Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.

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Introduction: Physical examination skills are receiving less attention in curricula and clinical practice, being supplanted by imaging and other technologies. We developed an online module to introduce auscultation of common cardiac murmurs to second-year medical students. Methods: The Murmur Online Learning Experience (MOLE) curriculum focused on nine common, unique, or highly testable cardiac murmurs, chosen collaboratively by the authors. The curriculum consisted of (1) a nine-item multiple-choice pretest containing a clinical vignette, a photo of stethoscope location, and an auditory clip; (2) nine modules each containing a several-minute-long auditory clip and a written description (location, quality, radiation, change with exam maneuvers); and (3) a nine-item multiple-choice posttest, identical to the pretest but randomly ordered. All second-year medical students at the University of Louisville were given access to MOLE during their cardiovascular curriculum and given an incentive to complete the ungraded activity. Results: One hundred forty-seven (91.8%) students voluntarily completed the pretest and posttest. The mean pretest score was 3.76 out of 9 (SD = 1.77). The mean posttest score was 7.14 out of 9 (SD = 1.78). Paired t-test results demonstrated a p value of <.001. Discussion: An online murmur curriculum consisting of repetitive auditory murmurs and narrative description of murmurs improved second-year medical students' ability to correctly identify common cardiac murmurs. This method of learning murmurs via online curriculum is a practical and effective way to hone students' physical exam skills in the modern era.

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Despite efforts to reduce disparities in cardiopulmonary resuscitation (CPR) provision, men are more likely than women to receive bystander CPR worldwide. 1,2 Women have worse outcomes following out-of-hospital cardiac arrest than men. [1][2][3] In the Resuscitation Outcomes Consortium registry, men had a 29% increased probability of survival to discharge compared with women. 1 Bystanders report common themes behind hesitation to perform CPR on women. Bystanders are less likely to remove clothing and place hands properly because of fears of personal violation, breasts interfering with CPR, and causing physical injury. 4,5 Methods | The study was a cross-sectional analysis performed using the most common online search engine (Google) and the most common online video site (YouTube) to identify free, online instructional CPR films. Institutional review board approval and consent procedures were not required because this was not human subjects research. Each site was queried by searching for the phrase "how to do CPR." The search was restricted to page 38 of the search results for Google (374 videos) and page 25 of the search results for YouTube (500 videos). Exclusion c riteria included humor/parody or noninstructional content, pediatric CPR, CPR on animals, non-English language content, live videos, content from an inhospital location, duplicate videos, CPR on a pregnant woman, or CPR on a man. The affected person's sex was assessed visually by the authors. Although the face of Resusci-Anne, a CPR manikin, is modeled after a young woman, the torso lacks breasts and the manikin is considered unisex. Therefore, videos with no person in cardiac arrest other than this manikin were not considered to feature a woman experiencing cardiac arrest, particularly given that breasts are a common barrier to performing CPR on a woman.Videos were scored (C.W.L.) and reviewed (L.E.B.T.) on 6 key aspects of CPR education: (1) assessing scene safety, (2) checking victim responsiveness, (3) activating emergency medical services, (4) properly positioning hands, (5) using an accurate rate of compression (100-120 per minute), and (6) using an appropriate depth (2-2.5 in [5-6 cm]). 6 Those that demonstrated 5 or more criteria were considered high quality. Videos were also coded according to whether they taught current, hands-only CPR technique and specifically addressed barriers to performing CPR on women. Videos from the American Heart Association and American Red Cross were separately evaluated. Data collection occurred in April and May 2019. Data were analyzed with Excel version 16.16.22 (Microsoft).

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We read with great interest the article by Barcella et al. regarding the 7 unfavorable 30-day survival following an out-of-hospital cardiac arrest 8 (OHCA) in 27,523 adult Danish patients. 1 We would like to contribute 9 empirical data to this crucial topic by providing a nationwide United 10 States (US) inpatient demographic perspective. 11 A majority of cardiac arrests in the US are OHCA, which have 12 abysmal survival rates. 2 Although the impact of OHCA on the mental 13 health of surviving patients is profound and has been well described, 3 14 the impact of mental health on OHCA has not been sufficiently studied. 15 It is essential to identify independent demographic risk factors that 16 may influence mortality outcomes among these patients. 17 We utilized the US National Inpatient Sample (NIS) database 18 (2007À2014) (https://www.hcup-us.ahrq.gov/nisoverview.jsp) to an-19 alyze the frequency of OHCA related hospitalizations in adult patients 20 with co-existing psychiatric disorders and their impact on in-patient 21 mortality. OHCA-related admissions were identified using ICD-9 code 22 427.5 to evaluate all primary discharge diagnoses. 4 Psychiatric 23 disorders were identified using ICD-9 codes as detailed in our earlier 24 studies. 5,6 25 Of total 68,386 OHCA-related admissions (2007À2014) in the US, 26 32.8 % (n = 22,426) had comorbid psychiatric disorders (Table 1).