Purpose To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. Methods A total of 621 sequential hand surgery ...cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. Results A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. Conclusions OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Type of study/level of evidence Economic/Decision Analysis III.
Purpose The objective of the current study was to compare surgeon-rated visualization in shoulder arthroscopy using irrigation fluid with and without epinephrine. Methods Eighty-three patients were ...randomized to receive irrigation fluid with (44 patients) or without (39 patients) epinephrine during their arthroscopic shoulder procedures. After each procedure, the blinded senior author (G.F.C.) evaluated visualization based on a visual analog scale (VAS), and all clinically important procedure variables were recorded. Results Eighty-three arthroscopic shoulder procedures were included in the study. Fifty-four of these procedures were arthroscopic rotator cuff repairs, allowing a subset analysis of this specific procedure. There was a significant difference, with improved visualization in the epinephrine group versus the group without epinephrine when comparing all procedures ( P < .0001) and when comparing only rotator cuff repairs ( P < .0001). However, there was no statistical difference in other clinically important variables, including operative time and amount of irrigation fluid used. Conclusions The addition of epinephrine to irrigation fluid significantly improves surgeon-rated visualization in shoulder arthroscopy. Without an observed significant difference in operative time or volume of irrigation fluid used, the clinical significance of this improved visualization is unclear, and the use of irrigation fluid without epinephrine remains a viable option in the hands of an experienced surgeon. Level of Evidence Level I, high-quality randomized controlled trial with statistically significant difference.
IntroductionIn a large biobank of over half a million people, we have several pairs of participants who appear to share their genome. As more individuals are sequenced, more pairs are likely to be ...found. If these are twins then this is great news, but it isn’t quite that simple.
Objectives and ApproachWhere 2 people share a genome we need to be able to confirm that these pairs are twins. However, there are a number of issues which could cause 2 people to appear to share a genome; for example being recruited twice, donating blood on another’s behalf, etc. We already identify and exclude participant data based on these conditions. We developed our methodology by looking at the first identified pair in great detail, looking for evidence which specifically ruled out possible alternate explanations, and then applying and refining the method on later pairs.
ResultsWe were able to demonstrate the pair were almost certainly twins using their biochemistry and family questionnaire data as principal sources. We also identified a number of variables which were useful in indicating the likelihood of a twin, and now form part of a methodology which we are still developing. Even more usefully, we identified a number of variables that seemed like useful measures but proved extremely misleading. To date we have 26 pairs of possible twins, with 9 confirmed as twins and the remainder looking likely to be twins but falling short of a threshold for confidence. We also have 75 pairs which confirm duplicate participants we have already excluded.
Conclusion/ImplicationsWe formed two lessons: even very simply linkages come with pitfalls, and you should gather more administrative data than you think. We’re proposing the collection of additional familial relationship data in our third resurvey. We are also looking into machine learning and statistical techniques to better identify twins and duplicates.
IntroductionWe have a large cohort study of half a million people, which continually incorporates new data through health insurance, centre for disease control records, death certificates, resurveys, ...and ongoing quality assurance and participant information updates. To support our researchers we need data which is correct, up-to-date, and unchanging.
Objectives and ApproachWe must provide the new data, fixes and corrections to researchers, without missing anything or introducing issues. We make sequential iterations of our data available to researchers on a biannual basis; allowing a static version that can be referenced with regards to earlier work and providing the newest version of the data for new work. Due to the very large size of the data/code base and the small size of the team managing it, delivering this without error is a struggle. To mitigate this we developed testing scripts which catch issues and flag for resolution prior to release to researchers.
ResultsWe currently have 32 tests which catch all known issues which occur during a rebuild. On any occasion where a new type of issue is encountered, tests which would catch that issue and related issues are developed. As a result our last few releases have gone far more smoothly, with few if any issues reported after a release and certainly no previously encountered issues! Examples of current tests include: detection of a failed health insurance import; that we have the same number of participants; failure to increment version number between releases; checking that disease numbers have not changed dramatically over the shared timeframe.
Conclusion/ImplicationsProducing multiple static releases is a good way to balance the needs of a researcher for both static and current data, but it does introduce opportunities for both human and computer errors. Mitigating this risk with automated testing is convenient and effective.
To evaluate the clinical success rate, along with risk factors for failure, in patients undergoing latissimus dorsi transfer for the treatment of massive, irreparable, previously failed rotator cuff ...tears.
We performed a retrospective chart review of prospectively collected data from an institutional shoulder outcome registry. All patients who underwent latissimus dorsi transfer for previously failed rotator cuff repair between 2006 and 2013 with a minimum follow-up period of 1 year were included in the study. The indications for inclusion were large (≥2 tendons), retracted, chronic rotator cuff tears with fatty infiltration or atrophy for which prior surgical repair had failed. Preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test scores were collected, along with postoperative Single Assessment Numerical Evaluation scores. Complications and clinical failures (Δ in ASES score <17) were recorded. Patient demographic and tear characteristics were evaluated as potential risk factors for failure.
A total of 22 patients (mean age, 53 ± 6 years) were included in the study, with a mean follow-up time of 3.4 ± 1.1 years. Over 63% of patients (n = 14) reported undergoing 2 or more prior failed rotator cuff repairs. Patients undergoing latissimus dorsi transfer showed significant improvements in ASES scores (from 35.2 ± 21.9 preoperatively to 55.8 ± 22.9 postoperatively, P = .001), Simple Shoulder Test scores (from 3.5 ± 3.1 preoperatively to 5.2 ± 3.4 postoperatively, P = .002), and pain scores (from 5.9 ± 2.8 preoperatively to 4.6 ± 4.3 postoperatively, P = .002) at final follow-up. The complication rate after latissimus transfer was 27%. The rate of revision to reverse total shoulder arthroplasty was 13.6% (n = 3) after a mean of 2.7 years, and the clinical failure rate was 41% (n = 9) at final follow-up. An acromiohumeral interval of less than 7 mm (P = .04) and high-grade fatty infiltration (grade 3 or greater, P = .004) were significant preoperative risk factors for clinical failure.
Latissimus dorsi tendon transfer resulted in a clinical failure rate of 41% and complication rate of 27%, with an acromiohumeral interval of less than 7 mm and high-grade fatty infiltration being associated with postoperative failure.
Level IV.
Purpose This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive ...form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. Methods Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. Results Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). Conclusions Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. Clinical relevance Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
Background A Regional Medical Campus (RMC) is a medical school campus separate from the main medical school at which a portion of preclinical or clinical training of medical students is carried out. ...The College of Community Health Sciences of The University of Alabama in Tuscaloosa, Alabama is the Tuscaloosa Regional Campus of the University of Alabama School of Medicine (UASOM). The question we sought to answer with this study is whether or not regional campuses produce general surgeons. Design, Setting and Participants Publicly available data for 6271 graduates of the University of Alabama School of Medicine from the Birmingham, Tuscaloosa and Huntsville campuses from 1974 to 2015 was obtained by using Google Search Engine. The list was expanded to include the data described by the variables in Table 1. Results Between 1974 and 2015, 789 graduates of the University of Alabama School of Medicine assigned to the Birmingham, Tuscaloosa and Huntsville Campuses matched into Categorical Surgery. All three campuses matched similar percentages of students ranging from 10.4% to 13.3% (Table 2). The main campus at Birmingham matched 599 medical students into general surgery and 202 practice general surgery. The Tuscaloosa Regional Campus matched 88 medical students into general surgery and 47 practice general surgery. The Huntsville Regional Campus matched 103 medical students into general surgery and 41 practice general surgery (Table 2). Conclusions A comparable percentage of medical students at each campus matched into general surgery. The main campus contributed a larger absolute number of practicing general surgeons while regional medical campuses contributed a higher percentage of practicing general surgeons. Regional medical campuses contribute significantly to the deficit of general surgeons in this country.
Metacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with ...advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct.
Five matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated.
For transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups.
Intramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work.
Basic Science Study, Biomechanics.
ABSTRACT Objectives In our Chinese biobank of half a million people, we use data gathered from health insurance agencies to supplement our follow-up. We have 217,000 participants with insurance ...records including a breakdown of what the insurance paid for, totalling 1.6 million insurance records and 60 million chargeable items. The objective was to find ways of using this information to enhance our Electronic Health Records (EHRs) by adding usable and reliable treatment data, as a basis for future research. Approach Machine translations of every charge description were produced so that early investigation could be done by analysts who were not Chinese speakers. Key phrases were produced by specialist clinicians in an iterative process. We began by focussing on haemodialysis treated ESRD, heart failure, and coronary revascularisation. With our refined techniques, key phrase searches were developed which could be tied into ongoing validation procedures elsewhere in the study (e.g. cancer) or which could be validated using existing data from other sources (e.g. death reporting). Results Machine translation provided both problems and unexpected solutions. While it could be inaccurate (‘Divine Comedy’, ‘semen’, ‘corpse cuisine’), more often than not it provided unexpected advantages, converting regional, archaic, or otherwise uncommon Chinese terms into the most common English equivalent. The majority of chargeable elements in our insurance records are not treatment data per se, but instead hospital fees, generic care, and records of tests without result data. This makes identification of relevant treatment data challenging. Targeted key phrase searches proved successful, demonstrating that it was possible to use this data to answer research questions, even teasing out details which would otherwise not be available to us (e.g. ESRD, location and type of revascularisation). Validation of these findings is ongoing. For example, we found that 395 of our participants have been charged for ‘corpse cuisine’ (more accurately ‘corpse preparation’). Comparing these figures to our death records (an independently gathered source) we confirmed that 326 are known to be dead, and we added the remaining 69 to our list for active follow-up. Similarly, will we be seeking hospital records for the 528 patients who are receiving cancer treatment with no record of cancer. Conclusion Our methods for dealing with treatment data are still being refined, but early results are looking promising. We are investigating standardisation to ICD-10-PCS codes, developing more treatment-based diagnoses, and feeding our findings back into our ongoing validation program.
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