Parachute Technique for Dermal Allograft Augmentation in Open Gluteal Abductor Repair.

Retracted full-thickness tears of the gluteus medius tendon are a well-recognized cause of disabling weakness and pain that significantly impact patients' quality of life. We present an efficient knotless parachute technique for dermal allograft augmentation in open gluteal abductor tendon repairs. Our technique reinforces the suture-tendon interface by incorporating a robust biological scaffold into a knotless double-row fixation. This approach capitalizes on the increased pressure and contact area achieved between the greater trochanter and the dermal allograft/gluteus medius tendon construct without the prominence of knotted sutures.

Tranexamic acid in total hip arthroplasty: An umbrella review on efficacy and safety.

Purpose: This comprehensive review was conducted to assess the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE) risk, and wound complications following total hip arthroplasty (THA). Additionally, it sought to evaluate the effects of various TXA dosages, modes of administration, and combinations with other antifibrinolytic drug. Methods: In search of systematic reviews and meta-analyses on the use of TXA in THA patients, we searched extensively through databases including Scopus, the Cochrane Library, Embase, Medline, the Web of Science, PubMed, and Google Scholar. We discovered 23 meta-analyses covering 32,442 patients overall that fulfilled our study criteria, spanning the period from the creation of these databases until May 2023. Results: This comprehensive review's meta-analyses, which together examined over 35,000 patients, repeatedly demonstrated how TXA administration during THA successfully lowers perioperative blood loss and the need for transfusions. TXA reduced total blood loss by an average of 151-370 ml, postoperative hemoglobin levels by 0.5-1.1 g/dL, and transfusion rates by 19-26% on average when compared to control groups. The information gathered did not indicate that using TXA significantly increased the risk of VTE or wound complications. When comparing different TXA doses, administration techniques, or its use in conjunction with other anti-fibrinolytic therapies, no discernible differences were found in terms of efficacy or safety outcomes. Conclusion: The comprehensive review clearly indicates that TXA improves THA outcomes without increasing the risk of adverse events by lowering blood loss and the requirement for transfusions. This insightful information can help surgeons decide whether to use TXA during THA procedures.

Self-reported side effects of COVID-19 vaccines among health professions students in India.

Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants (n = 492), 45.3% (n = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days-soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study's findings corroborate the safety of the Covishield/AstraZeneca vaccine's first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy.

Knowledge, Attitudes, and Practices of Hand Hygiene, Mask Use, and Social Distancing among Public Hospital and Polyclinic Nurses in Barbados during the Coronavirus 2019 Pandemic.

BACKGROUND: Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among nursing staff. Several preventive measures were adopted to contain the spread of the COVID-19 virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic. METHOD: An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) in Barbados from March 2021 to December 2021 was conducted. A nonsystematic convenience sampling method was employed to recruit nurses who were readily available and willing to participate. A questionnaire captured the sociodemographic information and knowledge and practices related to hand hygiene, the use of face masks, and social distancing. Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60-80%), or good (>80-100%). RESULTS: Of the 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). The findings revealed that 45.8% had poor knowledge of hand hygiene, and that the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% confidence interval 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask wearing, 53.6% of nurses had average knowledge, and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% confidence interval 1.5, 7.4) of having good knowledge compared to nursing assistants. A total of 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by the WHO. CONCLUSIONS: The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.

The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review.

Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.

Slightly reduced early subsidence with similar outcomes and complications rate in collared stems - A systematic review of randomized clinical trials.

Background: There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Purpose: Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Study design: Systematic Review, Level of Evidence 1. Methods: A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Results: Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5-72.4 years old, and mean BMI ranged 26.6-29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1-9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Conclusions: Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state.

Suicidal behaviour among the university students in the UK: A systematic review.

Introduction: Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK. Methods: An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed. Results: Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students. Conclusion: The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.

Menstruation among In-School Adolescent Girls and Its Literacy and Practices in Nigeria: A Systematic Review.

Background and Objectives: Menstruation is a natural occurrence marked by the periodic release of endometrial cells within the uterine lining from the female genital area. Menstruation knowledge remains highly essential for young adolescents. Inadequate awareness and understanding of menstruation have far-reaching consequences on the overall wellbeing and health outcomes of young adults worldwide. Adolescent girls make up a large percentage of high school students in Nigeria. Girls in countries with low to middle incomes are frequently misled or uneducated regarding menstruation. Menstrual health literacy (MHL) is the level of knowledge concerning matters related to menstrual health. It is observed that a lack of menstrual health literacy is seen among young adults. This systematic review aimed to examine menstruation literacy, attitudes, and adolescent girls' practices in Nigeria. Materials and Methods: This systematic review included quantitative, cross-sectional, quasi-experimental, and qualitative primary research studies relating to menstruation literacy, attitudes, and practices of adolescents in Nigeria. Articles for this study were searched for on databases such as PubMed and BioMed Central using keywords. These studies were subjected to stringent inclusion and exclusion criteria where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and 13 articles were included after critical appraisal. Data extracted were analysed using narrative synthesis. Results: Findings indicated that knowledge regarding menstruation among adolescents (82.6%) was poor. Menstruation information was obtained from mothers, which was positive as some adolescents reported their closeness to their mothers. Regarding attitudes towards menstruation among adolescents, it was reported that more respondents (70.3%) had negative attitudes towards menstruation. Conclusions: Most of the respondents in Nigeria were not adequately prepared for the onset of their first menstrual period. Knowledge and attitude levels were low regarding periods for adolescents. The only exception was their positive attitude towards using water and soap to wash their hands during menstruation. The review shows a significant gap between adolescents' menstruation knowledge and actual hygienic methods during menstruation. It is therefore required for educational awareness programmes and campaigns to be put in place to educate adolescents about menstruation.

Screening for Femoral Head Osteonecrosis Following COVID-19: Is It Worth It?

Objectives: Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally. In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratory distress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenous corticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if active screening should be utilized to diagnose post-COVID-19 ONFH in its early stages. Methods: The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022. The search terms were as follows: "COVID-19", "severe acute respiratory syndrome", "coronavirus", "systemic steroid", "corticosteroid", "femoral head osteonecrosis", "avascular necrosis", or "steroid therapy." The included studies for review were all required to be peer-reviewed studies in the English language with Reported complications linked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individuals recovering from the novel coronavirus have been documented. Results: Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDC reports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately over one million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateral involvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8 days. Conclusion: In summary, a distinct correlation exists between the administration of steroids to individuals with COVID-19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy in COVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening for high-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may be reasonable.

Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom: Systematic Review.

BACKGROUND: Nosocomial infections are infections incubating or not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear, particularly for the hospitalized population of the United Kingdom. OBJECTIVE: The aim of this systematic literature review was to explore the risk factors of nosocomial infections in hospitalized adult patients in the United Kingdom. METHODS: A comprehensive keyword search was conducted through the PubMed, Medline, and EBSCO CINAHL Plus databases. The keywords included "risk factors" or "contributing factors" or "predisposing factors" or "cause" or "vulnerability factors" and "nosocomial infections" or "hospital-acquired infections" and "hospitalized patients" or "inpatients" or "patients" or "hospitalized." Additional articles were obtained through reference harvesting of selected articles. The search was limited to the United Kingdom with papers written in English, without limiting for age and gender to minimize bias. The above process retrieved 377 articles, which were further screened using inclusion and exclusion criteria following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The retained 9 studies were subjected to critical appraisal using the Critical Appraisal Skills Programme (cohort and case-control studies) and Appraisal Tool for Cross-Sectional Studies (cross-sectional studies) checklists. Finally, 6 eligible publications were identified and used to collect the study findings. A thematic analysis technique was used to analyze data extracted on risk factors of nosocomial infections in hospitalized patients in the United Kingdom. RESULTS: The risk factors for nosocomial infections that emerged from the reviewed studies included older age, intrahospital transfers, cross-infection, longer hospital stay, readmissions, prior colonization with opportunistic organisms, comorbidities, and prior intake of antibiotics and urinary catheters. Nosocomial infections were associated with more extended hospital stays, presenting with increased morbidity and mortality. Measures for controlling nosocomial infections included the use of single-patient rooms, well-equipped wards, prior screening of staff and patients, adequate sick leave for staff, improved swallowing techniques and nutritional intake for patients, improved oral hygiene, avoiding unnecessary indwelling plastics, use of suprapubic catheters, aseptic techniques during patient care, and prophylactic use. CONCLUSIONS: There is a need for further studies to aid in implementing nosocomial infection prevention and control.

Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell-based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions-a systematic review.

PURPOSE: To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up. METHODS: The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM. RESULTS: Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47 years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score-Activities of Daily Living (p < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting. CONCLUSIONS: Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations. LEVEL OF EVIDENCE: IV.

Joint congestion and contention avoidance in a scalable QoS-aware opportunistic routing in wireless ad-hoc networks.

Opportunistic routing (OR) can greatly increase transmission reliability and network throughput in wireless ad-hoc networks by taking advantage of the broadcast nature of the wireless medium. However, network congestion is a barrier in the way of OR's performance improvement, and network congestion control is a challenge in OR algorithms, because only the pure physical channel conditions of the links are considered in forwarding decisions. This paper proposes a new method to control network congestion in OR, considering three types of parameters, namely, the backlogged traffic, the traffic flows' Quality of Service (QoS) level, and the channel occupancy rate. Simulation results show that the proposed algorithm outperforms the state-of-the-art algorithms in the context of OR congestion control in terms of average throughput, end-to-end delay, and Packet Delivery Ratio (PDR). Due to the higher PDR at different traffic loads and different node densities, it can be concluded that the proposed algorithm also improves network scalability, which is very desirable given the recent changes in wireless networks.

Challenging the food waste hierarchy.

Food waste is a multi-faceted and complex problem for urban circular economies with far-reaching environmental impacts. Effectively addressing this problem requires a comprehensive understanding of the food waste impacts on food, energy, water, and climate (FEWC) systems. Despite complex dynamics in the FEWC nexus, the most popular guidance for food waste management is the food waste hierarchy framework - which fails to account for ensuing impacts on all nexus elements. Aiming to optimise the framework, we adopt a participatory approach to develop the first comprehensive and replicable system dynamics model of the FEWC footprints of urban food waste throughout the agri-food supply chain. The quantitative model compares different food waste management options, and relevant policies in Bristol, UK (2018-2030). Unlike the guidance of the traditional waste hierarchy framework, our findings show that the preferability of each option can vary for each sector within the supply chain and for each FEWC element. Our results show that increasing food surplus redistribution in the supply sectors and reducing food waste in consumer sectors are the most preferable approaches to reduce the environmental impacts of food. Feeding food leftover to pets at household level also has a promising impact. Other options involve trade-offs between energy and carbon footprints, while having minimal impact on water footprint. We conclude that the traditional food waste hierarchy is too simplified to provide reliable guidance for environmentally sustainable food waste management and policy. Instead, we present an improved food waste hierarchy framework that accounts for the scale of preferability of each option for different sectors and different FEWC nexus elements. This novel framework thus provides more nuanced and more robust understanding of food waste impacts on the FEWC nexus in urban circular economies, thereby enabling the development of policy and management options that are optimised for environmental sustainability.

Evaluation of Short-Term Side Effects Following the First Dose of COVID-19 Vaccines Among Physicians and Dentists: A Cross-Sectional Study from India.

Background: Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India. Methods: A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs® platform was circulated via email and social media platforms. Results: More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects. Conclusion: Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.

Periacetabular Osteotomy in Athletes With Symptomatic Hip Dysplasia Allows for Participation in Low-, Moderate-, and High-Impact Sports, With Greater Than 70% Return to Sport for Competitive Athletes: A Systematic Review.

PURPOSE: To systematically review the literature and report the rate of return to sport (RTS) in athletes following periacetabular osteotomy (PAO) for symptomatic hip dysplasia. METHODS: A literature search of the PubMed, Embase, and Cochrane Library databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting on athletes undergoing PAO surgery for symptomatic hip dysplasia. A quality assessment was performed using the Methodological Index of Non-Randomized Studies (MINORS) grading system. Data collection included study characteristics, demographics, radiographic measurements, rate and timing of RTS, baseline and most recent patient-reported outcomes (PROs), and subsequent surgeries. RESULTS: Six studies met inclusion criteria with 341 patients undergoing PAO. There were 2 level III and 4 level IV studies, with an average MINORS score of 11. Preoperative and postoperative lateral center edge angles ranged from 8° to 18° and 23° to 41.3°, respectively. One study reported solely on dancers with a 63% rate of RTS at 1 year postoperatively. Two other studies reported RTS of 80% and 82% for multiple sports, with slightly lower rates (73% and 78%) in competitive athletes. Three studies demonstrated a comparable distribution of sports participation, from the preoperative to postoperative period, in low-impact (61.4% to 72.1% and 63.7% to 85.7%), moderate-impact (10.3% to 21.0% and 4.3% to 25.4%), and high-impact (8.5% to 17.6% and 5.1% to 10.8%) sports. Three studies reported time to RTS after PAO, ranging from 8.8 to 12.8 months. Of the 3 studies noting reasons for not returning to sport, concerns related to the operative hip ranged from 36.4% to 67%. Of the studies that reported both preoperative and postoperative PROs, improvements in all values were observed, with modified Harris Hip Scores and Hip Disability Osteoarthritis Outcome Scores at most recent follow-up ranging from 81 to 95 and 72 to 93, respectively. CONCLUSIONS: In athletes with symptomatic hip dysplasia undergoing PAO, postoperative participation in low-, moderate-, and high-impact sports was observed, with greater than 70% RTS for competitive athletes. These findings suggest that PAO, with appropriate indications, is an efficacious treatment option in this active patient population with severe dysplasia. LEVEL OF EVIDENCE: Level IV, systematic review of level III and IV studies.

Hip Capsular Repair Results in Improved Patient-Reported Outcomes and Survivorship: A Systematic Review of the Literature.

PURPOSE: To determine whether routine capsular closure following hip arthroscopy for femoroacetabular impingement (FAI) in patients without dysplasia results in improved patient-reported outcomes (PROs) and increased survivorship rates. METHODS: A literature search of the PubMed, Embase, and Cochrane Library databases was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting PROs following arthroscopic hip labral repair for FAI. A quality assessment was performed using the Methodological Index for Non-randomized Studies grading system. Inclusion criteria consisted of comparative clinical studies investigating routine capsular closure with nonclosure in patients undergoing hip arthroscopy for the treatment of FAI and labral tears. Exclusion criteria included non-English language, minimum follow-up of less than 2 years after surgery, technique articles, case reports, noncomparative case series of fewer than 10 patients, failure to report surgical technique, absence of postoperative PROs, or partial repair. Data collection included study characteristics, demographics, indications, radiographic metrics, perioperative findings, surgical technique, baseline and most recent PROs, and subsequent surgeries. RESULTS: A total of 531 articles were reviewed, of which 3 were included with 249 hips that underwent capsular repair and 157 hips that underwent capsulotomy with no repair. There were 2 Level III studies and 1 Level II study, with an average The Methodological Index for Non-randomized Studies score of 16.7. All studies cited FAI and labral tear as an indication for surgery. All studies demonstrated improved PROs from baseline to most recent follow-up. Postoperatively, the repair group reported modified Harris Hip Score values ranging from 80.8 to 87, whereas the nonrepair group reported scores ranging from 76 to 81.7. In addition, the repair group reported postoperative Hip Outcome Score - Sports-Specific Subscale values ranging from 68.1 to 9, whereas the nonrepair group reported scores ranging from 65.3 to 76.1. The studies also reported minimal clinically important difference for modified Harris Hip Score, with the repair group reporting percentages ranging from 71 to 100 and the nonrepair group reporting percentages ranging from 52 to 95.6. All 3 studies also observed a lower rate of hip survivorship in the nonrepair group, ranging from 94.6 to 100 in the repair group and 90.8 to 100 in the nonrepair group. There were no significant differences in the rate of revision arthroscopy between groups. CONCLUSIONS: Patients without dysplasia who undergo capsular repair have greater improvements in PROs and greater survivorship rates at early- and mid-term follow-up than patients who do not undergo capsular repair. LEVEL OF EVIDENCE: III, systematic review of level II and III studies.

Patient-Reported Outcomes Improve at 2-Year Minimum Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review.

PURPOSE: To provide an updated review of recent literature on postoperative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), focusing on larger-population studies with a minimum 2-year follow-up published within the last 5 years. METHODS: A literature search of the PubMed, Ovid Medline, Web of Science, and Cochrane databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were screened for clinical studies published from 2017 to 2022 with greater than 100 patients and minimum 2-year follow-up. Exclusion criteria included failure to report postoperative patient-reported outcomes (PROs), no preoperative radiographic measurements, and surgery for pathology other than FAIS. Data collection included study characteristics, patient demographics, radiographic findings, intraoperative findings, procedures performed, postoperative PROs, and subsequent surgeries. RESULTS: Nine studies met inclusion criteria. Mean or median patient ages ranged from 32.3 to 41 years, with 4 studies reporting on greater than 50% female patients. Mean preoperative lateral center edge angles and alpha angles ranged from 30.2° to 37° and from 56.2° to 71°, respectively. Labral repairs (range 69.7%-100%) were performed more commonly than debridements (range 0%-26.3%). All studies demonstrated improved PROs at most recent follow-up. Seven studies reported mean or median modified Harris Hip Scores, with preoperative and postoperative values that ranged from 53.1 to 80 and from 67.4 to 100, respectively. Revision hip arthroscopies and conversions to hip arthroplasty ranged from 0.8% to 11.6% and from 0% to 34%, respectively. CONCLUSIONS: All included studies found improvements in PROs after hip arthroscopy for FAIS at a minimum of 2-year follow-up. Conversion to total hip arthroplasty is most common in older patients at minimum 10-year follow-up. LEVEL OF EVIDENCE: Level IV, systematic review of Level I through IV studies.

Perception of Availability, Accessibility, and Affordability of COVID-19 Vaccines and Hesitancy: A Cross-Sectional Study in India.

Background: The current study aimed to identify the perceptions and issues regarding the affordability, availability, and accessibility of COVID-19 vaccination and determine the extent of vaccine hesitancy among non-vaccinated individuals. Methods: A Prospective cross-sectional study was conducted among 575 individuals for a period of six months. All the relevant information was collected using the peer-validated survey questionnaire. An independent t-test was applied to check the association between variables. Results: Among 575 participants, 80.8% were vaccinated, and 19.2% were non-vaccinated. Among the vaccinated, 35.1% were vaccinated in private centres and 64.9% in public health centres (PHC). In total, 32% had accessibility issues and 24.5% had availability issues. However, responders vaccinated at PHC were having more issues in comparison to other groups which was statistically significant (p < 0.05). Among the 163 privately vaccinated participants, 69.9% found it completely affordable. Another 26.9% and 3.1% found vaccines partly affordable and a little unaffordable. Among the 110 non-vaccinated, 38.1% were found to be vaccine-hesitant. Conclusions: Individuals vaccinated at PHC experienced issues such as long waiting times, unavailability of doses, and registration. Further, a significant level of hesitancy towards COVID-19 vaccines was observed. The safety and efficacy of COVID-19 vaccines contributed to negative attitudes.