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Introduction: Vaginal cuff dehiscence (CD) after hysterectomy is a rare but serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH). The authors of this study aimed to compare the incidence and risk factors of CD following RLTH among patients with and without endometrial cancer., Methods: This retrospective study included women aged 18 years or older who underwent RLTH by two surgeons at a single institution from 2013 to 2018. Patients with conversion to laparotomy, recent chemotherapy or radiation, or non-uterine malignancy were excluded. Data were abstracted from medical records., Results: Of 950 patients meeting inclusion criteria, 50.7% had endometrial cancer. CD was reported in 2.5% of all patients. While adjusting for cancer status, age, sexual activity after surgery, distance from home to location of surgery, and time interval from surgery to loss to followup, obese patients were 25.1% less likely than non-obese patients to experience CD (62.5 vs. 37.5, p = 0.01). Surgeon A had a 2.8 times higher CD rate than surgeon B (70.8 vs. 29.2, p = 0.03). No other factors predicted CD., Conclusions: Endometrial cancer patients were not at greater risk of experiencing CD compared to non-cancer patients. Surgeon differences and body mass index (BMI) were associated with CD risk, with normal BMI patients at higher risk., (Copyright © 2024 Nichols, et al.)

Introduction: This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs., Methods: Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up., Results: Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation., Conclusions: The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury., (Copyright © 2024 Durler, et al.)

Introduction: The purpose of this study was to determine if augmentation of the helical blade with polymethylmethacrylate bone cement decreases the rates of varus cut-out and medial perforation in geriatric intertrochanteric hip fracture fixation., Methods: This was a retrospective comparative cohort study at two urban Level I trauma centers. Patients with an intertrochanteric hip fracture (classified as AO 31A1-3) who were treated with the TFN-Advanced Proximal Femoral Nailing System (TFNA) from 2018 to 2021 were eligible for the study. Medical records and post-operative radiographs were reviewed to determine procedure complications and reoperations., Results: Of the 179 patients studied, cement augmentation (CA) was used in 93 patients (52%) and no cement augmentation (NCA) was used in 86 (48%). There were no significant differences between group demographics and fracture reduction grades. Varus cut-out occurred three times in the CA group and five times in the NCA group (p = 0.48). Medial perforation occurred three times, all in the NCA group (p = 0.11). The most frequent complication was symptomatic blade lateralization from fracture collapse, with eight occurrences in the CA group compared with two in the NCA group (p = 0.10). There were 10 reoperations in the CA group and 9 in the NCA group (p = 0.99). The most common reason for reoperation was varus cut-out and the most common revision procedure was hip arthroplasty., Conclusions: Intertrochanteric hip fractures treated with the TFNA fixation system with and without cement augmentation have similar complication profiles and reoperation rates., (Copyright © 2024 Bianco, et al.)

Introduction: The topic of childhood vaccinations has become increasingly contentious, sparking debate, and creating challenging decisions for parents. This study aimed to explore the factors influencing COVID-19 vaccination decisions for parents of unvaccinated children and identify the most common reasons for not vaccinating children against COVID-19 in the U.S., Methods: Authors analyzed data from Phase 3.7, Week 53 of the United States Census Bureau's Household Pulse Survey (N = 68,504), collected from January 4 to January 16, 2023. Standard descriptive statistics and adjusted odds ratio (aOR) were used to analyze the data., Results: The top three reasons for vaccine hesitancy were concerns about side effects, lack of trust in the vaccine, and the perception that children in the household were not part of a high-risk group. Among respondents, nearly 87% (n = 59,363) reported receiving a COVID- 19 vaccination, and these individuals were more inclined to vaccinate their children across all age groups studied. Additionally, participants with higher levels of education (bachelor's degree or higher) were more likely to vaccinate their children against COVID-19 (aOR = 5.79; 95% CI, 5.43-6.17; p <0.001)., Conclusions: Findings from the study suggest that some parents are still concerned about the COVID-19 vaccine and are hesitant to vaccinate their children against the disease. Information and insights from this study allow for a greater understanding of how parents are making this decision nearly three years after the pandemic officially began. Further studies are needed to determine how other factors, such as geographical location, also may affect parental COVID-19 vaccination hesitancy., Competing Interests: Conflicting and Competing Interests: Samuel Ofei-Dodoo is the Editor-in-Chief for Kansas Journal of Medicine., (Copyright © 2024 Duncan, et al.)

Introduction: This study explored the connection between social determinants and patient self-rated health at Health Ministries Clinic (HMC) in a rural Kansas community. Community health centers, like HMC, strive to deliver comprehensive care that addresses patients' social needs., Methods: The authors employed a convenience sampling method to survey HMC patients with appointments from September to December 2018. The authors analyzed the data using Chi-square tests and descriptive statistics in RStudio, considering p <0.05 as significant., Results: Among 200 patient responses, education, income, employment, and insurance status were negatively correlated with self-rated health. Notably, 86.2% of college or graduate school graduates reported positive health ratings, compared to 40% of those who did not finish high school (χ 2 (12, N = 185) = 25.75, p = 0.012). Lower income individuals (income <$34,000 per year) consistently rated their health poorer than their higher income counterparts (χ 2 (12, N = 174) = 23.96, p = 0.021). Patients without insurance or with public insurance (Medicaid/ CHIP) perceived their health as worse than those on private health insurance and Medicare (χ 2 (12, N = 137) = 35.67, p <0.001)., Conclusions: Our findings suggest that low educational attainment, income, and lack of health insurance are associated with barriers to healthcare, resulting in poor health outcomes and chronic disease among those with lower socioeconomic status. This underscores the strong association between social determinants and self-rated health among HMC patients. These results can be used by other clinics to assess the needs of their patient population and enhance community health initiatives., (Copyright © 2024 Schmidt, et al.)

Introduction: Traumatic cardiac injury (TCI) poses a significant risk of morbidity and mortality, yet there is a lack of population-based outcomes data for these patients., Methods: The authors examined national yearly trends, demographics, and in-hospital outcomes of TCI using the National Inpatient Sample from 2007 to 2014. We focused on adult patients with a primary discharge diagnosis of TCI, categorizing them into blunt (BTCI) and penetrating (PTCI) cardiac injury., Results: A total of 11,510 cases of TCI were identified, with 7,155 (62.2%) classified as BTCI and 4,355 (37.8%) as PTCI. BTCI was predominantly caused by motor vehicle collisions (66.7%), while PTCI was mostly caused by piercing injuries (67.4%). The overall mortality rate was 11.3%, significantly higher in PTCI compared to BTCI (20.3% vs. 5.9%, χ 2 (1, N = 11,185) = 94.9, p <0.001). Additionally, 21.5% required blood transfusion, 19.6% developed hemopericardium, and 15.9% suffered from respiratory failure. Procedures such as heart and pericardial repair were more common in PTCI patients. Length of hospitalization and cost of care were also significantly higher for PTCI patients, W(1, N = 11,015) = 88.9, p <0.001)., Conclusions: Patients with PTCI experienced higher mortality rates than those with BTCI. Within the PTCI group, young men from minority racial groups and low-income households had poorer outcomes. This highlights the need for early and specialized attention from emergency and cardiothoracic providers for patients in these demographic groups., (Copyright © 2024 Mehta, et al.)

Introduction: Despite the groundbreaking research by Judet and Letournel in the 1960s, the specific equipment, surgical approach, fixation strategy, and post-operative course for treating acetabular fractures have not been standardized. Therefore, this study aimed to compare technological resources, operative procedures, and post-operative complications between patients treated for acetabular fractures in Romania and the United States (U.S.)., Methods: Between February 2011 and August 2018, a total of 116 Romanian patients and 373 U.S. patients underwent open reduction and internal fixation for acetabular fractures. Data were collected prospectively for Romania and retrospectively for the U.S. The authors used T-tests, Fisher's exact tests, and odds ratios to analyze categorical data while ordinal date were assessed using logistic regression., Results: U.S. patients had higher comorbidity rates for diabetes, obesity, and hypertension. However, the initial quality of reduction, graded with Matta's criteria, was similar between American and Romanian patients. Post-operatively, U.S. patients had significantly higher Brooker criteria scores for heterotopic ossification. Rates of deep vein thrombosis, infections, sciatic nerve lesions, and loss of reduction between the two countries were not significantly different., Conclusions: Given the similar initial reduction quality despite technological differences, the authors suggest that fundamental factors, such as surgeon training and experience, may have a greater impact than the availability of technologically advanced operative resources. Future research focusing on the efficacy of these advanced resources for acetabular fracture fixation could help determine their true impact on patient outcomes and improve the cost-effectiveness of this surgery., (Copyright © 2024 Dallman, et al.)

Introduction: Rural patients have greater need but less access to orthopedic surgical care than their urban counterparts. Previous studies have investigated rural surgical care, but this is the first to assess the Kansas orthopedic surgery workforce to identify changes over time and rurality and inform thinking about future workforce composition., Methods: The authors analyzed 2009 and 2019 AMA MasterFile and Area Health Resource File (AHRF) data. Using frequencies, percentages, and calculations of orthopedic surgeons per capita, we assessed workforce changes by rurality (Rural Urban Continuum Codes)., Results: The dataset included 307 orthopedic surgeons; 197 were in both 2009 and 2019. Of these, 165 were in active practice in 2009 and 244 in 2019, an increase of 79 (47.9%). Kansas had smaller proportions of surgeons in rural (non-metro) versus urban (metro) counties in both years. Orthopedic surgeons per capita grew throughout the state, but the increase was smaller in rural counties. There were 11 women orthopedic surgeons in both years, 3.6% of the total 307. Among the 197 surgeons in both years, four (2.0%) were women. No women orthopedic surgeons were in non-metro counties either year., Conclusions: Although the Kansas orthopedic surgery workforce grew from 2009 to 2019, rural Kansas remains a surgery desert based on orthopedic surgeons per capita. Further studies could determine whether this trend is similar to that in other rural states and how to attract orthopedic surgeons to rural practice., (Copyright © 2024 Hughes, et al.)

Introduction: A comprehensive definition of culture encompasses shared norms, beliefs, expectations, language, and customs, all of which are crucial considerations when working with patients with limited English proficiency (LEP). In this study, the authors examined how language, external influences, and patient-provider relational factors associated with decisional conflict in prenatal care patients., Methods: The authors conducted a cross-sectional study to assess decisional conflict related to postpartum contraception, elective induction, and newborn feeding methods. The survey included questions about demographics, communication methods, external influences, and provider trust, and was distributed to prenatal care patients who spoke either English or Spanish. Data analysis involved using descriptive statistics and chi-square analyses., Results: Out of the 23 respondents, 12 were Spanish-speaking and 11 were English-speaking. Spanish-speaking participants were less likely to have health insurance compared to English-speaking participants (χ 2 (1, N = 23) = 3.67, p = 0.016). There was no statistically significant difference in decisional conflict between English- and Spanish-speaking participants. Religion affected 11 of 23 participants' decisions, while partner expectations influenced 10 of 23 participants. Working with an interpreter and the quality of interpretation were crucial for Spanish-speaking individuals. Most participants (59%) felt that the provider's understanding of the patient's cultural background was important for decision-making., Conclusions: While there was no association between language discordance and decisional conflict, several factors influencing prenatal decision-making were identified. The use and quality of interpretation significantly affected decision-making and should be prioritized for patients with LEP. Religion and partner expectations were found to be highly influential in decision-making. Respondents also emphasized the importance of the provider's understanding of the patient's cultural background., (Copyright © 2024 Schelbar, et al.)

Introduction: The study goal was to understand telemedicine's role in improving access to rural specialty care. Other outcomes included assessing specialty availability and frequency of referrals at rural sites., Methods: This mixed methods study included surveys and semi-structured interviews of rural primary care physicians (PCPs). Survey data were analyzed with summary statistics and cross-tabulations. Interview transcripts were inductively thematically analyzed., Results: Of the 19 PCPs who completed the survey, 37% agreed/strongly agreed current telemedicine practices connected patients to better specialty care; 90% agreed/strongly agreed it had such potential. Interviews revealed telemedicine could improve care when local specialists were unavailable and provided the most benefit in acute care settings or specialist follow-ups. Most survey respondents reported outreach specialists were highly effective in addressing rural specialty care needs. Respondents reported cardiology, general surgery, orthopedic surgery, ENT/otolaryngology, and dermatology as the most frequently referred-to specialties. In-person neurology, gastroenterology, and dermatology were unavailable in many communities. Respondents identified psychiatry as a high priority for telemedicine and discussed clinic-to-clinic visits to optimize telemedicine use., Conclusions: The perceived discrepancy between the current and potential roles of telemedicine in rural specialty care suggests that telemedicine may not fully align with the needs of rural patients and could be optimized for rural practice settings. While local, in-person access to specialists remains a priority, telemedicine can reduce patient burdens and improve care when in-person specialists are unavailable. Telemedicine proponents can identify high-priority areas for implementation through quantitative assessment of specialty care utilization and access as reported by PCPs., (Copyright © 2024 Hampton, et al.)

Introduction: Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end-of-life counseling (EOLC) has proven to significantly reduce provider stress and burnout. The purpose of this study was to determine whether training in EOLC reduces levels of moral injury among transplant providers., Methods: This was a mixed methods study. We interviewed 10 patient participants and administered a survey to staff in the solid organ transplant department at the University of Kansas Health System. Respondents indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, we conducted semi-structured interviews with transplant providers, then performed inductive coding followed by thematic network analysis., Results: Thirty-seven percent (14/38) of respondents reported a moral injury score at or above the threshold for psychosocial dysfunction associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p = 0.362, power (1-β) = 0.842). Thematic network analysis demonstrated high-level themes of "challenges", "training", and "stress relief"., Conclusions: Our study demonstrated a concerning prevalence of moral injury among transplant staff and suggested that EOLC training did not significantly mitigate the threat of moral injury., (Copyright © 2023 David, et al.)

Introduction: This study aimed to assess the feasibility of evaluating the short-term and long-term effectiveness of a surgery residency prep course throughout the intern year., Methods: The authors offered a surgery residency prep course to graduating medical students. We used an anonymous survey to assess the perceived confidence in medical knowledge, clinical skills and surgical skills pre-course, post-course, and at six months into residency. Participants also completed a pre- and post-course quiz., Results: Eleven students completed the course and participated in a pre-course survey, seven completed the post-course survey, and four completed the six month survey. Students felt significantly more confident for intern year following the course compared to before the course (4.0 vs. 2.7, p = 0.018). There was no significant change in perceived confidence at six months compared to post-course results (4.0 vs. 3.9, p = 0.197). Objectively, there was a significant improvement in postcourse quiz results compared to pre-course quiz results (12.9 vs. 10.6, p = 0.004)., Conclusions: This study demonstrates that a surgery prep course may have long-term positive effects on resident confidence when entering a surgery residency., (Copyright © 2023 Crouch, et al.)

Introduction: JayDoc Free Clinic (JayDoc) serves medical needs of uninsured patients in the Kansas City metropolitan area. It is known that patients who have access to primary care are less likely to visit their local Emergency Department (ED) for non-emergent needs. However, it is not well described if JayDoc lowers usage of The University of Kansas Health System (TUKHS) ED. This is the first study to assess the patient referral process between TUKHS ED and JayDoc., Methods: The authors administered a voluntary survey to every patient triaged at JayDoc, even if they were ultimately not accepted for a visit. Items on the questionnaire included health insurance status, primary language, and access to a primary care physician. The authors included questions on the usage of TUKHS ED in the last 12 months., Results: Seventy-three patients completed the questionnaire. Approximately 10% of respondents reported they visited the ED in the last 12 months and received a referral to JayDoc from staff. However, authors observed no statistically significant difference in the proportion of new patients who used the ED in the last 12 months compared to that of returning patients., Conclusions: Results of this study demonstrated an existing referral system between JayDoc and TUKHS ED. However, the authors could not conclude that JayDoc reduces non-emergent ED visits among its patient population. Future initiatives will include further education to ED providers to increase the number of patients being referred to JayDoc., (© 2023 The University of Kansas Medical Center.)

Introduction: The purpose of this study was to assess gender-based mistreatment during medical education recalled by women who attended medical school between 1948 and 1975 and their perspectives on the #MeToo movement., Methods: Methods included a qualitative analysis of video-recorded structured interviews., Results: The 37 participants graduated in classes of 2-20% women. They described pervasive, multi-faceted gender-based mistreatment during training. Twenty (54%) disclosed personal experience of serious sexual mistreatment. Interviewees stressed that attitudes and behaviors toward women and trainees, now regarded as unacceptable, were previously widely accepted or tolerated. The majority (86%) expressed overall positive opinions of their training. Twenty-eight (76%) supported the #MeToo movement, four (11%) had negative opinions, and five (13.5%) were ambivalent or unwilling to comment. Seventeen (46%) were concerned that #MeToo damaged working relationships, twelve (32%) were concerned about overreach, and eight (22%) about false accusations., Conclusions: This group of older female physicians reported extensive experience of gender-based mistreatment and strong support of #MeToo. Nevertheless, about one quarter of the group did not support the #MeToo movement and even supporters expressed high rates of concern about the movement going too far, falsely accusing men of inappropriate behavior, and damaging working relationships. The interviewees did not want their medical training to be characterized as entirely negative, or to be portrayed as victims., (© 2023 The University of Kansas Medical Center.)

Introduction: Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy., Methods: This systematic review utilized PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through December 22, 2022. Key words used in the search included: "tranexamic acid," "TXA," "foot," "ankle," "calcaneal," and "surgery." The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour post-operative blood loss, blood loss from hour 24 to hour 48, post-operative hemoglobin (Hgb), and post-operative hematocrit [Hct]), as well as wound complications and vascular events. Meta-regression was included to assess the impact of age on between-study variation., Results: Ten studies met preliminary inclusion criteria. Upon further inspection, eight met full inclusion criteria for the meta-analysis. Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour post-operative blood loss (MD=-183.41 mL, 95% CI=-247.49 to -119.34 mL, p<0.001), increased post-operative hemoglobin (MD=0.71 g/dL, 95% CI=0.11 to 1.31 g/dL, p=0.020) and hematocrit (MD=2.66%, 95% CI=0.07 to 5.24%, p=0.040) when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications. Meta-regression indicated no clinically relevant association of age to between-study variation., Conclusions: TXA was found to be a safe treatment that did affect wound healing or infection rates while decreasing perioperative blood loss. Further research should be performed to evaluate the long-term effects of TXA administration on patient outcomes after foot and ankle surgery., Competing Interests: Conflicts of Interest: Dr. Damon Mar has served as a consultant for Agada Medical and Texas Back Institute. Dr. Bryan Vopat has served as a consultant for Artelon and holds a role within the American Orthopaedic Foot and Ankle Society., (© 2023 The University of Kansas Medical Center.)

Objective: A literature review was completed to outline the effects of xylazine on the pregnant patient while raising awareness of the increasing prevalence of opioid use disorder in pregnancy and the increase in adulterants in non-prescribed controlled substances., Data Sources: PubMed and Google Scholar were searched using the key words "xylazine, adulterant," "xylazine, humans," "xylazine, pregnancy," and "xylazine, placenta" to identify the studies evaluating xylazine's effects on humans and the pregnant patient., Study Selection: Studies were included if they provided information on symptoms of xylazine exposure, the prevalence of xylazine in pregnant humans and the hemodynamic effects of xylazine on both human and animal pregnant populations. Animal studies were included given the limited data on xylazine in pregnant humans. Four studies were utilized for background data and five studies were included in the final review of the effects of xylazine on pregnancy., Results: Studies involving humans show that xylazine toxicity can cause respiratory depression, bradycardia, and central nervous system depression. There is evidence of xylazine in human umbilical cord tissue, showing that the fetus is exposed to xylazine. Animal studies show decreased uterine blood flow, increased uterine vascular resistance, and decreased fetal growth in response to xylazine., Conclusions: Due to the limited studies on the effects of xylazine on pregnant populations, providers rely on animal studies for knowledge on xylazine's effects throughout pregnancy. Animal studies suggest an increased risk of adverse effects during pregnancy in response to xylazine. Future studies should focus on the pregnancy outcomes in patients exposed to xylazine to create more robust recommendations for treatment and pregnancy surveillance., (© 2023 The University of Kansas Medical Center.)

Introduction: Overuse injuries such as tendinosis are a common complaint at sports medicine clinics. When conservative management for tendinosis has failed, ultrasound-guided tendon fenestration and injection procedures, such as dry needling, needling tenotomy, autologous whole blood injections, and prolotherapy, can be utilized for treatment. This study examined the effectiveness of these procedures for pain improvement and ability to return to activity for patients with tendinosis., Methods: This study involved a chart review of patients 15 years or older who underwent at least one treatment for tendinosis at a sports medicine clinic between January 1, 2014 and April 17, 2019. Eligible patients had at least one of the following procedures: 1) percutaneous dry needling, 2) percutaneous needle tenotomy, 3) autologous whole blood injection, and/or 4) prolotherapy. A Current Procedural Terminology (CPT) code query was used to screen patient charts for study inclusion., Results: In total, 680 patients' data were reviewed, and 343 patients met inclusion criteria. Patients underwent a total of 598 unique procedures. Dry needling represented most procedures (62.8%, n = 375). Most patients reported diminished pain at follow up (73.0%, n = 268). Prolotherapy had the highest percentage among the follow up patients reporting diminished pain (81.0%, n = 17). Most patients were able to return to activity at follow-up (47.4%, n = 172). A greater proportion of patients with autologous whole blood injection were able to return to activity (60.7%, n = 85)., Conclusions: Most patients with tendinosis who underwent tendon fenestration or injection procedures reported diminished pain at follow-up. Autologous whole blood injection may be more likely to diminish patient pain and allow return to activity than other procedure types. More research is needed across all anatomical sites to compare the generalized effectiveness of these procedures., (© 2023 The University of Kansas Medical Center.)

Introduction: At home suture or staple removal can be stressful for patients and may lead some to seek out additional instruction via online resources as an adjunct to what was explained to them by their provider. The purpose of this study was to examine the existing online resources available to patients who may be interested in or have been instructed to remove sutures at home after a simple procedure, such as a skin biopsy or excision., Methods: A systematic search was conducted using internet search engines to identify videos and webpages targeting at home suture removal instruction. The DISCERN instrument was used to evaluate the information quality of each included resource., Results: There was no statistically significant difference between average DISCERN scores for videos and webpage resources, and the majority were rated poor in quality., Conclusions: The online resources for at home suture and staple removal were often not comprehensive and were below the standard quality for written information. Health care providers should consider referring their patients to validated online sources for suture removal to prevent misinformation and improve patient safety., (© 2023 The University of Kansas Medical Center.)

Introduction: Screening for adverse childhood experiences (ACEs) is a significant component of trauma informed care (TIC), as intervention can mitigate negative health outcomes. However, as few as 4% of physicians with pediatric patients screen and intervene for all ACEs. The authors of this study sought to: 1) understand resident physicians' perceptions of TIC; 2) identify areas of training needed to improve screening and intervention of ACEs., Methods: This descriptive study occurred in a large Midwestern Family Medicine residency and involved a convenience sample of 38 resident physicians. Participants completed a survey, which included a total of 22 Likert-scale and open-ended questions. Descriptive frequencies were used to represent Likert-scale responses, and the open-ended questions were analyzed utilizing a thematic analysis approach., Results: Participants identified screening for ACEs as useful. However, they reported a lack of confidence in their ability to screen and intervene. Barriers to screening and intervention also were noted and included lack of time, discomfort in assessment, perceived inability to help, insufficient knowledge and skills, and competing primary care recommendations., Conclusions: Family Medicine residents identified the screening and intervention of ACEs to be important. However, lack of confidence, competing primary care recommendations, and concern for receptiveness can deter residents from screening and intervention. Based on this study's findings, the authors recommend that graduate medical education focuses on building systems of training that provide learners with the knowledge, skills, and resources to routinely screen and intervene for ACEs in primary care., (© 2023 The University of Kansas Medical Center.)

Introduction: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration., Methods: A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure., Results: The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported., Conclusions: This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use., (© 2023 The University of Kansas Medical Center.)

Introduction: Encounters for preoperative assessments are common within primary care offices, so it is imperative that family medicine residents learn how to perform preoperative evaluations. We assessed family medicine residents' knowledge of preoperative evaluation in preparation for surgery by providing a pre- and post-test alongside a didactic seminar., Methods: A didactic seminar on preoperative evaluations was presented at a family medicine resident didactics session by two senior anesthesiology residents. A 16-question, multiple choice test was used as both a pre-test and post-test to assess family medicine residents' knowledge., Results: A total of 31 participants took the pre-test (residents = 24; medical students = 7), and 30 participants took the post-test (residents = 23; medical students = 7). Mean scores and standard deviations were calculated for both tests with an average score of 37.50% ± 10.58% and 45.42% ± 11.12% on the pre- and post-test, respectively. Using the Kruskal-Wallis test, residents showed a significant improvement in test scores following the didactic presentation (p = 0.041), while overall results (residents and medical students) also reported a significant difference (p = 0.004)., Conclusions: Our results demonstrated that educating family medicine residents and medical students on preoperative evaluation showed significant, quantifiable gains in knowledge following a brief didactic presentation. Given the current gap between guidelines and practice, our results emphasize the need for a formal medical school and residency-based curriculum related to preoperative patient evaluation., (© 2023 The University of Kansas Medical Center.)

Introduction: The COVID-19 pandemic impacted multiple aspects of surgical education. This survey delineates steps taken by general surgery residency programs to meet changing patient-care needs while continuing to provide adequate education., Methods: A survey was administered to program directors and coordinators of all United States general surgery residency programs to assess the early effects of the pandemic on residents from March 1 through May 31, 2020., Results: Of 303 programs contacted, 132 (43.6%) completed the survey. Residents were asked to work in areas outside of their specialty at 27.3% of programs. Residency curriculum was changed in 35.6% of programs, and 76.5% of programs changed their academic conferences. Resident schedules were altered at a majority of programs to limit resident-patient exposure, increase ICU coverage, or improve resident utilization. Surgical caseloads decreased at 93.8% of programs; 31.8% of those programs reported concerns regarding residents' achieving the minimum case numbers required to graduate., Conclusions: These results provided insight into the restructuring of general surgery residency programs during a pandemic and may be used to establish future pandemic response plans., (© 2023 The University of Kansas Medical Center.)

Introduction: Dementia increases the risk of polypharmacy. Timely detection and optimal care can stabilize or delay the progression of dementia symptoms, which may in turn reduce polypharmacy. We aimed to evaluate the change in polypharmacy use among memory clinic patients living with dementia who participated in a dementia care program compared to those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in standard care., Methods: We retrospectively analyzed data extracted from electronic medical records from a university memory clinic. Data from a total of 381 patients were included in the study: 107 in the program and 274 matched patients in standard care. We used adjusted odds ratios to assess the association between enrollment in the program and polypharmacy use at follow-up (five or more concurrent medications), controlling for baseline polypharmacy use and stratified polypharmacy use by prescription and over-the-counter (OTC)., Results: The two groups did not differ in the use of five or more overall and prescription medications at follow-up, controlling for the use of five or more of the respective medications at baseline and covariates. Being in the program was associated with a three-fold lower odds of using five or more OTC medications at follow-up (adjusted odds ratio = 0.30; p <0.001; 95% Confidence interval = 0.15-0.58) after controlling for using five or more OTC medications at baseline and covariates., Conclusions: Dementia care may reduce polypharmacy of OTC medications, potentially reducing risky drug-drug interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy., (© 2023 The University of Kansas Medical Center.)

Introduction: Recent research has focused on evaluating the impact of pharmalogical sources on fracture risk. The purpose of this study was to review the literature on anxiolytic medications that may be associated with an increased risk of fracture., Methods: A search was conducted in MEDLINE and Embase databases to identify primary clinical studies of patients who sustained a fracture while prescribed anxiolytic medications and were published prior to July 2021. Anxiolytics defined by ATC Class N05B, beta blockers, and zolpidem were included. The search terms consisted of variations of the following: ("Psychotropic Drugs" or MeSH terms) AND ("Fracture" or MeSH terms)., Results: Of 3,213 studies, 13 (0.4%) met inclusion criteria and were evaluated. Fractures associated with benzodiazepine were reported in 12 of 13 studies; the highest risk occurred in patients aged 60 years and older (RR=2.29, 95% CI (1.48-4.40)). The ATC Class N05B showed an increased fracture risk for those ≤ 55 years of age that differed by sex: for men (RR=5.42, 95% CI(4.86-6.05)) and for women (RR=3.33, 95% CI (3.03-3.66)). Zolpidem also showed an increase fracture risk (RR=2.29, 95% CI(1.48-3.56)), but only during the first four weeks of treatment. A relative risk of 0.77, 95% CI(0.72-0.83) was observed for beta blockers., Conclusions: Fractures are a mainstay of traumatic injuries and are accompanied by economical, physiological, and psychological hardship. With proper assessment and prophylactic measures, fracture risk can be reduced dramatically. Anxiolytic medications have been described widely to increase fracture risk, such as benzodiazepines in 60+ year old patients, and ATC Class N05B anxiolytics increased fracture risk in 55+ year old men and in 55+ year old women. Yet, some studies showed that at low doses, nitrazepam lowered fracture risk. Other anxiolytic medications, such as zolpidem and beta blockers, also showed a decrease in fracture risk. Ultimately, this scoping review helped to illuminate the inconsistency of anxiolytic fracture risk assessment while simultaneously illustrating the necessary steps to guide future research., (© 2023 The University of Kansas Medical Center.)