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Revision Rates in Prepectoral Versus Subpectoral Delayed-Immediate Autologous Breast Reconstruction.

Ann Plast Surg 2021 Mar 24. Epub 2021 Mar 24.

From the College of Medicine, SUNY Upstate Medical University, Syracuse, NY College of Medicine, University of Nebraska Medical Center, Omaha, NE Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA.

Introduction: Breast reconstruction in the prepectoral plane has recently fallen into favor. Minimizing the number of revisionary procedures after reconstruction is an important factor in improving patient care, but long-term studies on the effects of prepectoral reconstruction are limited. In this study, we compare the revision rates after delayed-immediate, autologous reconstruction between prepectoral and subpectoral reconstructions. Read More

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Fifteen-minute consultation: Recognition of sickle cell crises in the paediatric emergency department.

Arch Dis Child Educ Pract Ed 2021 Apr 8. Epub 2021 Apr 8.

Paediatric Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK.

Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to migration patterns and improved survival rates in high-prevalence countries, there is an increased tendency to encounter these patients across the UK. These factors warrant regular revisions in sickle cell crisis management, along with education for medical personnel and patients to improve clinical care and patient management. Read More

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Regulatory, scientific, and ethical issues arising from institutional activity in one of the 90 Italian Research Ethics Committees.

BMC Med Ethics 2021 Apr 7;22(1):40. Epub 2021 Apr 7.

Clinical Pharmacology and Pharmacovigilance Unit, Regional Pharmacovigilance Center of Catania, G Rodolico-San Marco University Hospital, Catania, Italy.

Background: This paper highlights the issues that one of the 90 Italian Research Ethics Committees (RECs) might encounter during the approval phase of a clinical trial to identify corrective and preventive actions for promoting a more efficient review process and ensuring review quality. Publications on the subject from Italy and the rest of Europe are limited; encouraging constructive debate can improve RECs' service to the subject of the clinical trial.

Methods: We retrospectively reviewed a cohort of 822 clinical trial protocols, initially reviewed by REC, from June 2014 to December 2018. Read More

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Malnutrition in Elective Shoulder Arthroplasty: A Multi-Institutional Retrospective Study of Preoperative Albumin and Adverse Outcomes.

J Shoulder Elbow Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address:

Background: Malnutrition is associated with poor postoperative outcomes following knee, hip, and spine surgery. However, whether albumin labs should be part of the routine preoperative workup for shoulder arthroplasty remains understudied. This study investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty. Read More

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Visitation policies at NCI-designated comprehensive cancer centers during the COVID-19 pandemic.

Support Care Cancer 2021 Apr 2. Epub 2021 Apr 2.

Division of Palliative Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.

Purpose: Family/caregiver visitation provides critical support for patients confronting cancer and is associated with positive outcomes. However, the COVID-19 pandemic brought historic disruptions including widespread visitation restrictions. Here, we characterize in-depth the visitor policies of NCI-designated comprehensive cancer centers (CCCs) and analyze geographic/temporal patterns across CCCs. Read More

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Recognition of posterior thoracolumbar instrumentations used in spinal deformity surgery and techniques for implant removal.

J Clin Neurosci 2021 Apr 10;86:217-222. Epub 2021 Feb 10.

Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

Spinal surgeries requiring implant removals/revisions are becoming more common, as a long time has passed since contemporary spinal instrumentation was developed and utilized. Recognizing implants and manufacturers preoperatively from radiographs and preparing appropriate instruments for removal are mandatory. The objective of the present paper was to review the various designs of contemporary posterior thoracolumbar spinal implants along with their radiographic features to facilitate the identification of previously used systems in removal or revision surgeries. Read More

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Knee arthrodesis using a custom modular intramedullary nail in failed, infected knee arthroplasties: A concise follow-up note of 31 cases at a median of 13 years post-arthrodesis.

Orthop Traumatol Surg Res 2021 Mar 24:102898. Epub 2021 Mar 24.

Département universitaire de chirurgie orthopédique et traumatologique, University of Lille, CHU de Lille, ULR 4490, 59000 Lille, France; CRIOAC, centre de référence pour le traitement des infections ostéo-articulaires complexes Lille Tourcoing, Lille, France; Service de chirurgie orthopédique, Hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France.

Introduction: Knee arthrodesis utilizes an arthrodesis nail as a salvage technique for infected total knee arthroplasty (TKA), especially when the extensor mechanism is damaged, or the skin is compromised. This implant helps to minimize or prevent leg length discrepancy, while allowing immediate weight bearing without requiring bone fusion. However, there is a risk of infection. Read More

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Validation of the Chinese Version of Dementia Quality of Life Measure - Proxy in Care Home Residents with Dementia.

East Asian Arch Psychiatry 2021 Mar;31(1):9-12

Hong Kong Society for the Blind, Hong Kong SAR, China.

Objective: To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy).

Methods: Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. Read More

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Factors associated with functional arteriovenous fistula at hemodialysis start and arteriovenous fistula non-use in a single-center cohort.

J Vasc Access 2021 Mar 22:11297298211002574. Epub 2021 Mar 22.

Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.

Background: The gold standard of commencing hemodialysis with a functional arteriovenous fistula (AVF) is challenging. We aim to review factors associated with functional AVF at hemodialysis start at a tertiary hospital.

Methods: We retrospectively reviewed incident hemodialysis patients or who had AVF creation at a single tertiary hospital from 2011 to 2016. Read More

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Dual-mobility bearings in complex revision hip arthroplasty.

Hip Int 2021 Mar 18:1120700021999795. Epub 2021 Mar 18.

St. George's Hospital NHS Foundation Trust, London, UK.

Background: Revision total hip arthroplasty (rTHA) is associated with an increased dislocation risk. Dual-mobility (DM) bearings have been used to address this issue. Such constructs offer increased range of motion and enhanced stability whilst avoiding some issues associated with fully-constrained devices. Read More

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Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget's disease: a combined registry and single-institution retrospective observational study.

J Orthop Traumatol 2021 Mar 17;22(1):13. Epub 2021 Mar 17.

1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.

Background: Total hip arthroplasty (THA) in patients with Paget's disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications.

Material And Methods: Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed. Read More

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Squeaking Is Common and Increases Over Time Among Patients With Long-term Follow-up After Ceramic-on-ceramic THA.

Clin Orthop Relat Res 2021 04;479(4):736-744

K. Taniguchi, M. Quacinella, B. Barlow, Naval Medical Center San Diego, San Diego, CA, USA.

Background: Ceramic-on-ceramic (CoC) is a durable bearing with excellent wear characteristics, but squeaking remains a concern. The proportion of patients who report squeaking varies widely between studies performed at short- and mid-term follow-up.

Questions/purposes: (1) What proportion of patients treated with CoC THA bearings report squeaking at a minimum of 10 years of follow-up? (2) Are patient, implant, or radiographic factors associated with squeaking? (3) Are THAs that squeak more likely to be revised than those that do not? (4) Are patient-reported functional outcome scores lower between THAs that squeak and THAs that do not squeak at long-term follow-up?

Methods: Between January 1, 2003 and August 31, 2008 a total of 80 patients received THAs with third-generation alumina-on-alumina bearings at one center. Read More

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A New Additive-Manufactured Cementless Highly Porous Titanium Acetabular Cup for Primary Total Hip Arthroplasty-Early Two-Year Follow Up.

Surg Technol Int 2021 03 16;38. Epub 2021 Mar 16.

Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.

Introduction: Additive-manufacturing technologies are increasingly being used, not only to create acetabular components with porous coating architecture very similar to the complex trabecular structure of cancellous bone, but also for producing the entire implant in a single step. The aim of this study is to assess two-year clinical and radiological outcomes of a new additive-manufactured cup in primary total hip arthroplasty (THA).

Materials And Methods: We reviewed 266 primary THAs (254 patients) performed in our institution between December 2016 and December 2018 using a new highly porous titanium acetabulum shell fabricated via additive manufacturing. Read More

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New or vanishing frontiers: associated juvenile arthritis.

Int J Pediatr Adolesc Med 2021 Mar 12;8(1):44-47. Epub 2020 Nov 12.

King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: The classification and pathogenic basis of juvenile idiopathic arthritis (JIA) are a subject of some controversy. Essentially, JIA is an exclusion diagnosis that represents a phenotypically heterogeneous group of arthritis of unknown origin. Familial aggregation of JIA supports the concept of genetic influence in the pathogenesis of JIA. Read More

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Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons.

Arthroplast Today 2021 Apr 26;8:40-45. Epub 2021 Feb 26.

NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.

Background: An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-trained surgeons and non-AR (NAR) fellowship-trained surgeons.

Material And Methods: We retrospectively reviewed 7415 patients who underwent primary TKA from 2016 to 2020. Read More

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Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years.

Acta Paediatr 2021 Mar 12. Epub 2021 Mar 12.

Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan.

Aim: Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles.

Methods: Preterm infants born <28 weeks gestation between January 2006 and December 2015 were retrospectively analysed. Read More

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Endoscopic Third Ventriculostomy in Failed Ventriculoperitoneal Shunt in Pediatric Population.

Asian J Neurosurg 2020 Oct-Dec;15(4):937-940. Epub 2020 Oct 19.

Department of Neurosurgery, AIIMS, Jodhpur, Rajasthan, India.

Introduction: Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients. Read More

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October 2020

The reasons for ceramic-on-ceramic revisions between the third- and fourth-generation bearings in total hip arthroplasty from multicentric registry data.

Sci Rep 2021 Mar 10;11(1):5539. Epub 2021 Mar 10.

Department of Orthopedic Surgery, Korea University College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.

This study aimed to evaluate (1) the overall reasons for first revision in CoC THAs; (2) whether the reasons for revision differ between third-generation and fourth-generation CoC THAs; and (3) the specific factors associated with bearing-related problems as the reason for revision. We retrospectively reviewed 2045 patients (2194 hips) who underwent first revision THA between 2004 and 2013, among which 146 hips with CoC bearings underwent revision. There were 92 hips with third-generation ceramic bearings and 54 hips with fourth-generation ceramic bearings. Read More

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Development and validation of a measure of organizational capacity for implementing youth development programs.

Eval Program Plann 2021 Jun 23;86:101916. Epub 2021 Feb 23.

American Institutes for Research, United States.

Accumulating evidence indicates that incorporating youth development (YD) principles, strategies, and supports into an organization promotes positive adult and youth outcomes. However, few validated measures assess this type of capacity. The YMCA commissioned a study to validate its Capacity Assessment for Youth Development Programming (Y-CAP), which examines the organizational infrastructure required to implement YD programs and processes in seven areas. Read More

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Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts.

Med Decis Making 2021 Mar 4:272989X21996342. Epub 2021 Mar 4.

University of Michigan, Ann Arbor, MI, USA.

Background: Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids.

Methods: As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. Read More

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[The causes of Latarjet surgery failure and the revision surgeries].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Feb;35(2):246-251

Institute of Sports Medicine, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China.

Objective: To review the causes of Latarjet surgery failure and various revision surgeries, in order to provide the reference for the revision of treatment options for Latarjet surgery failure.

Methods: Literature on the causes of Latarjet surgery failure and revision surgeries was extensively reviewed and analyzed.

Results: Latarjet surgery is widely used in clinical practice for recurrent anterior dislocation of shoulder with glenoid defects, especially for the defects of more than 25%. Read More

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February 2021

Adapting Nephrology Training Curriculum in the Era of COVID-19.

Can J Kidney Health Dis 2021 5;8:2054358120988446. Epub 2021 Feb 5.

Division of Nephrology, The University of British Columbia, Vancouver, Canada.

Purpose Of Review: The COVID-19 pandemic has widespread implications not only for clinical practice but also for academic medicine and postgraduate training. The need to promote physical distancing and flexibility within our department has generated important revisions to the core curriculum for the Adult Nephrology Training Program in Vancouver, Canada.

Sources Of Information: We reviewed available educational resources and objectives to develop curricular adaptations informed by staff and trainee feedback. Read More

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February 2021

Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up.

J Arthroplasty 2021 Jan 23. Epub 2021 Jan 23.

Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain.

Background: The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes.

Methods: Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65. Read More

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January 2021

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach.

Aust Occup Ther J 2021 Feb 18. Epub 2021 Feb 18.

Central Queensland University, Rockhampton, Queensland, Australia.

Introduction: Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice.

Methods: A mixed methods research approach was used in this study. Read More

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February 2021

Digital Transfer for Hand Reconstruction in Cleft Hand and Foot Differences.

J Reconstr Microsurg 2021 Feb 17. Epub 2021 Feb 17.

Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.

Background:  Digital transfer for hand reconstruction in children with cleft hand and foot differences present unique challenges with anomalous anatomy and rare opportunities to dramatically improve function of one- or two-digit hands.

Methods:  Medical records were reviewed for patients with cleft hand and foot treated at two pediatric institutions between 1996 and 2018. Hospital records, clinical photographs, radiographs, and alginate molds were available on all patients. Read More

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February 2021

A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options.

Orthop Rev (Pavia) 2020 Dec 27;12(4):9011. Epub 2021 Jan 27.

Department of Orthopedic Surgery, Rush University Medical Center, and Midwest Orthopaedics at Rush, Chicago, IL, USA.

Management of periacetabular lesions involves complex clinical decision making. The modified Harrington procedure with total hip arthroplasty can recreate pelvic stability with a cement rebar construct as well as a functional hip. This study analyzes the modified Harrington procedure to assess construct longevity and patient outcomes. Read More

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December 2020

Clinical and laboratory reporting impact of ACMG-AMP and modified ClinGen variant classification frameworks in MYH7-related cardiomyopathy.

Genet Med 2021 Feb 10. Epub 2021 Feb 10.

Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.

Purpose: ClinGen provides gene-specific guidance for interpretation of sequence variants in MYH7. We assessed laboratory and clinical impact of reclassification by the American College of Medical Genetics and Genomics-Association for Molecular Pathology (ACMG-AMP) and ClinGen recommendations in 43 MYH7 variants reported by a diagnostic laboratory between 2013 and 2017.

Methods: Fifty-two proband reports containing MYH7 variants were reinterpreted by original ACMG-AMP and ClinGen guidelines. Read More

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February 2021

Custom Implants in TKA Provide No Substantial Benefit in Terms of Outcome Scores, Reoperation Risk, or Mean Alignment: A Systematic Review.

Clin Orthop Relat Res 2021 Feb 5. Epub 2021 Feb 5.

E. Beit Ner, Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: Failure to accurately replicate the native anatomy and biomechanics of the knee has been suggested to contribute to dissatisfaction after TKA. Custom implants promise a personalized surgical approach, with the aim of improving patient satisfaction and pain as well as lowering revision rates. However, some published research on custom TKA implants has found no clinically important improvements in postoperative validated outcomes scores, risks of revision or reoperation, and implant alignment. Read More

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February 2021

Outcomes in Revision Stapes Surgery.

Otolaryngol Head Neck Surg 2021 Feb 9:194599821991479. Epub 2021 Feb 9.

Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA.

Objectives: To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases.

Study Design: Retrospective cohort study.

Setting: Large single-institution database. Read More

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February 2021

Gender-Affirming Mastectomy in Transmasculine Patients: Does Obesity Increase Complications or Revisions?

Ann Plast Surg 2021 Feb 3. Epub 2021 Feb 3.

From the Department of Surgery, University of California San Francisco-East Bay, Oakland Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco Division of Research, Kaiser Permanente Northern California, Oakland Department of Plastic Surgery, Kaiser Permanente Northern California, Richmond, CA.

Background: Obesity can often be a barrier to gender-affirming top surgery in transmasculine patients because of concern for increased surgical site complications.

Study Design: All adult patients (N = 948) within an integrated health care system who underwent gender-affirming mastectomy from 2013 to 2018 were retrospectively reviewed to evaluate the relationship between obesity and surgical site complications or revisions.

Results: One third of patients (n = 295) had obese body mass index (BMI), and those patients were further stratified into obesity class I (BMI of 30-34. Read More

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February 2021