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Ambulatory surgery centers (ASCs) are an alternative to hospitals for outpatient orthopedic surgeries. ASCs can offer lower costs, faster turnover times, and lower operative times while maintaining similar safety and readmission rates. However, hospitals can offer more robust care in the perioperative period and are better equipped to handle any complications. Physician-owned ASCs offer a unique perspective into what a potential physician-owned health care model could look like and raise the question of whether there should be a push for physician-owned hospitals, given the efficiencies seen in ASCs., Competing Interests: Disclosures C.C. Bettin is a partner in 2 physician-owned surgery centers at Campbell Clinic Orthopaedics. The other authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Antibiotic agents have been shown to improve outcomes in open extremity fractures. The first-generation cephalosporins, which are used most often, are often under-dosed based on weight and recommended frequency. Ceftriaxone offers a broader coverage and a decreased frequency of administration. Our institution began utilizing ceftriaxone for open fracture management in 2017 to address those concerns. Objective: To examine the efficacy of cefazolin versus ceftriaxone for open fracture management of extremity trauma. Patients and Methods: Retrospective study from 2015-2019 of patients who sustained open extremity fractures. Patients were stratified by antibiotic administered and Gustilo-Anderson grade. Outcomes included non-union/malunion, superficial surgical site infection (SSI), deep SSI, osteomyelitis, re-operation after index hospital visit, re-admission due to prior injury, limb loss, and death. Subgroup analysis stratified each antibiotic group by Gustilo-Anderson grade 1 or 2 and grade 3. Results: Data was collected from 2015 to 2019. Of the 1,149 patients, 619 patients met inclusion criteria. Three hundred fifty-five patients received cefazolin and 264 patients received ceftriaxone. There were no statistically significant differences between groups on specified outcomes. No statistically significant differences existed during subgroup analysis for the specified outcomes. Multivariable analysis demonstrated increased Gustilo-Anderson grade increased risk of infectious outcome. Conclusions: Ceftriaxone is a safe and effective alternative for open fracture extremity management that offers the advantage of 24-hour dosing and single antibiotic coverage for grade 3 open fractures. It does not increase infectious complications and offers benefits of resource efficiency.

The Building Healthy Urban Communities initiative presents a path for organizations partnering to improve patient outcomes with continuing education (CE) as a key component. Components of the CE initiative included traditional CE delivery formats with an essential element of adaptability and new methods, with rigorous evaluation over time that included evaluation prior to the course, immediately following the CE session, 6 to 8 weeks after the CE session, and then subsequent monthly "testlets." Outcome measures were designed to allow for ongoing adaptation of content, reinforcement of key learning objectives, and use of innovative concordant testing and retrieval practice techniques. The results after 1 year of programming suggest the stepwise skill reinforcement model is effective for learning and is an efficient use of financial and human resources. More important, its design is one that could be adopted at low cost by organizations willing to work in close partnership. J Contin Educ Nurs. 2016;47(6):283-288., (Copyright 2016, SLACK Incorporated.)

Aligning quality outcomes with cost effectiveness is the cornerstone of the direction of health care in the United States. Implementing and supporting an evidence-based practice (EBP) environment requires resources. Because research is a foundational element of the EBP process, resources allocated for nursing research are essential. As part of operational costs, PhD nurse researchers can affirmatively impact an organization by improving quality of care and patient outcomes. Incorporation of a PhD nurse researcher can favorably alter the organization in a pay-for-performance environment.

Care coordination for the older adult is growing based on increases in aging populations, fragmentation in healthcare systems, and the desire by many older adults to remain in their homes. Geriatric Care Managers (GCMs) guide older adults and families in navigating the complexities of the continuum of care and with finding available resources for long-term care planning. This article reviews the GCM role, which patients may be appropriate for the service, and patient benefits.

Five compounds, which inhibited the amidolytic activity of soluble tissue factor/activated factor VII complex (sTF/VIIa), were isolated from two traditional Chinese medicinal plants commonly used in the treatment of cardiovascular and cerebrovascular diseases. The active compounds were found to be linolenic, linoleic, and oleic acids from roots of Salvia miltiorrhiza; and two anacardic acids, 6-(8'Z-pentadecenyl)- and 6-(10'Z-heptadecenyl)-salicylic acids, from leaves of Ginkgo biloba. The IC50 values were in the range 30-80 micromol/L. Palmitic acid, isolated from roots of Salvia miltiorrhiza, and 2-[(3',7',11',15'-tetramethyl)-2'E,6'E,10'E, 14'E-hexadecatetraenyl]-1,4-hydroquinone, isolated from the marine sponge Adocia viola, did not inhibit sTF/VIIa. Further expansion of the structure-activity relationship to include anacardic acids, 6-(8'Z,11'Z-heptadecadienyl)- and 6-(8'Z, 11'Z, 14'Z-heptadecatrienyl)-salicylic acids from leaves of Anacardium spondias, and other fatty acids demonstrated that at least one cis double bond was essential for inhibitory activity, and that fatty acids containing two or three cis double bonds were optimal. Evidence from preincubation studies implied that these fatty acids may exert their effect by binding to VIIa and consequently preventing binding of sTF to VIIa.

The cancer pattern among Inuit in the Circumpolar area is remarkably different from those of other populations in the world. The current paper summarizes the most important risk factors in Canadian Inuit residing in the Northwest Territories, northern Quebec (Nunavik) and Labrador, particularly during the time period 1969-1988 covered by the study. Factors considered include: the geographic area and physical environment; population and human environment, including fertility and life expectancy; lifestyle and diet, including tobacco and alcohol use; other lifestyle factors, and health conditions; and health services and cultural accessibility. Development of the cancer registry and population databases supporting the analysis of cancer rates is described. The information in the present paper is needed to interpret cancer incidence patterns and differences among the Circumpolar Inuit of Canada, Alaska and Greenland.

A new derivative of phenylalanine, phenamide, was discovered from the fermentation broth of an actinomycete identified as a member of the Streptomyces albospinus cluster. Phenamide was purified using successive C18 reverse phase and cation exchange chromatography. Its structure was determined by spectroscopic and chemical methods. Its molecular formula, C14H20N2O3, was determined by HRFAB-MS. Phenamide showed activity against Septoria nodorum, the causal agent of wheat glume blotch.

A new trichothecene, harzianum A [1], was isolated from the soil-borne fungus Trichoderma harzianum. The structure of 1 was determined by extensive spectral analyses including the nmr techniques of PS-COSY, HMQC, HMBC, and NOESY. Harzianum A [1] contains a (Z,E,E)-2,4,6-octatriendioic acid esterified on the 4 beta hydroxyl group of trichodermol and is structurally related to the trichoverroids. Harzianum A [1] showed no cytotoxicity against baby hamster kidney cells, no activity against Gram-negative and Gram-positive bacteria, but modest antifungal activity at 100 micrograms/ml.

Clear differences occurred in the cancer patterns among the population sub-groups in the NWT. When compared to those for the total Canadian population, rates for all cancers tended to be higher than expected among Inuit, lower than expected among Status Indians, and at expected levels for the Other NWT population. Among Inuit, traditional patterns still persist. Cancers of the lung, cervix, nasopharynx and salivary gland, and choriocarcinoma, occurred more often, and cancers of the breast, prostate, uterus and colon less often than in the total Canadian population. Among Status Indians, small numbers precluded definitive conclusions. However, several cancer sites occurred less often than expected, including colon, bladder and prostate among males, and uterus in females. While no cancer was significantly elevated in either males or females, SIRs for cervix and lung were above 1.0 for females, and kidney cancer was significantly higher when data for both sexes were combined (SIR = 2.0). For the Other NWT group--comprising about 50% of the population--most types of cancers occurred at about the expected rate, except that lung cancer was significantly elevated in females. Nevertheless, the generally high rates for lung and cervical cancer, which were particularly evident among the Inuit, are clearly targets for prevention programmes. It is hoped the cancer registry data now available for twenty years for the NWT, as well as for the overall Canadian Inuit population, can be used by researchers for studies to further determine the etiology of cancers, especially where distinctive patterns occur in these populations.

Screening of microbial fermentation broths for herbicidal activity led to the discovery of a novel polyketide, herboxidiene, from an actinomycete identified as a member of the Streptomyces chromofuscus cluster. A 14- to 20-fold increase in fermentation production of herboxidiene was achieved as a result of media optimization. Herboxidiene was purified using successive reverse phase C18 steps and Sephadex LH-20 chromatography. Its molecular formula, C25H42O6, was determined by HRFAB-MS. Herboxidiene demonstrated exceptionally potent, selective, herbicidal activity against a variety of weed species and was inactive against wheat, even at rates as high as 5.6 kg/hectare.

It has been assumed that it is beneficial for patients to become active and informed participants in health care. Previous research, however, suggests that individuals differ in their receptiveness to information and self-care in treatment stiuations. This article reports the development and validation of the Krantz Health Opinion Survey, a measure of preferences for different treatment approaches. This measure yields a total score and two relatively independent subscales that measure, respectively, preferences for information and for behavioral involvement (i.e., self-care and active participation) in medical care. Three related studies demonstrated the ability of the subscales or total score to predict with some specificity (a) criterion group membership (clinic users and enrollees in a self-care course), (b) reported use of clinic facilities, and (c) overt behavior (e.g., inquisitiveness, self-diagnosis) in a medical setting. Discriminant validity of the instrument is also established. Theoretical implications of the preference constructs are described in terms of the concept of personal control, and practical implications of the measure are presented.