Preoperative PROMIS Depression Scores Can Predict Failure to Improve after Trapeziectomy and LRTI

INTRODUCTION: Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Having a model to stratify likelihood of improvement based on pre-operative variables may allow for better decision making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI) METHODS: Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Demographic data along with preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At their follow-up appointment, patients were asked a follow-up anchor question: “Since your treatment, how would you rate your overall function?”. Possible responses represent a 7-point Likert scale from “Much Worse” to “Much Improved”. Significance between preoperative scores and subjective improvement were modeled using univariable logistic regression. Correlation between preoperative scores and patient anchor question response was calculated using Receiver Operating Characteristic (ROC) Curves and reported as area under the curve (AUC) (values 0.6 - 0.69; moderate predictive ability, 0.7 - 0.79; strong, and \u3e 0.8; excellent). RESULTS: There were 69 patients included in this study. The mean age was 62 years and 78% of patients were female. The median follow-up time was 40 days (interquartile range 13-86 days). Forty-two patients (61%) reported “somewhat improved” or better and 27 patients (39%) reported “no change” or worse. Univariate logistic regression revealed that preoperative PROMIS Depression scores were significantly correlated with achieving subjective improvement (Table 1), with patients with higher pre-operative depression scores demonstrating a lower likelihood of reporting improvement. ROC curves an AUC of 0.76 for preoperative PROMIS Depression scores indicating a strong predictive ability (Table 2). Preoperative PROMIS UE, PI, and QD scores were not significantly correlated with subjective improvement. DISCUSSION: Patients with higher preoperative PROMIS Depression scores are significantly less likely to report improvement after trapeziectomy with LRTI; this had overall strong predictive ability. Development of a predictive model through utilization of preoperative PROMIS Depression scores will allow for providers to elucidate improved decision making and more realistic patient expectations after intervention which may improve patient satisfaction overall. Lack of significant correlation between PROMIS UE, PI, and QD scores and subjective improvement indicates a limitation of this study in utilizing these scores within the predictive model. SIGNIFICANCE/CLINICAL RELEVANCE: This study is significant because use of preoperative PROMIS Depression scores to predict patients’ likelihood to improve after trapziectomy and LRTI may improve patient selection and pre-operative counseling in the future. FIGURES: Table 1. Univariable Logistic Regression. Odds ratio are reported relative to achieving subjective improvement. Non-Improved [Mean (SD)] Improved [Mean (SD)] Odds Ratio (1-point increase) 95% Confidence Interval P-value Preop UE 31.5 (5.6) 32.1 (5.6) 1.03 0.94-1.12 P = 0.56 Preop PI 63 (7.9) 61.4 (5.1) 0.95 0.87-1.04 P = 0.30 Preop DP 52.6 (4.6) 45.8 (9.7) 0.88 0.77-1.00 P = 0.03 Preop QD 55.1 (18.4) 51.0 (17.0) 0.98 0.96-1.01 P= 0.37 Preop, Preoperative; UE, PROMIS Upper Extremity; PI, PROMIS Pain Interference; DP, PROMIS Depression; QD QuickDASH Table 2. ROC Curve illustrating diagnostic abilities of the preoperative PROMIS and QD scores to predict subjective patient outcome (AUC values of 0.6 to 0.69 - moderate predictive ability, 0.7 to 0.79 - strong, and \u3e 0.8 - excellent). Variable AUC UE 0.55 PI 0.65 DP 0.76 QD 0.60 AUC, Area Under the Curve; UE, Preoperative PROMIS UE Score; PI, Preoperative PROMIS PI Score; DP, Preoperative PROMIS Depression Score; QD, Preoperative QuickDASH Scor

Preoperative PROMIS Depression Scores Can Predict Failure to Improve After Trapeziectomy and LRTI

Introduction Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Predicting likelihood of improvement based on pre-operative variables may allow for better decision-making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI) Methods Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At follow-up appointments, patients were asked an anchor question: “Since your treatment, how would you rate your overall function?”. Responses represent a 7-point Likert scale from “Much Worse” to “Much Improved”. Univariable logistic regression modeled significance between preoperative scores and subjective improvement. Correlation between preoperative scores and anchor question responses was calculated using Receiver Operating Characteristic (ROC) Curves and reported as area under the curve (AUC). Results There were 69 patients included in this study. Forty-two patients (61%) reported “somewhat improved” or better and 27 patients (39%) reported “no change” or worse. Univariate logistic regression revealed that PROMIS Depression scores were significantly correlated with subjective improvement. Patients with higher PROMIS Depression scores demonstrated a lower likelihood of reporting improvement. AUC of 0.76 for PROMIS Depression scores indicated a strong predictive ability. Conclusion Patients with higher pre-operative PROMIS Depression scores are significantly less likely to report improvement after trapeziectomy with LRTI. This had a strong predictive ability and may improve future patient selection and pre-operative counseling

Tendonitis and Tendon Rupture in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

INTRODUCTION: Dorsal plating of distal radius fractures has been associated with high rates of hardware removal, tendonitis, and tendon rupture. Much of this research was performed using 2.5mm thick distal radius plating, whereas modern dorsal plates are thinner (1.2mm-1.5mm). We examine whether modern plates have higher rates of complications than volar plates. METHODS: We search Ovid MEDLINE, Web of Science, and EMBASE for literature describing tendon complications associated with plating of distal radius fractures. Inclusion criteria included any comparison between volar and dorsal plating and report of tendon complication. Exclusion criteria included: failure to specify low-profile dorsal plates; lack of volar plating comparison arm; no reporting of tendon complications. All studies were assessed for quality using MINOR’s criteria. RESULTS: All 5 included studies were retrospective cohorts, totaling 806 subjects; 584 received volar plates and 222 received dorsal plates. Minimum average follow-up was 5 months. Of the volar plate group, 2% had symptoms consistent with tendonitis, 1% experienced a tendon rupture, and 4% underwent hardware removal. In the dorsal group, 6% had tendonitis, 1% had tendon ruptures, and 11% underwent hardware removal. Meta-analysis showed no significant difference in rates of tendonitis (4 studies, Z=0.79, P=0.43) or tendon rupture (5 studies, Z=0.59, P=0.56). DISCUSSION: To our knowledge, this review provides the largest comparison of modern dorsal and volar distal radius plates to date. Our results do not demonstrate increased risk of tendon complications in patients who underwent dorsal plating. This study sets a precedent for more routine use of dorsal plating

Development and Validation of a Novel Decision Aid for WALANT Hand Surgeries: Investigating Patient Preferences

INTRODUCTION: This study aims to develop a novel decision aid packet (DAP) for hand surgery patients deciding between Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) and traditional anesthesia. METHODS: Development: The DAP was developed following International Patient Decision Aid Standards. Validation: Alpha Testing Seven hand surgeons experienced in WALANT and traditional surgeries belonging to the WALANT Research Consortium in the U.S. commented on the DAP through three rounds of editing utilizing the Delphi method. Seven patient advocates provided readability feedback. Beta Testing Orthopedic hand surgery patients were assigned to the control or experimental group. The experimental group was given the DAP pre-surgery. Both groups completed a validated regret scale at follow-up. A paired t-test was conducted to analyze the difference between average scores on the regret scale and pre- and post-DAP knowledge tests (p RESULTS: The experimental group (n=58) demonstrated a 145% increase (p DISCUSSION: Increased knowledge test scores following the DAP suggest that patients are better informed after DAP usage. Low decisional conflict scores suggest that the DAP increases patients’ confidence. Lower average regret scale scores among the experimental group indicate a relationship between DAP administration and reduced post-surgical regret. The greater patient preference for WALANT following DAP usage, alongside the lower postoperative regret, elucidates a general preference in informed patients towards the WALANT modality

Determining Access of In-Person vs Virtual Clinic Visits in Orthopedic Medicine

INTRODUCTION: Virtual visits in orthopedics provide added benefits compared to in-person visits. We hypothesize that virtual visits will offer patients greater same-day and future access to orthopedic physicians. METHODS: Two previously established methodologies were used to measure orthopedic surgeons: same-day and third-next-available. Same-day access is analyzed using a ratio of unfilled to filled virtual return and in-person return appointments for every clinic day of each physician. Third-next-available is measured as the number of total non-clinic days and clinic days until each physician’s third next-available-virtual and in-person appointments. RESULTS: For same-day access, the ratio of unfilled virtual to filled virtual appointments was 1.04 on average, while the ratio of unfilled in-person to filled return in-person visits was 0.38 on average (p=0.00323). For third-next-available appointments, the in-person opening was 5.81 days out on average compared to the virtual visit being 8.31 days out on average (p=0.01525). Additionally, the in-person appointment was 2.5 clinic-days out on average and the virtual appointment was 3.95 clinic-days out on average (p\u3c0.001). As virtual visits are a fraction of total visits, we divided the third-next-available data by the rate at which each physician books virtual appointments. This resulted in a significantly increased standardized third-next-available measure of access for virtual appointments using both total days (p\u3c0.001) and clinic days (p\u3c0.001). DISCUSSION/CONCLUSION: Virtual return visits offer greater same-day access for patients compared to analogous in-person return visits. However, in-person appointment availability offers better access for patients in terms of scheduling a future visit, which may be due to the increased number of in-person visits offered compared to virtual visits provided at this time. When standardizing the third-next-available data for how often each visit modality is offered, virtual visits displayed greater levels of patient access. Thus, an increased volume of virtual visit appointments may offer patients greater access for scheduling purposes in the future

Burkholderia pseudomallei Is Spatially Distributed in Soil in Northeast Thailand

Melioidosis is a severe infection caused by the environmental bacterium Burkholderia pseudomallei. Soil sampling is important to identify geographic regions where humans and animals are at risk of exposure. The purpose of this study was to examine a factor that has a major bearing on the accuracy of soil sampling: the spatial distribution of B. pseudomallei in soil of a specified sampling site. Soil sampling was performed using a fixed-interval grid of 100 sampling points in each of two sites (disused land and rice field) in northeast Thailand, and the presence and amount of B. pseudomallei determined using culture. Mapping of the presence and B. pseudomallei count demonstrated that samples taken from areas adjacent to sampling points that were culture positive (negative) for B. pseudomallei were also likely to be culture positive (negative), and samples taken from areas adjacent to sampling points with a high (low) B. pseudomallei count were also likely to yield a high (low) count (spatial autocorrelation). These data were used as the basis for highlighting several pitfalls in current approaches to soil sampling, together with a discussion of the suitability of a range of sampling strategies in different geographical locations and for different study objectives

Latent variables and structural equation models for longitudinal relationships: an illustration in nutritional epidemiology

<p>Abstract</p> <p>Background</p> <p>The use of structural equation modeling and latent variables remains uncommon in epidemiology despite its potential usefulness. The latter was illustrated by studying cross-sectional and longitudinal relationships between eating behavior and adiposity, using four different indicators of fat mass.</p> <p>Methods</p> <p>Using data from a longitudinal community-based study, we fitted structural equation models including two latent variables (respectively baseline adiposity and adiposity change after 2 years of follow-up), each being defined, by the four following anthropometric measurement (respectively by their changes): body mass index, waist circumference, skinfold thickness and percent body fat. Latent adiposity variables were hypothesized to depend on a cognitive restraint score, calculated from answers to an eating-behavior questionnaire (TFEQ-18), either cross-sectionally or longitudinally.</p> <p>Results</p> <p>We found that high baseline adiposity was associated with a 2-year increase of the cognitive restraint score and no convincing relationship between baseline cognitive restraint and 2-year adiposity change could be established.</p> <p>Conclusions</p> <p>The latent variable modeling approach enabled presentation of synthetic results rather than separate regression models and detailed analysis of the causal effects of interest. In the general population, restrained eating appears to be an adaptive response of subjects prone to gaining weight more than as a risk factor for fat-mass increase.</p

Search for rare quark-annihilation decays, B --> Ds(*) Phi

We report on searches for B- --> Ds- Phi and B- --> Ds*- Phi. In the context of the Standard Model, these decays are expected to be highly suppressed since they proceed through annihilation of the b and u-bar quarks in the B- meson. Our results are based on 234 million Upsilon(4S) --> B Bbar decays collected with the BABAR detector at SLAC. We find no evidence for these decays, and we set Bayesian 90% confidence level upper limits on the branching fractions BF(B- --> Ds- Phi) Ds*- Phi)<1.2x10^(-5). These results are consistent with Standard Model expectations.Comment: 8 pages, 3 postscript figues, submitted to Phys. Rev. D (Rapid Communications

Prioritizing Risks and Uncertainties from Intentional Release of Selected Category A Pathogens

This paper synthesizes available information on five Category A pathogens (Bacillus anthracis, Yersinia pestis, Francisella tularensis, Variola major and Lassa) to develop quantitative guidelines for how environmental pathogen concentrations may be related to human health risk in an indoor environment. An integrated model of environmental transport and human health exposure to biological pathogens is constructed which 1) includes the effects of environmental attenuation, 2) considers fomite contact exposure as well as inhalational exposure, and 3) includes an uncertainty analysis to identify key input uncertainties, which may inform future research directions. The findings provide a framework for developing the many different environmental standards that are needed for making risk-informed response decisions, such as when prophylactic antibiotics should be distributed, and whether or not a contaminated area should be cleaned up. The approach is based on the assumption of uniform mixing in environmental compartments and is thus applicable to areas sufficiently removed in time and space from the initial release that mixing has produced relatively uniform concentrations. Results indicate that when pathogens are released into the air, risk from inhalation is the main component of the overall risk, while risk from ingestion (dermal contact for B. anthracis) is the main component of the overall risk when pathogens are present on surfaces. Concentrations sampled from untracked floor, walls and the filter of heating ventilation and air conditioning (HVAC) system are proposed as indicators of previous exposure risk, while samples taken from touched surfaces are proposed as indicators of future risk if the building is reoccupied. A Monte Carlo uncertainty analysis is conducted and input-output correlations used to identify important parameter uncertainties. An approach is proposed for integrating these quantitative assessments of parameter uncertainty with broader, qualitative considerations to identify future research priorities