Prevalence of Poor Mental Health Days and Adverse Childhood Experience Reporting in U.S. Adults Before and After COVID-19.

This is the first study of US adults to examine change in the prevalence of psychological burden (i.e., self-reported poor mental health days in the past 30 days, and ACEs recollections) before compared to after COVID-19 started. We analyzed the prevalence of self-reported poor mental health days, and ACEs recollections from 17 states using the Behavioral Risk Factor Surveillance System. Adjusted models identified an increase in prevalence from before compared to after COVID-19 onset in those married or partnered reporting 48% more poor mental health days in the past 30 days; persons of color reporting living with anyone with mental illness during childhood by 73% and reporting more ACEs by 35%; those employed or self-employed reporting childhood sexual abuse by 45%. This ecological-level analysis revealed population-level changes in psychological well-being reporting of U.S. adults from before compared to after the pandemic onset.

Improving detection of Hill-Sachs fractures on radiographs.

OBJECTIVE: To investigate factors which affect radiographic diagnosis of Hill-Sachs fractures, and find criteria which improve detection. MATERIALS AND METHODS: Retrospective search was made for the term "Hill Sachs" within MRI reports in our local PACS system, and cases with post-reduction radiographs were included in the study. Prospective diagnoses and subspecialty MSK training of the interpreting radiologist of record were recorded. Images were then retrospectively reviewed by two observers and statistical analysis was performed. RESULTS: Our retrospective study included 181 cases, of which 35% had prospective radiographic diagnosis of Hill-Sachs fracture. Retrospective review found that 73% of the radiograph series had at least 1 sign of a Hill-Sachs fracture. The internal rotation view showed a Hill-Sachs lesion in 59% of cases, but did not detect it in 14% of cases, where the lesion was instead visible on axillary, external rotation, and/or scapular Y view. Odds ratio of prospective Hill-Sachs detection on radiographs was 2.68 for musculoskeletal fellowship-trained radiologists versus non-musculoskeletal-trained radiologists. CONCLUSION: Hill-Sachs fractures are often not recognized on post-reduction radiographs. Diagnosis of Hill-Sachs lesion can be significantly increased if radiologists are aware that the internal rotation view may fail to show the injury, and if all 4 views of a shoulder series are scrutinized.

Assessing team communication with patients' families: Findings from utilizing the Communication Assessment Tool-Team (CAT-T) in an interprofessional error disclosure simulation.

OBJECTIVE: The CAT-T was incorporated into an interprofessional error disclosure (ED) simulation to assess team communication with a patient family member. METHODS: Interprofessional student groups (n = 55) planned for team-based ED with facilitation by faculty. Students participated in three scenarios of ED with a standardized family member (SFM) who displayed the emotions of sadness, anger, and distrust sequentially. SFMs completed the CAT-T tool for each emotion. CAT-T items were classified as empathy or disclosure skills by factor analysis. Qualitative comments from the SFM were provided during debrief. RESULTS: Students performed well on team-based ED from the SFM perspective. Team performance improved when the SFM displayed distrust after observing peers disclose for the sad and angry emotion. Higher composite scores were found on CAT-T items categorized as empathy skills. CONCLUSIONS: The ED simulation allowed students to practice disclosure skills in a low-stakes environment and receive feedback from a SFM based on behaviors evaluated on the CAT-T. The simulation design allowed students to improve their performance by incorporating feedback into subsequent cycles. PRACTICE IMPLICATIONS: Immersive experiences where observable student behaviors can be assessed are important to enhance IPE curriculum and to build skills in pre-licensure students that will be foundational for collaborative practice.

Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass.

BACKGROUND: Endoscopic sclerotherapy using sodium morrhuate has been used to treat patients with weight regain after Roux-en-Y gastric bypass whose presumed etiology is loss of restriction due to gastrojejunostomy dilation. Weight loss and stability have been demonstrated in several studies with short-term follow-up evaluation. METHODS: This retrospective review evaluated all the patients who underwent sclerotherapy for a dilated gastrojejunostomy between 2007 and 2012. RESULTS: The study identified 48 patients with a mean follow-up period of 22 months (range 12-60 months). The mean age of these patients was 47.5 ± 10.5 years, and 92 % were women. The average weight loss from the primary procedure was 132.5 ± 54.82 lb, and the average weight regain from the lowest weight to the maximum weight before sclerotherapy was 46 ± 40.32 lb. The median number of sclerotherapy sessions was two (range 1-4). The pre-procedure mean gastrojejunostomy diameter was 20 ± 3.6 mm, and the mean volume of sodium morrhuate injected per session was 12.8 ± 3.7 ml. The average weight loss from sclerotherapy to the final documented weight was 3.17 ± 19.70 lb, which was not statistically significant. The following variables in the multivariate analysis were not associated with statistically significant weight loss: volume of sodium morrhuate, patient age, gastrojejunostomy diameter, number of sclerotherapy sessions, decrease in gastrojejunostomy diameter between the first and second sessions, and number of follow-up years. Weight stabilization or loss was achieved by 58 % of our cohort, with a mean weight loss of 15.9 ± 14.6 lb in this subgroup. CONCLUSION: The long-term follow-up evaluation of patients undergoing sclerotherapy of the gastrojejunostomy for weight regain after gastric bypass showed only a marginal weight loss, which was not statistically significant in our study population, although more than 50 % of the patients achieved weight loss or stabilization.