Alcohol Drug Mental Health Board of Franklin County

BackgroundFrailty is an established risk factor for adverse outcomes following total joint arthroplasty, including higher rates of prosthetic joint infection (PJI), reoperation rates, and readmission, which may be greater in the setting of revision. The purpose of this study is to compare the association of frailty indices with mortality and complications following septic revision arthroplasty.MethodsA query from The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was performed for adult patients undergoing revision total knee or hip arthroplasty between 2015 and 2020, which records perioperative data (30 days postoperatively) for over 700 centers nationwide. PJI cases without revision arthroplasty were excluded. The RAI-rev and mFI-5 frailty scores were calculated for each patient. Outcomes included major complications, mortality, non-home discharge (NHD), DVT, readmission within 30 days, wound complications, pulmonary complications, cardiac complications, and postoperative infection. T-test and binary logistic regression assessed associations with frailty scores and outcomes. Predictability was evaluated through multivariate regression analysis, and its discriminative accuracy was measured using receiver operating curve (ROC) analysis and C-statistics.ResultsA total of 4395 patients were included (median age: 66 [IQR 59-73]). Within the cohort, 46.44% were female and 38.02% exhibited NHD. RAI-rev demonstrated increased association compared to mFI-5 with mortality (OR: 1.20 vs 1.10, CI: 95%) and NHD (OR: 1.15 vs 1.05, CI: 95%). RAI-Rev demonstrated significantly superior discriminatory accuracy when compared to mFI-5 for NHD (Cs: 0.670 vs 0.602, P < 0.001) and mortality (Cs: 0.795 vs 0.574, P < 0.001).ConclusionsFrailty may have a distinct association with mortality and NHD following septic rTJA, especially when assessed by the revised Risk Analysis Index. This understanding is important to educate the patient and their family and provide insight into the necessary resources and surveillance needed to manage frail patients undergoing septic revision total joint arthroplasty.

Professional identity (PI) has been linked to job satisfaction and retention, with research suggesting that fostering a strong PI during nursing education can help mitigate burnout and reduce turnover. However, few studies have explored how various learning experiences contribute to PI development. The purpose of this study was to describe the connections between educational experiences and PI. An open-ended prompt was disseminated to prelicensure nursing students. Participants described an experience that connected them to their PI. Thematic analysis was used to analyze responses and identify key themes. Four main themes emerged as influential in PI development: relationships, confidence, autonomy, and hinge moments. Positive relationships with patients, preceptors, and colleagues were identified as critical in strengthening PI. Clinical and classroom experiences that boosted confidence and autonomy were also essential. Hinge moments, such as meaningful patient interactions or significant clinical events, were pivotal in shaping students' PI. Findings identified key factors that shape PI, emphasizing the need for hands-on learning experiences such as simulations and early clinical exposure.

Alcohol dependence is a major public health problem. Studies have shown that a person dependent on alcohol often coabuses other substances, such as cocaine. Cocaine is a powerful stimulant whereas ethanol is generally considered to be a depressant, with some stimulating properties. The subjective effects of these two substances in a dependent individual may often appear to be more similar than they are different. Animals also self-administer both substances. Basically, although both substances have anesthetic properties and both act to functionally increase catecholaminergic function, especially that of dopamine, there are some differences in their actions. Both alcohol and cocaine have various effects on several neurotransmitters and systems, which ultimately interact to produce the feeling of well-being avidly sought by many individuals today. This drive often eventually produces a dependence which has associated social and medical consequences. It seems likely that the neurochemical changes that ensue following abuse of these substances underlie the phenomena of dependence, tolerance, and subsequent withdrawal. The apparent similarities and differences between these two substances will be reviewed in this chapter.

Journal Article A biallelic RFLP of the human α2-C4 adrenergic receptor gene (ADRA2RL2) localized on the short arm of chromosome 4 and encoding the putative α2B receptor is identified with Bsu 36 I, using a 1.5 kb probe (p ADRA2RL2) Get access Margaret R. Hoehe, Margaret R. Hoehe * *To whom correspondence should be addressed Search for other works by this author on: Oxford Academic PubMed Google Scholar Wade H. Berrettini, Wade H. Berrettini Search for other works by this author on: Oxford Academic PubMed Google Scholar John W. Regan John W. Regan 1The Howard Hughes Medical Institute, Duke University Medical Center, Departments of Medicine, Biochemistry, and PhysiologyDurham, NC277, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Nucleic Acids Research, Volume 17, Issue 23, 11 December 1989, Page 10148, https://doi.org/10.1093/nar/17.23.10148 Published: 11 December 1989