Katherine Rizzone

Psychosocial Interventions for Child Disruptive Behaviors: A Meta-analysis

BACKGROUND: Disruptive behavior disorders are among the most common child and adolescent psychiatric disorders and associated with significant impairment. OBJECTIVE: Systematically review studies of psychosocial interventions for children with disruptive behavior disorders. METHODS: We searched Medline (via PubMed), Embase, and PsycINFO. Two reviewers assessed studies against predetermined inclusion criteria. Data were extracted by 1 team member and reviewed by a second. We categorized interventions as having only a child component, only a parent component, or as multicomponent interventions. RESULTS: Sixty-six studies were included. Twenty-eight met criteria for inclusion in our meta-analysis. The effect size for the multicomponent interventions and interventions with only a parent component had the same estimated value, with a median of −1.2 SD reduction in outcome score (95% credible interval, −1.6 to −0.9). The estimate for interventions with only a child component was −1.0 SD (95% credible interval, −1.6 to −0.4). LIMITATIONS: Methodologic limitations of the available evidence (eg, inconsistent or incomplete outcome reporting, inadequate blinding or allocation concealment) may compromise the strength of the evidence. Population and intervention inclusion criteria and selected outcome measures eligible for inclusion in the meta-analysis may limit applicability of the results. CONCLUSIONS: The 3 intervention categories were more effective than the control conditions. Interventions with a parent component, either alone or in combination with other components, were likely to have the largest effect. Although additional research is needed in the community setting, our findings suggest that the parent component is critical to successful intervention.

Low Proportion of High School Senior Athletes Receiving Recommended Immunizations

Abstract Background: The preparticipation physical evaluation (PPE) often serves as the only preventive health care visit for athletes, but immunization status is not uniformly addressed in such visits. Thus, athletes may not be receiving recommended immunizations. Our aim was to determine the proportion of high school senior athletes who received all recommended immunizations. Hypothesis: Our hypothesis was that females would be less likely than males to receive all recommended immunizations given suboptimal human papillomavirus (HPV) vaccine uptake. Methods: We conducted a cross-sectional survey evaluation of the immunization status of high school senior athletes in Davidson County, TN. The primary composite outcome was receipt of recommended immunizations for tetanus, meningococcal, and seasonal influenza. For females, the primary outcome also included completion of the HPV series. Results: A total of 162 participants, 104 males and 58 females, were included. More males than females received all recommended immunizations (15.4% vs 3.5%; P = 0.02). When HPV immunization was excluded from the composite outcome, there was no difference in the proportion of males and females who received all recommended immunizations (15.4% vs 15.5%; P = 0.98). The odds of receiving all recommended immunizations was 0.14 (95% CI, 0.03–0.72) for females compared with males when adjusted for covariates. Athletes seen at retail-based clinics for their PPE were less likely to receive all recommended immunizations compared with athletes seen in primary care (OR, 0.13; 95% CI, 0.02–0.69). Conclusions: Only 1 in 6 high school senior athletes received the recommended tetanus, meningococcal, and influenza immunizations. A lower proportion of females, only 1 in 28, received all recommended immunizations due to the HPV series. Policy changes requiring a review of immunizations at the PPE would benefit many high school athletes.

A systematic review of cost-effective treatment of postoperative rotator cuff repairs

OBJECTIVE The Bundled Payments for Care Improvement initiative combines payment of multiple services for episodes of care into 1 bundle. Rotator cuff repair is a likely candidate for future inclusion. The objective of this study was to determine cost-effective, high-quality postoperative rehabilitation dosing and cryotherapy for patients undergoing rotator cuff repair based on systematic review of the literature. METHODS Systematic review of level I and level II articles was performed in PubMed, Cochrane Databases, and PEDro. Conference references and bibliographies were also reviewed. For postoperative therapy, keywords included rotator cuff, rotator cuff repair, exercise therapy, exercise, unsupervised, self-care, postoperative period, physical therapy, and physiotherapy; for cryotherapy, keywords included rotator cuff repair, shoulder, cryotherapy, and ice. RESULTS Five studies compared postoperative outcomes in participants assigned to supervised therapy vs. unsupervised therapy. Three found no difference between groups. One found improved outcomes in supervised therapy. Limitations included that therapies were not consistently defined and significant methodologic issues were present, decreasing the applicability and validity of the results. Five articles examined cryotherapy outcomes in the postoperative shoulder. Two studies showed improved patient outcomes with cryotherapy vs. no cryotherapy; 2 studies showed no decrease in joint space temperatures at 90 minutes but decrease in temperature at 4 to 23 hours postoperatively. One study indicated that an ice bag and Ace bandage might be as effective as continuous, compressive cryotherapy units using patient-reported outcomes. CONCLUSION Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair. Cryotherapy is favorable and cost-effective using simple methods for delivery.

Rock climbers’ management of hand injuries and perceptions on seeking healthcare: A mixed methods analysis

Abstract This study examined rock climbers’ behaviors and perspectives on utilizing healthcare for climbing-related hand injuries. Twenty-eight climbers were interviewed and completed questionnaires on their management of the 88 climbing-related hand injuries in their lifetimes. The most prevalent reasons for not seeking professional healthcare for hand injuries were: trust in own and/or peers’ treatment knowledge (57%), belief that utilizing healthcare is unnecessary because injuries will self-resolve (35%), and belief that healthcare providers do not have appropriate knowledge to treat climbing-related hand injuries (21%). Ten injuries (11%) were evaluated by primary care physicians, hand specialists, and/or physical therapists. Reasons climbers did seek professional healthcare included an injury required a clearly urgent intervention (57%), repeated or worsening injuries (53%), and knowing a trusted provider (21%). This information can be used to better establish healthcare relationships with climbers to prevent and treat these common injuries and avoid long-term disability from improper management.