The 2022 Annual Report of DataDerm: The database of the American Academy of Dermatology.

The American Academy of Dermatology (AAD) launched DataDerm in 2016 as the clinical data registry platform of AAD. DataDerm has evolved to be the largest database containing information about dermatology patients in the world. As of December 31, 2021, DataDerm contained data from 13.2 million unique patients and 47.0 million unique patient visits, with 403 practices representing 1670 clinicians actively participating in DataDerm in 2021. Of the 1670 clinicians participating in DataDerm in 2021, the majority were dermatologists (978) followed by physician assistants (375) and nurse practitioners (163) who are employed by AAD members and meet the AAD definition of the AAD DermCare team. Furthermore, in 2021, 834 clinicians submitted data via DataDerm to the Merit-based Incentive Payment System of the Centers for Medicare & Medicaid Services. This article is the third annual report about the status of DataDerm. This year's 2022 annual report presents the progress DataDerm has made over the past year in conjunction with OM1, the data analytics partner of DataDerm, as well as the current status and future plans of DataDerm.

DataDerm: Improving trends in performance measurement.

BACKGROUND: Medicare's legacy quality reporting programs were consolidated into the Merit-Based Incentive Payment System (MIPS) in 2015. PURPOSE: The DataDerm registry of the American Academy of Dermatology was examined to understand the potential for and subsequent rate of improvement across 23 performance measures. METHODS: We examined the level of performance across 23 performance measures with at least 20 clinicians reporting on at least 50 patients' experience. We calculated the following values: the aggregate performance rate for each measure and the overall aggregate performance rate. RESULTS: The aggregate performance rate for each measure ranged from 20.4% for AAD 1 (Psoriasis: Assessment of Disease Activity), to 99.9% for measure ACMS 1 (Avoidance of Opioid Prescriptions for Reconstruction After Skin Resection). Three of 23 measures had an aggregate performance over 95%. The overall aggregate performance rate across all 23 measures was 81.2%, indicating an aggregate potential for improvement of 18.8% across the 23 measures. Nine performance measures reported across the first five years of DataDerm's existence were tracked through time to understand trends in performance through time. The performance across the nine performance measures meeting the inclusion criteria consistently improved in the initial years (2016 through 2018) of DataDerm participation and showed some variation in 2019 and 2020. CONCLUSIONS: These data provide evidence that the very act of participation in a multi-institutional registry and tracking compliance with performance measures can lead to improvements in compliance with the performance measures and therefore improvements in quality of care.

The completeness and accuracy of DataDerm: The database of the American Academy of Dermatology.

The utility of any database or registry depends on the completeness and accuracy of the data it contains. This report documents the validity of data elements within DataDerm, the clinical registry database of the American Academy of Dermatology. An external audit of DataDerm, performed by a third-party vendor, involved the manual review of 1098 individual patient charts from calendar year 2018 from 8 different dermatology practices that used 4 different electronic health records. At each site, 142 discrete data fields were assessed, comparing the data within DataDerm to the source data within the electronic health record. Audited data included 3 domains of data elements (diagnoses, medications, and procedures) and a performance measure ("Biopsy Reporting Time-Clinician to Patient"), which is 1 of several measures used by DataDerm as a Qualified Clinical Data Registry. Overall completeness of data was 95.3%, with a range among practices of 90.6% to 98.5%. Overall accuracy of data was 89.8%, with a range of accuracy among practices of 81.2% to 94.1%. These levels of completeness and accuracy exceed the rates in the literature for registries that are based on data that is extracted from electronic health records; and therefore, this audit validates the excellent quality of data in DataDerm.

The 2021 annual report of DataDerm: The database of the American Academy of Dermatology.

The American Academy of Dermatology launched DataDerm in 2016 as the clinical data registry platform of the American Academy of Dermatology. DataDerm has evolved to be the largest database containing information about dermatology patients in the world. As of December 31, 2020, DataDerm contained data from 11.3 million unique patients and 40.0 million unique patient visits, with 782 practices representing 2290 clinicians actively participating in DataDerm. This article is the second in a series of annual reports about the status of DataDerm. While last year's 2020 first annual report presented the history of DataDerm as well as the rationale for its creation, maintenance, and expansion, this year's 2021 annual report presents the progress DataDerm has made over the past year along with its current status and future plans.

What They Are Not Telling Us: Analysis of Nonresponders on a National Survey of Resident Well-Being.

To characterize nonrespondents to a national survey about trainee well-being, examine response patterns to questions of sensitive nature, and assess how nonresponse biases prevalence estimates of mistreatment and well-being. Background: Surgical trainees are at risk for burnout and mistreatment, which are discernible only by self-report. Therefore, prevalence estimates may be biased by nonresponse. Methods: A survey was administered with the 2018 and 2019 American Board of Surgery In-Training Examinations assessing demographics, dissatisfaction with education and career, mistreatment, burnout, thoughts of attrition, and suicidality. Responders in 2019 were characterized as survey "Completers," "Discontinuers" (quit before the end), and "Selective Responders" (selectively answered questions throughout). Multivariable logistic regression assessed associations of respondent type with mistreatment and well-being outcomes, adjusting for individual and program characteristics. Longitudinal survey identifiers linked survey responses for eligible trainees between 2018 and 2019 surveys to further inform nonresponse patterns. Results: In 2019, 6956 (85.6%) of 8129 eligible trainees initiated the survey, with 66.5% Completers, 17.5% Discontinuers, and 16.0% Selective Responders. Items with the highest response rates included dissatisfaction with education and career (93.2%), burnout (86.3%), thoughts of attrition (90.8%), and suicidality (94.4%). Discontinuers and Selective Responders were more often junior residents and racially/ethnically minoritized than Completers. No differences were seen in burnout and suicidality rates between Discontinuers, Selective Responders, and Completers. Non-White or Hispanic residents were more likely to skip questions about racial/ethnic discrimination than non-Hispanic White residents (21.2% vs 15.8%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.19-1.53), particularly when asked to identify the source. Women were not more likely to omit questions regarding gender/gender identity/sexual orientation discrimination (OR, 0.91; 95% CI, 0.79-1.04) or its sources (OR, 1.02; 95% CI, 0.89-1.16). Both Discontinuers and Selective Responders more frequently reported physical abuse (2.5% vs 1.1%; P = 0.001) and racial discrimination (18.3% vs 13.6%; P < 0.001) on the previous survey (2018) than Completers. Conclusions: Overall response rates are high for this survey. Prevalence estimates of burnout, suicidality, and gender discrimination are likely minimally impacted by nonresponse. Nonresponse to survey items about racial/ethnic discrimination by racially/ethnically minoritized residents likely results in underestimation of this type of mistreatment.

Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US.

Importance: Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective: To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, Setting, and Participants: This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures: Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main Outcomes and Measures: Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results: The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and Relevance: In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.

National Evaluation of Surgical Resident Grit and the Association With Wellness Outcomes.

Importance: Grit, defined as perseverance and passion for long-term goals, is predictive of success and performance even among high-achieving individuals. Previous studies examining the effect of grit on attrition and wellness during surgical residency are limited by low response rates or single-institution analyses. Objectives: To characterize grit among US general surgery residents and examine the association between resident grit and wellness outcomes. Design, Setting, and Participants: A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year. Multivariable logistic regression models were constructed to assess the association of grit with resident burnout, thoughts of attrition, and suicidal thoughts. Statistical analyses were performed from June 1 to August 15, 2019. Exposures: Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]). Main Outcomes and Measures: The primary outcome was burnout. Secondary outcomes were thoughts of attrition and suicidal thoughts within the past year. Results: Among 7464 residents (7413 [99.3%] responded; 4469 men [60.2%]) from 262 general surgery residency programs, individual grit scores ranged from 1.13 to 5.00 points (mean [SD], 3.69 [0.58] points). Mean (SD) grit scores were significantly higher in women (3.72 [0.56] points), in residents in postgraduate training year 4 or 5 (3.72 [0.58] points), and in residents who were married (3.72 [0.57] points; all P ≤ .001), although the absolute magnitude of the differences was small. In adjusted analyses, residents with higher grit scores were significantly less likely to report duty hour violations (odds ratio [OR], 0.85; 95% CI, 0.77-0.93), dissatisfaction with becoming a surgeon (OR, 0.53; 95% CI, 0.48-0.59), burnout (OR, 0.53; 95% CI, 0.49-0.58), thoughts of attrition (OR, 0.61; 95% CI, 0.55-0.67), and suicidal thoughts (OR, 0.58; 95% CI, 0.47-0.71). Grit scores were not associated with American Board of Surgery In-Training Examination performance. For individual residency programs, mean program-level grit scores ranged from 3.18 to 4.09 points (mean [SD], 3.69 [0.13] points). Conclusions and Relevance: In this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. Given that surgical resident grit scores are generally high and much remains unknown about how to employ grit measurement, grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.

Burnout Phenotypes Among U.S. General Surgery Residents.

OBJECTIVE: Although well-established metrics exist to measure workplace burnout, researchers disagree about how to categorize individuals based on assessed symptoms. Using a person-centered approach, this study identifies classes of burnout symptomatology in a large sample of general surgery residents in the United States. DESIGN, SETTING, PARTICIPANTS: A survey was administered following the 2018 American Board of Surgery In-Training Examination (ABSITE) to study wellness among U.S. general surgery residents. Latent class models identified distinct classes of residents based on their responses to the emotional exhaustion and depersonalization questions of the modified abbreviated Maslach Burnout Inventory (aMBI). Classes were assigned representative names, and the characteristics of their members and residency programs were compared. RESULTS: The survey was completed by 7415 surgery residents from 263 residency programs nationwide (99.3% response rate). Five burnout classes were found: Burned Out (unfavorable score on all six items, 9.8% of total), Fully Engaged (favorable score on all six items, 23.1%), Fatigued (favorable on all items except frequent fatigue, 32.2%), Overextended (frequent fatigue and burnout from work, 16.7%), and Disengaged (weekly symptoms of fatigue and callousness, 18.1%). Within the more symptomatic classes (Burned Out, Overextended, and Disengaged), men manifested more depersonalization symptoms, whereas women reported more emotional exhaustion symptoms. Burned Out residents were characterized by reports of mistreatment (abuse, sexual harassment, and gender-, racial-, or pregnancy and/or childcare-based discrimination), duty hour violations, dissatisfaction with duty hour regulations or time for rest, and low ABSITE scores. CONCLUSIONS: Burnout is multifaceted, with complex and variable presentations. Latent class modeling categorizes general surgery residents based on their burnout symptomatology. Organizations should tailor their efforts to address the unique manifestations of each class as well as shared drivers.

Development of a conceptual model for understanding the learning environment and surgical resident well-being.

BACKGROUND: Surgeon burnout is linked to poor outcomes for physicians and patients. Several conceptual models exist that describe drivers of physician wellness generally. No such model exists for surgical residents specifically. METHODS: A conceptual model for surgical resident well-being was adapted from published models with input gained iteratively from an interdisciplinary team. A survey was developed to measure residents' perceptions of their program. A confirmatory factor analysis (CFA) tested the fit of our proposed model construct. RESULTS: The conceptual model outlines eight domains that contribute to surgical resident well-being: Efficiency and Resources, Faculty Relationships and Engagement, Meaning in Work, Resident Camaraderie, Program Culture and Values, Work-Life Integration, Workload and Job Demands, and Mistreatment. CFA demonstrated acceptable fit of the proposed 8-domain model. CONCLUSION: Eight distinct domains of the learning environment influence surgical resident well-being. This conceptual model forms the basis for the SECOND Trial, a study designed to optimize the surgical training environment and promote well-being.

Procedure coding in the American Joint Replacement Registry.

In October 2015, the Centers for Medicare & Medicaid Services transitioned from the 9th version of the International Classification of Diseases (ICD-9) codes for reporting patient diagnosis and medical procedures to the 10th version (ICD-10). The multitude of coding options for total joint arthroplasty in ICD-10-procedural coding (ICD-10-PCS) poses some challenges for the American Joint Replacement Registry (AJRR) in identifying precise procedures being reported. While AJRR participating hospitals are familiar with ICD-10-PCS, this new coding may not have been introduced to most AJRR participating surgeons. To address these issues, AJRR initiated an ICD-10 workgroup to define and map appropriate ICD-10 codes to total joint procedure types. This initiative sought to improve accuracy of AJRR data.

What Are the Migration Patterns for U.S. Primary Total Joint Arthroplasty Patients?

BACKGROUND: Evaluation of total joint arthroplasty (TJA) patient-reported outcomes and survivorship requires that records of the index and potential revision arthroplasty procedure are reliably captured. Until the goal of the American Joint Replacement Registry (AJRR) of more-complete nationwide capture is reached, one must assume that patient migration from hospitals enrolled in the AJRR to nonAJRR hospitals occurs. Since such migration might result in loss to followup and erroneous conclusions on survivorship and other outcomes of interest, we sought to quantify the level of migration and identify factors that might be associated with migration in a specific AJRR population. QUESTIONS/PURPOSES: (1) What are the out-of-state and within-state migration patterns of U.S. Medicare TJA patients over time? (2) What patient demographic and institutional factors are associated with these patterns? METHODS: Hospital records of Medicare fee-for-service beneficiaries enrolled from January 1, 2004 to December 31, 2015, were queried to identify primary TJA procedures. Because of the nationwide nature of the Medicare program, low rates of loss to followup among Medicare beneficiaries, as well as long-established enrollment and claims processing procedures, this database is ideal for examining patient migration after TJA. We identified an initial cohort of 5.33 million TJA records from 2004 to 2016; after excluding patients younger than 65 years of age, those enrolled solely due to disability, those enrolled in a Medicare HMO, or residing outside the United States, the final analytical dataset consisted of 1.38 million THAs and 3.03 million TKAs. The rate of change in state or county of residence, based on Medicare annual enrollment data, was calculated as a function of patient demographic and institutional factors. A multivariate Cox model with competing risk adjustment was used to evaluate the association of patient demographic and institutional factors with risk of out-of-state or out-of-county (within-state) migration. RESULTS: One year after the primary arthroplasty, 0.61% (95% confidence interval [CI], 0.60-0.61; p < 0.001 for this and all comparisons in this Results section) of Medicare patients moved out of state and another 0.62% (95% CI, 0.60-0.63) moved to a different county within the same state. Five years after the primary arthroplasty, approximately 5.41% (95% CI, 5.39-5.44) of patients moved out of state and another 5.50% (95% CI, 5.46-5.54) Medicare patients moved to a different county within the same state. Among numerous factors of interest, women were more likely to migrate out of state compared with men (hazard ratios [HR], 1.06), whereas black patients were less likely (HR, 0.82). Patients in the Midwest were less likely to migrate compared with patients in the South (HR, 0.74). Patients aged 80 and older were more likely to migrate compared with 65- to 69-year-old patients (HR, 1.19). Patients with higher Charlson Comorbidity Index scores compared with 0 were more likely to migrate (index of 5+; HR, 1.19). CONCLUSIONS: Capturing detailed information on patients who migrate out of county or state, with associated changes in medical facility, requires a nationwide network of participating registry hospitals. At 5 years from primary arthroplasty, more than 10% of Medicare patients were found to migrate out of county or out of state, and the rate increases to 18% after 10 years. Since it must be assumed that younger patients might exhibit even higher migration levels, these findings may help inform public policy as a "best-case" estimate of loss to followup under the current AJRR capture area. Our study reinforces the need to continue aggressive hospital recruitment to the AJRR, while future research using an increasingly robust AJRR database may help establish the migration patterns of nonMedicare patients. LEVEL OF EVIDENCE: Level III, therapeutic study.

Perioperative Periprosthetic Femur Fractures are Strongly Correlated With Fixation Method: an Analysis From the American Joint Replacement Registry.

BACKGROUND: Perioperative periprosthetic femur fractures (PPFx) after total hip arthroplasty (THA) remain a leading cause of early stem failure and revision and are associated with high rates of morbidity and mortality. American Joint Replacement Registry (AJRR) data have been analyzed to determine the relationship of femoral stem fixation to PPFx revision. METHODS: All early (≤3 months from index arthroplasty) linked primary and revision hip arthroplasties reported to the AJRR between 2012 and 2017 were analyzed. We evaluated patient demographics, arthroplasty type (hemiarthroplasty vs THA), and stem fixation. RESULTS: A total of 10,277 linked revisions were reported to the AJRR during 2012-2017. Early PPFx requiring revision occurred in 628 patients (6.1%) due to osteoarthritis (82.4%), femoral neck fracture (12.1%), and other causes (15.6%). Five hundred twenty-nine patients (84%) were treated with THA and 99 patients with hemiarthroplasty (16%). Females (70%) have a higher prevalence of revisions. Fifty-eight percent of patients were ≥70 years of age, and 20% were ≥80 years of age. Patients with cementless stems were 2.6 times (account 94.9% of the fractures, 95% confidence interval 0.59-11.1) more likely to undergo early revision for PPFx than those with cemented fixation, although not statistically significant with its sample size. CONCLUSION: Mirroring other studies and national registries, there was an association between cementless fixation and PPFx in AJRR. Nevertheless, AJRR data demonstrate a trend of increasing utilization of cementless femoral fixation for THA and hemiarthroplasty, with cementless fixation accounting for 93% of THA stems with early periprosthetic fracture. Additional analysis is needed to better understand this phenomenon, especially in the elderly.

Creation and Validation of Linkage Between Orthopedic Registry and Administrative Data Using Indirect Identifiers.

BACKGROUND: Registries and administrative databases have unique and complementary strengths in device epidemiologic studies. We sought to develop, validate, and assess a sequential algorithm using indirect identifiers to link registry and administrative data. METHODS: Hip and knee arthroplasty procedures performed at 6 New York State hospitals enrolled in American Joint Replacement Registry in 2014 were included. After conducting a direct linkage using patient identifiers including name and social security numbers, we validated the methodology of indirect linkage using facility ID, patients' year and month of birth, sex, and zip code, and procedure date and site (hip/knee). We further evaluated the influence of absent indirect identifier(s) and compromised data quality on linkage success. RESULTS: Using our sequential algorithm, 3739 of the 4063 directly linked records (92.03%) were matched with indirect identifiers, with an accuracy of >99.9%. Main reasons for nonmatching included discrepancies in procedure codes and dates. When one of the indirect identifiers was not available, the linkage algorithm still achieved over 90% sensitivity and 99.8% accuracy. Analyses showed that the algorithm was robust when quality of data was moderately compromised. CONCLUSION: This study demonstrated high sensitivity and accuracy of an algorithm to create linkages between a registry and an administrative database using indirect identifiers. The methodology will enable long-term surveillance and outcome assessment of a wide variety of devices and procedures. Variations in the coding of procedures, availability of indirect identifiers, and their quality have limited impact on this algorithm.

Early Results From the American Joint Replacement Registry: A Comparison With Other National Registries.

BACKGROUND: The American Joint Replacement Registry (AJRR) was created to capture knee and hip arthroplasty data in the United States. The purpose of this study was to compare early reports from the AJRR to other national registries to identify topics for future analysis. METHODS: Hip and knee arthroplasty data were extracted from the AJRR, Australia, New Zealand, United Kingdom, Norway, and Sweden from 2014 to 2016. Hip arthroplasty data including femoral and acetabular fixation, bearing surface, head size, dual-mobility bearings, resurfacing, and revision burden were compared. Knee arthroplasty data including polyethylene type, unicondylar arthroplasty, mobile bearings, cruciate-retaining implants, patella resurfacing, and revision burden were compared. Registry characteristics and patient demographics were reported using descriptive statistics. RESULTS: In 2016, the AJRR captured 28% of arthroplasty procedures performed in the United States compared with 95%-98.3% among other registries. Cementless femoral fixation was 96.7% in the AJRR compared with 21.8%-63.4%. Ceramic and 36-mm heads were most common in AJRR; all other registries reported that metal and 32-mm heads were most popular. Dual-mobility articulations were used in 8% of primary and 28% of revision total hip arthroplasty procedures in the AJRR. The AJRR reported a unicondylar knee arthroplasty rate of 3.2% compared with 5.1%-13.3% in other registries, but the highest rates of posterior-stabilized total knee arthroplasties (48.5% compared to 8.2%-28.7%) and patella resurfacing (93.9% compared to 2.4%-51.6%). CONCLUSION: Several differences in hip and knee arthroplasty practices exist between the United States and other countries. Future studies should focus on understanding why differences in practice trends exist and assess outcomes associated with these practices. LEVEL OF EVIDENCE: Level III, retrospective.

Infection burden in total hip and knee arthroplasties: an international registry-based perspective.

BACKGROUND: Infection remains a leading cause of failure of hip and knee replacements. Infection burden is the ratio of implants revised for infection to the total number of arthroplasties in a specific period, measuring the steady state of infection in a registry. We hypothesized infection burden would be similar among arthroplasty registries. METHODS: We evaluated publicly reported data from 6 arthroplasty registries (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR], New Zealand Joint Registry, Swedish Hip Arthroplasty Register, Swedish Knee Arthroplasty Register, National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man, and the American Joint Replacement Registry) for revisions performed with an infection diagnosis over the last 6 years. RESULTS: The 2015 hip infection burden varied between registries from 0.76% (AOANJRR) to 1.24% (Swedish Hip Arthroplasty Register), and the unweighted overall average for hip infection burden was 0.97%. In 2012, 2013, and 2014, average hip infection burden held steady at 0.87%, 0.93%, and 0.94%, respectively, higher than the preceding 2 years. The 2015 knee infection burden varied from 0.88% (AOANJRR) to 1.28% (Swedish Knee Arthroplasty Register), and the unweighted average was 1.03%. In 2012, 2013, and 2014, knee infection burden was 1.04%, 1.11%, and 1.02%, respectively. These numbers were also higher than the preceding 2 years. CONCLUSIONS: Infection burden may be one measure of the overall success in registry populations as well as monitoring the steady state of infection worldwide. Despite global efforts to reduce postoperative infection, infection burden has actually increased in the selected registries over time.

Comparing contemporary revision burden among hip and knee joint replacement registries.

BACKGROUND: Hip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls. METHODS: We evaluated the national joint registries of 5 health systems (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR]; National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man; New Zealand Joint Registry [NZJR]; Swedish Hip Arthroplasty Register [SHAR] and Swedish Knee Arthroplasty Register [SKAR]; and the American Joint Replacement Registry [AJRR]) for hip and knee revision burden over the past 4 years or since registry inception. Historic controls were obtained from previously published reports. RESULTS: The 2014 hip revision burden varied from 9.7 percent (NJR) to 11.9 percent (NZJR), and the unweighted average was 10.4 percent. The 2011, 2012, and 2013 mean hip revision burden was 11.9, 11.9, and 11.4 percent. The 2014 knee revision burden varied from to 6.0 percent (NJR) to 8.1 percent (AJRR), and the unweighted average for the 5 registries studied was 7.0 percent. The 2011, 2012, and 2013 mean knee revision burden was 6.9, 7.0, and 7.0 percent. Historically, the observed hip revision burden was 15.8 percent and the knee revision burden 8.0 percent. CONCLUSIONS: Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

Impact of an Individualized Physical Activity Intervention on Improving Mental Health Outcomes in Family Caregivers of Persons with Dementia: A Randomized Controlled Trial.

PURPOSE: This study examined secondary benefits of an individualized physical activity intervention on improving dementia family caregivers' subjective burden, depressive symptoms and positive affect. DESIGN AND METHODS: A community-based randomized controlled trial (RCT) was implemented with family caregivers of persons with dementia (N = 211) who received the Enhanced Physical Activity Intervention (EPAI: treatment intervention, n = 106) or the Caregiver Skill Building Intervention (CSBI: control intervention, n = 105). Interventions were delivered over 12 months, including a baseline home visit and regularly spaced telephone calls. Data were collected in person at baseline, 6 and 12-months; and telephonically at 3 and 9-months. The EPAI integrated physical activity and caregiving content while the CSBI focused only on caregiving content. Descriptive, bivariate and intention-to-treat analyses using generalized estimating equations (GEE) were performed to examine secondary benefits of the EPAI on family caregiver burden, depressive symptoms and positive affect. RESULTS: Compared to caregivers in the CSBI group, caregivers in the EPAI significantly increased their overall and total moderate physical activity and showed a positive interaction between the intervention and time for positive affect at both six (p = 0.01) and 12-months (p = 0.03). The EPAI was significantly associated with improving burden at 3 months (p = 0.03) but had no significant effect on depressive symptoms. IMPLICATIONS: Caregiver involvement in an individualized physical activity intervention was associated with increased overall and total moderate physical activity and improved positive affect from baseline to 12 months. Improved positive affect may help caregivers to feel better about themselves and their situation, and better enable them to continue providing care for their family member for a longer time at lower risk to their own mental health.