Patient-Reported Outcomes Measurement Information System Mobility Computerized Adaptive Testing Maintains High Correlation and Low Test Burden Compared With Legacy Hip-Specific Instruments in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement.

PURPOSE: To evaluate the reliability, construct validity, and responsiveness of the lower extremity-specific Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility (MO) bank in patients who underwent hip arthroscopic surgery for femoroacetabular impingement. METHODS: Patients who underwent primary hip arthroscopic surgery at a large academic musculoskeletal specialty center between November 2019 and November 2020 completed the following baseline and 6-month measures: PROMIS MO, PROMIS Pain Interference (PI), PROMIS Physical Function (PF), modified Harris Hip Score, International Hip Outcome Tool 33, visual analog scale, and Single Assessment Numeric Evaluation. Construct validity was evaluated using Spearman correlation coefficients. The number of questions until completion was recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) for each measure was recorded to measure inclusivity. Responsiveness was tested by comparing differences between baseline and 6-month measures, controlling for age and sex, using generalized estimating equations. Magnitudes of responsiveness were assessed through the effect size (Cohen d). RESULTS: In this study, 660 patients (50% female patients) aged 32 ± 14 years were evaluated. PROMIS MO showed a strong correlation with PROMIS PF (r = 0.84, P < .001), the International Hip Outcome Tool 33 (r = 0.73, P < .001), PROMIS PI (r = -0.76, P < .001), and the modified Harris Hip Score (r = 0.73, P < .001). Neither PROMIS MO, PROMIS PI, nor PROMIS PF met the conventional criteria for floor or ceiling effects (≥15%). The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS MO, 4.1 ± 0.6 for PROMIS PI, and 4.1 ± 0.6 for PROMIS PF. From baseline to 6 months, the PROMIS and legacy measures exhibited significant responsiveness (P < .05), with similar effect sizes between the patient-reported outcome measures. CONCLUSIONS: This longitudinal study reveals that in patients undergoing hip arthroscopy, PROMIS MO computerized adaptive testing maintains high correlation with legacy hip-specific instruments, significant responsiveness to change, and low test burden compared with legacy measures, with no ceiling or floor effects at 6-month postoperative follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Satisfaction With the Process vs Outcome of Care in Total Hip and Knee Arthroplasty.

BACKGROUND: Patient satisfaction, with both process of care and outcome of care, is critical for measuring the quality and value of elective procedures such as arthroplasty. The purpose of this study is to evaluate the correlation between early postoperative satisfaction with the process of care and 2-year satisfaction with the outcome of care after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: We retrospectively analyzed data from institutional arthroplasty registries. Satisfaction with the outcome of care was measured on a scale of 0-100 by a previously validated questionnaire administered 2 years postoperatively. Patient satisfaction with the process of care was measured by the Press Ganey (PG) inpatient survey, also scored 0-100. We examined the correlation between these 2 measures of satisfaction in patients who underwent primary THA or TKA. RESULTS: In total, 721 TKA patients and 760 THA patients underwent surgery and completed both the PG survey and 2-year satisfaction questionnaire. The mean age was 65.1 years with a mean body mass index of 28.8 and 56% were female. The mean PG survey score for the entire cohort was 95.6. The mean 2-year satisfaction score was 90.3. The Spearman correlation coefficient between the PG survey and the 2-year satisfaction survey was 0.23 for TKA patients (P < .001) and 0.13 for THA patients (P < .001). CONCLUSION: We found a weak correlation between the measurement of satisfaction with the process of care surrounding hip and knee arthroplasty using the PG survey and measurement of satisfaction with the outcome of care after arthroplasty using a validated 2-year satisfaction instrument.

Preoperative Evaluation of the Lower Extremity-Specific PROMIS Mobility Bank in Patients with ACL Tears.

PURPOSE: The purpose of this study was to preoperatively assess the Patient-Reported Outcomes Measurement Information System (PROMIS) Item Bank v2.0-Mobility in patients with anterior cruciate ligament (ACL) tears to (1) determine construct validity by correlating with legacy patient-reported outcomes (PROs), (2) evaluate test burden, (3) determine the presence of floor or ceiling effects, and (4) revisit the conventional threshold for inclusiveness (floor/ceiling effects) in the modern era of computer adaptive testing (CAT)-based PROs. METHODS: Patients at a large academic musculoskeletal specialty center diagnosed with ACL tears indicated for surgery were administered the following outcomes measures before surgery: PROMIS Mobility CAT, PROMIS Pain Interference CAT (PROMIS PI), International Knee Documentation Committee (IKDC), the Marx Knee Activity Rating Scale (Marx), and Single Assessment Numeric Evaluation (SANE). Construct validity was evaluated using Spearman correlation coefficients. Correlation strengths were defined as high (≥0.7), high-moderate (0.61-0.69), moderate (0.4-0.6), moderate-weak (0.31-0.39) and weak (≤0.3). Number of questions to completion were recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) of each measure was recorded to measure inclusivity. RESULTS: A total of 1126 patients were evaluated. The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS Mobility and 4.5 ± 1.9 for PROMIS PI. PROMIS Mobility demonstrated a high correlation with IKDC, (r = 0.81, P < .001), a high-moderate correlation with PROMIS PI (r = -0.63), and a moderate correlation with SANE (r = 0.46, P < .01). Neither PROMIS Mobility nor PROMIS PI met conventional criteria for floor or ceiling effects (>15%). CONCLUSIONS: The PROMIS Mobility measure maintains construct validity, because its scores correlate strongly with other PROs measuring physical function with high efficiency among preoperative patients with ACL injuries. Although ceiling effects of PROMIS Mobility CAT were below the conventional significance threshold of 15% at the preoperative timepoint in this population, this study provides critical feedback for redesigning the Mobility bank. LEVEL OF EVIDENCE: Level III (Diagnostic study).

Clinical Experience with COVID-19 at a Specialty Orthopedic Hospital Converted to a Pandemic Overflow Field Hospital.

BACKGROUND: COVID-19, the illness caused by the novel coronavirus, SARS-CoV-2, has sickened millions and killed hundreds of thousands as of June 2020. New York City was affected gravely. Our hospital, a specialty orthopedic hospital unaccustomed to large volumes of patients with life-threatening respiratory infections, underwent rapid adaptation to care for COVID-19 patients in response to emergency surge conditions at neighboring hospitals. PURPOSES: We sought to determine the attributes, pharmacologic and other treatments, and clinical course in the cohort of patients with COVID-19 who were admitted to our hospital at the height of the pandemic in April 2020 in New York City. METHODS: We conducted a retrospective observational cohort study of all patients admitted between April 1 and April 21, 2020, who had a diagnosis of COVID-19. Data were gathered from the electronic health record and by manual chart abstraction. RESULTS: Of the 148 patients admitted with COVID-19 (mean age, 62 years), ten patients died. There were no deaths among non-critically ill patients transferred from other hospitals, while 26% of those with critical illness died. A subset of COVID-19 patients was admitted for orthopedic and medical conditions other than COVID-19, and some of these patients required intensive care and ventilatory support. CONCLUSION: Professional and organizational flexibility during pandemic conditions allowed a specialty orthopedic hospital to provide excellent care in a global public health emergency.

Follow-Up of the Libby, Montana Screening Cohort: A 17-Year Mortality Study.

OBJECTIVE: To evaluate mortality patterns among participants in a community-based screening program for asbestos-related disease. METHODS: We calculated standardized mortality ratios (SMRs) and stratified results by exposure group (three occupational exposure groups, household contacts and residents without occupational asbestos exposure) and by radiographic abnormality presence. RESULTS: All-cause mortality (15.8%; 1,429/8,043) was statistically lower than expected. Asbestosis was statistically elevated in all exposure groups. Lung cancer was moderately associated with vermiculite miner/miller employment. Mesothelioma was elevated in that same exposure group and among residents. Systemic autoimmune disease mortality was also elevated. Radiographic parenchymal abnormalities were associated with lung cancer mortality. CONCLUSION: In addition to asbestos-related mortality in occupational exposure groups, this initial follow-up of this cohort also shows elevated mortality for some asbestos-related causes in non-occupational exposure groups.

Surveillance for occupational respiratory diseases in developing countries.

The burden of chronic diseases, including occupational respiratory diseases (ORDs), is increasing worldwide. Nevertheless, epidemiological data on these conditions are scarce in most countries. Therefore, it is important to conduct surveillance to monitor ORDs, particularly in developing countries, where the working population is especially vulnerable and the health system infrastructure is usually weak. This article provides a general framework for the implementation of ORD surveillance in developing countries. The main objectives of surveillance are to describe incidence and prevalence of ORDs, as well as to identify sentinel events and new associations between occupational exposures and health outcomes. Diseases with high morbidity and mortality and those in which early diagnosis with standardized tests are available are especially suitable for surveillance activities. Simple strategies, preferably using existing resources and technology, are the best option for surveillance in developing countries. This article offers examples of specific surveillance systems that are in place in Brazil, China, Cuba, India, and South Africa.

Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003-2008.

BACKGROUND: The decline in asbestos use in the United States may impact mesothelioma incidence. OBJECTIVE: This report provides national and state-specific estimates of mesothelioma incidence in the United States using cancer surveillance data for the entire US population. METHODS: Data from the National Program for Cancer Registries and the Surveillance, Epidemiology, and End Results program were used to calculate incidence rates and annual percent change. RESULTS: During 2003-2008, an average of 1.05 mesothelioma cases per 100 000 persons were diagnosed annually in the United States; the number of cases diagnosed each year remained level, whereas rates decreased among men and were stable among women. CONCLUSION: US population-based cancer registry data can be used to determine the burden of mesothelioma and track its decline. Even 30 years after peak asbestos use in the United States, 3200 mesothelioma cases are diagnosed annually, showing that the US population is still at risk.

Associations between radiographic findings and spirometry in a community exposed to Libby amphibole.

BACKGROUND: Among asbestos-exposed individuals, abnormal spirometry is usually associated with parenchymal abnormalities or diffuse pleural thickening. Localised pleural thickening (LPT), the most common abnormality associated with asbestos exposure, is typically thought to be a marker of exposure with little clinical consequence. Our objective was to determine if abnormal spirometry is associated with LPT independent of other abnormalities, using data from community-based screening conducted in Libby, Montana. METHODS: Subjects were a subset of screening participants comprising persons with interpretable spirometry and chest radiograph results (n=6475). Chest radiographs were independently evaluated by two or three B readers, and participants were classified by mutually exclusive categories of spirometry outcome: normal, restriction, obstruction or mixed defect. RESULTS: Restrictive spirometry was strongly associated with parenchymal abnormalities (OR 2.9; 95% CI 1.4 to 6.0) and diffuse pleural thickening (OR 4.1; 95% CI 2.1 to 7.8). Controlling for the presence of these abnormalities as well as age, smoking status and other covariates, restrictive spirometry was also associated with LPT (OR 1.4; 95% CI 1.1 to 1.8). The risk of restrictive spirometric findings correlated with the severity of LPT. CONCLUSIONS: In this large community-based screening cohort, restrictive spirometry is significantly associated with LPT, indicating that this abnormality may result in lung function impairment. Physicians treating patients exposed to Libby amphibole should be aware that LPT may have functional consequences.

Association between cumulative fiber exposure and respiratory outcomes among Libby vermiculite workers.

OBJECTIVE: To examine the association between cumulative fiber exposure and health outcomes in workers (n = 336) with Libby amphibole exposure. METHODS: Exposure-response relationships were explored by the use of logistic regression, with cumulative fiber exposure modeled in categories and as a continuous variable. RESULTS: The use of spline functions with lifetime cumulative fiber exposure as a continuous variable showed that the odds of localized pleural thickening were significantly elevated at less than 1 f/cc-y. Odds of parenchymal abnormalities, restrictive spirometry, and chronic bronchitis were also significantly elevated at 108, 166, and 24 f/cc-y, respectively. CONCLUSIONS: The odds of several pulmonary health outcomes are correlated with cumulative exposure to Libby amphibole. That relatively low-lifetime cumulative exposures are associated with localized pleural thickening has implications for the non-cancer-risk assessment for Libby amphibole.

Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases.

PURPOSE OF REVIEW: The vermiculite ore formerly mined in Libby, Montana, contains asbestiform amphibole fibers of winchite, richterite, and tremolite asbestos. Because of the public health impact of widespread occupational and nonoccupational exposure to amphiboles in Libby vermiculite, numerous related studies have been published in recent years. Here we review current research related to this issue. RECENT FINDINGS: Excess morbidity and mortality classically associated with asbestos exposure have been well documented among persons exposed to Libby vermiculite. Excess morbidity and mortality have likewise been documented among persons with only nonoccupational exposure. A strong exposure-response relationship exists for many malignant and nonmalignant outcomes and the most common outcome, pleural plaques, may occur at low lifetime cumulative exposures. SUMMARY: The public health situation related to Libby, Montana, has led to huge investments in public health actions and research. The resulting studies have added much to the body of knowledge concerning health effects of exposures to Libby amphibole fibers specifically and asbestos exposure in general.

Vermiculite worker mortality: estimated effects of occupational exposure to Libby amphibole.

OBJECTIVE: To examine the relationship between cumulative fiber exposure (CFE) and mortality in a retrospective cohort study of vermiculite workers exposed to Libby amphibole (n = 1862). METHODS: Extended Cox regression was used to estimate the hazards associated with CFE as a time-dependent covariate of multiple-cause mortality. RESULTS: The Cox models for mesothelioma, asbestosis, lung cancer, and non-malignant respiratory disease were significant with rate ratios that increased monotonically with CFE. The model for deaths due to cardiovascular disease was also significant (rate ratio for CFE > or =44.0 f/cc-y vs <1.4 f/cc-y was 1.5; 95% confidence interval = 1.1 to 2.0). CONCLUSIONS: By using a within-cohort comparison, the results demonstrate a clear exposure-response relationship between CFE and mortality from asbestos-related causes. The finding of an association between CFE and cardiovascular mortality suggests persons exposed to Libby amphibole should be monitored for this outcome.

Tracheobronchopathia osteochondroplastica in a patient with silicosis: CT, bronchoscopy, and pathology findings.

A case of tracheobronchopathia osteochondroplastica in a patient with silicosis is reported, showing a rare association of disease. Etiological hypotheses and clinical aspects are discussed. Radiologic, bronchoscopic, and pathologic findings are demonstrated with emphasis on the role of computed tomography (CT) in the diagnosis of this disease.

Malignant mesothelioma surveillance: a comparison of ICD 10 mortality data with SEER incidence data in nine areas of the United States.

With the implementation in 1999 of ICD-10 death certificate coding in the United States, mortality data specific to malignant mesothelioma became readily available on a national basis. To evaluate the accuracy and completeness of diagnosis and coding for mesothelioma on the death certificate, mortality information was compared with incidence data. A mortality/incidence ratio was calculated for each of the nine areas covered by the SEER Program, using National Vital Statistics mortality data from 1999 and 2000, and the SEER incidence data for 1998 and 1999. The mortality/incidence ratio for the two years combined for all areas was 0.82. Only two areas (Connecticut and Atlanta) had ratios <80%. The overall correlation coefficient between mortality and incidence rates was 0.96. Thus, mortality data coded using ICD-10 can be a valid source for mesothelioma surveillance and can be instituted without major cost if a national mortality statistics program based on ICD-10 is in place, making it feasible even for developing countries.

Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments.

To obtain information about the occurrence of pleural mesothelioma on a population basis in Brazil, mortality related to pleural tumors in the State of Rio de Janeiro during 1979-2000 was examined. Death certificates with pleural tumors as the main cause of death and hospital records were analyzed, together with histopathologic material, which was reevaluated. Of 217 death certificates coded as pleural tumors, 34.1% were considered wrongly coded. Results after reclassification were: definite mesothelioma = 45 cases; probable = 7; possible = 31; inconclusive = 65; other tumors = 11. Thus, the number of mesotheliomas in Rio de Janeiro in 1979-2000 is estimated to have been 83. The analysis also suggests a problem with mortality codification in the State.