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Background: Mountain biking (MTB) is an increasingly popular sport that has been associated with serious spinal injuries, which can have devastating effects on patients and significant impacts on healthcare resources. Herein, we characterized the occurrence of these MTB spinal injuries over a 15-year period and analyzed the affiliated acute-care hospital costs. Methods: Patients seen at Vancouver General Hospital for MTB spinal injuries between 2008-2022 were retrospectively reviewed. Demographics, injury details, treatments, outcomes, and resource requirements for acute hospitalization were collected. The Canadian Institute for Health Information was referenced for cost analysis. Results: Over the 15 years of analysis, 149 MTB spinal injuries occurred. The majority (87.2%) were male. 59 (39.6%) were associated with spinal cord injury; most of these were in the cervical spine (72.3%) and majority were AIS Grade A (36.1%). 102 patients (68.5%) required spine surgery; 26 (17.4%) required intensive care; 34 (22.8%) required inpatient rehabilitation. Mean length of stay was 13.5 days and acute admission costs for the healthcare system averaged $35,251 (95% CI $27,080-$43,424). Conclusions: MTB spinal injuries are associated with significant medical, personal, and financial burden. As injury prevention remains paramount, further investigation of the roles of education and safety measures is recommended.
Using data from 708 French-Canadian nurses, the present study relies on self-determination theory (SDT) and its proposed motivation mediation model to examine the associations between need satisfaction, work motivation, and various manifestations of psychological wellbeing (work satisfaction, emotional exhaustion, and turnover intentions). To increase the precision and accuracy of these analyses, we relied on analytic approaches that explicitly account for the dual global/specific nature of both work motivation and need satisfaction. Results revealed that nurses' global psychological need satisfaction, and their specific autonomy and competence satisfaction, were positively associated with their global self-determined work motivation and specific intrinsic motivation. In turn, global self-determined work motivation and specific intrinsic motivation were associated with more desirable outcome levels. Nurses' global need satisfaction and specific autonomy satisfaction were also directly associated with more desirable outcome levels. Our results provided support for a partially mediated version of SDT's motivation mediation model.
Background: Delayed Cerebral Ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. A paucity of high-quality evidence is available to guide the management of DCI. As such, our objective was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI. Methods: The Canadian Neurosurgery Research Collaborative (CNRC) performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. The survey was distributed to members of the Canadian Neurosurgical and Neurocritical Care Societies, respectively. Responses were analyzed using quantitative and qualitative methods. Results: The response rate was 129/340 (38%). Agreement among respondents included the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for prevention of DCI. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients felt to require intravenous milrinone, intra-arterial vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI. Conclusions: DCI is an important clinical entity for which no consensus exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the diagnosis and management of DCI.
While research suggests that work centrality has a positive effect on work engagement and a negative influence on family satisfaction, these relations may differ as a function of one's work setting (onsite vs. remote working). In the present study, we examined the direct and indirect – through work-family conflict (WFC), family-work conflict (FWC), work-family enrichment (WFE), and family-work enrichment (FWE) – effects of work centrality on work engagement and family satisfaction. We also examined whether these effects of work centrality on work engagement and family satisfaction differed between onsite and remote employees. We used a cross-sectional survey design to test our hypotheses among a total of 432 employees, including 152 always working onsite and 280 working remotely. As expected, our results revealed that work centrality was positively related to work engagement and negatively to family satisfaction. Moreover, the indirect effects (IE) of work centrality on work engagement were significantly mediated by WFE, whereas the IE of work centrality on family satisfaction were significantly mediated by FWC, WFE, and FWE. Finally, the relations between work centrality and the outcomes (work engagement and family satisfaction) were stronger among onsite employees than among remote employees. These results revealed that remote working may act as a double-edged sword by buffering the negative effects of work centrality on family satisfaction but also limiting the positive effects of work centrality on work engagement. Organizations and managers should thus consider addressing employees' work centrality and work type in their efforts to promote employees' professional and personal well-being.
Background: Mean arterial pressure augmentation is one current established practice for management of patients with SCI. We present the first data investigating the effectiveness of Intrathecal Pressure (ITP) reduction through CSF drainage (CSFD) in managing patients with acute traumatic SCI at a large academic center. Methods: Data from 6 patients with acute traumatic SCI were included. A lumbar intrathecal catheter was used to monitor ITP and volume of CSFD. CSFD was performed and recorded hourly. ITP recordings were collected hourly and the change in ITP was calculated (hour after minus before CSFD). 369 data points were collected and change in ITP was plotted against volume of CSFD. Results: Data across all patients showed variability in the ITP over time without a significant trend (slope=0.016). We found no significant change in ITP with varying amounts of CSFD (slope=0.007, r2=0.00, p=0.88). Changes in ITP were not significantly different across groups of CSFD but the variation in the data decreased with increasing levels of CSFD. Conclusions: We present the first known data on changes in ITP with varying degrees of CSFD in patients with acute traumatic SCI. These results may provide insight into the complexity of ITP changes in patients post-injury and help inform future SCI management.
Background: Length of stay (LOS) is a surrogate for care complexity and a determinant of occupancy and service provision. Our primary goal was to assess changes in and determinants of LOS at a quaternary spinal care center. Secondary goals included identifying opportunities for improvement and determinants of future service planning. Methods: This is a prospective study of patients admitted from 2006 to 2019. Data included demographics, diagnostic category (degenerative, oncology, deformity, trauma, other), LOS (mean, median, interquartile range, standard deviation) and in-hospital adverse events (AEs). Results: 13,493 admissions were included. Mean age has increased from 48.4 (2006) to 58.1 years (2019) (p=<0.001). Mean age increased overtime for patients treated for deformity (p=<0.001), degenerative pathology (p=<0.001) and trauma (p=<0.001), but not oncology (p=0.702). Overall LOS has not changed over time (p=0.451). LOS increased in patients with degenerative pathology (p=0.019) but not deformity (p=0.411), oncology (p=0.051) or trauma (p=0.582). Emergency admissions increased overtime for degenerative pathologies (p=<0.001). AEs and SSIs have decreased temporally (p=<0.001). Conclusions: This is the first North American study to analyze temporal trends in LOS for spine surgery in an academic center. Understanding temporal trends in LOS and patient epidemiology can provide opportunities for intervention, targeted at the geriatric populations, to reduce LOS.
Background: Prolonged length of stay (LOS) is associated with increased resource utilization and worse outcomes. The goal of this study is identifying patient, surgical and systemic factors associated with prolonged LOS overall and per diagnostic category for adults admitted to a quaternary spinal care center. Methods: We performed a retrospective analysis on 13,493 admissions from 2006 to 2019. Factors analyzed included patient age, sex, emergency vs elective admission, diagnostic category (degenerative, deformity, oncology, trauma), presence of neurological deficits in trauma patients, ASIA score, operative management and duration, blood loss, and adverse events (AEs). Univariate and multivariate analyses determined factors associated with prolonged LOS. Results: Overall mean LOS (±SD) was 15.80 (±34.03) days. Through multivariate analyses, predictors of prolonged LOS were advanced age (p<0.001), emergency admission (p<0.001), advanced ASIA score (p<0.001), operative management (p=0.043), and presence of AEs (p<0.001), including SSI (p=0.001), other infections (systemic and UTI) (p<0.001), delirium (p=0.006), and pneumonia (p<0.001). The effects of age, emergency admission, and AEs on LOS differed by diagnostic category. Conclusions: Understanding patient and disease factors that affect LOS provides opportunities for QI intervention and allows for an informed preoperative discussion with patients. Future interventions can be targeted to maximize patient outcomes, optimize care quality, and decrease costs.
Intramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental health
To assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.
A two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile Range
From the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.
This study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectives
Stress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.
Attention Deficit-Hyperactivity Disorder (ADHD) is present in both DSM-IV and ICD-10, with slight differences. For instance, one item is allocated to hyperactivity in DSM-IV and to impulsivity in ICD-10. ADHD is best conceived as a set of core symptoms with some specificity in phenotypal symptomatology. Regarding the specific components, their number remains an open question, the answer oscillating between two (Attention and Hyperactivity-Impulsivity) and three (Attention, Hyperactivity, and Impulsivity).
The aim of this study is to contrast alternative measurement models of instruments assessing ADHD symptoms (2 versus 3 specific factors, hierarchical versus bifactor models) across instruments, and age groups.
We analysed data from the new ChiP-ARD study. Youths (n = 892) aged 5 to 18 years-old were randomly selected and rated by their teachers (ADHD-Rating Scale, and SWAN). Parents (n = 1,171) of these youths rated their own behaviour using the Adult ADHD Symptom Rating Scale (ASRS). The fit of alternative models for ordered-categorical items was tested using the robust Weighted Least Square Estimator (WLSMV).
Results support a bifactor model including one global ADHD factor and two specific Inattention and Hyperactivity- Impulsivity factors. The results also show that the Hyperactivity-Impulsivity factor is improperly defined, and unreliable, calling into question the existence of this subtype. Furthermore, the fit improved when Impulsivity was measured by 4 (ICD-10) versus 3 (DSM-IV) items.
ADHD is a continuous condition from childhood to adulthood, and the “Talk too much” item is best conceived as a measure of Impulsivity than Hyperactivity.
The attention deficit is the main symptom of the Attention Deficit Hyperactivity Disorder (ADHD) in adults. This diagnosis is difficult in adults and comorbidity with substance abuse (SA) is high. As ADHD influences negatively the prognosis of the patients with SA, it is important to treat the ADHD in individuals with DS. Furthermore, it is common the use of substances to relieve ADHD and its comorbidities's symptoms.
It is known the paradoxical effect of amphetamines in individuals with ADHD and it was also described with cocaine. This characteristic is an important clinical clue to the diagnosis of ADHD and it is a predictor of a positive response to the therapeutics.
It is intended to approach the issues related to the psycopathology, differential diagnosis, prognostic and therapeutic implications when there is comorbidity between ADHD and SA in the adult.
Therapeutic implications of the comorbidity between ADHD and SA.
Materials and methods
Analyses of a clinical case and a non-systematic review of the literature was made.
A 23-year-old woman, lawyer, has the diagnosis of ADHD since childhood. She regularly used cocaine for the last 2 years, without doing any medication, as she felt quiet, relax and focused, being more productive at work. The treatment with prolonged-release methylphenidate allowed to stop the use of cocaine without a recurrence of cognitive symptoms.
The ADHA is an independent risk factor to the SA; The early detection and treatment of ADHD helps to prevent the substance abuse;
Attention Deficit-Hyperactivity Disorder (ADHD) is common in childhood (affecting about 5% of children) and persists into adulthood up to 80% of the time. As a result, up to 3.5% of adults may have ADHD, which much higher rates in parents of children referred for ADHD, as heredity plays a role in ADHD. Thus, screening ADHD in adults is relevant in psychiatric and public health practice. The Adult ADHD Symptom Rating Scale (ASRS) was specifically developed for this reason by the World Health Organisation and translated into many languages, including French.
This study aims to estimate the prevalence rates of ADHD in a community sample of French adults, a population where no valid estimates are currently available.
A total of 1,171 adults were asked to rate their behaviours on the ASRS. The total score on the first six items is used as a screener, and the total score of the full set of 18 items is used for adults scoring in the clinically significant zone on the screener (i.e. two-stage algorithm). Maximum-likelihood prevalence rates were estimated in the entire sample and in gender (men vs. women) and age (below and above 43 years-old) subgroups.
The 6-item screener score suggests that 11.27% of participants (10.59% for females, 12.16% for males, 10.66% for younger adults, 12.16% for older ones). The two-stage algorithm suggests that 2.99% of participants (2.57%/3.53% for females/males, 2.16%/4.19% for younger/older adults) present clinical levels of ADHD, which is the rate commonly reported in other countries.
The Gender Identity Disorder (GID) is characterized by a strong sense of identity with the opposite gender, by a persistent discomfort with the one's gender and with a feeling of inadequacy to the social role of the biological gender.
The possibility of a higher presence of Borderline Personality Disorder (BPD) in patients with GID has been a subject of research in several studies.
The diagnosis criteria of the BPD includes a global disorder in the individual identity.
Both BPD and GID are associated with a high risk of self-mutilation and suicide.
To analyze and discuss a case report, addressing subjects related to the psychopatology, differential diagnosis and prognosis and therapeutic implications.
Our discussion is focused on a case report, that led us to a non systematic review of the literature.
Our case report is related to a 20 year old man with GID and BPD. This situation is lived in a great social isolation and frequent self-mutilation episodes and suicide attempts.
The clinical outcome is aggravated by a severe instability in the personal relationships, self-image, ambitions and the future projects.
We have discussed the differential diagnosis, psychopatology, prognosis and the identity disorder that the subject presents.
The biologic gender, age and the treatment phase are factors that influence the risk of suicide and self-mutilation in these patients. We did not found a higher probability of BPD in a patient with GID.
In many European countries including France, awareness for Attention Deficit-Hyperactivity Disorder (ADHD) is increasing. Unfortunately, estimates of prevalence based on validated instruments and reasonably large and representative samples are still lacking in many of these countries.
This study aims to estimate the prevalence rates of ADHD in school-aged children based on teacher ratings of the ADHD rating scale (ADHD-RS-IV) and of the Strengths and Weaknesses of ADHD-Symptoms scale of the Normal-Behavior (SWAN). These scales differ in item wording and scoring, and have both been extensively validated.
892 youths aged from 5 to 18 are included in the present study. Maximum-likelihood prevalence rates were estimated (based on recommended scoring criteria) in the entire sample and in gender (boys vs. girls) and age (below and above 12 years-old) subgroups.
Using the ADHD-RS, 10.65% of youths might have ADHD (4.37% Predominantly Inattentive subtype, 3.36% Combined subtype and 2.91% Predominantly Hyperactive-Impulsive subtype). Boys were more affected than girls (sex ratio 1.4:1), children were more affected than adolescents, and ADHD girls were more likely to be of the Inattentive subtype. Using the SWAN, 2.25% of youths might have ADHD (1.13% Combined subtype, .90% Predominantly Hyperactive-Impulsive subtype, .34% Predominantly Inattentive subtype). No overall differences between genders were observed, children were more affected than adolescents, and ADHD boys were more likely to be of hyperactive-impulsive subtype.
There are true differences according to the rating scales. Teacher ratings provide useful information that also has to be combined with parental and clinical ratings.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
Introduction: Identification of severe bacterial infections (SBI) among infants presenting to the emergency department (ED) for fever without a source (FWS) remains challenging. Controversies persist on the usefulness of blood biomarkers, especially when used for assessing infants 22 to 60 days old. Although C-reactive protein (CRP) and white blood cells count (leucocytes) are commonly prescribed, this practice relies on poor and conflicting evidence. Our objective was to determine the performance of those two markers at identifying SBI. Methods: This is a sub-analysis of an ongoing retrospective cohort study conducted in an academic pediatric ED in Quebec City, that aims to determine whether a lumbar puncture should routinely be performed in the FWS workup of 22 to 60 days old infants. All consecutive charts of eligible febrile infants were reviewed. Premature infants (<37 weeks), as well as infants with chronic diseases, immunodeficiency, previous antimicrobial therapy, in-dwelling catheters, or septic shock were excluded. Among others, data related to final diagnosis and investigations were gathered. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios were estimated for each blood biomarkers. Results: Out of 1261 charts reviewed, 920 patients were included in this analysis. SBI prevalence was 13.0% (95%CI: 10.9-15.2) among infants of our cohort. The sensitivity, specificity, PPV, NPV, LR+ and LR- of the leucocytes <5000 or≥15000/□L were 43% (95%CI: 34-53%), 80% (95%CI: 77-83%), 25% (95%CI: 21-30%), 90% (95%CI: 88-91%), 2.1 (95%CI: 1.7-2.8), and 0.72 (95%CI: 0.61-0.84), respectively. The sensitivity, specificity, PPV and NPV of CRP >= 25 mg/L were 46% (95%CI: 37-56%), 96% (95%CI: 94-97%), 65% (95%CI: 55-73%), and 91% (95%CI: 89-92%), respectively. ROC curves analysis indicates that a CRP≥25 mg/L offers the best LR+ (10.4; 95%CI: 6.9-15.6) with a corresponding LR- of 0.56 (95%CI: 0.47-0.67). Conclusion: When evaluating febrile infants in the ED, leucocytes appear to have limited added value, while CRP≥25 mg/L significantly increases the pre-test probability of SBI. CRP should be considered for inclusion in the workup of FWS for infants of 22 to 60 days of age.
Introduction: Fever is a common presenting complaint in the emergency department (ED). Febrile infants are at particularly high risk of serious bacterial infection including bacterial meningitis. Unfortunately, recommendations as to when to perform a lumbar puncture in febrile infants older than 21 days remain conflicting. Our study seeks to establish the prevalence of bacterial meningitis in infants 22 to 60 days old and to evaluate the performance of our local fever without a source (FWS) workup protocol at identifying bacterial meningitis. Methods: This analysis represents the results of a retrospective cohort study which took place in an academic pediatric ED in Quebec City. Infants 22 to 60 days old investigated for FWS, were included in the study. Premature infants ( <37 weeks), as well as infants with chronic diseases, immunodeficiency, previous antimicrobial therapy, in-dwelling catheters, or septic shock were excluded. We evaluated the performance of our local FWS workup protocol which includes the Yale Scale, a complete blood count, blood culture, C-reactive protein, urinalysis and urine culture. The protocol recommends a lumbar puncture in all febrile infants <1 month old, and in all infants <3 months old with either leukocytes <5.0 or >15.0 X 10^9cells/L, petechia, or a Yale between 11 and 16. Results: We reviewed 1261 charts from 2012 to 2017, of which 920 met our inclusion criteria. In our cohort, 171 infants were 22 to 30 days old, 369 were 31 to 45 days old, and 380 were 46 to 60 days old. The proportion of infants with cerebrospinal fluid analysis in these 3 groups was 76% (n = 130), 25% (n = 98) and 12% (n = 46) respectively. In the entire cohort, two infants were diagnosed with bacterial meningitis resulting in a prevalence of 0.2% (95%CI: 0-0.5%); viral meningitis had a prevalence of 4.7% (95%CI: 3.3-6.1%). Sensitivity and specificity of the protocol were 100% and 52.8%; positive and negative predictive values were 0.4% and 100%, respectively. All charts were reviewed for 2 weeks following the index visit to screen for missed cases of bacterial meningitis. Conclusion: Systematically performing a lumbar puncture for workup of fever without a source in infants 22 to 60 days old appears unwarranted given the low prevalence of bacterial meningitis in this population. Our FWS workup protocol correctly identified the 2 cases of bacterial meningitis in our cohort. This is an ongoing study and more cases will be recruited to better evaluate the safety and performance of our protocol.
The availability of analytical methods that utilize the very intense and bright X-rays from synchrotron radiation sources has fundamentally changed the way in which geoscientists, environmental scientists and soil scientists study complex environmental samples and decipher the chemical and biological processes that impact the speciation, transport and potential bioavailability of environmental toxins (Brown et al., 2006). Such samples are often mixtures of crystalline and amorphous phases in particle-sizes ranging from cm to nm, adsorbed metal ions and organic molecules, natural organic matter, microbial organisms, algae, plant materials and aqueous solutions. The processes that affect the chemical forms and environmental fate of contaminants in such mixtures range from surface adsorption, desorption, precipitation and dissolution reactions, often involving a combination of hydrolysis, ligand exchange and electron transfer, to biological interactions in which microbial organisms, algae or plants interact with mineral surfaces and environmental contaminants.