Methods: This retrospective case series examined 54 cases of osteosarcoma patients who were treated during a ten-year period. Relevant clinical information included age, gender, tumour location, stage, adjuvant therapy, morbidity, mortality, and tumour subtypes. The clinical information was analysed for correlation of VEGF expression and tumour prognosis. Tumour sections were examined by routine H&E and by immunohistochemistry for VEGF, CD31, and the oncogenes c-myc and c-fos. Results: There was a significantly positive correlation between VEGF expression and tumour stages among these cases ( p < 0.01). The data also suggested a higher cancer recurrence and more frequent cases of remote metastasis in the high-VEGF group compared to the low-VEGF group. VEGF expression also positively associated with c-fos and c-myc expressions in the primary tumour sections. Conclusion: The results of this study highlight the role of VEGF in angiogenesis and tumour burden. Data also suggest the influence of VEGF may associate with the elevations of c-fos and c-myc expression. The development of novel therapies to target the VEGF pathway in osteosarcoma may lead to improved survival. [ABSTRACT FROM AUTHOR]

The Communities Organizing to Promote Equity (COPE) Project was implemented in 20 counties across Kansas to build capacity to address health equity by forming local health equity action teams (LHEATS), hiring and training community health workers, facilitating state-wide learning collaboratives, and tailoring communication strategies. We conducted interviews and focus groups with project stakeholders who identified pragmatic recommendations related to LHEAT formation and leadership, establishing trust, nurturing autonomy, and optimizing impact. Insights can improve future community-based health equity efforts. ( Am J Public Health . Published online ahead of print August 28, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307802).

Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) Kansas worked with 10 Kansas counties from November 2020 through June 2022 to form local health equity action teams (LHEATs), develop COVID-19 testing strategies, foster communication about COVID-19, and share best practices through a learning collaborative. Participating counties documented 693 distinct COVID-19 testing and 178 communication activities. Although the intervention was not associated with changes in the proportion of positive COVID-19 tests, LHEATs in the learning collaborative implemented new testing strategies and responded to emerging COVID-19 challenges. ( Am J Public Health . Published online ahead of print August 22, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307771).

Introduction: This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs., Methods: Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up., Results: Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation., Conclusions: The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury., (Copyright © 2024 Durler, et al.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Some research suggests that physicians who are not neurosurgeons can safely place intracranial pressure (ICP) monitors. The purpose of this study was to compare intracranial pressure monitor placement complications between neurosurgeons, trauma physicians, and general surgery residents. We hypothesized that with appropriate training, general residents can safely place ICP monitors., Methods: A 10-year retrospective chart review of all trauma patients that required ICP monitor placement between January 1, 2012, and December 31, 2021, was conducted. Comparisons were made between treatment groups., Results: During the study period, 194 patients required ICP monitor placement. General surgery residents placed 94.3% of ICP monitors, 3.6% were placed by attending trauma physicians, and 2.1% by neurosurgeons. No ICP monitors were placed by attending trauma physicians or neurosurgeons between 2015 and 2018. Overall, minor complications during ICP monitor placement included device malfunction (2.7%) and inaccurate readings (.5%). There were no major complications during ICP monitor placement. Post-ICP monitor placement complications included one patient who experienced a central nervous system infection (.5%) and three patients who had mechanical problems (1.5%). No complications occurred among the neurosurgeon or attending trauma physician treatment groups., Conclusion: Most intracranial pressure monitors in our study sample were safely placed by surgical residents. Based on our study findings and considering the shortage and downtrend of neurosurgery specialists, ICP bolt placement needs to become a core clinical skill in surgical resident programs across the United States., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis., Methods: To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models., Discussion: This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pacheco, Bridges, Ellerbeck, Ablah, Greiner, Chen, Collie-Akers, Ramírez, LeMaster, Sykes, Parente, Corriveau, Miras Neira, Scott, Knapp, Finocchario-Kessler and COPE Team.)

Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency., Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs., Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction., Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources., Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings., (©Harshdeep Acharya, Kevin J Sykes, Ton Mirás Neira, Angela Scott, Christina M Pacheco, Matthew Sanner, Elizabeth Ablah, Kevin Oyowe, Edward F Ellerbeck, K Allen Greiner, Erin A Corriveau, Sarah Finocchario-Kessler. Originally published in JMIR Formative Research (https://formative.jmir.org), 01.04.2024.)

Background Context: 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., Purpose: This study sought to compare lengths of stay between patients on a day zero PT protocol and those on a day one PT protocol., Study Design/setting: Retrospective chart review., Patient Sample: 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., Primary Outcome Measure: Length of hospital stay following surgery., Methods: 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)., Results: 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., Conclusions: 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., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: This study aimed to describe patients admitted for attempted or completed suicide during the COVID-19 pandemic., Methods: A 1-year retrospective review was performed of adult patients admitted for attempted or completed suicide., Results: Of the 30 patients included, most injuries involved firearms (37%) and cutting/piercing (30%). Sixty-three percent of patients presented with an Injury Severity Score ≥16, and 37% of injuries involved the head. Upon admission, an alcohol test was completed for 83% of patients, 56% of whom tested positive. Thirty percent of patients died from their injuries, with all but one involving a firearm. Most of those who survived to discharge (62%) were discharged to an inpatient behavioral health facility., Discussion: The current study indicated a large proportion of suicides during the COVID-19 pandemic involved firearms and alcohol use. These findings point to the need for interventions aimed at preventing suicide and substance abuse during pandemic situations., Competing Interests: Declaration of Conflicting InterestThe authors declare that there is no conflict of interest.

Introduction: Overuse injuries such as tendinosis are a common complaint at sports medicine clinics. When conservative management for tendinosis has failed, ultrasound-guided tendon fenestration and injection procedures, such as dry needling, needling tenotomy, autologous whole blood injections, and prolotherapy, can be utilized for treatment. This study examined the effectiveness of these procedures for pain improvement and ability to return to activity for patients with tendinosis., Methods: This study involved a chart review of patients 15 years or older who underwent at least one treatment for tendinosis at a sports medicine clinic between January 1, 2014 and April 17, 2019. Eligible patients had at least one of the following procedures: 1) percutaneous dry needling, 2) percutaneous needle tenotomy, 3) autologous whole blood injection, and/or 4) prolotherapy. A Current Procedural Terminology (CPT) code query was used to screen patient charts for study inclusion., Results: In total, 680 patients' data were reviewed, and 343 patients met inclusion criteria. Patients underwent a total of 598 unique procedures. Dry needling represented most procedures (62.8%, n = 375). Most patients reported diminished pain at follow up (73.0%, n = 268). Prolotherapy had the highest percentage among the follow up patients reporting diminished pain (81.0%, n = 17). Most patients were able to return to activity at follow-up (47.4%, n = 172). A greater proportion of patients with autologous whole blood injection were able to return to activity (60.7%, n = 85)., Conclusions: Most patients with tendinosis who underwent tendon fenestration or injection procedures reported diminished pain at follow-up. Autologous whole blood injection may be more likely to diminish patient pain and allow return to activity than other procedure types. More research is needed across all anatomical sites to compare the generalized effectiveness of these procedures., (© 2023 The University of Kansas Medical Center.)

Objective: The objective was to identify risk and protective factors associated with post-stroke pneumonia readmission., Method: 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., Results: 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., Discussion: 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., Conclusion: 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., Competing Interests: Declaration of Competing Interest This original paper has not been published elsewhere nor is it under review in another journal. There are no conflicts of interest to disclose and there are no funding sources. All authors have contributed to, read, and approved of this paper., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary for prehospital behavioral emergency. However, the final decision of which medication to administer to a patient is made independently by paramedics. The authors evaluated circumstances in a prehospital behavioral emergency when paramedics considered chemical restraints, and factors that go into choosing which medications to administer., Methods: A qualitative research design was used involving paramedics from a Midwestern County in the United States, between November 18 and 26, 2019. A total of 149 paramedics were asked to complete a survey consisting of two open-ended questions to measure their clinical decision-making process and factors considered when selecting a medication from a behavioral emergencies protocol. An immersion-crystallization approach was used to analyze the content of the interviews., Results: There was a 53% (n = 79) response rate. Six major themes emerged regarding the paramedics' decisions to use medication for behavioral emergencies: safety of the patients and paramedics, inability to use calming techniques, severity of the behavioral emergency, inability to assess the patient due to presentation, etiology of the behavioral episode, and other factors, such as age, size, and weight of the patient. Six major themes emerged regarding factors considered when choosing medication for behavioral emergency: etiology of the behavioral emergency, patient presentation, the patients' history and age, desired effect and intended outcome of the medication, and other factors., Conclusions: Emergency medical services (EMS) paramedics relied on several factors, such as safety of all parties involved and etiology of the behavioral emergency in deciding when, and which medication to use in a behavioral emergency. The findings could help EMS administrators to develop protocols, such as how paramedics respond and treat patients with behavioral health emergencies., (© 2023 The University of Kansas Medical Center.)

Background: Research describing male breast cancer with HER2 overexpression is limited. This study evaluated the characteristics, treatment, and outcomes of HER2 positive breast cancer in men., Methods: Information for January 2010 through December 2017 was obtained from the SEER Research Plus database., Results: Four hundred sixty-two men were HER2 positive (13%) of 3594 cases of breast cancer. Compared to HER2 negative patients, these patients were younger at diagnosis (63 vs. 67 years, p < 0.001), had more poorly differentiated cancer (Grade III 53% vs. 33%, p < 0.001), and larger tumor size (28.8 vs. 24.6 mm, p < 0.001). HER2 positive males also had distant site and/or contralateral lymph node involvement more often (13% vs. 7%, p < 0.001), had higher rate of cancer-related mortality (15% vs. 10%, p = 0.002), and shorter overall survival (34 vs. 38 months, p = 0.004)., Conclusion: Men diagnosed with HER2 positive breast cancer had more advanced disease at diagnosis and worse outcomes than HER2 negative men despite increased utilization of systemic therapy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Abdominal vascular injuries are associated with significant morbidity and mortality. Treatment options include non-operative management, open repair, and endovascular procedures. This study aimed to characterize patients and detail treatment modalities among those who sustained a traumatic abdominal vascular injury., Methods: A six-year descriptive retrospective study was conducted at a level 1 trauma center and included all adult patients who sustained an abdominal vascular injury. Data abstracted included demographics, admitting characteristics, mechanism of injury, admitting vitals, injury details, diagnostic and treatment information, hospital course, and follow-up data., Results: Fifty-seven patients were admitted with abdominal vascular injuries, however, 14 patients sustained injuries to smaller vascular branches and were excluded. Most vascular injuries involved the iliac artery (27.9%, n = 12), abdominal aorta (25.6%, n = 11), and inferior vena cava (25.6%, n = 11). Twenty-seven percent (n = 12) of patients sustained an injury to more than one vascular structure. Thirty-four percent of patients (n = 15) died before treatment of the abdominal vascular injury. Among the 28 patients (65.1%) treated for their vascular injuries, 46.4% (n = 13) were treated with open surgery, 32.1% (n = 9) were treated non-operatively, and 21.4% (n = 6) with coil embolization. Sixty-four percent of the patients (n = 18) who survived to discharge presented for follow-up care with a mean follow-up period of 3 ± 4.1 months. There were no vascular reinterventions after discharge for patients who followed up with our hospital., Conclusions: Study findings suggested that appropriately selected cases of traumatic vascular injuries may be managed non-operatively and safely, as there were no mortalities, complications, or reinterventions among these patients., (© 2023 The University of Kansas Medical Center.)

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Introduction: There have been many efforts to combat the United States opioid crisis that has been occurring for the past two decades, specifically with postpartum patients that often were prescribed opioids. Prior studies described how accounting for usage of inpatient opioids on the day prior to discharge had an impact on how much discharge opioids were prescribed on the day of discharge. These studies provided a guideline to use the inpatient opioid amount from the day before discharge to determine discharge opioid quantity and minimize how much was being prescribed. In July 2018, the American College of Obstetrics and Gynecologists (ACOG) published Committee Opinion 742, guidelines for obstetricians-gynecologists about post-partum pain management. Prescription pain medications (including opioids, if necessary) require a shared decision-making approach between the physician and patient to determine the medication type and quantity. This study aimed to determine if there were differences in prescribing practices based on the specific post-operative day that opioid prescriptions were written, and if there were differences in the prescribing practices for cesarean deliveries following the publication of ACOG Committee Opinion 742., Methods: This retrospective chart review included patients who had a live cesarean birth at one rural Midwest facility anytime between July 1, 2017 and February 28, 2021. This study excluded those with chorioamnionitis and those discharged after more than four days. Opioid amounts were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were stratified into two groups based on the day that their discharge opioid medication prescriptions were written (i.e., a day prior to discharge or the day of discharge). Patients were also stratified based on date of delivery, before or after the publication of ACOG Committee Opinion 742., Results: Of 411 cesarean patients, 93.9% (n = 386) had opioids prescribed at discharge, 86% (n = 330) of whom received a prescription written on the day of discharge. There was no difference in the quantity of MMEs, doses per day, or dosage from discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 (63.9%, n = 263) received discharge prescriptions with fewer average MMEs (159.53 ± 61.64) than those whose deliveries occurred before the publication (36%, n = 148; 187.35 ± 53.42; χ 2 (1, N = 411) = 17.71; p < 0.001), and they were prescribed fewer doses per day., Conclusions: After cesarean sections, the specific post-operative day did not seem to impact the prescribing trends as there were no differences in MMEs, doses per day, or dosage between prescriptions that were written on the day of discharge and before the day of discharge. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, fewer doses per day, and the same dosage than those whose deliveries occurred before the publication, reflecting the overall national trend of decreasing prescription opioids over these years., (© 2022 The University of Kansas Medical Center.)

Introduction: Pregnancy-related mortality in the United States occurs in 32.3 per 100,000 live births. Rural maternal mortality rates were even higher, and these patients were less likely to receive routine care. The purpose of this cross-sectional study was to compare primary and prenatal care and health behaviors among perinatal mothers living in rural and urban Kansas., Methods: Data were collected from 1,971 pregnant women who participated in Phase 8 Pregnancy Risk Assessment Monitoring System (PRAMS) for Kansas between 2016 and 2018. Respondent location (urban or rural based on NIH classification) was abstracted from birth certificates and frequencies of healthcare visits and secondary healthcare variables were compared., Results: Most respondents (75.1%, n = 1,481) resided in an urban area. Most (84.4%, n = 1,664) women were Caucasian, and the largest category (31.1%, n = 613) was 25 to 29 years old. More urban women reported visiting an obstetrician/gynecologist within 12 months before pregnancy than rural women (p < 0.0001). Urban women reported attending pre-pregnancy dental visits (p = 0.019) and teeth cleanings (p = 0.004) more than rural women. Of the 35.7% of respondents (n = 516) who reported receiving pre-pregnancy counseling on folic acid, prenatal vitamins, or multivitamins, 78.9% (n = 407) resided in an urban area., Conclusions: Rural women reported fewer routine primary and prenatal care behaviors compared to their urban counterparts. Efforts are needed to improve access to obstetrician/gynecologist services, especially for women in rural areas., (© 2022 The University of Kansas Medical Center.)

Introduction: Combustible cigarette use is associated with an increased risk of several cardiovascular diseases; however, less is known about associations between these cardiovascular conditions and electronic cigarette use., Methods: This study investigated relationships between electronic and/or combustible cigarette use and diagnoses of cardiovascular diseases using the National Health Interview Survey from 2014, 2016, 2017, and 2018., Results: Compared to non-users, dual users of electronic and combustible cigarettes had increased likelihood of having prior diagnoses of hypertension (OR 1.660, 95% CI = 1.519-1.814), stroke (OR 2.396, 95% CI = 2.011-2.855), diabetes mellitus (OR 1.219, 95% CI = 1.108-1.341), coronary artery disease (OR 2.211, 95% CI = 1.837-2.660), and myocardial infarction (OR 3.839, 95% CI = 3.232-4.560). Exclusive use of electronic cigarettes was associated with an increased likelihood of having hypertension compared to non-users (OR 1.244, 95% CI = 1.048-1.477)., Conclusions: There were no differences in diagnoses of stroke, diabetes mellitus, coronary artery disease, or myocardial infarction among exclusive electronic cigarette users compared to non-users; however, these associations could change as young electronic cigarette users with hypertension age, indicating the need for continued research., (© 2022 The University of Kansas Medical Center.)

Introduction: Patient controlled analgesia (PCA) is a common form of pain management after spine surgeries, in which patients get custom control of their opioid dose. PCA has been demonstrated as a safe form of analgesia; however, use of PCA comes with risks that can be mitigated by opting for alternative pain management. This study aimed to compare the outcomes of patients using PCA to those with an alternative analgesia protocol that does not involve PCA., Methods: A retrospective chart review from January 2017 to July 2018 was conducted. Patients included in this study were those 18 or older who were admitted to a large midwestern tertiary medical center in Wichita, Kansas, and underwent thoracic or lumbar spinal surgery from a single spine surgeon. Data from patient demographics, comorbidities, and type of procedure were collected and compared to control for possible confounding variables. Patients were divided into two groups: patients receiving a PCA pain protocol post-operatively and those receiving a non-PCA protocol. Statistical analyses were performed and all tests with p < 0.05 were considered significant., Results: This study found patients in the PCA protocol had similar outcomes to those in the alternative analgesia protocol. This was true for both primary and secondary outcomes. The primary outcome was patient length of stay after the operation. Secondary outcomes included readmission rates, frequency of naloxone rescue, transfers to higher levels of care, and total opioid consumption., Conclusions: This study supported that a non-PCA protocol for post-operative pain management yields similar outcomes to a PCA protocol in the setting of thoracic and lumbar surgery., (© 2022 The University of Kansas Medical Center.)