Understanding the Influence of Single Payer Health Insurance on Socioeconomic Disparities in Total Hip Arthroplasty (THA) Utilization: A Transnational Analysis.

Objective: Access to care varies between countries. It is theorized that income-based disparities in access may be reduced in countries with universal health insurance relative to the United States, but data are currently limited. We hypothesized that income-based differences in total hip arthroplasty (THA) utilization and outcomes would be larger in the United States than in Canada.

Does the Type of Reconstruction Matter? A Propensity Score Analysis of Immediate Postmastectomy Implant and Flap Reconstruction.

Background: No randomized controlled trials have compared implant and flap reconstruction. Recently, worse longitudinal outcomes have been suggested for flap reconstruction. The authors compared long-term oncologic outcomes of postmastectomy breast reconstruction using propensity score matching.

Improving Communication and Response to Clinical Deterioration to Increase Patient Safety in the Intensive Care Unit.

Background: In the critical care setting, early recognition of clinical decompensation is imperative to trigger prompt intervention and optimize patient outcomes.

Local Problem: In a 20-bed surgical intensive care unit of an urban academic medical center, cases of clinical deterioration that highlighted opportunities to improve the communication process prompted a reassessment of health care provider roles and responsibilities.

Methods: A quality improvement initiative was implemented to enhance communication among intensive care unit clinical staff members, improve the timeliness of reporting clinical deterioration, and ensure implementation of timely, appropriate interventions to eliminate adverse outcomes.

What Is the Accuracy of Bimaxillary Orthognathic Surgery Using Occlusally-Based Guides and Patient-Specific Fixation in Both Jaws? A Cohort Study and Discussion of Surgical Techniques.

Purpose: The development of advanced digital orthognathic surgical protocols requires investigation to determine the accuracy of surgical outcomes. This report's purpose is to quantify 3-dimensional linear discrepancies between simulated and actual results for double-jaw orthognathic surgery utilizing occlusally-based guides in conjunction with patient-specific fixation in both jaws.

Methods: This retrospective cohort study assessed the accuracy of double-jaw orthognathic surgery, in all cases performed by 1 surgeon between May 2019 and January 2021, utilizing occlusally-based guides and patient-specific fixation plates in both maxillary and mandibular surgeries.

ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial.

Background: Use of medical devices represents a unique opportunity to facilitate scale-up of early infant male circumcision (EIMC) across sub-Saharan Africa. The ShangRing, a circumcision device prequalified by WHO, is approved for use in adults and adolescents and requires topical anaesthesia only. We aimed to investigate the safety and efficacy of the ShangRing versus the Mogen clamp for EIMC in infants across eastern sub-Saharan Africa.

Are Income-based Differences in TKA Use and Outcomes Reduced in a Single-payer System? A Large-database Comparison of the United States and Canada.

Background: Income-based differences in the use of and outcomes in TKA have been studied; however, it is not known if different healthcare systems affect this relationship. Although Canada's single-payer healthcare system is assumed to attenuate the wealth-based differences in TKA use observed in the United States, empirical cross-border comparisons are lacking.

Questions/purposes: (1) Does TKA use differ between Pennsylvania, USA, and Ontario, Canada? (2) Are income-based disparities in TKA use larger in Pennsylvania or Ontario? (3) Are TKA outcomes (90-day mortality, 90-day readmission, and 1-year revision rates) different between Pennsylvania and Ontario? (4) Are income-based disparities in TKA outcomes larger in Pennsylvania or Ontario?

Methods: We identified all patients hospitalized for primary TKA in this cross-border retrospective analysis, using administrative data for 2012 to 2018, and we found a total of 161,244 primary TKAs in Ontario and 208,016 TKAs in Pennsylvania.

Medicare/Medicaid Insurance Status Is Associated With Reduced Lower Bilateral Knee Arthroplasty Utilization and Higher Complication Rates.

Whether to undergo bilateral total knee arthroplasty (BTKA) depends on patient and surgeon preferences. We used the National Inpatient Sample to compare temporal trends in BTKA utilization and in-hospital complication rates among TKA patients ≥50 with Medicare/Medicaid versus private insurance from 2007 to 2016. We used multivariable logistic regression to assess the association between insurance type and trends in utilization and complication rates adjusting for individual-, hospital-, and community-level covariates, using unilateral TKA (UTKA) for reference.

Patient and surgeon factors contributing to bailout cholecystectomies: a single-institutional retrospective analysis.

Background: Laparoscopic cholecystectomies continue to pose trouble for surgeons in the face of severe inflammation. In the advent of inability to perform an adequate dissection, a "bailout cholecystectomy" is advocated. Conversion to open or subtotal cholecystectomy is among the standard bailout procedures in such instances.

Demonstrating the Efficacy of Incorporating Peers Into Addiction Training for Internal Medicine Residents.

Although internists frequently care for patients with substance use disorders (SUDs), they do not receive training that is adequate for the task. The resultant deficiencies in care are compounded by widespread stigma toward SUDs that exists within medicine. However, research demonstrates that sharing personal perspectives and experiences of living with an SUD generate empathy and change attitudes toward this disorder.

Vertebral Fractures After Denosumab Discontinuation in Breast Cancer Survivors: A Single Institution Experience.

Denosumab is approved to prevent fragility fractures in patients with osteoporosis at high risk for fracture and to prevent bone loss in patients with breast and prostate cancer who receive endocrine therapy. The antiresorptive effect of denosumab rapidly dissipates when it is delayed or discontinued, but the risk for, and incidence of, multiple clinical vertebral fractures in patients with breast cancer after stopping denosumab is currently unclear. : We sought to identify the incidence of clinical vertebral fractures in patients with breast cancer who received at least 2 doses of denosumab (60 mg) and then discontinued the medication.

Social and Clinical Determinants of COVID-19 Outcomes: Modeling Real-World Data from a Pandemic Epicenter.

Importance: As the United States continues to accumulate COVID-19 cases and deaths, and disparities persist, defining the impact of risk factors for poor outcomes across patient groups is imperative.

Objective: Our objective is to use real-world healthcare data to quantify the impact of demographic, clinical, and social determinants associated with adverse COVID-19 outcomes, to identify high-risk scenarios and dynamics of risk among racial and ethnic groups.

Design: A retrospective cohort of COVID-19 patients diagnosed between March 1 and August 20, 2020.

Impact of Use of Antibiotics on Response to Immune Checkpoint Inhibitors and Tumor Microenvironment.

Background: Antibiotic use can result in reduced efficacy of immune checkpoint blockade (ICB), presumably because of dysbiosis of the intestinal microbiome. We sought to determine the precise temporal relation between antibiotic therapy and its possible effects on ICB efficacy. We also investigated the histologic changes in the tumor microenvironment secondary to antibiotics use.

Bilateral vs Unilateral Total Knee Arthroplasty: Racial Variation in Utilization and In-Hospital Major Complication Rates.

Background: We sought to examine bilateral total knee arthroplasty (BTKA) vs unilateral TKA (UTKA) utilization and in-hospital complications comparing African Americans (AAs) and Whites.

Methods: In this retrospective analysis of patients ≥50 years who underwent elective primary TKA, the (2007-2016) database of the Healthcare Cost and Utilization Project (National Inpatient Sample) was used. We computed differences in temporal trends in utilization and major in-hospital complication rates of BTKA vs UTKA comparing AAs and Whites.

An evaluation of the federal adverse events reporting system data on adverse effects of 5-alpha reductase inhibitors.

Objective: To investigate the sexual, physical, and mental adverse effects associated with exposure to 5-alpha reductase inhibitors (5ARIs).

Methods: FAERS data containing finasteride and dutasteride reports were analyzed from January 2000 to April 2019. Reports identified one or more adverse effects, along with all concurrent medications.

Community Deprivation Index and Discharge Destination After Elective Hip Replacement.

Objective: To examine how the deprivation level of the community in which one lives influences discharge disposition and the odds of 90-day readmission after elective total hip arthroplasty (THA).

Methods: We performed a retrospective cohort study on 84,931 patients who underwent elective THA in the Pennsylvania Health Care Cost Containment Council database from 2012 to 2016. We used adjusted binary logistic regression models to test the association between community Area Deprivation Index (ADI) level and patient discharge destination as well as 90-day readmission.

Race, Discharge Disposition, and Readmissions After Elective Hip Replacement: Analysis of a Large Regional Dataset.

Total hip arthroplasty (THA) is one of the fastest growing procedures. There is increasing evidence that social determinants of health influence health care utilization and outcomes after THA, including postoperative care. We sought to examine how race impacts discharge destination after elective THA, and we assessed the impact of discharge destination on 90-day readmission to an acute care hospital.