Revision Medial Patellofemoral Ligament Reconstruction for Recurrent Instability After Patellofemoral Arthroplasty.

Recurrent patellar instability is a rare complication after patellofemoral arthroplasty (PFA) and usually involves a traumatic injury. Medial patellofemoral ligament (MPFL) reconstruction after arthroplasty is a complicated and technically challenging surgical procedure because the lack of patellar bone stock due to resurfacing significantly increases the risk of patellar fracture. We present our surgical technique for revision MPFL reconstruction for recurrent instability after PFA.

Why Competency Frameworks Are Insufficiently Nuanced for Health Equity Teaching and Assessment.

This article suggests how competency-based medical education should robustly integrate health equity by focusing on physicians' responsibilities to (1) know why and how underlying structural mechanisms contribute to health equity and then (2) take action to achieve health equity in their practice. This article first canvasses currently available frameworks for helping trainees cultivate these 2 specific skills of discernment and action. This article then offers strategies for teaching and assessing these skills in specific learning activities.

Fentanyl Exposure and Detection Strategies Utilized by Clinical Trial Participants Seeking Linkage to Opioid Use Disorder Treatment at a Syringe Service Program.

Introduction: The USA continues to face a fentanyl-driven overdose epidemic. Prior research has demonstrated users of illicit opioids are concerned about fentanyl exposure and overdose, but the strategies they report using to detect fentanyl's presence lack empirical support. This study compares self-report and biologically detected fentanyl use and investigates overdose risk and risk reduction behaviors among a sample of high-risk people who use opioids.

Racial disparities in incidence, treatment, and survival in adult brain metastases: a 10-year national database analysis.

Objective: The aim of this study was to assess demographic and racial disparities in incidence, treatment, and survival of adults with metastatic malignancy to the brain.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) Program database, the authors identified adults with nonprimary brain metastases between 2010 and 2019. Incidence was calculated for all 10 years while data from 2010 to 2014 were used for survival analysis.

Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment.

Background: Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum.

Effect of perioperative anticoagulant prophylaxis in patients with traumatic subdural hematoma and a history of anticoagulant use: a propensity-matched National Trauma Data Bank analysis.

Objective: The use of anticoagulation to prevent venous thromboembolism (VTE) is controversial in the setting of neurosurgical decompression for traumatic subdural hematoma (SDH). In these patients, there is concern that anticoagulation may cause secondary hemorrhage, increasing the risk of death and other complications. Patients with a history of anticoagulant use are at further risk of VTE, but the effect of VTE prophylaxis (VTEP) following neurosurgery for SDH has not been thoroughly investigated in this population.

Diagnosis of Indolent and Infections as Risk Factors for Cholangiocarcinoma: An Unmet Medical Need.

Background: Cholangiocarcinoma is a highly aggressive cancer of the biliary tract epithelium. This form of cancer is prevalent in Asia, and recent reports show that its incidence is relatively rare but increasing in the United States. Although risk factors for cholangiocarcinoma have yet to be elucidated, a growing body of literature suggests chronic infection of genetically susceptible individuals with the food-borne zoonotic trematodes () and () may play a role.

Female sexual medicine: an assessment of medical school curricula in a major United States city.

Background: Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions.

Aim: This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula.

Methods: Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area.

Characteristics of work-related spine injury in the USA: a National Trauma Data Bank analysis.

Purpose: Workplace injury is a commonplace occurrence in the USA. Spine injuries are especially devastating as they can cause chronic pain and limit mobility which prevents patients from returning to work. Gaining a better understanding of the patients, mechanisms, and treatments associated with these injuries can aid in improving outcomes.

Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements.

Arteriovenous malformations (AVMs) are high-pressure, low-resistance arterial-venous shunts without intervening capillaries. Up to 60% of AVMs present with an intracranial hemorrhage; however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention.

The gap between hospital-based violence intervention services and client needs: A systematic review.

Background: Survivors of intentional interpersonal violence face social challenges related to social determinants of health that led to their initial injury. Hospital-based violence intervention programs reduce reinjury. It is unclear how well they meet clients' reported needs.

Promoting lung cancer screening of high-risk patients by primary care providers.

Background: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) of the chest of eligible patients remains low. Accordingly, augmentation of appropriate LCS referrals by primary care providers (PCPs) was sought.

Methods: The quality improvement (QI) project was performed between April 2021 and June 2022.

Patient with newly diagnosed type 2 diabetes? Remember these steps.

In addition to promoting glycemic control, you'll need to initiate statin therapy for CV risk, administer appropriate vaccinations, and screen for depression regularly.

Predicting chronic postsurgical pain: current evidence and a novel program to develop predictive biomarker signatures.

Chronic pain affects more than 50 million Americans. Treatments remain inadequate, in large part, because the pathophysiological mechanisms underlying the development of chronic pain remain poorly understood. Pain biomarkers could potentially identify and measure biological pathways and phenotypical expressions that are altered by pain, provide insight into biological treatment targets, and help identify at-risk patients who might benefit from early intervention.

Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis.

Objective: Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than in White patients.

Should Uterus Transplantation for Transwomen and Transmen Be Subsidized?

Success in uterus transplantation (UTx) among ciswomen suggests that transwomen and some transmen will also likely have interest in this intervention. It does not seem likely, however, that all parties interested in UTx will have the same standing when it comes to federal subsidies or insurance coverage benefits. This analysis describes the comparative moral strength of claims for financial support for UTx that different parties might make.

Risk for Depressive Symptoms Among Adolescents with a History of Adversity: Unique Role of Stress Appraisals.

Lifetime social adversity predicts elevated depressive symptoms in adolescence. However, most adversity-exposed youth do not develop depression, highlighting the importance of examining risk and protective factors. The present study leveraged a multi-method approach, incorporating self-report, interview, and independent coding to examine whether appraisals of recent stressors moderate the effect of social adversity on depressive symptoms in 81 adolescent girls (M = 16.

Cemented total knee arthroplasty provides greater knee range of motion at 2 years than cementless technique.

Introduction: Optimal fixation method between cemented, cementless, and hybrid techniques for total knee arthroplasty (TKA) is still debated. The purpose of this study is to evaluate the clinical outcomes of patients undergoing cemented versus cementless TKA.

Methods: We reviewed 168 patients who underwent a primary TKA at a single academic institution between January 2015 and June 2017.