Health Literacy and Patient Reported Outcomes in Orthopaedic Surgery Patients

Background: Health literacy may be an important factor in patient health outcomes, however, prior research has primarily focused on primary care patients with research in orthopaedic specific populations lacking. Questions/purposes: The purpose of this study was to examine the relationship between health literacy and patient reported outcomes in an orthopaedic patient population. Patients and Methods: 183 patients \u3e18 years of age who presented to our institution’s sports orthopaedic surgery clinic with shoulder or knee complaints were analyzed. The primary outcomes were physical function recorded using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and Single Assessment Numerical Evaluation (SANE) scores. Health literacy was determined utilizing Health LiTT, a self-administered multimedia touchscreen test based on item response theory that provides a numerical score of 0-100 with a score \u3e50 suggestive of health literacy. In addition, demographic data including age, race, gender, highest level of education, injury location, and surgery status were collected. Results: Bivariate analysis revealed that low health literacy (Health LiTT score Conclusions: Our data showed that PROMIS scores are less reliant on health literacy and more dependent on age, employment status, having surgery and low education level achieved. Adaptations to clinical practice may be necessary to better guide these select populations and improve patient-reported physical function. Furthermore, PROMIS measures can be administered successfully to patients regardless of health literacy. Level of Evidence: Level I

Identification of emulsifier potato peptides by bioinformatics: application to omega-3 delivery emulsions and release from potato industry side streams

We are grateful for the financial support from Innovation Fund Denmark (Grant nr: 7045-00021B, PROVIDE project). We also acknowledge K.M.C. amba (Brande, Denmark) and A.K.V. amba (Langholt, Denmark) for providing the potato samples used in this study.In this work, we developed a novel approach combining bioinformatics, testing of functionality and bottom-up proteomics to obtain peptide emulsifiers from potato side-streams. This is a significant advancement in the process to obtain emulsifier peptides and it is applicable to any type of protein. Our results indicated that structure at the interface is the major determining factor of the emulsifying activity of peptide emulsifiers. Fish oil-in-water emulsions with high physical stability were stabilized with peptides to be predicted to have facial amphiphilicity: (i) peptides with predominantly α-helix conformation at the interface and having 18–29 amino acids, and (ii) peptides with predominantly β-strand conformation at the interface and having 13–15 amino acids. In addition, high physically stable emulsions were obtained with peptides that were predicted to have axial hydrophobic/hydrophilic regions. Peptides containing the sequence FCLKVGV showed high in vitro antioxidant activity and led to emulsions with high oxidative stability. Peptide-level proteomics data and sequence analysis revealed the feasibility to obtain the potent emulsifier peptides found in this study (e.g. γ-1) by trypsin-based hydrolysis of different side streams in the potato industry.Innovation Fund Denmark 7045-00021

Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment?

The safety committee of the American Academy of Orthopedic Surgeons (AAOS) recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it

Arthroscopic Release of the Deep Medial Collateral Ligament to Assist in Exposure of the Medial Tibiofemoral Compartment

Arthroscopy of the knee is a widely used surgical procedure for addressing intra-articular pathology. In assessing the intra-articular structures, visualization is of paramount importance. The medial tibiofemoral compartment is often difficult to fully visualize in tight knees in which limited access can compromise surgical efficacy. Poor visualization can increase the possibility of a residual meniscal tear after attempted partial meniscectomy, as well as the possibility of iatrogenic chondral injury from arthroscopic instruments. We describe a technique that allows improved medial tibiofemoral visualization with release of the deep medial collateral ligament. We use standard arthroscopic portals, without the need for further incisions or stab holes and with minimal additional patient morbidity. This procedure allows easier exposure of the medial knee chondral surfaces and meniscus and easier use of arthroscopic instrumentation in the medial compartment

Interobserver and Intraobserver Reliability of an MRI-Based Classification System for Injuries to the Ulnar Collateral Ligament.

BACKGROUND: Despite improvements in understanding biomechanics and surgical options for ulnar collateral ligament (UCL) tears, there remains a need for a reliable classification of UCL tears that has the potential to guide clinical decision making. PURPOSE: To assess the intra- and interobserver reliability of the newly proposed magnetic resonance imaging (MRI)-based classification for UCL tears. Secondary objectives included assessing the effect of additional views, discrimination between distal and nondistal tears, and correlation of imaging reads with intraoperative findings of the UCL. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Nine fellowship-trained specialists from 7 institutions independently completed 4 surveys consisting of 60 elbow MRI scans with UCL tears using a newly proposed 6-stage classification system. The first and third surveys contained 60 coronal images, while the second and fourth contained the same images with coronal and axial views presented in a random order to assess intraobserver variability via the weighted kappa value and the effect of additional imaging views. Weighted kappa values were also calculated for each of the 4 surveys to acquire interobserver reliability. Reliability analysis was repeated through a 2-group classification analysis for distal and nondistal tears. Observer readings were compared with intraoperative UCL findings. RESULTS: For the newly proposed 6-stage MRI-based classification, intra- and interobserver reliability demonstrated near perfect and substantial agreement, respectively. These values increased only when substratified into the 2-group distal and nondistal tear classification ( P \u3c .05). The additional axial view did not statistically improve the agreement within and among readers. When compared with intraoperative findings from 30 elbows, observer readings were accurate for tear grade (partial and complete), proximal location, and distal location but not midsubstance tears. CONCLUSION: The newly proposed 6-stage MRI-based classification utilizing grade and location of the injury had substantial to near perfect agreement among and within fellowship-trained observers