bluuebunny/crossref_metadata_2025 huggingface dataset:
Using appreciative inquiry to implement person-centred dementia care in hospital wards
Authors: Scerri Anthony , Innes Anthea , Scerri Charles
Published: October 2016

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.
A Gaussian process–based approach to cope with uncertainty in structural health monitoring
Authors: Teimouri Hessamodin , Milani Abbas S. , Loeppky Jason , Seethaler Rudolf
Published: October 2016

Structural health monitoring is widely applied in industrial sectors as it reduces costs associated with maintenance intervals and manual inspections of damage in sensitive structures, while enhancing their operation safety. A major concern and current challenge in developing “robust” structural health monitoring systems, however, is the impact of uncertainty in the input training parameters on the accuracy and reliability of predictions. The aim of this article is to adapt an advanced statistical pattern recognition technique capable of considering variations in input parameters and arriving at a new structural health monitoring system more immune to the effect of uncertainty. Gaussian processes have been implemented to predict the state of damage in a typical composite airfoil structure. Different covariance functions were evaluated during the training stage of structural health monitoring. Results through a case study showed a remarkable capability of the Gaussian process–based approach to deal with uncertainty in the pattern recognition problem in structural health monitoring of a multi-layer composite airfoil structure. To illustrate robustness advantage of the approach as compared to conventional neural network models, the damage size and location prediction accuracy of the Gaussian process structural health monitoring has been compared to multi-layer perceptron neural networks. Some practical insights and limitations of the approach have also been outlined.
Feasibility study of a multi-parameter probability of detection formulation for a Lamb waves–based structural health monitoring approach to light alloy aeronautical plates
Authors: Gianneo Andrea , Carboni Michele , Giglio Marco
Published: October 2016

In view of an extensive literature about guided waves–based structural health monitoring of plate-like structures made of metallic and composite materials, a lack of information is pointed out regarding an effective and universally accepted approach for characterizing capability and reliability in detecting, localizing and sizing in-service damages. On the other hand, in the frame of traditional non-destructive testing systems, capability is typically expressed by means of suitable ‘probability of detection’ curves based on Berens’ model, where a linear relationship is established between probability of detection and flaw size. Although the uncertain factors are usually different between a non-destructive inspection technique and a structural health monitoring approach, it seems that a similar mathematical framework could be assumed. From this point of view, this research investigates the feasibility of application of the very recent ‘multi-parameter’ probability of detection approach, developed within the traditional non-destructive testing field, to guided waves–based structural health monitoring. In particular, numerical simulations as well as experimental responses from flawed aluminium alloy plates were combined to bring about a ‘master’ probability of detection curve. Once established, this curve can be used to study the intrinsic capability of the system in terms of probability of detection curves, overcoming the intrinsic limitation of a single predictor (like the crack size) and a statistical model typically based upon a linear behaviour between the predictor and the response.
Connecting and Reflecting
Authors: Hooper Michaela D. Willi , Scharf Emily
Published: October 2016

This literature review is intended to examine transformative learning within the context of academic libraries and its applications for librarians. Although the main audience is academic librarians who facilitate student learning, it may also be of interest to other practitioners and researchers who are interested in applying transformative learning across the disciplines. We analyzed relevant works on transformative learning from fields, such as education and library science. This article provides a history and definition of transformative learning and examines parallels between transformative learning and existing library and information research. Potential applications of transformative learning to instruction and reference services are examined. Transformative learning is an important theory in higher education with which librarians should be familiar. The new Association of College and Research Libraries’ Framework for Information Literacy in Higher Education implements several ideas related to transformative learning. The theory may help librarians connect with diverse, adult learners.
Low-complexity timer-based multi-relay selection and sequential power allocation of cooperative cognitive radio networks for future Internet of things
Authors: Rahman Md Arifur , Lee Youngdoo , Koo Insoo
Published: October 2016

Cooperative cognitive radio networks use cooperative relays to forward signal from the source to the destination. In cooperative cognitive radio networks, the transmission power of each relay is limited by the interference constraint of the primary user receiver. Thus, it is essential to optimize power allocation and multi-relay selection jointly to maximize the secondary system throughput. Optimizing multi-relay selection and power allocation requires an exhaustive search for all possible relay combinations, since this approach uses a large amount of valuable resources and entails high computational complexity. A suboptimal solution for power allocation may reduce the computational complexity but still involves high implementation complexity. Thus, for an efficient utilization of resources to support the applicability of cognitive radio for the Internet of things, we propose a low-complexity timer-based multi-relay selection that determines a forwarding relay set before the source begins to transmit its data. This allows the source to know the instantaneous channel state information of the relays, which helps the source to assign appropriate transmission power to the relays. By simulation, we show that the proposed scheme achieves near-optimal secondary system throughput performance to the optimal multi-relay selection as well as provides a significant secondary system throughput gain when compared to conventional and random relay selection scheme with equal power allocation.
TCB: A feature transformation method based central behavior for user interest prediction on mobile big data
Authors: Zhou Chen , Jiang Hao , Chen Yanqiu , Wu Jing , Zhou Jianguo , Wu Yuanshan
Published: October 2016

Although traditional spatial-temporal features, such as gyration, probability, and the intervals between consecutive records, have contributed to model human dynamics, the importance of these basic spatial-temporal features in predicting mobile user interest is not fully investigated. Moreover, these typical features ignore the fact that human behaviors are highly predictable and centralized. Specifically, human mobility is constrained in a small area depicted by several hotspots, and users tend to access mobile Internet intensively on several particular timeslots, which are defined as hot-times in this article. Thus, this article proposes a feature transformation method based central behavior to construct informative feature sets. Transformation method based central behavior only requires small amount of records to extract hotspots/hot-times information for every user, and projects original records into a relative vector space, of which coordinates represent the effects suffered from corresponding centralities (hotspots/hot-times). Then, the new space is further enriched by statistical summaries related to hotspots/hot-times. Based on the state-of-the-art classification algorithms, the proposed transformation method based central behavior is validated on a large Usage Detail Records dataset generated in real physical world. Results show that features generated by transformation method based central behavior surpass traditional spatial-temporal features and preference in the terms of precision, recall, and f1-score.
Gastrointestinal manifestations of mitochondrial disorders: a systematic review
Authors: Finsterer Josef , Frank Marlies
Published: October 2016

Mitochondrial disorders (MIDs) due to respiratory-chain defects or nonrespiratory chain defects are usually multisystem conditions [mitochondrial multiorgan disorder syndrome (MIMODS)] affecting the central nervous system (CNS), peripheral nervous system, eyes, ears, endocrine organs, heart, kidneys, bone marrow, lungs, arteries, and also the intestinal tract. Frequent gastrointestinal (GI) manifestations of MIDs include poor appetite, gastroesophageal sphincter dysfunction, constipation, dysphagia, vomiting, gastroparesis, GI pseudo-obstruction, diarrhea, or pancreatitis and hepatopathy. Rare GI manifestations of MIDs include dry mouth, paradontosis, tracheoesophageal fistula, stenosis of the duodeno-jejunal junction, atresia or imperforate anus, liver cysts, pancreas lipomatosis, pancreatic cysts, congenital stenosis or obstruction of the GI tract, recurrent bowel perforations with intra-abdominal abscesses, postprandial abdominal pain, diverticulosis, or pneumatosis coli. Diagnosing GI involvement in MIDs is not at variance from diagnosing GI disorders due to other causes. Treatment of mitochondrial GI disease includes noninvasive or invasive measures. Therapy is usually symptomatic. Only for myo-neuro-gastro-intestinal encephalopathy is a causal therapy with autologous stem-cell transplantation available. It is concluded that GI manifestations of MIDs are more widespread than so far anticipated and that they must be recognized as early as possible to initiate appropriate diagnostic work-up and avoid any mitochondrion-toxic treatment.
Implication of alcohol consumption on aggregate wellbeing
Authors: Parackal Mathew , Parackal Sherly
Published: October 2016

Aims:

The effects of drinking alcohol extend beyond the individuals concerned to the wider community. While there is recognition of such a global implication, currently no study has quantified the impact of alcohol consumption on aggregate wellbeing. This study aims to address this gap and attempts to investigate the impact of various levels of alcohol consumption on aggregate happiness.

Methods:

The study was carried out on a random selection of participants ( n = 1,817) drawn from the 3Di consumer panel, comprising over 170,000 New Zealanders aged 18 and above. Using a subjective happiness scale (SHS) in conjunction with the Alcohol Use Disorders Identification Test (AUDIT), investigation was carried out to find whether drinking behaviour affected aggregate happiness.

Results:

SHS and AUDIT scores were negatively correlated and the strength of the correlation increased with the intensity of problematic drinking. Regression analysis showed that the beta coefficient was positive for the low-risk (.074) and negative for the high-risk (−.081) category, suggesting approaches to intervene with the growing problem of alcohol consumption in modern societies.

Conclusion:

Measurements of happiness can explain the global implication of alcohol in wellbeing terms. The findings of this study indicated that low-risk drinkers affected aggregate happiness positively, whereas high-risk drinkers affected aggregate happiness negatively. While the latter observation is not new, the former raises the need to promote moderation in drinking alcohol for the common good of everyone.
Making Intergroup Contact More Fruitful
Authors: Goldenberg Amit , Endevelt Kinneret , Ran Shira , Dweck Carol S. , Gross James J. , Halperin Eran
Published: October 2016

For decades, increasing intergroup contact has been the preferred method for improving cooperation between groups. However, even proponents of this approach acknowledge that intergroup contact may not be effective in the context of intractable conflicts. One question is whether anything can be done to increase the impact of intergroup contact on cooperation. In the present study, we tested whether changing perceptions of group malleability in a pre-encounter intervention could increase the degree of cooperation during contact encounters. Jewish and Palestinian-Israeli adolescents ( N = 141) were randomly assigned either to a condition that taught that groups are malleable or to a coping, control condition. During a subsequent intergroup encounter, we used two behavioral tasks to estimate the levels of cooperation. Results indicated that relative to controls, participants in the group malleability condition showed enhanced cooperation. These findings suggest new avenues for enhancing the impact of contact in the context of intractable conflicts.
Endoscopic removal of over‐the‐scope clips: Clinical experience with a bipolar cutting device
Authors: Bauder Markus , Meier Benjamin , Caca Karel , Schmidt Arthur
Published: October 2016

Background

Over‐the‐scope clips (OTSCs) are increasingly used for the closure of perforations/fistulae, hemostasis and endoscopic full‐thickness resection (FTRD system). When OTSC‐associated complications occur or re‐therapy at the OTSC site is needed, OTSC removal may be indicated. An experimental study in an animal model and a case series have shown good results for OTSC removal with a bipolar cutting device. We present a larger clinical study using this device.

Methods

Data of all consecutive patients with indication for OTSC removal were collected and analyzed retrospectively. OTSCs were cut at two opposing sites using a bipolar grasping device to apply short direct current impulses. OTSC fragments were extracted with a standard forceps and a cap at the tip of the endoscope to avoid tissue damage.

Results

Between December 2012 and February 2016 a total of 42 OTSC removals in the upper (n  = 25) and lower (n  = 17) gastrointestinal tract have been performed at our department. Overall technical success, defined as cutting the OTSC at two opposing sites and extraction of both fragments, was achieved in 92.9% (39/42) of all cases. Successful fragmentation of the OTSC was achieved in 97.6% (41/42). Minor bleedings were rare and could be managed endoscopically in all cases. There were no perforations and no major or delayed bleedings.

Conclusion

Endoscopic OTSC removal with a bipolar cutting device is feasible, effective and safe. This technique can be applied in the upper and lower gastrointestinal tract.
Evaluation of rapid diagnostic test kits for feline leukemia virus infection using samples from naturally infected cats
Authors: Liu Jiayou , O’Connor Thomas , Beall Melissa , Chandrashekar Ramaswamy , Lappin Michael
Published: October 2016

Objectives

Feline leukemia virus (FeLV) is a potentially life-threatening oncogenic retrovirus. The p27 viral core protein is produced by the virus in infected feline cells, is found in the cytoplasm in several blood cells and can be free in the serum and plasma. ELISA or particle-based immunoassay are commonly used to detect the presence of the p27 core protein in samples obtained from blood. The objective of this study was to compare the performance of several in-clinic tests: the SNAP Feline Triple Test (IDEXX Laboratories), the WITNESS FeLV-FIV Test (Zoetis) and the VetScan Feline FeLV/FIV Rapid Test (Abaxis).

Methods

The sample population (100 positive, 105 negative samples) consisted of serum and plasma samples submitted to IDEXX’s worldwide reference laboratory for feline retrovirus testing. Virus isolation and reverse transcriptase PCR results were not available and so samples were judged to be positive or negative based on the results of the ViraCHEK FeLV (Zoetis) microtiter plate assay.

Results

The percentage of samples positive and negative for FeLV p27 antigen using the three in-clinic tests compared with the ViraCHEK method were as follows: IDEXX Feline Triple (positive 98.0%, negative 100%); Zoetis WITNESS (positive 79.0%, negative 97.1%); Abaxis VetScan (positive 73.0%, negative 97.1%).

Conclusions and relevance

The SNAP Feline Triple Test demonstrated a high level of agreement for FeLV-positive and FeLV-negative samples when assessed in this model. Results of FeLV assays can vary among tests.
Occupational Exposure to Antineoplastic Agents
Authors: Graeve Catherine Utecht , McGovern Patricia Marie , Alexander Bruce , Church Timothy , Ryan Andrew , Polovich Martha
Published: October 2016

Approximately 8 million health care workers are unnecessarily exposed to highly toxic drugs used to treat cancer; antineoplastic drugs can contribute to negative health effects for these workers. The drugs have been detected in the urine of workers and on the floors and counters of worksites. Safety precautions that could reduce the risk of exposure are underutilized. This cross-sectional study of 163 oncology health care workers used a survey to measure workplace and individual factors, and environmental sampling to measure surface contamination. The study objective was to identify potential exposures to antineoplastic drugs and factors influencing safety behavior. Personal protective equipment (PPE) use was lower than recommended; unit of employment was significantly associated with PPE use. Chemical residue from antineoplastic drugs was found, revealing potential exposures. Workplace safety must be a higher organizational priority. The contamination of common work areas where PPE use is not expected was of utmost concern.
In the Ear of the Beholder: Self-Other Agreement in Leadership Communication and Its Relationship With Subordinates’ Job Satisfaction
Authors: Erben Julian , Schneider Frank M. , Maier Michaela
Published: October 2016

This article deals with the question of how agreement or disagreement in the perception of leadership communication from the perspective of both leader and subordinate is related to subordinates’ job satisfaction. Employees of a department in a large, globally operating insurance company and their managers ( N = 110) completed questionnaires including instruments to assess leadership communication from the perspective of the managers and their respective employees as well as employees’ job satisfaction. Results from polynomial regression with response surface modeling suggest that there is a positive linear relationship between self- and other ratings of leadership communication and subordinates’ job satisfaction, in which the highest scores of job satisfaction are related to high in-agreement ratings of leadership communication. In addition, discrepancies in perceptions of leadership communication decrease job satisfaction, particularly when leaders are overestimators.
Assessment of Capacity to Consent by Nurses Who Deliver Health Care to Patients Who Misuse Substances
Authors: Taylor Darlene , Ho Anita , Mâsse Louise C. , Van Borek Natasha , Li Neville , Patterson Michelle , Ogilvie Gina , Buxton Jane A.
Published: October 2016

This qualitative study explored the current practice that nurses use to assess capacity to consent to health care (CTC-HC) in street outreach settings. Key informant interviews were conducted with a purposive sample of nurses from each of British Columbia’s five regional health authorities, allowing nurses to describe their lived experiences with assessing CTC-HC. Content analysis was used to summarize information captured in the data. A total of 19 nurses participated in the study. Five themes emerged from the data: (a) internal guiding forces that contribute to the nurses’ assessment, (b) external influences that contribute to the nurses’ assessment, (c) measures that are important for assessing CTC-HC, (d) threshold setting, and (e) context (physical and interpersonal) within which assessment of capacity takes place. These elements will be incorporated into a capacity assessment tool that can be used in nursing best practices.
Can Fifth Metatarsal Morphology Predict Proximal Fifth Metatarsal Fracture Risk? A Radiographic Analysis of National Football League Players
Authors: Rosenbaum Andrew J. , DeSandis Bridget A. , Warren Russel , Taylor Samuel A. , Murphy Conor , Drakos Mark C.
Published: October 2016

Category:

Sports.

Introduction/Purpose:

Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Unfortunately, optimal treatment is often challenging, as the repetitive stresses endured by the fifth metatarsal can lead to delayed union and refracture following treatment. We therefore performed a radiographic analysis of fifth metatarsal morphology and foot type in NFL players, in search of morphologic risk factors for these injuries.

Methods:

NFL players treated by the senior authors between 1992 and 2012, as well as participants in the 2014 NFL Combine were evaluated. A total of 96 feet (51 athletes) were included. Fractures were present in 15 of the feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior (AP), lateral and oblique radiographs, after receiving measurement training by the senior authors. Table 1 lists the specific parameters studied. Reviewers’ measurements were averaged, as were those from the radiographic series for each athlete. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined via Student’s t-test analysis.

Results:

Athletes had an average height of 6’2” (range 5’8” to 6’8”) ft’in”, weight of 251 (range 184 to 336) lbs, and age of 22.4 (range 21.0 to 26.0) years. Reviewers’ inter-observer reliability was generally good to very good. On AP radiographs, statistically significant differences in apex medullary canal width, 4-5 intermetatarsal angle, 5th metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet (p=0.001, 0.003, 0.004, 0.008, respectively; Table 1). On lateral radiographs, statistically significant differences in the 5th metatarsal length, distance to apex, apex height, 5th metatarsal angle, and talocalcaneal angle were observed between fractured and non-fractured feet (p=0.04, 0.01, 0.02, 0.01, 0.01, respectively; Table 1). On oblique radiographs, a statistically significant difference was observed in apex height between fractured and non-fractured feet (p=0.002; Table 1).

Conclusion:

This investigation elucidates the relationship between fifth metatarsal morphology, foot type and proximal fifth metatarsal fractures. Specifically, individuals with long, straight and narrow fifth metatarsals, with an adducted forefoot are most at risk. Given athletes’ predisposition to refracture and nonunion following treatment of proximal fifth metatarsal fractures, which is at times career threatening, we believe that these findings are clinically relevant. With such insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at-risk. Admittedly, future research must evaluate the utility of such interventions.
Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA
Authors: O’Malley Martin , DeSandis Bridget A. , Allen Answorth , Levitsky Matthew M. , O’Malley Quinn , Williams Riley
Published: October 2016

Category:

Sports.

Introduction/Purpose:

Proximal fractures (Zones II and III) of the fifth metatarsal are common in the elite athlete population with basketball players being especially prone to developing these injuries. Fractures in Zones II and III of the fifth metatarsal can be difficult to treat due to tendency toward delayed union, nonunion, or refracture. The purpose of this case series is to report our experience in treating 10 professional basketball players from the National Basketball Association (NBA) for proximal fifth metatarsal fractures and determine the healing rate, return to play, refracture rate and role of foot type in these athletes.

Methods:

The records of 10 professional basketball players who were treated for fifth metatarsal fractures between September 2008 and October 2014 were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) while the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features associated with recurrent fifth metatarsal fractures were reported including fourth-fifth intermetatarsal (IMA4-5), fifth metatarsal lateral deviation (MT5-LD), calcaneal pitch (CP), and metatarsus adductus (MAA) angles. Differences in clinical and radiographic features were assessed between athletes who refractured (n=3) and those who did not (n=7).

Results:

Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. When comparing the refracture group (n=3) with the control group (n=7), there were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest measured MAA. Four of 10 fit the criteria for having metatarsus adductus as measured by the Sgarlato method (MAA greater than 14 degrees) while 5 of 10 had metatarsus adductus using the Engel method (greater than 24 degrees). All refractures had an abnormal angle using the Engel method. Seven of the 10 athletes were classified as pes planus and 9/10 had a bony prominence under the proximal base of their fifth metatarsals styloid.

Conclusion:

This is the largest series of operatively treated professional basketball players that possess a unique foot type that seems to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type is one which has forefoot metatarsus adductus and a fifth metatarsal that is curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high IMA4-5, MT5-LD and MAA angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture.
Is Total Ankle Arthroplasty Justified in Stiff Ankles?
Authors: Kane Justin M. , Brodsky James W. , Coleman Scott C. , Daoud Yahya
Published: October 2016

Category:

Ankle Arthritis.

Introduction/Purpose:

Although recent studies have shown comparability of gait function following total ankle arthroplasty (TAA) and ankle arthrodesis, TAA is regarded to be functionally advantageous by preserving tibiotalar motion. However, it is unknown whether arthritic ankles with severe loss of sagittal plane motion are appropriate surgical candidates for arthroplasty. This study was undertaken to address the question: Is there a rationale for motion-preserving surgery in patients with little or no preoperative sagittal plane motion?

Methods:

A retrospective review of 76 patients who underwent isolated TAA with a minimum one-year follow-up, including patient demographics and pre and postoperative gait studies was conducted. Using a linear regression model, an effect size for total preoperative sagittal ROM was calculated, as well as effects of age, and patient demographics. Gait function was evaluated for postoperative improvement using multivariate analysis to determine the influence the variable on parameters of gait. P-values of < 0.05 were considered statistically significant.

Results:

Outcomes/p-values are listed in table 1. Temporal Spatial Older patients had slower preoperative/postoperative walking speeds, and increased age resulted in diminished function. Increased preoperative ROM predicted greater preoperative and trended towards greater postoperative step length. Greater preoperative ROM predicted less total improvement. Kinematic Age was predictive of improved postoperative plantarflexion with negligible clinical significance. Preoperative ROM predicted greater postoperative ROM although less improvement was noted. Preoperative/postoperative sagittal angle at toe off was greater with increased preoperative ROM. No improvement was detected. Preoperative and postoperative plantarflexion/dorsiflexion were both greater with increased preoperative ROM. Less overall improvement in plantarflexion was noted with greater preoperative ROM. Kinetic Preoperative ROM was predictive of greater preoperative/postoperative ankle power. Greater preoperative ROM resulted in less improvement in power.

Conclusion:

Irrespective of preoperative total sagittal range of motion, there was a statistically and clinically significant improvement in function as measured by multiple, objective parameters of gait. While pre-operative range of motion was predictive of overall post-operative gait function, patients with greater pre-operative range of motion experienced less overall improvement in gait. The data show that TAA can offer statistically significant, and clinically meaningful improvement in gait function and is a reasonable treatment alternative even in patients with end-stage tibiotalar arthritis who have very limited preoperative sagittal range of motion.
Effect of Facility on the Operative Costs of Total Ankle Arthroplasty
Authors: Gross Christopher E. , Scott Daniel J. , Adams Samuel B. , Parekh Selene G. , Mather Richard , Nunley James A.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Cost containment is increasingly important in health care. Currently, Medicare does not reimburse for total ankle replacement (TAR) in the outpatient, ambulatory setting. Therefore, TAR in Medicare patients must be performed in the inpatient setting. The purpose of this study was to investigate if ambulatory surgery centers (ASC) can deliver lower-cost care and to identify sources of those cost savings in total ankle replacement (TAR). We hypothesize that total ankle arthroplasties cost significantly less than when performed in an inpatient setting.

Methods:

We performed a cost identification analysis of primary TAR at a single academic medical center. Multiple costs and time measures were taken from 574 consecutive patients over 4 years at either an inpatient facility or ASC. The relationships between total cost and operative time and multiple variables, including patient age, gender, comorbidities, type of implant used, and concurrent procedures performed were examined, using multivariate analysis and regression modeling to identify cost drivers or explanatory variables.

Results:

The mean operative cost over 4 years was significantly greater at the inpatient facility ($50,460) than at the outpatient facility ($46,283) (p < 0.0001, CI $3,752-$4,685). Significant cost drivers of this difference were in-patient ($1,759), physical/occupational therapy ($346), pharmacy ($233), and operating room costs ($2,752). If we were to perform all total ankle replacements in the four-year period at the ASC, the hospital system would have saved $1,445,242.00.

Conclusion:

The most significant predictor of cost was facility type. This study supports the use of ASC facilities to achieve efficient resource utilization in the operative treatment of total ankle arthroplasties. We also identified several specific costs and time measurements that can serve as potential targets to improve utilization.
Measuring Functional Range of Motion in Patients with Ankle Arthritis
Authors: Goldberg Andy J. , Thornton James D. , Sabah Shiraz A. , Segaren Neil , Cullen Nick , Singh Dishan
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Measurement of range of motion is an important outcome measure following ankle surgery. However, there is wide variation in its measurement: from clinical evaluation, to radiographic metrics, and gait analysis. The purpose of this study was to present and validate a simple, standardized technique for measurement of function total range of motion between the tibia and the floor using a digital goniometer.

Methods:

Institutional review board approval was obtained. Forty-five ankles from 33 participants were recruited into two groups. Group 1 (Healthy controls), comprised 20 ankles from 10 participants. None had any musculoskeletal or neurological pathology. Group 2 (Ankle osteoarthritis), comprised 25 ankles from 23 patients. Ankle pathology had been treated with ankle arthrodesis (n=5), total ankle replacement (n=6), and non-operative treatment (n=14). Measurement was performed by two testers according to a standardized protocol developed for the Pivotal Total Ankle Replacement Versus Arthrodesis (TARVA) RCT. Intra- and inter-rater reliability was calculated using intra-class correlation coefficients.

Results:

Group 1 (Healthy controls). The median difference for all measurements within an observer was 1.5 (IQR 0.7-2.5) degrees. The ICC for inter-rater total ankle range of motion was excellent 0.95 (0.91-0.97, 95% confidence interval, p < 0.001). The ICC for intra-rater total ankle range of motion was excellent 0.942 (0.859-0.977, 95% CI, p < 0.001). Group 2 (Ankle osteoarthritis). The median difference for all measurements within an observer was 0.6 (IQR 0.2 -1.3) degrees. The intra-class coefficient (ICC) for inter-rater total ankle range of motion was excellent 0.99 (0.97 -1.0), 95% CI, p < 0.001). The ICC for intra-rater total ankle range of motion was 0.99 (0.96 -1.0), 95% CI p < 0.001).

Conclusion:

This technique provides a reliable, standardized method for measurement of total functional range of motion between the tibia and the floor. The technique requires no specialist equipment or training, and provides a valid functional assessment for patients with and without ankle osteoarthritis and also following treatment even with an ankle arthrodesis.
Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the Ankle is Safe and Effective - 2-Year-Followup in 130 Patients
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

For treatment of chondral defects, matrix-associated stem cell transplantation (MAST) is a modification of autologous matrix-induced chondrogenesis (AMIC) with a potential higher concentration of stem cells due to harvesting fluid at the bone marrow and in-vitro processing. The aim of the study was to assess the 2-year-followup of MAST in chondral defects of the ankle.

Methods:

In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April 1st 2009 to March, 31st, 2013 were analyzed. Patients with bilateral treatment or with MAST at more than one joint surface were excluded from the study. The size and location of the chondral defects, method-associated problems and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at followup were registered and analyzed. MAST was performed as a single open procedure including debridement and microfracturing of the chondral defects. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide®, Geistlich, Baden-Baden, Germany) that was cut to the size of the defect before. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, USA).

Results:

One hundred and fifty chondral defects in 144 patients were included in the study. The age of the patients was 35 years on average (range, 10-68 years), 85 (59%) were male. The VAS FA before surgery was 58.5 on average (range, 16.5-78.8). The defects were located as follows, medial talar shoulder, n=62; lateral talar shoulder, n=66 (medial and lateral talar shoulder, n=6), distal tibia, n=22. The defect size was 1.6 cm2 on average (range, .6 - 6 cm2). Additional autologous bone transplantation (harvested from the proximal tibia) was performed in 19 cases (medial/lateral talar shoulder, n=8/8; distal tibia, n=3). 130 patients (90%) completed 2-year-follow-up. No method related complications or consecutive surgery were registered. The VAS FA improved to an average of 87.5 (range, 62.1-100; t-test (comparison with preoperative scores), p=.01).

Conclusion:

MAST led to good clinical scores. No complications were registered. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the ankle. The main advantage of MAST in comparison with ACI and MACI is the single procedure methodology. The advantage in comparison with AMIC is the potential higher concentration of stem cells. It remains unclear if this method is superior to AMIC, and what kind of tissue is created.
Long-Term Outcome Following Interpositional Arthroplasty of the First Metatarsophalangeal Joint
Authors: Aynardi Michael , Dein Eric J. , Zahoor Talal A. , Atwater Lara C. , Schon Lew C. , Miller Stuart D.
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Surgical treatment for osteoarthritis of the first metatarsophalangeal joint (MTPJ) includes cheilectomy or fusion for advanced arthritis. In addition, procedures to preserve or restore motion have demonstrated promising short-term results. Currently, no studies have described long-term results following interpositional arthroplasty. Our institution has performed interpositional arthroplasty with autograft (joint capsule/extensor hallucis brevis) or allograft (dermal matrix) with anecdotal success for over 15 years. The purpose of this study is to report long-term outcomes following interpositional arthroplasty.

Methods:

All patients undergoing interpositional arthroplasty at our institution from 2000-2015 were identified and a retrospective chart review was performed. Long-term follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Average follow-up was 89.1 months (range, 6 to 179 months). Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure.

Results:

From 2000-2015, 292 interpositional arthroplasties were performed at our institution. The overall failure rate was 1.7 % (5/292), which included patients requiring revision surgery (2 patients) or subsequent fusion (3 patients). Autograft interpositional arthroplasty had a failure rate of 2.1% (2/94) and allograft interposition was 1.5% (3/198). Failure and reoperation occurred at an average of 11 months from the index procedure (range, 6-17 months). 88.7% of patients rated their overall satisfaction as excellent or good. Average preoperative VAS score was 8.2 ± 1.5 (range, 6 to 10) and 2.1 ± 1.6 (range, 0 to 7) at latest follow-up, and (79.1%) patients reported tolerance to fashionable shoes. There were no major wound complications. The most common complications were metatarsalgia (8.6%) and cock-up deformity (5.7%).

Conclusion:

Interpositional arthroplasty demonstrated excellent long-term survivorship and high patient satisfaction at long-term follow-up.
Evaluating the Safety of Percutaneous Dorsolateral Talonavicular Joint Fixation in Modified Double Arthrodesis
Authors: Aynardi Michael , Atwater Lara C. , Melvani Roshan T. , Schon Lew C. , Miller Stuart D.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

Hindfoot arthrodesis has demonstrated reliable long-term outcomes for treatment of symptomatic hindfoot arthritis, but the incidence of nonunion of the talonavicular joint has been reported as high as 29%. Retrograde percutaneous insertion of a dorsolateral screw in addition to the standard medial distal to proximal screw has been shown to add significant construct stiffness across the talonavicular joint in biomechanical testing. However, placement of this dorsolateral screw may result in increased neurovascular injury. The purpose of this cadaveric study was to investigate the proximity of important anatomic structures to dorsal, percutaneous, screw fixation across the talonavicular joint for hindfoot arthrodesis.

Methods:

17 fresh frozen cadaveric limbs without deformity were transected across the supracondylar femur. A single fellowship-trained orthopedic surgeon performed all procedures. Percutaneous dorsolateral fixation across the talonavicular joint was performed with a cannulated screw. A 1.5-cm incision was created over the lateral third of the navicular after localization under fluoroscopy, and a 4.5 mm cannulated screw was inserted using standard AO technique. The guide wire was left within the screw. The incision was extended 2 cm proximal and distal and a separate orthopaedic surgeon used a caliper to measure the distance from the guide wire to the superficial peroneal nerve, extensor hallucis longus, extensor digitorum longus, deep peroneal nerve, and deep peroneal artery. Injuries to neurovascular structures were noted. Finally, solder wire was laid atop the deep neurovascular bundle to allow radiographic imaging of the screw and the bundle.

Results:

Injury to the deep neurovascular bundle occurred in 6 of 17 specimens (35.3%). There were 5 injuries (29.4%) to the deep peroneal nerve, 3 to the deep peroneal artery, and 2 to branches of the superficial peroneal nerve. The average distances from the guide wire to anatomic structures were superficial peroneal nerve: 1.8 mm (0.5-4.10 mm), extensor hallucis longus: 6.10 mm (0.6-15.0), extensor digitorum longus: 6.8 mm (0.5-14.0 mm), deep peroneal artery: 2.27 mm (0.0-5.1), and deep peroneal nerve: 2.4 mm (0.0-7.10 mm).

Conclusion:

A high rate of neurovascular injury was observed after percutaneous dorsolateral fixation across the talonavicular joint. These data suggest that this approach should be avoided in favor of an open approach, which allows identification and protection of the superficial peroneal nerve, extensor tendons, and the neurovascular bundle.
Endoscopic Resection for Talocalcaneal Coalition Using Posteromedial Approach
Authors: Nakazora Shigeto , Nishimura Akinobu , Ito Naoya , Kato Ko , Sudo Akihiro
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

Initial treatment of symptomatic talocalcaneal coalition (TCC) is reduced activity or cast immobilization. If these conservative treatments does not relieve symptoms, surgical treatment is recommended. The operation for TCC is usually treated by an open procedure. We report the results of the three cases by endoscopic resection using posteromedial approach.

Methods:

Three consecutive patients (3 feet, 2 men and 1 female) who underwent surgery for TCCs were reviewed. Patient’s age at the time of surgery were 12, 13, 19 years respectively. All patients suffered from a foot pain after ankle sprain. Two patients didn’t play sports because of this pain. This operation is performed in the supine position. Two portals are each created at the proximal and distal to the vertex of the medial malleolus. Portal positions are marked by use of sonography to avoid the injury of tendons and neurovascular. By use of a shaver a radiofrequency device, as much soft tissue must be removed as possible to allow easy coalition resection, the surgeon performs sufficient resection of the coalition using an abrader until the normal articular surface can be confirmed. Movements of ankle and toes are encouraged from immediately post-operatively. Weight bearing is permitted 1 week after surgery.

Results:

All patients had a relief of pain. The mean preoperative and final follow-up AOFAS ankle-hind foot scale scores were from 65.3 to 92.3. Two patients returned to playing sports by three months. The mean operation time was 123 minutes (range: 97–148 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred.

Conclusion:

A posteromedial approach for TCC is a useful technique because the advantage of allowing (1) a direct approach to both the middle- and posterior-facet coalitions without obstruction, (2) the creation of sufficient working space, (3) the obtuse insertion angle between the endoscope and instrument. On the basis of these advantage, endoscopic resection of a TCC using the posteromedial approach is considered a useful technique. To decrease the risk of neurovascular damage and tendon injury, portal positions are marked in advance by use of sonography, so that, a safe endoscopic resection of the coalition is performed.
Flexible Adult Acquired Flatfoot Deformity
Authors: Netto Cesar Cesar , Demehri Shadpour , Dein Eric J. , Thawait Gaurav K. , Zhang Hanci , Fonseca Lucas F. , Zahoor Talal A. , Lee Moses , Guo Yi , Ficke James R. , Schon Lew C.
Published: October 2016

Category:

Other

Introduction/Purpose:

Adult acquired flatfoot deformity (AAFD) is a biomechanical derangement involving the three- dimensional (3D) midfoot and hindfoot osseous complex, which can be challenging to optimally characterize using conventional two-dimensional (2D) plain radiographs. Weightbearing (WB) Cone-Beam CT (CBCT) can better demonstrate the deformity of the 3D structures during WB. Therefore, we compared validated AAFD measurements between non-weightbearing (NWB) and WB CBCT images.

Methods:

In this prospective, IRB approved study, 20 patients were included, 12 males and 8 females, mean age of 54.21 (20-88) years, with clinical diagnosis of flexible AAFD. Subjects were scanned with standing (WB) and seated (NWB) CBCTs. WB and NWB CBCT images were assessed with traditional flatfoot measurements obtained at sagittal, coronal, and axial planes using predefined anatomical landmarks, by two independent observers. Interobserver reliability was calculated using Pearson correlation.

Results:

The measurements in patients with AAFD differed significantly between WB and NWB CBCT images. Specifically, WB images showed, when compared to NWB, decreased forefoot arch angle (mean difference: 9.91°, p < 0.0001), increased talus-first metatarsal angle (10.59°, p < 0.0001), increased navicular-medial cuneiform angle (13.89°, p < 0.0001), decreased navicular-floor (coronal 14.05mm/sagittal 14.91mm, p < 0.0001) and navicular-skin distances (coronal 5.87mm/sagittal 8.25mm, p < 0.0001), decreased medial cuneiform-floor (coronal 10.79mm/sagittal 11.07mm, p < 0.0001) and medial cuneiform-skin distances (coronal 4.45mm/sagittal 5.78mm, p < 0.0001), and decreased cuboid-floor (5.78mm, p < 0.0001) and cuboid-skin distances in the sagittal plane (4.60mm, p < 0.0001). Interobserver reliability was good to excellent (0.610-0.991).

Conclusion:

Traditional adult acquired flatfoot deformity radiographic measurements are obtainable using high resolution 3D WB CBCT imaging, and can help characterize the biomechanical derangements during weightbearing in subjects with flexible AAFD.