OBJECTIVES Medicare beneficiaries recovering from a critical illness are increasingly being discharged home instead of to post-acute care facilities. Rehabilitation services are commonly recommended for intensive care unit (ICU) survivors; however, little is known about the frequency and dose of home-based rehabilitation in this population. DESIGN Retrospective analysis of 2012 Medicare hospital and home health (HH) claims data, linked with assessment data from the Medicare Outcomes and Assessment Information Set. SETTING Participant homes. PARTICIPANTS Medicare beneficiaries recovering from an ICU stay longer than 24 hours, who were discharged directly home with HH services within 7 days of discharge and survived without readmission or hospice transfer for at least 30 days (n = 3,176). MEASUREMENTS Count of rehabilitation visits received during HH care episode. RESULTS A total of 19,564 rehabilitation visits were delivered to ICU survivors over 118,145 person-days in HH settings, a rate of 1.16 visits per wefewer visits, suggesting a need for their consideration during discharge planning. © 2020 The American Geriatrics Society.in English, Spanish ANTECEDENTES Se discute el beneficio del bloqueo perianal asociado a la anestesia general o regional. Este ensayo clínico aleatorizado tuvo como objetivo comparar el dolor a las 24 horas y hasta los 14 días tras cirugía proctológica en pacientes con y sin bloqueo perianal. MÉTODOS Entre enero de 2018 y abril de 2019 se asignaron los pacientes para recibir un bloqueo perianal con ropivacaína o placebo como complemento de la anestesia. Los pacientes, los cirujanos y los evaluadores desconocían el grupo al que habían sido aleatorizados los pacientes. La variable principal fue el dolor a las 24 horas medido en una escala de numérica (numeric rating scale, NRS). Las variables secundarias fueron la necesidad de analgesia de rescate y el dolor a las 1, 2, 3, 6 y 12 horas. También se obtuvieron las puntuaciones media, en reposo y máxima de NRS durante 14 días. RESULTADOS Se incluyeron 138 pacientes, de los que 46 recibieron anestesia general con ropivacaína, 44 anestesia general sin ropivacaína, 2r, una menor necesidad de opioides y una recuperación más rápida con efectos adversos escasos.BACKGROUND Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. METHODS Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors. RESULTS A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income 400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income less then 400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]). CONCLUSIONS There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population. © 2020 American Cancer Society.BACKGROUND Managing hemophilia is challenging both in terms of medical treatment and its broad impact on many aspects of the individual’s life, including self-perception. Several psychosocial issues are potentially relevant in the clinical management of hemophilia, including it being a chronic and incurable condition; e.g. people with hemophilia must adapt to optimally interact with peers and to practice sports – even choosing a sport represents an issue for perceived limitations, expectations and cultural influences on the individual and their family. People with hemophilia can react by denying their condition and its manifestations and not adhering to treatment. Due to the complexity of relationships surrounding genetic diseases, parents and relatives may have their own issues that contribute to making life easier or more difficult for the person with hemophilia. Anxiety, sadness and depression resulting in mental health disorders are reported in this population and may influence quality of life (QoL) depenbleeding (physical health) and adherence to the intervention. The four newer trials assessed psycho-educational interventions all mediated by the use of technologies (DVD or computer) and often created according to age needs of the target group. In these cases, attention was shifted to our pre-defined primary outcomes. This review has identified low- and very low-certainty evidence, prompting caution in its interpretation. The major problem we encountered was the heterogeneity of trial designs, of interventions and of outcome measures used across the trials. We strongly suggest that researchers consider developing a core outcome set to streamline future research; randomization was proven to be safe and acceptable, and blinding should be considered for those assessing patient-reported outcomes. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.OBJECTIVES The cervical spine is the junction between the head and trunk, and it therefore facilitates head mobility and stability. The goal of this study is to test several predictions regarding cervical morphology and intervertebral ranges of motion. MATERIALS AND METHODS Intervertebral ranges of motion for 12 primate species were collected via radiographs or taken from the literature. Morphometric data describing functionally relevant aspects of cervical vertebral morphology were obtained from museum specimens representing these species. We tested for correlations between intervertebral movement and vertebral form using phylogenetic generalized least-squares regression. RESULTS Results demonstrate limited support for the hypothesis that range of motion (ROM) is influenced by cervical vertebral morphology. Few morphological variables correlate with ROM and no relationship is consistently significant across cervical joints. MK-28 PERK activator DISCUSSION These results indicate that the relationship between vertebral morphology and joint ranges of motion is, at most, weak, providing little support the use of bony morphology to reconstruct axial mobility in fossil specimens.