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Osteochondral lesions of the talus (OLTs) are difficult to treat. Despite a multitude of interventions, there are no generally-agreed-upon guidelines regarding treatment. The objective of this study was to conduct a systematic review of clinical outcomes after fresh osteochondral allografts transplantation of the talus. PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes after fresh osteochondral allograft transplantation for OLTs were included. Clinical outcomes, according to standardized scoring systems, such as the American Orthopaedics FootAnkle Society (AOFAS) Ankle/Hindfoot Scale and the Visual Analog Scale (VAS) were compared across studies. The literature search yielded 12 eligible studies with a mean Coleman Methodology Score of 68.1 (57-79). A total of 191 patients were included with an average age of 37.5 (17-74) years and average follow-up of 56.8 (6-240) months. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the studies and had significant improvements in each (p.05). Similarly, the VAS pain score was evaluated in 5 studies and showed significant decreases from pre- to postoperatively (p.05). While there were no reported short-term complications, 21.6% of patients required minor subsequent procedures, most commonly arthroscopic debridement and hardware removal. The aggregate graft survival rate was 86.6%. Based on these findings, osteochondral allograft transplantation for OLTs results in positive outcomes with high rates of graft survival and patient satisfaction at intermediate follow-up.

Study objective Accurate information about the mobility of independently living older adults is essential in determining whether they may be safely discharged home from the emergency department (ED). We assess the accuracy of self-reported ability to complete a simple mobility task among older ED patients. Methods This was a cross-sectional study of cognitively intact patients aged 65 years and older who were neither nursing home residents nor critically ill, conducted in 2 academic EDs. Consenting participants were asked whether they could get out of bed, walk 10 feet, turn around, and get back in bed without assistance, and if not, whether they could perform this task with a cane, walker, or assistance. Each participant was then asked to perform the task and was provided with a mobility device or assistance as needed. Results Of 272 patients who met eligibility criteria and answered the physical task question, 161 (59%) said they could do the task unassisted, 45 (17%) said they could do it with a cane or walker, 21 (8%) said they could do it with assistance, and 45 (17%) said they would be unable to do it even with assistance. Among those who said they could do the task either with or without assistance and who were subsequently willing to attempt the task (N=172), discrepancies between self-reported ability and actual performance were common. Of those who said they could perform the task without assistance, 12% required some assistance or were unable to complete the task. Of those who said they could perform the task with a cane or walker, 48% required either assistance or were unable to perform the task. Of those who said they could perform the task with assistance, 24% were unable to perform the task even with assistance. Conclusion In this sample of older adults receiving care in the ED, the accuracy of their self-reported ability to perform a simple mobility task was poor, particularly for those who reported some need for assistance. For older adults being considered for discharge who report a need for assistance with mobility, direct observation of the patient's mobility by a member of the emergency care team should be considered.

Study objective We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. Methods We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed with the Mini Nutritional Assessment Short-Form (0 to 14 scale), with malnutrition defined as a score of 7 or less and at risk for malnutrition defined as a score of 8 to 11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression–10 score of 4 or more (0 to 10 scale). Results Among 138 older adults, 16% (95% confidence interval [CI] 11% to 23%) were malnourished and 60% (95% CI 52% to 68%) were either malnourished or at risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously receiving a diagnosis of malnutrition. The prevalence of malnutrition was not appreciably different between men and women, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms (52%), those residing in assisted living (44%), those with difficulty eating (38%), and those reporting difficulty buying groceries (33%). Conclusion Among a random sample of cognitively intact older ED patients, more than half were malnourished or at risk for malnutrition, and the majority of malnourished patients had not previously received a diagnosis. Higher rates of malnutrition among individuals with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions.

Objectives The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain. Methods This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects. Propensity score matching was used to compare side effects among patients initiating treatment with any opioid-containing analgesics to side effects among those initiating treatment with only nonopioids. Results Of 104 older patients initiating analgesic treatment following ED visits for musculoskeletal pain, 71 patients took opioid-containing analgesics, 15 took acetaminophen, and 18 took ibuprofen. Among the patients who took opioids, at least one side effect of moderate or severe intensity (score ≥ 4) was reported by 62%. Among patients with matching propensity scores, those taking opioids were more likely to have had moderate or severe side effects than those taking only nonopioids (62%, 95% confidence interval [CI] = 48% to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%, 95% CI = 0% to 13%). The most common side effects due to opioids were tiredness, nausea, and constipation. Conclusions Among older adults initiating treatment with opioid-containing analgesics for musculoskeletal pain, side effects were common and sometimes resulted in medication discontinuation. Resumen Efectos Secundarios de los Opioides Orales Utilizados para Tratar el Dolor Agudo Musculoesqueletico en Adultos Mayores Durante la Primera Semana de Tratamiento Objetivos Describir la frecuencia de los efectos secundarios a corto plazo experimentados por los adultos mayores que inician tratamiento con un analgesico que contiene opioides para el dolor agudo musculoesqueletico. Metodologia Estudio transversal de sujetos de 65 anos o mas que iniciaron tratamiento analgesico tras una visita al servicio de urgencias (SU) por dolor agudo musculoesqueletico. Se contacto con los pacientes por telefono de 4 a 7 dias despues de la visita al SU para valorar la intensidad de los seis efectos secundarios mas frecuentes relacionados con los opiaceos usando una escala de 0 a 10. Se valoro la interrupcion de la medicacion debido a los efectos secundarios. Se utilizo el emparejamiento mediante puntuacion de propension (propensity store) para comparar los efectos secundarios entre los pacientes que inician el tratamiento con cualquier analgesico que contiene opioides y los efectos secundarios en aquellos que inician tratamiento unicamente con no opioides. Resultados De los 104 pacientes mayores que iniciaron tratamiento analgesico tras una visita al SU por dolor musculoesqueletico, 71 tomaron un analgesico que contenia opioides, 15 acetaminofeno y 18 ibuprofeno. Entre los pacientes que tomaron un opioide, al menos se documento un efecto secundario de intensidad moderada o grave (puntuacion ≥ 4) en el 62% de ellos. Entre los pacientes con emparejamiento mediante puntuaciones de propension, aquellos que tomaron opioides tuvieron mayor probabilidad de haber tenido un efecto secundario moderado o grave que aquellos que tomaron unicamente un no opioide (62%, intervalo de confianza [IC] 95% = 48% a 74% vs. 4%, IC 95% = 1% a 20%) y tambien tuvieron mayor probabilidad de haber interrumpido el tratamiento debido a los efectos secundarios (16%, IC 95% = 8% a 29% vs. 0%, IC 95% = 0% a 13%). Los efectos secundarios mas frecuentes debido a los opioides fueron cansancio, nauseas y estrenimiento. Conclusiones En los adultos mayores que inician tratamiento analgesico que contiene opioides para el dolor musculoesqueletico, los efectos secundarios fueron comunes y algunas veces llevaron a la interrupcion de la medicacion.

Objectives: To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week. Design: Cross-sectional study. Setting: Single academic emergency department. Participants: Individuals aged 65 and older with acute musculoskeletal pain. Measurements: Two components of shared decision-making were assessed: information provided to the patient about the medication choice and patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being �a lot� satisfied. Pain scores were assessed in the ED and at 1 week using a 0-to-10 scale. Results: Of 159 individuals reached by telephone, 111 met all eligibility criteria and completed the survey. Fifty-two percent of participants reported receiving information about pain medication options, and 31% reported participating in analgesic selection. Participants who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs 34%; P < .001). Participants who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs 43%; P = .008) and had a greater average decrease in pain score (4.1 vs 2.9; P = .05). After adjusting for measured confounders, participants who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs 38%; P = .04). Conclusion: Shared decision-making in analgesic selection for older adults with acute musculoskeletal pain may improve outcomes.