The literature suggests a trend toward decreased surgical failures with femoral fixation at the joint line with an interference screw. However, there is no difference when postoperative functional outcomes are compared. Future studies are needed with standardized fixation methods and outcomes assessment to determine the importance of femoral fixation.

IMPORTANCE Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke. OBJECTIVE To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat. INTERVENTIONS The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach. MAIN OUTCOMES AND MEASURES The primary outcome was systolic blood pressure reduction at 12 months postdischarge. RESULTS A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, −1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, −4.1 to 10.7) and non-Hispanic black participants (β = −1.6; 95% CI, −10.1 to 6.8). CONCLUSIONS AND RELEVANCE Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01836354.

OBJECTIVE To compare breastfeeding duration in postpartum mothers randomized to a behavioral educational intervention versus enhanced usual care. STUDY DESIGN Randomized trial. Self-identified black and Latina early postpartum mothers were randomized to receive a behavioral educational intervention or enhanced usual care. The two-step intervention aimed to prepare and educate mothers about postpartum symptoms and experiences (including tips on breastfeeding and breast/nipple pain), bolster social support and self-management skills. Enhanced usual care participants received a list of community resources and received a 2-week control call. Intention-to-treat analyses examined breastfeeding duration (measured in weeks) for up to six-months of follow-up. This study is registered with clinicaltrial.gov (NCT01312883). RESULTS Five hundred forty mothers were randomized to the intervention (n=270) versus controls (n=270). Mean age was 28 (range 18–46); 62% were Latina and 38% were black. Baseline sociodemographic, clinical, psycho-social, and breastfeeding characteristics were similar among intervention versus controls. Mothers in the intervention arm breastfed for longer duration than controls (median of 12.0 weeks versus 6.5 weeks, respectively, p =.02) Mothers in the intervention arm were less likely to quit breastfeeding over the first six-months postpartum (hazard ratio of 0.79; 95% CI 0.65–0.97). CONCLUSION A behavioral educational intervention increased breastfeeding duration among low-income, self-identified black and Latina mothers during the six-month postpartum period.

BACKGROUND: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement. OBJECTIVE: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model. DESIGN: Controlled trial. SETTING: 2 geographic areas of a medical unit using a clinical microsystem structure. PATIENTS: 2005 hospitalizations over a 12-month period. INTERVENTIONS: A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist. MEASUREMENTS: The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital-acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre-and postimplementation.RESULTS: There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model. LIMITATIONS:The trial was performed at a single hospital.CONCLUSIONS: Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.