bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Portfolios for Assessment of Resident Teaching Skills
Authors: Donato Anthony A. , Harris Ilene 
Published: July 2013

Abstract

Background
Portfolios are effective instruments for assessment of teaching skills among professional teachers and have recently been adapted in medical education. However, scoring rubrics are needed to effectively guide assessors.

Intervention
Portfolio assessors reviewed and made assessment comments about the resident-as-teacher sections of 11 internal medicine residents' electronic portfolios and discussed their assessments in an assessor group discussion. We performed qualitative analyses of written and oral comments. Major themes were identified, and member checking and triangulation with the literature was performed to evaluate the trustworthiness of the qualitative analysis.

Results
Three faculty educators reviewed and commented on 241 uploaded e-portfolio documents accompanying reflections. Three major themes were identified: Application of Teaching Skills, Presentation Skills, and Insights as a Teacher. Themes and subthemes matched closely to several components of the conceptual framework of effective presentations formulated in Glassick standards for scholarly work, as well as themes found in assessments of professional teachers' portfolios.

Conclusions
Assessments of portfolios by experienced faculty educators appear to be useful for identifying many important facets of formal teaching presentations and may be useful for creation of a scoring rubric.
Early Feedback on the Use of the Internal Medicine Reporting Milestones in Assessment of Resident Performance
Authors: Aagaard Eva , Kane Gregory C. , Conforti Lisa , Hood Sarah , Caverzagie Kelly J. , Smith Cynthia , Chick Davoren A. , Holmboe Eric S. , Iobst William F. 
Published: July 2013

Abstract

Background
The educational milestones were designed as a criterion-based framework for assessing resident progression on the 6 Accreditation Council for Graduate Medical Education competencies.

Objective
We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and Systems-Based Practice.

Methods
All participants in our mixed-methods study were members of competency committees in internal medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Surveys were tabulated using descriptive statistics. Conventional content analysis method was used to assess the focus group data.

Results
Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice.

Conclusions
Draft reporting milestones for 2 competencies demonstrated significant construct validity in both the content and response process and the perceived utility for the assessment of resident performance. To ensure success, additional feedback from the internal medicine community and faculty development will be necessary.
Financial Implications of Different Interpretations of ACGME Anesthesiology Program Requirements for Rotations in the Operating Room
Authors: Backeris Mark E. , Forte Patrick J. , Beaman Shawn T. , Metro David G. 
Published: July 2013

AbstractBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity.ObjectiveWe quantified and compared the costs of replacing residents by using two different working patterns that are compliant with the ACGME anesthesiology program requirements: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR.MethodsWe calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons.ResultsDepending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from $236,000 to $581,876, assuming a 50-hour resident work week, and $373,400 to $931,001, assuming an 80-hour resident work week. This cost was per resident over the entire 3 years of their residency.ConclusionsVarying the amount of time residents work in the OR (as allowed under ACGME program requirements) has significant financial implications over a 36-month anesthesiology residency. The larger the residency, the more significant will be the impact on the department and sponsoring institution.
Twenty-one Years Clinical Experience of 461 Femoral Revision Total Hip Arthroplasties with a Calcar Replacement Prosthesis
Authors: Berend Michael E , Ritter Merrill A , Meding John B , Davis Peter 
Published: July 2013

ABSTRACT
Outcomes following femoral reconstruction during revision total hip arthroplasty (THA) may be influenced by femoral deformity, fixation interface and implant type. The purpose of this study was to determine the long-term clinical and radiographic outcomes of a series of 461 femoral reconstructions with a calcar replacement prosthesis performed over a 21-year period. Multivariate analysis was performed based on age, femoral Paprosky class, implant length, modularity and mode of failure. Mean follow-up was 5.6 years. There were 18 stem revisions for an overall stem survivorship of 96.3%. Infection (n = 13) and dislocation (n = 2) were the most common indications for revision. Two stems were revised for aseptic loosening for an aseptic failure rate of 0.4%. Increased femoral deformities had higher revision rates due to all failure modes (p < 0.006). Overall complication rate was 13.4%, most commonly instability, infection and periprosthetic fracture, but most often did not lead to stem revision. We conclude that an uncemented bowed calcar replacement prosthesis has excellent clinical results in a wide range of femoral deformities, and most complications are unrelated to the femoral implant. All implants in this study have FDA approval.
Berend ME, Ritter MA, Meding JB, Davis P. Twenty-one years Clinical Experience of 461 Femoral Revision Total Hip Arthroplasties with a Calcar Replacement Prosthesis. The Duke Orthop J 2012;2(1):1-4.
Total Hip Arthroplasty after Vascularized Fibular Grafting
Authors: Vail Thomas P , Dimitroulias Apostolos , Hodrick Jeff , Brand Rusty , Viens Nicholas , Attarian David E 
Published: July 2013

ABSTRACT

Background
Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure.

Materials and methods
We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings.

Results
The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS).

Conclusion
Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty.
Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.
Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging
Authors: Manvar Ankur M , Bhalani Sheetal M , Garrigues Grant E , Major Nancy M 
Published: July 2013

ABSTRACT

Objective
To improve the magnetic resonance imaging (MRI) and magnetic resonance arthrogram (MRA) interpretation of a ‘meniscoid-type’ superior labrum vs a superior labral tear by evaluation of a simple sign.

Materials and methods
Retrospective analysis of our institution's shoulder MRIs and MRAs yielded 144 patients thought to have a superior labral tear. Fifty-five patients had arthroscopy. Analysis of the orthopaedic database for superior labral repair surgeries performed in the same time frame yielded seven additional patients without prospective MRI/MRA diagnosis of superior labral tear.

Results
Two of 17 (11.8%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy. Both cases failed to have extension of high signal intensity behind the biceps anchor to the most posterior oblique coronal image. Nine of 38 (23.7%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy, but a meniscoid-type superior labrum. Four of seven patients known to have superior labral tears by arthroscopy but incorrectly diagnosed as meniscoid-type superior labrum on MRI or MRA, were retrospectively found to have extension of high signal intensity in the superior labrum to the most posterior image.

Conclusion
Signal abnormality that continues through the remainder of the superior labrum posterior to the biceps anchor indicates a superior labral tear. Absence of this sign in the setting of more anterior high signal under the labrum may indicate a meniscoid variant.
Manvar AM, Bhalani SM, Garrigues GE, Major NM. Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging. The Duke Orthop J 2012;2(1):44-49.
Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)
Authors: Nasca Richard J 
Published: July 2013

ABSTRACT
Osteolysis may occur following lumbar interbody fusion procedures in which recombinant human bone morphogenetic protein-2, more commonly known as rhBMP-2, is used. The actual incidence of this process is unknown. Osteolysis results from an osteoclastic, rather than an osteoblastic response to rhBMP-2 and its carrier on trabecular vertebral bone, early in the sequence of bone graft healing. This osteoclastic response may represent an idiosyncratic reaction in those affected. The patient usually does well in the immediate postoperative period with resolution of their preoperative complaints of axial and radicular pain. However, at 4 to 12 weeks following the index surgery, the patient experiences a recurrence of severe back and radicular pain corresponding to the dermatomal level(s) operated upon. Laboratory studies including erythrocyte sedimentation rate, C reactive protein, and cultures are negative for infection. Imaging studies show areas of bone destruction and cyst formation containing fluid. In the majority of post-operative patients with osteolysis, there is an osteoblastic healing response with symptom resolution. Supportive, nonoperative care is usually effective in managing the patient.
Nasca RJ. Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2). The Duke Orthop J 2012;2(1):50-54.
Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques
Authors: Adams Samuel B , Viens Nicholas A , Sutter E Grant , Mangiapani Daniel S 
Published: July 2013

ABSTRACT

Background
Ankle fractures are among the most common injuries sustained by older patients. Management of these fractures remains both controversial and challenging. Clinical outcomes from a series of older patients treated surgically for unstable ankle fractures were reviewed to determine the effects of patient, injury and fixation factors on postoperative outcomes.

Materials and methods
A retrospective series of 58 consecutive patients age 60 years and older with 63 unstable ankle fractures treated surgically by a single surgeon over a 5- year period was reviewed. Forty-seven females (81.0%) and 11 males (19.0%) with a mean age of 72.6 (range, 60 to 88.4) years made up the sample.

Results
The most common injuries were OTA type 44-B2 (66.7%) or Lauge-Hansen supination-external rotation type-4 (76.2%) fractures. Forty-seven (74.6%) fractures were due to a low energy mechanism. Nineteen (30.6%) injuries were fracturedislocations and seven (11.1%) fractures were open. Augmented techniques were used in 31 (49.2%) cases overall. Ten (17.2%) patients experienced postoperative complications. Males, patients with fracture dislocations, high energy fractures, and open fractures experienced significantly worse outcomes (p < 0.05). Age, fracture type and the use of augmented technique were not predictive of clinical outcomes.

Conclusion
Overall in this series, older patients treated surgically for ankle fractures experienced good clinical outcomes. Further investigations are required in order to find patient and injury factors that can assist preoperative planning and predict outcomes.
Viens NA, Sutter EG, Mangiapani DS, Adams SB, Zura RD. Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques. The Duke Orthop J 2013;3(1):25-31.
The Anatomic Variability of the ‘Rotator Interval Capsule’: A Comparison of Arthroscopic and Open Investigations
Authors: Svoboda Steven J , Magnussen Robert A 
Published: July 2013

ABSTRACT

Introduction:
Variably present rotator interval capsular openings (RICOs) complicate anterior shoulder capsular anatomy. Open and arthroscopic approaches may lead to differences in the appearance and size of RICOs. The purposes of this study are to: (1) Confirm that RICOs viewed from inside and outside the joint are the same structures, and (2) compare the size of RICOs when approached in an open manner vs arthroscopically.

Materials and methods
Twelve fresh cadaveric shoulders were randomized to two different approaches in order to identify and mark RICOs. In the first group, the superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) were marked arthroscopically. Sutures were placed in these structures in an open fashion. Repeat arthroscopy was then performed to determine whether the sutures penetrated the marked SGHL and MGHL. In the second group, these steps were reversed and arthroscopically placed sutures were evaluated in an open manner. Dimensions of the RICOs were measured both arthroscopically and open in each shoulder.

Results
All specimens had a RICO visualized both arthroscopically and open. Five of 12 specimens had an additional second RICO. RICO size measurements were similar for the arthroscopic and open techniques. Sutures placed via both the arthroscopic and open technique were noted to penetrate the marked structures in all cases. In addition, sutures placed through the SGHL while viewing arthroscopically always captured the coracohumeral ligament (CHL). Sutures placed through the SGHL with an open technique never engaged the CHL.

Conclusion
The capsular openings in the rotator interval were confirmed to be the same structures when observed arthroscopically and through an open approach.
Svoboda SJ, Taylor DC, Magnussen RA. The Anatomic Variability of the ‘Rotator Interval Capsule’: A Comparison of Arthroscopic and Open Investigations. The Duke Orthop J 2013;3(1):54-60.
Relative Age Effect: Beyond the Youth Phenomenon
Authors: Garrett William E , Joyner Patrick W , Mallon William J , Kirkendall Donald T 
Published: July 2013

ABSTRACT
The relative age effect (RAE) refers to the oversampling of youth born in the first quarter of the birth year when auditioning for selected age-restricted sports. This advantage conferred to the older athlete is the result of the older athlete being more physically and emotionally mature and, therefore, assumed to be a more advanced player. Chosen players will be exposed to better coaching, competition, teammates, and facilities in their respective sport. This RAE was first described in 1988 for ice hockey, and has since been described in numerous other sports, with a vast majority of the literature demonstrating an RAE in small cohorts, as well as in team sports and sports that incorporate a ball (i.e. soccer, basketball, hockey, etc). We extended the exploration of an RAE beyond specific sports by examining the birth quarter of over 44,000 Olympic athletes birth dates, born between 1964 and 1996. Our hypothesis is that not only did an RAE exist in Olympic athletes, but that it existed across selected categories of athletes (by gender), such as team vs individual sports, winter vs summer athletes, and sports using a ball vs those not using a ball. The fractions of births in the first vs the fourth quarter of the year were significantly different (p < 0.001) from each other for the summer and winter Olympians, ball and nonball sports, and team as well as individual sports. This significant difference was not gender specific. We found the general existence of an RAE in Olympic athletes regardless of global classification.
Joyner PW, Mallon WJ, Kirkendall DT, Garrett WE Jr. Relative Age Effect: Beyond the Youth Phenomenon. The Duke Orthop J 2013;3(1):74-79.
Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty
Authors: Nunley James A , Leversedge Fraser J , Wray Walter H , Aldridge J Mack 
Published: July 2013

ABSTRACT

Purpose
A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury.

Materials and methods
We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria.

Results
Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons.

Conclusion
Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed.

Type of study/Level of evidence
This is a retrospective case series representing a level IV study.

Funding
No outside funding was received and the authors have no conflicts of interest to disclose.
Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.
Points in Time: Direct Radiocarbon Dates on Great Basin Projectile Points
Authors: Smith Geoffrey M. , Barker Pat , Hattori Eugene M. , Raymond Anan , Goebel Ted 
Published: July 2013

AbstractTypological cross-dating is the primary means by which archaeological sites are placed into chronological frameworks. This approach relies on the assumption that artifacts at undated sites—usually projectile points—are coeval with similar artifacts found at Other, dated sites. While typological cross-dating is necessary in regions dominated by open-air lithic scatters, the approach can be problematic when undated and dated sites are separated by significant distances. Here, we present radiocarbon dates on projectile points with organic hafting material still attached or found within organic storage bags. Our results provide unequivocal ages for various morphological projectile point types at several Great Basin locales and should be useful to researchers seeking local age estimates for those point types, which often involves relying on chronological data from more distant sites. The results also highlight potential issues with uncritically applying typological cross-dating using typologies based on metric attributes, and in two cases, suggest the need to revise the age ranges for certain point styles in the western Great Basin.