Postpartum Psychiatric Admissions in the United States.

OBJECTIVE: This study aimed to assess risk for postpartum psychiatric admissions in the United States. STUDY DESIGN: This study used the 2010 to 2014 Nationwide Readmissions Database to identify psychiatric admissions during the first 60 days after delivery hospitalization. Timing of admission after delivery discharge was determined. We fit multivariable log-linear regression models to assess the impact of psychiatric comorbidity on admission risk, adjusting for patient, obstetrical, and hospital factors. RESULTS: Of 15.7 million deliveries from 2010 to 2014, 11,497 women (0.07%) were readmitted for a primary psychiatric diagnosis within 60 days postpartum. Psychiatric admissions occurred relatively consistently across 10-day periods after delivery hospitalization discharge. Psychiatric diagnoses were present among 5% of women at delivery but 40% of women who were readmitted postpartum for a psychiatric indication. In the adjusted model, women with psychiatric diagnoses at delivery hospitalization were 9.7 times more likely to be readmitted compared with those without psychiatric comorbidity. Women at highest risk for psychiatric admission were those with Medicare and Medicaid, in lower income quartiles, and of younger age. CONCLUSION: While a large proportion of psychiatric admissions occurred among a relatively small proportion of at-risk women, admissions occurred over a broad temporal period relative to other indications for postpartum admission.

Two-Dimensional Speckle Tracking Echocardiography-Derived Strain Measurements in Survivors of Childhood Cancer on Angiotensin Converting Enzyme Inhibition or Receptor Blockade.

Speckle tracking echocardiography (STE)-derived strain indices are believed to detect early cardiac dysfunction in survivors of childhood cancer and have potential to identify patients who may benefit from early heart failure treatment. However, effects of heart failure treatment on STE-derived strain measurements in this population are unknown. The aim of this study was to assess STE-derived strain measurements in survivors of childhood cancer treated with angiotensin converting enzyme inhibition or receptor blockade (ACEi/ARB). Two-dimensional speckle tracking analysis was retrospectively performed on echocardiograms from childhood cancer survivors before and during therapy with ACEi/ARB. Global left ventricular longitudinal and circumferential strain (GLS and GCS) and strain rates (LSR and CSR) were assessed and correlated with conventional echocardiographic measures of function. In 22 childhood cancer survivors (median age: 14.8, range 6.4-21.6 years), mean GLS (- 13.83 ± 0.74% to - 15.94 ± 0.74%, p = 0.002), GCS (- 18.79 ± 1.21% to - 20.74 ± 0.84%, p = 0.027), LSR (- 0.78 ± 0.04 to - 0.88 ± 0.04 s-1, p = 0.022), and CSR (- 1.08 ± 0.07 to - 1.21 ± 0.06 s-1, p = 0.027) improved on therapy. Improvement in GLS was maintained for greater than 1 year on ACEi/ARB (p = 0.02). Measures of strain and strain rate correlated with standard echocardiographic measures of function and were reproducible. These findings support the use of ACEi/ARB to treat post-chemotherapy-related cardiovascular changes in childhood cancer survivors, provide proof-of-concept that STE-derived strain and strain rate may be used to reliably monitor cardiac function during therapy, and support continued investigation into the clinical benefit of strain measurements in this population.

Systemic Lupus Erythematosus Does Not Increase Risk of Adverse Events in the First 6 Months After Total Knee Arthroplasty.

BACKGROUND: Increasing numbers of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA). Whether postsurgical adverse events (AEs) are higher in patients with SLE than patients with osteoarthritis (OA) is unknown. OBJECTIVES: This study aims to compare AEs within 6 months of TKA. METHODS: Patients in a single institution's arthroplasty and SLE registries who underwent TKA from 2007 to 2014 were eligible. SLE cases were matched 1:2 to OA on age, sex, year of TKA, and procedure type. AEs were collected through chart review and registry responses. Baseline characteristics were compared and regression analysis performed to determine predictors of AEs. RESULTS: Fifty-two SLE TKA were matched to 104 OA TKA. There was no difference in follow-up between groups. SLE patients had more comorbidities (≥1 Charlson-Deyo comorbidity: SLE 38.4% vs. OA 17.3%; P-value < 0.001) and steroid use (preoperative [SLE 28.8% vs. OA 1.9%, P-value < 0.001] and perioperative "stress-dose" [30.8% vs. 2.9%, P-value = 0.01]). SLE patients did not experience more major (SLE 25.0% vs. OA 19.2%; P-value = 0.41), minor (15.4% vs. 10.6%; P-value = 0.39), or total (38.5% vs. 27.9%; P-value = 0.18) AEs. AEs were not increased among patients on stress-dose steroids. In a multiple logistic regression analysis controlling for comorbidities and diagnosis, neither SLE (OR 1.61, 95% CI 0.74-3.50) nor >1 comorbidity (OR 1.05, 95% CI 0.46-2.39) was an independent risk factor for AEs. CONCLUSION: SLE is not an independent risk factor for increased AEs 6 months after TKA. Stress-dose steroid use does not heighten AE risk. These findings should inform recommendations for SLE patients considering TKA.

Impact of a Student-Run Free Clinic's Women's Health Program on Perceived Readiness for Clinical Rotations.

INTRODUCTION: Women's health is only briefly explored in the preclerkship medical curriculum. Volunteering in student-run free clinics (SRFCs) increases clinical confidence; such service learning could bridge the gap between limited curricular offerings and student desire for exposure to women's health topics. This study aimed to identify weaknesses in the women's health preclerkship curriculum, build an educational intervention, and explore SRFCs as a teaching tool. METHODS: We performed chart review of SRFC female patients to evaluate care. We held student focus groups to elicit feedback about the established curriculum. Based on this information, we devised a workshop to review practical skills. Participants attended the workshop, volunteered at SRFC, and completed surveys preintervention and at 3 months postintervention. A control group completed baseline and follow-up surveys. RESULTS: We invited all 151 second-year students to participate; six attended the workshop and 21 served as control. There were no baseline differences between groups regarding age, prior experience with women's health, confidence in relevant skills, and subjective readiness for clinical rotations; the control group had more men. After the workshop, intervention participants reported increased confidence in women's health-related skills and in readiness for the OB/GYN rotation. Gains persisted at 3 months. Three of six students in the workshop group volunteered at SRFC; three of 12 in the control group volunteered. CONCLUSIONS: The addition of an interactive workshop to the existing preclinical curriculum on women's health has lasting impact on subjective readiness for clinical clerkships. SRFC may be a useful addition to classroom learning. This initiative is student-led and reproducible, and could serve as an adjunct to established preclerkship curriculum.

Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013.

BACKGROUND CONTEXT: The typically accepted surgical procedure for cervical disc pathology has been the anterior cervical discectomy and fusion (ACDF), although recent trials have demonstrated equivalent or improved outcomes with cervical disc arthroplasty (CDA). Trends for these two procedures regarding utilization, revision procedures, and other demographic information have not been sufficiently explored. PURPOSE: The present study aims to provide data regarding ACDF and CDA from 2006 to 2013 in the United States. DESIGN: The present study is a retrospective national database analysis. PATIENT SAMPLE: The present study included 20% sample of discharges from US hospitals, which is weighted to provide national estimates. OUTCOME MEASURES: Functional measures such as national incidence, hospital costs, length of stay (LOS), routine discharge, revision burden, and patient characteristics were used in the present study. METHODS: Patients from the National Inpatient Sample (NIS) database who underwent primary ACDF, revision ACDF, primary CDA, and revision CDA from 2006 to 2013 were included. Demographic and economic data for the procedures' respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were collected. RESULTS: A total of 1,059,403 ACDF and 13,099 CDA surgeries were performed in the United States from 2006 to 2013. The annual number of ACDF increased by 5.7% nonlinearly from 120,617 in 2006 to 127,500 in 2013 (mean per year 132,425; range 120,617-147,966); CDA increased by 190% nonlinearly from 540 in 2006 to 1,565 in 2013 (mean per year 1,637; range 540-2,381). Cervical disc arthroplasty patients were younger and had more private or "other" insurance, including worker's compensation (p<.0001). Mean LOS was longer for ACDF (ACDF 2.3 days vs. CDA 1.5; p<.0001). Routine discharge was higher in the CDA group (CDA 96% vs. ACDF 89%; p-value<.0001). The mean hospital-related cost was more expensive for ACDF (ACDF $16,178 vs. CDA $13,197; p-value=.0007). Cervical disc arthroplasty mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was greater (CDA 5.9% vs. ACDF 2.3%, p-value=.01). CONCLUSIONS: Nationally approximately 132,000 ACDFs are done each year compared with only 1,600 CDAs. The number of ACDF surgeries performed far outpaces CDA by a ratio of 81:1 in the United States without a clear direction in the trend for utilization given recent fluctuations. Cervical disc arthroplasty revision burden was more than double compared with the ACDF revision burden (5.9% vs. 2.3%), which was not accounted for by patient baseline demographics. The etiologies of these findings are likely multifactorial and require further research.

Patients with Systemic Lupus Erythematosus Have Increased Risk of Short-term Adverse Events after Total Hip Arthroplasty.

OBJECTIVE: Total hip arthroplasty (THA) is performed more frequently in patients with systemic lupus erythematosus (SLE) than in the general population. However, whether patients with SLE have higher complication rates than patients with osteoarthritis (OA) is unknown. This study compares adverse events (AE) in SLE with OA controls. METHODS: Patients in our institution's registry were eligible. SLE was identified by the International Classification of Diseases, 9th ed code. AE were identified by chart review and questionnaire. Patients with SLE were matched with OA controls. Multivariate regression was performed to identify independent predictors of AE. RESULTS: Fifty-eight patients with SLE THA were matched with 116 OA controls. Of the patients with SLE, 47.4% had Charlson-Deyo comorbidity scores (excluding SLE) > 1 versus 13.1% of OA (p < 0.0001). Length of stay was longer for SLE (6.0 days vs 4.7 days, p = 0.0008). Patients with SLE had more falls (10.3% vs 1.7%, p = 0.017), deep vein thrombosis (5.2% vs 0%, p = 0.036), acute renal disease (8.6% vs 0%, p = 0.004), wound infections (6.9% vs 0.9%, p = 0.043), and revision surgeries (5.2% vs 0%, p = 0.036). In a logistic regression controlling for comorbidities, SLE had an increased risk of AE (OR 3.77, 95% CI 1.74-8.16). Comorbidity scores were not significantly associated with AE. Among those with SLE, there were no significant differences in AE in those taking corticosteroids. CONCLUSION: SLE is an independent risk factor for AE after THA. Patients with SLE had higher rates of falls, acute renal disease, infections, and revision surgeries than matched OA controls. Further research is needed to understand the causes of increased AE in patients with SLE.