Efficacy and safety of batroxobin in patients with acute ischemic stroke: A multicenter retrospective analysis.

AIMS: The objective of this study was to evaluate the effectiveness of batroxobin in improving functional outcomes and reducing stroke recurrence among patients with acute ischemic stroke beyond the therapeutic time window for thrombolytic therapy. METHODS: This multicenter, retrospective study enrolled 492 patients with acute moderate-to-severe ischemic stroke within 24 h. 238 patients were given standard (basic) therapy. On the basis of standard treatment, 254 patients received an initial intravenous infusion of batroxobin 10 U on day 1, followed by subsequent infusions of batroxobin 5 U on the 3rd and 5th days, respectively. RESULTS: In the batroxobin group, 8.3% of patients experienced recurrence stroke, compared to 17.2% in the control group (HR, 0.433; 95% CI, 0.248 to 0.757; p = 0.003). Furthermore, intravenous batroxobin significantly improved the distribution of 90-120 day disability. Moderate-to-severe bleeding events were reported in three patients (1.2%) in the batroxobin group and one patient (0.4%) in the control group (p = 0.369). CONCLUSIONS: Among patients with acute moderate-to-severe ischemic stroke beyond the time window for thrombolytic therapy, treatment with intravenous batroxobin had a lower risk of stroke recurrence and a better recovery of function outcome without increasing bleeding events. Prospective studies are needed to further confirm.

How structural racism, neighborhood deprivation, and maternal characteristics contribute to inequities in birth outcomes.

Decades of disparities in health between infants born to Black and White mothers have persisted in recent years, despite policy initiatives to improve maternal and reproductive health for Black mothers. Although scholars have increasingly recognized the critical role that structural racism plays in driving health outcomes for Black people, measurement of this relationship remains challenging. This study examines trends in preterm birth and low birth weight between 2007 and 2018 separately for births to Black and White mothers. Using a multivariate regression model, we evaluated potential factors, including an index of racialized disadvantage as well as community- and individual-level factors that serve as proxy measures for structural racism, that may contribute to White-Black differences in infant health. Finally, we assessed whether unequal effects of these factors may explain differences in birth outcomes. We found that differences in the effects of these factors appear to explain about half of the underlying disparity in infant health.

The Use of Nonmonetary Outcomes in Health-Related Delay Discounting Research: Review and Recommendations.

Delay discounting (DD) refers to the tendency to devalue an outcome as a function of its delay. Most contemporary human DD research uses hypothetical money to assess individual rates of DD. However, nonmonetary outcomes such as food, substances of misuse, and sexual outcomes have been used as well, and have advantages because of their connections to health. This article reviews the literature on the use of nonmonetary outcomes of food, drugs, and sexual outcomes in relation to health and reinforcer pathologies such as substance use disorders, obesity, and sexual risk behaviors, respectively, and makes a case for their use in discounting research. First, food, substances, and sex may be more ecologically valid outcomes than money in terms of their connections to health problems and reinforcer pathologies. Second, consistent trends in commodity-specific (i.e., domain) effects, in which nonmonetary outcomes are discounted more steeply than money, enhance variation in discounting values. Third, commodity-specific changes in discounting with treatments designed to change health choices are described. Finally, methodological trends such as test-retest reliability, magnitude effects, the use of hypothetical versus real outcomes, and age-related effects are discussed in relation to the three outcome types and compared to trends with monetary discounting. Limitations that center around individual preferences, nonsystematic data, and deprivation are discussed. We argue that researchers can enhance their DD research, especially those related to health problems and reinforcer pathologies, with the use of nonmonetary outcomes. Recommendations for future directions of research are delineated.

Concizumab prophylaxis in persons with hemophilia A or B with inhibitors: patient-reported outcome results from the phase 3 explorer7 study.

Background: Patient-reported outcomes (PROs) reflect patient perceptions of disease and treatment and are important for evaluating new therapies. Objectives: Evaluate the effects of once-daily concizumab prophylaxis on health-related quality of life (HRQoL), treatment burden, and treatment preference in males aged ≥12 years with hemophilia A/B with inhibitors. Methods: Patients enrolled in the multicenter, open-label explorer7 phase 3 study (ClinicalTrials.gov identifier: NCT04083781) were randomized to receive no prophylaxis (arm 1) or concizumab prophylaxis (arm 2) or were nonrandomly allocated to concizumab prophylaxis (arms 3 and 4). The study included questionnaires to assess patients' perception of HRQoL (Haemophilia Quality of Life Questionnaire for Adults), treatment burden (Hemophilia Treatment Experience Measure), and treatment preference (Haemophilia Patient Preference Questionnaire). Results: The estimated treatment difference between patients receiving concizumab prophylaxis vs no prophylaxis at week 24 for Haemophilia Quality of Life Questionnaire for Adults "total score" was -22.6 points (95% CI, -42.5; -2.7), directionally favoring patients receiving concizumab prophylaxis. For Hemophilia Treatment Experience Measure "total score," the estimated treatment difference was -19.9 points (95% CI, -34.3, -5.6) in favor of concizumab vs no prophylaxis. The majority of patients receiving concizumab expressed a preference for concizumab over their previous treatment, the main reasons being "fewer bleeds," "require less time," and "less painful to inject." Across all PROs, there were less responses collected than anticipated, limiting interpretations. Conclusion: PROs collected during the explorer7 study showed improvements in some domains of HRQoL, treatment burden, and patient treatment preference in persons with hemophilia A or B with inhibitors receiving concizumab prophylaxis compared with no prophylaxis.

Adherence to ACSM exercise guidelines and its influence on Fibromyalgia treatment outcomes: a meta-analysis of randomized controlled trials.

Background: The Fibromyalgia Syndrome (FMS) is a multifaceted chronic pain disorder that exerts a substantial impact on the overall state of health and quality of life of patients. Purpose: Investigate the effects of exercise therapy and adherence to the American College of Sports Medicine (ACSM) guidelines on treatment outcomes in FMS patients. Methods: The literature search, which concluded in October 2023, encompassed studies investigating the impact of exercise interventions on patients diagnosed with FMS and providing adequate data for calculating standardized mean difference (SMD). The primary outcome measures encompassed the Fibromyalgia Impact Questionnaire (FIQ) and Health Assessment Questionnaire (HAQ), while secondary outcome measures comprised pain levels, sleep quality, fatigue, and mental health. Results: Among 4,008 records, 19 studies (patients = 857) were eligible for qualitative synthesis. The meta-analysis revealed that the SMD for overall state of health impact was -0.94 (95%CI -1.26, -0.63), and the pooled SMD for the subgroup with high adherence to ACSM guidelines was -1.17 (95%CI -1.65, -0.69). The SMD for the subgroup with low or uncertain adherence was -0.73 (95%CI -1.12, -0.34). The overall effects included a -1.21 (95%CI -1.62, -0.79) SMD for pain relief, with high adherence achieving a -1.32 (95%CI -2.00, -0.64) SMD and low adherence a -1.06 (95%CI -1.55, -0.57) SMD. Mental health improvements showed a -0.95 (95%CI -1.32, -0.57) overall SMD, with high and low adherence subgroups at -0.96 (95%CI -1.62, -0.30) and -0.94 (95%CI -1.29, -0.60), respectively. Sleep quality impact was -1.59 (95%CI -2.31, -0.87) overall, with high adherence at -1.71 (95%CI -2.58, -0.83) and low adherence at -1.11 (95%CI -1.88, -0.33). Fatigue impact had a -1.55 (95%CI -2.26, -0.85) overall SMD, with -1.77 (95%CI -3.18, -0.36) for high adherence and -1.35 (95%CI -2.03, -0.66) for low adherence. Conclusion: Exercise therapy can improve the overall state of health, pain, sleep, and fatigue of FMS patients, particularly when adhering to ACSM guidelines. However, adherence levels do not affect mental health gains, indicating a need for future research on psychological impact. Systematic Review Registration: https://inplasy.com/inplasy-2024-3-0106/, identifier INPLASY202430106.

The Role of Imageless Computer-Assisted Navigation During Total Knee Arthroplasty on Femoral Component Sagittal Alignment and Outcomes.

Background: While total knee arthroplasty (TKA) is highly successful, 15%-20% of patients are not satisfied postoperatively, which may be due to alignment of the TKA components. Imageless computer navigation was developed to increase implant alignment accuracy and precision, but controversy surrounds the patient benefit of this technology. The target of femoral sagittal alignment and its role in patient-reported outcomes (PROMs) after TKA using assistive technology has not been well-defined. Methods: Femoral sagittal alignment, 30-day complications, and PROMs through 1 year were collected retrospectively from unilateral elective TKA patients who underwent surgery between July 2020 and February 2023. Two surgeons equally versed in conventional and imageless navigation techniques participated in patient record identification. Students t-tests and chi-square tests of proportion were used to compare outcomes, 30-day complications, and alignment. Results: Completed PROMs were available for 387 patients; 181 in the computer navigation group and 206 in the conventional arthroplasty group. PROMs were statistically significantly different between groups, favoring computer navigation (P = .014 at 12 months). Lateral femoral angle measurements were greater in females who underwent TKA with computer navigation (P < .001). Of note, 14 patients in the conventional technique group returned to the emergency department within 30 days, as compared to 4 in the navigation group (P = .033). Conclusions: PROMs are improved in the navigation group compared to the conventional technique group. Fewer patients in the navigation group returned to the emergency department. Navigation appeared to provide a small benefit compared to conventional techniques, though final lateral femoral angle was not predictive of outcomes. Additional surgical characteristics may need to be examined to determine the reasons for the differences in outcomes between these techniques.

Incidence of Lateral Femoral Cutaneous Nerve Dysfunction After Total Hip Arthroplasty Through the Anterior-Based Muscle-Sparing Surgical Approach.

Background: The anterior-based muscle-sparing (ABMS) approach, using the intramuscular interval between the tensor fascia lata and gluteus medius, is an increasingly popular total hip arthroplasty (THA) approach. Its incidence of lateral femoral cutaneous nerve (LFCN) numbness has not been defined. The incidence of LFCN symptoms in direct anterior THA ranges from 7%-32% at 1-year follow-up. The purpose of this study is to determine the incidence of LFCN symptoms in patients who underwent ABMS THA at 1-year follow-up. Methods: This was a single-center, multisurgeon retrospective study of ABMS THAs with minimum 1-year follow-up data between January 2014 and September 2021. Eight hundred sixty-nine THAs were included. Mean age of the patients was 67.2 years, with 43.4% male and 56.5% female. Mean body mass index was 26.8, and mean American Society of Anesthesiologists was 2.3. Statistical analysis included chi-square tests, 2-sample t-test, and binomial logistic regression. A P-value of .05 was considered statistically significant for all tests. Results: Nine patients (1%) reported LFCN-associated symptoms at 1-year follow-up. The most common complaint was numbness (n = 5, 55.6%), followed by diminished sensation (n = 2, 22.2%), burning (n = 1, 11.1%), and generalized pain (11.1%). There was no difference in age, sex, body mass index, or American Society of Anesthesiologists between the group that experienced symptoms and the group that did not (P = 1.00, P = .34, P = .74, P = .80). Conclusions: The incidence of LFCN dysfunction is 1% at 1 year after surgery with the ABMS approach. Additional studies may elucidate all risks and benefits of the ABMS approach with respect to LFCN injuries.

COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock.

Introduction and Objectives: Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients. Material and Methods: This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit. Results: Patients with a mean age of 73 (IQR 62-82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53-0.759) for leukocytes, 0.613 (95% CI: 0.509-0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548-0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS. Conclusion: Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.

The long shadow of accumulating adverse childhood experiences on mental health in the United Arab Emirates: implications for policy and practice.

Introduction: This study investigates the cumulative effects of adverse childhood experiences (ACEs) on adult depression, anxiety, and stress in Abu Dhabi, controlling for demographic factors, lifestyle, and known health and mental health diagnoses. Methods: Utilizing a cross-sectional design and self-report measures, the research aims to fill a critical gap in understanding the specific impacts of ACEs in the UAE. Based on a multi-site, cross-sectional community sample of 697 residents of Abu Dhabi. Results: The findings reveal significant variances in current screening values for depression, anxiety, and stress attributable to ACEs after controlling for demographic factors, lifestyle risk factors, and adult diagnoses of health and mental health conditions. Discussion: The results underline the lifelong impact of ACEs and reinforce the importance of early identification and intervention. In particular, the implications for policy and practice in understanding and mitigating ACEs long-term effects on mental health are considered.

Hospital outcomes for young adults with COVID-19.

Background: Older adults are at higher risk of severe outcomes from COVID-19 with comorbidities increasing such risk. Much less is known about the outcomes of young adults with COVID-19 despite their having had high infection rates. Objectives: Our objective was to determine outcomes of hospitalized young adults with COVID-19 infection including rates of oxygen use, mortality, ICU admission, intubation, duration of hospitalization, and factors associated with adverse outcomes. Study design: This retrospective cohort study included EHR data from 21 health systems in the United States on 18-29-year-olds hospitalized with COVID-19 from March 1, 2020 - January 31, 2022. Oxygen need was used to identify symptomatic COVID-19. Rates for mortality, ICU admission, and intubation were calculated for the symptomatic and asymptomatic groups. Effects of demographic and health characteristics on outcomes were assessed as were changes in hospital outcomes over time. Results: Our sample included 9871 young adults hospitalized with COVID-19; 35% required oxygen. Of those who required oxygen, 53.5% were female, 23.7% had an anxiety disorder, 2.6% died (n = 89), 27.7% were admitted to the ICU (n = 955), and 15.8% were intubated (n = 547). A past-year history of any cancer was associated with a 2.1 times increased odds of death. Vaccination was associated with a >40% reduction in the odds of ICU admission. Mortality rates did not change significantly across the study period. Conclusions: COVID-19 caused significant morbidity and mortality in hospitalized young adults who required oxygen. A cancer history was associated with increased risk of death. Vaccination appeared to have had a protective effect on illness severity.

Three-dimensional-printing-guided preoperative planning of upper and lower extremity pediatric orthopedic surgeries: A systematic review of surgical outcomes.

Purpose: Three-dimensional printing has evolved into a cost-effective and accessible tool. In orthopedic surgery, creating patient-specific anatomical models and instrumentation improves visualization and surgical accuracy. In pediatric orthopedics, three-dimensional printing reduces operating time, radiation exposure, and blood loss by enhancing surgical efficacy. This review compares outcomes of three-dimensional printing-assisted surgeries with conventional surgeries for upper and lower extremity pediatric surgeries. Methods: A complete search of medical literature up to August 2023, using Ovid Medline, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Broad search terms included "pediatrics," "orthopedic," and "3D-printing." Eligible studies were assessed for intraoperative time, blood loss, and fluoroscopy exposure. Results: Out of 3299 initially identified articles, 14 articles met inclusion criteria. These studies included 409 pediatric patients, with ages averaging 9.51 years. The majority were retrospective studies (nine), with four prospective and one experimental study. Studies primarily utilized three-dimensional printing for navigation templates and implants. Results showed significant reductions in operative time, blood loss, and radiation exposure with three-dimensional printing. Complication occurrences were generally lower in three-dimensional printing surgeries, but there was no statistical significance. Conclusions: Three-dimensional printing is an emerging technology in the field of orthopedics, and it is primarily used for preoperative planning. For pediatric upper and lower extremity surgeries, three-dimensional printing leads to decreased operating room time, decreased intraoperative blood loss, and reduced radiation exposure. Other uses for three-dimensional printing include education, patient communication, the creation of patient-specific instrumentation and implants. Level of evidence: Level III.

Associations between serum albumin level trajectories and clinical outcomes in sepsis patients in ICU: insights from longitudinal group trajectory modeling.

Background: Sepsis triggers a strong inflammatory response, often leading to organ failure and high mortality. The role of serum albumin levels in sepsis is critical but not fully understood, particularly regarding the significance of albumin level changes over time. This study utilized Group-based Trajectory Modeling (GBTM) to investigate the patterns of serum albumin changes and their impact on sepsis outcomes. Methods: We conducted a retrospective analysis on ICU patients from West China Hospital (2015-2022), employing GBTM to study serum albumin fluctuations within the first week of ICU admission. The study factored in demographics, clinical parameters, and comorbidities, handling missing data through multiple imputation. Outcomes assessed included 28-day mortality, overall hospital mortality, and secondary complications such as AKI and the need for mechanical ventilation. Results: Data from 1,950 patients revealed four serum albumin trajectories, showing distinct patterns of consistently low, increasing, moderate, and consistently high levels. These groups differed significantly in mortality, with the consistently low level group experiencing the highest mortality. No significant difference in 28-day mortality was observed among the other groups. Subgroup analysis did not alter these findings. Conclusion: The study identified four albumin trajectory groups in sepsis patients, highlighting that those with persistently low levels had the worst outcomes, while those with increasing levels had the best. Stable high levels above 30 g/L did not change outcomes significantly. These findings can inform clinical decisions, helping to identify high-risk patients early and tailor treatment approaches.

Incidence of overt diabetes in pregnancy among women with 50-g glucose challenge test ≥ 200 mg/dL.

Objectives: To determine the incidence of overt diabetes in pregnancy (ODIP) among women with 50-g GCT results ≥ 200 mg/dL and compare characteristics and pregnancy outcomes between women with and without gestational diabetes (GDM). Methods: A retrospective cohort study was conducted in 212 pregnant women whose 50-g GCT results ≥ 200 mg/dL. ODIP was diagnosed from 75-g OGTT if fasting plasma glucose ≥ 126 and/or 2-h plasma glucose ≥ 200 mg/dL. Various characteristics and pregnancy outcomes were compared between ODIP and those with and without GDM. Results: Incidence of ODIP was 1.9% of all pregnant women and 23.6% of women with 50-g GCT ≥ 200 mg/dL. Women with ODIP and GDM were more likely to be overweight or obese than those without GDM (52%, 39.6%, and 18.2%, p < 0.001). Women with ODIP had significantly higher 50-g GCT results, lower gestational weight gain, and were less likely to deliver vaginally. Insulin therapy was significantly more common in women with ODIP compared to GDM (70.2% vs. 15.4%, p < 0.001). Rates of LGA, macrosomia, and other neonatal outcomes were comparable. BMI ≥ 25 kg/m2 and 50-g GCT ≥ 240 mg/dL independently increased the risk of any abnormal glucose tolerance [adjusted OR 3.22 (95% CI 1.55-6.70) and 2.28 (95% CI 1.14-4.58)] and ODIP [adjusted OR 9.43 (95% CI 2.15-41.38) and 6.36 (95% CI 2.85-14.18)], respectively. Conclusion: Incidence of ODIP was 23.6% of women with 50-g GCT ≥ 200 mg/dL. BMI ≥ 25 kg/m2 and 50-g GCT ≥ 240 mg/dL independently increased the risk of GDM and ODIP. Neonatal complications were comparable between ODIP and those with and without GDM.

Racial and Ethnic Disparity in Shoulder Surgery: A Systematic Review.

BACKGROUND: Healthcare disparity exists in utilization and delivery of musculoskeletal care and continues to be an obstacle for orthopedic healthcare providers to mitigate. Racial and ethnic disparities exist within various surgical fields including orthopedic surgery and are expected to continue to rise in upcoming years. The aim of this systematic review is to analyze the racial and ethnic disparities on utilization and outcomes after common shoulder surgical procedures. QUESTIONS/PURPOSE: Are there racial or ethnic disparities in outcomes and utilization of shoulder surgeries? Is there evidence to explain the etiology underlying the differences in outcomes among racial and ethnic groups after shoulder surgery? PATIENTS/METHODS: A primary literature search was performed using PubMed, Embase, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases using comprehensive Medical Subject Headings and subject-heading search terms. Studies were included if they reported utilization and or outcomes across two or more racial/ethnic groups in patients (age >16) who underwent shoulder arthroplasty (TSA), rotator cuff repair (RCR), arthroscopic Bankart repair (ABR), Latarjet (LP) and internal fixation (ORIF) of PHF. Baseline demographics, data on procedure utilization, perioperative measures including mortality, operative time, length of stay (LOS), readmission and complications were extracted from included studies, and descriptive statistical analysis performed. RESULTS: Eighteen studies were identified for full text review of which 13 found race and ethnicity as factors affecting utilization and outcomes in TSA, RCR, ABR, LP and ORIF of PHF. Compared to White patients, Black patients were found to have decreased utilization, longer LOS, and greater operative time and mortality after TSA; Black patients also had longer operative times and time to discharge, and lower levels of reported satisfaction after RCR. Hispanic/Latino ethnicity was reported as an independent risk factor for post operative falls following TSA. Hispanic/Latino and Black patients have a higher risk of delayed surgery and greater risk of readmission after surgical treatment of PHF compared to patients of White race. CONCLUSION: This systematic review highlights the limited literature reporting the existence of racial and ethnic disparities in utilization and outcomes after common shoulder surgical procedures. Additionally, there is paucity of studies exploring the underlying etiology of racial and ethnic disparity in outcomes after shoulder surgery. More research is necessary to pave the way for evidence-based action plans to mitigate healthcare disparities after shoulder surgeries, but this review serves as a baseline for where efforts in direct improvement can begin.

Comparison of short- and mid-term outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties.

BACKGROUND: Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients due to potential activity restriction and concerns about glenoid loosening. The Ream-and-run (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising though more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple timepoints between matched aTSA and RnR cohorts. Secondarily, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort. Lastly, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering. METHODS: We performed a retrospective matched-cohort study comparing patients who underwent a RnR versus patients who underwent the aTSA procedure between 2017-2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES), and daily and worst pain outcomes were compared between groups at 3- and 6-months, and 1- and 2-years post-arthroplasty. Pre- and Postoperative glenoid anatomy and humeral decentering were measured radiographically, and correlation analyses were conducted to explore relationships between these factors and 2-year pain and function scores. RESULTS: Forty-six shoulders (23 RnR/ 23aTSA) belonging to 43 male patients with an average age of 56.2±8.3 were included. Eighteen matched pairs were available at 3- and 6- months, 21 matched pairs at 1 year, and all 23 matched pairs at the 2-year timepoint. RnR patients reported significantly higher daily pain ratings (P = .047) and lower ASES scores (P = .031) compared to the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoantatomy outcomes were not directly related to final reported pain or function in RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort. CONCLUSIONS: Young male patients undergoing RnR can likely expect similar short-term results as young male patients who undergo aTSA. Additionally, the RnR outcomes were not affected by preoperative glenoid wear or humeral head decentering. Our findings support the RnR as a viable surgical alternative for young, active patients with shoulder arthritis.

Utilization of Telemedicine to Supervise Medical Students in the Post-Acute/Long-Term Care Setting.

OBJECTIVES: Telemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments. DESIGN: Prospective cohort study of student subjects using observational survey data. SETTING AND PARTICIPANTS: A total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH). METHODS: A total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects. RESULTS: A nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities. CONCLUSIONS AND IMPLICATIONS: The results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.

Obstetric transport in rural settings: Referral and transport of pregnant patients in a state without a perinatal regionalized system of care.

OBJECTIVE: To assess factors impacting obstetric transport and referral processes for pregnant patients experiencing an emergency in a rural state without a perinatal regionalized system of care. DATA SOURCES AND STUDY SETTING: Data is from Critical Access Hospitals (CAHs) without obstetric units and healthcare providers involved in obstetric care and transport at hospitals with varying levels of obstetric capacity in Montana. STUDY DESIGN: This mixed-methods study involved surveying CAHs without obstetric units about the hospitals' capacity for obstetric emergencies and transport policies. Survey data were collected from 32 of 34 CAHs without obstetric units (94% response rate) in the fall of 2021. Subsequent interviews were conducted in the fall and winter of 2022-2023 with 20 hospital and emergency medical services (EMS) personnel to provide further insights into the referral and transport process during obstetric emergencies. DATA COLLECTION/EXTRACTION METHODS: Survey data were collected using REDCap; interviews were conducted via videoconference. We performed descriptive statistics and Fisher's exact tests for quantitative data. We analyzed qualitative data using a three-phase pragmatic analytic approach. PRINCIPAL FINDINGS: The survey of CAHs found 12 of 32 facilities faced difficulties coordinating transport for pregnant patients. Qualitative data indicated this was often due to the state's decentralized transport system. Challenges identified through both quantitative and qualitative data included weather, securing a receiving facility/provider, and coordinating medical transport. Only 10 CAHs reported having written protocols for transporting pregnant patients; of those, four facilities had formal transfer agreements. Qualitative data emphasized variations in awareness and the utility of obstetric transport policies. CONCLUSIONS: A decentralized transport system in a rural state can exacerbate existing challenges faced by providers arranging transport for pregnant patients during an obstetric emergency. State and interfacility policies could enhance the transport process for increased regionalization as well as increased support for and coordination of existing EMS.

Parent-Reported Academic Outcomes After a Mild Traumatic Brain Injury in the Pediatric Population.

BACKGROUND: Millions of children are diagnosed with a traumatic brain injury (TBI) each year, most being mild TBI (mTBI). The effect of mTBIs on academic performance is of significant importance. We investigate mTBI's impact on parent-reported academic outcomes in school-aged pediatric participants. METHODS: This cross-sectional survey study queried parents (N = 285) regarding letter grade performance and the presence or absence of academic accommodations before and after an mTBI, including complicated mTBI (c-mTBI, or mTBI with radiographic abnormality). RESULTS: We found a parent-reported decline in letter grades following c-mTBI (p < .001), with no significant change following uncomplicated mTBIs. Degree and length of recovery were also associated with grade changes (p < .05). Those with no academic accommodations prior to the injury showed significant decreases in grades after injury regardless of post-injury accommodation status (p < .05). IMPLICATIONS OF SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: This study underscores the need for an improved framework of support to maximize academic performance of children following mTBI, especially in those with a c-mTBI and still recovering from their injury. CONCLUSION: Our study identifies children who are at risk for adverse academic outcomes following mTBI. We encourage efforts to better support school nurses in this effort, including improved communication between health care teams and school teams.

Using a measurement type-independent metric to compare patterns of determinants between patient-reported versus performance-based physical function in hemodialysis patients.

PURPOSE: We applied a previously established common T-score metric for patient-reported and performance-based physical function (PF), offering the unique opportunity to directly compare measurement type-specific patterns of associations with potential laboratory-based, psychosocial, sociodemographic, and health-related determinants in hemodialysis patients. METHODS: We analyzed baseline data from the CONVINCE trial (N = 1,360), a multinational randomized controlled trial comparing high-flux hemodialysis with high-dose hemodiafiltration. To explore the associations of potential determinants with performance-based versus patient-reported PF, we conducted multiple linear regression (backward elimination with cross-validation and Lasso regression). We used standardized T-scores as estimated from the PROMIS PF short-form 4a (patient-reported PF) and the Physical Performance Test (performance-based PF) as dependent variables. RESULTS: Performance-based and patient-reported PF were both significantly associated with a laboratory marker-based indicator of muscle mass (simplified creatinine index), although the effects were relatively small (partial f2 = 0.04). Age was negatively associated with PF; the effect size was larger for performance-based (partial f2 = 0.12) than for patient-reported PF (partial f2 = 0.08). Compared to performance-based PF, patient-reported PF showed a stronger association with self-reported health domains, particularly pain interference and fatigue. When using the individual difference between patient-reported and performance-based T-scores as outcome, we found that younger age and more fatigue were associated with lower patient-reported PF compared to performance-based PF (small effect size). CONCLUSION: Patient-reported and performance-based assessments were similarly associated with an objective marker of physical impairment in hemodialysis patients. Age and fatigue may result in discrepancies when comparing performance-based and patient-reported scores on the common PF scale. Trial Registration CONVINCE is registered in the Dutch Trial Register (Register ID: NL64750.041.18). The registration can be accessed at: https://onderzoekmetmensen.nl/en/trial/52958 .

Predictors of maternal and neonatal outcomes in labors complicated by shoulder dystocia: a comparative analysis.

INTRODUCTION: Studies investigating the risk factors associated with unfavorable maternal/neonatal outcomes in cases of shoulder dystocia are scarce. This study aims to uncover the predictive factors that give rise to unfavorable outcomes within the context of shoulder dystocia. MATERIALS AND METHODS: Medical records of pregnancies complicated by shoulder dystocia was obtained between 2008-2022 from a single tertiary center. This study involved the comparison of sociodemographic, sonographic, and delivery characteristics among pregnancies complicated by shoulder dystocia resulting in favorable vs. unfavorable maternal/neonatal outcomes. RESULTS: A total of 275 pregnancies were analyzed, with 111 (40.3%) classified as unfavorable outcomes and 164 (59.7%) as favorable outcomes. Employing a multivariable regression analysis, several independent associations were identified with unfavorable maternal/neonatal outcomes. Specifically, short maternal stature, pre-gestational diabetes, vacuum extraction, Wood's screw maneuver, and macrosomia merged as significant predictors of unfavorable maternal/neonatal outcomes. CONCLUSION: Short maternal stature, pre-gestational diabetes, vacuum extraction, Wood's screw maneuver, and macrosomia may all contribute to poor maternal/neonatal outcomes in shoulder dystocia cases. This knowledge allows clinicians to improve their decision-making, patient care, and counseling.