bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation: Two Year Outcomes
Authors: Ebnezar Rakesh , Wong Ivan H. 
Published: July 2019

Objectives: To analyse the clinico-radiologic outcomes of patients who underwent an all arthroscopic procedure to treat shoulder instability with glenoid bone loss using a distal tibial allograft; with a minimum 2 year follow-up. Methods: A retrospective chart review of prospectively collected data was completed for patients who underwent arthroscopic stabilization with Bankart repair and allograft bony augmentation of the glenoid; by the same surgeon. Western Ontario Shoulder Instability Index (WOSI), Disability of the Arm Shoulder and Hand (DASH), Veterans Rand - 12 and MARX questionnaires were completed pre and post-operatively. Radiological assessment was performed with radiographs and CT scans obtained pre-operatively and at approximately one year post surgery. Results: A total of 41 patients (29 males, 12 females) with a mean age of 26 ± 9 years were included. An excellent safety profile was observed, with no intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections. At 2- year follow-up, there was statistically significant improvement of the WOSI score when compared preoperatively (preoperative=62.6 ± 17.06; at 2-year=22.96± 12.92; p<0.001). The mean pre-operative bone loss was 30.32% (SD ± 7.90). There were no cases of non- union or partial union. No resorption of the graft (grade 0) was seen in 42% patients, whereas 42% and 16% of patients had grade 1 and grade 2 resorption; respectively. There was 100% healing at the interface between allograft and native glenoid. The mean sagittal dimension of the remaining allograft post-operatively was 5.10 ± 2.27 mm in the patients with ≥50% resorption which indicates there was still bone graft present and there was no complete resorption. Mean post-operative external rotation for the population was also observed to near full. Conclusion: Arthroscopic stabilization with DTA augmentation has an excellent outcome at 2-year follow-up; long-term follow-up studies are necessary for better assessment of outcomes.
The Timing of Corticosteroid Injections following Knee Arthroscopy Influence Infection Risk
Authors: Cancienne Jourdan M. , Casp Aaron Joseph , Kew Michelle Elizabeth , Carson Eric W. , Miller Mark D. , Werner Brian C. 
Published: July 2019

Objectives: Although some surgeons will offer an intra-articular corticosteroid injection to accelerate post-operative recovery and decrease inflammation and swelling following knee arthroscopy, there is a paucity of literature evaluating the safety of this practice. Therefore, the purpose of the present study was to examine any association between between the timing of postoperative corticosteroid injection following knee arthroscopy and infection. Methods: Private-payer (PP) and Medicare (MC) national insurance databases were queried for patients who underwent simple arthroscopic knee procedures, including partial meniscectomy and chondroplasty. Patients undergoing concomitant open or more complex procedures with grafts were excluded. Patients who received ipsilateral knee corticosteroid injections within 2, 4, 6, and 8 weeks postoperatively were then identified. Postoperative infection within 90 days after the injection was assessed using ICD-9 and CPT coding for all study groups and compared using a multivariate binomial logistic regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated with p < 0.05 considered significant. Results: 5,533 patients were identified and met inclusion criteria, including 725 that received an injection within 2 weeks, 1,236 patients that received within 4 weeks, 1,716 that received an injection within 6 weeks, and 1,856 patients that received an injection within 8 weeks postoperatively. In both the PP and MC datasets the rate of infection was significantly higher in the 2-week cohort compared to the 6 week (PP: OR 3.81, p = 0.012; MC: OR 9.36, p = 0.001) and 8 week (PP: OR 8.59, p = 0.003; MC: OR 7.80, p = 0.001) cohorts [Tables 1, 2]. The rate of infection was also higher in the 4-week cohort compared to the 6 week (PP: OR 2.54, p = 0.024; MC: OR 8.91, p = 0.001) and 8 week (PP: OR 5.64, p = 0.009; MC: OR 7.80, p = 0.001) cohorts [Tables 1,2]. There were no differences in infection rates between the 2 and 4 week cohorts in either dataset (PP: p = 0.278; MC: p = 0.861). Conclusion: The findings of the present study add to a growing body of evidence that discourages the use of corticosteroids in the perioperative period for knee arthroscopy due to the risk of infectious complications. There was a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared to patients with steroid injections more than 4 weeks postoperatively. In the absence of any prospective studies on this topic, we caution against the use of steroid injections within one month following knee arthroscopy. [Table: see text][Table: see text][Table: see text][Table: see text]
Hamstring Graft Harvest Side Does Not Affect Performance or RTS Rates and Does Not Increase Risk for Future Hamstring Injuries Following UCL Reconstruction in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Ahmad Christopher S. , Dines Joshua S. , Romeo Anthony A. 
Published: July 2019

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear if hamstring tendon harvest side for UCLR alters a player’s risk of subsequent hamstring injuries. The purpose of this study was to compare, performance, return to sport (RTS) rate, and injury rates between professional baseball players with a history of UCLR using an ipsilateral (drive leg) hamstring autograft to those with UCLR using contralateral (landing leg) hamstring autograft. The authors’ hypothesized that players with prior UCLR using ipsilateral (drive leg) hamstring autograft will have the same RTS rate and performance upon RTS, but higher number of subsequent lower extremity injuries than those using contralateral (landing leg) hamstring autograft. Methods: All players between 2010-2015 who underwent UCLR using hamstring autograft were included. Surgical details of their procedure were recorded using operative reports. Players with a hamstring UCLR were compared within group to compare grafts taken from the drive leg vs. landing leg. Results: Overall, 191 players underwent UCLR using hamstring autograft (58 [30%] landing/contralateral and 133 [70%] ipsilateral/drive leg). The docking technique was more common in the contralateral/landing leg group while the figure-of-8 technique was more common in the ipsilateral/drive leg group (p>0.001). More patients in the ipsilateral/drive leg group underwent concomitant treatment of the ulnar nerve than the contralateral/landing leg group (p<0.001). No difference existed in return to sport (RTS) rates, or timing of RTS between groups. No differences in subsequent ipsilateral or contralateral hamstring injuries between players who underwent UCLR using hamstring from the ipsilateral/drive leg or contralateral/landing leg was seen (p=1.000; p=0.460 respectively). No difference in overall upper or lower extremity injury rates existed between groups. Conclusion: No difference in RTS rate, performance upon RTS, or subsequent hamstring, lower extremity, or upper extremity injury rates existed between players who underwent UCLR using hamstring autograft from the ipsilateral/drive or contralateral/landing leg.
The Timing of Corticosteroid Injections after Shoulder Arthroscopy Affects Postoperative Infection Risk
Authors: Kew Michelle Elizabeth , Cancienne Jourdan M. , Christensen James E. , Werner Brian C. 
Published: July 2019

Objectives: To examine the association between the timing of post-operative corticosteroid injections with rates of post-operative infection in arthroscopic shoulder procedures. Methods: Private-payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1 month, 2 months, 3 months, or 4 months post-operatively were identified and compared to a matched control group that underwent the same surgeries without a postoperative steroid injection. ICD-9 and CPT codes were used to identify rates of post-operative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups and adjusted odds ratios (OR) and 95% confidence intervals were calculated with p< 0.05 considered significant. Results: A total of 3,946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1,037 within, 1,874 within 4 months, and 2,640 matched controls. Compared to controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (PP: OR 2.63, p=0.014; MC: OR 11.2, p<0.0001). There were no differences in infection rates at all other time points: (p =0.264 -0.835). Conclusion: This study adds to the evidence suggesting caution when administering injections in the immediate post-operative period following arthroscopic shoulder surgery. Although causality cannot be determined on the basis of this administrative database review, we found a significant association between intra-articular ipsilateral corticosteroid injections administered 1 month post-operatively and an increased rate of post-operative infection, in both a Medicare and private payer patient cohort, when compared to a control patient group. [Table: see text][Table: see text]
Impact of a Quality Improvement Infection Risk Reduction Program on Pathogen Presence in High School and Collegiate Athletic Training Room Facilities
Authors: LaBelle Mark W. , Knapik Derrick M. , Voos James Everett 
Published: July 2019

Objectives: Athletic training rooms have a high prevalence of bacteria, including multidrug resistant organisms, increasing the risk for both local and systematic infections in athletes. There is limited data outlining formal protocols or standardized programs to reduce the bacterial and viral burden in training rooms as a means of decreasing infection rate at the collegiate and high school levels. The purpose of this study is to implement established hygiene principles to high school and collegiate athletic training rooms to reduce bacterial and viral burden using a quality improvement infection control program. The authors hypothesize that implementation of such a program will reduce bacterial and viral counts in athletic training rooms over the course of one academic year. Methods: Two high school and two college athletic training rooms were studied over the course of one academic year. A three-phase protocol, including introduction of disinfectant products, implementation of posters and checklists, and student-athlete and athletic trainer education was implemented at the four schools. Multiple surfaces in athletic training rooms were swabbed at four time points throughout the investigation, corresponding with each phase of protocol implementation (Image 1). Bacterial and viral burden from swabs were analyzed for overall bacterial aerobic plate count (APC), influenza viral load and the presence of multidrug resistant organisms such methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE). Results: Overall bacterial load, as measured by APC, was reduced by 94.7% (95% CI [72.6, 99.0], p = 0.003) over the course of the investigation following protocol implementation. Image 2 demonstrates the downward trend in bacterial load averaged across all surfaces sampled over the course of the study. MRSA and VRE were found on 24% of surfaces prior to intervention and were reduced to 0% by the end of the study. Influenza was initially detected on 25% of surfaces with no detection following intervention. No cases of athletic training room acquired infections were reported during the study period. Conclusion: A uniform infection control protocol implemented in the athletic training room of four secondary schools was effective in reducing bacterial and viral burden, including multidrug resistant organisms, over the course of one academic year. Future investigations will focus on expanding this protocol to a larger number of schools with broader demographics.
Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction
Authors: Atanda Alfred , Leyden Kathryn , Student Medical 
Published: July 2019

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.
Partial-thickness Rotator Cuff Tear Itself Did Not Cause Shoulder Pain Or Muscle Weakness In Baseball Players
Authors: Mihata Teruhisa , Morikura Rei , Fukunishi Kunimoto , Fujisawa Yukitaka , Kawakami Takeshi , Hasegawa Akihiko , Neo Masashi 
Published: July 2019

Objectives: Rotator cuff tears are common shoulder injuries in baseball players. In some severe tears (i.e. through more than 50% of the cuff’s thickness), conservative treatment does not work well, and surgical treatment is sometimes chosen in an effort to ensure return to play. In contrast, some partial thickness rotator cuff tears do not cause shoulder symptoms, even during throwing motion. The objective of this study was to assess whether partial thickness rotator cuff tears cause shoulder pain and muscle weakness in baseball players. Methods: We studied 87 university baseball players (age: 19.5±0.8 years; baseball career: 11.5±1.6 years). Rotator cuff tendons were ultrasonographically examined (Fig 1), then divided into 4 groups; (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, (4) both supraspinatus and infraspinatus tendons tear. Current shoulder pain and shoulder muscle strength (Dominant/Non-dominant) in abduction, external rotation, and internal rotation were compared using Chi square test and t-test. Results: Forty-one (47%) players were diagnosed with articular-sided partial-thickness rotator cuff tears using ultrasonography. Nineteen tears were in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and the infraspinatus. Tear depth was 4.6±2.3 mm in the supraspinatus and 6.2±3.6 mm in the infraspinatus. There was no significant difference in rate of shoulder pain (p=0.96) and muscle strength among four groups (p=0.15 - 0.70). Conclusion: In this study, articular-sided partial-thickness rotator cuff tears did not cause shoulder pain and muscle weakness in university baseball players. Most of articular-sided partial-thickness rotator cuff tears are tears of the superior capsule but not the rotator cuff tendons, because the superior capsule is attached in the articular half of the greater tuberosity. Therefore, most so-called articular-sided partial-thickness rotator cuff tears may not be pathological tendon tear.
Goals and Adverse Effects: Rate of Concordance Between Patients and Providers
Authors: Duckworth Katharine E. , Morrell Robert , Russell Gregory B. , Powell Bayard , Canzona Mollie , Lichiello Stephanie , Riffle Olivia , Tolbert Aimee , McQuellon Richard 
Published: July 2019

PURPOSE: Adequate understanding of the goals and adverse effects of cancer treatment has important implications for patients’ decision making, expectations, and mood. This study sought to identify the degree to which patients and clinicians agreed upon the goals and adverse effects of treatment (ie, concordance). METHODS: Patients completed a demographic questionnaire, the National Comprehensive Cancer Network Distress Thermometer, the Medical Outcomes Study Social Support Survey, the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire, and a 13-item questionnaire about the goals and adverse effects of treatment. Providers completed a 12-item questionnaire. RESULTS: One hundred patients (51 female) and 34 providers participated (questionnaire return rate mean difference, 5 days; SD, 16 days). Patient and provider dyads agreed 61% of the time regarding the intent of treatment. In cases of nonagreement, 36% of patients reported more optimistic therapy goals compared to providers. Patients and providers agreed 69% of the time regarding the patient’s acknowledgement and understanding of adverse effects. Patients who reported an understanding of likely adverse effects endorsed significantly lower distress scores (mean, 2.5) than those who endorsed not understanding associated adverse effects (mean, 4.1; P = .008). CONCLUSION: Timely data capturing of patient-provider dyadic ratings is feasible. A significant discrepancy exists between a substantial percentage of patients’ and providers’ views of the intent and adverse effects of treatment. Patients were almost always more optimistic about the intent of treatment. Higher rates of distress were noted in cases of discordance. Providers may benefit from conversational feedback from patients as well as other integrated feedback systems to inform them about patient understanding.
Tremor
Authors: Louis Elan D. 
Published: July 2019

ABSTRACT

PURPOSE OF REVIEW
Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.

RECENT FINDINGS
Focused ultrasound thalamotomy of the ventral intermediate nucleus of the thalamus is an emerging and promising therapy for the treatment of essential tremor.

SUMMARY
The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.
Tardive Syndromes
Authors: Friedman Joseph H. 
Published: July 2019

ABSTRACT

PURPOSE OF REVIEW
This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes.

RECENT FINDINGS
The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or “mask,” symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor–blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants.

SUMMARY
Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.