Attitudes Toward Aging Among Patients With Upper Extremity Illness.

Background: An adaptive attitude toward aging might limit symptom intensity and magnitude of limitations. This study sought factors associated with attitudes toward aging (measured with the Brief Aging Perceptions Questionnaire [B-APQ]) and studied the relationship of having an age-related disease to magnitude of limitations, pain intensity, patient satisfaction, and patient comfort with completing a questionnaire about attitudes toward aging. We also looked for a subset of questions from B-APQ that maintained the construct validity and internal consistency of B-APQ, without unacceptable flooring or ceiling effects. Methods: A total of 161 upper extremity patients completed the following questionnaires: B-APQ, Patient Health Questionnaire-Short Form, Pain Self-efficacy-Short Form, Pain Catastrophizing Scale-Short Form, Patient-Reported Outcomes Measurement Information System Physical Function-Upper Extremity, pain intensity, satisfaction with the surgeon, and comfort with completing the B-APQ. We created multivariable linear regression models to test for associations. Results: Factors independently associated with less positive perceptions about aging included white race, retired work status, having nonspecific comorbidities, and more catastrophic thinking. Variation in the magnitude of limitations and pain intensity was accounted for by effectiveness of coping strategies rather than attitudes toward aging in particular. A 4-question version of the B-APQ has acceptable performance. Conclusion: Adaptive attitudes toward aging are associated with psychological and social determinants of health. We present a 4-item short form of B-APQ that could be used as a brief measure to assess attitudes toward aging. Interventions to improve adaptiveness to nociception (eg, cognitive behavioral therapy to limit catastrophic thinking) might help with adaptation to age-related changes.

The Growth of Poorly Cited Articles in Peer-Reviewed Orthopaedic Journals.

BACKGROUND: In general, journals can be divided in three categories: subscription-model, open-access, and hybrid (that is, open-access by choice). One measure of an article's impact is the number of citations it receives after publication. Open-access publishing may make articles more widely available because there is no financial barrier to a reader seeing the full-text version. As a result, we wondered whether articles published in fully open-access journals would be more likely to be cited than articles in other kinds of journals. QUESTIONS/PURPOSES: We assessed the yearly number and proportion of poorly cited articles published in orthopaedic journals and compared the proportion of poorly cited articles that were published in subscription-model journals with the proportion of poorly cited articles that were published in open-access and hybrid journals. METHODS: We identified all original articles (n = 135,029) published in orthopaedic peer-reviewed journals (n = 204) that were active from 2002 to 2012 and indexed in the Scopus® citation database. For each journal, we recorded the type of access (subscription-model, open-access, or hybrid journal), their most-recent CiteScore, the number of well- and poorly cited articles per year (more than five versus five or fewer citations after publication) calculated from the date of publication until December 31, 2017 (data collection April 2018), and then calculated if the journals themselves were poorly cited per year (defined as journals that published 75% or more articles ranked as poorly cited per year). We compared the proportion of poorly cited articles in subscription-model journals with the proportion of poorly cited articles in open-access journals. Additionally, we compared these with hybrid journals. RESULTS: In total, 48,133 (36%) articles were classified as poorly cited. The total number and proportion of poorly cited articles increased over the years, from 2121 of 7860 (27%) in 2002 to 6927 of 16,282 (43%) in 2012. The proportion of poorly cited articles in subscription-model journals increased from 226 of 395 (57%) in 2002 to 411 of 578 (71%) in 2012. The proportion of poorly cited articles in open-access journals decreased from 264 of 434 (61%) in 2002 to 296 of 801 (37%) in 2006, and then increased again to 1387 of 2259 (61%) in 2012. When we compared yearly proportions of poorly cited articles in subscription-model versus open-access journals using Mann-Whitney U tests, we only found a difference in 2012, with a higher proportion of poorly cited articles in subscription-model journals that year (median [IQR] of poorly cited article proportions for open-access, 0.61; IQR, 0.38-0.96 and subscription-model journals, 0.92; IQR, 0.54-1.0; p = 0.049). Comparisons of poorly cited articles for all three types of access showed lower proportions of poorly cited articles in hybrid journals for each year, with the lowest proportion found in 2002 (0.20; IQR, 0.09-0.67; p = 0.003). CONCLUSIONS: We found no difference in the likelihood that an article would be cited based on whether the article appeared was published in a subscription-model journal or an open-access journal. A future study might compare open-access and paywall articles on similar topics published in the same journal or investigate the characteristics of poorly cited articles, so that researchers and editorial staffs might understand which topics are more impactful and to determine if any important work is less-well appreciated. Additionally, an article-by-article analysis will provide more insight in citation rates for articles published within hybrid journals. LEVEL OF EVIDENCE: Level III, therapeutic study.

Do Patients Unconsciously Associate Suggestions for More-invasive Treatment with Better Care?

BACKGROUND: It seems common for patients to conceive of care in physical terms, such as medications, injections, and procedures rather than advice and support. Clinicians often encounter patients who seem to prefer more testing or invasive treatments than expertise supports. We wanted to determine whether patients unconsciously associate suggestions for invasive treatments with better care. QUESTIONS/PURPOSES: (1) Do patients have (A) an implicit preference and (B) an expressed preference for a physical intervention (such as a pill, an injection, or surgery) over supportive care (such as reassurance and education)? (2) What factors are independently associated with both an implicit and an expressed preference for a physical intervention over supportive care? (3) Is there a relationship between a patient's implicit preference toward or away from a physical intervention and his/her expressed preference on that subject? METHODS: In this study, we approached 129 new patients in a large urban area visiting one of 13 participating surgeons divided among six upper and lower extremity specialist offices. After excluding four patients based on our exclusion criteria, 125 patients (97%) completed a survey of demographics and their expressed preference about receiving either physical treatment or support. Treatment was defined as any surgery, procedure, injection, or medication; support was defined as reassurance, conversation, and education, but no physical treatment. Patients then completed the Implicit Association Test (IAT) to evaluate implicit preferences toward treatment or support. Although other IATs have been validated in numerous studies, the IAT used in this study was specifically made for this study. Scores (D scores) range from -2 to 2, where 0 indicates no implicit preference, positive scores indicate a preference toward receiving a physical treatment is good care, and negative scores indicate a preference toward receiving supportive care is good care. According to the original IAT, break points for a slight (± 0.15 to 0.35), moderate (± 0.35 to 0.65), and strong preference (± 0.65 to 2) were selected conservatively according to psychological conventions for effect size. Patients' mean age was 50 ± 15 years (range, 18-79 years) and 56 (45%) were men. The patients had a broad spectrum of upper and lower extremity musculoskeletal conditions, ranging from trigger finger to patellofemoral syndrome. RESULTS: We found a slight implicit association of good care with support (D = -0.17 ± 0.62; range, -2 to 1.2) and an expressed preference for physical treatment (mean score = 0.63 ± 2.0; range, -3 to 3). Patients who received both physical and supportive treatment had greater implicit preference for good care, meaning supportive care, than patients receiving physical care alone (ß = -0.42; 95% CI, -0.73 to -0.11; p = 0.008; semipartial R = 0.04; adjusted R full model = 0.13). Gender was independently associated with a greater expressed preference for physical treatment, with men expressing this preference more than women (ß = 1.0; 95% CI, 0.31-1.7; p = 0.005; semipartial R = 0.06; adjusted R full model = 0.08); receiving supportive treatment was independently associated with more expressed preference for support (ß = -0.98; 95% CI, -1.7 to -0.23; p = 0.011; semipartial R = 0.05). An expressed preference for treatment was not associated with implicit preference (ß = 0.01; 95% CI, -0.04 to 0.06; p = 0.721). CONCLUSIONS: Although surgeons may sometimes feel pressured toward physical treatments, based on our results and cutoff values, the average patient with upper or lower extremity symptoms has a slight implicit preference for supportive treatment and would likely be receptive. LEVEL OF EVIDENCE: Level II, prognostic study.

Assessment of terbium (III) as a luminescent probe for the detection of tuberculosis biomarkers.

A detection method for nicotinic acid, a specific metabolite marker of Mycobacterium tuberculosis present in cultures and patients' breath, is studied in complex solutions containing other metabolites and in biological media such as urine, saliva and breath condensate. The method is based on the analysis of the luminescence increase of Tb(3+) complexes in the presence of nicotinic acid due to the energy transfer from the excited ligand to the lanthanide ion. It is shown that other potential markers found in M. tuberculosis culture supernatant, such as methyl phenylacetate, p-methyl anisate, methyl nicotinate and 2-methoxy biphenyl, can interfere with nicotinic acid via a competitive absorption of the excitation photons. A new strategy to circumvent these interferences is proposed with an upstream trapping of volatile markers preceding the detection of nicotinic acid in the liquid phase via the luminescence of Tb(3+) complexes. The cost of the method is evaluated and compared with the Xpert MTB/RIF test endorsed by the World Health Organization.