bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing the quality of medicine handover at hospital discharge: a priority setting workshop
Authors: Hattingh H Laetitia , Johnston Kate , Percival Matt , de Wet Carl , Memon Salim , Raleigh Rachael , Morgan Mark A , Baglot Noela , Gillespie Brigid M 
Published: August 2024

Background: When a patient is discharged from hospital it is essential that their general practitioner (GPs) and community pharmacist are informed of changes to their medicines. This necessitates effective communication and information-sharing between hospitals and primary care clinicians. Objective: To identify priority medicine handover issues and solutions to inform the co-design and development of a multifaceted intervention. Method: A modified nominal group technique was used to reach consensus on medicine handover priority areas. The first hour of an interactive 2-hr workshop focused on ranking pre-identified issues drawn from literature. In the second hour, participants identified solutions that they then ranked from highest to lowest priority through an online platform. Descriptive statistics were used to analyse workshop data. Results: In total 32 participants attended the workshop including hospital doctors ( n = 8, 25.0%), GPs and hospital pharmacists ( n = 6 each, 18.8%), consumers and community pharmacists ( n = 4 each, 12.5%), and both hospital and aged care facility nurses ( n = 2 each 6.3%). From the list of 23 issues, the highest ranked issue was high workload and time pressures impacting the discharge process (22/32). From the list of 36 solutions, the participants identified two solutions that were equally ranked highest (12/27 each). They were mandating that patients leave hospital with a discharge summary, including medication reconciliation information and, developing an integrated information technology system where medication summary and notes are accessible for primary, secondary and tertiary health provider. Conclusion: The consensus process highlighted challenges in hospital procedures where potential solutions may be implemented through co-design of a multifaceted intervention to improve medicine handover quality.
Thinking Clearly: A Preventative Cognitive Health Visit Integrated in Primary Care
Authors: Buchanan Amy L. , Kotecha Rachana 
Published: August 2024

Objective: The pandemic contributed to increased mental and cognitive health concerns as well as reduced utilization of preventive and treatment focused care. Deferred care can contribute to negative clinical outcomes, including increased acuity of mental and cognitive health concerns that benefit from early intervention. A new visit type was launched with the aim of reaching patients who may need care and supporting early identification of cognitive and mental health issues. Methods: We developed the Healthy Mind visit, a preventative visit administered by Primary Care Providers (PCPs) within outpatient clinics. The Healthy Mind visit included use of a pre-visit mental health screener as well as a brief computerized cognitive assessment. The clinical interaction focused on identifying mental and cognitive health concerns and developing a plan for wellness. Outcomes data collection occurred over nearly 2.5 years and focused on analyzing booking patterns, depression screening and follow-up, and clinical outcomes such as health confidence and post-visit motivation. Results: The visit was effective in supporting depression screening and follow-up with 29.6% of those participating in a Healthy Mind visit receiving a PHQ-9, and 82.5% of patients with elevated PHQ-9 scores attending a subsequent visit with their PCP. Improvements in health confidence and high patient reported motivation post-visit represent other notable clinical outcomes. The visit also promoted care utilization, with 73.5% of patients who attended a Healthy Mind visit being new to the practice or those who had not attended an appointment in the past 6 months. Conclusions: The Healthy Mind visit, with a focus on mental and cognitive health, was successful in reaching patients who may not have otherwise sought care and supported positive clinical outcomes including early identification and treatment of depression and increased health confidence. Recommendations: These findings reflect the importance of developing innovative programs to connect patients with care, especially those who may have deferred care due to a variety of factors. Focusing on mental and cognitive health with the use of innovative tools such as a computerized assessment, can drive patient interest in care offerings and support positive clinical outcomes.
Paper 02: Combined ACL Reconstruction and Lateral Extra-Articular Procedures Reduce Graft Ruptures in Patients Over the Age of 30 Years Old: A Matched-Pair Analysis of 1102 Patients
Authors: Saithna Adnan , Pettinari Francesco , Ali Ahmad Abed , Alayne Ali , Dutra Vieira Thais , Sonnery-Cottet Bertrand 
Published: August 2024

Objectives: Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) and Lateral Extra-Articular Procedures (LEAP) over isolated ACL reconstruction (ACLR), in terms of reducing graft rupture and reoperation rate. However, most of the published studies included young patients, and there are no studies focusing on population over 30 years old. The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at mid-term follow-up in patients over the age of 30 years old. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. Methods: Patients older than 30 years old who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was achieved to determine whether patients had experienced any complications or reoperations. Graft survivorship was assessed using Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model. Results: Two groups of 551 patients were included in the study with a mean follow-up of 97.19 ± 47.23 months. The mean age for both groups was 37 ± 6.14. The LEAP group was composed by 516 (93.6%) anterolateral ligament and 35 (6.4%) Lemaire. Overall, 19 (1.7%) patients had graft failure, 15 (2.7%) in the No LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significatively associated with the absence of LEAP (hazard ratio [HR], 3.309 [1.088; 10.065], P = 0.0350) and age between 30 to 35 years old (HR 4.533 [1.484; 13.841] P = .0080). A higher rate of reoperation for secondary meniscectomy were founded in the No LEAP group (5.6% vs 2.2%; P = .0031). Conclusions: Patients over 30 years old who underwent combined ACLR and LEAP experienced > 3-fold lower risk of ACL graft failure compared to isolated ACLR. Furthermore, the group without LEAP also experienced a higher rate of reoperation for secondary meniscectomy.
Paper 10: 5-Year Outcomes: Arthroscopic Anatomic Glenoid Augmentation is Superior to Bankart Repair
Authors: Wong Ivan , Pancura Devan , Ma Jie 
Published: August 2024

Objectives: Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. AAGR shows a promising short-term safety profile and clinicoradiological outcomes, suggesting its efficacy is comparable to Bankart repair. Recurrence rates reported in the literature are up to 30% following Bankart repair, however, there is a lack of literature comparing the long-term outcomes of AAGR versus Bankart repair. The purpose was to compare recurrence rates and patient-reported outcomes in patients who received AAGR to patients who received Bankart repair with a minimum of 5-year follow-up. Methods: This was a retrospective study comparing 73 patients who underwent AAGR and 76 patients who underwent Bankart repair consecutively between 2012 and 2018. Patients who had a minimum 5-year follow-up were included in the final analysis. Data collected included demographics, pre- and postoperative Western Ontario Shoulder Instability (WOSI) Index and Disabilities of the Arms, Shoulders, and Hands (DASH) Scores, postoperative complications and recurrence. The primary outcome measure was dislocation recurrence, with secondary outcome measures of patient-reported outcomes and postoperative complications. Results: The demographics and preoperative outcome scores were similar between groups. Patients in the AAGR group presented with significantly higher bone loss (>10%, p<0.05) than those in the Bankart group. There were fewer incidences of recurrence in the AAGR group (1.4%) than the Bankart group (18.4%). There was a significant difference in pre-to-post operative WOSI (p=0.02) and DASH (p=0.01) scores between groups, as well as a significant difference in the number of patients who met the WOSI (p<0.001) and the DASH (p<0.001) minimum clinically important difference threshold, with the AAGR group showing a greater improvement pre- to postoperatively. Conclusions: AAGR has better long-term outcomes and fewer incidences of recurrence compared to Bankart repair.
Paper 11: Open Latarjet Procedure in Athletes with a Minimum of 5 Years Follow Up: An Analysis of Factors Associated with Success
Authors: Doyle Tom , Keogh Carl , Kearney Jack , Kilkenny Conor , Moore Thomas , Albesharah Bader , Khan Sami , Hurley Eoghan , Mullett Hannan 
Published: August 2024

Objectives: The open Latarjet (OL) is a bony transfer procedure used in the treatment of anterior shoulder instability in those at greater risk of recurrence. OL has shown excellent return to play (RTP) and low recurrence in athletes, but there is limited published evidence for outcomes over long-term follow-up. The purpose of this study was to evaluate the outcomes of athletes 5-years postoperatively following the OL procedure, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value (SSV). Methods: A retrospective review of athletes who underwent OL under a single surgeon with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) for pain, satisfaction, SSV, Rowe score, Shoulder Instability-Return to Sport After Injury (SI-RSI) score, whether they would undergo the same surgery again, along with rate, level and timing of RTP, were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction and SSV level. Results: Overall, 126 shoulder in 117 male athletes who underwent OL were included, with a mean age of 22.8 ± 5.8 years old, with mean follow-up of 71.5 ±10.3 months (range 60-84 months). At final follow-up, 92.46% were satisfied/very satisfied, and the mean SSV was 85.5 ± 14.9. Overall, the rate of RTP was 90.5%, with 79.8% returning at the same level or higher level at a mean of 7.3 ± 2.9 months. There were 9 athletes (7.1%) who experienced further dislocation, all during contact sports. In total, 9 (7.1%) athletes had a further operation, 3 (2.4%) of which were for further instability. The mean SI-RSI score was 82.3 ± 27.3 and the mean Rowe score was 84.7 ± 17.4, while the mean VAS score was 2.1 ± 1.9. Linear regression revealed that the SI-RSI score (p < 0.001), SSV (p = 0.003), and RTP (p = 0.049) were associated with satisfaction. The SI-RSI score (p = 0.023), VAS score (p < 0.001), Rowe score (p = 0.028), and RTP (p = 0.013), were all associated with SSV score. Conclusions: At a minimum 5-year follow-up, there was a very high rate of satisfaction, with excellent patient-reported outcomes, low rates of recurrent instability, and a high rate of RTP among athletes. This study identified that the SI-RSI score, VAS score, Rowe score and ability to RTP at the same level were associated with both satisfaction and SSV score.
Paper 46: Modern Hip Arthroscopy for FAIS Delays the Natural History of Osteoarthritis in a Fourth of Patients: A 12-Year Follow-Up Analysis
Authors: Ramkumar Prem , Olsen Reena , Shaikh Hashim , Nawabi Danyal , Kelly Bryan 
Published: August 2024

Objectives: Little is known about the impact of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. The purpose of this investigation was to (1) characterize the natural history of FAIS and (2) understand the impact of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of ten years. Methods: Between 2010-2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary unilateral hip arthroscopy (labral repair, femoroplasty, capsular closure), and minimum ten-year follow-up. The preoperative and minimum ten-year postoperative radiographs of patients were evaluated at each timepoint. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by two independent reviewers. Subgroup analyses were performed. Results: A total of 200 hips from 100 patients were available with 74% follow-up at a mean of 12.0 years were evaluated. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared to 28% (28/100) among operative hips (Table 1). At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time (Table 2). Modern hip arthroscopy conferred a relative risk reduction of 42% in osteoarthritis progression. Borderline dysplasia, age, preoperative Tönnis grade, and alpha angle > 65° were key risk factors in the radiographic progression of osteoarthritis. Conclusions: While the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history was favorably altered in a quarter of patients after arthroscopic correction (Figure 1). Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Mixed patterns of impingement and instability that underwent arthroscopy were the fastest to degenerate.
Paper 51: Characteristics of Unsalvageable Osteochondritis Dissecans Lesions From the ROCK Prospective Cohort
Authors: ROCK Study Group  
Published: August 2024

Objectives: The goal of treatment of osteochondritis dissecans (OCD) is most commonly to preserve the native chondral surface to avoid long term development of osteoarthritis. However, some OCD lesions are not considered amenable to fixation and therefore deemed unsalvageable. Little is known about the OCD subpopulation presenting with such lesions or the detailed characteristics of unsalvageable lesions and their treatment. The purpose of this study is to investigate the characteristics of lesions and their treatment in a large volume of patients with OCD lesions that were determined to be unsalvageable upon presentation. Methods: A review of the ROCK (Research in Osteochondritis of the Knee) study group’s prospective cohort database from 2014 to 2022 was performed to identify condylar lesions in patients <20 years old that were deemed unsalvageable, based on a cartilage resurfacing technique being preliminary treatment performed. Demographic data, radiographic descriptors, intraoperative lesion findings, and treatments performed were analyzed. Treatments for lesions considered unsalvageable were categorized as marrow stimulation (e.g. microfracture, McFx), osteochondral autograft transplantation surgery (e.g. OATS), osteochondral allograft transplantation (OCA), and cultured chondrocyte/cell-based therapy (e.g. MACI). Comparative analysis was performed between the cohort with unsalvageable lesions and those who underwent lesion preservation techniques associated with unstable lesions (ie fixation). Results: A total of 590 out of 1291 (45.7%) surgically treated OCDs (mean age 13.7 years old, 2:1 male: female) were included with 10.8% considered unsalvageable. The distribution of techniques for unsalvageable lesions was McFx (4.4%), OCA (2.9%), and MACI (2.0%). Compared to the lesion preservation cohort, the unsalvageable was older (15.9 vs. 14.6; p=-0.006), had a higher body mass index (24.2 vs. 22.7; p<0.001), and was more likely to have had prior surgery (33.3% vs. 10.3%; p<0.001). The presence of bone in the progeny, a linear signal on MRI, and bone edema were less common in unsalvageable lesions (p<0.05 for all). A multivariate analysis model resulted in significant associated in unsalvageable OCD lesions with prior surgery (p<0.001, OR 1.97, CI 2.736-19.929). Conclusions: OCD patients with unsalvageable lesions are more likely to be identified in those that have undergone prior surgical procedure, but MRI signs of instability still undergo preservation techniques. Given the implications of long-term joint health, comparative analyses of outcomes of the different cartilage resurfacing techniques for such lesions is of critical importance for future study.
Poster 152: Clinical Outcomes for Dermal Allograft Glenoid Augmentation in Patients With Anterior Shoulder Instability and Subcritical Bone Loss
Authors: Bailey Kevin , Wang Patrick , Akhavan Sam , Wells Corey 
Published: August 2024

Objectives: To assess minimum 1-year magnetic resonance imaging (MRI) and clinical outcomes for 20 cases of dermal allograft augmentation of subcritical glenoid bony defects. Methods: Twenty patients with subcritical glenoid bone loss underwent arthroscopic dermal allograft augmentation along with labral repair. All patients were evaluated with postoperative MRI at a minimum of 12-month follow-up. Preoperative and postoperative patient-reported outcomes were collected including University of California Los Angeles Shoulder (UCLA) scores, Visual Analogue Scale (VAS) scores, and American Shoulder and Elbow Surgeons (ASES) scores. Scores were assessed for statistical significance using the analysis of variance test. Results: Average postoperative follow-up was 19 months (range 12-54 months). The average preoperative bony defect size was 16% (range 6.6-39%), with 19 of the patients having defects under 20%. Postoperative MRIs (Figure 1) revealed an average of 32% (range 27.7-37.4%) increase in glenoid diameter size and the average glenoid size was restored to 102.3% (range 94-114%), with excellent incorporation of the graft. There were statistically significant improvements in preoperative and postoperative scores with respect to UCLA scores (21.25 to 33.7, p < 0.05), VAS scores (5.4 to 0.2, p < 0.05) and ASES scores (58.6 to 96.4, p < 0.05). One patient had a recurrent traumatic dislocation (5%) and underwent a Latarjet procedure at 13 months from the index surgery. At the time of the Latarjet, the dermal allograft was harvested and sent for histologic analysis. Histologic analysis of the glenoid augmentation graft at the time of revision surgery revealed recellularization with fibroblast-like cells, revascularization, and incorporation of the graft into the surrounding tissue with bony ingrowth. (Figure 2) Conclusions: Subcritical glenoid bone loss has been associated with high failure rates when treated with standard labral repair. While a Latarjet procedure can provide stability, high complication rates and the risk of long-term arthritis makes this procedure less than ideal when bone loss is under 20%. Arthroscopic labrum repair with the addition of a dermal allograft is a viable option in patients with subcritical bone loss. In the case series with 1-year follow-up, 20 patients who underwent arthroscopic labrum repair with the addition of a dermal allograft had a significant improvement in outcome scores, and excellent incorporation of the graft as seen on MRI at 12 months from the index procedure. In the 1 failure that later underwent revision surgery, histologic analysis demonstrated recellularization and revascularization, with incorporation of the graft.
Poster 204: Periacetabular Osteotomy: A Case Series of More Than 500 Cases with Sub-Analysis Based on Patient Age at Surgery
Authors: Kraeutler Matthew J. , Girardi Nicholas G. , Lee Jessica H. , Mei-Dan Omer 
Published: August 2024

Objectives: The purpose of this study is to report outcomes of a unique periacetabular osteotomy (PAO) technique for hip dysplasia developed at our institution. Methods: This was a retrospective, single-surgeon case series of prospectively collected data on all primary PAOs performed by the senior surgeon between April 2015 and April 2023. The technique has previously been described in the literature. This technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight bearing postoperatively. All patients underwent hip arthroscopy for treatment of intra-articular pathology and cam-type femoroacetabular impingement 3 to 10 days prior to PAO. Some patients also underwent de-rotational femoral osteotomy (DFO) for treatment of femoral torsion abnormalities. Revision PAOs or cases with concomitant hamstring or gluteus repair were excluded. Follow-up occurred at 6 weeks; 3 and 6 months; and 1, 2, and 5 years postoperatively. Patient-reported outcomes (PROs) included the Non-Arthritic Hip Score (NAHS) and the 12-item International Hip Outcome Tool (iHOT-12). A subanalysis was performed to compare 2-year PROs between 3 groups of patients based on age at the time of surgery: 13 to 29 years old, 30 to 39 years old, and >40 years old. Results: A total of 511 hips underwent primary PAO during the study period. The mean age at the time of surgery was 31 years old (range, 13 to 61 years old). Female patients accounted for 90% of hips included in this study. A concomitant DFO was performed in 25 hips (4.9%). The mean NAHS improved from 58.7 preoperatively to 85.9 at 2-year follow-up (p < 0.0001) and 83.4 at 5-year follow-up (p < 0.0001). The mean iHOT-12 improved from 41.0 preoperatively to 77.5 at 2-year follow-up (p < 0.0001) and 72.7 at 5-year follow-up (p < 0.0001). No significant differences were found in postoperative NAHS (p = 0.82) or iHOT-12 scores (p = 0.73) between age groups. Conclusions: PAO enables corrective realignment of symptomatic acetabular dysplasia with good outcomes up to 5 years postoperatively. Careful patient selection can result in good outcomes regardless of patient age at the time of surgery.