Primary care providers practice patterns regarding female pelvic floor disorders.

Introduction: Pelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary care providers (PCPs) have a unique opportunity to increase treatment and provide appropriate referrals for these patients.

Methods: An online survey was administered to PCPs to assess provider practices, knowledge, comfort managing and ease of referral for PFDs.

Cost and Utilization Implications of a Health Plan's Home-Based Palliative Care Program.

A California-based health plan offered home-based palliative care (HBPC) to members who needed support at home but did not yet qualify for hospice. This study compares hospital and emergency department (ED) utilization and costs and mortality for individuals receiving HBPC to a cohort not receiving palliative care services (Usual Care). This is an observational retrospective study using claims data covering a prestudy period and a study period during which time half of the study population received HBPC services.

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery.

Purpose: To determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery or additional nonsurgical therapy, in a consecutive group of patients undergoing partial repair of massive rotator cuff tears.

Methods: A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016. All patients with massive rotator cuff tears (>30 cm) who underwent partial repair were included in the study.

Surgical Management of Shoulder Heterotopic Ossification.

The formation of heterotopic ossification around the shoulder is a rare but potentially debilitating condition. It is found most commonly around the hip and is usually associated with an inciting event such as trauma, burn, previous surgery, or traumatic brain/spinal cord injury. The formation of shoulder heterotopic ossification following arthroscopic surgery is very uncommon, with few data pertaining to it in the current literature.

Return to Baseline Functional Status in Older Women Undergoing Surgery for Pelvic Organ Prolapse.

Objective: The aim of the study was to determine the rate of return to baseline functional status 3 months after surgery for pelvic organ prolapse (POP) in women 65 years or older.

Methods: This is a multicenter prospective cohort study of women older than 65 years undergoing POP surgery. Functional status was determined by the Activities Assessment Scale at the preoperative visit and 3 months after surgery.

Urinary Incontinence and Pelvic Organ Prolapse Knowledge, Care-Seeking, and Embarrassment in Women Planning Bariatric Surgery: A Cross-sectional Study.

Objective: The objective of this study was to assess whether patients seeking bariatric surgery were at least as proficient in urinary incontinence (UI) and pelvic organ prolapse (POP) knowledge as the general population. Our secondary objective was to determine care-seeking and impact of embarrassment on knowledge of pelvic floor disorders (PFDs).

Methods: An anonymous survey was administered to adult women who attended a bariatric surgery information session from May 2015 to January 2016.

Preoperative Narcotic Use and Inferior Outcomes After Anatomic Total Shoulder Arthroplasty: A Clinical and Radiographic Analysis.

Introduction: Our purpose was to determine whether the chronic use of preoperative narcotics adversely affected clinical and/or radiographic outcomes.

Methods: Seventy-three patients (79 shoulders) with primary total shoulder arthroplasty for osteoarthritis were evaluated clinically and radiographically at preoperative visits and postoperatively at a minimum follow-up of 2 years: 26 patients (28 shoulders) taking chronic narcotic pain medication for at least 3 months before surgery and 47 patients (51 shoulders) who were not taking narcotics preoperatively.

Results: Postoperatively, significant differences were noted between the narcotic and nonnarcotic groups regarding American Shoulder and Elbow Surgeons scores and visual analog scale scores, as well as forward elevation, external rotation, and all strength measurements (P < 0.

Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment.

Purpose: This study aimed to identify patient and treatment factors that predict a favourable response to intra-articular hyaluronic acid (HA) treatment to better guide patient and treatment selection.

Methods: This prospective, observational study evaluated patients with mild-to-moderate (Kellgren-Lawrence grades 1-3) primary knee osteoarthritis treated between March 2013 and May 2016. Patient function and pain scores were assessed by the Western Ontario and McMaster Universities Arthritis Index/Knee Injury and Osteoarthritis Outcome Score (WOMAC/KOOS) and visual analogue scale (VAS) surveys, with response to treatment defined according to the Osteoarthritis Research Society International (OARSI) 2004 criteria.

Patient satisfaction and informed consent for surgery.

Background: Informed consent is a process that necessitates time and effort. Underlying this investment is the belief that informing patients about the surgery promotes patient satisfaction with the decision for surgery and potentially satisfaction more broadly.

Objective: The objective of the study was to investigate the extent to which preoperative satisfaction with a decision to pursue surgery is associated with understanding after an informed consent discussion.

Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity.

Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear.

The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update.

Using a lifespan model, this article presents new scientific findings regarding risk factors for pelvic floor disorders (PFDs), focusing on the role of childbirth in the development of single or multiple coexisting PFDs. Phase I of the model includes predisposing factors, such as genetic predisposition and race. Phase II includes inciting factors, such as obstetric events.

NeutrAvidin Functionalization of CdSe/CdS Quantum Nanorods and Quantification of Biotin Binding Sites using Biotin-4-Fluorescein Fluorescence Quenching.

We developed methods to solubilize, coat, and functionalize with NeutrAvidin elongated semiconductor nanocrystals (quantum nanorods, QRs) for use in single molecule polarized fluorescence microscopy. Three different ligands were compared with regard to efficacy for attaching NeutrAvidin using the "zero-length cross-linker" 1-ethyl-3-[3-(dimethylamino)propyl]carbodiimide (EDC). Biotin-4-fluorescene (B4F), a fluorophore that is quenched when bound to avidin proteins, was used to quantify biotin binding activity of the NeutrAvidin coated QRs and biotin binding activity of commercially available streptavidin coated quantum dots (QDs).

Cost utility analysis of urethral bulking agents versus midurethral sling in stress urinary incontinence.

Objective: The aim of this study was to determine the cost utility of urethral bulking agents (BA) compared with midurethral slings (MUS) in the treatment of stress urinary incontinence (SUI) in patients without urethral hypermobility.

Methods: A decision tree was constructed to compare the cost utility of urethral BA versus MUS in the setting of SUI without urethral hypermobility. Probability estimates for success, failure, and complications were obtained from the published literature.

AB5075, a Highly Virulent Isolate of Acinetobacter baumannii, as a Model Strain for the Evaluation of Pathogenesis and Antimicrobial Treatments.

Unlabelled: Acinetobacter baumannii is recognized as an emerging bacterial pathogen because of traits such as prolonged survival in a desiccated state, effective nosocomial transmission, and an inherent ability to acquire antibiotic resistance genes. A pressing need in the field of A. baumannii research is a suitable model strain that is representative of current clinical isolates, is highly virulent in established animal models, and can be genetically manipulated.

Longitudinal changes in pelvic organ support among parous women.

Objective: The objective of this study was to characterize changes in pelvic organ support and symptoms of prolapse over time and identify characteristics associated with worsening of support.

Methods: Participants were recruited based on the mode of delivery (cesarean vs vaginal delivery) of their first child. The Pelvic Organ Prolapse Quantification system was used to describe support at baseline and 12 to 18 months later.

Ligaments of the craniocervical junction.

The specialized ligaments of the craniocervical junction must allow for stability yet functional movement. Because injury to these important structures usually results in death or morbidity, the neurosurgeon should possess a thorough understanding of the anatomy and function of these ligaments. To the authors' knowledge, a comprehensive review of these structures is not available in the medical literature.

Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions.

Medical education in the Caribbean has undergone significant change and growth in the past decades. Currently, approximately 60 medical schools in the Caribbean provide medical training to a combination of domestic and international students. External quality assurance of these institutions has varied in effectiveness and scope throughout the region.

Short-chain fatty acid-mediated effects on erythropoiesis in primary definitive erythroid cells.

Short-chain fatty acids (SCFAs; butyrate and propionate) up-regulate embryonic/fetal globin gene expression through unclear mechanisms. In a murine model of definitive erythropoiesis, SCFAs increased embryonic beta-type globin gene expression in primary erythroid fetal liver cells (eFLCs) after 72 hours in culture, from 1.7% (+/- 1.

Migration of doctors for undergraduate medical education.

Background: Global shortages of healthcare workers in both developed and developing countries are of great concern. Research on physician migration typically focuses on medical school graduates, most often those seeking postgraduate training opportunities elsewhere.

Description: An overview of medical school migration patterns is presented in this paper.

Celebrating 50 years of experience: an ECFMG perspective.

As indicated in its mission statement, the Educational Commission for Foreign Medical Graduates (ECFMG), established in 1956, "promotes quality health care for the public by certifying IMGs for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals.

The international medical graduate pipeline: recent trends in certification and residency training.

International medical graduates (IMGs) represent a large proportion of the population entering graduate medical education (GME) programs. Many of these internationally trained physicians go on to practice medicine in the United States. To be eligible for GME, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG).