Pectoralis-major-pedicled bone window for revision of a shoulder arthroplasty.

PURPOSE: The aim of this study is to review our experience with the pectoralis-major-pedicled bone window for the revision of shoulder arthroplasty. METHODS: This study used the retrospective case series of six patients who underwent a pectoralis-major-pedicled bone window for revision of shoulder arthroplasty, with a minimum follow-up of 2 years. Demographic, clinical, and radiological data were analyzed. RESULTS: The mean age of the included patients was 72.6 years old (standard deviation (SD) 4.7), and 83.3% were women (5/1). The mean follow-up was 36.6 months (range 25-48 months). Five patients had a shoulder hemiarthroplasty and one patient a reverse shoulder arthroplasty. The indications for revision were pain in five patients and recurrent dislocation in one patient. No intraoperative complications were found. One patient developed a wound infection that required debridement and a two-stage revision. Despite complications, 2 years after surgery, the range of motions and functional scores were improved from preoperative levels. The difference between preoperative and postoperative VAS pain scores was 7.1 points (p < 0.001). The difference between preoperative and postoperative CSS and ASES questionnaires were 32 and 31.6 points, respectively (p < 0.001). At the final follow-up, all radiographs showed bone union of the osteotomy, good fixation of all components, without evidence of prosthetic loosening or migration. CONCLUSIONS: Revision of a shoulder arthroplasty using a pectoralis-major-pedicled bone window can be an effective treatment that can yield pain relief; however, improvements in motion and function were difficult to achieve.

Patient outcomes after humeral fracture surgery during the COVID-19 outbreak in Spain.

BACKGROUND: The global spread of the 2019 novel coronavirus (COVID-19) has profoundly affected the way we conduct our health care practices. The goal of this paper is to report the outcomes of 11 patients who underwent humeral fracture surgery in the first few weeks of the COVID-19 outbreak in Spain. METHODS: This was a retrospective case series of 11 patients who underwent humeral fracture surgery during the first weeks of the COVID-19 outbreak in Spain, between March 10 and April 25, 2020. The clinical outcomes of these operative patients were monitored up to May 12, 2020, the final date of follow-up, a minimum of 15 days after all patients were discharged from the hospital. COVID-19 infection, mortality, demographic, clinical, and laboratory data were analyzed. RESULTS: Thirty-six humeral fractures were recorded between March 10 and April 25, 2020. During this period, humeral fracture fixation was the third most common surgery for fracture in our institution after hip fracture and ankle fracture surgery. Eleven patients underwent surgery (30.5%), of whom 7 were women (63.3%). The mean age was 64.8 years (standard deviation, 13.5). Nine operated cases had a proximal humerus fracture and 2 had a humeral shaft fracture. One of the 11 patients was positive for SARS-CoV-2 on the basis of the quantitative reverse transcription polymerase chain reaction of throat swab samples. The overall median surgical time was 101.2 minutes (standard deviation, 28.4). The overall median hospital length stay for the patient discharged was 2.2 days (range, 1-4 days). No COVID-19 nosocomial intrahospital infection occurred, and no patient reported COVID-19 infection during the 15 days after hospital discharge. No intrahospital mortality was recorded. Furthermore, no COVID-19 infection was reported in the shoulder surgeons who performed the surgeries. CONCLUSIONS: Although humeral fractures were not the most frequent fractures during this outbreak, some required surgery. With good preoperative management that included reverse transcription polymerase chain reaction for COVID-19 and chest radiographs, protective measurements for the surgical team, and rapid discharge of the patients, we were able to operate on 11 humeral fractures with no COVID-19 nosocomial intrahospital infection in the patients or in the shoulder surgeons who performed the surgeries.

Shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus in the elderly.

PURPOSE: The aim of this paper was to present our experience and the outcomes in 3 elderly patients who underwent combined shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus in our center. Also, we evaluate difficulties in their treatment and report their final follow-up. MATERIAL AND METHODS: Three cases of elderly patients who underwent shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus were reviewed. Demographic, clinical, and radiological data were analyzed. Also, Constant Shoulder Score, Mayo Elbow Performance Score, Short-Form Health Survey, and four-point Likert scale were evaluated. RESULTS: All patients were females (100%). Mean age was 75 years (range 73-78). Mean follow-up was 36.6 months (SD 11.5). Mean time between injury and surgery was 12 days (SD 7.6). The 3 patients had a displaced and comminuted fracture of the humeral head (4-part, by Neer classification) and a comminuted intraarticular fracture of the distal humerus (13-C3, by AO classification). One patient presented a wound infection that required debridement. Despite the complications, at final follow-up, all patients showed a sufficient capacity to perform comfortably in their daily activities. Radiographs showed good fixation of all components, without evidence of prosthetic loosening or migration. All evaluated scores had good or excellent results. CONCLUSIONS: Our study provides further evidence that the shoulder and elbow arthroplasty could be a reliable management for ipsilateral fractures of the proximal and distal humerus in the elderly. In our study, this technique showed in the final follow-up patient's good outcomes.

COVID-19 Infection After a Total Knee Arthroplasty in a Patient with Hemophilia A: A Case Report.

CASE: Minimal information is available regarding coronavirus disease-19 (COVID-19) patients with hemophilia A. Coagulopathy is a major pathophysiological characteristic of COVID-19; however, because of a paucity of data, it is not clear whether these patients with hemophilia are more or less prone to the severe form of the COVID-19 disease. We report the case of a hemophilic patient with confirmed COVID-19 after total knee arthroplasty. CONCLUSION: This case highlights the idea that patients with a congenital hypocoagulability stated as haemophilia may be protected against COVID-19 hypercoagulability-related adverse effects. Thromboprophylaxis with low-molecular-weight heparin should be evaluated in patients with hemophilia and COVID-19 disease.

Validity of the DSM-Oriented scales of the child behavior checklist and youth self-report / Validez de las escalas DSM del Child Behavior Checklist y el Youth Self-Report

BACKGROUND: The school-age versions of the ASEBA (Achenbach System of Empirically Based Assessment) incorporate the DSM-Oriented scales. These scales make it possible to quantify and normalize problems defined in the DSM. The objective was to study the incremental validity of the DSM-Oriented scales of the ASEBA inventories, the Child Behavior Checklist - CBCL, completed by parents of children aged 6-18 years, and the Youth Self-Report -YSR, a self-report for children/adolescents aged 11-18, over: (a) scores on the Syndromes Scales for making DSM-IV diagnoses; and (b) diagnoses obtained with structured interviews for the assessment of functioning. METHOD: A clinical sample of 420 children and adolescents (8-17 years) was assessed with the CBCL, and 108 adolescents were assessed with the CBCL and YSR questionnaires. All underwent a diagnostic interview, and interviewers completed a measure of global functional impairment. RESULTS: The DSM-Oriented scales showed significant incremental validity in conjunction with the Empirical Syndrome scales for discriminating DSM-IV diagnoses, and considerable incremental validity in conjunction with the diagnoses obtained through the diagnostic interview for predicting the level of functional impairment. CONCLUSION: DSM-Oriented scales should be considered simultaneously with the Syndrome Scales of the ASEBA taxonomy, as they provide useful additional information in the clinical process

ANTECEDENTES: las formas esclares de ASEBA (Achenbach System of Empirically Based Assessment) incorpora las Escalas DSM. Estas dimensiones ofrecen la posibilidad de cuantificar y normalizar problemas que figuran en el DSM. El objetivo fue estudiar la validez incremental de las Escalas DSM de los inventarios ASEBA; Child Behavior Checklist - CBCL, contestado por padres de niños de 6-18 años, y Youth Self-Report - YSR, un autoinforme para niños/adolescentesANTECEDENTES: las formas esclares de ASEBA (Achenbach System of Empirically Based Assessment) incorpora las Escalas DSM. Estas dimensiones ofrecen la posibilidad de cuantificar y normalizar problemas que figuran en el DSM. El objetivo fue estudiar la validez incremental de las Escalas DSM de los inventarios ASEBA; Child Behavior Checklist - CBCL, contestado por padres de niños de 6-18 años, y Youth Self-Report - YSR, un autoinforme para niños/adolescentes de 11-18 años: a) mediante puntuaciones en las Escalas de Síndromes para realizar diagnósticos DSM-IV; y b) mediante diagnósticos obtenidos con entrevistas estructuradas para evaluar el funcionamiento. MÉTODO: se evaluó una muestra clínica de 420 niños y adolescentes (8-17 años) mediante el CBCL y 108 adolescentes fueron evaluados con el CBCL y YSR. Todos contestaron una entrevista diagnóstica y los evaluadores completaron una medida de deterioro funcional global. RESULTADOS: las Escalas DSM suponen un incremento de la validez significativo en relación a las Escalas de Síndromes Empíricos para discriminar diagnósticos DSM-IV, y una considerable validez incremental con respecto a los diagnósticos DICA-IV en la estimación del deterioro funcional. CONCLUSIÓN: las Escalas DSM deben ser consideradas simultáneamente con las Escalas de Síndromes de ASEBA, puesto que proporcionan información adicional en el proceso clínico

Validity of the DSM-Oriented scales of the Child Behavior Checklist and Youth Self-Report.

BACKGROUND: The school-age versions of the ASEBA (Achenbach System of Empirically Based Assessment) incorporate the DSM-Oriented scales. These scales make it possible to quantify and normalize problems defined in the DSM. The objective was to study the incremental validity of the DSM-Oriented scales of the ASEBA inventories, the Child Behavior Checklist - CBCL, completed by parents of children aged 6-18 years, and the Youth Self-Report -YSR, a self-report for children/adolescents aged 11-18, over: (a) scores on the Syndromes Scales for making DSM-IV diagnoses; and (b) diagnoses obtained with structured interviews for the assessment of functioning. METHOD: A clinical sample of 420 children and adolescents (8-17 years) was assessed with the CBCL, and 108 adolescents were assessed with the CBCL and YSR questionnaires. All underwent a diagnostic interview, and interviewers completed a measure of global functional impairment. RESULTS: The DSM-Oriented scales showed significant incremental validity in conjunction with the Empirical Syndrome scales for discriminating DSM-IV diagnoses, and considerable incremental validity in conjunction with the diagnoses obtained through the diagnostic interview for predicting the level of functional impairment. CONCLUSION: DSM-Oriented scales should be considered simultaneously with the Syndrome Scales of the ASEBA taxonomy, as they provide useful additional information in the clinical process.

Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol.

BACKGROUND: Lifestyle is one of the main determinants of people's health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors' communication skills, and more specifically the Motivational Interviewing. METHODS/DESIGN: The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. - SCOPE: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product-moment correlation coefficient). DISCUSSION: The verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes. TRIALS REGISTRATION Dislip-EM study: NCT01282190 (ClinicalTrials.gov).

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol.

BACKGROUND: The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. METHODS/DESIGN: An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. DISCUSSION: Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity. TRIALS REGISTRATION: ClinicalTrials.gov (NCT01282190).