bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL
Authors: Leary Jessica , Lynskey Timothy , Muller Andrew 
Published: May 2024

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.
AN EIGHT-YEAR RETROSPECTIVE REVIEW OF FLEXOR SHEATH INFECTIONS
Authors: Gerlach Sean , Chou Justin , Lee Michael , Morris Holly 
Published: May 2024

IntroductionFlexor sheath infections require prompt diagnosis, and management with intravenous antibiotics and/or surgical washout followed by physiotherapy. Complication rates as high as 38% have been reported.MethodsA retrospective review was carried out of all patients between January 2014 and May 2021 attending with a suspected or confirmed diagnosis of flexor sheath infection. Age, gender, co-morbidities, cause of infection, management, and subsequent complications recorded.ResultsOf 132 patients, 67% were male. Mean age was 50.8 years. A trend towards fewer presentations each year with animal bites, foreign bodies and penetrating trauma as the main cause of infection. 89% (n=117) required admission, 77% (n=101) underwent a surgical washout. 11% (n=15) were treated as an outpatient. 7% (n=9) suffered a complication.DiscussionWhilst flexor sheath washout continues to be the treatment of choice, 23% of patients were managed with intravenous antibiotics, 48% of these purely via an outpatient service. Our overall complication rate was 7%.
RISK FACTORS FOR MENISCAL REPAIR FAILURE FOLLOWING CONCURRENT PRIMARY ACL RECONSTRUCTION: RESULTS FROM THE NEW ZEALAND ACL REGISTRY
Authors: Clatworthy Mark , Rahardja Richard , Young Simon , Love Hamish 
Published: May 2024

BackgroundAnterior cruciate ligament (ACL) reconstruction with concomitant meniscal injury occurs frequently. Meniscal repair is associated with improved long-term outcomes compared to resection but is also associated with a higher reoperation rate. Knowledge of the risk factors for repair failure may be important in optimizing patient outcomes.PurposeThis study aimed to identify the patient and surgical risk factors for meniscal repair failure, defined as a subsequent meniscectomy, following concurrent primary ACL reconstruction.MethodsData recorded by the New Zealand ACL Registry and the Accident Compensation Corporation, the New Zealand Government's sole funder of ACL reconstructions and any subsequent surgery, was reviewed. Meniscal repairs performed with concurrent primary ACL reconstruction was included. Root repairs were excluded. Univariate and multivariate survival analysis was performed to identify the patient and surgical risk factors for meniscal repair failure.ResultsBetween 2014 and 2020, a total of 3,024 meniscal repairs were performed during concurrent primary ACL reconstruction (medial repair = 1,814 and lateral repair = 1,210). The overall failure rate was 6.6% (n = 201) at a mean follow-up of 2.9 years, with a failure occurring in 7.8% of medial meniscal repairs (142 out of 1,814) and 4.9% of lateral meniscal repairs (59 out of 1,210). The risk of medial failure was higher in patients with a hamstring tendon autograft (adjusted HR = 2.20, p = 0.001), patients aged 21–30 years (adjusted HR = 1.60, p = 0.037) and in those with cartilage injury in the medial compartment (adjusted HR = 1.75, p = 0.002). The risk of lateral failure was higher in patients aged ≤ 20 years (adjusted HR = 2.79, p = 0.021) and when the procedure was performed by a surgeon with an annual ACL reconstruction case volume of less than 30 (adjusted HR = 1.84, p = 0.026).ConclusionWhen performing meniscal repair during a primary ACL reconstruction, the use of a hamstring tendon autograft, younger age and the presence of concomitant cartilage injury in the medial compartment increases the risk of medial meniscal repair failure, whereas younger age and low surgeon volume increases the risk of lateral meniscal repair failure.
TOTAL KNEE ARTHROPLASTY FOLLOWING SEPTIC ARTHRITIS: A LONGITUDINAL STUDY OVER 20 YEARS
Authors: Wells Zoe , Zhu Mark , Sim Katarina , Schluter Dean , Young Simon W 
Published: May 2024

ObjectivesPost-infective arthritis is an important sequalae of septic arthritis(SA). While total knee arthroplasty(TKA) is an effective treatment for said arthritis, previous SA brings challenges for treatment planning. Using prospectively collected data from a cohort of patients with knee SA, this study aims to determine the proportion of patients requiring eventual TKA, and risk factors of developing prosthetic joint Infection(PJI).MethodsAll cases of 1st episode knee SA from 01/01/2000 to 31/12/2020 were identified in the Auckland region. Patient records and NZJR records of all cases were searched to identify subsequent TKA. PJI following arthroplasty was identified using ICM criteria.Univariate and multivariate analysis was performed to determine risk factors for developing PJI.Results854 cases of native SA were identified. Of these, 71 (8.3%) progressed to TKA. Average time from completion of SA treatment to TKA was 3.8 years (SD 3.4). At an average follow-up of 7.8 years(1–19.6), 11(15.5%) developed PJI and required reoperation in the form of; DAIR (n =5), revision (n= 6). A further 4 were readmitted for superficial infections. Five-year and ten-year implant survival was 90.0% and 87.1%, significantly lower than average survival of TKA in the NZJR (97.3% at 5 years and 95.7% at 10). Average time between completion of SA treatment and TKA was 2.1 years in those developing PJI, vs 4.1 years in those who did not(p = 0.0019). 4.8% of cases developed PJI when TKA was performed >5 years after SA, compared with 20% risk of PJI within 5 years(p=0.16). Multivariate analysis showed no significant impact of pre-defined medical risk factors or demographic on outcomes.ConclusionA significant percentage of patients required TKA following knee SA. Time lapsed from SA treatment completion to TKA is an important risk factor for developing PJI.
CLAVICULAR OSTEOTOMY FOR SURGICAL EXPOSURE OF THE SHOULDER JOINT: FUNCTIONAL OUTCOMES, COMPLICATIONS, AND SURGICAL TECHNIQUE. A REGIONAL NZ EXPERIENCE
Authors: Penumarthy Rushi , Turner Perry 
Published: May 2024

AimClavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand.MethodsA retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS).Oxford Shoulder Score (OSS) and a Simple Shoulder Test (STT) were used to assess functional outcomes and were compared with the reported literature. Operative times and Complications were reviewed.Results66 patients were included in the study. 33 patients in the OS group and 33 in the N-OS group. No difference in age, sex, indications for operative intervention and the surgery provided was identified. No significant difference in operative time between groups (N-OS 121 minutes; OS 128 minutes).No clinically significant difference was identified in the OSS (N-OS; mean 38 vs OS 39) or the STT (N-OS 8.3 vs OS 9). The outcomes scores of both groups are in keeping with published literature.Two post operative clavicle fractures, one prominent surgical knot occurred in the OS that required further surgical intervention. Two cases of localized pain over the clavicle and one case of the prominent lateral clavicle were reported in the OS group. Two cases of localized pain over clavicle reported in the N-OS group.ConclusionUse of clavicular osteotomy is not associated with inferior patient reported. The osteotomy introduces specific risks, however, the study provides evidence that these complications are infrequent and avoidable. Surgeons should feel confident in using this adjunct when exposure to the shoulder is difficult.
RISK FACTORS FOR MORBIDITY AND MORTALITY FOLLOWING HIP FRACTURES: AN ANZHFR STUDY
Authors: Zhu Mark , Mayo Christopher , Rahardja Chris , Seow Min Yee , Young Simon 
Published: May 2024

AimsUsing the Australian and New Zealand Hip Fracture Registry (ANZHFR) data, this study aimed to identify patient, fracture, and management factors associated with survival, mobility and residential status at 120 days. This will allow future interventions to target modifiable risk factors to improve the overall care of patients with hip fractures.MethodsAll NZ patients from 2018 – 2020 were included. Baseline demographics, management factors, and outcomes were recorded. Key outcomes were change in walking status, residential status and survival at 120 days. Univariate analysis was performed to compare differences in demographics, surgical and management factors for the key variables. Multivariate analysis was conducted to identify factors independently associated with outcomes.ResultsData from 9432 patients were analysed. The average age was 82.8 years (SD 9.8). 70.3% were females. 39.5% of patients were cognitively impaired on admission, 71.4% were from their own residence.At 120 days post injury, 10.9% (1029) had died 1029 (10.9%), 15.3% (1034) had a decrease in their residential status, 44.9% (2966) had a reduction in walking ability. On multivariate analysis; older age (RR1.1/yr, p<0.001), male sex (RR1.7, P<0.001), cognitive impairment (RR2.2, p<0.001) and ASA>3 (RR3.7, p=0.015) were risk factors for death. Similarly, increasing age (RR1.1 per year, p<0.001), cognitive impairment (RR1.2, p=0.04) and ASA>3 (RR2.9, p=0.047) were significant risk factors for worsening residential status. Decreasing mobility was associated with extracapsular fractures (RR1.4, p=0.01).After adjustment for demographics, ASA and fracture type, performing total hip arthroplasty was preventative for both worsening residential status (RR0.23, p<0.001) and decreasing walking ability (RR 0.21, p<0.001). There was no significant survival, functional or revision differences for other fixation types.ConclusionThere is a significant decline in walking ability post hip fracture which may be a key contributor to long-term morbidity. The benefits of THA in preserving mobility and independence should be further investigated. Additional discharge planning and multi-disciplinary team input are likely required for high-risk patients of older age, with cognitive impairment and extracapsular fractures.
OUTCOMES OF SINGLE VERSUS COMBINATION FIXATION IN DISTAL FEMUR FRACTURES: A CHRISTCHURCH EXPERIENCE
Authors: Zhang J. , Miller R. , Chuang T. 
Published: May 2024

IntroductionDistal femur fractures have traditionally been stabilized with either lateral locking plate or retrograde intramedullary nail. Dual-plates and nail-plate combination fixation have the theoretical biomechanical advantage, faster union and allows patients to weight bear immediately.The aim of this study is to compare single vs combination fixation, and evaluate outcomes and complications.MethodWe retrospectively reviewed all patients over 60, admitted to Christchurch Hospital, between 1st Jan 2016 and 31st Dec 2022, with an AO 33A/33B/33C distal femur fracture. Patient demographics, fracture characteristics, operation details, and follow up data were recorded.Primary outcomes are union rate, ambulatory status at discharge, and surgical complications. Secondary outcomes include quality of reduction, operation time and rate of blood transfusions.Results114 patients were included. (92 single fixation, 22 combination fixation).Baseline demographic data and fracture characteristics did not differ between the cohorts.There was no difference in the rate of union or time to union between the two cohorts. Combination fixation patients were allowed to weight-bear as tolerated significantly more than single fixation patients (50% vs 18.9%, p=0.003). There was no difference in length of hospital stay, transfusion, complication and mortality rates.Medial translation of the distal articular block was significantly lower in the combination fixation cohort (1.2% vs 3.4%, p=0.021). Operation time was significantly longer in the combination fixation cohort (183mins vs 134mins, p<0.001).DiscussionThe results show no difference in achieving union or time to union, despite better quality of fracture reduction with dual fixation. This differs to previously published literature. The clear benefit of combination fixation is immediate weight-bearing. As expected, operation times were longer with combination fixation, however this did not translate to more complications.ConclusionCombination fixation allows earlier weight bearing, at the cost of longer operation times.
Curriculum Making Across Sites of Activity in Upper Secondary School Vocational Education and Training: A Review of the Research in Sweden
Authors: Alvunger Daniel 
Published: May 2024

Purpose: This paper presents a qualitative systematic review of Swedish research on vocational education and training (VET) at the upper secondary school level over the past 20 years. The review is based on a theoretical model on curriculum making as social practice that may serve as model for comparative studies between countries. By introducing the model, the ambition is to open for new perspectives on VET curriculum in policy and practice. Questions regarding key themes and the interplay of discourses and processes across multiple sites in the education system have not been addressed in previous systematic reviews of Swedish VET research.
Methods: The methodological approach in the present paper is a qualitative systematic research review with an integrative and interpretative purpose and research design. The qualitative review is based on the conceptual model of curriculum making as social practice, seeking to capture the inherent complexity and porous boundaries of education systems and movements of ideas, discourses and actors between sites of activity. The model is used for mapping the research, and a content analysis for identifying main themes and emphases and exploring and discussing the potential gaps that may inform future international research studies.
Findings: The results show that the research is focused on the micro and nano sites of curriculum making, with connections to macro site activities of national curriculum policy enactment. Research focusing on the macro site of activity has an emphasis on national policy and policymaking regarding the relationship between academic and vocational knowledge/programmes and apprenticeship and employability. In the micro and nano sites of activity – which comprise the majority of the research – the main themes are vocational knowing and identity, teaching, learning and assessment practices and work-based learning.
Conclusion: An observation is the absence of principals and middle leaders as actors and informants in the studies. There is little evidence of actors moving between sites of activity and the meso site of activity only comprise a very small part of the research. In this respect, there is a potential gap to be explored, not least regarding how local curricula and syllabi are made and shaped in terms of the influence of representatives from local authorities, companies, trade unions, employer associations, universities and regional agencies. Curriculum making as social practice has the potential to be used for comparative international studies and as a framework that takes national differences in VET education systems into account.
Children and young people’s body mass index measures derived from routine data sources: A national data linkage study in Wales
Authors: Griffiths Lucy J. , Rafferty James , Fry Richard , Daniels Helen , Dezateux Carol , Firman Nicola , Pouliou Theodora , Stratton Gareth , Mizen Amy , Lyons Ronan A. , Watkins Alan , Davies Jo , Bailey Rowena 
Published: May 2024

Background
Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of unhealthy childhood weight. We examined and compared the presence and representativeness of children and young people’s (CYPs) BMI recorded in two routinely collected administrative datasets: general practice electronic health records (GP-BMI) and the Child Measurement Programme for Wales (CMP-BMI), which measures height and weight in 4-5-year-old school children. We also assessed the feasibility of combining GP-BMI and CMP-BMI data for longitudinal analyses.

Methods
We accessed de-identified population-level GP-BMI data for calendar years 2011 to 2019 for 246,817 CYP, and CMP-BMI measures for 222,772 CYP, held within the Secure Anonymised Information Linkage Databank. We examined the proportion of CYP in Wales with at least one GP-BMI record, its distribution by child socio-demographic characteristics, and trends over time. We compared GP-BMI and CMP-BMI distributions. We quantified the proportion of children with a CMP-BMI measure and a follow-up GP-BMI recorded at an older age and explored the representativeness of these measures.

Results
We identified a GP-BMI record in 246,817 (41%) CYP, present in a higher proportion of females (54.2%), infants (20.7%) and adolescents. There was no difference in the deprivation profile of those with a GP-BMI measurement. 31,521 CYP with a CMP-BMI had at least one follow-up GP-BMI; those with a CMP-BMI considered underweight or very overweight were 87% and 70% more likely to have at least one follow-up GP-BMI record respectively compared to those with a healthy weight, as were males and CYP living in the most deprived areas of Wales.

Conclusions
Records of childhood weight status extracted from general practice are not representative of the population and are biased with respect to weight status. Linkage of information from the national programme to GP records has the potential to enhance discussions around healthy weight at the point of care but does not provide a representative estimate of population level weight trajectories, essential to provide insights into factors determining a healthy weight gain across the early life course. A second CMP measurement is required in Wales.
The self-reported driving and pedestrian behaviour of adults with developmental coordination disorder
Authors: Shipley Isobel , Esselaar Maaike , Wood Samuel , Parr Johnny V. V. , Wright David J. , Wood Greg 
Published: May 2024

Background
Developmental coordination disorder (DCD) affects movement coordination, but little is known about how the condition impacts the behaviours of car drivers and pedestrians.

Aims
This study examined the self-reported driving and pedestrian behaviours of adults with Developmental Coordination Disorder (DCD).

Methods and procedures
One hundred and twenty-eight participants (62 adults with DCD vs. 66 TD adults) responded to an online survey asking them about their perceptions of confidence and self-reported driving and pedestrian behaviours in the real-world.

Outcomes and results
Results suggested that adults with DCD felt less confident and reported more lapses in attention (e.g., forgetting where their car was parked) and errors (e.g., failing to check their mirrors prior to a manoeuvre) when driving compared to typically developed (TD) adults. Adults with DCD also reported feeling less confident and reported less adherence to road traffic laws (e.g., not waiting for a green crossing signal before crossing the road) when walking as pedestrians.

Conclusions and implications
These results offer some much-needed insight into the behaviours of those with DCD outside of the laboratory environment and underline the need for research investigating the driving and pedestrian behaviours of individuals with DCD in ‘real-world’ contexts.
Cost-effectiveness of avelumab first-line maintenance therapy for adult patients with locally advanced or metastatic urothelial carcinoma in France
Authors: Porte Fanny , Granghaud Anna , Chang Jane , Kearney Mairead , Morel Aya , Plessala Ingrid , Cawston Hélène , Roiz Julie , Xiao Ying , Solbes Marie-Noelle , Lambert Prisca , Ravaud Alain , Loriot Yohann , Thiery-Vuillemin Antoine , Lévy Pierre 
Published: May 2024

Background
This study evaluated the cost-effectiveness of avelumab first-line (1L) maintenance therapy plus best supportive care (BSC) versus BSC alone for adults with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed following platinum-based chemotherapy in France.

Methods
A three-state partitioned survival model was developed to assess the lifetime costs and effects of avelumab plus BSC versus BSC alone. Data from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) were used to inform estimates of clinical and utility values considering a 10-year time horizon and a weekly cycle length. Cost data were estimated from a collective perspective and included treatment acquisition, administration, follow-up, adverse event–related hospitalization, transport, post-progression, and end-of-life costs. Health outcomes were measured in quality-adjusted life-years (QALYs) and life-years gained. Costs and clinical outcomes were discounted at 2.5% per annum. Incremental cost-effectiveness ratios (ICERs) were used to compare cost-effectiveness and willingness to pay in France. Uncertainty was assessed using a range of sensitivity analyses.

Results
Avelumab plus BSC was associated with a gain of 2.49 QALYs and total discounted costs of €136,917; BSC alone was associated with 1.82 QALYs and €39,751. Although avelumab plus BSC was associated with increased acquisition costs compared with BSC alone, offsets of −€20,424 and −€351 were observed for post-progression and end-of-life costs, respectively. The base case analysis ICER was €145,626/QALY. Sensitivity analyses were consistent with the reference case and showed that efficacy parameters (overall survival, time to treatment discontinuation), post-progression time on immunotherapy, and post-progression costs had the largest impact on the ICER.

Conclusions
This analysis demonstrated that avelumab plus BSC is associated with a favorable cost-effectiveness profile for patients with la/mUC who are eligible for 1L maintenance therapy in France.