Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

Background: The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism. Methods: Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association\u27s Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results. Results: Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more \u3c level 3 scores in a domain) and who also scored below expectations by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%). Conclusions: The ABOSBT was able to identify 2.4% low score evaluations ( Level of Evidence: Level II

Novel intramedullary device for lengthening transfemoral residual limbs

Abstract Background Lower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. Recovery becomes especially challenging if an amputee has a short residual limb, which can complicate proper prosthetic fitting, causing discomfort, difficulties in suspension, and reduced mobility. Current limb lengthening techniques such as the Ilizarov apparatus and external fixators are cumbersome, uncomfortable, and have high complication rates. In this study, we investigated the effectiveness of a novel limb-lengthening device that uses intramedullary bone lengthening and requires only one percutaneous rod at the end of the limb during the distraction phase. Only the intramedullary nail remains after the distraction phase, and no external components are required during the consolidation phase. We hypothesize that this system would create a much easier experience for the patient. Methods The system was first tested in a mock surgical implantation using plastic femur bones. The device was then tested in a series of cadaveric experiments using pelvis-to-knee specimens by a group of surgeons. Surgeons evaluated the surgical insertion technique, soft tissue considerations, hardware fixation strategies, and the effectiveness of the distraction mechanism. Revisions and improvements to the device and surgical procedure were made based on the results from the cadaveric experiments. Results A questionnaire was given to two visiting surgeons following the final iteration of the device. The surgeons reported that the system effectively lengthened the limb, was sturdy, and could be installed efficiently. However, there remains a risk of infection and soft tissue imbalances, similar to that introduced by an external fixator device. Suggestions on how to improve the design of the device and mitigate infection through postoperative management and surgical standard of care will be considered for future clinical trials. Conclusions The described intramedullary residual limb-lengthening device has evolved from a prototype to a mature model tested in six cadaveric experiments to date. Further mechanical and functional testing is needed to finalize the device before testing in patients

Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty.

BACKGROUND: Symptomatic pre-discharge venous thromboembolism (VTE) rates after total or partial hip or knee arthroplasty have been proposed as patient safety indicators. However, assessing only pre-discharge VTE rates may be suboptimal for quality measurement as the duration of stay is relatively short and the VTE risk extends beyond the inpatient setting. METHODS: Patients who underwent total or partial hip or knee arthroplasty were identified in the 2008 through 2010 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Outcomes of interest were the deep venous thrombosis (DVT), pulmonary embolism (PE), and overall VTE rates within thirty days after surgery and the rates during the pre-discharge and post-discharge portions of this time period. Risk-adjusted hospital rankings based on only pre-discharge (inpatient) events were compared with those based on both pre-discharge and post-discharge events within thirty days of surgery. RESULTS: A total of 23,924 patients underwent total or partial hip arthroplasty (8499) or knee arthroplasty (15,425) at ninety-five hospitals. For hip arthroplasty, the VTE rate was 0.9%, with 57.9% of the events occurring after discharge. For knee arthroplasty, the VTE rate was 1.9%, with 38.3% of the events occurring after discharge. The median time of VTE occurrence was eleven days postoperatively for hip arthroplasty and three days for knee arthroplasty. The median duration of stay was three days for both hip and knee arthroplasty. When hospitals were ranked according to VTE rates, hospital outlier status designations changed when post-discharge events were included (κ = 0.386; 44% false-positive rate for low outliers). The median change in hospital quality ranking was 7 (interquartile range, 2 to 17), with a rank correlation of r = 0.82. CONCLUSIONS: Nearly twice as many VTE complications were captured if both pre-discharge and post-discharge events were considered, and inclusion of post-discharge events changed hospital quality rankings. These data suggest that inclusion of post-discharge events should be considered when comparing the quality of hospitals on the basis of postoperative VTE rates. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Cytoplasmic and/or nuclear accumulation of the beta-catenin protein is a frequent event in human osteosarcoma.

The molecular events that precede the development of osteosarcoma, the most common primary malignancy of bone, are unclear, and concurrent molecular and genetic alterations associated with its pathogenesis have yet to be identified. Recent studies suggest that activation of beta-catenin signaling may play an important role in human tumorigenesis. To investigate the potential role of beta-catenin deregulation in human osteosarcoma, we analyzed a panel of 47 osteosarcoma samples for beta-catenin accumulation using immunohistochemistry. Potential activating mutations were investigated by sequencing exon 3 of the beta-catenin gene in genomic DNA isolated from tumor samples. Our findings revealed cytoplasmic and/or nuclear accumulation of beta-catenin in 33 of 47 samples (70.2%); however, mutation analysis failed to detect any genetic alterations within exon 3, suggesting that other regulatory mechanisms may play an important role in activating beta-catenin signaling in osteosarcoma. In our survival analysis, beta-catenin deregulation conferred a hazard ratio of 1.05, indicating that beta-catenin accumulation does not appear to be of prognostic value for osteosarcoma patients. When analyzed against other clinicopathologic parameters, beta-catenin accumulation correlated only with younger age at presentation (26.4 vs. 39.8 years). Nevertheless, our results demonstrate that the deregulation of beta-catenin signaling is a common occurrence in osteosarcoma that is implicated in the pathogenesis of osteosarcoma