Applying Situational Leadership to Redeployment Duties During COVID-19: Lessons Learned.

BACKGROUND AND OBJECTIVES: In March 2020, the coronavirus disease-2019 (COVID-19) pandemic caused many disruptions to usual operations and demands in excess of normal capacity at NYU Langone Hospital Long Island and NYU Long Island School of Medicine. Significant increases in volume of critically ill patients necessitated hospital administrators to redeploy faculty physicians and other staff to support other areas as a way of exercising option value. This commentary describes our experiences as 2 medical school deans and teaching professors where we recently applied the model of situational leadership during our redeployment as unit clerks on newly-created COVID patient care units at the height of the COVID-19 pandemic in our local area. Our experience yielded personal feelings of accomplishment and allowed us to exercise nonlinear thinking, which we believe contributed to greater staff operational efficiency, using principles of situational leadership during these hospital redeployment initiatives. KEY TAKEAWAYS: Situational leadership is an effective management model for hospital academic leaders who are not routinely in clinical operations to initiate in emergency conditions when unprecedented working scenarios and feelings of staff uncertainty are occurring, while option value is being exercised with faculty/staff redeployment. Our experience led to increased self-actualization. We provide recommendations to health care administrators on how to better prepare for future faculty/staff redeployments in the hospital.

The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement.

The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on femoroacetabular impingement syndrome (FAIS) was intended to build an international physiotherapy consensus on the assessment, non-surgical physiotherapy treatment, pre-/post-operative management, and return to sport decisions for those patients with FAIS. The panel consisted of 11 physiotherapists and 8 orthopaedic surgeons. There is limited evidence regarding the use of physiotherapy in the overall management of those with FAIS. Therefore, a group of ISHA member physiotherapists, who treat large numbers of FAIS patients and have extensive experience in this area, constructed a consensus statement to guide physiotherapy-related decisions in the overall management of those with FAIS. The consensus was conducted using a modified Delphi technique. Six major topics were the focus of the consensus statement: (i) hip assessment, (ii) non-surgical physiotherapy management, (iii) pre-habilitation prior to hip arthroscopy, (iv) post-operative physiotherapy rehabilitation, (v) stages of post-operative rehabilitation and (vi) return to sports criteria/guidelines after surgery.

Erratum to: The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement.

[This corrects the article DOI: 10.1093/jhps/hnaa043.].

Cross-cultural adaptation and validation of Spanish version of The Foot and Ankle Ability Measures (FAAM-Sp).

BACKGROUND: The Foot and Ankle Ability Measure (FAAM) is a Patient Reported Outcome (PRO) commonly used to determine the effectiveness of therapeutic interventions for patients with foot and ankle pathologies and associated impairments of body function and structure, activity limitations, and participation restrictions. The aim of this study was to cross-culturally adapt the FAAM into Spanish. METHODS: Cross-cultural adaptation was performed according to the international guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Cronbach's alpha, test re-test reliability, and item-total and inter-item correlations were analyzed. Confirmatory factor analysis (CFA) was carried out to test construct validity. Pearson correlations were calculated to assess the convergent validity between FAAM and EuroQol-5. RESULTS: Spanish data set comprised 194 patients, with a mean age of 38.45 (16.04) and 130 (67.1%) were female, seeing a podiatrist with a wide variety of foot and ankle related disorders. CFA was carried out to test structure matrix (which has three factors). The test-retest reliability was high with global ICC of 0.95 (95% CI: 0.93 to 0.98). A 15 items version of the FAAM-Sp Activities of Daily Living (ADL) obtained the best fit: relative chi-square (x2/df) of 2.46, GFI 0.90 CFI 0.95, NFI 0.93, and RMSEA 0.08 (90% CI 0.04 to 0.09). For exploratory factor analysis for the FAAM-Sp Sport, a one factor solution was obtained, which explained 76.70% of total variance. CFA corroborated this model with an excellent goodness of fit:: relative chi-square (x2/df) of 0.80, GFI 0.99 CFI 1.00, NFI 0.99, and RMSEA 0.00 (90% CI 0.00 to 0.75). CONCLUSIONS: This study validated a new 15-item FAAM-Sp ADL and FAAM-Sp Sport subscales, which can be used as a self-reported outcome measure in clinical practice and research for patients resident in Spain whose main language is Spanish.

Extraction of SelectSecure leads compared to conventional pacing leads in patients with congenital heart disease and congenital atrioventricular block.

BACKGROUND: SelectSecure™ pacing leads (Medtronic Inc) are increasingly being used in pediatric patients and adults with structural congenital heart disease. The 4Fr lead is ideal for patients who may require lifelong pacing and can be advantageous for patients with complex anatomy. OBJECTIVE: The purpose of this study was to compare the extraction of SelectSecure leads with conventional (stylette-driven) pacing leads in patients with structural congenital heart disease and congenital atrioventricular block. METHODS: The data on lead extractions from pediatric and adult congenital heart disease (ACHD) patients from August 2004 to July 2014 at Bristol Royal Hospital for Children and the Bristol Heart Institute were reviewed. Multivariable regression analysis was used to determine whether conventional pacing leads were associated with a more difficult extraction process. RESULTS: A total of 57 patients underwent pacemaker lead extractions (22 SelectSecure, 35 conventional). No deaths occurred. Mean age at the time of extraction was 17.6 ± 10.5 years, mean weight was 47 ± 18 kg, and mean lead age was 5.6 ± 2.6 years (range 1-11 years). Complex extraction (partial extraction/femoral extraction) was more common in patients with conventional pacing leads at univariate (P < .01) and multivariate (P = .04) levels. Lead age was also a significant predictor of complex extraction (P < .01). CONCLUSION: SelectSecure leads can be successfully extracted using techniques that are used for conventional pacing leads. They are less likely to be partially extracted and are less likely to require extraction using a femoral approach compared with conventional pacing leads.

Perceptions of the roles of social networking in simulation augmented medical education and training.

Simulation-augmented education and training (SAET) is an expensive educational tool that may be facilitated through social networking technologies or Computer Supported Collaborative Learning (CSCL). This study examined the perceptions of medical undergraduates participating in SAET for knot tying skills to identify perceptions and barriers to implementation of social networking technologies within a broader medical education curriculum. The majority of participants (89%) found CSCL aided their learning of the technical skill and identified privacy and accessibility as major barriers to the tools implementation.

Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations.

Factors relating to acute blockage of modified Blalock-Taussig shunts (MBTS) have not been well described in the literature. Our aim was to determine the outcomes in patients early after undergoing MBTS operations and to identify potential risk factors for acute shunt blockage in the early postoperative period. A retrospective study was performed in a tertiary referral congenital cardiac unit. All children who underwent first shunt insertion for cyanotic congenital heart disease during the study period from 2002 to 2006 were included. Seventy-six children underwent first shunt insertion with a median age of 37 days (range 2 days-8 years) and median weight of 3.75 kg (range 2.1-17.2 kg). The shunt sizes varied from 3 to 6 mm. The rate of acute shunt blockage was 11.8% (9/76), all within the first 24 h. There were 3 early deaths (3.9%), none of which were associated with shunt blockage. The main risk factors for blockage were preoperative high hemoglobin, weight less than 3 kg, and duct patency on echocardiogram after surgery. This study identifies that high preoperative hemoglobin, a weight less than 3 kg at operation, and the presence of a patent duct are statistically significant risk factors for shunt blockage in the acute postoperative period. Further work is needed to determine if reduction in preoperative hemoglobin concentration and attempts to reduce postoperative ductal patency may alter the outcome.

Proprioception after total ankle arthroplasty.

BACKGROUND: Total ankle arthroplasty (TAA) is becoming an effective treatment for end-stage ankle arthritis. It is unknown if TAA alters the patient's ability to sense ankle joint position. MATERIALS AND METHODS: Thirteen unilateral TAA patients with a minimum of 2-years followup completed proprioceptive testing of the TAA and the contralateral side. The task was to reproduce a given ankle angle using a joystick-driven device while the lower limb was obscured from view. Nine angles were tested, including two angles in dorsiflexion, three in plantarflexion, two in inversion, and two in eversion. A repeated-measures ANOVA was used to evaluate the results. RESULTS: No statistically significant differences between the TAA ankle and the contralateral side were found. CONCLUSION: TAA does not cause a change in proprioceptive abilities in arthritis patients when compared to the contralateral, unaffected side in a small sample of unilateral patients. Surgeons and rehabilitation professionals may use this information when designing rehabilitation plans following the insertion of a TAA.

Echocardiographic, chest X-ray and electrocardiogram findings in children presenting with heart failure to a Ugandan paediatric ward.

The aim of this study was to describe the aetiology of congestive cardiac failure (CCF) in children with suspected structural abnormalities presenting to a regional hospital in southwestern Uganda. The method used was a prospective descriptive study of successive admissions of children with persistent cardiac signs after routine treatment of CCF. Children with severe anaemia (haemoglobin [Hb]<7 g/dL), pneumonia, sepsis or severe malnutrition were excluded. Chest X-ray, electrocardiogram and echocardiography data were validated by a paediatric cardiologist and radiologist at the Bristol Royal Hospital for Children, UK. A cohort of 58 patients was identified. The aetiology of heart failure in this cohort (n = 58) was due to congenital heart disease (35%), renal hypertensive disease (26%), rheumatic heart disease (17%), cardiomyopathies (12%), endomyocardial fibrosis (7%) and tamponade (3%). In conclusion, this study confirmed the ongoing prevalence of congenital heart disease, rheumatic heart disease and endomyocardial fibrosis in this area. The cardiac effect of renal hypertension was a new and significant finding.

Wide-field Fizeau imaging telescope: experimental results.

A nine-aperture, wide-field Fizeau imaging telescope has been built at the Lockheed-Martin Advanced Technology Center. The telescope consists of nine, 125 mm diameter collector telescopes coherently phased and combined to form a diffraction-limited image with a resolution that is consistent with the 610 mm diameter of the telescope. The phased field of view of the array is 1 murad. The measured rms wavefront error is 0.08 waves rms at 635 nm. The telescope is actively controlled to correct for tilt and phasing errors. The control sensing technique is the method known as phase diversity, which extracts wavefront information from a pair of focused and defocused images. The optical design of the telescope and typical performance results are described.