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Background: Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood. Purpose/Hypothesis: The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost <$50,000 per quality-adjusted life-year over 10 years. Study Design: Systematic review. Methods: A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure. Results: Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm2 to 36.0 for OCA of bipolar lesions. Failure rates ranged from <5% for osteochondral autograft for defects requiring 1 or 2 plugs to 46% for OCA of bipolar defects. All treatments were cost-effective over 10 years in the baseline model if costs were increased 50% or if failure rates were increased an additional 15%. However, if efficacy was decreased by a minimum clinically important amount, then ACI (periosteal cover) of femoral condylar lesions ($51,379 per quality-adjusted life-year), OCA of bipolar lesions ($66,255) or the patella ($66,975), and microfracture of defects >3 cm2 ($127,782) became cost-ineffective over 10 years. Conclusion: Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm2. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously. [ABSTRACT FROM AUTHOR]

Several studies comparing primate locomotion under lab versus field conditions have shown the importance of implementing both types of studies, as each has their advantages and disadvantages. However, three-dimensional (3D) motion capture of primates has been challenging under natural conditions. In this study, we provide a detailed protocol on how to collect 3D biomechanical data on primate leaping in their natural habitat that can be widely implemented. To record primate locomotion in the dense forest we use modified GoPro Hero Black cameras with zoom lenses that can easily be carried around and set up on tripods. We outline details on how to obtain camera calibrations at greater heights and how to process the collected data using the MATLAB camera calibration app and the motion tracking software DLTdv8a. We further developed a new MATLAB application "WildLeap3D" to generate biomechanical performance metrics from the derived x, y, z coordinates of the leaps. We provide details on how to collect data on support diameter, compliance, and orientation, and combine these with the jumps to study locomotor performance in an ecological context. We successfully reconstructed leaps of wild primates in the 3D space under natural conditions and provided data on four representative leaps. We provide exemplar data on primate velocity and acceleration during a leap and show how our protocol can be used to analyze segmental kinematics. This study will help to make motion capture of freely moving animals more accessible and help further our knowledge about animal locomotion and movement., (© 2024 The Author(s). Journal of Experimental Zoology Part A: Ecological and Integrative Physiology published by Wiley Periodicals LLC.)

Black men need safe spaces to express emotions free from bias and stigma. They have been underserved in emotional support due to systemic inequalities. Creating nurturing environments can empower Black men to heal from trauma. Stigma plays a crucial role in their reluctance to seek mental health treatment. This research uses a qualitative approach, combining an action research methodology with a generic qualitative inquiry. This study was conducted to answer the following research question: How can social workers and barbers collaborate to address the stigma of mental health treatment among Black men better? In this study, five social workers, five barbers, and five social work supervisors were interviewed to collect data for the study. Audio recordings were transcribed, and thematic analysis was used to analyze the interview data. Several key themes emerged: (a) collaboration strategies, (b) barbershops as safe spaces, (c) overcoming stigma, (d) cultural competence, and (e) challenges and barriers. The research study produced a pamphlet aimed at raising awareness of mental health stigma's impact on Black men. The implications for the study highlight that partnerships between social workers and barbers can play a pivotal role in dismantling stereotypes and barriers associated with mental health issues among Black men, fostering a cultural shift toward greater mental well-being, acceptance, and understanding.

Background: The utility and risks associated with the use of cervical collars in the postoperative period after cervical spine surgery have been of debate. The purpose of this study was to systematically review the currently available evidence on the use of cervical collars after cervical spine surgery to assess their impact on outcomes., Methods: A literature search of the PubMed database was performed using keywords "cervical collar," "anterior cervical discectomy and fusion (ACDF)," "posterior cervical decompression and fusion," "laminoplasty," "post-operative orthotic bracing," "cervical decompression," and "cervical orthosis" in all possible combinations. All English studies with the level of evidence of I to IV that were published from May 1, 1986, to December 3, 2023, were considered for inclusion., Results: A total of 25 articles meeting the inclusion criteria were identified and reviewed. Regarding anterior and posterior fusion procedures, cervical collar use demonstrated improved short-term patient-reported outcomes and pain control. While surgeon motivation for collar use was to increase fusion rates, this is not well drawn out in the literature with the majority of studies demonstrated no significant difference in fusion rates between patients who wore a cervical collar and those who did not. Regarding motion-preserving procedures such as cervical laminoplasty, patients with prolonged postoperative cervical collar use demonstrated increased rates of axial neck pain and decreased final range of motion (ROM)., Conclusion: Surgeon motivation for postoperative cervical collar immobilization after completion of fusion procedures is to increase fusion rates and improve postoperative pain and disability despite this not being fully drawn out in the literature. After completion of motion-sparing procedures, the benefits of collar immobilization diminish with their prolonged use which could lead to increased rates of axial neck pain and decreased ROM. Cervical collar immobilization in the postoperative period should be considered its own intervention, with its own associated risk-benefit profile., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosures: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B156)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Objectives: Despite qualitative observations of wild primates pumping branches before leaping across gaps in the canopy, most studies have suggested that support compliance increases the energetic cost of arboreal leaping, thus limiting leaping performance. In this study, we quantified branch pumping behavior and tree swaying in wild primates to test the hypothesis that these behaviors improve leaping performance., Materials and Methods: We recorded wild colobine monkeys crossing gaps in the canopy and quantitatively tracked the kinematics of both the monkey and the compliant support during behavioral sequences. We also empirically measured the compliance of a sample of locomotor supports in the monkeys' natural habitat, allowing us to quantify the resonant properties of substrates used during leaping., Results: Analyses of three recordings show that adult red colobus monkeys (Piliocolobus tephrosceles) use branch compliance to their advantage by actively pumping branches before leaping, augmenting their vertical velocity at take-off. Quantitative modeling of branch resonance periods, based on empirical measurements of support compliance, suggests that monkeys specifically employed branch pumping on relatively thin branches with protracted periods of oscillation. Finally, an additional four recordings show that both red colobus and black and white colobus monkeys (Colobus guereza) utilize tree swaying to cross large gaps, augmenting horizontal velocity at take-off., Discussion: This deliberate branch manipulation to produce a mechanical effect for stronger propulsion is consistent with the framework of instrumental problem-solving. To our knowledge, this is the first study of wild primates which quantitatively shows how compliant branches can be used advantageously to augment locomotor performance., (© 2024 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.)

Background: Venous thromboembolism (VTE) is a known complication of coronavirus disease (COVID-19) in patients requiring hospitalization and intensive care. We examined the association between extended pharmacological VTE prophylaxis and outcomes among patients hospitalized with COVID-19., Methods: This was a retrospective cohort study of patients with an index positive SARS-CoV-2 polymerase chain reaction (PCR) test at the time of, or during hospitalization. Patients who were prescribed extended pharmacological VTE prophylaxis were compared against patients who were not. Multivariable logistic regression was used to produce odds ratio (OR) estimates and Cox proportional hazard models for hazard ratios (HR) with 95% CI to examine the association between pharmacological VTE prophylaxis and outcomes of interest. Primary outcomes were 30- and 90-day VTE events. Secondary outcomes included 30- and 90-day mortality, 30-day superficial venous thrombosis (SVT), acute myocardial infarction (MI), acute ischemic stroke, critical limb ischemia, clinically significant bleeding, and inpatient readmissions., Results: A total of 1936 patients were included in the study. Among them, 731 (38%) were discharged on extended pharmacological VTE prophylaxis. No significant difference was found in 30- and 90-day VTE events among groups. Patients discharged on extended VTE prophylaxis showed improved survival at 30 (HR: 0.35; 95% CI: 0.21-0.59) and 90 days (HR: 0.36; 95% CI: 0.23-0.55) and reduced inpatient readmission at 30 days (OR: 0.12; 95% CI: 0.04-0.33) when compared to those without., Conclusion: Patients discharged on extended VTE prophylaxis after hospitalization due to COVID-19 had similar thrombotic events on follow-up. However, use of extended VTE prophylaxis was associated with improved 30- and 90-day survival and reduced risk of 30-day inpatient readmission.

Direct-acting oral anticoagulants (DOACs) are prescribed in the treatment of venous thromboembolism, including pulmonary embolism (PE). Evidence is limited regarding the outcomes and optimal timing of DOACs in patients with intermediate- or high-risk PE treated with thrombolysis. We conducted a retrospective analysis of outcomes among patients with intermediate- and high-risk PE who received thrombolysis, by choice of long-term anticoagulant agent. Outcomes of interest included hospital length of stay (LOS), intensive care unit LOS, bleeding, stroke, readmission, and mortality. Descriptive statistics were used to examine characteristics and outcomes among patients, by anticoagulation group. Patients receiving a DOAC (n = 53) had shorter hospital LOS compared to those in warfarin (n = 39) and enoxaparin (n = 10) groups (mean LOS 3.6, 6.3 and 4.5 days, respectively; P  < .0001). This single institution retrospective study suggests DOAC initiation <48 h from thrombolysis may result in shorter hospital LOS compared to DOAC initiation ≥48 h ( P  < .0001). Further larger studies with more robust research methodology are needed to address this important clinical question.

Objective: To determine outcomes in hospitalised patients with sepsis and reported penicillin allergy (PcnA)., Design: Observational retrospective cohort study using data from electronic health records., Setting: A large single health system with 11 hospitals of small, medium and large sizes including a 630-bed tertiary care teaching hospital., Participants: Patients (n=5238) ≥18 years of age, hospitalised with sepsis, severe sepsis or septic shock between 1 January 2016 and 31 December 2018, received antibacterial agents, and had documented PcnA status. Patients <18 years of age at admission were excluded., Outcome Measures: Primary outcomes evaluated were inpatient mortality and 30-day mortality posthospital discharge. Secondary outcomes were hospital length of stay, 30-day readmissions, duration of antibiotic use, rate of Clostridium difficile infection and total cost of care., Results: There was no difference in outcomes including inpatient or 30-day mortality, hospital length of stay, in-hospital antibiotic duration, C. difficile infection, total cost of care and 30-day readmission rate between patients labelled with a PcnA vs patients who did not report PcnA (non-PcnA)., Conclusion: In this retrospective single health system study, there was no difference in key outcomes including inpatient or 30-day mortality in patients admitted with sepsis and reported PcnA compared with patients who reported no PcnA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Benzodiazepines are the gold standard for alcohol withdrawal treatment but choice and dosing vary widely. In 2015, our institution implemented a Minnesota detoxification scale (MINDS) and single standardized high-dose diazepam based protocol for treatment of alcohol withdrawal to replace multiple Clinical Institute Withdrawal Assessment for Alcohol (CIWA) based protocols using lower dose benzodiazepines. We compared use of MINDS versus CIWA assessment protocols with high front loading diazepam treatment in care of patient experiencing alcohol withdrawal during hospitalization., Methods: Retrospective cohort study of hospitalized patients experiencing alcohol withdrawal to statistically analyze difference in outcomes between CIWA based lower benzodiazepine dose protocols used in 2013-2015 versus the MINDS based high-dose front-loading diazepam protocol used in 2015-2017., Results: Patients treated with MINDS based high dose diazepam protocol were less likely to have physical restraints used (AOR = 0.8, CI: 0.70-0.92), had a shorter hospital length of stay, and fewer days on benzodiazepines (p < 0.001). Patients were more likely to be readmitted to the hospital within 30 days (AOR = 1.13, CI: 1.03-1.26) in MINDS based diazepam treatment group. Total diazepam equivalent dosing was similar in both groups. Mortality rates and ICU use rates were similar between the groups., Conclusions: Higher dose front loading long acting benzodiazepine can be safely used with beneficial outcomes in hospitalized alcohol withdrawal patients., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Background: Infectious morbidity and mortality in the first week of life is commonly caused by early-onset neonatal Group B streptococcus (GBS) disease. This infection is spread from GBS positive mothers to neonates by vertical transmission during delivery and results in serious illness for newborns. Intrapartum prophylactic antibiotics have decreased the incidence of early-onset neonatal GBS disease by 80%. Patients labeled with a penicillin allergy (PcnA) alternatively receive either vancomycin or clindamycin but effectiveness is controversial. We evaluated the influence of a reported PcnA label versus no PcnA label on inpatient maternal and neonatal outcomes., Methods: Our goal was to examine the relationship between a PcnA label, maternal and neonatal outcomes, and hospital costs. We collected retrospective data with institutional IRB approval from 2016 - 2018 for hospitalized patients who were GBS positive, pregnant at time of admission, ≥ 18 years of age, received antibiotic prophylaxis for GBS, were labeled as PcnA or non-PcnA, and completed a vaginal delivery. Patient characteristics and maternal/neonatal outcomes were examined. Statistical tests included calculations of means, medians, proportions, Mann-Whitney, two-sample t-tests, Chi-squared or Fisher's Exact tests, and generalized linear and logistic regression models. Significance was set at p < 0.05., Results: Most PcnA patients were white, older, had a higher median body mass index and mean heart rate, and a greater proportion used tobacco than non-PcnA patients. In regression analyses, PcnA hospitalized patients received a shorter duration of antibiotic treatment than non-PcnA patients [incidence rate ratio (IRR): 0.45, 95% CI: 0.38-0.53]. PcnA patients were also more likely to have their baby's hospital LOS be > 48 h [adjusted odds ratio (AOR): 1.35, 95% CI: 1.07-1.69] even though the PcnA mothers' LOS was not different from non-PcnA mothers. Cost of care, mortality, intensive care, median parity, mean gravidity, and miscarriage were similar between the groups., Conclusions: In hospitalized obstetric patients, a PcnA label was associated with a shorter maternal course of antibiotic treatment and a longer neonatal LOS. Further prospective studies are needed to clarify the underlying reasons for these outcomes., (© 2021. The Author(s).)

Background: Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. Sleep deprivation is a significant risk factor for developing delirium and is a patient dissatisfier., Problem: An internal assessment revealed that up to 25% of all patients on medical-surgical units had a diagnosis of delirium while in the hospital., Approach: An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions., Outcomes: Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment., Conclusions: Implementation of a dedicated period to sleep was associated with a reduction in delirium and increased patient satisfaction for quietness at night., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients' ratings of hospital care and hospitalist communication., Methods: Data were retrospectively collected from patients' electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records., Results: Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, P = 0.04 and adjusted odds ratio 1.56, P = 0.021) that varied by patient age at first admission ( P = 0.001 and P = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant., Conclusions: This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.

In a recent randomized trial, inpatient palliative care (PC) visits were associated with improved quality of life and symptom burden for patients with heart failure. To better understand what actions by PC providers may have led to those outcomes, we conducted chart reviews of 101 patients in the intervention group (who received PC). Palliative care actions are described for all patients and for those with higher symptoms. Orders were written for 24% of patients, most frequently for pain. Recommendations to change current care were made for 40% of patients. At least 1 element of future care planning was documented for 99% of patients. Palliative care for inpatients with HF led to additive actions beyond standard care, especially for pain, and promoted HF-specific goals of care discussions., (© The Author(s) 2015.)

Background: Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models., Objective: Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services., Methods: Patients hospitalized with acute HF were randomized to receive a PC consult with follow-up as determined by provider or standard care. Two hundred thirty-two patients (116 intervention/116 control) from a large tertiary-care urban hospital were recruited over a 10-month period. Primary outcomes were symptom burden, depressive symptoms, and QOL measured at baseline, 1, and 3 months. Secondary outcomes included advance care planning (ACP), inpatient 30-day readmission, hospice use, and death., Results: Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age, gender, and marital status differences between study groups. QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month (difference+4.92, p<0.001). Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month (+3.69, p<0.001). ACP was the only secondary outcome associated with the intervention (hazard ratio [HR] 2.87, p=0.033)., Conclusion: An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.

A majority of adolescents who are formally involved with the juvenile courts and detained or incarcerated are dealing with past or present maltreatment victimization, learning disabilities, and/or mental health/substance abuse difficulties. Addressing these problems and traumas is an integral part of preventing delinquency and breaking a youthful offender's recidivist cycle, a pattern that often predicts adult offending and incarceration. Fortunately, there are effective programs across the social work profession that decrease or may even eliminate delinquent behaviors, both for low-level and more serious youthful offenders. Unfortunately, the use of these social work preventative programs is not consistent or extensive within the juvenile justice system.

Exercise-associated hyponatremia has been described after sustained physical exertion during marathons, triathlons, and other endurance athletic events. As these events have become more popular, the incidence of serious hyponatremia has increased and associated fatalities have occurred. The pathogenesis of this condition remains incompletely understood but largely depends on excessive water intake. Furthermore, hormonal (especially abnormalities in arginine vasopressin secretion) and renal abnormalities in water handling that predispose individuals to the development of severe, life-threatening hyponatremia may be present. This review focuses on the epidemiology, pathogenesis, and therapy of exercise-associated hyponatremia.