Southeastern Health

Background: Meniscal preservation has been demonstrated to contribute to long-term knee health and has been a successful intervention in isolation and in patients with anterior cruciate ligament reconstruction (ACLR). The long-term results of meniscal repair in the setting of revision ACLR have yet to be documented. Purpose: To report the incidence of meniscal repair failures at the 6-year follow-up in a cohort of patients who underwent concurrent revision ACLR and primary meniscal repair. Study Design: Prospective cohort study; Level of evidence, 2. Methods: All revision ACLRs with concomitant primary meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained to determine whether any subsequent surgery had occurred since their initial revision ACLR. If so, operative reports were obtained, whenever possible, to verify pathological condition and treatment. Results: In total, 221 patients from 1234 revision ACLRs underwent concurrent primary meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The majority of these repairs (n = 181; 76%) were performed with an all-inside technique. Six-year surgical follow-up was obtained in 77% (171/221) of the cohort, or 189 of 238 (79%) of the repairs (136 medial, 53 lateral). The meniscal repair failure rate, defined as reoperation, was 16% (31/189) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 28/136 = 20.6% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 3/53 = 5.7% failure rate). Three medial failures were treated in conjunction with a subsequent repeat revision ACLR. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears (20.6% vs 5.7%; P = .01) and had a significantly shorter survival time compared with lateral tears (P = .02). No difference was found between the failure and nonfailure groups when it came to tear type, tear length, repair technique utilized, suture/implant type, or number of sutures used between the 2 groups. Conclusion: Meniscal repair in the revision ACLR setting has a 16% failure rate at 6 years. Failure rates for medial tears (20.6%) were found to be higher than that for lateral tears (5.7%), which aligns with previous studies in both the revision and primary ACLR setting.

BackgroundThere has been a shift in the management of choledocholithiasis from laparoscopic common bile duct exploration to endoscopic retrograde cholangiopancreatography. This has led to an increase in hospital length of stay, costs, and specifically for rural hospitals, transfer to a tertiary center for ERCP. Given this shift of choledocholithiasis management to advanced GI endoscopists, general surgery residents are rarely performing laparoscopic transcystic common bile duct explorations.MethodsA retrospective study of 69 consecutive laparoscopic transcystic common bile duct explorations (LCBDE) performed by 2 general surgeons in a rural community over 5years between 2017 and 2022. Primary outcomes included successful duct cannulation, successful stone clearance, instruments used, operative time, and significant complications (pancreatitis, bile leak, bleeding, bile duct injury). Specific technique for laparoscopic transcystic common bile duct exploration is outlined in Appendix 1.ResultsThere was a median age of 54years (Range 17-91). There was successful cannulation in 97% and successful stone clearance in 82% of cases. In the vast majority of cases only a guide wire and biliary balloon dilation catheter were utilized to perform the procedure. Median operative time for laparoscopic cholecystectomy with cholangiogram was 40minutes. Median operative time for laparoscopic cholecystectomy with cholangiogram and transcystic common bile duct explorations was 64minutes (Range 39-168). Therefore, the median time added by performing LCBDE was 24minutes There were no complications during laparoscopic transcystic common bile duct explorations.ConclusionsLaparoscopic transcystic common bile duct exploration can be safely, efficiently, and successfully performed with 0.035-inch Roadrunner PC guidewire, TAUT intraducer and an Advance Biliary Balloon Catheter. In order to shift the management of choledocholithiasis back to the general surgeon to decrease the length of stay and cost, there needs to be a change at the residency training level.

The promise of achieving desired outcomes in community-engaged research relies upon an ongoing and long-term connection between the community and researchers. However, many community–researcher relationships begin and end in the confines of a single project, often precluding the sustainability and scalability of programs and initiatives that can benefit the community. Few examples exist in the literature, especially for the focus of this paper—school behavioral health (SBH)—to understand how the complex, challenging, and nuanced process of continued engagement between researchers and community members can be sustained and succeed. In this article, we chronicle the development of the Southeastern School Behavioral Health Community across 13 years, from its inception in a single state to its regional expansion through two research awards, to illustrate how long-term community engagement and a history of community connections can shape SBH research and practice across project action cycles. We describe the strengths, challenges, and lessons learned from this long-term community engagement experience. Numerous examples illustrate proactive and responsive strategies for initiating and sustaining community engagement throughout all phases of the longitudinal initiative and demonstrate tangible ways in which meaningful engagement influenced both research and practice. The reflections include the extent to which engagement principles of the research funder (the Patient-Centered Outcomes Research Institute, PCORI) were enacted during this research program; our roles as researchers, facilitators, and community members; the impact of the COVID-19 pandemic; engagement facilitators and structures; and what was achieved regarding levels of engagement. Future directions are provided for sustaining interconnected, community-engaged research and practice in SBH.

Williams syndrome is a rare congenital disorder affecting connective tissue and the cardiovascular and central nervous systems. Pediatric patients diagnosed with Williams syndrome face significant risk for cardiac collapse and death when undergoing anesthesia. We sought to evaluate our institution's historical practices, evaluate individual risk stratification, and create detailed standardized perianesthesia guidelines for management of this population, particularly during noncardiac procedures. The study included a retrospective chart review of pediatric patients with Williams syndrome who received anesthesia over a 10-year period at a single institution. A total of 23 patients underwent 46 procedures. At time of procedure, median age was 5.8 years (range, 0.4-17.6 yr), and the majority (n = 19) had a "low" Williams syndrome risk category and required anesthesia for noncardiac procedures. Most (61%) had no cardiac involvement beyond mild supravalvar or branch pulmonary artery stenosis. No intraprocedure adverse cardiac events were identified. One patient experienced an adverse cardiac event approximately 60 minutes postanesthesia emergence which included ST segment depression and development of refractory ventricular fibrillation, necessitating deployment of venoarterial extracorporeal membrane oxygenation. This patient was eventually stabilized and was taken to the operating room 3 days later for definitive severe supravalvar aortic stenosis repair. Patients with Williams syndrome have a reported risk for sudden cardiac death that is 25 to 100 times greater than that of the age-matched general population. The incidence of adverse cardiac events in our cohort of patients with Williams syndrome undergoing anesthesia was lower compared with previous studies, which reported rates ranging from 4.2% to 11%. These findings support the idea that risk stratification and institutional practice guidelines can aid anesthesia providers in making informed decisions, and standardization of pre-, intra-, and postprocedural care according to existing guidelines may further reduce risks. Our review offers valuable insight into historical anesthesia management and contributes to a broader interdisciplinary understanding of care provision for this high-risk group.

To support public health efforts of local healthcare teams. A cross-sectional study of HSB among rural elderly age 60+, located in three rural villages near Vellore, Tamil Nadu. Participants included residents 60 years and older living in rural villages near Vellore. We asked through in-person interviews about demographics, chronic and acute morbidities, and HSB. Their answers were reviewed and analyzed with the statistical software package "R." Our participants near Vellore exhibited a high proportion of HSB, with 93% of affected individuals choosing to seek care. Despite the large number of different socioeconomic variables we studied, the only significant predictor of disease presence was gender, with males exhibiting much lower odds of reporting disease compared to females. We found no relationship between the type of illness and the type of healthcare facility approached for treatment. Finally, we found evidence of a relationship between the type of chronic illness suffered by a participant and whether the participant sought treatment at all. Public health efforts in the Vellore area have been highly successful compared to other parts of India and the world. Local providers may continue to improve patient engagement with healthcare by studying gender trends in morbidities and focusing on patients with less-common diseases.

Thyrotoxicosis, a potentially life-threatening endocrine disorder, can result in severe complications, particularly when it progresses to thyroid storm. Analyzing hospitalization trends, outcomes, and the healthcare burden associated with thyrotoxicosis is essential for enhancing management strategies and optimizing resource allocation. We analyzed trends in thyrotoxicosis hospitalizations with and without thyroid storm in the United States between 2016 and 2020. We analyzed data from the national inpatient database using International Classification of Diseases, Tenth Revision (ICD-10) codes for thyrotoxicosis (E05). We compared demographics using χ2 tests. Trends in hospitalization outcomes were assessed using the Cuzick test. Hospital costs were adjusted for inflation using the 2020 consumer price index. Odds of mortality and secondary outcomes were analyzed using multivariable logistic regression. Hospital stay in the 95th percentile was considered prolonged. A total of 33 430 hospitalizations were analyzed. Hospitalization rates declined from 7444 in 2016 to 5424 in 2020 (Ptrend = .002). Mortality rates increased both for hospitalizations without storm (10 [0.17%] in 2016 to 55 [1.30%] in 2020; Ptrend < .001) and with thyroid storm (10 [0.62%] in 2016 to 50 [4.15%] in 2020; Ptrend = .051). There was an uptrend in prolonged hospitalization rates in the total study cohort (11.9% [3978] to 14.6% [4881]; Ptrend = .030). Total hospital costs increased from $36 408 to 49 031 (Ptrend < .001). A similar uptrend was observed with ($45 343 to $69 321; Ptrend < .001) and without storm ($34 066 to $42 703; Ptrend < .001). Thyroid storm was correlated with higher odds of major adverse cardiovascular events (adjusted odds ratio [aOR]: 1.05; 95% CI, 1.02-1.17; P = .002), including acute heart failure (aOR: 1.15; 95% CI, 1.03-1.78; P < .001), sudden cardiac death (aOR: 1.23; 95% CI, 1.04-2.17; P = .041), and atrial fibrillation (aOR: 1.17; 95% CI, 1.05-2.06; P < .001). In the present study, we examined trends in hospilization and outcomes of thyrotoxicosis across the United States. Hospitalization rates for thyrotoxicosis were reduced while mortality rates significantly increased. There was an uptrend in health care costs, prolonged hospitalization, and the incidence of MACEs.

Introduction and background The Early Learning Period (ELP) hypothesis posits that hospital mortality increases during the early academic months, traditionally attributed to transitional challenges such as trainee inexperience and changes in care teams.Understanding the validity of this hypothesis is crucial for guiding healthcare strategies, either toward trainee-focused reforms if validated or systemic interventions if refuted. However, systemic and seasonal factors, such as winter respiratory illness surges and healthcare resource strain, may play a more significant role in hospital mortality trends. Methods This was a retrospective observational study utilizing the 2021 National Inpatient Sample (NIS), a nationally representative database covering approximately 20% of U.S. hospitalizations. The study analyzed 5.6 million adult hospitalizations from 2021, excluding pediatric cases and records with missing mortality data. Hospital mortality trends were compared quarterly (Q1: January-March, Q2: April-June, Q3: July-September, Q4: October-December) to evaluate associations with seasonal and systemic factors. Results Contrary to the ELP hypothesis, hospital mortality was highest in Q1 (4.0%), consistent with seasonal factors like winter illnesses, and lowest in Q2 (2.7%). Mortality in Q3 (3.6%), the period associated with new trainee arrivals, was lower than in Q1. Conclusion This study refutes the ELP hypothesis, demonstrating that systemic and seasonal factors, rather than trainee inexperience, primarily drive hospital mortality trends. Proactive resource allocation targeted at seasonal drivers, particularly during high-demand periods such as Q1, is crucial to improving patient outcomes. These findings emphasize the need for systemic interventions, including enhanced resource allocation and flexible staffing models, rather than trainee-centered reforms. Future research should incorporate monthly mortality trends and teaching hospital-specific data for a more comprehensive understanding.

While the physical health effects of obesity are well-characterized, an emerging branch of research has shown that obesity additionally plays a critical role in one's mental health. Young adults, in a pivotal transition phase in their lives, may be particularly prone to the concurrent effects of obesity and adverse mental health outcomes. The purpose of this review is to comprehensively examine existing data regarding the connection between obesity and two widely validated measures of mental health: psychological distress and depression. The connection between mental health outcomes and obesity is mediated by a complex interplay between biological and sociocultural factors, which is explored in this review with particular focus on younger adults aged 20-39. Further, the impact of several demographic factors including race/ethnicity, gender, and immigration status are examined closely. To our knowledge, this review is one of the first efforts to integrate existing knowledge between obesity and mental health, with particular regard for young adults and the impact of other key sociodemographic characteristics. This review has important implications at the interface of two of the most pressing public health crises in the United States.

The rapid expansion of the direct-to-consumer telehealth model has revolutionized healthcare accessibility, particularly in prescribing glucagon-like peptide-1 receptor agonists for weight management. While glucagon-like peptide-1 receptor agonist therapies are effective in promoting weight loss, their widespread use within the direct-to-consumer telehealth model raises significant patient safety concerns. Key risks include polypharmacy, compounded medications, inadequate patient education, and a lack of long-term safety studies. Additionally, the absence of comprehensive regulatory oversight, fragmented care coordination, and limited adverse event reporting increase the potential for improper dosing, medication-related complications, and suboptimal health outcomes. Policy recommendations to address these risks emphasize the need for improved data-sharing practices, stricter oversight of compounded glucagon-like peptide-1 receptor agonist formulations, improved patient education, and enhanced collaboration between direct-to-consumer telehealth platforms and traditional healthcare systems to enhance safety, continuity, and transparency. Addressing these challenges is crucial to ensure safe and effective glucagon-like peptide-1 receptor agonist therapies for weight management, especially as their use has surged, with 12% of the US population having used these medications. Future research should focus on the long-term safety and efficacy of glucagon-like peptide-1 receptor agonist medications, comparative effectiveness and safety between direct-to-consumer telehealth and traditional care models, and regulatory interventions to optimize patient outcomes and safety while maintaining accessibility to care.--Author's abstract