bluuebunny/crossref_metadata_2025 huggingface dataset:
Taking ACTION to detect myocarditis related to recombinant gene transfer therapy for Duchenne Muscular Dystrophy; Consensus recommendations for cardiac surveillance
Authors: Kaufman Beth D. , Veerapandiyan Aravindhan , Soslow Jonathan H , Wittlieb-Weber Carol , Esteso Paul , Olson Aaron K. , Shih Renata , Bansal Neha , Lal Ashwin , Gambetta Katheryn , Hsu Daphne , Cripe Linda , Villa Chet , Nandi Deipanjan
Published: December 2024

Background:

A viral vector recombinant gene transfer therapy (GTT) has recently been approved by the FDA for males of all ages with Duchenne Muscular Dystrophy (DMD) without limitations regarding preexisting cardiac impairment. Acute myocarditis is a potential life-threatening short-term complication that has been reported following GTT. This immune mediated response can range from troponin elevation to rapid cardiovascular compromise and death, particularly in those with abnormal cardiac status at baseline. Early detection of cardiac compromise is essential to optimize outcomes.

Objectives:

The primary objective of this consensus statement is to advocate for caution with DMD GTT patient selection and to initiate preemptive monitoring for those who may be at increased risk for cardiac adverse events. Secondary objective is to deepen our understanding of short and long-term impact of DMD gene therapies on the heart.

Methods:

A national learning network of pediatric cardiologists with expertise in DMD developed recommendations for cardiac surveillance of DMD males receiving GTT based on available evidence and expert consensus opinion. A monitoring and treatment plan for standard and high cardiac risk patients was developed.

Conclusion:

Partnership of cardiologists with GTT prescribers is essential to identify patient-specific considerations that might influence risk for adverse cardiac events and alter post infusion monitoring and management plans. Consistency in cardiac surveillance practices across centers will expedite our knowledge regarding potential short- and long-term cardiac effects of GTT for DMD.
Systemic induction therapy in patients with locally advanced or node-positive urothelial carcinoma: Evaluating treatment outcomes
Authors: Rutten Vera C , Mellema Jan-Jaap , Zuiverloon Tahlita CM , Robbrecht Debbie GJ , van der Heijden Michiel S , Boormans Joost L
Published: December 2024

Background

The presence of lymph node metastases in patients with urothelial carcinoma (UC) plays a pivotal role in disease management and prognosis. Patients with locally advanced irresectable or clinically node-positive UC are often considered ineligible for surgery due to the extent of affected lymph nodes. Long term remission or even cure may be achieved in a subset of patients who experience response to systemic induction therapy and consolidative locoregional treatment.

Objective

To assess the pathological response to preoperative systemic induction therapy followed by radical surgery in patients with locally advanced irresectable or clinically node-positive UC.

Methods

Searches were performed until September 2023 in 5 databases (EMBASE, MEDLINE, Web-of-Science, Cochrane and Pubmed Publisher). Studies including patients with cT4bNxM0/cTxN1-3M0 UC, treated with induction chemotherapy or non-chemo induction therapy followed by radical surgery, were selected. The primary outcome was the pathological complete response (pCR) rate, i.e., the proportion of patients without residual disease in the surgical resection specimen (ypT0N0). Secondary outcomes included overall and cancer-specific survival (OS, CSS).

Results

Fourteen studies were included, representing 5715 patients. Two studies reported on non-chemo induction therapy. The reported pCR rate in patients receiving induction chemotherapy varied from 9% to 27% compared to 25% after induction immunotherapy. The 5-year OS and CSS after induction chemotherapy and radical surgery ranged from 25 to 34% and 30 to 49%.

Conclusion

Systemic induction therapy in patients with locally advanced irresectable or clinically node-positive UC resulted in modest pCR rates. Due to considerable heterogeneity between studies, no direct comparison on the efficacy of induction therapy regimens was possible.
Repeat TURBT in large volume high-grade non-invasive bladder cancer
Authors: Durant Adri M. , Nguyen Mimi , Choudry Mouneeb M. , Mi Lanyu , Andrews Jack R. , Tyson Mark D.
Published: December 2024

Background

The American Urological Association (AUA)/Society of Urology Oncology (SUO) guidelines recommend a repeat transurethral resection of bladder tumor (TURBT) for high-risk, non-invasive (HR Ta) nonmuscle invasive bladder cancer (NMIBC) patients. The evidence base for this recommendation is weak (grade C) and fraught with methodological shortcomings, such as the lack of adjuvant intravesical Bacillus Calmette Guerin (BCG) and single-center study designs.

Objective

We sought to evaluate the effect of repeat TURBT on recurrence-free survival at a population level in HR Ta NMIBC patients who completed BCG induction therapy.

Methods

High-grade Ta NMIBC patients who underwent TURBT for a ≥5 cm tumor were identified within the SEER-Medicare database. All patients completed induction BCG and were stratified into two groups: repeat TURBT within eight weeks of initial TURBT and a group without repeat TURBT (control group). The primary endpoint was the 3-year high-risk recurrence rate.

Results

A cohort of 604 patients was identified, with 93 (15.4%) undergoing a repeat TURBT within eight weeks of initial TURBT and 511 (84.6%) without a repeat TURBT. Patient demographic and clinical characteristics were similar overall. No significant difference in the 3-year recurrence rate was noted (repeat TURBT: 20.4% vs. control group: 15.7%, p = 0.25). After adjusting for demographic and clinical characteristics, no association between repeat TURBT and 3-year high-risk recurrence was observed (HR (95% CI): 1.27 (0.76, 2.11); p = 0.36).

Conclusion

Although our study contains several major limitations, our results suggest that repeat TURBT in large volume HG Ta NMIBC treated with induction BCG therapy was not associated with improved high-risk recurrence-free survival.
Behavioral Medicine Can Help Reduce Premature Mortality among People who Experience Homelessness
Authors: Vickery Katherine Diaz , Busch Andrew M.
Published: December 2024

Unprecedented numbers of Americans experienced homelessness in 2023. Homelessness causes premature mortality from several preventable causes. Historically, research in homelessness has been driven by psychiatric and social science fields and has focused on neither health behavior nor valid measurement of health outcomes. Only in HIV/AIDS populations is there specific evidence linking housing with improved health outcomes. A partnership between behavioral medicine researchers and housing and homeless service providers could address health behaviors linked to premature mortality. This requires improving measurement of homeless mortality and validating health and wellness measures for people experiencing homelessness. We outline implications for policy to pair support for health behavior change in the context of homelessness with various housing support programs. When done with attention to multi-level health drivers and inclusion of people with lived experience, this partnership could improve health outcomes and reduce premature mortality for people without housing.
Identification of Core Interprofessional Preceptor Competencies and Development of a Preceptor Self-Assessment Tool
Authors: Thompson Hilaire J. , Moore Megan , Levy Marni , Lee Tzu Hsien , Mike Leigh Ann , Fathi Joelle , Christianson Phyllis , Dreesmann Nathan
Published: December 2024

Objective

The purpose of this study was to determine what activities and skills interprofessional health science preceptors (IHSPs) perform and value as a part of their pedagogical practice in order to support the development of a preceptor self-assessment tool and assist in preceptor training.

Methods

We administered an online survey to identify core preceptor activities across health sciences disciplines that interact with nursing. The initial survey items were developed based on the Interprofessional Education Collaborative (IPEC) core competencies as well as a search of literature on expected preceptor competencies and activities across individual health sciences professions. Items were refined and then finalized using a modified Delphi technique and the final survey instrument reflected the four IPEC core competencies: (a) roles and responsibilities, (b) values and ethics, (c) communication, and (d) teams and teamwork. The survey asked professionals to separately rate the frequency and importance of performing each item to support learners in the clinical setting.

Results

Survey respondents ( N = 260) indicated that 41% of activities across all domains were both of high priority and performed frequently. Activities were categorized into a six category IHSP self-assessment and reflection tool: (a) Prepare Learner for Clinical Environment and Rotation; (b) Prepare Learner for Clinical Day and Encounters; (c) Promote Engagement, Critical Thinking and Self-Reflection; (d) Coaching and Feedback; (e) Foster Growth and Independence and (f) Knowledge, Skills and Attitudes to intentionally Role Model.

Conclusion

Core competencies for IHSPs have been identified, resulting in the development of a preceptor self-assessment tool. The tool can assist nursing and other health sciences training programs to develop preceptor orientation materials and training to optimize the learner experience and promote standardization in the development of clinical practice competencies.
Nurses Engagement on Continuing Professional Development Programs and its Barriers in Selected Hospitals in Addis Ababa, Ethiopia
Authors: Wehabe Meaza , Gebretensaye Tigistu Gebreyohannis , Bizuwork Ketema
Published: December 2024

Background

Continuous Professional Development (CPD) programs are crucial for enhancing the quality of healthcare delivery. The presence of incompetent and unskilled healthcare professionals is not satisfactory. This study aimed to evaluate nurses’ engagement in CPD programs and identify the barriers affecting this engagement.

Methods

A mixed-methods approach, combining quantitative and qualitative cross-sectional studies, was employed from April 1 to 30, 2022. The quantitative component involved 271 randomly selected nurses, while nine key informants were purposively chosen for qualitative analysis. Data were collected using a structured self-administered questionnaire with a content validity index of 0.91 and an interview guide. Ethical guidelines were strictly followed. Quantitative data were entered into Epi-data version 3.1 and analyzed with SPSS version 25.0. Descriptive statistics described participant characteristics, while chi-square tests and logistic regression analyses assessed the relationships between independent and outcome variables, with significance set at p < 0.05 and goodness-of-fit evaluated by the Hosmer–Lemeshow test (>0.05). Qualitative data were analyzed using manual exploratory descriptive methods and thematic analysis.

Results

Of the 271 nurses, 262 (96.7%) participated, with a median age of 28 years. The overall CPD engagement rate was 34.4%. Factors influencing CPD engagement included financial constraints (adjusted odds ratio [AOR] = 3.1, 95% CI: 1.28–7.52), lack of access to CPD information (AOR = 0.3, 95% CI: 0.12–0.76), time constraints due to family commitments (AOR = 3.35, 95% CI: 1.08–10.34), and insufficient CPD resources (AOR = 0.15, 95% CI: 0.03–0.742). Qualitative findings revealed low CPD engagement levels, insufficient financial support, reluctance to self-finance training, the positive impact of diverse training mediums, and barriers related to nurses’ attitudes and the availability of training.

Conclusion

Nurses’ engagement in CPD is notably low. Financial and time constraints, along with limited access to information and resources, significantly hinder participation in CPD activities.
8-year survivorship of a 4th Generation Fixed Bearing Total Ankle Replacements
Authors: Kostusiak Milo , Dahill Mark , Dean Michael , Hughes Adrian , Kingman Anji , Kakwani Rajesh , Murty Arudhyula , Townshend David , Sharpe Ian
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The Infinity (Wright Medical Group) Total Ankle Replacement (TAR) has been implanted in patients since 2014 and is now the most common primary ankle used in the National Joint Registry of England and Wales. We report a prospective series of 106 Infinity TARs, with 8-year survivorship data from two, non-designer centres in the UK. The primary aims were to assess survivorship and complications of the Infinity TAR. The secondary aims were to assess patient reported and radiological outcomes.

Methods:

Prospectively collected data between March 2014 to December 2016 was assessed from two specialist centres in the United Kingdom. All operations were performed, or supervised, by one of 5 surgeons with a minimum experience of 10 TAR per year. Inclusion criteria were any patient with end-stage tibiotalar arthritis, considered by the operating surgeon to be suitable for primary TAR. Revision TAR, or conversion from arthrodesis, were not included in this study. Implant survivorship, complications, patient reported outcome scores (PROMS) and radiological data were collected for each patient. PROMS data comprised the Manchester Oxford Foot Questionnaire (MOX-FQ) and the EuroQol-5 Dimension (EQ5D-5L) score. Pre-operatively, weight bearing radiographs were assessed for the degree of sagittal and coronal deformity. Post-operatively, weight bearing radiographs at 6 weeks were assessed for the degree of deformity correction. Cystic radiolucencies on the most recent follow up radiograph was assessed by using an established scoring system.

Results:

102 patients, comprising 106 TARs, were included. Mean age at implantation was 68 years (range 42 to 89 years). Mean follow up time was 98 months (range 83 to 113 months). 12 patients received further surgeries: 8 revision TARs, 3 debridement and grafting of talar cysts, and 1 capsular release. The reasons for revision surgery were unexplained pain (5 patients), proven deep infection (1 patient), tibial subsidence (1 patient) and instability (1 patient). Mean time to revision surgery was 43 months (range 15 to 82 months). Current survivorship of the cohort is 91%. Cystic radiolucencies were present in 35% of patients but the majority were small and asymptomatic. MOXFQ and EQ5D-5L PROMS showed significant and sustained post-operative improvements (p < 0.01).

Conclusion:

This series of 106 modern fixed bearing TAR shows an 8-year survivorship of 91%. 3 cases of talar cysts were grafted. The most common reason for revision surgery was unexplained pain and the deep infection rate was 1%. The fixed bearing Infinity TAR appears to be a safe, effective intervention in the treatment of end stage ankle osteoarthritis and gives significant improvement in disease specific and general health status outcomes.
A Comparison of the Long-Term Outcome after Fixed and Non-Fixed Volkmann Fractures
Authors: Chidda Amal , Soares Sergio , Schwab Joseph , Seidel Angela
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Our first aim was to compare the long term clinical and radiological outcome of patients sustaining a trimalleolar fracture with a posterior malleolar fragment (PMF) between the patients who had a fixation of the PMF and those who did not. Our secondary aims were to compare the postoperative complication rate, to identify independent risk factors associated with worse clinical and radiological outcome and to assess if the indication of PMF fixation was correlated with the fragment size.

Methods:

For this monocentric retrospective comparative study, we included 69 consecutive patients who were operated on for a trimalleolar fracture between 2008 to 2013. They completed the SF-12 and the EFAS score at least 10 years after surgery. The radiological osteoarthritis was assessed according to the Kellgren and Lawrence classification. Their demographics (BMI, sex, annual income, smoking status and presence of diabetes) were taken from the chart. The postoperative complications were evaluated according to the Sink classification. The size of the PMF was measured in the preoperative x-ray and the CT and classified according to the Haraguchi classification. 69 patients (49 female (71% /20 male (29%)) with tri-malleolar fractures were included at mean follow-up of 11.3 years. Mean age was 51.4 y.o.

Results:

21 (30.4%) of them had a fixation of the PMF by plate and 48 (69.6%) of them not. 9patients (13.04%) had diabetes and 20 patients (29.4%) were smokers. There was no difference between the two groups in the long-term clinical PROMS (EFAS, EFAS Sports, MCS, PCS) nor in degree of osteoarthritis (p=0.05501). Patients in the fixated PMF group had a higher complications rate (p=0.0004527). In the linear regression analysis diabetes was a predictor of negative outcome for the PCS (p=0.007798) and malreduction of syndesmosis was a predictor of negative outcome for the EFAS-score (p=0.0310) and osteoarthritis (p< 0.0001). The PMF size was significantly higher in the fixated group and wasn't correlated to the long-term clinical outcome, except for the mental part of the SF-12 (p=0.0288).

Conclusion:

Fixation of PMF does not change the clinical and radiological outcome in the long term if the ankle joint is congruent. In contrast the posterolateral approach presents more complications. Surgeons must be aware of this during their design making.
A Novel Self-Compressing Single Screw for Subtalar Arthrodesis
Authors: Bariteau Jason T. , Ogden Liliana A. , Crockett Kasey
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

Subtalar fusions have become the standard of care for a variety of pathologies of the hindfoot that have failed non-operative management, both as an isolated procedure or combined as a double or triple arthrodesis. Multiple fixation methods exist for this procedure, although newer technology has introduced the ability for sustained dynamic compression via the use of nitinol. The purpose of this work was to assess a new internal compressing screw on subtalar arthrodesis.

Methods:

We examined 15 patients who underwent subtalar fusion with a single screw utilizing an internal nitinol device. Serial radiographs were reviewed for migration of the nitinol implant over time, spanning from 3 months to up to a year post operatively. We also assessed for post-operative complications including nonunion, infection, and pulmonary embolism.

Results:

There was an average of 63% of recovered compression, ranging from 26%-88%. The majority of the recovery was within the first three months post operatively. Our follow up averaged 9.5 months (range, 3 months to 1 year 8 months). There was one patient with a nonunion of the subtalar joint and one patient who suffered a post-operative pulmonary embolus. There were no infections requiring surgical treatment.

Conclusion:

The nitinol element provides sustained compression to combat bone resorption or settling. While the majority of this is seen in the first three months, it is still possible to have more recovery beyond this time. This small case series demonstrates a low complication rate and high union rate with utilization of this implant. Future studies are needed to compare this fixation method to traditional screws and review differences in union rates and complications. Xrays taken at time of surgery, at 3 months post-op, and 1 year post-op of a 7×80mm screw with an available 3.0mm of post-operative compression. The implant had compressed nearly 50% at 3 months with additional compression noted between 3 months to 1 year post implantation.
A Review of the Outcome of Geriatric Ankle Open Fracture Management at a Single Institution
Authors: Peng Khor Yuet , Jacob Abraham Manu , Chua Alynna
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

There is an increasing trend of geriatric ankle fractures worldwide. The mortality rate of geriatric open ankle fractures is comparable to that of geriatric hip fractures. We aim to review the management and outcome of geriatric open ankle fractures at a single institution.

Methods:

Retrospective review of medical records of all patients above 60 years of age who had surgery foropen ankle or distal tibia and fibula fracutres between years 2017-2021 was performed. Demographic data, ambulatory status, ASA grade, comorbidities, surgical management, length of stay, outcome and radiographic data were recorded into a data collection form. A descriptive analysis of their outcome was performed.

Results:

12 of 99 patients had open ankle fractures. Mean age cohort was 69.5 years (61- 85 years). 7 were female (58%). 67% (n=8) had low energy falls. 83% were independent community ambulators (n=10). 33% had diabetes, 17% had peripheral vascular disease and 25% had renal disease. Average follow up was 8.6 months (2 weeks- 32 months). 42% were Gustillo- Anderson grade 1 injuries, 33% Grade 2, 8% and 25% Grade 3 injuries. Mean length of stay patients was 13.5 days compared to 10.8 days for closed fractures.Patients spent a mean 52.6 days (28-77days) at the step down facility. 1 year mortality rate was 8% . Malunion and post traumatic arthritis rate was 11% each. There were no cases of deep surgical site infection or amputation.

Conclusion:

Open geriatric ankle fractures account for 12% of geriatric ankle fractures at our institution. They required longer length of stay and spent a mean 52.6 days at a stepdown facilty. Mortality rate was 8%. 50% of patients were able to return to previous ambulatory status. If the trend for geriatric ankle fractures continue to rise, health care systems need to cater for eventual increase in need for longer hospital stay and step down care.
An Examination of Negative One-Star Patient Reviews for Foot and Ankle Orthopedic Surgery
Authors: Anastasio Albert T. , Baumann Anthony N. , Curtis Devin , Rogers Hudson , Hogge Caleb , Ryan Savannah , Joan Luo Emily , Talaski Grayson M. , Walley Kempland C. , Adams Samuel B.
Published: December 2024

Category:

Other

Introduction/Purpose:

Despite the questionable validity of online-based physician review websites (PRWs), negative reviews can adversely affect a provider's practice. Several investigations have explored the effect of extremely negative "one-star" reviews across subspecialties such as adult reconstruction, sports medicine, and orthopaedic traumatology; however, to date, no study has explored one-star reviews in foot and ankle surgery. The goal of this study was to characterize factors that contribute to extremely negative, one-star reviews for foot and ankle surgeons on an online review website.

Methods:

We conducted a retrospective analysis of negative one-star reviews on Vitals.com with corresponding patient complaints for foot and ankle surgeons (both orthopaedic surgeons as well as podiatrists) in the United States. Physicians included were selected within a 10-mile radius of the top ten largest cities in the United States. Data was stratified by patient type (e.g., those receiving surgery and those not undergoing surgical intervention) and binned according to type of patient complaint, as previously described.

Results:

Of the 2645 foot and ankle surgeons identified in our initial query, 13.8% of surgeons contained one-star reviews eligible for analysis. Patient complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly 50% of the complaints related to surgical patients.

Conclusion:

Complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly half of the complaints related to surgery. This data serves to inform practicing foot and ankle surgeons as to the influences behind patients leaving extremely negative reviews on PRWs.
Ankle Arthrodesis Increases Risk of Progression to Subtalar Arthrodesis Compared to Total Ankle Arthroplasty
Authors: Coden Gloria , Hofmann Kurt
Published: December 2024

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

There is a known association between ankle arthritis and ipsilateral subtalar arthritis. It is unknown how the increased range of motion and improved gait mechanics provided by total ankle arthroplasty (TAA) effects the progression of subtalar arthritis compared to ankle arthrodesis (AA). We hypothesized that patients treated with TAA would have a lower incidence of postoperative subtalar arthrodesis (SA) compared to AA.

Methods:

We retrospectively reviewed 2564 AA and 3014 TAA performed between 1/1/2016 and 12/31/2022 using a commercial claims database. Patients with a history of an ipsilateral subtalar arthrodesis preoperatively were excluded. Records were reviewed for demographics, medical history, and postoperative subtalar arthrodesis up to 5 years after AA or TAA. Patients who underwent a TAA tended to be older (mean=58.62 versus 53.80 years, p< 0.001), but gender (p=0.098) and obesity (p=0.225) were similar between cohorts). TAAs were more likely to be diagnosed with osteoarthritis (53.32% versus 41.38%), posttraumatic arthritis (41.80% versus 38.53%), rheumatoid arthritis (1.53% versus 0.98%), or psoriatic arthritis (0.07% versus 0.00%) and less likely to be indicated due to another diagnosis (19.11% versus 3.28%, p< 0.001). Mean follow-up was 2 years in both cohorts.

Results:

Cumulative incidence of an ipsilateral subtalar arthrodesis was higher at 5 years with an AA (4.20%, 95% confidence interval (CI)=2.60%-5.80%) than a TAA (1.30%, CI=0.60%-2.00%, p=0.004). A multivariate analysis showed that AA increased the risk of progressing to subtalar arthrodesis compared to TAA (OR=1.95, CI=1.08-3.52, p=0.027), but not age (OR=0.98, CI=0.96-1.01, p=0.183), female gender (OR=1.16, CI=0.68-1.99, p=0.587), obesity (OR=1.74, CI=0.93-3.26, p=0.083), posttraumatic arthritis (OR=1.04, CI=0.57-1.90, p=0.896), inflammatory arthritis (p=1.000), or another diagnosis (OR=1.60, CI=0.75-3.40, p=0.224) compared to osteoarthritis. For those patients who underwent an ipsilateral subtalar arthrodesis, patients in the TAA cohort tended to wait longer before proceeding with the subtalar arthrodesis (mean=1.78 years (range=0.002-4.62 years) than the AA cohort (mean=1.11, range=0.10-3.62 years, p=0.049).

Conclusion:

There is a significantly higher incidence of patients undergoing subtalar arthrodesis after AA compared to TAA. For those patients who required a subtalar arthrodesis, patients with a TAA tended to wait longer before undergoing the subtalar arthrodesis compared to those with an AA. We recommend that surgeons consider TAA over AA, especially in patients with minimal subtalar arthritis as a strategy to help delay the progression of subtalar arthritis. Cumulative incidence of an ipsilateral subtalar arthrodesis was higher at 5 years with an AA (4.20%, 95% confidence interval (CI)=2.60%-5.80%) than a TAA (1.30%, CI=0.60%-2.00%, p=0.004).
Arthroscopic vs Open Ankle Arthrodesis: The Canadian Multi-Center Long Term Study
Authors: Li Shuyuan , Veljkovic Andrea , Wing Kevin , Gagne Oliver , Qian Hong , Hubert Wong Msc , Sadr Hooman , Penner Murray J. , Daniels Timothy R. , Morash Joel , Glazebrook Mark A. , Younger Alastair S.E.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

This multi-center study aimed to compare complication rates, reoperation rates, and patient-reported outcome measures (PROMs) between open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA) in treating end-stage ankle arthritis.

Methods:

This was a prospectively collected retrospective study utilizing data from three medical centers in the Canadian Orthopaedic Foot and Ankle Society (COFAS) database. Primary ankle arthrodeses for the treatment of end-stage arthritis with a minimum of 2 years follow up and valid PROM scores were included. Preoperative COFAS ankle arthritis type, validated PROMs including the Ankle Osteoarthritis Scale (AOS), Short Form-36 (SF-36) with 2 components (the Physical Component Summary (PCS) and Mental Component Summary (MCS)), as well as major complications including malunion, nonunion, infection, amputations, and reoperations related to the arthrodesis were evaluated using CROCS (Canadian Reoperation Coding System).

Results:

2,835 prospectively enrolled patients who underwent surgical treatment of end-stage ankle arthritis (COFAS Types 1-4) from 2001 to 2020 were screened. 447 ankle arthrodeses were included (178 AAA, 269 OAA) with 1-15 years of followup (7.13 yrs +/- 3.8). There was no difference between the two groups in demographics except more cases of type 1 and 4 arthritis in OAA group. There was a 6.9% incidence of major complications (3.79% related operations around the ankle, 0.67% deep infection, 1.78% revisions for nonunion/malunion, 0.67% amputations). For the 4 types of arthritis, AOS score improved significantly at 1 year, stabilized in type 1 group, but fluctuated in the remaining 3 types of arthritis after 8 years postoperatively. Average postoperative AOS score was better in the AAA group.

Conclusion:

Better outcomes were found for the arthroscopic cohort. However differences may be less after correction for confounding factors such as surgeon, site, and COFAS grade. Revision surgery is rare in both groups. AOS Treated Total Scores in Arthroscopic versus Open Ankle Arthrodesis Groups
Assessing Complication Rates of Constructs Used in Midfoot Arthrodesis
Authors: Dalloul John M. , Balu Abhinav R. , Shen Peter C. , Bergman Rachel , Chang Shaun , Kelikian Armen , Patel Milap , Kadakia Anish R. , Mutawakkil Muhammad Y.
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Midfoot arthrodesis is an essential procedure for restoring function and structural integrity to the foot for patients with end stage arthritis of the tarsometatarsal and naviculocuneiform joint complexes. There is little evidence regarding the optimal fixation construct for midfoot arthrodesis. In addition to fusion outcomes, complications such as revision procedures, infection, and deep vein thrombosis (DVT) are essential considerations that require analysis. The purpose of this study is to evaluate the rate of revision surgery for nonunion, infection requiring irrigation and debridement (I&D), symptomatic hardware removal, surgical site infections, and deep venous thrombosis (DVT) between the various constructs used in midfoot arthrodesis to better aid surgeon selection and preoperative decision making.

Methods:

Patients who underwent midfoot arthrodesis between 2010-2023 at a single institution were included in final analysis. Qualifying procedures included fusion of any of the tarsometatarsal (TMT) joints, the Lisfranc articulation, or the naviculocuneiform (NC) joint. Complications were classified as revision surgery for nonunion, infection, or other revision procedure (e.g. symptomatic hardware removal). Additional complication categories included surgical site infection and postoperative DVTs. Rates of each complication were compared across constructs used in the arthrodesis procedures and the joints being fused. P-values were calculated using Pearson’s chi-squared test. Statistical analyses were carried out using Python 3.11.7 and Microsoft Excel.

Results:

In total, 150 patients with arthrodesis performed across 195 joints were followed for an average of 2 years post-operatively as part of this study. Arthrodesis constructs using combination staples and screws were found to have a significantly higher total revision rate (27.2%) than those using only staples (5.4%, p = 0.048) or only screws (5.3%, p = 0.043). This relationship held true when looking specifically at revision surgery to address symptomatic hardware, with combination staple and screw constructs demonstrating a higher rate (22.7%) than either staples (0%, p = 0.011) or screws (2.6%, p = 0.040) alone. Additionally, revisions due to infection, regardless of construct, occurred at a higher rate in the 2nd TMT joint (3.9%) than in the NC joint (0%, p = 0.038).

Conclusion:

The combination of staples and screws for midfoot arthrodesis results in higher complication rates, particularly revision due to symptomatic hardware, than screws or staples alone. Increased hardware in the relatively small margins of the midfoot are not well tolerated and increase risk of reoperation.
Assessing Plantar Pressure Distribution and Time Parameters Following Total Ankle Replacement Surgery
Authors: Khan Ryan , Halai Mansur , Daniels Timothy R. , Kayum Shahin , Pinsker Ellie
Published: December 2024

Category:

Ankle Arthritis; Other

Introduction/Purpose:

This study intended to use plantar pressure analysis to obtain supplementary objective outcome assessments of total ankle replacement surgery.

Methods:

Twenty subjects that were previously consented and booked for total ankle replacements participated in the study. Each subject performed a 10 meter walk prior to surgery and then again at six and twelve months post-operative. Plantar pressures were measured using the Pedar® (by Novel, Munich, DE) pressure insoles. Six parameters: initial contact time, terminal contact time, maximum force time, peak pressure time, maximum force and peak pressure were calculated and averaged over trials in ten regions of foot. The parameters in each region were compared between pre and post-surgery.

Results:

We observed that patient’s hind foot total contact time notably increased after total ankle replacement. The average baseline hind foot contact time was 387ms, which increased to 448ms at 6 months post op and further increased to 487ms at the one-year visit. Suggesting that patients are able to better tolerate a load on the hind foot for considerably longer after having ankle replacement surgery.

Conclusion:

Plantar pressure measurements using the Pedar® measurement system of pressure and time showed to be strong tools for objective evaluation of ankle joint replacement surgery. Future research comparing outcomes of ankle arthrodesis is planned Pedar software
Testing Bayesian Informative Hypotheses in Five Steps With JASP and R
Authors: Garofalo Sara , Finotti Gianluca , Orsoni Matteo , Giovagnoli Sara , Benassi Mariagrazia
Published: December 2024

One of the most common applications of Bayes’s theorem for inferential purposes consists of computing the ratio between the probability of the alternative and the null hypotheses via a Bayes factor, which allows quantifying the most likely explanation of the data between the two. However, the actual scientific questions that researchers are interested in are rarely well represented by the classically defined alternative and null hypotheses. Bayesian informative-hypothesis testing offers a valid and easy way to overcome such limitations via a model-selection procedure that allows comparing highly specific hypotheses formulated in terms of equality (A = B) or inequality (A > B) constraints among parameters. Although packages for testing informative hypotheses in the most used statistical software have been developed in recent years, they are still rarely used, possibly because their implementation and interpretation may not be straightforward. Starting from a brief theoretical overview of the Bayesian theorem and its applications in statistical inference (i.e., Bayes factor and Bayesian informative hypotheses), in this article, we provide two step-by-step tutorials illustrating how to test, interpret, and report in a scientific article Bayesian informative hypotheses using JASP and R/RStudio software for running a 2 × 2 analysis of variance and a multiple linear regression. The complete JASP files, R code, and data sets used in the article are freely available on the OSF page at https://osf.io/dez9b/ .
Hydrometallurgical, pyrometallurgical and electrometallurgical extraction of niobium and tantalum: an overview
Authors: Haile Michael Girma , Oladunni Oyelola Alabi , Olufemi Aramide Fatai , Ojo Seidu Saliu , Akinlabi Oyetunji
Published: December 2024

This review paper discusses the extraction processes of niobium and tantalum, encompassing hydrometallurgical, pyrometallurgical and electrometallurgical methods. The hydrometallurgical approach discussed includes ore preparation, leaching, solvent extraction, solid–liquid separation, fractional crystallisation and precipitation. The pyrometallurgical processing includes calcination, roasting and smelting techniques. And the electrometallurgical methods include electrowinning, electrofining processes along with two basic approaches of electrometallurgy called aqueous processing and fused-salt processing. Environmental concerns in relation to the extraction of these metals and newer development trends are also discussed within each process. The paper also compares existing methodologies, and provides the author's opinion on the three processes including the current state of the arts.
Geology of critical mineral deposits of the Kuljuktau Mts., Central Kyzylkum (Uzbekistan)
Authors: Mirkamalov Rustam , Divaev Farid , Uzokov Rustamjon , Dolgopolova Alla , Seltmann Reimar , Armstrong Robin , Buret Yannick , Broderick Cindy , Khalmatov Rustam , Oripova Nigora , Mun Yulia , Mizernaya Marina
Published: December 2024

This article presents characteristics of geological and tectonic structures of the Kuljuktau Mountains, mineralogical and geochemical features of its volcanic and intrusive rocks and associated mineralisation of critical elements. The Taskazgan graphite, Shaidaraz lithium, and Tozbulak high-purity quartz deposits, and new prospects for rare earth mineralisation have been identified as the most significant critical mineral resources of the Kuljuktau Mts. The Taskazgan graphite deposit is confined to the melange at the contact between the gabbroids and the marbleised carbonate rocks. Rare metal (lithium) mineralisation is associated with pegmatite and aplite veins of the Shaidaraz intrusion. The Tozbulak high-purity quartz vein cuts through the intrusion of leucocratic granites and is the largest quartz manifestation in Uzbekistan. The new U–Pb zircon ages of the Kuljuktau and West Tozbulak intrusive complexes of 353.5 ± 2.1 Ma for the former and 349.1 ± 2.5 Ma, respectively, allowed the refinement of the regional metallogenesis in space and time.
Towards a novel framework for identifying commonalities and differences in older people’s end-of-life trajectories: aims and interdisciplinary mixed-methods approach of the ERC-funded TRAJECT project
Authors: Tripathi Khyati , Gobiet Emma , Van den Block Lieve , Van den Bossche Casper , Pivodic Lara
Published: December 2024

Background:

Older people who die from serious chronic disease typically experience long periods (months or years) of illness and complex fluctuations in their physical health and in their social, psychological and existential well-being. Our understanding of these end-of-life trajectories is very limited, focuses predominantly on physical function and clinical predictors and neglects inter-individual differences. A better understanding of end-of-life trajectories, including what is shared among people and what is individually specific, is needed for an optimal provision of palliative care and health services planning.

Objectives:

TRAJECT is a European Research Council-funded interdisciplinary project with a central aim to gain understanding of what is generalisable and what is individually specific in older people’s end-of-life trajectories and in the circumstances that shape them.

Design:

Convergent mixed-methods design including a quantitative longitudinal survey study, a serial narrative study and a mortality follow-back survey.

Methods and analysis:

TRAJECT applies a novel methodological and analytical framework, examining trajectories through two distinct scientific lenses, both suited for uncovering variability as well as general principles: a structured quantitative approach to capture fluctuations in a standardised way, and an experience-focused qualitative approach to study the subjective stories and meanings behind changes in health. The findings of the quantitative and qualitative methods will be integrated through triangulation and by systematically threading key findings from one method across to the other. The research is conducted in Belgium.

Discussion:

This project will lead to a new understanding of the varied ways in which older people’s end-of-life trajectories unfold and which circumstances and experiences shape them. It will also reveal which elements of trajectories are shared across groups of people and which are individually specific. These new insights will provide a much-needed evidence base concerning groups at risk of poor well-being as they near death, which is needed to optimise palliative care practice, needs assessment, as well as health service planning.
A qualitative exploration of the experiences of self-diagnosed autistic women and gender-diverse individuals who are not pursuing an autism diagnosis
Authors: Friedman Alina , Paltoglou Aspasia , Sorte Rossella
Published: December 2024

A growing number of adults are choosing to self-identify as autistic without obtaining a formal diagnosis; yet, research into this population remains scarce. Women and gender non-conforming autistics are particularly underresearched, with women facing additional barriers to diagnosis. This study examined the lived experiences of self-diagnosed autistic women and gender-diverse adults and explored how autistic identity is constructed outside of formal diagnosis in this population. Participants ( n = 6) between the ages of 18 and 69 took part in semi-structured one-to-one online interviews with an autistic researcher to discuss their experiences of being self-diagnosed. Interview transcripts were analysed using interpretive phenomenological analysis. Three superordinate themes were found: (1) autistic self-discovery, (2) living without a diagnosis and (3) self-doubt and self-diagnosis. The findings suggest that many of the experiences of self-diagnosed autistic women and gender-diverse adults are similar to those who are diagnosed but with unique challenges and benefits. This study offers a new perspective on self-diagnosis as an empowering way of attaining a positive autistic identity outside of the deficit paradigm embedded within the diagnostic pathway.

Lay Abstract

As awareness of neurodiversity continues to grow, more adults are seeking autism assessments. This rise in demand is placing pressures on diagnostic services resulting in long waiting lists and high private costs. Many autistic adults are choosing to self-diagnose as an alternative to a lengthy and expensive diagnostic process which pathologizes their experiences. Research into this population remains very scarce, and little is known about how and why autistic adults choose to self-diagnose. Autistic women are especially underdiagnosed and underresearched, with gender-diverse autistics rarely included. This study explored how autistic women and gender-diverse adults acquire and shape their autistic identity outside of formal diagnosis and what effect this has had on their lives. An autistic researcher recruited six self-diagnosed autistic adults through social media and conducted online one-to-one video interviews with them. Three main themes were found: (1) autistic self-discovery, (2) living without a diagnosis, and (3) self-doubt and self-diagnosis. The findings offer new insights into the lives of self-diagnosed autistic women and gender-diverse adults and how their experiences are often similar to those who are diagnosed but with unique challenges and benefits. This study offers a new perspective on self-diagnosis as an empowering way of gaining a positive autistic identity outside of the diagnostic model which views autism as a disorder rather than a difference. This may help self-diagnosed autistics feel more able to disclose their identity to others, access more support and experience less invalidation, stigma and self-doubt.
Predictors of Functional Impairment in Severe COVID-19 Patients Two Months After Discharge
Authors: El Kik Antoine , Eid Hind , Nassim Nabil , Hoyek Karim , Riachy Albert , Habr Bassem , Sleilaty Ghassan , Riachy Moussa
Published: December 2024

Background

The Post-COVID-19 Functional Status (PCFS) scale is a validated tool used to measure the functional status of patients discharged from the hospital.

Objectives

To describe the functional limitations of hospitalized COVID-19 patients at the time of discharge and two months afterward, and to identify risk factors associated with functional impairment.

Design

Retrospective study.

Methods

A total of 540 patients were included in this monocentric study. The functional status assessment using the PCFS scale and ventilatory needs were recorded at discharge and two months later. Univariate and multivariate analyses were performed in order to identify the risk factors of a high PCFS score.

Results

Two months after discharge, the PCFS grade was 0 in 60,6% of the survivors, 1 in 24.5%, 2 in 6.9%, 3 in 2.8%, and 4 in 5.3%. The identified risk factors of a high PCFS scale were: age, arterial hypertension, diabetes mellitus, immunosuppression, cardiovascular disease, high need for oxygen and high News2 score at admission, a high percentage of ground glass at chest CT scan performed at admission or during follow-up, elevated leukocytes, neutrophils, LDH, D-dimers, procalcitonin, and serum creatinine levels. During the hospital stay, treatment with steroids, tocilizumab, longer duration of hospitalization, ICU admission and prolonged stay, and the occurrence of thromboembolic or hemorrhagic events were also significantly associated with a higher PCFS. Multivariate analysis identified that only age and a high News2 score at admission were independent risk factors of a low PCFS score.

Conclusion

Multiple risk factors for a higher PCFS score were identified, but only age and a high News2 score at admission were found to be independent risk factors.