bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 18: The Pendulum Has Swung: A 14-Year Analysis of Patients Presenting for Failed Hip Arthroscopy Shows Rising Incidence of Cam Over-Resection and Decreasing Incidence of Under-Resection
Authors: Domb Benjamin , Padilla Paulo , Kingham Yasemin , Padmanabhan Saiswarnesh , Carbone Andrew , Maldonado David
Published: October 2024

Background:

There is a paucity of literature regarding prevalence of femoral resection in the setting of revision hip arthroscopy. Few studies have examined different types of resections and their presentation.

Purpose:

To describe the prevalence of femoral resection types in the setting of revision hip arthroscopy for residual femoroacetabular impingement syndrome (FAIS) symptomatology.

Methods:

A search of the institutional prospective registry was performed for patients who presented for evaluation of failed previous arthroscopy between February 2008 and June 2022, and subsequently underwent revision arthroscopy. AP and Dunn view radiographs were reviewed from our study population. On the basis of measurements on both radiographs, patients were divided into 3 categories: overresection (OR) in which the resection measured 5% or more of the femoral head diameter, underresection (UR) in which residual CAM morphology was found (alpha angle >60°), and neutral resection, alpha angle less than 60° and no overresection. Both AP and Dunn radiographs were used to identify over- and under- resections.

Results:

A total of 622 hips were reviewed and measured on both AP and Dunn radiographs. Of the 622 hips, there were 373 right and 249 left hips. The average age was 33.7 ± 12.0, and the average body mass index (BMI) was 26.0 ± 5.2. Three hundred sixty-five hips were classified as UR and 265 hips as OR.  The mean prevalence rates from 2008 to 2022 for neutral resection, over-resection and under-resection were 48.1%, 20.3%, and 31.6%, respectively. The prevalence rates of UR have decreased since 2008, while prevalence rates of OR have increased concomitantly. The steadily decreasing prevalence rates of UR was negatively correlated with the increasing OR ((R=-0.829,  P<.0001), as well as with neutral resections (R=-0.735,  P=0.002). The ratio of UR to OR reversed entirely, from 4:1 in 2010, to 1: 2.3 ( P < 0.00001) in 2020.

Conclusions:

Amongst patients presenting for failed hip arthroscopy over the last 14 years, the pendulum has swung from under-resection towards over-resection. Indeed, as of 2020, over-resections were more than twice as common as under-resections. This may be a result of heightened awareness in FAIS, and previous literature emphasizing the risks of under-resection. As we gain increased understanding of the risks of over-resection, the findings of this study highlight the importance of achieving an anatomical spherical resection.
Paper 21: Anatomic Medial Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation in Throwing Athletes
Authors: Camp Christopher , Jurgensmeier Kevin , Boos Alex , Hintz Christian , Dines Joshua
Published: October 2024

Objectives:

Injury to the Medial Ulnar Collateral Ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12-18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL which may contribute to the prolonged course of rehabilitation. In recent years, we described an anatomic MUCL reconstruction with internal brace augmentation which demonstrated improved biomechanical strength when compared to the docking technique in cadaveric specimens. The purpose of this study was to evaluate the postoperative course of both amateur and professional throwing athletes that underwent anatomic MUCL reconstruction with internal brace augmentation. We hypothesized that throwers would return to the same level of play and that return to play (RTP) would be a shorter duration compared to current reported outcomes.

Methods:

In this surgical technique, the native MUCL is formally repaired. The graft and a suture tape are folded over a suspensory loop and secured in a socket of the medial epicondyle of the humerus to maximize tendon to bone contact. On the ulnar side, the graft and internal brace are secured proximally by two suture anchors on either side of the sublime tubercle and further secured across the sublime tubercle ridge distally to re-create the anatomic triangular insertion of the native ligament. All surgeries were performed by a single surgeon. Patient reported outcomes in addition to date of RTP, level of play, and functional outcomes were retrospectively gathered. All patients initially followed an Accelerated Rehabilitation Protocol and were converted to a Standard Paced protocol if setbacks were encountered.

Results:

A total of 26 baseball players underwent primary (n=23) or revision (n=3) MUCL reconstruction with the Anatomic Technique. Of these, 15 were professional and 11 were amateur athletes. 92% of throwers returned to play at a mean of 9.9 months following reconstruction. 89% were able to advance through the accelerated postoperative protocol without issues and 85% returned to the same role and level of play. Post injury KJOC scores improved from 41 to 86.9 and SANE scores improved from 32.5 to 95.5. No significant difference was identified in pre-injury versus post-reconstruction throwing velocity, ball spin rate, or horizontal/vertical ball movement.

Conclusions:

Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries. Advantages include increased tendon-bone contact of the reconstruction, multiple fixation points, and anatomic restoration of the MUCL. This technique allowed an expedited return to sport for these baseball athletes.
Poster 155: An Ultrasound and Clinical Evaluation in Patients Following Treatment for Proximal Humerus Fractures: Reverse Versus Anatomical Total Shoulder Arthroplasty
Authors: Gaj Eduardo , Pagnotta Susanna , Criseo Natale , Maggiori Alessandro , Forsythe Brian , Gamsarian Vahram , Mirle Vikranth , Khazi-Syed Daanish , Chang Joshua , Giallorenzi Maria Agostina , De Carli Angelo
Published: October 2024

Objectives:

Anatomic Total Shoulder Arthroplasty (ATSA) and Reverse Total Shoulder Arthroplasty (RTSA) are both viable treatment options for complex proximal humerus fractures. With its principal role as an abductor and internal rotator in a native joint, the subscapularis potentially plays an important functional and stability role postoperatively. Although less studied in RTSA, studies have found that failure of subscapularis repair is associated with anterior instability, and decreased range of motion (ROM), strength, and outcome scores following ATSA. The purpose of our study is to evaluate and compare the postoperative clinical, radiographic, and patient-reported outcomes following subscapularis reattachment in patients treated with either ATSA or RTSA.

Methods:

Sixty-eight consecutive patients with proximal humeral fractures were prospectively enrolled in the study between June 2015 and May 2020 (RTSA = 40; TSA = 28). Ultrasound scans of the subscapularis were performed postoperatively, and the subscapularis muscle cross-sectional area (iSMCSA) and contralateral subscapularis muscle cross-sectional area (cSMCSA) were measured. The ratio of the 2 values (iSMCSA/cSFCSA) was utilized to standardize values. Patient-reported outcomes (PROs) and ROM were evaluated at the final follow-up.

Results:

Demographically, there was no significant difference between age, arm dominance, surgical laterality, diabetes, or hypertension between the patient groups (Table 1). The RTSA group demonstrated higher PROs compared to TSA patients: Constant Score (p = .0007), Quick Dash (p = .0005), and ASES score (p = .09). ROM was better in the RTSA cohort, with statically significant values with internal rotation (p = .022 abduction), external rotation (p = .02 adduction and p = .01 abduction), abduction (p = 0.02), and forward flexion (p = .003). Radiographic ultrasound findings illustrated greater reduction in size of the subscapularis in the TSA cohort when compared to the contralateral, nonoperative subscapularis (40% vs 27%; p = 0.002). Reduction of subscapularis size of >35% occurred in 2 RTSA (7%) and 8 TSA patients (44%) (p = 0.01) (Table 2).

Conclusions:

Subscapularis repair following RTSA demonstrated better results compared to subscapularis repair following TSA, providing better PROs and ROM. Subscapularis muscle tissue decreased 50% more in the ATSA versus RTSA patients (40% vs 27%). Subscapularis condition demonstrated no correlation with functional outcome in RTSA.
Poster 182: Pain and Quality of Life Scores Following Hip Arthroscopy for Femoroacetabular Impingement are More Related to Mental Health Than Hip Pathology
Authors: Steiner Quinn , Watson Andrew , Mosiman Samuel , Spiker Andrea
Published: October 2024

Objectives:

Symptom severity in patients with femoroacetabular impingement (FAI) has been demonstrated to have a stronger association with mental health status than pathology. However, there is limited data on the relationship between mental health status and postoperative outcomes in FAI patients. This study aims to evaluate the relationship of mental health status and structural hip pathology to pain and quality of life.

Methods:

This was a retrospective review of patients from a single surgeon’s hip outcomes registry. Mental health status was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety and PROMIS-Depression scores. Pain was evaluated with Single Assessment Numerical Evaluation Score for Activities of Daily Living (SANE ADL) while quality of life (QOL) was evaluated with the International Hip Outcome Tool (iHOT-12). Repeated measures mixed modeling was used to evaluate the association between hip pathology (size of labral tear, grade of chondral damage, preoperative alpha angle), pain, QOL, anxiety, and depression pre- and postoperatively.

Results:

A total of 337 patients were included in this study. The degree of preoperative alpha angle, intra-operative cartilage damage and size of labral tear did not influence postoperative improvements in pain or QOL (p>0.05). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (anxiety estimate: -0.608, SE (0.079), p<0.0001), (depression estimate: -0.677, SE (0.086), p<0.0001), and lower iHOT-12 scores (anxiety estimate: -0.709, SE (0.069), p<0.0001), (depression estimate: -0.706, SE (0.077), p<0.0001). These associations were seen both preoperatively and up to 2 years postoperatively. Furthermore, anxiety and depression do not appear to moderate the relationship between hip pathology and patient outcomes.

Conclusions:

All patients had similar improvements in pain scores and QOL following hip arthroscopy for FAI suggesting this surgery is beneficial for varying degrees of hip pathology. Additionally, preoperative anxiety and depression are associated with greater pain and decreased QOL both pre- and postoperatively regardless of the degree of hip pathology. This may suggest a need for pre- and postoperative psychological interventions in patients with anxiety and depression, and clinicians should prioritize mental health treatment at or above the level of the hip pathology itself.
Poster 210: Flexible Athletes with Borderline Hip Dysplasia Achieve Successful and Similar Outcomes after Hip Arthroscopy Compared to Flexible Athletes without Borderline Hip Dysplasia
Authors: Wright-Chisem Joshua , Vogel Michael J. , Alvero Alexander B. , Jan Kyleen , Nho Shane J.
Published: October 2024

Objectives:

To compare minimum 2-year patient-reported outcomes and achievement of clinically significant outcomes in flexibles athletes with and without borderline hip dysplasia (BHD) undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with capsular plication.

Methods:

Data was prospectively collected for patients undergoing primary hip arthroscopy for FAIS with borderline hip dysplasia (BHD), defined as a lateral center edge angle (LCEA) of 18° to 25°, with primary participation in a sport with high flexibility requirement including dance, gymnastics, figure skating, yoga, cheerleading, and martial arts. These patients were matched 1:2 to flexible athletes with an LCEA >25° controlling for age, sex, body mass index (BMI) and follow up duration. Preoperative and minimum 2-year postoperative patient-reported outcomes included: Hip Outcome Score (HOS) Activities of Daily Living, HOS Sports Scale, International Hip Outcome Score 12, modified Harris Hip Score, and Visual Analog Scale for Pain. Cohort-specific Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated and compared between groups.

Results:

Fifty-two flexible athletes with BHD were matched to 104 flexible athletes without BHD. Similar sport participation (45% dance vs. 41%, p=0.874) and level of competition (74% vs. 74% recreational, p=0.877) were observed. Preoperative LCEA (22.2° ± 1.6 vs. 31.5° ± 3.9, p < 0.001) and Tönnis angle (10.9 °± 3.7 vs. 5.8° ± 4.4, p < 0.001) differed significantly between groups. Capsular plication was performed in all cases (100% and 100%, p = 1.000). Both groups achieved significant improvement in all PROs (p ≤ 0.001) with no differences in PROs between groups (p ≥ 0.147). High MCID (95.7%, 94.8%) and PASS (71.7%, 72.2%) achievement for any PRO was observed with no differences between groups (p ≥ 0.222).

Conclusions:

Flexible athletes with BHD achieve successful and similar outcomes to those without BHD after primary hip arthroscopy for FAIS with capsular plication.
Poster 238: Accuracy, Safety, and Cost of Patient-Specific Cutting Guides for Alignment-Correcting Osteotomy
Authors: Savage-Elliott Ian , Li Zachary I. , Rao Naina , Triana Jairo , Garra Sharif , Ranawat Anil S. , Alaia Michael J. , Jazrawi Laith M.
Published: October 2024

Objectives:

The purpose of this study was to determine the cost, accuracy of radiographic correction, and safety with respect to complication rates and fluoroscopic usage in patient-specific cutting guides (PSCG) osteotomies compared to an age- and body mass index (BMI)-matched group of controls using standard cutting guides (SCG).

Methods:

Patients were retrospectively reviewed between 2017 and 2022 at a single urban academic institution. Patients undergoing high tibial osteotomy (HTO) or distal femoral osteotomy (DFO) with PSCG (Bodycad 3d, Quebec, Canada) were identified. Traditional osteotomies were selected for the SCG group using propensity matching based on age, sex, BMI, osteotomy type. All procedures were performed by 1 of 2 fellowship-trained sports orthopaedic surgeons. Procedure time, fluoroscopy time, tourniquet time, and concomitant procedures were extracted from operative notes. Blinded, 2-reader hip-knee-ankle (HKA), posterior tibial slope (PTS) and mechanical axis deviation (MAD) measurements were performed on pre- and postoperative weightbearing radiographs for each procedure. Intraclass correlation coefficients (ICCs) were calculated to determine the reliability between the intended intraoperative correction of HKA and/or PTS the measured result on postoperative radiographs. A time-driven activity-based costing (TDABC) analysis was performed to compare costs of PSCG versus SCG.

Results:

Forty-two patients were included in the final analysis. Each group was 47.6% female, with 11 HTOs and 10 DFOs performed in each group. Final HKA (2.7° vs 1.9°, p = 0.355), PTS (1.6° vs 2.6°, p = 0.794) and MAD (10.2 vs 5.8 mm, p = 0.214) did not significantly differ between SCG and PSCG groups (MAD seems higher for SCG. The ICC between the intended and measured HKA correction was 0.841 (good) in the PSCG group and 0.623 (moderate) in the SCG group. PSCG osteotomies averaged 18.5 minutes less (p = 0.392) and required 16.7 minutes less tourniquet time (p = 0.121). Fluoroscopy time was significantly lower in the PSCG group compared to SCG (99 vs 43 seconds, p < 0.001), as well as radiation dose (7.8 vs 2.9 mGy, p = 0.013). TDABC analysis demonstrated a base cost of $21,067 for PSCG and $23,896 for SCG. When the cost of the cutting guide and pre-operative imaging were included, PSCG was $2,829 more expensive than SCG. There was a lower, though non-statistically significant, rate of hinge fractures (9.5% vs 33.3%, p = 0.130) and return to the OR (4.8% vs 19.0%, p = 0.343) when comparing PSCG and SCG groups.

Conclusions:

Both traditionally guided osteotomies and PSCG-guided osteotomies accurately corrected lower extremity malalignment. Utilization of PSCG resulted in similar procedure times and cost. PSCG required less fluoroscopy and resulted in less radiation to conventional osteotomy and trended toward a decreased rate of postoperative complications.
Poster 249: Distal Femoral Coronal Realignment Osteotomies Alter CT-Measured Tibial Tuberosity to Trochlear Groove (TT-TG) Distance in Addition to Mechanical Axis Deviation – A Cadaveric Study
Authors: Tauberg Brandon M. , Williams Derrick , Aboulafia Alexis H. , Haidar Layla , Mansour Alfred A.
Published: October 2024

Objectives:

Patellar tracking has been shown to be affected by limb alignment. Many patients with underlying valgus deformity with patellar instability have elevated tibial tuberosity–trochlear groove (TT-TG) measurements. Correction of limb alignment improves Q-angle, however, its effect on TT-TG as measured by computed tomography (CT) has yet to be demonstrated. We hypothesize that changing the limb alignment as measured by mechanical axis deviation (MAD) through a distal femoral osteotomy (DFO) would also cause a change in TT-TG distance as measured by CT.

Methods:

Lateral distal femoral osteotomies were performed on 5 cadaveric specimens (10 limbs) and fixed with an external fixator. The native MAD and baseline TT-TG were measured using a CT scanogram. Subsequent scans were then performed altering the MAD using calibrated radiolucent wedges in 5 mm increments (0-25 mm) on a single side, using the contralateral limb as the control. Repeat measurements of MAD and TT-TG were obtained, and once completed, original alignment was restored, and the contralateral limb was taken through the same protocol with the opposite limb serving as the control. Measurements were performed by two independent observers and averages obtained. Linear regression models were created, and statistical analysis of variance was performed.

Results:

A CT-scanogram that measured TT-TG distances were significantly altered by changes in limb alignment. According to our linear regression model, each 1° of MAD alteration resulted in TT-TG change of approximately 0.4 mm. With every 5° change in limb alignment, the TT-TG changed by approximately 2 mm (Figure 1). Altering MAD from 6° valgus to 7° varus decreased the TT-TG mean from 14.3 mm to 7.7 mm, p < 0.05.

Conclusions:

Changes in coronal limb alignment through a distal femoral corrective osteotomy produce significant changes in TT-TG in addition to correcting MAD in a cadaveric model. These findings should be considered when determining appropriate corrective procedures for patients with valgus alignment and patellar instability. [Figure: see text]
Poster 269: Radiographic Outcome of Meniscal Root Repairs: Evaluating Osteoarthritic Progression Over Two Years
Authors: Flanigan David C. , Magnussen Robert A. , Kaeding Christopher C. , Barker Tyler , Burnett Zachary , Cavendish Parker A. , Milliron Eric , Kashyap Anjali
Published: October 2024

Objectives:

Root tears account for 10-21% of meniscal injuries, defined as radial tears occurring within 1 cm of the meniscal attachment horn. Menisci play a critical role in load transmission and shock absorption, with the goal of surgical intervention to retain knee functionality over time. While meniscal root repairs demonstrate better clinical outcomes to meniscectomies, total knee replacements, or non-surgical intervention, current literature suggests progression of knee osteoarthritis following repair. The purpose of this study is to evaluate osteoarthritic impacts, specific to joint space narrowing (JSN) and Kellgren Lawrence grades, through pre- and post-operative radiographs of root repair patients. We hypothesize root repair radiographs will demonstrate both anatomic narrowing of joint space and increased KL Grades over a 2-year follow-up. The purpose of this study was to evaluate osteoarthritic impacts of meniscal root repairs by using standardized protocol to measure JSN and KL Grades through pre- and postoperative patient radiographs.

Methods:

Patients who underwent meniscal root repairs during the study period of 2012 to 2022 at our academic center were identified. Inclusion criteria included patients who received a weightbearing preoperative, 1-year postoperative, and/or 2-year postoperative radiograph. Joint space and KL scores, including evaluation of osteophytes, sclerosis, and definite deformity of boney ends, were assessed by two separate independent readers with protocol consistent with previously published grading scale literature.

Results:

Forty-nine patients (35 females and 12 males) with an average age of 47.7 (± 9.06) years and BMI of 32.73 (±6.75) underwent meniscal root repairs and proper imaging during the study period. Preliminary data indicates significant (p <.005) medial joint space narrowing across medial, lateral, and bilateral repairs from preoperative measurements (4.79 ± 0.7 mm) to 1-year postoperative (4.24 ± 0.7 mm), as well as 2-year postoperative (4.24± 1.0 mm). Over 2-year follow-up, 47.4% patients went on to hold the same KL grade, 44.7% patients increased by 1 grade, 7.9% patients increased by 2 grades, and two patients were converted to arthroplasty (i.e. 1 total knee, 1 unicompartmental). Overall, KL scores demonstrate an average 51.9% increase in pre-op grading (1.29 ± 0.4) to 2-year post-op grading (1.96 ± 0.29) respectively.

Conclusions:

Radiographic images of meniscal root repairs indicate mild progression of osteoarthritic knee characteristics over a 2-year follow-up. Quantified joint space narrowing was shown in most patients and over 50% had an increase in Kellgren Lawrence grade. Despite successful repair in most patients, osteoarthritic progression occurs in post patients.
Poster 284: The Effect of Pressurized Carbon Dioxide Lavage on Osteochondral Allograft Preparation: A Comparative Study
Authors: Atzmon Ran , Chang Wen-Teh , Chan Calvin , Lin Kenneth M. , Cole Brian J. , Abrams Geoff D. , Sherman Seth L.
Published: October 2024

Objectives:

Osteochondral allografts (OCA) transplantation is often utilized for treating osteochondral lesions of the knee due to limited cartilage regenerative capabilities. The use of concentrated bone marrow aspirate (cBMA) has gained traction as a method to enhance OCA incorporation and healing. Pulse lavage and pressurized carbon dioxide lavage are cleaning methods used during OCA preparation to rid native marrow elements and improve graft porosity, but their isolated and combined effects are not fully understood. This study aimed to assess the impact of incorporating pressurized carbon dioxide lavage as an adjunct to pulse lavage during OCA preparation. Our hypothesis was that adding pressurized carbon dioxide lavage would enhance the OCA absorption capacity for liquid-based materials like cBMA.

Methods:

OCA plugs were harvested from medial hemi-condyles. The plugs were divided into two groups: one group underwent pulse lavage alone, and the other group underwent pulse lavage followed by pressurized carbon dioxide lavage (sequential group). The plugs were weighed before and after each cleaning step and a liquid dye solution with consistency similar to cBMA was added by dripping over the cancellous portion of the graft. Next, the liquid content was determined by centrifugation and spectrophotometry. Results were analyzed statistically.

Results:

Thirty-four OCA plugs with a 14 to 18 mm diameter were harvested. After the cleaning phase, the sequential group showed a significant weight reduction of 107 ± 21.92% (p < 0.0001) and subsequent weight gain of 96.32 ± 18.99% (p < 0.0001) after the cleaning and dye-dripping procedures. In contrast, the pulse lavage-only group exhibited minimal weight loss and a small  weight gain of 10.55 ± 3.86% after the dye-dripping procedure.

Conclusions:

Adding pressurized carbon dioxide lavage to reduce marrow elements and improve graft porosity significantly improved the OCA cleaning process and created more vacant space enhancing OCA absorption capacity for orthobiologic agents such as cBMA. The study findings highlight the potential of incorporating pressurized carbon dioxide lavage as an adjunct to pulse lavage during OCA preparation. These findings may contribute to the surgical procedure of incorporating cBMA or other orthobiologics to promote the integration and healing of OCA plugs.
An Initial Exploration into Job Satisfaction Among Long-Term Care Administrators and State Tested Nursing Assistants in Ohio
Authors: Ward Rachel E. , Dudash Shannon , Van Dussen Daniel J. , Debevec Macy S.
Published: October 2024

This pilot study examines Ohio’s licensed nursing home administrators and state tested nursing assistant’s perspectives about job satisfaction, future career and employment plans, potential beneficial changes to their organizations, and their thoughts on reducing turnover rates in their field. Ohio Board of Executives of Long-Term Services and Supports provided their contact list of all 1,969 licensed nursing home administrators in Ohio in the fall of 2023. Two surveys were created for licensed nursing home administrators and state tested nursing assistants. Results were analyzed for themes within the open-ended responses; 28 surveys were received from licensed nursing home administrators and 17 surveys were received from state tested nursing assistants. Residents and their families are among the top reasons for job satisfaction, many employees face symptoms of burnout, and wages are a concern among both state tested nursing assistants and licensed nursing home administrators. Future career plans differed between the two professions and had distinct driving factors. A discussion of licensed nursing home administrators’ opinions on improving retention and turnover rates should include more accountability, personal responsibility, and adding opportunities for professional growth and development.
A Virtual Reality Anatomy Model of the Temporal Bone in ORL Residency Training—Gain or Gadget?
Authors: Everad Friederike , Albrecht Tobias , Kromeier Jan , Heermann Stephan , von Schnakenburg Philip , Hildenbrand Tanja , Speck Iva , Knopf Andreas , Offergeld Christian
Published: October 2024

OBJECTIVES

Virtual reality (VR) appears to be a promising educational tool for otorhinolaryngology (ORL) residency training, as it allows for safe and effective practice immediate feedback and potential improvements in patient outcomes. Despite these advantages, VR has not yet been incorporated into residency training in ORL, which may be due to limited availability or validation and skepticism toward incorporation of new training methods. This study investigates whether a VR model of the temporal bone improves learning success for ORL residents in comparison to standard plastic models and whether it depends on surgeon's experience. We also included a subjective evaluation of the learning experience with both models.

METHODS

ORL residents and specialists at 2 German university hospitals were tested on their knowledge of temporal bone anatomy after training with either VR or standard plastic models. In addition, we compared knowledge of the temporal bone anatomy before- and after-VR training. Lastly, a subjective survey on the benefits and limitations of VR was conducted to assess participants’ views on this new technology.

RESULTS

About 85% of the participants considered VR to be better than conventional models and agreed that VR was a useful tool for teaching complex anatomy. Objective evaluation showed significant improvement in knowledge after using VR (before/after comparison), especially in participants with a higher level of preexisting knowledge. Direct comparison to conventional plastic models showed no superiority of the VR model.

CONCLUSION

VR models in ORL are not only appealing and motivating for residents, but also objectively improve their anatomical knowledge, especially in advanced residency. In addition, VR—in contrast to the plastic model—offers opportunities for further development and optimization.
Exploring Factors Influencing Parent-Adolescent Communication on Sexual and Reproductive Health (SRH)—A Qualitative Study from Bengaluru, India
Authors: Likith R S
Published: October 2024

Background:

Sexuality and reproductive health have remained a topic of taboo and disgust in India, owing to its deep-rooted cultural, traditional and religious practices. Lack of right sources of information and negligible communication about sexual and reproductive health (SRH) with trusted adults encourages adolescents to rely on unsafe sources, both online and offline, which could lead to detrimental consequences on their physical and mental health.

Methods:

This study utilizes a qualitative descriptive design to explore the factors influencing parent-adolescent communication on SRH. It focuses on mothers of adolescent children (10–19 years) from Urban Bengaluru. Data is collected through in-depth interviews of mothers and thematic analysis is performed on the data collected.

Results:

The qualitative analysis identified five core themes: Knowledge about SRH and gender-based needs, cultural and traditional influences, role of family, role of partner and inhibition of children. The perspectives of parents provided scope for what could be done to facilitate healthy and open communication.

Conclusion:

This study portrays the factors that hinder free communication between parents and adolescents about SRH. Suggestions for breaking the taboo pertaining to sexuality conversations and future studies have also been mentioned.
Study of Attitude Toward Homosexuality Among the Health Professionals
Authors: Patel Vishal K. , Joshi Vaibhav M. , Patel Falguni B. , Barot Anand , Sharma Vivek , Prajapati Ronak
Published: October 2024

Background:

Despite the level of awareness of homosexuality is in the increasing trend, health professionals lack a positive attitude toward homosexuality.

Aim:

The purpose of this study was to determine the level of attitudes toward homosexuality among health professionals.

Subject and Methods:

This was a cross-sectional study conducted among 600 health professionals. The attitude toward homosexuality questionnaire was used to assess the attitude of health professionals toward homosexuality. A descriptive analysis, Mann–Whitney U test, and Kruskal Wallis test were used to analyze the data.

Observations:

The mean score for attitude toward homosexuality questionnaire was 73.04 + 23.39 among the participants. The males had lesser degree of positive attitude compared to higher degree of positive attitude of females toward homosexuality. Participants from rural areas had neutral attitudes, and participants from the urban areas had positive attitudes toward homosexuality. Participants living in nuclear families had positive attitudes toward homosexuality, and participants living in joint families had negative attitudes toward homosexuality. Participants with heterosexual orientation had negative attitudes toward homosexuality.

Conclusion:

Overall, health professionals had a lesser degree of positive attitude toward homosexuality; they require sensitization to upgrade their positive attitude toward homosexuality for better doctor–patient relationship.
People with dyslexia or dyscalculia are less biased: Results of a preregistered study from over 450,000 people on the implicit association test
Authors: Cross Liam , Atherton Gray , Nicolson Roderick I
Published: October 2024

The implicit association test (IAT) provides a sensitive measure of attitudes to social dimensions such as race, gender or disability using a response speed procedure. The automatisation deficit account of dyslexia attributes the reading (and broader) difficulties of dyslexic people to reduced speed and strength of stimulus–response habit formation and, therefore, predicts reduced implicit bias for individuals with dyslexia. This novel prediction was tested using the ‘Project Implicit’ IAT database on attitudes to disability. Data from over 460,000 respondents was analysed, including 22,747 with physical disability (PD), 14,700 with dyslexia, and 1721 with dyscalculia. The dyslexia group did indeed show significantly less ‘Disability Bias’ than both the PD and no disability groups. Intriguingly, the dyscalculia group showed significantly less disability bias even than the dyslexia group. The results are interpreted within the learning framework of broader automatisation deficit and have ramifications for understanding both conditions and the processes of development of implicit bias in neurodiverse and neurotypical populations.
The effect of graded exercise therapy on fatigue in people with serious respiratory illness: a systematic review
Authors: Burge Angela T. , Gadowski Adelle M. , Romero Lorena , Vagheggini Guido , Spathis Anna , Smallwood Natasha E. , Ekström Magnus , Holland Anne E.
Published: October 2024

Background

In adults with serious respiratory illness, fatigue is prevalent and under-recognised, with few treatment options. The aim of this review was to assess the impact of graded exercise therapy (GET) on fatigue in adults with serious respiratory illness.

Methods

Electronic databases were searched to identify randomised controlled trials (RCTs) testing GET (involving incremental increases in exercise from an established baseline) in adults with serious respiratory illness. The primary outcome was fatigue and secondary outcomes were health-related quality of life (HRQoL) and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.

Results

76 RCTs were included with 3309 participants, most with a diagnosis of COPD or asthma. Reductions in fatigue measured by the Chronic Respiratory Disease Questionnaire fatigue domain score were demonstrated following GET consisting of aerobic with/without resistance training (mean difference (MD) 0.53 points, 95% CI 0.41–0.65, 11 RCTs, 624 participants) and GET using resistance training alone (MD 0.58 points, 95% CI 0.21–0.96, two RCTs, 82 participants) compared with usual care. Although the mean effect exceeded the minimal important difference, the lower end of the confidence intervals did not always exceed this threshold so the clinical significance could not be confirmed. GET consistently improved HRQoL in people with a range of chronic respiratory diseases on multiple HRQoL measures. No serious adverse events related to GET were reported.

Conclusion

GET may improve fatigue alongside consistent improvements in HRQoL in people with serious respiratory illness. These findings support the use of GET in the care of people with serious respiratory illness.
Epidemiology of bronchiectasis
Authors: Nigro Mattia , Laska Irena F. , Traversi Letizia , Simonetta Edoardo , Polverino Eva
Published: October 2024

Bronchiectasis is a chronic respiratory disease characterised by permanent enlargement of the airways associated with cough, sputum production and a history of pulmonary exacerbations. In the past few years, incidence and prevalence of bronchiectasis have increased worldwide, possibly due to advances in imaging techniques and disease awareness, leading to increased socioeconomic burden and healthcare costs. Consistently, a mortality increase in bronchiectasis patient cohorts has been demonstrated in certain areas of the globe, with mortality rates of 16–24.8% over 4–5 years of follow-up. However, heterogeneity in epidemiological data is consistent, as reported prevalence in the general population ranges from 52.3 to more than 1000 per 100 000. Methodological flaws in the designs of available studies are likely to underestimate the proportion of people suffering from this condition worldwide and comparisons between different areas of the globe might be unreliable due to different assessment methods or local implementation of the same method in different contexts. Differences in disease severity associated with diverse geographical distribution of aetiologies, comorbidities and microbiology might explain an additional quota of heterogeneity. Finally, limited access to care in certain geographical areas is associated with both underestimation of the disease and increased severity and mortality. The aim of this review is to provide a snapshot of available real-world epidemiological data describing incidence and prevalence of bronchiectasis in the general population. Furthermore, data on mortality, healthcare burden and high-risk populations are provided. Finally, an analysis of the geographical distribution of determinants contributing to differences in bronchiectasis epidemiology is offered.
An investigative study on Yersinia enterocolitica in animals, humans and dried milk in New Valley Governorate, Egypt
Authors: Sotohy Sotohy A. , Diab Mohamed Said , Ewida Rania M. , Aballah Allaa , Eldin Nehal K. Alm
Published: October 2024

Background

Yersiniosis is one of the most significant intestinal disorders caused by Yersinia enterocolitica and affects both humans and animals. This study aimed to investigate the prevalence of Y. enterocolitica in New Valley Governorate, Egypt in animals, humans, fresh milk and dried milk. Additionally, this study analyzed the presence of virulence genes, including ail and Yst in tested isolates and conducted a phylogenetic analysis to determine the genetic similarity between human, and animal Y. enterocolitica isolates. Finally, the antimicrobial resistance patterns of the isolates were examined.

Results

Among the 982 samples examined, the prevalence of Y. enterocolitica based on ISO10273-2017 was 11.7% in animal samples including 12.8% of animal faeces, and 10.4% in milk samples. Moreover, the prevalence of Y. enterocolitica was 13.2% in human stool, and 9.5% in dried milk samples. The molecular characterization of the six randomly selected isolates showed that the 16S rRNA, ail and Yst genes were found in 50, 33.3 and 100% of the examined Y. enterocolitica isolates, respectively. Phylogenetic analysis of animal and human isolates based on the 16S rRNA gene revealed a high degree of similarity between the isolates. All the tested animal and human Y. enterocolitica isolates (100%) were resistant to ampicillin and cefotaxime, but highly sensitive to norfloxacin.

Conclusions

The high prevalence of Y. enterocolitica in animal and human samples with high degrees of genetic similarity poses a threat to public and animal health. Animal faeces, milk and milk powder represent the main sources of Y. enterocolitica infection in humans. Additionally, high levels of antibiotic resistance of Y. enterocolitica can cause public health hazards by leading to the failure of disease prevention and treatment programs in humans and animals.
General practitioners may improve cervical screening equality in France
Authors: Druel Vladimir , Delpierre Cyrille , Ouanhnon Lisa , Bugat Marie-Eve Rougé , Grosclaude Pascale
Published: October 2024

Background

Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics.

Methods

This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression.

Results

A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs.

Conclusions

Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations.
Predictors of seropositivity to SARS-CoV-2 among employees at a large urban medical center
Authors: Kupferwasser Deborah , Flores Evelyn A. , Merino Prudencio , Tran Donna Phan , Liu Honghu , Huang Yilan , Bolaris Michael , Nguyen Megan H. , Gonzales Mildred , Da Silva Wellington , Astorga-Cook Leslie , Abueg Angel , Mason Holli , Miller Loren G.
Published: October 2024

Background

Before SARS-CoV-2 vaccination availability, medical center employees were at high risk of COVID-19. However, risk factors for SARS-CoV-2 infection in medical center employees, both healthcare and non-healthcare workers, are poorly understood.

Methods

From September-December 2020, free IgG antibody testing was offered to all employees at a large urban medical center. Participants were asked to complete a questionnaire on work and non-work related risk factors for COVID-19 infection.

Results

SARS-CoV-2 seropositivity was found in 4.7%. Seropositivity was associated with close contact with COVID-19 cases with or without the use of adequate personal protective equipment (PPE), (OR 3.1 [95% CI 1.4–6.9] and OR 4.7 [95% CI 2.0–11.0] respectively), never wearing a mask outside of work (OR 10.1 [95% CI 1.9–57]), and Native Hawaiian/Pacific Islander race (OR 6.3 95% CI (1.6–25)].

Conclusions

Among workers in a large urban medical center, SARS-CoV-2 seropositivity was associated with work-related COVID-19 close contacts and low mask use outside of work, suggesting that non-workplace close contacts are also relevant routes of COVID-19 spread among healthcare workers.
Forecasting severe respiratory disease hospitalizations using machine learning algorithms
Authors: Albrecht Steffen , Broderick David , Dost Katharina , Cheung Isabella , Nghiem Nhung , Wu Milton , Zhu Johnny , Poonawala-Lohani Nooriyan , Jamison Sarah , Rasanathan Damayanthi , Huang Sue , Trenholme Adrian , Stanley Alicia , Lawrence Shirley , Marsh Samantha , Castelino Lorraine , Paynter Janine , Turner Nikki , McIntyre Peter , Riddle Patricia , Grant Cameron , Dobbie Gillian , Wicker Jörg Simon
Published: October 2024

Background

Forecasting models predicting trends in hospitalization rates have the potential to inform hospital management during seasonal epidemics of respiratory diseases and the associated surges caused by acute hospital admissions. Hospital bed requirements for elective surgery could be better planned if it were possible to foresee upcoming peaks in severe respiratory illness admissions. Forecasting models can also guide the use of intervention strategies to decrease the spread of respiratory pathogens and thus prevent local health system overload. In this study, we explore the capability of forecasting models to predict the number of hospital admissions in Auckland, New Zealand, within a three-week time horizon. Furthermore, we evaluate probabilistic forecasts and the impact on model performance when integrating laboratory data describing the circulation of respiratory viruses.

Methods

The dataset used for this exploration results from active hospital surveillance, in which the World Health Organization Severe Acute Respiratory Infection (SARI) case definition was consistently used. This research nurse-led surveillance has been implemented in two public hospitals in Auckland and provides a systematic laboratory testing of SARI patients for nine respiratory viruses, including influenza, respiratory syncytial virus, and rhinovirus. The forecasting strategies used comprise automatic machine learning, one of the most recent generative pre-trained transformers, and established artificial neural network algorithms capable of univariate and multivariate forecasting.

Results

We found that machine learning models compute more accurate forecasts in comparison to naïve seasonal models. Furthermore, we analyzed the impact of reducing the temporal resolution of forecasts, which decreased the model error of point forecasts and made probabilistic forecasting more reliable. An additional analysis that used the laboratory data revealed strong season-to-season variations in the incidence of respiratory viruses and how this correlates with total hospitalization cases. These variations could explain why it was not possible to improve forecasts by integrating this data.

Conclusions

Active SARI surveillance and consistent data collection over time enable these data to be used to predict hospital bed utilization. These findings show the potential of machine learning as support for informing systems for proactive hospital management.
The relationship between moral distress and clinical care quality among nurses: an analytical cross-sectional study
Authors: Safari Fateme , MohammadPour Ali , BasiriMoghadam Mahdi , NamaeiQasemnia Alireza
Published: October 2024

Background

Nurses constitute the largest group of service providers in the healthcare system and significantly influence the quality of healthcare services. Factors such as ethical considerations may be related to the quality of care. This study aimed to determine the relationship between moral distress and the quality of clinical care among nurses working in Gonabad, Iran.

Methods

An analytical cross-sectional study was conducted on 252 nurses working in emergency, internal medicine, surgery, psychiatry, critical care and maternity wards at Allameh Bohlool Hospital from May to July 2023. This research used demographic information questionnaire, the revised Moral Distress Scale (MDS-R), and the Quality Patient Care Scale (QUALPAC). The significance level for the study was set at p < 0.05.

Results

There was a significant relationship between the frequency of moral distress and the quality of clinical care (p = 0.032), as well as between the intensity of moral distress and the quality of clinical care (p = 0.043). Nurses who experienced moral distress more frequently and intensely provided better quality care. However, there was no significant relationship between the effect of moral distress and the quality of clinical care (r = 0.032, p = 0.619). Additionally, a significant statistical relationship was found between the intensity of moral distress and the physical dimension of clinical care quality (r = 0.171, p = 0.007), indicating that increased moral distress intensity was associated with higher quality of physical care.

Conclusions

Nurses who experience higher levels of moral distress, both in terms of frequency and intensity, perform better in the care they provide and deliver it in the best possible manner, particularly in the physical dimension of care.