Assessing an intervention to improve the safety of automatic stop orders for inpatient antimicrobials.

Background: Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs.

Methods: An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials.

Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations.

Importance: The United States spends more than $12 billion annually on graduate medical education. Understanding how residents balance patient care and educational activities may provide insights into how the modern physician workforce is being trained.

Objective: To describe how first-year internal medicine residents (interns) allocate time while working on general medicine inpatient services.

Impact of Human Immunodeficiency Virus Infection on Survival and Acute Toxicities From Chemoradiation Therapy for Cervical Cancer Patients in a Limited-Resource Setting.

Purpose: To prospectively compare survival between human immunodeficiency virus (HIV)-infected versus HIV-uninfected cervical cancer patients who initiated curative chemoradiation therapy (CRT) in a limited-resource setting.

Methods And Materials: Women with locally advanced cervical cancer with or without HIV infection initiating radical CRT in Botswana were enrolled in a prospective, observational, cohort study from July 2013 through January 2015.

Results: Of 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study.

Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine.

Background: Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians.

Methods: We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores.

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial.

Importance: Transportation barriers contribute to missed primary care appointments for patients with Medicaid. Rideshare services have been proposed as alternatives to nonemergency medical transportation programs because of convenience and lower costs.

Objective: To evaluate the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients.

Rideshare-Based Medical Transportation for Medicaid Patients and Primary Care Show Rates: A Difference-in-Difference Analysis of a Pilot Program.

Background: Transportation to primary care is a well-documented barrier for patients with Medicaid, despite access to non-emergency medical transportation (NEMT) benefits. Rideshare services, which offer greater convenience and lower cost, have been proposed as an NEMT alternative.

Objective: To evaluate the impact of rideshare-based medical transportation on the proportion of Medicaid patients attending scheduled primary care appointments.

CanSupport: a model for home-based palliative care delivery in India.

Background: According to the 2014 WHO Global Atlas of Palliative Care, there is insufficient access to palliative care services worldwide, with the majority of unmet need in low- and middle-income countries. In India, there are major disparities in access to palliative care, with the majority of services being offered by non-governmental organizations (NGOs) scattered throughout the country. The barriers to expanding palliative care services in India are common to many lower- and middle-income countries-a lack of financial resources, a paucity of trained staff, and a focus on curative rather than comfort care.

A systematic review of radiotherapy capacity in low- and middle-income countries.

Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC.

Methods: A systematic review of the literature was undertaken.

Relative head size increase using an anatomic dual mobility hip prosthesis compared to traditional hip arthroplasty: impact on hip stability.

Smaller head sizes and head/cup ratios make cups smaller than 50mm and larger than 58mm, more prone to dislocation. Using computer modeling, we compared average head sizes and posterior horizontal dislocation distance (PHDD) in two 78-patient matched cohorts. Cup sizes were small (≤50mm) or large (≥58mm).

Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty.

Background: Acetabular osteophytes are common findings during total hip arthroplasty (THA).

Purpose: This study was designed to determine the extent to which osteophytes may limit range of motion (ROM) and in which locations impingement is likely to occur if osteophytes are not removed during surgery.

Methods: Computer-aided design was used to compare ROM of a modern hip implant in four cadaver models with and without 10-mm acetabular rim osteophytes added.

Are bilateral total joint arthroplasty patients at a higher risk of developing pulmonary embolism following total hip and knee surgery?

Despite developments in prophylactic methods, venous thromboembolism (VTE) continues to be a serious complication following total joint arthroplasty. The new AAOS/ACCP guidelines on preventing pulmonary embolism (PE) after total hip/knee arthroplasty (THA/TKA) do not make specific recommendations for bilateral vs. unilateral procedures.

Calpain-mediated degradation of MDMx/MDM4 contributes to HIV-induced neuronal damage.

Neuronal damage in HIV-associated Neurocognitive Disorders (HAND) has been linked to inflammation induced by soluble factors released by HIV-infected, and non-infected, activated macrophages/microglia (HIV M/M) in the brain. It has been suggested that aberrant neuronal cell cycle activation determines cell fate in response to these toxic factors. We have previously shown increased expression of cell cycle proteins such as E2F1 and phosphorylated pRb in HAND midfrontal cortex in vivo and in primary neurons exposed to HIV M/M supernatants in vitro.

Computerized range of motion analysis following dual mobility total hip arthroplasty, traditional total hip arthroplasty, and hip resurfacing.

Newer arthroplasty designs claim to provide superior range of motion (ROM) and greater stability than their predecessors. However, there is no way to compare ROM of implant systems in an equivalent anatomical environment in a clinical setting. This study used computer-aided design to compare ROM after hip resurfacing, 28 mm THA, 36 mm THA, and anatomic dual mobility (ADM) THA in 3D models of 5 cadaver pelvises.

The increased utilization of operating room time in patients with increased BMI during primary total hip arthroplasty.

While obesity is associated with increased need for total hip arthroplasty (THA), the relationship between body mass index (BMI) and operative duration is unknown. We reviewed a series of 425 primary THAs implanted by one surgeon from 2004 to 2010. Patients were grouped by BMI based on the World Health Organization's categorization.

Increased range of motion to impingement with large head total hip arthroplasty: point of diminishing returns.

Large head total hip arthroplasty (THA) is known to increase range of motion to impingement and decrease risk of dislocation, however, this is dependent on accurate component positioning and patient anatomy. In this study, a computer-aided design model was used to determine the effects of component positioning on range of motion to impingement with increasing head size. Three-dimensional models were made of 7 cadaver CT scans and virtual THA was performed with a conventional implant system.