bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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).