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Introduction: This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. Methods: A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. Results: In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9–98.5) and 97.0% (95% CI, 95.6–98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09–1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. Conclusions: The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome. [ABSTRACT FROM AUTHOR]

Background: Late‐gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS), but available studies had small sample sizes and did not consider all relevant endpoints. Objective: To evaluate the association between LGE on CMR in patients with CS and mortality, ventricular arrhythmias (VA) and sudden cardiac death (SCD), and heart failure (HF) hospitalization. Methods: A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints were mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow‐up duration was 1 year. Results: A total of 17 studies and 1915 CS patients (595 with LGE vs. 1320 without LGE) were included; mean follow‐up was 3.3 years (ranging between 17 and 84 months). LGE was associated with increased all‐cause mortality (OR 6.05, 95% CI 3.16–11.58; p <.01), cardiovascular mortality (OR 5.83, 95% CI 2.89–11.77; p <.01), and VA and SCD (OR 16.48, 95% CI 8.29–32.73; p <.01). Biventricular LGE was associated with increased VA and SCD (OR 6.11, 95% CI 1.14–32.68; p =.035). LGE was associated with an increased HF hospitalization (OR 17.47, 95% CI 5.54–55.03; p <.01). Heterogeneity was low: df = 7 (p =.43), I2 = 0%. Conclusions: LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization. Biventricular LGE is associated with an increased risk of VA and SCD. [ABSTRACT FROM AUTHOR]

Insufficient research has compared the impact of subtle and overt discrimination on somatic symptom disorder (SSD) among young adults with immigrant backgrounds in South Korea, a country that is becoming increasingly racially and ethnically diverse. Therefore, this study sought to examine this. A cross-sectional survey was conducted in January 2022 involving 328 young adults aged 25 to 34 years who had at least one foreign-born parent or were foreign-born immigrants. We used ordinary least squares (OLS) regression with SSD as the dependent variable. The results showed that subtle and overt discrimination were positively associated with SSD among young immigrant adults. Subtle discrimination seems more strongly related to SSD among Korean-born immigrant adults (N = 198) than foreign-born immigrant young adults (N = 130). This result partially supported the theory that both forms of discrimination were differently related to increased SSD tendencies by place of birth. [ABSTRACT FROM AUTHOR]

Background: Preoperative planning is a fundamental step for successful total hip arthroplasty (THA). Studies have highlighted the accuracy of preoperative digital templating for estimating acetabular cup and stem size. Stem design such as single-wedge metadiaphyseal (Type 1 stem) versus mid-short stem (microplasty) and surgical approach (anterior, direct lateral or posterior) have not been well investigated as predictors of THA templating accuracy. Methods: 204 patients (220 hips) who had undergone elective THA between November 2016 and December 2019 and presented a saved preoperative template were retrospectively reviewed. Templates from 5 different surgeons were involved in the analysis. 3 different approaches were used: direct lateral (DL), posterior (PA), direct anterior (DAA). 2 different stem designs were used: single-wedge metadiaphyseal and single-wedge mid-short (Biomet Taperloc Microplasty), while the acetabular component remained the same. Bivariate and multivariate regression analyses were performed to determine predictors of accuracy. Results: Femoral component size templating accuracy was significantly improved when using the single-wedge mid-short stem (Taperloc Microplasty) design when performing bivariate analysis. Although accuracy of cup sizing was not affected by approach, precision was significantly better in the PA group (p < 0.05). Accuracy of templating was found to be independent of BMI and gender but dependent on presence of calibration marker and stem design (p < 0.05). Conclusions: When striving for improved templating accuracy, acetabular and femoral component accuracy were best achieved using a calibration marker and a metaphyseal short femoral stem design. [ABSTRACT FROM AUTHOR]

Objectives: Use of acute care telemedicine is growing, but data on quality, utilization, and cost are limited. We evaluated a Veterans Affairs (VA) tele–emergency care (tele‐EC) pilot aimed at reducing reliance on out‐of‐network (OON) emergency department (ED) care, a growing portion of VA spending. With this service, an emergency physician virtually evaluated selected Veterans calling a nurse triage line. Methods: Calls to the triage line occurring January–December 2021 and advised to seek care acutely within 24 h were included. We described tele‐EC user characteristics, common triage complaints, and patterns in referral to and management by tele‐EC. The primary outcome was acute care visits (ED, urgent care, and hospitalizations at VA and OON sites) within 7 days of the index call. Secondary outcomes included mortality, OON acute care spending, and the effect of tele‐EC visit modality (phone vs. video). We used both standard regression and instrumental variable (IV) analysis, using the tele‐EC physician schedule as the instrument. Results: Of 7845 eligible calls, 15.5% had a tele‐EC visit, with case resolution documented in 57%. Compared to standard nurse triage, tele‐EC users were less likely to be Black, had more prior ED visits, and were triaged as higher acuity. Calls concerning dizziness/syncope, blood in stool, and chest pain were most likely to have a tele‐EC visit. Tele‐EC was associated with fewer ED visits than standard nurse triage in both regression (average marginal effect [AME] −16.8%, 95% confidence interval [CI] −19.2 to −14.4) and IV analyses (AME −17.5%, 95% CI −25.1 to −9.8), lower hospitalization rate (AME −3.1%, 95% CI −6.2 to −0.0), and lower OON spending (AME –$248, 95% CI −$458 to −$38). Conclusions: Among Veterans initially advised to seek care within 24 h, use of tele‐EC compared to standard phone triage led to decreased ED visits, hospitalizations, and OON spending within 7 days. [ABSTRACT FROM AUTHOR]

Background: To investigate the clinical safety and efficacy of ViBone® Viable Bone Matrix (VBM), a next generation cellular bone matrix allograft that comprises all three essential bone-forming components: osteogenic, osteoinductive, and osteoconductive factors, and is optimized to enhance cell viability and bone formation. Methods: This was a multi-center, prospective, post-market study evaluating the safety and efficacy of ViBone VBM in patients undergoing 1–3 level anterior cervical discectomy and fusion or lumbar interbody fusion surgery. Patients were evaluated at baseline, 6-month, and 12-month follow-up clinically and radiographically. Clinical assessment included Visual Analog Scale for pain (VAS-pain), the Neck Disability Index (NDI) for patients with cervical pathologies, and the Oswestry Disability Index (ODI) for patients with lumbar pathologies. Fusion success defined by an independent radiologist was determined radiographically by plain films. Results: Clinical outcomes evaluated with VAS-pain, NDI, and ODI scales were improved significantly at 6 and 12 months compared to baseline. All patients reached clinically significant improvements at 12 months. There were no adverse events or infections attributed to ViBone VBM. At 12 months, the fusion rate per patient was 88.1% in cervical and 97.6% in lumbar patients, while per-level fusion was 98.5% for cervical and 100% for lumbar segments. Conclusions: Patients undergoing cervical and lumbar spinal fusion implanted with ViBone VBM demonstrated favorable outcomes at 6 months and 12 months as measured by subjective clinical measures and radiographic fusion rates. Trial registration This study was registered as NCT03425682 on 1/29/2018. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cancer care is described as insufficiently patient-centered, requiring improved accessibility and coordination. Breast oncology nurse navigators may help provide timely patient care by improving care coordination. OBJECTIVES: This study evaluated a breast cancer navigation (BCN) program in a large ambulatory healthcare system. It examined measures related to quality and value, including timely service delivery, appropriate use of resources, and care coordination. METHODS: Using Lean methods, a BCN program focused on women receiving a breast biopsy was developed at a pilot site and later implemented throughout the healthcare system. Study data evaluated timely disclosure of biopsy results, prompt scheduling of initial consultations, outpatient use of cancer specialists, and coordination between primary care and oncology practices. FINDINGS: After implementing the BCN program, more timely biopsy results were delivered to patients. Patients were more likely to complete an initial consultation within two weeks of biopsy and made fewer outpatient visits. Referrals to cancer specialists within a month of biopsy increased, and primary care encounters with patients decreased. [ABSTRACT FROM AUTHOR]

An economic model was developed to estimate the cost of negative pressure wound therapy with instillation and dwelling of a topical wound solution vs control therapies. Economic model inputs were means derived from the results of a recently published systematic review and meta‐analysis of 13 comparative studies of negative pressure wound therapy with instillation. Means across studies comprising complex acute and chronic wounds for negative pressure wound therapy‐instillation vs control (negative pressure wound therapy without instillation, gauze dressings, or gentamicin polymethylmethacrylate beads) groups were 1.77 vs 2.69 operating room visits (P =.008) and 9.88 vs 21.80 therapy days (P =.02), respectively. These inputs plus hospital cost data were used to model costs for the United States, Germany, and the United Kingdom. For the United States, Germany, and United Kingdom, respectively, economic model estimates of total potential per patient savings were $33 338, €8467, and £5626 for negative pressure wound therapy‐instillation group vs control, based on assumed number of OR visits during therapy, cost of therapy system, and length of therapy. Model results showed an overall potential cost‐savings with negative pressure wound therapy‐instillation vs control, based on fewer OR visits and shorter therapy duration as reported in the published systematic review and meta‐analysis. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) in patients younger than 50 years poses significant challenges including postoperative limitations of activity and higher failure rates. Sub-par outcomes of hip resurfacing arthroplasty (HRA) in registries remain controversial due to multiple confounders. Favourable HRA results in some studies are often regarded as irreproducible. The aim of this study is to analyse HRA outcomes in a large international cohort. Patients and methods: We compiled a database of 11,382 HRA patients ⩽50 years from an international group of 27 experienced HRA centres from 13 countries. 18 different metal-on-metal (MoM) HRA designs were included with a mean follow-up of 7.6 years. Outcomes were implant survivorship, revision rates, causes for revision, clinical scores and metal ion levels. Outcomes were compared between genders, sizes, implant types and pre-operative diagnoses. Results: Overall cumulative Kaplan-Meier survivorship was 88.9% at 22 years (95% CI: 88.3–89.5%). 2 HRA designs (DePuy Articular Surface Replacement (ASR), and Corin Cormet Hip Resurfacing System (CORMET)) led to inferior results while all others yielded similar survivorships. Excluding ASR and CORMET, implant survivorship in 11,063 cases was 95% at 10 years and 90% at 22 years. In men, implant survivorship was excellent: 99% at 10 years and 92.5% at 21 years. In females, implant survivorship was 90% at 10 years and 81.3% at 22 years. The overall revision rate was 3.6% with most common reasons for revision being implant loosening and adverse local tissue reactions. The best survivorship was found in patients with osteoarthritis (95% CI, 92.1–93.3% at 22 years), the poorest was among dysplastic hips (78.3%; 95% CI, 76.5–80.1% at 20 years, p < 0.001). Conclusions: Comparable revision rates demonstrated here may mitigate some concerns for safety and longevity of MoM HRA implants. Higher demands for activity and functionality in younger patients make HRA a potential alternative to THA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patient navigators can improve patient experiences of care and outcomes, but little is known about how navigation programs may affect physician workflows and experience. OBJECTIVES: This study aimed to understand patient and physician experiences with a breast cancer navigation (BCN) program using Lean design principles. METHODS: Surveys were developed and distributed from 2019 to 2020 to 255 patients diagnosed with breast cancer and 128 physicians in primary care and cancer-related specialties. Descriptive analyses were conducted. FINDINGS: Eighty-three physicians and 94 patients completed the survey. A large majority of physicians reported that the BCN program "made their day easier" and improved flow, care coordination, and patient experience. A large majority of patients reported receiving the right level of support during diagnosis communication and high satisfaction in other domains measured. [ABSTRACT FROM AUTHOR]

Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two‐table set‐up of sterile instruments, in addition to glove exchange, to reduce instrument cross‐contamination during these procedures. This is a prospective, single‐site, institutional review board‐approved observational study of surgical debridements of infected wounds over a 17‐month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set‐up) and Table B for wound coverage/closure (clean set‐up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P =.001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two‐table set‐up reduced instrument cross‐contamination by 78%, suggesting avoidable re‐contamination of the wound. [ABSTRACT FROM AUTHOR]

There is a paucity of quantitative measures of microvascular perfusion values in the skin. Newly developed, handheld hyperspectral imaging devices identify unique spectral fingerprints of oxygenated and deoxygenated haemoglobin in the superficial microvasculature. Establishing value ranges for healthy patients without vascular complications will subsequently help standardise assessments for perfusion defects. In particular, diabetics who are prone to vascular calcifications and lower extremity wounds may benefit. A total of 73 subjects were enrolled in the study and split in two cohorts: 36 'non‐diabetic' non‐vascularly compromised patients and 37 'diabetic' patients with a formal diagnosis of diabetes but without history of pedal ulceration. Values of oxygenated haemoglobin (HT‐Oxy) and deoxygenated haemoglobin (HT‐DeOxy) from both devices are analysed. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to determine the effect of positive bacterial cultures at the time of closure on dehiscence rates. Pre- and post-débridement wound cultures from patients undergoing serial surgical débridement of infected wounds were compared with outcomes 30 days postoperatively. One-hundred patients were enrolled; 35 were excluded for incomplete culture data. Sixty-five patients were evaluated for species counts, including Coagulase negative Staphylococcus (CoNS), and semiquantitative culture data for each débridement. The post-débridement cultures on the date of closure had no growth in 42 patients (64.6%) of which 6 dehisced (14.3%), and 36 remained closed; with no statistically significant difference in dehiscence rates ( p = 0.0664). Pre-débridement cultures from the 1st débridement of the 65 patients showed 8 patients had no growth, 29 grew 1 species, 19 grew 2 species, and 9 had 3-5 species. There was a reduction in the number of species and improvement of semiquantitative cultures with each subsequent débridement. The dehiscence rate for those who had 2 débridements ( n = 42) was 21.4% at 30 day follow-up and 21.7% in those who had 3 débridements ( n = 23). The number of débridements had no statistical significance on dehiscence rates. The presence of CoNS on the day of closure was a statistically significant risk for dehiscence within 30 days ( p = 0.0091) postoperatively. This data demonstrates: (1) positive post-débridement cultures (scant/rare, growth in enrichment broth) at the time of closure did not affect overall dehiscence rates ( p = 0.0664), (2) the number of species and semiquantitative culture results both improved with each subsequent débridement, (3) the number of surgical débridement did not influence postclosure dehiscence rates. (4) Positive cultures containing CoNS at the time of closure is a risk factor for dehiscence ( p = 0.0091). [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the frequency of changes in patient care resulting from the use of a surgical safety checklist. Data were retrospectively obtained from 233 patients. The number and types of changes made to the patients' intra-operative management, based on the use of the checklist, were recorded. The number of patients whose management was modified as a result of the checklist was 113 (48%) out of 233. The total number of changes made was 132, and 18 patients had more than one modification made to their care plan. Further stratification was identified: among the 132 changes made, antibiotics were held or administered in 73 (55%), changes related to anaemia involving type and screen or transfusion occurred in 27 (20%), modifications made regarding anti-coagulation occurred in 8 (7%), beta-blockers were held in 2 (2%), an allergy was identified in 7 (5%), modifications made to the surgical procedure were 3 (2%) and a category labelled 'other' encompassed 9 (7%) changes. The surgical safety checklist is a standardised form of team communication that leads to modifications of the patient care plan in a large percentage of cases. The ever-increasing complexity of medicine means that patients are at greater risk of oversight and harm without the use of a checklist. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the efficacy of three off-loading techniques to heal diabetic foot wounds: total contact casts ( TCCs), healing sandals ( HSs) and a removable boot with a shear-reducing foot bed ( SRB). This was a 12-week, single-blinded randomised clinical trial with three parallel treatment groups of adults with diabetes and a foot ulcer ( n = 73). Ulcer healing was defined as full reepithelialisation with no drainage. Diabetic patients with grade UT1A or UT2A forefoot ulcers on the sole of the foot were enrolled. Patients with malignancy, immune-compromising diseases, severe peripheral vascular disease (ankle-brachial index < 0·60 or transcutaneous oxygen < 25 mm/Hg), alcohol or substance abuse within 6 months, untreated osteomyelitis or Charcot arthropathy with residual deformity that would not fit the HS or boot were excluded. In the intent-to-treat analysis, significantly higher proportion of patients were healed in the TCC group (69·6%) compared to those treated with the SRB (22·2%, P < 0·05). There was no difference in the rate of healed ulcers in the HS (44·5%) and TCC groups. Ulcers in the TCC group healed faster than those in the HS group (5·4 ± 2·9 versus 8·9 ± 3·5 weeks, P < 0·02). However, there was no difference in the time to healing in the TCC and SRB groups (6·7 ± 4·3 weeks, P = 0·28). Patients who used HS were significantly more active (4022 ± 4652 steps per day, P < 0·05) than those treated with TCCs (1447 ± 1310) or SRB (1404 ± 1234). It is concluded that patients treated with TCCs had the highest proportion of healed wounds and fastest healing time. The novel shear-reducing walker had the lowest healing and highest rate of attrition during the study. [ABSTRACT FROM AUTHOR]

The authors examined the moderating role of positive and negative religious coping in the relation between racism and psychological well-being in a sample of Catholic and Protestant Asian American college students (N = 107). On the basis of prior theorizing on the 2 types of religious coping, combined with some limited empirical evidence, they predicted that positive religious coping would have a buffering effect (Hypothesis 1) on the racism-mental health relation and that negative religious coping would have an exacerbating effect (Hypothesis 2). Participants completed an online survey containing measures corresponding to the study variables. Results indicated that the interaction between positive religious coping and racism was nonsignificant, so Hypothesis 1 was not supported. For Hypothesis 2, the negative religious coping and racism interaction term was statistically significant, but the moderating effect was in an unexpected direction, such that negative religious coping actually protected against the deleterious impact of racism on mental health. The findings suggest that the theorized deleterious influence of negative religious coping may need to be reconsidered in an Asian American setting. The findings have the potential to inform practitioners who work with Asian American college students to better cope with the detrimental consequences of racism. [ABSTRACT FROM AUTHOR]

Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. [ABSTRACT FROM AUTHOR]

Infected foot wounds are one of the most common reasons for hospitalization and amputation among persons with diabetes. The objective of the study was to investigate a new wound therapy system that employs negative pressure wound therapy ( NPWT) with simultaneous irrigation therapy. For this study, we used a porcine model with full-thickness excisional wounds, inoculated with Pseudomonas aeruginosa. Wounds were treated for 21 days of therapy with either NPWT, NPWT with simultaneous irrigation therapy using normal saline or polyhexanide biguanide ( PHMB) at low or high flow rates, or control. Data show that NPWT with either irrigation condition improved wound healing rates over control-treated wounds, yet did not differ from NPWT alone. NPWT improved bioburden over control-treated wounds. NPWT with simultaneous irrigation further reduced bioburden over control and NPWT-treated wounds; however, flow rate did not affect these outcomes. Together, these data show that NPWT with simultaneous irrigation therapy with either normal saline or PHMB has a positive effect on bioburden in a porcine model, which may translate clinically to improved wound healing outcomes. [ABSTRACT FROM AUTHOR]

A proactive employer-sponsored mental health program facilitated linkage to mental health services and prescription medications among participants who connected with a care concierge. Objective: The aim of this study is to determine if a proactive employer-sponsored mental health program closed gaps in detection and treatment of mental health conditions. Methods: Of n = 56,442 eligible, n = 8170 (14.5%) participated in the optional screening. Participants with mental health risk were offered care concierge services including support, care planning, and connection to care. Difference in behavioral health care utilization, diagnoses, and prescriptions were evaluated postintervention through claims analysis. Results: Compared with controls (n = 2433), those receiving concierge services (n = 369) were more likely to fill mental health prescriptions (adjusted hazards ratio [HR], 1.2; 1.0–1.5; P = 0.042), use professional mental health services (adjusted HR, 1.4; 1.1–1.8; P = 0.02), and use new mental health services (adjusted HR, 1.9; 1.2–2.8; P = 0.004) in the following 6 months. Conclusions: This proactive mental health program with care concierge services identified risk, connected individuals to mental health care, and facilitated mental health treatment, among program participants. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a proactive, voluntary screening program designed to identify employees with emerging mental health risk and engage them in care. Methods: Risk was proactively identified through online screening of 344 participants. At-risk participants were offered a mental health care concierge to provide support, develop a care plan, and connect to care. Results: Risk for common mental health conditions was identified in 244 (71%) participants, of whom 66 (27%) connected with a care concierge. Compared with participants who did not connect to a care concierge, those who did were more likely to report a financial crisis (68.2% vs 50.8%) and less likely to report verbal abuse (9.1% vs 19.6%) and difficulty meeting daily needs (12.1% vs 25.1%). Conclusion: Implementation of this screen- ing program identified employees at risk for mental health conditions and facilitated connection to care. [ABSTRACT FROM AUTHOR]