bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing incisional wounds with Prevena VAC therapy in lower-extremity vascular surgery: A comparative study
Authors: Kasten Kody , Yang Andrew , Shaffer Lynn , Kociola Samuel , Holland Conor , Roche Faith Anne , Pilbeam Calvin
Published: April 2024

Background

Vascular surgical site infections have been reported with an overall incidence of 5–10% for patients undergoing arterial interventions and as high as 10–20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence.

Methods

A prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained.

Results

A total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; p = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; p < .0001).

Conclusion

The results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.
Heretical enemy or vanguard of commerce? The pirate in the 16th-century legal and literary imagination
Authors: Krever Tor
Published: April 2024

This article uses legal and literary accounts of Francis Drake’s 16th-century depredations to consider the historical figure of the pirate in legal thought. Against the transhistorical figure of universal enmity of many international legal accounts, the article argues that the 16th-century pirate was a fundamentally contested figure reflecting contrasting juridical-political visions of world order. In the 16th-century Spanish imagination, piratical enmity, rooted in confessional identity, posed a threat to a universalising res publica Christiana and the juridico-political structure of Christendom. The emergence of a nascent English commercial imperialism challenging Iberian dominance in the Americas undergirded a quite different legal and literary piratical identity, Drake not heretical foe but vanguard of English imperial aspirations.
The Trials of Apuleius: An Ironic Legal History
Authors: ward Ian
Published: April 2024

This article is an exercise in what might be termed ‘ironic’ legal history. The first part explores the idea of ‘ironic’ history, which aligns the insights of literary ‘ironism’ with those of micro and ‘anecdotal’ history and ‘new’ historicism. It will focus more particularly on the work of Richard Rorty, Carlo Ginzburg and Stephen Greenblatt. The second part of the article will present a ‘case-study’ in ironic legal history; revisiting the second-century trial of the Roman orator and writer Apuleius. Apuleius wrote two notably different accounts of the same experience, one pretending to fact, the other to fiction. To read these accounts is to engage in an exercise in ironic legal history.
Correlating technical and tactical, and kinematic elements: An in-depth analysis of game-related metrics and running activities in sub-elite senior male rugby union players
Authors: Ungureanu Alexandru Nicolae , Lupo Corrado , Chiarello Francesco , Brustio Paolo Riccardo
Published: April 2024

To comprehend the complexity of rugby union performance, it is crucial to correlate technical and tactical, and kinematic elements specifically for playing roles. Hence, this study investigated the relationship between game-related metrics and running activities in sub-elite senior males. Technical and tactical performance and running activity of 36 sub-elite senior players (age mean = 25 years; total performances = 200) were assessed in relation to 17 key performance indicators (KPIs). A series of general linear mixed models were performed to evaluate the relationship between KPIs according to roles (backs, forwards and scrum halves), including subjects and games as random effect. The main finding was that the tactical context relates distinctly running activities, and this effect varies between backs and forwards. Tackling mainly involves impacts and deceleration, whereas carrying the ball is associated with impacts and accelerations. Furthermore, the percentage of missed tackles is related to higher occurrences of acceleration events. These findings offer a more profound understanding of the physiological requirements in sub-elite rugby performance, especially given the limited evidence on the interaction between technical and tactical performance and running activities in sub-elite rugby union games. As a result, coaches and physical practitioners should design and execute diverse training sessions that consider both the tactical context and the players’ positions.
Roles, experience and views of nurses working in robotic surgery settings: A mixed-methods study
Authors: Şenol Çelik Sevilay , Tunçbilek Zahide , Sarıköse Seda , Topaktaş Gülsen , Canda Abdullah Erdem
Published: April 2024

Robotic-assisted surgery has benefits for patients, but there are challenges to working in this field. In Turkey, training is not provided for nurses working in robotic-assisted surgery, and national legislation on nurses’ roles in these settings has not been implemented. This study aimed to demonstrate the roles and experiences of nurses in robotic-assisted surgery in Turkey. This study was conducted as a mixed-methods research. The qualitative data were analysed by content analysis. More than half of the nurses had received basic training in robotic-assisted surgery. Qualitative data consisted of five themes, including the effects of robotic surgery, feelings and thoughts on robotic surgery, working as a nurse in robotic surgery settings, responsibilities of nurses and competence of nurses working in robotic surgery settings. Determining the working conditions and roles of nurses working in robotic-assisted surgery settings by policymakers in regulations is crucial for improving the quality of nursing care and the outcomes of patients.
From bloodthirsty parasites to surgical superstars: The humble leech, a suck-cess story in surgical history
Authors: Bates Ann
Published: April 2024

This historical review delves into the extensive and intriguing history of leeches in surgery. The utilisation of leeches in medical practice dates back thousands of years, from ancient civilisations to the modern era. The therapeutic properties of leeches have led to their persistent presence in surgical procedures. The ‘Age of Leeches’ during the 18th and 19th centuries witnessed a heightened utilisation of leeches in surgical treatment, given their perceived ability to promote postoperative wound healing and alleviate blood congestion. However, advancements in medical knowledge subsequently diminished their popularity as emerging technologies overshadowed them. Nevertheless, recent years have witnessed a resurgence in the use of leeches in reconstructive surgery, driven by both a greater understanding of their biological mechanisms and their potential source of therapeutic agents. This historical review provides a comprehensive exploration of the historical timeline, societal perceptions and scientific advancements surrounding the use of leeches in surgical practice.
Meta-analysis of perioperative outcomes and safety of percutaneous nephrostomy versus retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection
Authors: Wang Xidong , Wu Gang , Wang Tianqi , Liu Shangjing , Ding Guixin , Mao Qiancheng , Chu Yongli , Cui Yuanshan , Wu Jitao
Published: April 2024

Background:

The debate regarding the optimal drainage method for acute obstructive upper urinary tract infection persists, focusing on the choice between percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS).

Aims:

This study aims to systematically examine the perioperative outcomes and safety associated with PCN and RUS in treating acute obstructive upper urinary tract infections.

Methods:

A comprehensive investigation was conducted using the Medline, Embase, Web of Science, and Cochrane databases up to December 2022, following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The utilized keywords included ‘PCN’, ‘RUS’, ‘acute upper obstructive uropathy’, and ‘RCT’. Inclusion criteria encompassed studies providing accurate and analyzable data, which incorporated the total subject count, perioperative outcomes, and complication rates. The assessed perioperative outcomes included fluoroscopy time, normalization of temperature, normalization of serum creatinine, normalization of white blood cell (WBC) count, and operative time. Safety outcomes encompassed failure rate, intraoperative and postoperative hematuria, postoperative fever, postoperative pain, and postoperative nephrostomy tube or stent slippage rate. The study protocol was prospectively registered at PROSPERO (CRD42022352474).

Results:

The meta-analysis encompassed 7 trials involving 727 patients, with 412 assigned to the PCN group and 315 to the RUS group. The outcome of the meta-analysis unveiled a reduced occurrence of postoperative hematuria in the PCN group [odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.30–0.99, p = 0.04], along with a decreased frequency of insertion failure (OR = 0.42, 95% CI 0.21–0.81, p = 0.01). In addition, the RUS group exhibited a shorter fluoroscopy time than the PCN group (mean difference = 0.31, 95% CI 0.14–0.48, p = 0.0004).

Conclusion:

Given the significant impact of hematuria and catheterization failure on postoperative quality of life, the preference for PCN appears more advantageous than RUS.
Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence
Authors: Szmuilowicz Emily D. , Barbour Linda , Brown Florence M. , Durnwald Celeste , Feig Denice S. , O’Malley Grenye , Polsky Sarit , Aleppo Grazia
Published: April 2024

Ascertaining the utility of continuous glucose monitoring (CGM) in pregnancy complicated by diabetes is a rapidly evolving area, as the prevalence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) escalates. The seminal randomized controlled trial (RCT) evaluating CGM use added to standard care in pregnancy in T1D demonstrated significant improvements in maternal glycemia and neonatal health outcomes. Current clinical guidance recommends targets for percentage time in range (TIR), time above range (TAR), and time below range (TBR) during pregnancy complicated by T1D that are widely used in clinical practice. However, the superiority of CGM over blood glucose monitoring (BGM) is still questioned in both T2D and GDM, and whether glucose targets should be different than in T1D is unknown. Questions requiring additional research include which CGM metrics are superior in predicting clinical outcomes, how should pregnancy-specific CGM targets be defined, whether CGM targets should differ according to gestational age, and if CGM metrics during pregnancy should be similar across all types of diabetes. Limiting the potential for CGM to improve pregnancy outcomes may be our inability to maintain TIR > 70% throughout gestation, a goal achieved in the minority of patients studied. Adverse pregnancy outcomes remain high in women with T1D and T2D in pregnancy despite CGM technology, and this review explores the potential reasons and questions yet to be investigated.
Relationality as Relationalities and a Model of Human (and Other) Justice Through Qualitative Inquiry
Authors: Cruz Joshua
Published: April 2024

Based on the most recent meeting of the International Congress of Qualitative Inquiry (2023), it is clear that using theories of relationality to situate our work is on the rise. Given this growing interest in relationality, I attempt to describe several philosophical approaches to relationality, explain how relationality is not simply a theory but an ontic stance, and consider relational theory’s implications for social justice. Regardless of the varieties of relationality that exist (be they ancient, current, Eastern, or Indigenous), research adopting a relational stance is antithetical to the world in which we find ourselves today: in brief, well-populated with (substantialist) sentiments that would seek to divide and isolate individuals, rather than show our inherent connectivity. Qualitative work is in a position to tease out the nuanced, multifaceted, and shared relationships that, by relationality’s standards, are our ontic foundations. I close with the idea that qualitative work may be pedagogical in its ability to spread these sentiments not only to fellow researchers, but to participants in this work as well.
Holocene utopias and dystopias: Views of the Holocene in the Anthropocene and their impact on defining the Anthropocene
Authors: Conte Matthew , Bates Jennifer
Published: April 2024

In delineating the Anthropocene, the Holocene is being redefined as the formative epoch of human development leading to the Anthropocene. This has led to a diversity of views of the Holocene and Holocene humanity in the Anthropocene, the extremes of which may be described as “Holocene utopianism” and “Holocene dystopianism.” The former views the Holocene as a solution to the predicament of the Anthropocene, as an idealized past of human activities and stable climate that must be aspired to. The latter perceives the Holocene and Holocene humanity as the root cause of the ills of the Anthropocene that must be avoided in the future. These views reflect a gross simplification of human activities and the environment of the Holocene. Human activity in the Holocene is characterized by diverse human behaviors that can be perceived as both destructive and sustaining to the earth’s ecological systems, and in many cases, emerged as a response to fluctuations in the Holocene climate. The Holocene does not provide an escape from the Anthropocene, as a solution or as a cautionary tale. Nonetheless, future human endeavors must necessarily draw from the diversity of human activities and systems of organization observed in the Holocene, but do so carefully.
International Mobility and Knowledge Exchange Between China and the West: A Study of Chinese Humanities and Social Sciences Scholars
Authors: Shen (沈裕挺) Yuting
Published: April 2024

Purpose

This study examines the impact of international academic mobility on knowledge exchange between China and the West, including its potential benefits and risks, specifically in the humanities and social sciences (HSS) fields.

Design/Approach/Methods

This study employed qualitative research methods; specifically, data were collected through interviews and analyzed using thematic analysis.

Findings

With increasing knowledge flows in global academia, Chinese HSS scholars are benefiting from international academic mobility. They engage in various activities, such as international visits, conferences, and research collaborations, and praise the role of mobility in building an understanding of Western culture and knowledge, including research dynamics, embodied and encultured knowledge, and location-specific textual materials. However, international mobility has inadvertently exacerbated global knowledge asymmetries, with some Chinese scholars uncritically adopting Western paradigms. Nonetheless, pioneering Chinese HSS scholars aim to promote a two-way knowledge exchange between China and the West by fostering cultural reflexivity and enhancing their global visibility.

Originality/Value

Chinese HSS scholars serve as an illuminating example in the context of global knowledge asymmetries dominated by the Anglo-American West. These findings have theoretical and practical implications for fostering equitable and inclusive knowledge exchange between Western and non-Western societies through international academic mobility.
Research Productivity and Publishing Trends in Publicly Funded Social Work and Psychology Schools in India: A Bibliometric Analysis
Authors: Jadhav Bhoomika N. , Abdul Azeez E. P. , Mishra Nishtha , Senthil Kumar A. P.
Published: April 2024

There is a growing emphasis on research across disciplines, and higher educational institutions’ research productivity (RP) is a matter of serious consideration. However, a knowledge gap exists in RP in social science disciplines in India. In this context, the present study aimed to (1) understand the RP of social work and psychology schools at publicly funded central universities (CU) in India, (2) evaluate the RP and research impacts of faculty members in these schools, and (3) identify the publishing trends and patterns in social work and psychology disciplines. Using the Scopus database, we collected bibliometric information on publications of 19 social work and 16 psychology schools and their faculty members. The results indicate that schools’ research productivity remained unpromising, constituting many faculty members (Social work 51.08%; Psychology 43.4%) with no publications. Although the average RP of social work ( M = 16.0, SD = 17.40) and psychology ( M = 45.63, SSD = 61.08) schools differed, the difference was not statistically significant ( t = 1.88, p = .078). An increase in the publication was evident after 2016, indicating positive-policy impacts. A difference in RP across professional ranks was evident for social work ( p < .05) but not for psychology ( p > .05). For research impact, a difference existed based on ranks for academicians from psychology only ( p < .05). Publications in high-impact journals and an output of international collaborations remained low in both disciplines. Implications point to developing appropriate workshops and training to provide hands-on experience to improve quality research among academicians. Further policy changes are also essential to enhance research culture and productivity.
Is Face-to-Face Scrambled Teaching Practice Supervision Effective Amidst Natural Disasters and Pandemics? The Teaching Practice Students’ Perspectives
Authors: Banda Lazarus Obed Livingstone , Liu Jin , Zhou Wenhui , Banda Jane Thokozani
Published: April 2024

With the United Nations’ Sustainable Development Goals in place, the quality of teacher education is a global concern. With so much talent mobility and brain circulation, any migration of low-quality educators from one region will affect the quality of education in the destination part of the global village. The study examined how the interplay in the aftermath of the cyclones, COVID-19, supervisors’ quality, and student characteristics impacted student-teachers' experiences during the scrambled teaching practice supervision model. Thematic and content analyses of data from document analysis and semi-structured interviews from purposefully sampled Southern Africa Development Community countries revealed that relying on physical teaching practice supervision negatively impacts assessment, especially when even non-specialists are involved in the supervision. Educators’ inadequate pedagogical content knowledge, space effect, and multiple exposures to assessment compromise teacher education amidst pandemics and natural disasters. The study recommends migration to computer-based online supervision strategies as a mitigation strategy. Recommendations for an educational policy, practicum, and architectural adaption are discussed.
Validation of Hungarian Version of Teacher Responsibility Scale in Pre-Service Teachers
Authors: Fejes József Balázs , Vígh Tibor , Rausch Attila , Mezei Tímea , Szenczi Beáta
Published: April 2024

Several instruments measure teacher responsibility, but none is available in Hungarian. Thus, this study aimed to adapt a Hungarian version of the Teacher Responsibility Scale (TRS) developed by Lauermann and Karabenick and validate it. The sample was pre-service teachers ( N = 296). The results of exploratory and confirmatory factor analyses supported the hypothesized structure of the Hungarian version of the TRS. The four factors (responsibility for student motivation, student achievement, relationships with students, and teaching) had satisfactory internal consistencies (Cronbach’s alphas = .75–.83), and the test–retest reliability was moderate (intraclass correlation coefficients = .64–.75). Correlation patterns of the TRS with the Teacher Efficacy Scale and the Approaches to Instruction scale confirmed the convergent and divergent validity. Based on these results, the Hungarian version of the TRS is a valid, reliable instrument suitable for use in further research in Hungarian pre-service teachers.
Student Teachers’ Perceptions and Application of Questionnaire Survey in an EFL Context
Authors: Hu Pingping , Xu Honglei
Published: April 2024

Although questionnaire surveys are widely applied in second-language research, there is still little research on the application of questionnaire among early career researchers. Problems such as the lack of details concerning why the questionnaire survey is adopted, how the questionnaire is constructed, and how the survey is administered and reported are prevalent in student teachers’ research proposals or theses, which greatly impairs the quality of their academic work. However, few studies have been conducted to address these problems. This study aims to explore the real situation of the questionnaire survey application by examining student teachers’ perceptions of a questionnaire survey and their application of this research method to their theses. Using a mixed-method approach, the study collected quantitative and qualitative data from 138 student teachers, including 103 fresh undergraduates and 35 post-graduates. Quantitative data analysis used descriptive statistics, while qualitative data analysis used semi-structured interviews and content analysis. The study found that: (1) student teachers had some basic but unsystematic perceptions of the questionnaire survey. They had insufficient awareness of the rules of writing good questions, piloting questionnaires, sampling strategies, doing reliability, and validity analysis, etc. (2) Most student teachers developed questionnaires based on existing questionnaires without explaining reasons and adjustments. They introduced questionnaire design in their theses in an incomplete way, with piloting, selecting sample strategies, and statistical analysis methods often missing. Thus, some pedagogical implications can be drawn to improve student teachers’ awareness and competencies of the questionnaire survey.
The Impact of Empowerment on Women Entrepreneurial Intention in Lebanon: The Mediating Effect of Work–Life Balance
Authors: Aloulou Wassim J. , Shatila Khodor , Ramadani Veland
Published: April 2024

The article explores the relationships between different forms of empowerment—psychological, social, political and economic and their influence on work–life balance and women’s start-up intentions in Lebanon. The study also investigates the mediating role of work–life balance in these relationships. Utilizing a sample of 380 Lebanese women, the study employs factor analysis, reliability analysis, regression models and mediation analysis to examine the direct and indirect effects of different empowerment variables on work–life balance and start-up intentions. The study reveals statistically significant correlations between various types of empowerment and work–life balance. Work–life balance acts as a mediator between the empowerment variables and entrepreneurial intentions. The partial mediation suggests that while work–life balance plays a significant role, other factors may contribute to women’s start-up intentions. The study is limited by its sample size and reliance on self-reported data. It is context-specific to Lebanon, and the results may not be generalizable to other cultural contexts. Despite these limitations, the findings provide valuable insights for policymakers, practitioners and scholars interested in women’s empowerment and entrepreneurship. The study offers essential guidance for developing programmes and policies to empower Lebanese women to launch their businesses. By understanding the role of work–life balance, interventions can be more effectively tailored to improve entrepreneurial well-being and entrepreneurial activity.
Impact of time to start of tranexamic acid treatment on rebleed risk and outcome in aneurysmal subarachnoid hemorrhage
Authors: Germans Menno R , Tjerkstra Maud A , Post René , Brenner Amy , Vergouwen Mervyn DI , Rinkel Gabriël JE , Roos Yvo BWEM , van den Berg René , Coert Bert A , Vandertop W Peter , Verbaan Dagmar ,   for the ULTRA Investigators
Published: April 2024

Introduction:

The ULTRA-trial investigated effectiveness of ultra-early administration of tranexamic acid (TXA) in subarachnoid hemorrhage (SAH) and showed that TXA reduces the risk of rebleeding without concurrent improvement in clinical outcome. Previous trials in bleeding conditions, distinct from SAH, have shown that time to start of antifibrinolytic treatment influences outcome. This post-hoc analysis of the ULTRA-trial investigates whether the interval between hemorrhage and start of TXA impacts the effect of TXA on rebleeding and functional outcome following aneurysmal SAH.

Patients and methods:

A post-hoc comparative analysis was conducted between aneurysmal SAH patients of the ULTRA-trial, receiving TXA and usual care to those receiving usual care only. We assessed confounders, hazard ratio (HR) of rebleeding and odds ratio (OR) of good outcome (modified Rankin Scale 0–3) at 6 months, and investigated the impact of time between hemorrhage and start of TXA on the treatment effect, stratified into time categories (0–3, 3–6 and >6 h).

Results:

Sixty-four of 394 patients (16.2%) in the TXA group experienced a rebleeding, compared to 83 of 413 patients (19.9%) with usual care only (HR 0.86, 95% confidence interval (CI): 0.62–1.19). Time to start of TXA modifies the effect of TXA on rebleeding rate ( p < 0.001), with a clinically non-relevant reduction observed only when TXA was initiated after 6 h (absolute rate reduction 1.4%). Tranexamic acid treatment showed no effect on good outcome (OR 0.96, 95% CI: 0.72–1.27) with no evidence of effect modification on the time to start of TXA ( p = 0.53).

Discussion and conclusions:

This study suggests that the effect of TXA on rebleeding is modified by time to treatment, providing a protective, albeit clinically non-relevant, effect only when started after 6 h. No difference in functional outcome was seen. Routine TXA treatment in the aneurysmal SAH population, even within a specified time frame, is not recommended to improve functional outcome.
Classifying and mapping residential structure through the London Output Area Classification
Authors: Singleton Alex D , Longley Paul A
Published: April 2024

This paper outlines the creation of the London Output Area Classification (LOAC) from the 2021 Census, set within the broader context of geodemographic classification systems in the United Kingdom. The LOAC 2021 was developed in collaboration with the Greater London Authority (GLA) and offers an enhanced, statistically robust typology adept at capturing the unique spatial, socio-economic and built characteristics of London’s residential neighbourhoods. The paper asserts the critical importance of nuanced, area-specific geodemographic classifications for urban areas with unique geography relative to the national extent.
Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review
Authors: Bakaes Yianni , Hall SarahRose , Jackson J. Benjamin , Johnson A. Holly , Schipper Oliver N. , Vulcano Ettore , Kaplan Jonathan R. M. , Gonzalez Tyler A.
Published: April 2024

Background:

Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines.

Methods:

A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies.

Results:

A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO.

Conclusion:

Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund’s deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
Agreement Analysis on Postoperative Care Between ChatGPT and a High-Volume Foot and Ankle Surgeon
Authors: Efrima Ben , Barbero Agustin , Indino Cristian , Maccario Camilla , Usuelli Federico Giuseppe
Published: April 2024

Introduction/Purpose:

ChatGPT is an Artificial intelligence (AI) algorithm based on a user-friendly interface that does not requires advanced programming skills. Since its release to the public, it has made AI more accessible. As a result, the Patient refers to chat GTP for medical inquiries. This study compares the postoperative (PO) information provided by chatGPT to those of a high- volume foot and ankle orthopedics surgeon.

Methods:

The study includes 251 patients treated for end-stage osteoarthritis with total ankle arthroplasty. Postoperative emails containing inquiries about their PO status were uploaded to chatGTP. We then evaluated the agreement in simple (SA) and complex (CA) answers. The SA abbreviated the answer provided into "yes" or "no" Its agreement analysis was made using Cohens Kappa. In contrast, CA contained detailed information, and answers were classified into complete agreement, partial agreement, or complete disagreement. Additionally, in partial agreement answers, we calculated the percentage of agreement. Finally, we measured the cases where the surgeon added additional information unrelated to the inquiry.

Results:

There was only a slight agreement in the SA category (K=0.08). In the CA category, we found 27 percent of complete agreement; in 52 percent, we found complete disagreement; in 20 percent, we found only partial agreement. In 50 % of the cases, the surgeon added information unrelated to the question.

Conclusion:

We found limited agreement between chat GPT and the primary surgeon regarding postoperative information. Indicating that chat, GPT is currently an unreliable source for postoperative management. Table 2 Distribution of agreement percentage between a High-volume foot and ankle surgeon and ChatGPT response to postoperative inquiries from patients with total ankle arthroplasty in those with partial agreement
Anatomical Structures at Risk in Percutaneous Distal Bunionette Correction
Authors: Nihalani Shrey , Scheinberg Mila , Shah Ashish
Published: April 2024

Introduction/Purpose:

Bunionette deformity affects 23% of the population and has numerous surgical options, including a minimally invasive approach (MIA) to decrease complications. Percutaneous surgery is favored by patients as it decreases pain, inflammation, and noticeable incision sites. Three possible osteotomy sites have been identified: proximal, diaphyseal, and distal. The study investigates the anatomic structures at risk during distal osteotomy of bunionette deformity using a Shannon burr. The distal osteotomy site was on average greater than 8mm from the extensor digitorum longus and adductor digiti minimi while it was 1.64mm from the lateral dorsal cutaneous nerve. The study highlighted the challenges posed by minimally invasive approaches to treating bunionette deformity and the need for cautious consideration when utilizing percutaneous methods.

Methods:

Eleven fresh frozen below-knee amputated foot and ankle cadavers were used for this study. Cadavers were allowed to thaw for 12 hours at room temperature before performing any tissue handling. All cadavers were visually inspected for evidence of gross pathology. Fluoroscopic radiographs were used to inspect for evidence of preexisting pathology of the fifth metatarsal. All cadavers with gross pathology or radiographic fifth metatarsal pathology were excluded from the study. All procedures were performed by a fellowship trained orthopaedic foot and ankle surgeon.

Results:

All eleven cadavers met the inclusion criteria for this study. The average age of the patients was 66.6 +/- 20.1 years. There were five female feet and six male feet. There were seven right feet and four left feet. Distance from the percutaneous access site was measured to structures at potential risk. The closest structure at risk was the lateral dorsal cutaneous nerve (LDCN) (1.64 mm), which was contacted 2/11 times and transected both times. The extensor digitorum longus (EDL) and abductor digiti minimi (ADM) had no instances of contact during the procedure. Dissection allowed for the identification of structures at risk and the assessment of osteotomy. All procedures resulted in a complete osteotomy.

Conclusion:

Overall, distal percutaneous bunionette osteotomy is largely safe. Structures pertinent to the surgery were identified with ease and were intact after osteotomy with a Shannon burr. Anatomic variations of LDCN can present challenges to the procedure. Meticulous dissection and judicious use of fluoroscopy can help prevent further damage. Surgeons should be aware of anatomic variations in order to proceed safely.
Arthroscopic Assisted Reduction of Talus Fractures Leads to Improved Clinical Outcomes at Mid- Term Follow-Up
Authors: Hartman Hayden , Tornberg Haley N. , Fine-Lease Paul , Gianakos Arianna
Published: April 2024

Introduction/Purpose:

Talus fracture is an uncommon and challenging pathology to treat due to its relationship with articular cartilage, ligamentous network, and avascular nature. The purpose of this systematic review was to evaluate the clinical outcomes after arthroscopic talar fracture fixation, compare to conventional open reduction and internal fixation (ORIF), and analyze the quality and level of evidence of the included studies.

Methods:

A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2023. Articles were included if they evaluated outcomes following arthroscopic treatment of talus fractures, were written in English, were peer-reviewed, had a minimum of 2 patients per cohort, had human patients, and had a minimum 6-month follow-up. Inclusion criteria consisted of: Studies reporting clinical data following arthroscopy for the treatment of talus fractures were included and assessed.

Results:

Seven studies were analyzed, including 4 case series, 1 retrospective cohort, and 2 retrospective comparative studies. 237 patients treated with arthroscopic assisted reduction were compared to 76 patients treated with ORIF. Amongst arthroscopically treated patients, the AOFAS score improved from 71.2 ± 5.2 preoperatively to 89.9 ± 4.3 postoperatively. The SF-36 score improved from 73.2 ± 30.3 preoperatively to 104.5 ± 19.3 postoperatively. In total, 6 complications (3.0%) were observed in arthroscopically treated patients, of which the most common was peri-talar osteoarthritis in 2 patients (0.84%). In comparative cohorts, ORIF patients experienced a 13.0% complication rate in 6 patients (talar necrosis, malunion, nonunion, infection, and post-traumatic arthritis), compared to 2.2% in 1 patient (malunion) in the arthroscopic cohort.

Conclusion:

This study demonstrates that arthroscopic assisted reduction of talar fractures results in good clinical outcomes with lower complication rates. This minimally invasive approach had lower complications than ORIF, with no cases of talar necrosis and decreased postoperative traumatic arthritis. This technique provides adequate exposure without additional osteotomy, while decreasing trauma to local anatomical trauma, minimizing the risk of postoperative complications, and improving fracture healing assessment of concomitant lesions. These findings indicate arthroscopic treatment of talus fractures is an efficacious and safe procedure with comparable or improved clinical and postoperative outcomes as compared to conventional ORIF.
Congruency of the TN Joint and Subtalar Joint Middle Facet Under With and Without Weightbearing: A Preliminary Report
Authors: Wittels Stephen , Zhu Mingjie , Myerson Mark , Li Shuyuan
Published: April 2024

Introduction/Purpose:

Peritalar subluxation is a key feature of both flatfoot and cavovarus deformities. Our preliminary studies have found that on WBCT there is 20% subluxation of the middle facet of the subtalar joint in normal controls, and >35% in patients with flexible flatfoot deformities; In the spherical talonavicular joint there is physiological uncovering of the talar head regardless of whether the joint is bearing weight or not, since the articular area of the talar head is 1.2 times of the navicular. We hypothesize that there may be a tendency to overestimate the pathological peritalar subluxation on both XR and WBCT. This study aimed to investigate the congruency of each peritalar joint using a weightbearing 3D CT scan remodeling technique.

Methods:

Five below-knee-amputated fresh frozen cadaveric feet were used (no history of surgery, trauma, arthritis, and deformities). Each specimen was CT scanned using both non-weightbearing and weightbearing protocols. Segmentation on Materialise Mimics software was used to remodel each peritalar bone three dimensionally. Congruency of the restored talonavicular joint and subtalar middle facet was evaluated in the GeoMagic. The total articular surface area for each bone was reconstructed, calculated and recorded. The articulation of each joint with or without weightbearing was restored for analyzing joint uncoverage. Paired t-test (P value ≤0.05) was used to compare the coverage % differences.

Results:

In the anterior and middle facets of the subtalar joint, There was 16.40% uncoverage of the calcaneus under non- weightbearing, and 30.68% of uncoverage under weightbearing; 17.94% uncoverage of the talus under non-weightbearing, and 24.89% of uncoverage under weightbearing. In the posterior facet of the subtalar joint, the total articular surface on the talus side (683.96±112.07 mm2) was 1.13 times larger than the calcaneus side (606.78±107.23 mm2). In the talonavicular joint, the total articular surface on the talus side (714.18±124.97 mm2) was 1.28 times larger than the navicular side (556.76±97.65 mm2).

Conclusion:

Our preliminary study in this group of normal cadaver feet has found that in both the talonavicular and middle facet of the subtalar joints, there is physiological uncovering or subluxation regardless of whether the joint is bearing weight or not. Further investigation with a larger sample size is in process.
Differences in Baseline Physical Function and Mental Health PROM Scores in Patients with Foot and Ankle Conditions
Authors: Smith Jeremy T. , Parker Emily Belle , Bluman Eric M. , Martin Elizabeth A. , Chiodo Christopher
Published: April 2024

Introduction/Purpose:

This study sought to establish normative values for baseline physical and mental health by foot and ankle diagnosis using validated Patient-Reported Outcomes Measurement Information System (PROMIS) scores and to compare the correlation between these two outcomes across common foot and ankle diagnoses. Additionally, it investigated the effect of specific foot and ankle diagnoses on self-reported mental health at first presentation.

Methods:

We retrospectively reviewed baseline PROMIS Physical Function Short Form 10a (PF10a) and PROMIS Global-Mental (PGM) scores of 14,374 patients who had one of the 10 most common foot and ankle diagnoses seen at our institution between 2016 and 2021. Pearson correlation coefficients were calculated to assess the relationship between PF10a and PGM by diagnosis. A multivariable regression model was also used to determine the effect of each diagnosis on PGM score.

Results:

On unadjusted analysis, patients diagnosed with an ankle fracture had the lowest mean physical function, while patients with hallux valgus had the highest (PF10a=33.9 vs 46.7). Patients with foot/ankle osteoarthritis had the worst mean self-reported mental health, while patients with hallux rigidus had the best (PGM=49.9 vs 53.4). PF10a and PGM scores were significantly positively correlated for all diagnoses; the correlation was strongest in patients diagnosed with foot/ankle osteoarthritis or hammertoes (r=0.511) and weakest in patients with ankle fractures (r=0.239) or ankle sprains (r=0.287). Chronic conditions, including hammertoes (β=-4.9, 95%CI [-5.6, -4.2], p< 0.001), foot/ankle osteoarthritis (β=-4.8, 95%CI [-5.5, -4.1], p< 0.001), and hallux valgus (β=-4.6, 95%CI [-5.3, -3.9], p< 0.001) were associated with the largest negative effects on patients’ self-reported mental health.

Conclusion:

Self-reported physical function and mental health varied across common foot and ankle diagnoses and were more tightly correlated in chronic than acute conditions. The effect of diagnosis on mental health scores appears to be worse for more chronic diagnoses, including those that are generally associated with relatively unimpaired physical function. Comparison of mean unadjusted PROMIS Physical Function 10a and PROMIS Global-Mental scores by diagnosis.
Impact of Midfoot Charcot Arthropathy (Brodsky Type 1) on Patient Reported Outcome Scores
Authors: Cutrone Joseph , Otten Michael , Tysor Seth J. , Morningstar Joshua L. , Scott Daniel , Gross Christopher E.
Published: April 2024

Introduction/Purpose:

Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation.

Methods:

A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases.

Results:

Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8.

Conclusion:

Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.