Leveraging Patient Education to Amplify Colorectal Cancer Screening in the United States: Strategies and Implications.

Despite several available screening modalities, colorectal cancer (CRC) remains a leading cause of cancer deaths, especially among populations with lower screening rates. Barriers to screening include cost, access, awareness, and education disparities, with interventions such as patient education programs and mailed screening kits showing promise in increasing participation rates. The current review elucidates the correlation between patient awareness/knowledge and screening rates in the United States, highlighting the pivotal role of education in mitigating these deficiencies. Different educational models, including online resources, mailed information, community programs, direct provider-based interventions, and narratives, are explored in terms of their effectiveness and limitations. We also offer a blueprint for primary care providers (PCPs) that highlights the importance of tailored education, barrier identification, and utilization of available resources to enhance CRC screening uptake. Large-scale adoption of educational strategies has the potential to significantly increase CRC screening rates and consequently reduce mortality associated with this preventable malignancy.

Reverse Total Shoulder Arthroplasty for Younger Patients: A Comparable Analysis of Patients Older and Younger Than 65 Years.

INTRODUCTION: Reverse total shoulder arthroplasty (rTSA) has become a popular option for the surgical management of rotator cuff arthropathy and complex fractures of the proximal humerus. However, there is a paucity of studies evaluating outcomes, especially between patients of different age groups. The purpose of this study was to compare functional outcomes and survivorship between patients older than 65 years (o65) and those 65 years and younger (y65). METHODS: A retrospective review was conducted at a single academic medical center identifying a consecutive cohort of patients undergoing rTSA between 2018 and 2020. The minimum follow-up time was 2 years. Patients were stratified into two groups for comparative analyses (y65 and o65). Patient demographics, perioperative and postoperative data, and functional outcomes were collected. A Kaplan-Meier survival analysis was conducted to determine survivorship, defined as revision surgery or implant failure. RESULTS: Forty-eight patients were included for final analysis. Nineteen patients comprised the y65 group while 29 patients comprised the o65 group. No difference was observed in Quick Disabilities of the Arm, Shoulder, and Hand scores at baseline nor at the latest follow-up between the two groups. Patients in the y65 group had significantly greater internal and external rotation (IR/ER) from 3 months to 2 years compared with patients in the o65 group (P ≤ 0.05). Finally, there were no differences in revision surgery rates between the y65 group and the o65 group (11% vs. 14%, P = 1.0). A KM survival analysis revealed no difference in implant failure, necessitating revision surgery between the two groups at the latest follow-up (P = 0.69). DISCUSSION: Despite a notable difference in the number of baseline comorbidities, there were no notable differences in functional outcomes, survivorship, and revision surgery rates between each cohort. Although both groups had a similar function initially, by 3 months postoperatively, the y65 group had markedly greater range of motion in IR and ER. Longer term survivorship is needed; however, rTSA may offer a reliable option for shoulder reconstruction even in the y65 patient group.

Are complications related to the perineal post on orthopaedic traction tables for surgical fracture fixation more common than we think? A systematic review.

BACKGROUND: Traction tables have long been utilized in the management of fractures by orthopaedic surgeons. The purpose of this study was to systematically review the literature to determine the complications inherent to the use of a perineal post when treating femur fractures using a traction table. METHODS: A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) using PubMed, EMBASE, and Cochrane Library. The search phrase used was "fracture" AND "perineal" AND "post" AND ("femur" OR "femoral" OR "intertrochanteric" OR "subtrochanteric"). Inclusion criteria for this review were: level of evidence (LOE) of I - IV, studies reporting on patients surgically treated for femur fractures, studies reporting on patients treated on a fracture table with a perineal post, and studies that reported the presence or absence of perineal post-related complications. The rate and duration of pudendal nerve palsy were analyzed. RESULTS: Ten studies (2 prospective and 8 retrospective studies; 2 LOE III and 8 LOE IV) were included consisting of 351 patients of which 293 (83.5%) were femoral shaft fractures and 58 (16.5%) were hip fractures. Complications associated with pudendal nerve palsies were reported in 8 studies and the mean duration of symptoms ranged between 10 and 639 days. Three studies reported a total of 11 patients (3.0%) with perineal soft tissue injury including 8 patients with scrotal necrosis and 3 patients with vulvar necrosis. All patients that developed perineal skin necrosis healed through secondary intention. No permanent complications relating to pudendal neurapraxia or soft tissue injuries were reported at final follow-up timepoints. CONCLUSION: The use of a perineal post when treating femur fractures on a fracture table poses risks for pudendal neurapraxia and perineal soft tissue injury. Post padding is mandatory and supplemental padding may also be required. Appropriate perineal skin examination prior to use is also important. Occurring at a higher rate than previously thought, appropriate post-operative examination for any genitoperineal soft tissue complications and sensory disturbances should not be ignored.

Comparison of Risk Factors and Postoperative Outcomes in Syndesmosis Injuries with Various Ankle Fracture Types.

There is a lack of understanding of risk factors and postoperative outcomes of syndesmotic injuries with singular versus multipart fractures. A retrospective analysis was done between 2008 and 2016, utilizing the American College of Surgeons National Surgical Improvement Program database. Patients with open reduction and internal fixation of isolated lateral malleolus fractures, bimalleolar fractures, or trimalleolar fractures were identified. A total of 2045 patients underwent syndesmotic fixation. Subjects with bimalleolar or trimalleolar fractures were more likely than those with unimalleolar fractures to be Caucasian (odds ratio [OR] = 1.5 and 1.9), female (OR = 1.8 and 2.9), aged > 65 years (OR = 1.6 and 1.9), or have American Society of Anesthesiologists (ASA) classification III (OR =1.5 and 1.4) (all, P ≤ 0.028). Patients with a unimalleolar fracture were more likely than those with a bimalleolar or trimalleolar fracture to be male (OR = 1.8 and 2.9), African American (OR = 1.5 and 1.8), aged < 30 years (OR = 1.4 and 1.8), or present with an ASA I classification (OR = 1.6 and 2.0) (all, P ≤ 0.004). Subjects with bimalleolar or trimalleolar fractures were more likely than those with unimalleolar fractures to have lengthier hospital stays (OR = 1.8 and 2.1), while patients with trimalleolar fractures were more likely than those with unimalleolar fractures to have hypoalbuminemia (OR = 2.3), develop a complication (OR = 2.2) or an open wound (OR = 1.9), or to be readmitted (OR = 2.2) (all, P ≤ 0.036). In this study, comorbidity rates and adverse postoperative outcomes significantly increased as the number-part fractures increased in syndesmotic fixation patients. Risk factors also varied across fracture severity.