Wear of Third-Generation Cross-Linked Polyethylene in Primary Total Hip Arthroplasty: A 10-Year Analysis.

BACKGROUND: Sequential modifications to the manufacturing process of highly cross-linked polyethylene (HXLPE) have improved the wear resistance and implant survival of these liners in total hip arthroplasty (THA). However, no study has examined the long-term (mean 10 year) wear rates and clinical outcomes of third-generation HXLPE in THA. The aim of our study was to report the longest-to-date analysis of wear rates and clinical outcomes of a third-generation HXLPE liner. METHODS: A series of 133 THAs using a specific HXLPE acetabular liner were retrospectively evaluated. Linear and volumetric wear rates were determined using a validated radiographic technique and clinical outcomes were analyzed. Multivariate analyses were performed to determine risk factors for accelerated wear. RESULTS: At a mean follow-up of 10.4 years (range, 8 to 13.4), the mean linear wear rate was 0.0172 mm/year and the mean volumetric wear rate was 16.99 mm3/year. There were no instances of osteolysis or mechanical failures at any time point and there was a 100% acetabular component survival rate. Younger age and use of offset liners were independent risk factors for increased wear (P < .01 for both). CONCLUSIONS: Our series of a third-generation HXLPE demonstrated very low wear rates and excellent implant survival at a mean of 10.4 years following primary THA. Future comparative studies at the 15- and 20-year follow-up timepoints are necessary to determine if such findings translate to true improvements in the tribological properties and longevity of these liners when compared to previous generations of HXLPE liners.

Is There a Change in Anxiety and Depression Following Total Knee Arthroplasty?

BACKGROUND: The primary purpose of this study was to investigate whether anxiety and depression change following total knee arthroplasty (TKA). A secondary objective was to explore the association between preoperative variables and changes in anxiety and depression. METHODS: This was a prospective, multicenter, cohort study. Participants (n = 1,852, age 64 ± 8.7 years, a body mass index of 31.3, a modified Comorbidity Index of 1.0 ± 1.3, and 61.7% were women) completed the EuroQol 5-dimension 5-level preoperatively and at 1- and 3-month postoperatively. Fulfillment of physical activity expectations and preparedness to resume activities was assessed at 3 months. The anxiety or depression dimension was analyzed using the Paretian classification profile changes and compared with the sign Fisher's exact test. Logistic regressions were used to analyze the relationship between patient characteristics, preoperative anxiety or depression, activity expectations, preparedness to resume activities, and changes in anxiety/depression. RESULTS: The percentage of patients reporting Level 1 (no anxious or depressed feelings) significantly (P < .0001) increased from preoperative (62.2%) to 3 months (77.1%) postoperative, while levels 2 to 5 (slightly through extremely anxious or depressed) all decreased. The percentage of worsening anxiety and depression was significantly (P < .0001) greater in patients who did not feel they were well prepared to resume activities of daily living (17.7 versus 4.4%) and physical recreation (12.9 versus 3.9%). Preoperative anxiety and depression (odds ratio [OR] 52.27, 95% confidence interval [CI]: 34.98, 80.67), EuroQol 5-dimension 5-level (OR: 2.55, 95% CI: 1.04, 6.34), activity of daily living (OR: 1.57, 95% CI: 1.19, 2.06), and body mass index (OR: 1.05, 95% CI: 1.02, 1.08) were significant (P < .05) predictors of an improving Paretian change profile at 3 months postoperative. CONCLUSIONS: Anxiety and depression decrease following TKA, and these changes appear heavily dependent on a patient's preoperative psychological well-being and postoperative preparedness to resume daily activities. Physicians' awareness of preoperative patient psychological well-being and management of patient preparedness and expectations to resume physical activity may modulate postoperative anxiety and depression.

Conversion Total Hip Arthroplasty in the Era of Bundled Care Payments: Impacts on Costs of Care.

BACKGROUND: Conversion hip arthroplasty is defined as a patient who has had prior open or arthroscopic hip surgery with or without retained hardware that is removed and replaced with arthroplasty components. Currently, it is classified under the same diagnosis-related group as primary total hip arthroplasty (THA); however, it frequently requires a higher cost of care. METHODS: A retrospective study of 228 conversion THA procedures in an orthopaedic specialty hospital was performed. Propensity score matching was used to compare the study group to a cohort of 510 primary THA patients by age, body mass index, sex, and American Society of Anesthesiologists score. These matched groups were compared based on total costs, implants used, operative times, length of stay (LOS), readmissions, and complications. RESULTS: Conversion THA incurred 25% more mean total costs compared to primary THA (P < .05), longer lengths of surgery (154 versus 122 minutes), and hospital LOS (2.1 versus 1.56 days). A subgroup analysis showed a 57% increased cost for cephalomedullary nail conversion, 34% increased cost for sliding hip screw, 33% for acetabular open reduction and internal fixation conversion, and 10% increased costs in closed reduction and percutaneous pinning conversions (all P < .05). There were 5 intraoperative complications in the conversion group versus none in the primary THA group (P < .01), with no statistically significant difference in readmissions. CONCLUSION: Conversion THA is significantly more costly than primary THA and has longer surgical times and greater LOS. Specifically, conversion THA with retained implants had the greatest impact on cost.

Retained Functional Antibiotic Hip Spacers Have High Rates of Stem Loosening, Subsidence, and Reoperation.

BACKGROUND: Functional antibiotic hip spacers for treatment of periprosthetic joint infection may be retained in patients deemed too sick for reimplantation, or who elect to forego additional surgery. Our aim was to characterize reoperations, modes of failure, and function outcomes in patients who have retained hip spacers. METHODS: We performed a retrospective review of 43 hips that underwent placement of an articulating hip spacer between January 1, 2014 and November 30, 2021. There were 28 hips that completed 2-stage exchange (TS group) and were reimplanted at mean 4 months (range, 2 to 10). The other 15 hips underwent planned spacer retention (RS group). Mean follow-up was 2.9 years (range, 1 to 6.1 years). The RS group was older (74 versus 66 years, P = .005) and had a higher age-adjusted Charlson Comorbidity Index (4.4 versus 3.3, P = .04) compared with the TS group. RESULTS: Overall survivorship free of reinfection was 91% at 1 year and 86% at 5 years. There were 6 RS hips that underwent reimplantation for spacer failure at a mean of 23 months (range, 6 to 71 months) and 8 had radiographic stem loosening/subsidence. Patients who had a retained spacer at final follow-up were more likely to require a walker (P = .005) or wheelchair (P = .049) compared with patients who underwent reimplantation. CONCLUSIONS: Retained hip spacers can decrease overall surgical burden, but are associated with high rates of stem loosening, subsidence, and unplanned reoperation. Planned spacer retention should be undertaken with caution in patients healthy enough to undergo reimplantation.

Drivers of flood-induced relocation among coastal urban residents: Insight from the US east coast.

Many coastal urban areas are experiencing impacts of accelerated chronic and episodic flooding on the built environment and people's livelihoods and quality of life. These impacts sometimes exceed the households' adaptive and coping capacities to deal with flooding, prompting residents to consider relocation. It is unclear how urban dwellers living in flood-prone locations perceive this adaptation strategy and under what flood-driven circumstances they would consider permanently moving. This paper provides empirical evidence on relocation preferences among urban residents along the U.S. East Coast. It further explores how this decision is influenced by socioeconomic determinants, experiences with flood exposure, comprehensive concerns with flooding, and preferences for relocation destinations. We administered an online survey to 1450 residents living in flood-prone urban areas across multiple states, from New York to Florida, and analyzed the results using descriptive and inferential statistics. Results show that almost half of respondents would consider relocating due to coastal flooding, with only 13 percent declining this option. The results show that age and race, several determinants of place attachment, problem-solving capacity, and flood-related household- and community-level concerns play a significant role in willingness to relocate.

The Occupational Health and Safety of Sign Language Interpreters Working Remotely During the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic has caused a dramatic shift in work conditions, bringing increased attention to the occupational health of remote workers. We aimed to investigate the physical and mental health of sign language interpreters working remotely from home because of the pandemic. METHODS: We measured the physical and mental health of certified interpreters who worked remotely 10 or more hours per week. We evaluated associations within the overall sample and compared separate generalized linear models across primary interpreting settings and platforms. We hypothesized that physical health would be correlated with mental health and that differences across settings would exist. RESULTS: We recruited 120 interpreters to participate. We calculated scores for disability (mean score, 13.93 [standard error of the mean (SEM), 1.43] of 100), work disability (mean score, 10.86 [SEM, 1.59] of 100), and pain (mean score, 3.53 [SEM, 0.29] of 10). Shoulder pain was most prevalent (27.5%). Respondents had scores that were not within normal limits for depression (22.5%), anxiety (16.7%), and stress (24.2%). Although disability was not associated with depression, all other outcomes for physical health were correlated with mental health (r ≥ 0.223, P ≤ .02). Educational and community/freelance interpreters trended toward greater adverse physical health, whereas educational and video remote interpreters trended toward more mental health concerns. CONCLUSION: Maintaining the occupational health of sign language interpreters is critical for addressing the language barriers that have resulted in health inequities for deaf communities. Associations of disability, work disability, and pain with mental health warrant a holistic approach in the clinical treatment and research of these essential workers.

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty.

BACKGROUND: Given the opioid crisis in America, patients are trying alternative medications including tetrahydrocannabinol (THC) and other cannabidiol (CBD) containing products in the perioperative period, especially in states where these products are legal. This study sought to analyze usage rates of CBD/THC products in the perioperative period for primary unilateral total hip and knee arthroplasty (THA/TKA) patients and identify a possible association with post-operative opioid use. METHODS: A prospective cohort of primary unilateral THA/TKA patients were enrolled at a single institution. Patients who completed detailed pain journals were retrospectively surveyed for CBD/THC product usage. Pain medications were converted to morphine milligram equivalents (MME). RESULTS: Data from 195 of the 210 patients (92.9% response rate) following primary arthroplasty were analyzed. Overall, 16.4% of arthroplasty-22.6% (n = 19) of TKA and 11.7% (n = 13) of THA-patients used CBD/THC products in the perioperative period. There was a wide variety of usage patterns among those using CBD/THC products. In comparing CBD/THC users and non-users, there was no significant difference in the length of narcotic use, total morphine milligram equivalents taken, narcotic pills taken, average post-op pain scores, the percentage of patients requiring a refill of narcotics, or length of stay. CONCLUSION: Understanding that CBD/THC usage was not consistent for patients who used these products, 22.6% of TKA and 11.7% of THA patients tried CBD/THC products in the perioperative period. In this small sample, CBD/THC use was not associated with a major effect on narcotic requirements. Further studies on the effects of CBD/THC are needed as these therapies become more widely available.

Opioid Use After Discharge Following Primary Unilateral Total Knee Arthroplasty: How Much Are We Over-Prescribing?

BACKGROUND: The opioid crisis pressures orthopedic surgeons to reduce the amount of narcotics prescribed for post-operative pain management. This study sought to quantify post-operative opioid use after hospital discharge for primary unilateral total knee arthroplasty (TKA) patients. METHODS: A prospective cohort of primary unilateral TKA patients performed by one of 5 senior fellowship-trained arthroplasty surgeons were enrolled at a single institution. Detailed pain journals tracked all prescriptions and over-the-counter pain medications, quantities, frequencies, and visual analog scale pain scores. Narcotic and narcotic-like pain medications were converted to morphine milligram equivalents (MME). Statistical analysis was performed using Student's t-test with α < 0.05. RESULTS: Data from 89 subjects were analyzed; the average visual analog scale pain score was 6.92 while taking narcotics. The average number of days taking narcotics was 16.8 days. The distribution of days taking narcotics was right shifted with 52.8% of patients off narcotics after 2 week, and 74.2% off by 3 weeks post-op. The average MME prescribed was significantly greater than MME taken (866.6 vs 428.2, P < .0001). The average number of narcotic pills prescribed was significantly greater than narcotic pills taken (105.1 vs 52.0, P < .0001). The average excess narcotic pills prescribed per patient was 53.1 pills. About 48.3% took fewer than 40 narcotic pills; 75.3% took fewer than 75 narcotic pills. About 3.4% did not require any narcotics; 40.5% required a refill of narcotics. Also, 9.0% went home the day of surgery. CONCLUSION: Significantly more narcotics were prescribed than were taken in the post-operative period following TKA with an average 53.1 excess narcotic pills per patient. Adjusting prescribing patterns to match patient narcotic usage could reduce the excess narcotic pills following TKA.

Opioid Use After Discharge Following Primary Unilateral Total Hip Arthroplasty: How Much Are We Overprescribing?

BACKGROUND: The opioid crisis pressures orthopedic surgeons to reduce the amount of narcotics prescribed for postoperative pain management. This study sought to quantify postoperative opioid use after hospital discharge for primary unilateral total hip arthroplasty (THA) patients. METHODS: A prospective cohort of primary unilateral THA patients were enrolled at a single institution. Detailed pain journals tracked all prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale pain scores. Pain medications were converted to morphine milligram equivalents (MME). RESULTS: Data from 121 subjects were analyzed; the average visual analog scale pain score was 3.44 while taking narcotics. The average number of days taking narcotics was 8.46 days. The distribution of days taking narcotics was right shifted with 50.5% of patients off narcotics after 1 week, and 82.6% off by 2 weeks postoperatively. The average number of narcotic pills prescribed was significantly greater than narcotic pills taken (72.5 vs 28.8, P < .0001). The average MME prescribed was significantly greater than MME taken (452.1 vs 133.8, P < .0001). The average excess narcotic pills prescribed per patient was 51.7 pills. And 71.9% took fewer than 30 narcotic pills; 90.9% patients took fewer than 50 narcotic pills. Also, 10.7% did not require any narcotics; 9.9% required a refill of narcotics; and 33.1% went home the day of surgery. CONCLUSION: Significantly more narcotics were prescribed than were taken in the postoperative period following THA with an average 51.7 excess narcotic pills per patient. Adjusting prescribing patterns to match patient narcotic usage could reduce the excess narcotic pills following THA.

Intraoperative Comparison of Measured Resection and Gap Balancing Using a Force Sensor: A Prospective, Randomized Controlled Trial.

BACKGROUND: For establishing femoral component position, gap-balancing (GB) and measured resection (MR) techniques were compared using a force sensor. METHODS: Ninety-one patients were randomized to undergo primary total knee arthroplasty using either MR (n = 43) or GB (n = 48) technique using a single total knee arthroplasty design. GB was performed with an instrumented tensioner. Force sensor data were obtained before the final implantation. RESULTS: GB resulted in greater range of femoral component rotation vs MR (1.5° ± 2.9° vs 3.1° ± 0.5°, P < .05) and posterior condylar cut thickness medially (10.2 ± 2.0 mm vs 9.0 ± 1.3 mm) and laterally (8.5 ± 1.9 mm vs 6.4 ± 1.0 mm). Force sensor data showed a decreased intercompartmental force difference at full flexion in GB (.8 ± 2.3 vs 2.0 ± 3.3u, 1u ≈ 15 N, P < .05). CONCLUSION: GB resulted in a greater range of femoral component rotation and thicker posterior condylar cuts resulting in an increased flexion space relative to MR. Intercompartmental force difference trended toward a more uniform distribution between full extension and full flexion in the GB vs MR group.

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty.

BACKGROUND: An increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA. METHODS: Retrospective review was performed of the initial 1120 consecutive patients who underwent direct anterior THA by 2 surgeons. RESULTS: A total of 899 patients (80.3%) had a 2-year follow-up (range, 2-8 years). Complications within 90 days occurred in 20 patients (1.8%): 10 calcar fractures, 1 greater trochanter fracture, 1 canal perforation, 3 hematomas, 2 dislocations, 2 superficial, and 1 deep infection. Nine patients (1%) underwent revision: 5 for aseptic femoral loosening (0.55%), 1 for periprosthetic joint infection, 1 for dislocation, 1 for hip flexor irritation, and 1 for a damaged polyethylene liner. Of the 5 patients with aseptic femoral loosening, 3 had a short, mediolateral tapered stem, 1 cemented stem, and 1 S-ROM stem placed to bypass a canal perforation. There were no revisions for aseptic loosening in the collared, fully hydroxyapatite (HA)-coated compaction broached or triple tapered proximal fit and fill stem designs (70.6% of all stems). Revision rate for femoral loosening was significantly higher for tapered wedge over HA-coated, compaction broached stems (P < .005). CONCLUSION: Pain and function improved predictably with a 0.55% rate of femoral loosening at 2-year follow-up. Among collared, fully HA-coated and triple taper fit and fill femoral stems, there were no instances of revision for aseptic loosening vs 3 in the short stem, collarless mediolateral tapered group.

Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach.

BACKGROUND: Few publications have raised concern with the safety of the anterior approach (AA) to total hip arthroplasty (THA). The purpose of this study is to report the early complications with AA THA in a combined, multicenter patient population from three different institutions. METHODS: The study cohort consisted of 5090 consecutive primary procedures in 4473 patients who had undergone THA utilizing the anterior approach between August 2006 and July 2013. Surgeries were performed by five surgeons at three sites that maintain prospective databases. Preoperative, intraoperative, and postoperative data were recorded on all patients. Demographic data including age, gender, and BMI were queried, as well as all intraoperative and postoperative complications in the first 90 days. RESULTS: The 5090 patients had a mean body mass index of 27.5, and mean age of 63.6 years. The overall 90-day complication rate was 1.9%. There were 41 intraoperative femur fractures including 29 calcar fractures, 9 greater trochanter fractures and 3 femoral shaft fractures. There were 7 postoperative femur fractures including 3 greater trochanter fractures, 2 calcar fractures, and 2 femur fractures. Other complications included 15 superficial infections, 5 deep infections, 12 dislocations, 8 hematomas, 3 cases of cellulitis, 2 sciatic nerve palsies, 1 peroneal nerve palsy, and intrapelvic bleed. The nonsurgical complication rate was 1.4%. Deep vein thrombosis occurred in 0.3% of cases. CONCLUSION: This large multicenter study of consecutive AA THAs demonstrates an acceptable risk profile within the first 90 days after surgery.

Ten Year Follow-Up of Gap Balanced, Rotating Platform Total Knee Arthroplasty in Patients Under 60 Years of Age.

68 patients (91 primary total knee arthroplasties) were evaluated at a mean 10-year, minimum 5 year follow up in patients younger than sixty years of age utilizing the gap balanced, rotating platform design. Follow up assessment included implant survivorship, adverse events, x-rays, Knee Society rating system and clinical evaluation. Three revisions were performed with only one for aseptic loosening at 45 months. Two manipulations were performed in the early postoperative period. Survivorship of the rotating platform, gap balanced knee was 96.7% using surgical revision for any reason and 98.9% using aseptic loosening as endpoints. The rotating platform design using the gap balancing technique in young patients had excellent survivorship at 10-year mean follow up.

Femoral Component Revision Using a 2nd Generation Modular Femoral Implant.

The purpose of this prospective multicenter study was to evaluate results of 122 revision THAs using a 2nd generation modular femoral implant in 120 patients. Majority of cases had significant femoral bone loss. HHS improved from a pre-operative mean score of 46 to 88 points, and SF-36 scores improved from 31 to 44 points at 2- to 5-year follow-up. There were 18 cases of intraoperative fractures of which 10 were femur shaft, 7 trochanteric, and 1 acetabular. Dislocation incidence was 9% and overall survivorship at 5 years was 97%. Use of modular femoral implants provides versatility and simplification to restore stability, limb length and offset in patients undergoing femoral component revision, Additional steps need to be undertaken to minimize incidence of fracture and dislocation.

Day of surgery discharge after unicompartmental knee arthroplasty: an effective perioperative pathway.

Day of surgery (DOS) discharge after unicompartmental knee arthroplasty (UKA) allows for safe, efficient care of the appropriately selected patient. Refinement of our perioperative pathway over the last decade has allowed for successful DOS discharge of 160 consecutive patients. The cohort averaged 65 years and American Society of Anesthesiology class was 1-3 (mean, 1.8). Perioperative pain control included a preoperative single shot femoral nerve block. Mean recovery room time was 121 (SD = 37) minutes. No patient required overnight admission for uncontrolled pain or nausea. Significant improvements in Knee Society Clinical Rating System (KSCRS) scores and high patient satisfaction were observed. This study details critical components of our simple perioperative pathway that can be utilized to safely perform UKA with discharge on the DOS.

Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty: short term results.

Stepped porous titanium metaphyseal sleeves may provide an option for enhanced fixation in managing challenging tibial defects in revision total knee arthroplasty (TKA). We retrospectively reviewed data on 51 patients who underwent revision TKA utilizing a metaphyseal sleeve for Anderson Orthopaedic Research Institute (AORI) Type II and III tibial defects between June 2007 and July 2011. Of these 51 patients, 36 patients had complete clinical and radiographic data. At final follow-up (mean: 38 months) significant improvements in knee range of motion and Knee Society scores were observed postoperatively (P < 0.001). Four revision procedures were necessary, but none for aseptic implant fixation failure. Radiographic review at final follow-up revealed stable, osteointegrated components without component migration or clinically significant osteolysis. Metaphyseal sleeve use in the management of moderate to severe tibial defects in revision TKA resulted in satisfactory clinical outcomes and is a versatile option for achieving stable fixation.

Deaf Weight Wise: A novel randomized clinical trial with Deaf sign language users.

OBJECTIVE: The goal of this study was to address the absence of evidence-based weight-control programs developed for use with Deaf people. METHODS: Community-based participatory research informed the design of the Deaf Weight Wise (DWW) trial and intervention. DWW focuses primarily on healthy lifestyle and weight through change in diet and exercise. The study enrolled 104 Deaf adults aged 40 to 70 years with BMI of 25 to 45 from community settings in Rochester, New York, and randomized participants to immediate intervention (n = 48) or 1-year delayed intervention (n = 56). The delayed intervention serves as a no-intervention comparison until the trial midpoint. The study collected data five times (every 6 months) from baseline to 24 months. All DWW intervention leaders and participants are Deaf people who use American Sign Language (ASL). RESULTS: At 6 months, the difference in mean weight change for the immediate-intervention arm versus the delayed-intervention arm (no intervention yet) was -3.4 kg (multiplicity-adjusted p = 0.0424; 95% CI: -6.1 to -0.8 kg). Most (61.6%) in the immediate arm lost ≥5% of baseline weight versus 18.1% in the no-intervention-yet arm (p < 0.001). Participant engagement indicators include mean attendance of 11/16 sessions (69%), and 92% completed 24-month data collection. CONCLUSION: DWW, a community-engaged, culturally appropriate, and language-accessible behavioral weight loss intervention, was successful with Deaf ASL users.

Experiences of Sign Language Interpreters and Perspectives of Interpreting Administrators During the COVID-19 Pandemic: A Qualitative Description.

OBJECTIVE: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. METHODS: From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. RESULTS: We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. CONCLUSIONS: The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health.

Mindful practice with medical interpreters.

Introduction: Medical interpreters experience emotional burdens from the complex demands at work. Because communication access is a social determinant of health, protecting and promoting the health of medical interpreters is critical for ensuring equitable access to care for language-minority patients. The purpose of this study was to pilot a condensed 8-h program based on Mindful Practice® in Medicine addressing the contributors to distress and psychosocial stressors faced by medical sign and spoken language interpreters. Methods: Using a single-arm embedded QUAN(qual) mixed-methods pilot study design, weekly in-person 1-h sessions for 8 weeks involved formal and informal contemplative practice, didactic delivery of the week's theme (mindfulness, noticing, teamwork, suffering, professionalism, uncertainty, compassion, and resilience), and mindful inquiry exercises (narrative medicine, appreciative interviews, and insight dialog). Quantitative well-being outcomes (mean±SEM) were gathered via survey at pre-, post-, and 1-month post-intervention time points, compared with available norms, and evaluated for differences within subjects. Voluntary feedback about the workshop series was solicited post-intervention via a free text survey item and individual exit interviews. A thematic framework was established by way of qualitative description. Results: Seventeen medical interpreters (46.2 ± 3.1 years old; 16 women/1 man; 8 White/9 Hispanic or Latino) participated. Overall scores for teamwork (p ≤ 0.027), coping (p ≤ 0.006), and resilience (p ≤ 0.045) increased from pre- to post-intervention and pre- to 1-month post-intervention. Non-judging as a mindfulness component increased from pre- to post-intervention (p = 0.014). Compassion satisfaction (p = 0.021) and burnout (p = 0.030) as components of professional quality of life demonstrated slightly delayed effects, improving from pre- to 1-month post-intervention. Themes such as workshop schedule, group size, group composition, interactivity, topics to be added or removed, and culture are related to the overarching topic areas of intervention logistics and content. Integration of the findings accentuated the positive impact of the intervention. Discussion: The results of this research demonstrate that mindful practice can serve as an effective resource for medical interpreters when coping with work-related stressors. Future iterations of the mindful practice intervention will further aspire to address linguistic and cultural diversity in the study population for broader representation and subsequent generalization.