Association of Hallucinogen Persisting Perception Disorder with Trait Neuroticism and Mental Health Symptoms.

Hallucinogen Persisting Perception Disorder (HPPD) is considered rare in hallucinogen users although there are conflicting reports about its incidence and prevalence. HPPD may be more common in those with trait neuroticism. In this study, we invited hallucinogen and other drug users to complete an online questionnaire about their use of hallucinogens, their experience of HPPD symptoms, and their trait neuroticism and mental health symptoms. We received 802 responses with 415 of these containing adequate data for further analysis. 39.7% of responders reported symptoms corresponding to Type I HPPD, and 4.3% reported symptoms corresponding to Type II HPPD. We found no significant difference between neuroticism scores for participants with or without HPPD. Individuals with Type II HPPD were more likely to report mental health symptoms including anxiety, obsessional thoughts, paranoia, hypochondria and panic attacks (p < .05). We also found that individuals with Type II HPPD were more likely to report the use of 25I-NBOMe, dextromethorphan, nitrous oxide and benzodiazepines (p < .05). 47.3% of participants had never tested their drugs, making the attribution of HPPD severity to specific drugs difficult. Further work into the development of HPPD is required, particularly with the rise of hallucinogens as potential treatments for depression and other mental illnesses.

A Scoping Review to Assess Risk of Fracture Associated with Anxiolytic Medications.

Introduction: Recent research has focused on evaluating the impact of pharmalogical sources on fracture risk. The purpose of this study was to review the literature on anxiolytic medications that may be associated with an increased risk of fracture. Methods: A search was conducted in MEDLINE and Embase databases to identify primary clinical studies of patients who sustained a fracture while prescribed anxiolytic medications and were published prior to July 2021. Anxiolytics defined by ATC Class N05B, beta blockers, and zolpidem were included. The search terms consisted of variations of the following: ("Psychotropic Drugs" or MeSH terms) AND ("Fracture" or MeSH terms). Results: Of 3,213 studies, 13 (0.4%) met inclusion criteria and were evaluated. Fractures associated with benzodiazepine were reported in 12 of 13 studies; the highest risk occurred in patients aged 60 years and older (RR=2.29, 95% CI (1.48-4.40)). The ATC Class N05B showed an increased fracture risk for those ≤ 55 years of age that differed by sex: for men (RR=5.42, 95% CI(4.86-6.05)) and for women (RR=3.33, 95% CI (3.03-3.66)). Zolpidem also showed an increase fracture risk (RR=2.29, 95% CI(1.48-3.56)), but only during the first four weeks of treatment. A relative risk of 0.77, 95% CI(0.72-0.83) was observed for beta blockers. Conclusions: Fractures are a mainstay of traumatic injuries and are accompanied by economical, physiological, and psychological hardship. With proper assessment and prophylactic measures, fracture risk can be reduced dramatically. Anxiolytic medications have been described widely to increase fracture risk, such as benzodiazepines in 60+ year old patients, and ATC Class N05B anxiolytics increased fracture risk in 55+ year old men and in 55+ year old women. Yet, some studies showed that at low doses, nitrazepam lowered fracture risk. Other anxiolytic medications, such as zolpidem and beta blockers, also showed a decrease in fracture risk. Ultimately, this scoping review helped to illuminate the inconsistency of anxiolytic fracture risk assessment while simultaneously illustrating the necessary steps to guide future research.

Teaching of Cost-Effective Care in Orthopaedic Surgery Residency Training: A Survey of Residency Programs in the US.

Costs of healthcare in the US continue to rise at rates that are unsustainable. Prior studies, most of which come from non-surgical specialties, indicate that a variety of strategies to teach this material are utilized but without consensus on best practices. No studies exist regarding the teaching of cost-effective care in orthopaedic residency training programs. The goal of this study was to assess the landscape in this area from the perspective of program leadership. Methods: A survey was developed that was sent to orthopaedic residency program leadership via email through their interaction with the COERG. Additional programs were included to enhance diversity of responding programs. The survey, based on those published from other areas of medicine, included questions about the experiences of the respondents in learning about cost-effective care, as well as how faculty and residents learned about this topic. Results: Seventy one percent (30) of respondents noted that their faculty did not receive formal training in cost-effective care, and education in this area was likely to come from the department, especially review of practice data (12, 44%). Only 19% (8) of respondents agreed with the statement that "the majority of teaching faculty in our program consistently model cost-effective healthcare to residents". Few of the programs (10, 24%) had formal curricula for residents regarding cost-effective care, and the primary mode of education in cost-effective care was through informal discussions with faculty (17, 43%). Few residents (3, 13%) were able to easily find the costs of tests or procedures. Discussion: There is not consistent education in cost-effective care for orthopaedic surgery program leadership, faculty, or trainees. The results of this survey demonstrate a need for discussion of best practices, including increasing access to cost data at a local level, and engaging with the AOA, CORD, and the American Academy of Orthopaedic Surgeons more broadly in the development of standard education modules for faculty and residents, to improve the current and future delivery of cost-effective musculoskeletal care.

Afterhours patient phone calls: a quality improvement study.

The objective was to determine the most common topic of patient phone calls received by on-call orthopedic residents at a single academic institution in order to identify areas of improvement for patient outcome and resident workload and wellbeing. Design: Patient phone calls over 82 shifts were documented from May 2020 to January 2021 by on-call orthopedic residents. The length, nature, and associated attending physician of each call were recorded, as well as whether the call resulted in an emergency department visit. The nature of each phone call was categorized into one of 12 categories. Setting: An urban, tertiary care academic institution in the Midwest, USA. Participants: All orthopedic residents on-call during this period logged the phone calls that they received and related relevant data. Results: Orthopedic surgery residents took an average of 8.6 patient phone calls (average 53.3 total minutes) per shift. The most common reasons for the phone calls were pain, prescription, and pharmacy concerns, which together represented over half of the calls. Twenty-one (4.1%) phone calls resulted in an emergency department visit. Conclusion: Concerns about pain and prescriptions were among the most common reasons for patient phone calls. This information points to opportunities for interventions that could help guide how postoperative pain is discussed with patients, including providing patients with reasonable expectations for pain control, function, and tools for better self-efficacy. This approach could not only enhance patient care but also decrease resident on-call workload and improve resident wellbeing.

Core Muscle Injury Producing Groin Pain in the Athlete: Diagnosis and Treatment.

Groin pain is a common cause of pain in the athlete and may be the result of a variety of causes. Musculoskeletal groin injuries are often associated with muscle strain, particularly the adductor and abdominal muscles, termed "core muscle injury" (CMI). Since the early 1960s, there have been a growing number of articles intending to identify, define, prevent, and treat this condition; to date, however, the lack of a universal definition and treatment approach has complicated the narrative around CMI. This article intends to review the recent literature surrounding CMI, identifying common defining characteristics, as well as delineating treatment protocols that benefit the injured patient populations. Emphasis is placed on the clinical outcomes of different treatment methodologies and failure rates.

Sex-Based Reporting of Common Musculoskeletal Conditions.

Introduction: Sex- and gender-based differences affect all aspects of health and disease, including musculoskeletal conditions. However, it is unknown how often authors publish outcomes of common conditions based on sex. We reviewed the frequency with which articles in orthopedic journals published sex-specific outcomes with regard to a condition with known sex-based differences and one in which differences are less known. Materials and Methods: Articles that reported original clinical studies from four high-impact orthopedic journals were reviewed: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), American Journal of Sports Medicine (AJSM), and Journal of Arthroplasty (JOA). JBJS and CORR were reviewed as journals intended for a general audience, while AJSM and JOA were included as subspecialty journals. Analysis of data based on sex beyond the statement of how many men and women were included was designated as successfully reporting sex-specific outcomes. The gender of authors was assessed for impact on reporting. Results: Sex-specific outcomes were reported in 24%-29% of articles regarding rotator cuff pathology and in 32%-40% of publications concerning knee osteoarthritis. There was a trend toward more publications with sex-specific outcomes in knee osteoarthritis (p = 0.0562). No significant changes in rates of reporting were noted over time. Articles listing a woman as the first or last author were significantly more likely to report results based on sex. Conclusions: While there was a trend for sex-specific outcomes to be reported more often in knee osteoarthritis, the level of reporting was still low. Reporting based on sex was higher if a woman was the first or last author. To improve care for all patients, sex-specific outcomes should be reported across all orthopedic conditions by all researchers.

Circadian genes, xBmal1 and xNocturnin, modulate the timing and differentiation of somites in Xenopus laevis.

We have been investigating whether xBmal1 and xNocturnin play a role in somitogenesis, a cyclic developmental process with an ultradian period. Previous work from our lab shows that circadian genes (xPeriod1, xPeriod2, xBmal1, and xNocturnin) are expressed in developing somites. Somites eventually form the vertebrae, muscles of the back, and dermis. In Xenopus, a pair of somites is formed about every 50 minutes from anterior to posterior. We were intrigued by the co-localization of circadian genes in an embryonic tissue known to be regulated by an ultradian clock. Cyclic expression of genes involved in Notch signaling has been implicated in the somite clock. Disruption of Notch signaling in humans has been linked to skeletal defects in the vertebral column. We found that both depletion (morpholino) and overexpression (mRNA) of xBMAL1 protein (bHLH transcription factor) or xNOCTURNIN protein (deadenylase) on one side of the developing embryo led to a significant decrease in somite number with respect to the untreated side (p<0.001). These manipulations also significantly affect expression of a somite clock component (xESR9; p<0.05). We observed opposing effects on somite size. Depletion of xBMAL1 or xNOCTURNIN caused a statistically significant decrease in somite area (quantified using NIH ImageJ; p<0.002), while overexpression of these proteins caused a significant dose dependent increase in somite area (p<0.02; p<0.001, respectively). We speculate that circadian genes may play two separate roles during somitogenesis. Depletion and overexpression of xBMAL1 and NOCTURNIN both decrease somite number and influence expression of a somite clock component, suggesting that these proteins may modulate the timing of the somite clock in the undifferentiated presomitic mesoderm. The dosage dependent effects on somite area suggest that xBMAL1 and xNOCTURNIN may also act during somite differentiation to promote myogenesis.