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Insights. The 2026 Annual Meeting of the Arthroscopy Association of North America (AANA) in Phoenix, Arizona, delivered an inspirational, informative, and impressive series of lectures, meetings, and reunions of friends in the desert. We look forward to seeing you again next year for another bright and sunny Annual Meeting in Hollywood, Florida, May 13 to 15, 2027.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) were developed to treat type 2 diabetes mellitus and later became widely used for the management of obesity. Recent evidence includes off-label uses for substance use disorders; nicotine and alcohol dependence; neurodegenerative diseases; and cardiovascular, kidney, and liver diseases. Certified registered nurse anesthetists (CRNAs) are likely to encounter patients using GLP-1RAs for both Food and Drug Administration-approved and nontraditional purposes. This review explores the pharmacology and mechanisms of action of GLP-1RAs, with a focus on their relevance in the perioperative period. It covers their effects on blood glucose control, gastric motility, and central nervous system pathways. Special attention is given to delayed gastric emptying, concerns about pulmonary aspiration, and the metabolic benefits of glucose-dependent insulin secretion and reduced blood glucose fluctuations. Current professional guidelines emphasize personalized, patient-centered perioperative care. The increasing use of GLP-1RAs, combined with more off-label prescribing and unregulated peptide use, emphasizes the need for thorough preoperative screening, clear medication reconciliation, and effective interdisciplinary communication. As more evidence emerges, CRNAs must remain vigilant while recognizing that the expanding role of GLP-1RAs is important for optimizing perioperative safety and achieving optimal patient outcomes in modern anesthesia practice.
Chronic pain is a complex and disabling condition that significantly impairs quality of life. It often arises from central sensitization, an amplified response to pain stimuli driven by neuroinflammatory changes in both the peripheral and central nervous systems. Emerging evidence highlights the gut microbiome's crucial role in the process because it modulates inflammation, immune function, and neurotransmitter production via the gut-brain axis. An imbalance in gut flora, known as dysbiosis, can exacerbate neuroinflammation by altering intestinal barrier integrity, facilitating the release of pro-inflammatory mediators, and activating microglia within the central nervous system. These changes contribute to increased pain sensitivity and the progression of chronic pain states. Consequently, strategies promoting a healthy gut microbiome, such as targeted dietary measures and microbiota-focused therapies, represent promising adjuncts to conventional chronic pain management. This journal course evaluates current research on the connection between the gut microbiome and chronic pain, offering a novel perspective on holistic, microbiome-centered interventions for alleviating pain disorders. As certified registered nurse anesthetists increasingly participate in pain management, understanding this emerging approach is vital for improving patient outcomes in chronic pain conditions.
Ice hockey places high demands on the hip, predisposing athletes to femoroacetabular impingement (FAI), although long-term outcomes after hip arthroscopy remain poorly defined. To evaluate the outcomes and return-to-sport (RTS) rates of ice hockey players undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral pathology at short-, mid-, and long-term follow-up (2, 5, and 10 years), with a secondary subanalysis of RTS durability. Case series; Level of evidence, 4. Prospectively collected data on ice hockey players who underwent hip arthroscopy between 2008 and 2020 were reviewed. Included patients reported ice hockey participation within 1 year from the surgery and completed preoperative and minimum 2-year postoperative questionnaires for at least 1 of the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), visual analog scale (VAS). Clinically relevant thresholds and secondary procedures were recorded. RTS analysis was based on the number of patients who attempted RTS at 2-, 5-, and 10-year points. A total of 72 hockey players were included, with a mean age of 31.3 ± 13.6 years and mean follow-up of 80.2 ± 41.7 months. Significant improvements were observed across all PROs from pre- to postoperative assessments (P < .001). At latest follow-up, thresholds for the minimal clinically important difference were achieved by 74.2% of participants for mHHS, 66.7% for NAHS, 95% for iHOT-12, 68.8% for HOS-SSS, and 76.8% for VAS. On the Patient Acceptable Symptom State anchor question, 86.2% of hockey players responded "yes" at the latest follow-up. Revision arthroscopy was performed in 6 patients (8.3%), and conversion to total hip arthroplasty occurred in 2 patients (2.8%). Of the 61 athletes who attempted RTS, 53 (86.9%) returned to hockey. At 2-year follow-up, 51 of the athletes (83.6%) were still active. At 5-year follow-up, 75.7% continued to play hockey. At 10 years, 57% continued to play. Among the patients who returned to sport, 74.5% returned to play at the same or a higher competitive level. Hip arthroscopy for FAIS and labral pathology in hockey players resulted in significant functional improvement and high midterm RTS rates. Importantly, most athletes who returned to play were able to compete at the same or a higher level compared with preoperative status, reinforcing the potential for functional durability of well-performed hip arthroscopy in this athletic cohort.
Retinoblastoma (RB) is the most common intraocular malignancy diagnosed in early childhood. Treatment is extensive, requiring multiple general anesthetics to facilitate eye examinations. However, little is known how repeated exposure to general anesthesia in early childhood affects cognitive function in RB survivors. The purpose of this cross-sectional study was to examine the effects of anesthesia exposure on cognition in 14- to 26-year-old RB survivors compared with those in healthy controls. Patients who previously received care for RB (n = 98) were recruited and compared to a cohort of healthy subjects (n = 97). Participants' cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). MoCA scores were compared between groups using Wilcoxon rank-sum tests. Relationships between MoCA scores and anesthesia exposure were assessed using Spearman's rank correlation coefficients. Multiple regression was used to evaluate the effect of anesthesia (both before the age of three and throughout childhood) on cognition. RB patients scored significantly lower than controls on the MoCA and several of its subscales (Naming, Attention, Language, and Abstraction; adjusted ps < 0.05). Total childhood anesthesia exposure was negatively associated with MoCA total scores (ρ = -0.19, p = 0.009) and some subscale scores. In regression models adjusted for covariates, each time anesthesia was administered before the age of three (β = -0.06, p = 0.02) or throughout childhood (β = -0.04, p = 0.005) was associated with a small but statistically significant decrease in cognition. Hollingshead socioeconomic status (β = 0.04, p = 0.001) and public insurance (β = -1.75, p < 0.0001) were stronger predictors of MoCA total scores than anesthesia exposure. Despite any effects of repeated anesthesia exposure in early childhood on cognition, MoCA scores for RB survivors were in the normal range. These findings add to the developing research on neurocognitive effects of anesthesia in early childhood in a population with large anesthesia exposure and minimal confounding factors. Future research should include additional measures of neurodevelopmental functioning and focus on the at-risk low socioeconomic status population. Continued follow-up and assessment of visual function in bilateral survivors are imperative.
Quadriceps tendon (QT) autograft is increasingly used for anterior cruciate ligament reconstruction (ACLR), yet rehabilitation guidelines remain extrapolated from patellar tendon (PT) or hamstring tendon (HT) protocols. This cross‑sectional study evaluated publicly available postoperative rehabilitation protocols from academic orthopaedic programmes to describe their content, assess variability and identify key trends. Accredited orthopaedic residency programmes were identified through the Electronic Residency Application Service (ERAS) and Canadian Resident Matching Service (CaRMS). A three-step systematic web-based search was conducted to identify publicly available QT-ACLR rehabilitation protocols. Protocols were included if specific to QT autografts and excluded if addressing concomitant meniscal repairs. Two independent reviewers extracted data on rehabilitation components and timelines. The proportion of protocols including each component and the median initiation time were calculated. Of 219 programmes screened, 16 eligible protocols were identified. Nine were QT-specific and seven were general ACLR protocols. Key trends included: (1) use of a hinged brace locked in extension for 2-4 weeks (86.7%); (2) initiation of icing, cryotherapy and patellar mobilizations immediately postoperatively (68.8%); (3) neuromuscular electrical stimulation use within the first 4 weeks (56.2%); (4) target of full extension by 2-4 weeks and flexion by 3-4 months (100%); (5) strengthening, balance and proprioceptive training beginning between 1-3 months (93.8%-100%) and (6) return‑to‑sport (RTS) testing between 5 and 9 months, using time-based and/or criterion-based recommendations (100%). Substantial variability existed in exercise prescriptions, adjunctive therapy use and RTS criteria. Publicly available QT-ACLR rehabilitation protocols from academic programmes emphasize early weight-bearing, range of motion restoration and progressive strengthening but reveal considerable variability in timing, adjunctive therapies and RTS guidelines. Many protocols mirror those for PT and HT autografts rather than being tailored to QT-specific considerations. Standardized, evidence-based rehabilitation guidelines that address graft-specific risks, psychological readiness and telehealth delivery are needed to optimize outcomes following QT-ACLR. Level IV.
Functional outcomes after peripheral nerve reconstruction remain suboptimal, particularly for large-gap defects. This study evaluated the combined use of the Missouri Osteochondral Preservation System for nerve (MOPS-N) preservation for nerve isografts and polyethylene glycol-mediated fusion (PEGf) in a rat sciatic nerve gap model. Adult male Lewis rats underwent an 8-mm sciatic nerve gap reconstruction. Animals were randomized to the following 6 groups: (1) MOPS-N isografts stored 28 days + PEGf, (2) MOPS-N isografts stored 56 days + PEGf, (3) Normosol-preserved isografts stored 28 days + PEGf, (4) Normosol-preserved isografts stored 56 days + PEGf, (5) autograft, and (6) autograft + PEGf. Functional outcomes were assessed through sciatic functional index, rotarod performance, and hindlimb grip strength testing over 6 weeks. At end point, gastrocnemius muscle mass ratios were measured, and nerve segments underwent histomorphometric analysis for G-ratio evaluation. MOPS-N groups consistently outperformed Normosol groups and autografts without PEGf. By week 6, both MOPS-N groups achieved significantly higher sciatic function index scores than both autograft groups and Normosol groups. Rotarod times were significantly greater in both MOPS-N groups and autograft + PEG group than Normosol across weeks 3-6. Grip strength recovery approached baseline in both MOPS-N groups and autograft + PEG group by week 4, whereas autografts without PEG and Normosol grafts remained impaired. Muscle mass ratios were highest in MOPS-N groups. Histomorphometric analysis of nerve segments showed MOPS-N groups maintained more uniform G-ratios across segments. MOPS-N-preserved viable nerve isografts combined with PEG-fusion promoted superior functional recovery, muscle reinnervation, and axonal integrity compared with autografts and Normosol preservation. This strategy has potential to address the barrier of limited shelf-life of stored viable peripheral nerve tissue, expanding the translational potential of viable nerve grafts for reconstruction of large-gap peripheral nerve injuries. Additional studies are needed to assess the immunogenicity of MOPS-N-stored allografts.
Subarachnoid block, colloquially referred to as spinal anesthesia, is a commonly employed method of anesthesia for most of the lower limb orthopedic procedures. Patients in preoperative hypovolemic states are more prone to post-spinal anesthesia hypotension (PSAH). Most orthopedic patients present in a preoperative fluid deficit state, thus, its recognition and appropriate correction are prudent. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is a tool to detect and correct hypotension secondary to hypovolemia. We hypothesized that pre-spinal IVCCI measurement is a reliable predictor of PSAH in patients undergoing elective lower limb orthopedic procedures. Ninety-nine participants, ASA grade I and II, aged 18-60 years, undergoing elective lower limb orthopedic surgeries were enrolled. Preoperative ultrasound inferior vena cava evaluation was performed and IVCCI was calculated. Preloading was done with intravenous crystalloid and subarachnoid block was administered in lateral position. Participants were placed supine and thereafter, level of sensory block was ascertained, and noninvasive blood pressure was measured every 2.5 min for 30 min. One hundred patients were screened and one was excluded due to failure of block. Mean IVCCI was 47.33 ± 9.62%. The receiver operating characteristic curve showed IVCCI has satisfactory predictive validity for predicting hypotension with AUC of 0.829 and P < 0.001. The sensitivity and specificity of IVCCI was found to be 87.36% and 83.3% at a cut-off value of 51.67%. Preoperative ultrasound evaluation of IVCCI is a reliable predictor for PSAH at a value of 51.67%.
While the clinical outcomes of acetabular labral repair and reconstruction have been reported, comparative cellular responses between common allografts to clinically relevant load are less clear. This study aims to compare acetabular labrum (LAB), anterior tibialis tendon (TEN), and knee meniscus (MEN) cellular responses to biaxial tensile strain during in vitro culture. LAB, TEN, and MEN tissues were recovered from skeletally mature research hounds (n = 5). Primary LAB, TEN, and MEN fibroblast cell cultures were established. Using a bioreactor, cells were loaded at 0%, 4%, or 10% biaxial tensile strain for 5 days. RNA was extracted and reverse transcription-polymerase chain reaction (RT-PCR) was used to determine relative gene expression levels. Cells were then tested for various stress-induced biomarkers. Statistical analysis determined significance between groups for relative gene expression levels and biomarker concentrations. LAB in the 0% strain group had more viable cells compared to the 4% and 10% strain groups, and MEN fibroblasts in the 4% strain group had more viable cells compared to the 10% strain group. LAB and MEN were associated with higher concentrations of MMP-3 in the 10% strain compared to the 0% strain group. The characterization of acetabular labrum cellular responses to clinically relevant loads of force more closely matches those of meniscal allograft tissue than tibialis anterior allograft tissue. This has potential implications for labral reconstruction, as meniscal allograft tissues may be more suited than tibialis anterior tissues to withstand compressive forces necessary for stabilization and chondroprotection within the hip.
Medial meniscus posterior root tears (MMPRTs) have been associated with rapidly progressive cartilage degeneration when left untreated in adults. However, their clinical presentation, tear morphology, and associated cartilage pathology remain poorly characterized in pediatric and adolescent patients. To identify risk factors for medial tibiofemoral compartment cartilage injury in pediatric and adolescent patients undergoing MMPRT repair, and secondarily to characterize MMPRT morphologies and skeletal maturity-associated injury patterns. Case series; Level of evidence, 4. Patients <19 years of age who underwent a transosseous MMPRT repair between 2015 and 2025 across 5 institutions were included. Operative records were reviewed to classify MMPRT morphology using the LaPrade classification and to document concomitant ligamentous procedures. The presence, location, and severity of arthroscopically identified medial tibiofemoral compartment cartilage injuries involving the medial femoral condyle (MFC) and/or medial tibial plateau were graded using the International Cartilage Regeneration & Joint Preservation Society (ICRS) classification. Patients with and without medial compartment cartilage injury were compared, and multivariable logistic regression was used to identify risk factors associated with its presence at the time of surgery. A total of 75 patients underwent a transosseous MMPRT repair (mean age, 15.2 ± 2.3 years), and 40% were skeletally immature. The most common MMPRT morphology was a type 5 root avulsion (55%), followed by a type 2 complete radial root tear (36%). Skeletally immature patients more frequently sustained isolated MMPRTs (60% vs 11%; P < .001), whereas skeletally mature adolescents more commonly had ligament-associated MMPRTs (89% vs 40%; P < .001). Overall, medial compartment cartilage injury was arthroscopically identified in 34 patients (45%) at the time of surgery. Most cartilage injuries involved the MFC (82%) and were classified as ICRS grade 1 (15%) or grade 2 (62%), while 24% were high-grade (ICRS grade 3 or 4). Multivariable logistic regression demonstrated that age (OR per year, 1.33; 95% CI, 1.02-1.73; P = .03) and delayed surgery (≥90 days after injury) (OR, 4.96; 95% CI, 1.6-15; P = .005) were significantly associated with medial compartment cartilage injury. The association between delayed surgery and medial compartment cartilage injury remained consistent in a sensitivity analysis incorporating concomitant ligament injury. Concomitant medial compartment cartilage injury was arthroscopically identified in 45% of pediatric and adolescent patients undergoing MMPRT repair. While most of these cartilage injuries involved the MFC and were classified as ICRS grade 2, nearly one-quarter were high-grade lesions (ICRS grade 3 or 4). Increasing age and delayed surgery (≥90 days after injury) were significantly associated with medial compartment cartilage injury. Overall, these findings underscore the potential importance of timely recognition and surgical treatment of MMPRTs in young patients.
Variables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined. To identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes. Case-control study; Level of evidence, 3. Data were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or professional sports within 1 year before surgery as well as the availability of preoperative and minimum 5-year patient-reported outcome scores for the modified Harris Hip Score, Nonarthritic Hip Score, HOS-SSS, and visual analog scale for pain. Exclusion criteria were age <18 or >50 years, workers' compensation status, previous ipsilateral hip surgery/conditions, Tönnis grade >1 osteoarthritis, or unwillingness to participate. Patients were stratified based on achievement of the PASS for the HOS-SSS at 5-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of achieving the PASS. Receiver operating characteristic analysis was utilized to determine clinically relevant threshold values. A total of 105 athletes were included, of whom 84 achieved the PASS at a minimum 5-year follow-up and 21 did not. Patient characteristics, preoperative radiographic measurements, intraoperative findings, and intraoperative procedures were similar between groups (P > .05). Multivariate logistic regression identified postoperative alpha angle (odds ratio, 0.89; P = .021) and postoperative anterior center-edge angle (ACEA) (odds ratio, 1.20; P < .001) as independent predictors of achieving the PASS. Receiver operating characteristic analysis demonstrated excellent discrimination (area under the curve = 0.814), with thresholds <47° for the alpha angle and >26° for the ACEA associated with significantly higher rates of achieving the PASS (P < .05). Postoperative alpha angle and ACEA were significant predictors of achieving the PASS for the HOS-SSS at a minimum 5-year follow-up in high-level adult athletes undergoing primary hip arthroscopy. These findings emphasize the importance of precise bony correction to optimize long-term patient-acceptable outcomes.
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A critical component of conducting systematic reviews or meta-analyses is assessing the methodological quality and bias of included studies. Several methodological quality assessment tools have been developed; however, these tools may not be relevant to observational sports medicine research, which carries numerous unique nuances and biases. To develop the Sport Publication Observational Research Tool (SPORT), which evaluates and scores the methodological quality of observational sports medicine research. Consensus statement. SPORT was developed through a modified Delphi approach involving members from the Herodicus Society and The FORUM. All active members were invited to participate in the process aimed at building consensus on SPORT content and scoring. After finalizing SPORT, a power analysis led to the independent selection of 55 observational clinical sports medicine studies, which were scored twice by 4 reviewers of varying training levels. Interrater and intrarater reliability for SPORT was assessed using intraclass correlation coefficients (ICCs). The distribution and percentiles for total SPORT score across the 55 studies were calculated. SPORT was also compared with the methodological index for non-randomized studies (MINORS), a commonly utilized quality assessment tool. A total of 51 members participated and achieved 100%, 100%, 98.0%, and 98.0% completion rates for rounds 1 through 4, respectively. The final SPORT included 19 subscores related to methodological quality and bias and achieved 94% consensus approval. Mean SPORT completion time was 6 minutes and 19 seconds per study, which varied significantly by reviewer training level. The subscore "peer review" demonstrated unacceptable reliability and was removed. The remaining 18 subscores exhibited ICC ranges of 0.599 to 0.955 for interrater reliability and 0.530 to 0.936 for intrarater reliability. Total SPORT score demonstrated excellent agreement, for interrater (ICC, 0.967) and intrarater reliability (ICC, 0.966). Median SPORT score across the 55 studies was 20.0 and skewed toward lower scores. There was a moderate significant correlation between SPORT and MINORS (r[53] = 0.575; P < .001). An objective tool to assess the methodologic quality of observational sports medicine research (SPORT) was successfully developed through a modified Delphi approach with numerous content experts in the field. This tool may be useful in assessing the methodological quality of primary observational sports medicine studies included in systematic reviews and meta-analyses.
The spectrum of hip pathology treated by hip preservation surgery ranges from femoroacetabular impingement to hip dysplasia. Borderline hip dysplasia (BHD) represents a challenging diagnosis where the surgical indication is not always clear. BHD is a complex pathology which presents challenges in surgical decision-making between hip arthroscopy and open surgery, specifically periacetabular osteotomy. Research has shown efficacy for both isolated hip arthroscopy and/or periacetabular osteotomy as a treatment option in the appropriately selected patients.
Gabapentin is widely used in perioperative analgesic protocols. Many clinical studies supporting the safety and analgesic efficacy of gabapentin for postoperative pain have been published over the last two decades. Several studies, many recently, have questioned its effectiveness and safety for perioperative pain management in early recovery after surgery (ERAS) and non-ERAS protocols leading to the research question: Is the use of gabapentin in perioperative analgesic protocols efficacious and safe for all perioperative patients? An integrative review was performed to identify, analyze, and synthesize a carefully selected sample of the evidence surrounding the inclusion of gabapentin in perioperative pain management practice. Analysis of the literature showed that gabapentin was found to be effective and safe in multiple studies yet may not be an effective treatment to include in all opioid-free multimodal pain regimens for ERAS and non-ERAS surgical pathways. Instead, gabapentin appears safe and effective for some populations of surgical patients undergoing a variety of procedures, while for other populations the medication is less efficacious and potentially harmful because of its side effects, which include respiratory depression, ataxia, and sedation.
Osteochondral allograft (OCA) transplantation is often utilized for treating osteochondral lesions of the knee due to limited cartilage regenerative capabilities. The use of liquid orthobiologic agents such as bone marrow aspirate concentrate has gained traction as a method to enhance OCA incorporation and healing. Pulse lavage and pressurized carbon dioxide (CO2) lavage are cleaning methods used during OCA preparation to remove native marrow elements, but their isolated and combined effects are not fully understood. This study aimed to assess the impact of incorporating pressurized CO2 lavage as an adjunct to pulse lavage during OCA preparation. It was hypothesized that adding pressurized CO2 lavage would enhance the OCA absorption capacity for liquid-based materials such as host-derived marrow constituents. Controlled laboratory study. OCA plugs were harvested from medial hemicondyles. The plugs were divided into 2 groups: one group underwent pulse lavage alone, and the other group underwent pulse lavage followed by pressurized CO2 lavage (sequential group). The plugs were weighed before and after each cleaning step, and a water-based dye solution was added by dripping. Next, the liquid content was determined by centrifugation and spectrophotometry. Results were analyzed statistically. A total of 34 OCA plugs with a 14 to 18 mm-diameter were harvested. After the cleaning phase, the sequential group showed a significant mean reduction in aqueous weight of 0.253 ± 0.110 g (107% ± 21%) (P < .0001) and a subsequent mean gain in aqueous weight of 0.231 ± 0.107 g (96% ± 19%) (P < .0001), after the cleaning and dye-dripping procedures. In contrast, the pulse lavage-only group exhibited a small mean weight gain of 0.028 ± 0.010 g (11% ± 4%) after the dye-dripping procedure. Adding pressurized CO2 lavage to pulse lavage improved OCA cleaning and increased uptake of an aqueous dye solution used as a surrogate for liquid orthobiologic agents in this ex vivo model. The study findings highlight the potential of incorporating pressurized CO2 lavage as an adjunct to pulse lavage during OCA preparation. These findings could enhance OCA preparation techniques by improving the removal of donor marrow elements and facilitating the subsequent ingress of fluid into the graft's cancellous portion.
To test new, more stable and long-lasting formulations of liposomal adenosine in the treatment of OA in a preclinical canine model. OA was induced by arthroscopic medial meniscus release (MR) in the right knee (stifle) of purpose-bred hounds. Symptomatic OA developed by 2 months after which knees were injected monthly with 3 mL of saline or 2 different liposomal adenosine preparations, RgnA09M or RgnA09N, for a total of 3 injections. Blinded assessments of knee pain, function, comfortable range of motion (CROM) and effusion were performed before induction of OA, at 2 months, 4 months and at the time of sacrifice (6 months post-Tx). Radiographic assessments and MRI of the knees were also performed. Plasma and synovial fluid were collected and COMP and CTX-II levels assessed by ELISA. Symptomatic OA developed by 2 months with increased pain, loss of function and diminished CROM. Saline treatment did not improve knee pain, CROM or loss of function at any time point but intraarticular injection of RgnA09M and RgnA09N markedly improved pain, CROM and function at all timepoints. Injections of RgnA09M and RgnA09N, but not saline, improved radiographic assessments at 4 months and 6 months. Similarly, MRI scores significantly improved in RgnA09M and RgnA09N treated dogs compared to saline. Histologic analysis showed that RgnA09M and RgnA09N injections reduced synovial inflammation. This is the first evidence that intraarticular injection of liposomal adenosine reduces pain, improves CROM and function and mitigates radiologic progression in a large animal OA model.
Graduate students, including medical students, use cognitive enhancer (CE) medications with or without legal prescription to aid academic performance despite little evidence that they improve performance in individuals without a medical diagnosis and subsequent prescription. However, there is limited information on CE medication use, with or without legal prescription, by resident registered nurse anesthetists (RRNAs). This cross-sectional survey assessed prevalence of CE medication use with or without legal prescription and its potential predictors (depression, anxiety, Attention Deficit Hyperactivity Disorder [ADHD] symptoms, and demographic variables) in 421 RRNAs. Descriptive and binary logistic regression analyses were conducted. The prevalence of CE use with or without prescription was 27.3%, with 93% obtained by prescription. The prevalence of clinically significant symptoms of ADHD (25.7%), depression (26.9%), and anxiety (23.1%) were assessed among RRNAs. No significant differences in age, gender, or program years were observed between CE medication users with or without legal prescription and CE non-users. However, white respondents were more likely to be CE medication users with or without legal prescription compared with respondents of other racial groups (P = .020). In the full logistic regression model, ADHD (aOR, 1.17; 95% CI, 1.10-1.24) was associated with increased odds of CE use. The Backward stepwise selection model retained ADHD and anxiety as significant predictors.
This study aimed to develop an evidence-based perioperative assessment tool for anesthesiology professionals to supplement standard preoperative assessments, targeting the unique health needs of transgender and gender-diverse (TGD) patients to enhance the perioperative experience. Many TGD patients express dissatisfaction with their care, while numerous healthcare professionals report feeling inadequately prepared to care for this population effectively. Using a modified Delphi design, a consensus-based Perioperative Gender-Diverse Assessment Tool (PGDAT) was developed to assist anesthesiology professionals in sensitively engaging with TGD patients and creating evidence-informed, patient-focused anesthetic plans. Fourteen expert panelists from the United States appraised the quality and clinical readiness of the PGDAT through iterative online surveys. Consensus was defined as 0.8 agreement among raters, and a thematic analysis was conducted following Braun and Clarke, with three core themes emerging. The interrater reliability was 0.75707 and 0.83977 using Gwet's AC2. The 0.8 consensus threshold was achieved after two survey rounds, which content-validated the PGDAT and established an evidence-based resource that future research opportunities can use to bring about systemic changes that promote safe and inclusive healthcare environments for all.
This study explored job satisfaction and turnover intentions among certified registered nurse anesthetists (CRNAs) in a prominent Southern California health system. Job satisfaction and turnover intentions were measured using the Misener Nurse Practitioner Job Satisfaction Scale and Turnover Intention scales, respectively. Of the 60 CRNAs who completed the survey, 30% expressed turnover intentions, which was higher among new practitioners. Marital status emerged as a significant influence on both job satisfaction and turnover intentions. Overall job satisfaction was high, with male CRNAs scoring slightly higher. Principal components and regression analyses unveiled key factors regarding job satisfaction including satisfaction with supervisors, peer interactions, and flexibility in practice. The findings highlight the specific factors that influence CRNAs' career choices, stressing the importance of providing targeted support, particularly for those new to practice. The correlation between job satisfaction and specific factors is highlighted, offering healthcare organizations actionable insights. Addressing these dynamics can enhance job satisfaction, particularly among new CRNAs, and ultimately contribute to stable healthcare services. Findings from this study provide valuable insight that could guide development of strategies that mitigate turnover intentions and improve job satisfaction in the CRNA workforce.