bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of information analysis optimizing future trial design from a pilot study on catheter securement devices
Authors: Tuffaha Haitham W , Reynolds Heather , Gordon Louisa G , Rickard Claire M , Scuffham Paul A
Published: August 2014

Background:

Value of information analysis has been proposed as an alternative to the standard hypothesis testing approach, which is based on type I and type II errors, in determining sample sizes for randomized clinical trials. However, in addition to sample size calculation, value of information analysis can optimize other aspects of research design such as possible comparator arms and alternative follow-up times, by considering trial designs that maximize the expected net benefit of research, which is the difference between the expected cost of the trial and the expected value of additional information.

Purpose:

To apply value of information methods to the results of a pilot study on catheter securement devices to determine the optimal design of a future larger clinical trial.

Methods:

An economic evaluation was performed using data from a multi-arm randomized controlled pilot study comparing the efficacy of four types of catheter securement devices: standard polyurethane, tissue adhesive, bordered polyurethane and sutureless securement device. Probabilistic Monte Carlo simulation was used to characterize uncertainty surrounding the study results and to calculate the expected value of additional information. To guide the optimal future trial design, the expected costs and benefits of the alternative trial designs were estimated and compared.

Results:

Analysis of the value of further information indicated that a randomized controlled trial on catheter securement devices is potentially worthwhile. Among the possible designs for the future trial, a four-arm study with 220 patients/arm would provide the highest expected net benefit corresponding to 130% return-on-investment. The initially considered design of 388 patients/arm, based on hypothesis testing calculations, would provide lower net benefit with return-on-investment of 79%.

Limitations:

Cost-effectiveness and value of information analyses were based on the data from a single pilot trial which might affect the accuracy of our uncertainty estimation. Another limitation was that different follow-up durations for the larger trial were not evaluated.

Conclusion:

The value of information approach allows efficient trial design by maximizing the expected net benefit of additional research. This approach should be considered early in the design of randomized clinical trials.
“We don’t have such a thing, that you may be allergic”: Newcomers’ understandings of food allergies in Canada
Authors: Harrington Daniel W , Dean Jennifer , Wilson Kathi , Qamar Zafar
Published: August 2014

Food allergies are emerging as important public health risks in Canada, affecting 3–4% of adults and 6–7% of children. Despite much lower prevalence rates among recent immigrants (i.e. in the country less than 10 years), evidence has shown this population to be more concerned about the risks of food allergies than the general population and have unique experiences around purchasing foods for allergen-free environments. As a substantial and growing segment of the Canadian population, it is important to understand newcomers’ perceptions and knowledge of food allergies and related policies developed to protect allergic children (e.g. nut-free schools and or classrooms). This paper draws upon the results of focus groups conducted with newcomers from food allergic households (i.e. directly affected), as well as those with school-aged children who have to prepare or buy foods for allergen-controlled classrooms or schools (i.e. indirectly affected) living in Mississauga, Ontario. Results indicate unique challenges and understandings of food allergies as a new and unfamiliar risk for most newcomers, particularly as the indirectly affected participants negotiate the policy landscape. The directly affected group highlights the supportive environment in Canada resulting from the same policies and increased awareness in the general population.
Challenging criminal justice? Psychosocial disability and rape victimization
Authors: Ellison Louise , Munro Vanessa E , Hohl Katrin , Wallang Paul
Published: August 2014

In a context in which research evidence indicates high rates of alleged sexual victimization among adults with psychosocial disabilities, this article draws upon rape allegation data collected by the Metropolitan Police Service in April and May 2012, to explore some of the challenges that are posed to the criminal justice system by these types of complainants. Although the insights that can be generated from these data in relation to complainants with psychosocial disabilities are limited, in the context of this article it provides a valuable snapshot into contemporary patterns of rape victimization and attrition in England and Wales. It also serves as a useful stepping off point from which to highlight the need for more sustained critical research and reflection on the treatment of complainants, and the adequacy of police and prosecutor training and practice in this area.
Earliest autobiographical memories in college students from three countries: Towards a situated view
Authors: de la Mata Manuel L , Santamaría Andrés , Hansen Tia GB , Ruiz Lucía
Published: August 2014

The relationship between culture and autobiographical memory has become an important research topic since research over the past three decades has shown (cross)-cultural variations in the content and style of autobiographical memories that are related to differences in how people from diverse cultures describe themselves and others. However, most research has compared North-American to Asian cultures, leaving a need to address the relationship in others. Our study examines differences in characteristics of autobiographical memory in three countries: Mexico, Spain and Denmark, using Qi Wang’s methodology and categories of analysis. College students from these three countries were asked to describe their earliest memory. Results confirm the expected differences, with Danish and Spanish participants’ earliest memories dating significantly earlier than that of the Mexican participants. At the same time, Danish participants were less likely to spontaneously mention emotions and feeling states in their earliest memories. On the other hand, Mexicans demonstrated a higher level of autonomous orientation than the participants in the other two groups. Gender was found to interact with several indicators, and even displayed a cross-over effect in emotion. The findings are interpreted as supporting the view of cultured self-construals, while also suggesting the need for more attention to the situated character of cultural differences.
Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers
Authors: Hao Chun , Liu Hongjie
Published: August 2014

Background:

Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level.

Method:

An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level.

Results:

We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers’ perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers.

Conclusion:

The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors.
Enhancing Māori food security using traditional kai
Authors: McKerchar Christina , Bowers Sharron , Heta Craig , Signal Louise , Matoe Leonie
Published: August 2014

Issue:

Lack of food security is one of the major nutrition issues facing Māori today. Loss of traditional kai (food) gathering places and practices following colonisation and urbanisation has impacted negatively on food security for Māori. This paper explores the role of Māori in enhancing Māori food security through revitalising traditional kai.

Methods:

A narrative literature review of peer reviewed and grey literature on revitalising traditional kai for Māori was conducted. The focus was on two areas: increasing the availability of traditional kai to Māori households (such as through replenishing fish stocks, and gardening projects) and increasing the financial means available to Māori households to purchase food (by economic development of traditional kai industries and employment creation).

Results:

A range of activities to improve food security for Māori by revitalising traditional kai was identified in the literature. Māori are now significant players in New Zealand’s fishing industry, and are developing their horticultural resources. Gardening initiatives have also grown considerably in Māori communities. Enabling factors included: the return of traditional kai resources by the Crown, and successful pursuit by Māori of the legal rights to develop them; development of Māori models of governance; government policy around Māori economic development and healthy eating; and Māori leadership on the issue. Barriers to revitalising traditional kai that remain to be addressed include: tensions between Government and Māori goals and models of resource management; economic pressures resulting in severely depleted fishing stocks; and pollution of marine and freshwater fish.

Conclusion:

Revitalising traditional kai has considerable potential to improve food security for Māori, both directly in terms of food supply and by providing income, and warrants policy and practical support. These findings have implications for other indigenous cultures who are struggling to be food secure.
Midwives’ perceptions and experiences of health promotion practice in Ghana
Authors: Owusu-Addo Ebenezer
Published: August 2014

Introduction:

This research explores midwives’ perceptions and experiences of health promotion practice in Ghana.

Methods:

A qualitative descriptive exploratory design was used in order to gain better insight into midwives’ perceptions and experiences of health promotion practice. A total of 21 midwives took part in the study. Data were collected by individual in-depth semi-structured interviews. Thematic analysis was used to analyse the transcript.

Results:

Five dominant themes emerged from the interview transcripts, namely: health promotion as education, health promotion activities, the value of health promotion, client participation, and midwives’ barriers to promoting health. Although midwives underscored the importance of health promotion to their work, their reports indicated that, in practice, midwives mostly delivered health education and behaviour change communication rather than health promotion. The midwives expressed the view that by way of their close association with women, they were in a better position to influence women’s health. Health promotion activities engaged by the midwives included weight management, healthy eating, infection prevention, personal hygiene, counselling on family planning, and screening for hazardous and harmful substance use such as alcohol and smoking. All the midwives mentioned that clients participated in their health promotion activities. Factors that were identified by the midwives to enhance client participation were trust, attitude of the midwife, building rapport, creating enabling environment, listening and paying attention to clients and using simple language. The barriers to health promotion identified by the midwives included time, stress, culture, lack of training and inadequate health educational materials.

Discussion:

Midwives in this study had limited knowledge about health promotion, yet could play a significant role in influencing health; thus there is a need for on-going in-service training for midwives to focus on health promotion.
Major neurovascular complications of clavicle fracture surgery
Authors: Clitherow Harry DS , Bain Gregory I
Published: August 2014

Clavicle fracture fixation is becoming an increasingly common operation, with good clinical outcomes and a low rate of significant complications. However, there are several reports of rare but potentially life or limb threatening, neurovascular complications. Arterial injuries are usually pseudoaneurysms associated with prominent screws. These may be clinically silent for several years before presenting as subcritical upper limb ischaemia. Venous injuries are a result of tearing of the vessel wall by fracture manipulation, drills or implants. This produces intra-operative haemorrhage and potentially air embolism, which can be fatal if not rapidly recognized and managed. Brachial plexopathy is the result of traction on adherent plexus or impingement by fracture fragments or callus. It presents as severe arm pain and paralysis immediately postoperatively. Neurovascular injuries can be avoided by a combination of pre-operative planning, communication with anaesthetic staff and strategic surgical technique. The plane of the surgical exposure, release of the soft tissues, drill direction and depth and screw length are all important factors.
Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy
Authors: Sato Seiya , Itamochi Hiroaki
Published: August 2014

Approximately 70% of women with epithelial ovarian cancer (EOC) are diagnosed with advanced stage disease, which is associated with high morbidity and mortality. The standard approach to treating patients with advanced EOC remains primary debulking surgery (PDS) followed by chemotherapy. EOC is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard chemotherapy combined with taxane and platinum. Furthermore, residual disease is a major prognostic factor for survival. On the basis of the clinical features, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is considered to be an alternative treatment option to standard treatment in patients unable to undergo complete resection during PDS. Noninferiority of NACT-IDS to PDS has been demonstrated in some randomized controlled trials and meta-analyses. NACT would also lead to improved quality of life (QOL) of patients, however there are still problems to be solved in the treatment strategy. The uncertainty of perioperative visual assessment of tumor dissemination after NACT has been reported. In addition, several papers have shown the possibility that NACT induces platinum resistance. Furthermore, a notable risk associated with NACT is that patients with significant side effects and refractory disease will lose the opportunity for debulking surgery. Appropriate selection of the patient cohort for NACT is an important issue. Bevacizumab (Bev) is active in patients with advanced EOC. However, the use of Bev is not recommended in the neoadjuvant setting. Bev has a specific adverse event profile that needs to be considered, especially for surgical management, such as gastrointestinal perforation, hemorrhage, and thromboembolic events. NACT could be an alternative treatment option in patients with stage III or IV EOC. However, further studies are needed to clarify the precise role of NACT in the management of advanced EOC.
Athletic Trainers’ Management Practices and Referral Patterns for Adolescent Athletes After Sport-Related Concussion
Authors: Williams Richelle M. , Welch Cailee E. , Weber Michelle L. , Parsons John T. , Valovich McLeod Tamara C.
Published: August 2014

Background:

Athletic trainers (ATs) play an important role in the evaluation, management, and referral of student-athletes after sport-related concussion. Understanding factors that influence ATs’ patient care decisions is important to ensure best practices are followed.

Purpose:

To identify ATs’ current concussion management practices and referral patterns for adolescent student-athletes after sport-related concussion as well as the factors associated with those practices.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A total of 851 participants from a convenience sample of 3286 ATs employed in the secondary school setting (25.9% response rate) completed the Athletic Trainers’ Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (BAKPAC-AT) survey. The BAKPAC-AT consists of several questions to assess ATs’ concussion management, referral practices, and established relationships with other health care professionals.

Results:

The majority of ATs had a written concussion policy (82.4%, n = 701) and standing orders approved by their directing physician (67.3%, n = 573); 75.1% (n = 639) of ATs conduct baseline testing, with the majority using computerized neurocognitive tests (71.2%, n = 606). Follow-up concussion testing was employed by 81.8% (n = 696). Years of certification ( P = 0.049) and type of secondary school ( P = 0.033) predicted ATs’ use of baseline testing. Nearly half of the respondents (48.8%, n = 415) refer 100% of concussion cases to a physician. The most influential factors that lead to a referral were state law (40.3%, n = 343), personal preference (34.7%, n = 295), and school district policy (24.8%, n = 211).

Conclusion:

Of the ATs surveyed, most were engaged in baseline and follow-up testing, primarily with neurocognitive tests. Most ATs refer patients to physicians after concussion. While state regulation and personal preference were primary factors influencing referral decisions, it is unclear at what point of care the referral occurs.
Small bowel feces sign in association with occlusive mesenteric ischemia
Authors: Abu-Hmeidan Jareer H , Bismar Hayan A , Hamid Abdullgabbar M
Published: August 2014

Small bowel feces sign (SBFS) is a computed tomography (CT) finding that appears as fecal like material in dilated small bowel loops. This sign is usually seen in association with gradually progressive small bowel obstruction. We present a case of occlusive mesenteric ischemia in which the SBFS appeared on CT scan early on in the course of the disease. We put forward a suggested alternative mechanism to the appearance of this sign in association with mesenteric ischemia. The SBFS might have the potential to serve as an early sign of mesenteric ischemia on CT scan.
Socioeconomic differences in the menopausal experience of Chinese women
Authors: Huseth-Zosel Andrea , Strand Mark , Perry Judith
Published: August 2014

Objective

This study explores the effect of employment status, occupation and education on menopausal symptoms experienced by women in an urban community in China.

Study design

Cross-sectional survey.

Main outcome measures

Menopausal symptoms, medication/supplement use to relieve menopausal symptoms, sociodemographic variables.

Results

Risks for more burdensome menopausal symptoms include less education, non-white collar occupation and unemployment/retirement status. Being employed in a white collar occupation and having higher formal education were protective for hot flashes, dry skin/eyes, heart palpitations and insomnia and were associated with increased usage of medication to alleviate menopausal symptoms.

Conclusions

As Chinese women age and continue working longer, they will spend increasing amounts of time postmenopausal and in the workplace. The development of worksite-based health programmes would be advantageous to female workers of menopausal age in China.
Prevalence of Hypertension and Associated Anthropometric Risk Factors in Indigenous Adults of Guatemala
Authors: Orellana-Barrios Menfil A. , Nuggent Kenneth M. , Sanchez-Barrientos Herman , Lopez-Gutierrez Jose R.
Published: August 2014

Background: Hypertension (HT) epidemiological studies in developing regions of the world like rural Guatemala are lacking. Methods: A sample size of 1104 subjects (552 females, all 18 years or older) was obtained through quota and geographical clustering in the entire Department of Sololá, Guatemala. Descriptive statistics and logistic regression were used. Results: Average systolic, diastolic, and mean arterial pressures were significantly higher in men compared with women (116.24 vs 113.80 mm Hg, 75.24 vs 72.69 mm Hg, and 88.91 vs 86.39 mm Hg, respectively; all with P < .05). The crude prevalence of HT was 12.5% with no gender differences. Women had a significantly higher mean body mass index (BMI) than men (26.25 vs 24.71 kg/m2, P < .001). An abnormally high waist circumference (WC) was found in 12.7% of men and in 50.7% of women. Significant associations were found between the presence of HT, age ≥55 years, and an elevated WC. The single most important isolated risk factor for HT was age in women (OR 6.76, 95% CI 3.59-12.72) and WC in men (OR 3.23, 95% CI 1.52-6.87). Increased BMIs (≥25-30 or ≥30 kg/m2) were not associated with HT in this study. Residing in Sololá’s capital was a protective factor in women (OR 0.33, 95% CI 0.13-0.83). Conclusion: Hypertension and associated anthropometric risk factors are present in rural regions of Guatemala. Significant associations are found between gender, age ≥55 years, and increased WC but not with an increased BMI in this population.
Effects of the Self-Directed Individualized Education Program on Self-Determination and Transition of Adolescents With Disabilities
Authors: Seong Youjin , Wehmeyer Michael L. , Palmer Susan B. , Little Todd D.
Published: August 2014

The 1990 Individuals with Disabilities Education Act (IDEA) reauthorization introduced transition mandates that included a “student involvement in transition planning” requirement, creating an emphasis on promoting such involvement so as to enhance the self-determination of students with disabilities and positive transition-related outcomes. This study used a randomized-trial control group design to study the impact of one widely used program to promote student involvement, the Self-Directed Individualized Education Program (IEP), on the self-determination and transition empowerment of youth with disabilities. A repeated-measures MANCOVA was conducted to determine the differences between an intervention group and the placebo-control group. Results showed that instruction using the Self-Directed IEP was significant on students’ level of self-determination, and positive differences were found in transition knowledge when compared with a placebo-control group.
Is Apology the Best Policy? An Experimental Examination of the Effectiveness of Image Repair Strategies During Criminal and Noncriminal Athlete Transgressions
Authors: Brown Kenon A.
Published: August 2014

Through the use of a 2 × 3 factorial experiment, the researcher examined the effects of response strategies on an athlete’s perceived image after they provide a response when faced with a criminal or a noncriminal transgression. Results showed that the attacking the accuser strategy was just as effective as the mortification strategy in the repair of the athlete’s image overall, as well as when the athlete is faced with a criminal transgression; the bolstering strategy was also the least effective strategy, regardless of the type of transgression. Implications for the experimental examination of response strategies and for strategic communication practitioners are provided.
Establishing a Typology of Social Media Uses in the Sport Industry
Authors: Witkemper Chad , Blaszka Matthew , Chung Jinwook
Published: August 2014

This study developed a typology of social media uses in the sport industry utilizing multidimensional scaling. Study progression followed three phases beginning with a qualitative analysis of sport social media consumers. The second phase examined responses collected through online surveys made available through social networking sites. The results suggest that social media uses in sport fluctuate along two separate but related dimensions: high and low activity and interactivity. During the final phase, exploratory factor analysis (EFA) was employed to determine elements that lead to the development of these dimensions. Based on the EFA results and established dimensions, social media uses fall categorically into four distinct domains: cooperation community, competition community, proactive community, and passive community. This study makes a significant contribution to the literature by empirically validating a framework upon which social media consumption can more accurately be measured.
Introduction to “Mapping the Terrain”
Authors: Butterworth Michael L. , Kassing Jeffrey W.
Published: August 2014

In this introduction to a Communication and Sport special issue on “Mapping the Terrain: Shaping the Landscape of Communication and Sport Scholarship,” guest editors Michael Butterworth and Jeffrey Kassing situate the need for broadening research on communication and sport beyond media studies and media-centric analysis to be inclusive of the breadth of lenses and concerns seen in communication studies. It is noted that this special issue features a wide range of concerns and approaches, from reframing the agenda for the communication of sport and disability, to how understandings of environmental communication help contextualize debates over building athletic facilities and sports stadia, to the dynamics of whistle-blowing amid communication about breaches in ethics in athletic settings, to how discourse about events such as the “Tough Mudder” can be better understood through a Foucauldian lens on ideology and capitalism, and how leader–member exchange theory can help better understand communication between coaches and athletes in the sport setting.
Vertical Tears of the Lateral Meniscus
Authors: Goyal Kanu S. , Pan Tiffany J. , Tran Diane , Dumpe Samuel C. , Zhang Xudong , Harner Christopher D.
Published: August 2014

Background:

Lateral meniscal tears are often seen with acute anterior cruciate ligament (ACL) injury and may be left in situ, repaired, or treated with meniscectomy. Clinical studies have shown good outcomes with vertical tears left in situ and poor outcomes following meniscectomy. However, clinically relevant studies are needed to establish a biomechanical foundation for treatment of these tears, particularly regarding the effects of meniscectomy.

Purpose:

To compare tibiofemoral joint mechanics following vertical lateral meniscal tears and meniscectomies. We hypothesized that a peripheral vertical tear of the lateral meniscus would alter joint mechanics, increasing contact pressure and area, and that more drastic effects would be seen following meniscectomy, at higher knee flexion angles, and with increased loads.

Study Design:

Controlled laboratory study.

Methods:

Ten fresh-frozen cadaveric knees (average age, 55 ± 12 years) were tested with 5 lateral meniscus states: intact, short vertical tear, extended vertical tear, posterior horn partial meniscectomy (rim intact), and posterior horn subtotal meniscectomy (rim excised). The specimens were loaded axially at knee flexion angles of 0°, 30°, and 60°, and musculotendinous forces were applied, simulating a 2-legged squat. Intra-articular contact pressures were measured using pressure-sensitive Fuji film. Kinematic data were acquired through digitization of fiducial markers.

Results:

Vertical tears did not cause a significant change in contact pressure or area. Partial meniscectomy increased maximum contact pressures in the lateral compartment at 30° and 60° from 5.3 MPa to 7.2 MPa and 7.6 MPa, respectively ( P = .02, P = .007). Subtotal meniscectomy (8.4 MPa) significantly increased contact pressure compared with partial meniscectomy (7.6 MPa) at 60° ( P = .04). Both meniscectomy states significantly increased contact pressures with increasing flexion from 0° to 60° ( P < .001, P < .001).

Conclusion:

Vertical tears of the lateral meniscus during a simulated 2-legged squat did not significantly change contact pressures and areas compared with an intact meniscus. However, treating these tears with partial and complete meniscectomy significantly increased maximum contact pressures.

Clinical Relevance:

Biomechanical evidence supports treating vertical lateral meniscus tears with meniscal-sparing techniques as opposed to meniscectomy, which may lead to progressive degenerative joint disease from altered joint biomechanics.
Return to Play After Shoulder Stabilization in National Football League Athletes
Authors: White Matthew J. , Fleisig Glenn S. , Aune Kyle , Andrews James R. , Dugas Jeffrey R. , Cain E. Lyle
Published: August 2014

Objectives:

Shoulder instability is a common and limiting injury to football players. The return to play (RTP) percentage and factors affecting RTP after shoulder stabilization in National Football League (NFL) players are not defined. The purpose of this study was to determine the rate of return to professional football play in the NFL after shoulder stabilization and to determine what factors may affect RTP in these athletes.

Methods:

Sixty NFL players who had undergone shoulder stabilization at our institution were followed to determine the rate of RTP and factors predicting RTP. Chart review was performed to glean perioperative data and follow-up was performed by accessing the statistics database maintained by the NFL. Successful RTP was defined as return to play in at least one regular season NFL game following surgery. Chi square and Student’s t-tests were performed to examine differences between perioperative and athletic history variables and a player’s ability to RTP.

Results:

Ninety percent (54 of 60) of NFL players were able to return to game play following shoulder stabilization. The average time to RTP was 8.6 months. Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not. Eleven of the sixty patients underwent open stabilization. Ninety-two percent (45/49) of the arthroscopically treated and eighty-two percent (9/11) of the openly treated athletes were able to RTP; these rates were not found to be significantly different. Playing history and demographics were similar between the open and arthroscopic groups. Players selected before the fourth round of the NFL draft were 7.6 times more likely to RTP. Circumferential labral tears were found in seven athletes, all of whom were able to RTP following surgery.

Conclusion:

The RTP rates for NFL players following shoulder stabilization are quite high (90%). There is no difference in RTP rates between open and arthroscopic repairs. Being selected in the first four rounds of the NFL draft is highly predictive of a player’s ability to RTP.
“Subcritical” Glenoid Bone Loss Increases Redislocation Rates in Primary Arthroscopic Bankart Repair
Authors: Shaha James S. , Cook Jay B. , Song Daniel J. , Rowles Douglas J. , Bottoni Craig R. , Shaha Steven H. , Tokish John M.
Published: August 2014

Objectives:

While bone loss is increasingly recognized as a risk factor for failure after arthroscopic stabilization, the precise definition of critical bone loss has not been defined. Additionally, there is no clarity on the amount of bone loss routinely present in patients presenting for primary arthroscopic stabilization of anterior glenohumeral instability. The purpose of this study is to report on the average bone loss measured in primary isolated Bankart reconstructions of the shoulder and to determine what amount of bone loss correlated to a recurrence of instability.

Methods:

This is a retrospective review of a consecutive series of 94 anterior instability patients (97 shoulders) who underwent arthroscopic labral repair at a single military institution by one of three fellowship trained orthopaedic surgeons. Data was collected on demographics and rate of redislocation as reported by the patient at the most recent follow-up. Glenoid bone loss was calculated from preoperative imagining using a “perfect-circle” technique. Patients were excluded if they had previously undergone any stabilization procedure.

Results:

The average age at surgery was 25.6 years (range, 16-42) with average follow-up of 36.8 months (range, 20-57). There were 5 females (5 shoulders) and 89 males (92 shoulders). The average bone loss in all patients was 14.4% (range, 0-34.7%). When analyzed based on the presence or absence of recurrence, there were 77 stable shoulders with no redislocations. In this group, the average bone loss was 14.5% (range, 0-33.3%) with a follow-up of 36.3 months (range, 20-57). There were 20 patients with recurrent dislocations who had an average of 20.8% (range, 0-33.3%) with a 39.1 month (range, 21-56) follow-up. There was a significantly greater amount of bone loss in those with redislocations (p=0.004). When further analyzed, there was a 95% likelihood of redislocation with 17.1% bone loss there was a 25% likelihood of redislocation with 7.0% bone loss.

Conclusion:

This study suggests that glenoid bone loss is a common finding in patients undergoing primary arthroscopic stabilization. Additionally, patients with “subcritical” bone loss of 17.1% are at a higher risk to have a recurrence than those with lesser amounts of bone loss. Patients with bone loss beyond this threshold should be counseled accordingly with consideration for alternative surgical procedures.
Classifying GBL: Severity And Attrition. Is There Enough Bone To Reconstruct The Glenoid?
Authors: McNeil John William , Bernhardson Andrew , LeClere Lance E. , Dewing Christopher , Lynch Joseph , Gaston Tistia , Provencher Matthew
Published: August 2014

Objectives:

Glenoid bone loss (GBL) continues to be a challenge in the management of recurrent anterior shoulder instability. Although the location of and percentage of GBL has been described, there is little information on how much bone is left to reconstruct the glenoid. Thus, the objective of this study is to describe a new GBL classification system that accounts for type of bone defect, amount of attritional loss, and correlate this to age, total time of instability and number of instability events.

Methods:

A total of 140 patients with recurrent anterior instability underwent an analysis of computed tomography (CT) three-dimensional imaging to assess GBL. The glenoid bone fragment was digitally analyzed (Osirix, Adobe) to qualitatively and quantitatively stratifyeach patient based upon attrition into- Type I “minimal atrittional” (no attrition -33%), Type II “partial attritional” (34 - 66%), and Type III “severe attritional” (67% - complete attrition). Additionally, demographic variables of age, total time of instability, and number of instability events were correlated to type of bone loss.

Results:

Patients had a mean age of 30.6 (range: 20 - 54) with a demonstrated mean GBL of 16.5% (range 5.1 - 62.3). Furthermore, the mean size of the remaining glenoid bone fragment was 27.8% of the full fragment size. Of 140 participants, 12 had attritional bone loss classified as Type I (12/140 = 8.6% of patients), 45 as Type II (45/140 = 32.1%), and 83 as Type III (83/140 = 59.3%). The mean percent loss for these three categories was 22.2%, 54.4%, and 88.5% respectively. Longer time of instability and more dislocations were associated with type III bone loss, and higher attrition of bone loss.

Conclusion:

This study highlights that GBL presents in a highly attritional nature and one should be cognizant that the remaining bone fragment does not come close to reconstituting glenoid bone stock. Patients with recurrent instability are predominantly severe attritional (Type III).
Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Implications in Arthroscopic Treatment
Authors: Hines Adam Christopher , Cook Jay B. , Shaha James S. , Krul Kevin P. , Tokish John M.
Published: August 2014

Objectives:

Glenoid bone loss is a well accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. While less common than its anterior counterpart, posterior glenohumeral instability can be a significant source of disability in a young athletic population. It has been reported in as high as 10% of all glenohumeral instability cases. Bone loss in posterior instability, however, has been rarely discussed, and it is unknown whether this is commonly present, or clinically significant, in the treatment of posterior glenohumeral instability.

Methods:

A retrospective review was conducted at an active Military Treatment Facility (MTF) over a five-year period, between 1 Apr 2006 and 31 May 2011. Isolated, primary posterior instability cases which underwent arthroscopic posterior labral repair were identified. Preoperative imaging was available in all patients, and posterior glenoid bone loss was calculated using a standardized “perfect circle” technique often employed in the measurement of bone loss in anterior instability. All medical records were then reviewed to identify complications and reoperation rates from the primary repair. Patients were divided into two groups based on percentage bone loss. Outcomes were analyzed across all patients and within these groups.

Results:

There were 47 consecutive cases of primary, isolated posterior instability cases, with 44 males and 3 females. The average age at the time of surgery was 28.6 (range 20-47), 19 were documented to have returned to full duty. Posterior glenoid bone loss in excess of 10% was found in 15/47 (32%) of patients, while an additional 26% had no bone loss noted. Greater than 20% bone loss was noted in 2/47 (4.3%). The average across the cohort was 7.6% (range 0-21.5%). Bone loss was associated with younger age. Those with >10% loss had an average age of 25.6 years compared to 30.1 years in those with <10% bone loss (p=0.03). Those with >10% were not associated with lower return to duty, higher complications (i.e. persistent symptoms), or increased return to the operating room. Those who returned to full active duty did not have a significantly decreased bone loss versus those who did not (6.5 vs 8.3%, p=0.17).

Conclusion:

Posterior instability accounts for up to 10% of all glenohumeral instability. It carries a more an insidious onset, and acute dislocations are not as commonly reported. While anterior glenoid bone loss is known to significantly affect patient outcomes for anterior glenohumeral instability, our data suggests posterior glenoid bone loss may not have as direct of a clinical correlation to patient outcomes.
Recurrence Of Cam Lesions: A Two-year Follow-up
Authors: Gupta Asheesh , Redmond John M. , Dunne Kevin F. , Finch Nathan , Stake Christine E. , Domb Benjamin G.
Published: August 2014

Objectives:

Early skepticism of surgery for femoroacetabular impingement arose in part from suspicion that the cam lesion on the femoral head-neck junction would recur after initial resection. There are currently no studies that have looked at the recurrence of the cam lesion after femoral neck osteoplasty for femoroacetabular impingement (FAI). While Patient Related Outcome (PRO) scores at mid-term follow-up have shown continued success, the maintenance of a normalized alpha-angle has not been shown radiographically. The purpose of the study was to assess the radiographic recurrence of cam deformity at 2-year follow-up after adequate decompression during the index hip arthroscopy and correlate with PRO scores. Our hypothesis is there will be no recurrence or regrowth of the cam deformity at the two-year postoperative time-point following adequate cam decompression during hip arthroscopy.

Methods:

Between March 2009 and January 2011 data was prospectively collected on all patients undergoing hip arthroscopy with femoral neck osteoplasty. Inclusion criteria consisted of all patients during the study period with preoperative alpha angles greater than 60 degrees and postoperative alpha angle less than 50 degrees after femoral osteoplasty. Minimum follow-up was two years with radiographic images for review.

Results:

A total of 47 patients met inclusion criteria. The mean age of our study group was 37.18 (31.7 - 47.43) years at the start of the study. There were 28 males (59.57%) and 19 females (40.43%). The mean follow-up was 28.32 months. Mean preoperative alpha angle (Dunn view) was 70 degrees (60-97 degrees). At 2-week postoperative follow-up, the mean alpha angle was 42.79 degrees (32-50 degrees) (p<.0001). The 2-year alpha angle was 42.72 degrees (32-54 degrees) which was not significantly different compared to the 2-week alpha angle (p = 0.93). Additionally, mean preoperative femoral offset was 3.7 mm (0-9.9 mm). Mean two-week postoperative femoral offset measurement was 7.8 mm (0.3 -13.9 mm) which was significantly different (p<.0001). Two-year postoperative femoral offset measurement was 8.0 mm (2.4-12.8 mm) which was not significantly different compared to the 2-week femoral offset measurement (p = 0.63). All Patient Related Outcome (PRO) scores were significantly improved at 3 months compared to preoperative scores and continued to show improvement except for Visual Analog Scale (VAS) at 2-year follow-up.

Conclusion:

There is no recurrence of cam deformity at 2-years following femoral neck osteoplasty for FAI with improved PRO scores at the 3-month and 2-year postoperative time-points.
Microfracture Of The Hip: A Two-year Follow-up With A Matched-pair Control Group
Authors: Domb Benjamin G. , Gupta Asheesh , Dunne Kevin F. , Stake Christine E. , Redmond John M.
Published: August 2014

Objectives:

Full thickness chondral defects have been suggested to portend poor prognosis in hip arthroscopy. Although there is a small amount of data suggesting favorable outcomes with microfracture for such cases, no comparative studies have been performed to assess outcomes of full thickness chondral defects treated with microfracture. The purpose of this study is to compare two-year clinical outcomes of patients treated with microfracture to a matched control group that did not have full thickness chondral damage.

Methods:

During the study period, between June 2008 and July 2011, data were collected on all patients treated with hip arthroscopy who underwent microfracture. A matched-pair control group of patients who did not undergo a microfracture procedure was selected in a 1:2 ratio. Matching criteria were age within 5 years, sex, surgical procedures, and radiographic findings. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10.

Results:

Forty-nine hips were included in the microfracture group and 98 in the control group. There was no significant difference in pre-operative PRO scores between the groups. For the microfracture group, the score improvement from preoperative to 2-year follow-up was 57.5 to 75.4 for mHHS, 53.6 to 71.8 for NAHS, 59.5 to 79.1 for HOS-ADL, and 35.5 to 55.5 for HOS-SSS. For the control group, the score improvement from preoperative to 2-year follow-up was 59.2 to 79.5 for mHHS, 54.4 to 76.2 for NAHS, 60.6 to 80.4 for HOS-ADL, and 38.6 to 64.2 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores (p <.05). All post-operative PRO scores, and all improvements in PRO scores, were found to be similar between the study and control groups.

Conclusion:

Our study demonstrated that patients receiving microfracture during hip arthroscopy did not show a statistically significant difference in PRO scores when compared to a matched-pair control group at two year follow-up. Both groups demonstrated significant improvement in all PRO scores. These results show that microfracture appears to be a viable treatment option for grade IV cartilage damage identified at the time of hip arthroscopy. Furthermore, full thickness chondral defects may not necessarily portend an inferior functional prognosis when treated with microfracture
Trends in the Presentation, Management and Outcomes of Little League Shoulder
Authors: Heyworth Benton E. , Martin Daniel , Kramer Dennis , Kocher Mininder S. , Bae Donald S.
Published: August 2014

Objectives:

With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis (“Little league Shoulder,” LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes or outcomes of LLS. This study’s purpose was to analyze the demographics, symptoms, diagnosis, and treatment of LLS, with an emphasis on identifying underlying risk factors for development and recurrence of LLS.

Methods:

A departmental database at a single pediatric referral center was queried to identify cases of LLS between 1999 and 2013, which were reviewed to analyze age, sex, physical examination and radiologic findings, treatment details, and rates of recurrence.

Results:

95 patients (93 males; mean age 13.1 years, range 8-17 years) were diagnosed with LLS, with volumes increasing over the study period (Figure 1). In addition to the primary complaint of shoulder pain with overhead athletics seen in all patients, 13% reported elbow pain, 10% reported shoulder fatigue or weakness, and 8% reported mechanical symptoms. While the vast majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), 3% were tennis players. On physical exam, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Treatment recommendations included rest in 98% of cases, physical therapy in 79% (100% of patients with GIRD), and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution. The odds ratio of recurrence between the group with diagnosed GIRD (14.3%) and those without GIRD (4.5%) was approximately 3:1.

Conclusion:

Little league shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms can occur, generally 6-12 months after return to sports. Almost one-third of LLS patients with had GIRD, and this group had three times higher probability of recurrence compared to those without GIRD.