Promoting Screening of Cognitive Impairment and Dementia in Vermont: A proposal for ongoing continuing medical education (CME)

In 2010, 11,382 Vermonters were diagnosed with dementia, many of whom had Alzheimer’s disease (AD). In 2025, an estimated 1 in 8 Vermonters aged 65 or older will have some form of dementia. Reported rates of overlooked dementia are between 35% and 90% or greater. Clinical presentations of dementia are often insidious and attributed to aging, making an accurate diagnosis difficult. Because of the challenges of dementia screening and diagnosis, primary care physicians (PCPs) are often unwilling to diagnose, discuss, and treat dementia due to AD.3 Although physicians are reluctant to screen for dementia, research in Vermont (VT) has shown a clear preference by patients and their families for earlier diagnosis. A timely diagnosis allows the patient and their family to plan for the future and start treatment earlier. Our research demonstrated PCPs may be misinformed about the usefulness and implications of dementia screening and diagnosis. In an effort to further educate physicians, we propose instituting a mandatory continuing medical education (CME) hour focused on screening for dementia. Our project surveyed 72 physicians to determine their attitudes towards screening, the assessment tools they use, and their attitudes towards a required CME hour.https://scholarworks.uvm.edu/comphp_gallery/1079/thumbnail.jp

An Arthroscopic Modification of Coracoclavicular Ligament Reconstruction and Distal Clavicle Fracture Fixation in the Lateral Position

Distal clavicle fractures and acromioclavicular injuries are common shoulder injuries. Despite the frequency of these injuries, there is no gold standard for treatment. Recent suspensory fixation techniques have minimized the amount of hardware required for surgical treatment of both acromioclavicular separations and distal clavicle fractures. Advantages include reconstruction of ligamentous anatomy, minimal hardware irritation, earlier return to activity, and decreased need for hardware removal. These reconstructions are classically done in the beach chair position in an open fashion. Our preferred technique for treatment of unstable distal clavicle fractures and acromioclavicular injuries is arthroscopy-assisted coracoclavicular ligament reconstruction with or without distal clavicle fixation in the lateral decubitus position

Early postoperative complications and discharge time in diabetic patients undergoing total shoulder arthroplasty

Abstract Purpose With the increasing elderly population and obesity epidemic, diabetes is an important factor in arthroplasty planning. Although research suggests diabetes is associated with increased postoperative morbidity after hip and knee replacement, the effect of diabetes and varying management with insulin versus non-insulin agents on total shoulder arthroplasty (TSA) is not established. Methods All TSAs from 2015 to 2016 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Age, gender, BMI, steroid, ASA, operative time, and smoking status were compared between all diabetics, diabetics on insulin, diabetics on non-insulin agents, and non-diabetics to account for confounding variables. Thirty-day postoperative complications, readmission rate, surgical site infection (SSI), and non-routine discharge to rehabilitation were compared using bivariate and multivariate binary logistic regression. Postoperative time to discharge between diabetic groups was analyzed using univariate ANOVA with Tukey’s test. Results The analysis included 7246 patients (insulin in 5% (n = 380), non-insulin in 13% (n = 922), and non-diabetics in 82% (n = 5944)). Diabetics were more likely to have an ASA ≥ 3 compared to non-diabetics (89.5% vs 50.1%; p < 0.001). Bivariate logistic regression showed statistical significance in readmission and non-routine discharge between all diabetics and non-diabetics (OR 1.7, 1.4; p = 0.001, 0.001), but there was no significance between SSI rate (0.3% vs 0.4%; p = 0.924). Multivariate logistic regression between groups showed significance in readmission between non-insulin diabetics vs non-diabetics (OR 1.5; p = 0.027), readmission and non-routine discharge in insulin vs non-diabetics (OR 2.1, 1.7; p = 0.003, < 0.001), and no significance between insulin and non-insulin diabetics. Postoperative days to discharge were 2.4, 2.0, and 1.8 days in insulin, non-insulin, and non-diabetics respectively. Mean differences were significant between all groups. Conclusions Diabetic patients are at a higher risk for readmission and non-routine discharge compared to non-diabetics. Despite no increased risk in SSI, longer postoperative discharge time in diabetics should be considered in TSA planning. Trial registration Not applicable Level of evidence Level III, case-control stud