There is No Difference in Clinical Outcomes of Tibial-based Versus Fibular-based Posterolateral Corner Reconstruction: A Systematic Review.

PURPOSE: The purpose of this study was to evaluate and analyze the current literature regarding clinical outcomes following posterolateral corner reconstruction (PLCR) using fibular-based and tibial-based techniques. METHODS: A systematic review of the literature was performed to evaluate patient-reported outcomes after PLCR. Embase, PubMed, and Scopus were searched from their respective inception through October 25, 2022. Studies containing patient-reported outcome scores of tibial and fibular-based PLCR were included. Outcomes collected from each study were summarized using t-tests for consistently reported Tegner, Lysholm, and IKDC scores. RESULTS: Twenty-four studies (16 with level of evidence IV, 6 with level III, and 2 with Level II) met the inclusion criteria and included 669 patients in total. Four studies comprising 111 patients directly compared the results of tibial- and fibular-based PLCR. Mean clinical follow-up across all studies was 3.3 years. The four studies that reported on both tibial and fibular-based PLCR were found to have no significant differences in patient-reported outcomes with p-values ranging from 0.0561 to 0.9881. CONCLUSION: Analysis of the available literature regarding tibial- and fibular-based posterolateral corner reconstruction suggests no clinical differences. LEVEL OF EVIDENCE: Systematic review of Level II-IV Studies.

Outpatient versus inpatient shoulder arthroplasty outcomes using an updated patient-selection algorithm: minimum two-year follow-up.

BACKGROUND: Previous studies have demonstrated the safety and cost-effectiveness of outpatient total shoulder arthroplasty (TSA), with the majority of studies focusing on 90-day outcomes and complications. Patient selection algorithms have helped appropriately choose patients for an outpatient TSA setting. This study aimed to determine the outcomes of TSA between outpatient and inpatient cohorts with at least a 2-year follow-up. METHODS: A retrospective review identified patients older than 18 years who underwent a TSA with a minimum of 2-year follow-up in either an inpatient or outpatient setting. Using a previously published outpatient TSA patient-selection algorithm, patients were allocated into three groups: outpatient, inpatient due to insurance requirements, and inpatient due to not meeting algorithm criteria. Outcomes evaluated included visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, range of motion (ROM), strength, complications, re-admissions, and re-operations. Analysis was performed between the outpatient and inpatient groups to demonstrate the safety and efficacy of outpatient TSA with midterm follow-up. RESULTS: A total of 779 TSA were included in this study, allocated into the outpatient (N = 108), inpatient due to insurance (N = 349), and inpatient due to algorithm (N = 322). The average age between these groups was significantly different (59.4 ± 7.4, 66.5 ± 7.5, and 72.5 ± 8.7, respectively; P < 0.0001). All patient groups demonstrated significant improvements in preoperative to final patient-outcomes scores, ROM, and strength. Analysis between cohorts showed similar final follow-up outcome scores, ROM, and strength, with few significant differences that are likely not clinically different, regardless of surgical location, insurance status, or meeting patient-selection algorithm. Complications, reoperations, and readmissions between all three groups were not significantly different. CONCLUSION: This study reaffirms prior short-term follow-up literature. Transitioning appropriate patients to outpatient TSA results in similar outcomes and complications compared to inpatient cohorts with mid-term follow-up.

Opioid-sparing pain management protocol after shoulder arthroplasty results in less opioid consumption and higher satisfaction: a prospective, randomized controlled trial.

BACKGROUND: The opioid epidemic has become a central focus in health care. In an effort to reduce opioid use, orthopedic surgeons use multimodal strategies to control postoperative pain. However, no clear consensus exists on ideal pain management strategies after shoulder arthroplasty, and most protocols are opioid-driven. This study sought to determine if patients undergoing shoulder arthroplasty using a postoperative opioid-sparing pain-control regimen would have equivalent pain scores and satisfaction as patients using a traditional opioid-based regimen. METHODS: Patients undergoing primary anatomic or reverse total shoulder arthroplasty were prospectively enrolled and randomized into an opioid-sparing (OS) or a traditional opioid-based (OB) postoperative pain protocol. Both groups received opioid education, periarticular injection with liposomal bupivacaine, and preoperative and postoperative multimodal management (acetaminophen, celecoxib, and gabapentin). The OB group was discharged with 40 oxycodone tablets and standard icing, whereas the OS group received ketorolac during admission, continuous cryotherapy, and discharged with 10 oxycodone tablets for rescue. Patients were queried regarding levels of pain and opioid consumption at days 1-7 and at 2, 6, and 12 weeks postoperatively. Patient satisfaction was recorded at 1, 2, 6, and 12 weeks. Range of motion (ROM), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numerical Evaluation (SANE) scores were assessed preoperatively and at 12 weeks postoperatively. Complications, readmissions, and reoperations were recorded. RESULTS: In 78 patients, no difference in VAS pain scores were seen at any time between groups. The OS group consumed less oral morphine equivalents (OME) from inpatient hospitalization to 12 weeks postoperatively (P < .05). Total OME consumption was reduced by 213% for the OS vs. the OB group (112 vs. 239; P < .0001). The OS group consumed fewer opioid pills at all time points (P < .05). A 395% reduction in number of opioid pills consumed in the first 12 weeks postoperatively was seen in the OS vs. the OB group (4.3 vs. 17.0; P < .0001). Significantly more patients in the OS group discontinued opioids by 2 weeks postoperatively (86.1% vs. 58.5%; P = .011), and 94.4% in the OS group discontinued opioids by 6 weeks postoperatively. The OS group was more satisfied with pain management at 1 and 6 weeks (P = .05). No difference in ROM, ASES or SANE scores, complications, readmissions, or reoperations were seen between groups. CONCLUSIONS: This study demonstrated a nearly 4-fold reduction in opioid pain pill consumption and earlier cessation of opioids with an OS pain management protocol. Patients also reported higher satisfaction with this pain management strategy.

In Vivo Performance of Moderately Crosslinked, Thermally Treated Polyethylene in a Prospective Randomized Controlled Primary Total Knee Arthroplasty Trial.

Cross-linked bearings have been developed for use in total knee arthroplasty that exhibit improved wear properties, but at the expense of a decrease in mechanical strength of the cross-linked material. Adoption has been slow due to fears of mechanical failure secondary to this alteration in mechanical properties. This prospective, randomized study compared mid-term survivorship, clinical and radiographic results of a conventional polyethylene (GVF) to a cross-linked polyethylene (XLK) in total knee prostheses of the same design. At minimum 5-year follow-up there was no difference in survivorship, clinical performance or radiographic findings between the groups. There were no revisions for polyethylene wear, osteolysis or tibial insert dissociation. Most importantly, there were no revisions for mechanical failure or fracture of the polyethylene bearing in either group.

In-vivo alignment comparing patient specific instrumentation with both conventional and computer assisted surgery (CAS) instrumentation in total knee arthroplasty.

Patient specific instrumentation (PSI) was developed to increase total knee arthroplasty (TKA) accuracy and efficiency. The study purpose was to compare immediate post-operative mechanical alignment, achieved using PSI, with conventional and computer assisted surgery (CAS) instruments in high volume TKA practices. This prospective, multicenter, non-randomized study accrued 66 TKA patients using PSI. A computed tomography (CT) based algorithm was used to develop the surgical plan. Sixty-two percent were females, 99% were diagnosed with osteoarthritis, average age at surgery was 66 years, and 33 was the average body mass index. A historical control group was utilized that underwent TKA using conventional instruments (n=86) or CAS (n=81), by the same set of surgeons. Postoperative mechanical alignment was comparable across the groups. Operative time mean and variance were significant.

Implantable system for treprostinil and lung transplantation: case series from delivery for pulmonary arterial hypertension study.

The implanted system for treprostinil has been described in previous publications. There is no information published about how to handle this system around lung or heart-lung transplantation. We present the experience from the DelIVery for Pulmonary Arterial Hypertension study. Seven subjects from five pulmonary arterial hypertension centers were included in this retrospective chart review. All subjects were participating in the previously described DelIVery for pulmonary arterial hypertension study. Seven subjects with implanted pumps have been listed for lung or heart-lung transplant. Six subjects underwent lung or heart-lung transplantation and one remains on the transplant list. Three different methods of patient management for transplant were used. In three subjects, the implanted system was filled with saline prior to transplantation and treprostinil was infused via an external system. Three subjects had their drug-filled implanted pump and catheter system explanted at the time of transplant. One patient had the drug-filled implanted system removed prior to being listed for transplantation. Four subjects were hospitalized while waiting for transplantation. In conclusion, the implanted system for treprostinil is an important advance in the care of pulmonary arterial hypertension subjects. The experience described here provides three effective strategies for managing the implanted system around lung or heart-lung transplantation. The optimal strategy will depend on patient characteristics and lung transplant program preferences and wait list times.

Guidelines for the uniform reporting of data for Medical Emergency Teams.

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.

Measuring final-year nursing students' satisfaction with the viva assessment.

This paper reports a study conducted to develop and test the psychometric properties of a brief 5-item Satisfaction with the Oral Viva Assessment Scale. The viva has been increasingly used to gauge students' learning, beyond the traditional written assessments. This assessment approach may pose additional challenges to various student groups. Using a prospective, correlational design, this study surveyed 275 final year nursing students about their satisfaction with the viva as an assessment approach. The survey was administered to those who attended a revision session in an undergraduate high dependency unit. Descriptive and inferential statistical analyses, as well as exploratory and confirmatory factor analyses of the scale were computed. Exploratory factor analysis yielded a one-component structure that explained 51% of the total variance, which was supported by confirmatory factor analysis (standardised factor loadings: 0.54-0.73). Internal consistency as computed by a Cronbach's alpha was 0.8. The results also revealed that those who obtained higher grades in their viva performance (OR: 2.78, 95% CI: 1.58-4.90) and English-speaking only students (OR: 1.87, 95% CI: 1.07-3.27) were more satisfied with the viva assessment. These findings support the validity and reliability of this scale, and can be used to assess students' satisfaction with the viva.

Effect of core strength and endurance training on performance in college students: randomized pilot study.

Core training continues to be emphasized with the proposed intent of improving athletic performance. The purpose of this investigation was to discover if core isometric endurance exercises were superior to core isotonic strengthening exercises and if either influenced specific endurance, strength, and performance measures. Ten untrained students were randomly assigned to core isometric endurance (n = 5) and core isotonic strength training (n = 5). Each performed three exercises, two times per week for six weeks. A repeated measures ANOVA was used to compare the measurements for the dependent variables and significance by bonferroni post-hoc testing. The training protocols were compared using a 2 × 3 mixed model ANOVA. Improvement in trunk flexor and extensor endurance (p < 0.05) along with squat and bench press strength (p < 0.05) occurred with the strength group. Improvement in trunk flexor and right lateral endurance (p < 0.05) along with strength in the squat (p < 0.05) were found with the endurance group. Neither training protocol claimed superiority and both were ineffective in improving performance.

ChemVassa: A New Method for Identifying Small Molecule Hits in Drug Discovery.

ChemVassa, a new chemical structure search technology, was developed to allow rapid in silico screening of compounds for hit and hit-to-lead identification in drug development. It functions by using a novel type of molecular descriptor that examines, in part, the structure of the small molecule undergoing analysis, yielding its "information signature." This descriptor takes into account the atoms, bonds, and their positions in 3-dimensional space. For the present study, a database of ChemVassa molecular descriptors was generated for nearly 16 million compounds (from the ZINC database and other compound sources), then an algorithm was developed that allows rapid similarity searching of the database using a query molecular descriptor (e.g., the signature of atorvastatin, below). A scoring metric then allowed ranking of the search results. We used these tools to search a subset of drug-like molecules using the signature of a commercially successful statin, atorvastatin (Lipitor™). The search identified ten novel compounds, two of which have been demonstrated to interact with HMG-CoA reductase, the macromolecular target of atorvastatin. In particular, one compound discussed in the results section tested successfully with an IC50 of less than 100uM and a completely novel structure relative to known inhibitors. Interactions were validated using computational molecular docking and an Hmg-CoA reductase activity assay. The rapidity and low cost of the methodology, and the novel structure of the interactors, suggests this is a highly favorable new method for hit generation.