Higher Return to Sport and Lower Revision Rates when Performing Arthroscopic Bankart Repair with Remplissage for Anterior Shoulder Instability with a Hill-Sachs Lesion: A Meta-Analysis.

BACKGROUND: Recurrent anterior shoulder instability remains the most common complication from a prior shoulder dislocation, especially among young and active individuals who engage in athletic activities. This instability can lead to repeated subluxation or dislocations of the humeral head from the glenoid fossa. The purpose of this study is to compare postoperative recurrence rates, instability-related revision and return to sport (RTS) rates between isolated arthroscopic Bankart repair (ABR) and ABR with remplissage (ABR+R) for anterior shoulder instability with subcritical glenoid bone loss (GBL) and a Hill-Sachs lesion (HSL). METHODS: PubMed, Embase, and Web of Science were searched on June 2022. Studies sought were those comparing postoperative outcomes of ABR+R versus isolated ABR for subcritical GBL and an HSL. Study quality was evaluated using the revised Cochrane tool. Redislocations, instability-related revisions, and return to sport rates were extracted and pooled estimates were calculated using the random-effect model. RESULTS: Twelve studies were included with a mean follow-up of 48.2 months for isolated ABR and 43.2 months for ABR+R. The meta-analytic comparison demonstrated that ABR+R resulted in statistically significant improvement in Rowe and American Shoulder and Elbow Surgeons scores by 6.5 and 2.2 points, respectively, however, the improvements in patient-reported outcomes were not clinically meaningful. ABR+R resulted in reduced external rotation at the side by 1˚ which was not clinically meaningful, and there was no significant difference in terms of forward elevation. ABR+R resulted in a statistically significant reduction of overall postoperative recurrences (odd ratio (OR): 9.36), postoperative dislocations (OR: 6.28) instability-related revision (OR: 3.46), and RTS to any level (OR: 2.85). CONCLUSION: The addition of remplissage to ABR for recurrent anterior shoulder instability with subcritical GBL and HSL results in significantly lower postoperative instability recurrence, lower instability-related revisions, and higher RTS to any level.

Predictors of poor and excellent outcomes following reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff.

BACKGROUND: As the indications for reverse total shoulder arthroplasty (RSA) continue to evolve, it has been more commonly utilized for the treatment of glenohumeral osteoarthritis with an intact rotator cuff (GHOA). Given the increased use of RSA for GHOA, it is important to identify factors influential of clinical outcomes. In this study, we sought to identify variables predictive of clinical outcomes following RSA for GHOA. METHODS: Patients undergoing primary RSA for GHOA between 2015 and 2020 were retrospectively identified through a prospectively maintained, single surgeon registry. Eligible patients had complete patient-reported outcome measures and range of motion measurements with a minimum 2-year follow-up. Univariate analysis was utilized to compare characteristics and outcome measures of patients with poor and excellent outcomes, which was defined as postoperative American Shoulder and Elbow Surgeons (ASES) scores in the bottom and top quartiles, respectively. Multivariate linear regression was performed to determine factors independently predictive of postoperative ASES score. RESULTS: A total of 230 patients were included with a mean follow-up of 33.4 months (SD 13.2). The mean age of the study population was 71.9 (SD 6.1). Two hundred twenty-four patients (97.4%) surpassed the minimal clinically important difference and 209 patients (90.1%) achieved substantial clinical benefit for ASES score. Preoperative factors differing between the poor and excellent outcome groups were sex (male: poor 37.9%, excellent 58.6%; P = .041), opioid use (poor 24.1%, excellent 5.2%; P = .009), ASES score (poor 32.9, excellent 41.0; P = .011), and forward elevation (poor 92°, excellent 101°; P = .030). Linear regression demonstrated that Walch B3 glenoids (ß 7.08; P = .010) and higher preoperative ASES scores (ß 0.14; P = .025) were predictors of higher postoperative ASES score, while postoperative complications (ß -18.66; P < .001) and preoperative opioid use (ß -11.88; P < .001) were predictive of lower postoperative ASES scores. CONCLUSION: Over 90% of patients who underwent RSA for GHOA with an intact rotator cuff experienced substantial clinical benefit. An unsurprising handful of factors were associated with postoperative clinical outcomes; higher preoperative ASES scores were slightly associated with higher postoperative ASES, whereas preoperative opioid use and postoperative complications were associated with lower postoperative ASES. Additionally, Walch glenoid type B3 was associated with higher postoperative ASES, indicating that patients with posterior glenoid defects are not predisposed to poor clinical outcomes following RSA. These results serve as a resource to improve preoperative patient counseling and manage postoperative expectations.

Estimation of racial and language disparities in pediatric emergency department triage using statistical modeling and natural language processing.

OBJECTIVES: The study aims to assess racial and language disparities in pediatric emergency department (ED) triage using analytical techniques and provide insights into the extent and nature of the disparities in the ED setting. MATERIALS AND METHODS: The study analyzed a cross-sectional dataset encompassing ED visits from January 2019 to April 2021. The study utilized analytical techniques, including K-mean clustering (KNN), multivariate adaptive regression splines (MARS), and natural language processing (NLP) embedding. NLP embedding and KNN were employed to handle the chief complaints and categorize them into clusters, while the MARS was used to identify significant interactions among the clinical features. The study also explored important variables, including age-adjusted vital signs. Multiple logistic regression models with varying specifications were developed to assess the robustness of analysis results. RESULTS: The study consistently found that non-White children, especially African American (AA) and Hispanic, were often under-triaged, with AA children having >2 times higher odds of receiving lower acuity scores compared to White children. While the results are generally consistent, incorporating relevant variables modified the results for specific patient groups (eg, Asians). DISCUSSION: By employing a comprehensive analysis methodology, the study checked the robustness of the analysis results on racial and language disparities in pediatric ED triage. The study also recognized the significance of analytical techniques in assessing pediatric health conditions and analyzing disparities. CONCLUSION: The study's findings highlight the significant need for equal and fair assessment and treatment in the pediatric ED, regardless of their patients' race and language.

Strategies to Mitigate Bleeding in Shoulder Arthroplasty in the Setting of an Arteriovenous Fistula: A Report of 3 Cases.

CASE: Arteriovenous (AV) fistula in the ipsilateral extremity for hemodialysis presents unique challenges during shoulder arthroplasty. We describe 3 cases of shoulder arthroplasty performed through a deltopectoral approach on the ipsilateral side of an AV fistula. In all cases, the cephalic vein was found to be arterialized with increased diameter and thickness. All procedures were successfully performed without injury to the arterialized cephalic vein. CONCLUSION: This report highlighted strategies to mitigate catastrophic bleeding from an arterialized cephalic vein during shoulder arthroplasty, which includes preoperative cross-matching, expeditious vascular surgery availability, meticulous surgical dissection, and careful retractor placement.

Evaluation of a COVID-19 Risk Tool.

Some of the most vexing issues with the COVID-19 pandemic were the inability of schools and work areas to track symptoms. Technology solutions to mitigate repercussions of the COVID-19 pandemic include tools that provide guidelines and interfaces to influence behavior, reduce exposure to the disease, and enable policy-driven avenues to return to a sense of normalcy (e.g., school and work). This presentation presents the implementation and early evaluation of a return-to-work COVID-19 symptom and risk assessment tool.

Social determinants of health disparities impact postoperative complications in patients undergoing total shoulder arthroplasty.

BACKGROUND: Understanding the role of social determinants of health disparities (SDHDs) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we use International Classification of Diseases (ICD) codes to identify SDHDs and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). METHODS: A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes, patients who underwent primary TSA with at least 2 years of follow-up in the database were identified. Patients with a history of SDHDs were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of 2 cohorts: (1) patients with no history of SDHDs (control) and (2) patients with a history of SDHDs (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. RESULTS: After matching, there were 8023 patients in the SDHD group and 8023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2 years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. DISCUSSION: This study highlights the association between SDHDs and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHDs is important in determining value-based payment models and risk stratifying to optimize patient care.

Predicting long-term outcomes of kidney transplantation in the era of artificial intelligence.

The ability to accurately predict long-term kidney transplant survival can assist nephrologists in making therapeutic decisions. However, predicting kidney transplantation (KT) outcomes is challenging due to the complexity of the factors involved. Artificial intelligence (AI) has become an increasingly important tool in the prediction of medical outcomes. Our goal was to utilize both conventional and AI-based methods to predict long-term kidney transplant survival. Our study included 407 KTs divided into two groups (group A: with a graft lifespan greater than 5 years and group B: with poor graft survival). We first performed a traditional statistical analysis and then developed predictive models using machine learning (ML) techniques. Donors in group A were significantly younger. The use of Mycophenolate Mofetil (MMF) was the only immunosuppressive drug that was significantly associated with improved graft survival. The average estimated glomerular filtration rate (eGFR) in the 3rd month post-KT was significantly higher in group A. The number of hospital readmissions during the 1st year post-KT was a predictor of graft survival. In terms of early post-transplant complications, delayed graft function (DGF), acute kidney injury (AKI), and acute rejection (AR) were significantly associated with poor graft survival. Among the 35 AI models developed, the best model had an AUC of 89.7% (Se: 91.9%; Sp: 87.5%). It was based on ten variables selected by an ML algorithm, with the most important being hypertension and a history of red-blood-cell transfusion. The use of AI provided us with a robust model enabling fast and precise prediction of 5-year graft survival using early and easily collectible variables. Our model can be used as a decision-support tool to early detect graft status.

Ichthyosis Follicularis, Alopecia, and Photophobia Syndrome in a Saudi Child: A Case Report.

Ichthyosis follicularis, atrichia, and photophobia (IFAP) syndrome is a rare autosomal recessive, X-linked, genetic disorder that involves a triad of follicular ichthyosis, atrichia of the scalp, and photophobia. We report a case of an 8-year-old boy with alopecia of the scalp, eyebrows, and eyelashes, which occurred in his first year of age. His birth was uneventful, and his developmental milestones were normal. The alopecia was non-scarring and was accompanied by mild generalized xerosis, photophobia, and recurrent angular cheilitis. Moreover, numerous non-inflammatory, follicular, keratotic tiny papules were noticed. His deciduous teeth had retention with gum hyperplasia, and his feet showed symmetrical plantar keratoderma and nail dystrophy of the right big toe. The genetic testing confirmed an X-linked recessive inheritance of IFAP syndrome without BRESHECK syndrome due to the mutation in the MBTPS2 (300294) gene located on chromosome Xp22.12. The patient was given symptomatic treatment with urea cream for plantar keratoderma and was advised to apply constant moisturizers to avoid generalized xerosis. Dermatological and ophthalmological follow-ups were recommended. This is the first case reported from Saudi Arabia. This case report throws light on the characteristics of IFAP syndrome and denotes the points of differentiation from similar conditions.

Using natural language processing to characterize and predict homeopathic product-associated adverse events in consumer reviews: comparison to reports to FDA Adverse Event Reporting System (FAERS).

OBJECTIVE: Apply natural language processing (NLP) to Amazon consumer reviews to identify adverse events (AEs) associated with unapproved over the counter (OTC) homeopathic drugs and compare findings with reports to the US Food and Drug Administration Adverse Event Reporting System (FAERS). MATERIALS AND METHODS: Data were extracted from publicly available Amazon reviews and analyzed using JMP 16 Pro Text Explorer. Topic modeling identified themes. Sentiment analysis (SA) explored consumer perceptions. A machine learning model optimized prediction of AEs in reviews. Reports for the same time interval and product class were obtained from the FAERS public dashboard and analyzed. RESULTS: Homeopathic cough/cold products were the largest category common to both data sources (Amazon = 616, FAERS = 445) and were analyzed further. Oral symptoms and unpleasant taste were described in both datasets. Amazon reviews describing an AE had lower Amazon ratings (X2 = 224.28, P < .0001). The optimal model for predicting AEs was Neural Boosted 5-fold combining topic modeling and Amazon ratings as predictors (mean AUC = 0.927). DISCUSSION: Topic modeling and SA of Amazon reviews provided information about consumers' perceptions and opinions of homeopathic OTC cough and cold products. Amazon ratings appear to be a good indicator of the presence or absence of AEs, and identified events were similar to FAERS. CONCLUSION: Amazon reviews may complement traditional data sources to identify AEs associated with unapproved OTC homeopathic products. This study is the first to use NLP in this context and lays the groundwork for future larger scale efforts.

Subscapularis management in anatomic total shoulder arthroplasty: A systematic review and network meta-analysis.

Background: This systematic review and network meta-analysis compare clinical outcomes of three different subscapularis management techniques in anatomic total shoulder arthroplasty: lesser tuberosity osteotomy, subscapularis peel, and subscapularis tenotomy. Methods: PubMed, Web of Science, Embase, and Cochrane's trial registry were searched in July 2021. Comparative studies and case series evaluating the outcomes of these three techniques were included. The network meta-analysis was performed only on comparative studies. Results: Twenty-three studies were included. Both lesser tuberosity osteotomy and subscapularis peel had significantly higher Western Ontario Osteoarthritis Scores compared to subscapularis tenotomy, but no difference in American Shoulder and Elbow Society Scores. Subscapularis peel had superior external rotation compared to lesser tuberosity osteotomy. However, no difference was found in external rotation between subscapularis peel and subscapularis tenotomy or between subscapularis tenotomy and lesser tuberosity osteotomy. The overall weighted average for lesser tuberosity osteotomy bony union was 93.6%, whereas the overall weighted average for subscapularis tendon healing was 79.4% and 87% for subscapularis tenotomy and subscapularis peel, respectively. Discussion: This network meta-analysis demonstrated that lesser tuberosity osteotomy and subscapularis peel were associated with the high union and subscapularis healing rates and may be associated with improved shoulder function and quality of life, compared to subscapularis tenotomy. Lesser tuberosity osteotomy and subscapularis peel demonstrate a trend of superior outcomes compared to subscapularis tenotomy during anatomic total shoulder arthroplasty.

Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort.

PURPOSE: This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction. METHODS: A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity. RESULTS: A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups. CONCLUSION: ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.

Metabolic syndrome and the likelihood of knee pain and functional disability: evidence from a large middle eastern population-based study.

OBJECTIVES: Metabolic Syndrome (MetS) has been associated with knee osteoarthritis (KOA) in animal studies, but epidemiologic evidence of the association remains controversial. We investigated the association between MetS and knee pain and functional disability, the hallmarks of KOA, in a Middle Eastern population with high reported MetS rates. METHODS: A population-based study of adult individuals was conducted between 01/2016 and 03/2019. Data collected included age, sex, blood pressure, body mass index (BMI), waist circumference (WC), and comprehensive metabolic panel blood tests. Knee symptoms were assessed using The Western Ontario and McMaster Arthritis index (WOMAC) The Adult Treatment Panel III criteria was applied to determine if participants had MetS. Multivariable regression was used to determine the association of MetS, and its components, with the WOMAC total and subscale scores. RESULTS: Of 6,000 participants enrolled, 15.5% had MetS. The multivariate regression demonstrated that participants with MetS had significantly higher WOMAC total and subscale scores after adjusting for demographic variables; however, these associations were not significant after adjusting for BMI. Multivariate regression examining the association between MetS components and the WOMAC scores showed sex-based significant differences with WOMAC scores; however, the differences were not larger than the minimally clinical important differences. CONCLUSIONS: This study demonstrated that after adjustment for BMI, neither MetS nor its individual parameters were associated with worse knee symptoms. As such, the association between MetS and worse knee symptoms requires further study.

Medullary brainstem gliomas in an adult: A rare case report and challenging tumor.

Background: Medullary brainstem lesions are rare tumors that are challenging to treat due to their location in the brainstem, which controls vital functions such as breathing, heart rate, and blood pressure. While the most common subtype is the aggressive diffuse intrinsic pontine glioma, other subtypes exist, including focal brainstem gliomas and cervicomedullary gliomas. The prognosis for patients with brainstem gliomas is generally poor, and treatment options are limited. Early detection and treatment are crucial to improve outcomes for patients with these tumors. Case Description: In this case report, the authors describe a 28-year-old male from Saudi Arabia who presented with headaches and vomiting. Imaging studies and clinical examination revealed a high-grade astrocytoma medullary brainstem lesion. The patient underwent radiation therapy and chemotherapy, effectively controlling tumor growth and improving his quality of life. However, a residual tumor remained, and the patient underwent neurosurgery to resect the remaining tumor was successful in removing the tumor, and the patient showed significant improvement in his symptoms and overall health. Conclusion: This case highlights the importance of early detection and treatment of medullary brainstem lesions. While radiation therapy and chemotherapy are primary treatment options, neurosurgery may be necessary to resect residual tumors. In addition, cultural and social factors may need to be considered in managing these tumors in Saudi Arabia.

Predictors of COVID-19 From a Statewide Digital Symptom and Risk Assessment Tool: Cross-Sectional Study.

BACKGROUND: Some of the most vexing issues with the COVID-19 pandemic were the inability of facilities and events, such as schools and work areas, to track symptoms to mitigate the spread of the disease. To combat these challenges, many turned to the implementation of technology. Technology solutions to mitigate repercussions of the COVID-19 pandemic include tools that provide guidelines and interfaces to influence behavior, reduce exposure to the disease, and enable policy-driven avenues to return to a sense of normalcy. This paper presents the implementation and early evaluation of a return-to-work COVID-19 symptom and risk assessment tool. The system was implemented across 34 institutions of health and education in Alabama, including more than 174,000 users with over 4 million total uses and more than 86,000 reports of exposure risk between July 2020 and April 2021. OBJECTIVE: This study aimed to explore the usage of technology, specifically a COVID-19 symptom and risk assessment tool, to mitigate exposure to COVID-19 within public spaces. More specifically, the objective was to assess the relationship between user-reported symptoms and exposure via a mobile health app, with confirmed COVID-19 cases reported by the Alabama Department of Public Health (ADPH). METHODS: This cross-sectional study evaluated the relationship between confirmed COVID-19 cases and user-reported COVID-19 symptoms and exposure reported through the Healthcheck web-based mobile application. A dependent variable for confirmed COVID-19 cases in Alabama was obtained from ADPH. Independent variables (ie, health symptoms and exposure) were collected through Healthcheck survey data and included measures assessing COVID-19-related risk levels and symptoms. Multiple linear regression was used to examine the relationship between ADPH-confirmed diagnosis of COVID-19 and self-reported health symptoms and exposure via Healthcheck that were analyzed across the state population but not connected at the individual patient level. RESULTS: Regression analysis showed that the self-reported information collected by Healthcheck significantly affects the number of COVID-19-confirmed cases. The results demonstrate that the average number of confirmed COVID-19 cases increased by 5 (high risk: ß=5.10; P=.001), decreased by 24 (sore throat: ß=-24.03; P=.001), and increased by 21 (nausea or vomiting: ß=21.67; P=.02) per day for every additional self-report of symptoms by Healthcheck survey respondents. Congestion or runny nose was the most frequently reported symptom. Sore throat, low risk, high risk, nausea, or vomiting were all statistically significant factors. CONCLUSIONS: The use of technology allowed organizations to remotely track a population as it is related to COVID-19. Healthcheck was a platform that aided in symptom tracking, risk assessment, and evaluation of status for admitting individuals into public spaces for people in the Alabama area. The confirmed relationship between symptom and exposure self-reporting using an app and population-wide confirmed cases suggests that further investigation is needed to determine the opportunity for such apps to mitigate disease spread at a community and individual level.

Quantum leap in the light of molecular elucidation of garlic genome.

Garlic, a popular vegetable cum condiment is known widely for its health benefits, pharmacological properties and in curing several pathological conditions. This compelling horticultural bulb crop is propagated asexually from individual bulbils or cloves. It is an obligate apomict that lost its fertility and blooming potential long ago and probable reason for evolution from fertility to sterility to greater contiguity of human selection to asexual propagules as they are used in culinary as and when required. The crop is likely to be sterile owing to nutritional competition between topsets, pollen degeneration, chromosomal deletion, irregular chromosomal pairing and abnormal meiosis during gametogenesis and thus curbing genetic variation is needed utmost for its improvement. With asexual reproduction, molecular studies are challenging due to its expected and complex genome. Alongside classical molecular markers like RAPDs, AFLPs, SRAPs, SSRs, and isozymes; recent high-throughput genotyping-by-sequencing (GBS) approaches like DArTseq has allowed characterization, mapping, whole-genome profiling, DNA fingerprinting among others in garlic. However, in recent years, biotechnological tools, genetic transformation via biolistic or Agrobacterium tumefaciens, polyploidization or chromosomal doubling have emerged as a potent breeding tool in enabling the improvement of vegetatively propagated plants such as garlic. In recent times biological responses of garlic and its compounds have been studied using epigenomics, proteomics and transcriptomics by researchers in preclinical studies instigating the biological effects of garlic and such gene expression revealed many early mechanistic events which may clinically underlie important health benefits pertaining to garlic intake. This review thus encompasses efforts achieved till present date towards elucidation of garlic genome with regard to molecular, biotechnological analysis and gene expression in terms of in vitro and in vivo studies.

Social determinants of health and race are independent predictors of reduced rotator cuff surgery rates in the Medicare population.

BACKGROUND: Racial disparities have been shown to influence rates of surgery for patients with rotator cuff disease. Some individuals have attributed adverse social determinants of health (SDOHs) as potential confounders of this relationship between race and surgery rate. However, there is a paucity of literature observing whether adverse SDOHs and race independently influence rotator cuff surgery rates. Therefore, the purpose of this study was to determine whether adverse SDOHs and race are independent predictors of rotator cuff surgery rates for Medicare beneficiaries. METHODS: A retrospective analysis was conducting using the Medicare Standard Analytic Files (SAF) data set of the PearlDiver database, observing 211,340 patients with rotator cuff pathology. Univariate and multivariable regression analyses were performed to observe whether race and adverse SDOHs were independent variables associated with rotator cuff surgery rates. To determine whether adverse SDOHs significantly influenced racial disparities, stratified analyses of patients with ≥1 adverse SDOH and those without adverse SDOHs were conducted to compare the odds ratios (ORs) and 95% confidence intervals (CIs) of racial disparities. RESULTS: Among patients with rotator cuff disease, 21,679 (10.26%) were of nonwhite race and 21,835 (10.33%) had ≥1 adverse SDOH. The variables of nonwhite race (OR, 0.622; 95% CI, 0.599-0.668; P < .001) and having ≥1 adverse SDOH (OR, 0.715; 95% CI, 0.501-0.814; P < .001) were independent predictors of not undergoing surgery. On stratified analysis, there was no significant difference in racial disparities in patients with ≥1 adverse SDOH (OR, 0.620; 95% CI, 0.440-0.875) and those without adverse SDOHs (0.635; 95% CI, 0.601-0.671) based on overlapping 95% CIs. DISCUSSION: This study demonstrated that among Medicare beneficiaries, adverse SDOHs and race are independent predictors of lower rotator cuff surgery rates, emphasizing the need to address disparities based on race alone.

Muscular Retraining and Rehabilitation after Shoulder Muscle Tendon Transfer.

Muscle tendon transfers around the shoulder involve transferring the tendon of a well-functioning muscle-tendon unit to the site of damaged muscle-tendon insertion. In turn, this restores function and strength of the injured shoulder muscle through dynamic muscular contraction and a tenodesis effect. Rehabilitation after shoulder muscle tendon transfers requires extensive and lengthy rehabilitation to achieve satisfactory clinical outcomes. It is crucial to gain detailed understanding of the rehabilitation requirements for different tendon transfer procedures such as the type of immobilization and specific range of motion limitations at specific time points during rehabilitations.

Trends in Venous Thromboembolism After Shoulder Arthroplasty in the United States: Analysis Following the 2009 American Academy of Orthopaedic Surgeons Clinical Practical Guidelines.

BACKGROUND: In 2009, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total shoulder arthroplasty (TSA). The purpose of this study was to examine the (1) change in incidence of 90-day VTE, deep vein thrombosis (DVT), and pulmonary embolism; (2) change in utilization of chemoprophylaxis; and (3) change in the economic burden associated with VTE after TSA from 2010 to 2019. METHODS: Using the PearlDiver database, national data from 2010 to 2019 were used to identify patients who underwent primary TSA for osteoarthritis and/or rotator cuff arthropathy. Exclusions entailed liver pathology, coagulopathy, or those on prior prescribed blood thinners before TSA. Multivariable regression was used controlling for age and Charlson Comorbidity Index for all years with 2010 as the reference year. RESULTS: From 2010 to 2019, there was a reduction in VTE rates from 0.89% in 2010 to 0.78% in 2019. Regarding implant type, there was no notable change in incidence of VTE, DVT, and pulmonary embolism within 90 days after anatomic TSA. Notable reductions were observed in both VTE and DVT after reverse TSA from 2010 to 2019. Prescribed chemical VTE prophylaxis utilization after TSA markedly increased from 4.41% in 2010 to 11.70% utilization in 2019. The utilization of aspirin markedly increased from 17.27% in 2010 to 65.17% in 2019. Among anticoagulants, the utilization of direct factor Xa inhibitors increased from 0.0% utilization in 2010 to 66.09% utilization in 2019. The added reimbursements associated with VTE after TSA markedly decreased from $14,122 in 2010 to $4,348 in 2019. CONCLUSION: The incidence and economic burden associated with VTE after TSA have markedly declined following the 2010 American Academy of Orthopaedic Surgeons clinical practice guidelines. This reduction can be attributed to both an increase in VTE prevention through increased utilization of prescribed chemoprophylaxis and improvement in VTE treatment strategies. LEVEL OF EVIDENCE: Therapeutic, III.

An AI-based Decision Support System for Predicting Mental Health Disorders.

Approximately one billion individuals suffer from mental health disorders, such as depression, bipolar disorder, schizophrenia, and anxiety. Mental health professionals use various assessment tools to detect and diagnose these disorders. However, these tools are complex, contain an excessive number of questions, and require a significant amount of time to administer, leading to low participation and completion rates. Additionally, the results obtained from these tools must be analyzed and interpreted manually by mental health professionals, which may yield inaccurate diagnoses. To this extent, this research utilizes advanced analytics and artificial intelligence to develop a decision support system (DSS) that can efficiently detect and diagnose various mental disorders. As part of the DSS development process, the Network Pattern Recognition (NEPAR) algorithm is first utilized to build the assessment tool and identify the questions that participants need to answer. Then, various machine learning models are trained using participants' answers to these questions and other historical data as inputs to predict the existence and the type of their mental disorder. The results show that the proposed DSS can automatically diagnose mental disorders using only 28 questions without any human input, to an accuracy level of 89%. Furthermore, the proposed mental disorder diagnostic tool has significantly fewer questions than its counterparts; hence, it provides higher participation and completion rates. Therefore, mental health professionals can use this proposed DSS and its accompanying assessment tool for improved clinical decision-making and diagnostic accuracy.