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eeded for recovery in patients with neck pain in primary care.

It remains unknown if a patient's prior episode-of-care (EOC) costs for total hip (THA) or knee (TKA) arthroplasty procedure can be used to predict subsequent costs for future procedures. The purpose of this study is to evaluate whether there is a correlation between the EOC costs for a patient's index and subsequent THA or TKA.

We reviewed a consecutive series of 11,599 THA and TKA Medicare patients from 2015 to 2019 and identified all patients who underwent a subsequent THA and TKA during the study period. We collected demographics, comorbidities, short-term outcomes, and 90-day EOC claims costs. A multivariate analysis was performed to identify whether prior high-EOC costs were predictive of high costs for the subsequent procedure.

Of the 774 patients (6.7%) who underwent a subsequent THA or TKA, there was no difference in readmissions (4% vs 5%, P= .70), rate of discharge to a skilled nursing facility (SNF) (15% vs 15%, P= .89), and mean costs ($18,534 vs $18,532, P= .99) between EOCs. High-cost patients for the initial TKA or THA were more likely to be high cost for subsequent procedure (odds ratio 14.33, P < .01). Repeat high-cost patients were more likely to discharge to an SNF for their first and second EOC compared to normative-cost patients (P < .01).

High-cost patients for their initial THA or TKA are likely to be high cost for a subsequent procedure, secondary to a high rate of SNF utilization. Efforts to reduce costs in repeat high-cost patients should focus on addressing post-operative needs pre-operatively to facilitate safe discharge home.

High-cost patients for their initial THA or TKA are likely to be high cost for a subsequent procedure, secondary to a high rate of SNF utilization. Efforts to reduce costs in repeat high-cost patients should focus on addressing post-operative needs pre-operatively to facilitate safe discharge home.

This study aimed to investigate rates of anticipatory guidance about technology use in primary care, as recommended by the American Academy of Pediatrics Bright Futures Guidelines, in a representative sample of California adolescents.

Adolescents 12-17 years of age were interviewed as part of the California Health Interview Survey, the largest state health surveillance survey in the U.S. Participants who reported seeing a doctor for a physical examination or checkup in the prior year were asked if their doctor had talked to them about technology use.

Overall, 29.7% of the 742 participants reported that their doctor talked to them about technology use. There were no statistically significant differences in rates by age, sex, race/ethnicity, household income, or family type.

While the American Academy of Pediatrics recommends that providers deliver anticipatory guidance about technology use to adolescents in primary care, less than one-third of adolescents surveyed reported having conversations about this topic with their doctor. Given concerns about potential impacts of technology use on adolescent health, medical education should facilitate provider screening and counseling of adolescents about technology use in primary care settings.

While the American Academy of Pediatrics recommends that providers deliver anticipatory guidance about technology use to adolescents in primary care, less than one-third of adolescents surveyed reported having conversations about this topic with their doctor. Bortezomib Proteasome inhibitor Given concerns about potential impacts of technology use on adolescent health, medical education should facilitate provider screening and counseling of adolescents about technology use in primary care settings.

Sexual and gender minority (SGM) youth (e.g., gay, lesbian, bisexual, questioning, transgender) are systemically impacted by victimization and poor mental health because of discrimination in society. To prevent adverse outcomes, we must understand factors that help communities support and protect SGM youth. This study examined to what extent protective factors longitudinally predict outcomes 2years later in an effort to inform more sensitive prevention efforts.

Students from nine Colorado high schools (N= 2,744) completed surveys across four consecutive school semesters (T1 to T4). Structural equation modeling was conducted to determine the longitudinal associations between baseline protective factors (access to medical and counseling services, help-seeking beliefs, trusted adults, family support, peer support, spirituality) and distal adverse outcomes (substance use, depression, suicidal ideation, peer victimization, bullying perpetration, sexual violence victimization and perpetration, homophobic name-cnitiatives should recognize intersectional identities of young people and build strategies that are relevant to specific identities to create more comprehensive and effective programing.

Among U.S. primary care physicians who delivered sexual and reproductive health (SRH) services to adolescents before the COVID-19 pandemic, we examine (1) changes in availability of in-person SRH services; (2) changes in accessibility and utilization of SRH services; and (3) use of strategies to support provision of SRH services during the pandemic.

Data were from the DocStyles provider survey administered September-October 2020. Descriptive analyses were restricted to family practitioners, internists, and pediatricians whose main work setting was outpatient and whose practice provided family planning or sexually transmitted infection services to ≥ one patient aged 15-19years per week just before the COVID-19 pandemic (n= 791).

Among physicians whose practices provided intrauterine device/implant placement/removal or clinic-based sexually transmitted infection testing before the COVID-19 pandemic, 51% and 36% indicated disruption of these services during the pandemic, respectively. Some physicians also on of confidential telehealth services and other service delivery strategies that could help promote adolescent SRH in the United States.Invasive candidiasis (IC) is the most common invasive fungal infection (IFI) affecting critically ill patients, followed by invasive pulmonary aspergillosis (IPA). International guidelines provide different recommendations for a first-line antifungal therapy and, in most of them, echinocandins are considered the first-line treatment for IC, and triazoles are so for the treatment of IPA. However, liposomal amphotericinB (L-AmB) is still considered a second-line therapy for both clinical entities. Although in the last decade the management of IFI has improved, several controversies persist. The antifungal drugs currently available may have a suboptimal activity, or be wrongly used in certain IFI involving critically ill patients. The aim of this review is to analyze when to provide individualized antifungal therapy to critically ill patients suffering from IFI, emphasizing the role of L-AmB. Drug-drug interactions, the clinical status, infectious foci (peritoneal candidiasis is discussed), the fungal species involved, and the need of monitoring the concentration of the antifungal drug in the patient are considered.