Comparing Treatment Options for Large Talar Osteochondral Lesions

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The surgical treatment of large or revision osteochondral (OCD) lesions of the talus remain challenging. Currently, there are several treatment options for these patients, including: osteochondral autograft (OATS), allograft cartilage extracellular matrix (Arthrex BioCartilage), and particulated juvenile articular cartilage allograft (Zimmer DeNovo). Due to the relative rarity of these procedures, the literature comparing these three modalities is scarce. The aim of this study was to assess midterm clinical outcomes after these surgical treatments for large or revision talar OCD lesions. Methods: Hospital IRB approval was obtained. We reviewed surgical case logs and identified 78 total patients between 2003- 2015 for inclusion in this retrospective study. Thirty-three patients were excluded due to incomplete preoperative or postoperative outcome scoring data, and 23 patients are pending followup, leaving a cohort of N = 22 patients (5 OATS, 5 DeNovo, 12 BioCartilage). Functional outcomes preoperatively and postoperatively were evaluated using Short Form 12-item Physical and Mental Health Survey (SF12 M and SF12P) and Foot Function Index (FFI) scores, ability to return to sport or work, and the need to return to the OR for revision surgery. Data were compared using paired student’s t-test and a one way ANOVA. Results: Mean age was 38y with mean followup of 4.3y (range 1.1-12.5). Of 22 patients, three were revisions. Mean lesion size was (12.6x9.1x6.5 mm). All groups showed significant improvements in FFI (p < 0.05) compared to preoperative baseline. Only the BioCartilage group showed significant improvement in SF12P (37.6 vs 47.8, p<0.05). The OATS and DeNovo groups did not show a significant increase in SF12P, and none of the groups demonstrated significant improvement in SF12 M. All patients returned to work, and 8/11 (73%) athletes returned to sport. There were no significant differences between groups when comparing SF12, FFI, and return to sport/work. Revision surgery was necessary in 6/22 (28%) patients. Post-hoc power analysis revealed limited power (0.23), and effect size (f=0.32) may be due to small sample size. Conclusion: All three treatment methods resulted in good medium-term functional results for the treatment of large or revision talar OCD lesions. However, we were unable to distinguish significant differences between OATS, Biocartilage, and Denovo, likely due to small cohort numbers and low power. Further study is warranted with increased patient numbers to improve power and differentiate among the three treatment options, as well as provide longer clinical and radiographic follow-up.

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Validating the Factor Structure of the Stigma of Suicide Scale–Short Form Spanish Version Among Healthcare Students

Crisis ◽

10.1027/0227-5910/a000728 ◽

2020 ◽

pp. 1-5

Author(s):

Ruthmarie Hernández-Torres ◽

Paola Carminelli-Corretjer ◽

Nelmit Tollinchi-Natali ◽

Ernesto Rosario-Hernández ◽

Yovanska Duarté-Vélez ◽

...

Keyword(s):

Factor Structure ◽

Structural Equation ◽

Short Form ◽

Small Sample Size ◽

Small Sample ◽

Spanish Version ◽

Equation Modeling ◽

Cross Sectional ◽

Healthcare Students ◽

Spanish Speaking

Abstract. Background: Suicide is a leading cause of death among Spanish-speaking individuals. Suicide stigma can be a risk factor for suicide. A widely used measure is the Stigma of Suicide Scale-Short Form (SOSS-SF; Batterham, Calear, & Christensen, 2013 ). Although the SOSS-SF has established psychometric properties and factor structure in other languages and cultural contexts, no evidence is available from Spanish-speaking populations. Aim: This study aims to validate a Spanish translation of the SOSS-SF among a sample of Spanish-speaking healthcare students ( N = 277). Method: We implemented a cross-sectional design with quantitative techniques. Results: Following a structural equation modeling approach, a confirmatory factor analysis (CFA) supported the three-factor model proposed by Batterham and colleagues (2013) . Limitations: The study was limited by the small sample size and recruitment by availability. Conclusion: Findings suggest that the Spanish version of the SOSS-SF is a valid and reliable tool with which to examine suicide stigma among Spanish-speaking populations.

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The SCIA Questionnaire: standards for communities for children and adolescents – a tool for the evaluation of good practices

Therapeutic Communities The International Journal of Therapeutic Communities ◽

10.1108/tc-01-2018-0002 ◽

2019 ◽

Vol 40 (1) ◽

pp. 1-15

Author(s):

Cinzia Guarnaccia ◽

Anna Maria Ferraro ◽

Maria Lo Cascio ◽

Simone Bruschetta ◽

Francesca Giannone

Keyword(s):

Children And Adolescents ◽

Short Form ◽

Small Sample Size ◽

Small Sample ◽

Self Report ◽

Community Treatment ◽

Short Version ◽

Therapeutic Communities ◽

Evaluation Tool ◽

Content Type

Purpose The purpose of this paper is to present the Italian validation of the standards for communities for children and adolescents (SCIA) Questionnaire, an evaluation tool of communities quality standards, based on the “Service Standards for Therapeutic Communities for Children and Young People – 2nd edition” of the Community of Communities (2009), that enables an empirical, multidimensional and complex evaluation of the therapeutic community (TC) “system”. It is a self-report that sets out and measures variables that allow to get an overview of organisational models and the possible development areas to improve the effectiveness of the protection of child and adolescents in community treatment. The validation and a preliminary analysis to develop a short version of the SCIA are presented. Design/methodology/approach The questionnaire (composed, in the extended form, by 143 items) was administered to 101 community workers, 20 males (19.8 per cent) and 81 females (81.2 per cent) aged between 24 and 61 years (M=36.20, SD=8.4). The analysis of reliability (Cronbach’s α) and a series of exploratory factor analysis allowed to eliminate redundant or less significant items. Findings The short form of the self-report consists of 67 items, divided into seven subscales, which explore different areas of intervention in TCs. Despite the limitations due to the small sample size, the utility of this tool remains confirmed by its clinical use and the development of good operating practices. Originality/value The SCIA Questionnaire responds to the need to adopt empirical variables in the process of evaluation of the communities. The SCIA is also a useful tool for clinical evaluation, as it allows a detailed observation of residential community treatment with children and adolescents that allows to analyse and monitor the structural and organisational aspects and the quality of practices that guide the interventions.

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Patients outcome after distal femur- and proximal tibia replacement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00322 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0032

Author(s):

Tilman Graulich ◽

Caroline Kranz ◽

Christoph Korallus ◽

Marcus Örgel ◽

Marco Haertle ◽

...

Keyword(s):

Revision Surgery ◽

Distal Femur ◽

Proximal Tibia ◽

Pathologic Fracture ◽

Postoperative Outcome ◽

Functional Results ◽

Contralateral Side ◽

Primary Surgery ◽

Traumatic Fracture ◽

Flexion Force

Aims and Objectives: Mega-knee-arthroplasty are rare and indications are heterogeneous after fracture, tumour and infection. The outcome after distal femur- and/or proximal tibia replacement are unclear. We therefore wanted to analyse the postoperative outcome in case of primary and revision surgery. We hypothesize that I) Implantation of distal femur- and/or proximal tibia replacement are associated with reduced range of motion and function compared to the contralateral side and II) implantation in case of primary surgery is associated with better outcome than in case of revision surgery. Materials and Methods: We retrospectively analysed all patients in our trauma department between 1998 and 2017 who underwent a MUTARS distal femur replacement or proximal tibia replacement (Implantcast GmbH, Buxtehude, Germany). We collected general patients’ data, rang of motion, determined the Toronto extremity selvage score (TESS), musculoskeletal tumour society score (MSTS), knee society score (KSS) and Western Ontario MacMaster questionnaire (WOMAC) Score. Knee extension and flexion force was measured. Results: We included 59 patients with a mean age of 65+/-20 years. Out of these we had 19 (32%) male and 40 (68%) female patients. Mean follow up (f/up) was 36+/-57 month (range: 1-218). Indication for R-TKA was periprosthetic fractures (n=14), tumour (n=16), infection (n=10), traumatic fracture (n=14), aseptic loosening (n=3) and pathologic fracture (n=2). Indication for primary implantation was given in 33 (56%) patients and for implantation in case of revision surgery in 26 (44%) patients. Mean TESS was 66+/-33, mean MSTS was 14+/-7, mean KSS was 49+/-30, mean WOMAC was 36+/-26. Mean flexion on the operated side was 83°+/-24° compared to the healthy side (115°+/-20°) (p<0.001). Mean extension force on the operated side at 60° was 20+/-12 (Nm) compared to 77+/-58 (Nm) on the not operated side (p=0.31). Mean flexion force on the operated side at 60° was 32+/-26 (Nm) compared to 53+/-42 (Nm) on the not operated side (p=0.43). In case of revision surgery significant worse function scores in the TESS and KSS could be overserved (both p<0.05). Conclusion: Implantation of a distal femur- and/or proximal tibia replacement are associated with loss of flexion, a trend to reduced extension and flexion power compared to the contralateral side. In case of primary surgery better functional results in terms of function Scores can be expected than in case of revision surgery.

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An Electronic Teaching Module for Improving Knowledge of Self-Management of Vaso-Occlusive Pain Crises in Patients With Sickle Cell Disease: Pilot Questionnaire Study (Preprint)

10.2196/preprints.13501 ◽

2019 ◽

Author(s):

Tammie Tam ◽

Maria R Baer ◽

Lewis L Hsu ◽

Jennie Y Law

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Small Sample Size ◽

Treatment Options ◽

Small Sample ◽

Self Management ◽

Cell Disease ◽

Teaching Module ◽

Baseline Knowledge ◽

Electronic Teaching

BACKGROUND For patients with sickle cell disease (SCD), effective management of vaso-occlusive crises (VOCs) is integral to provision of care, as nearly all affected individuals will suffer from VOCs in their lifetime. A recent systematic review of technological interventions to improve self-management in the care of SCD concluded that electronic health has the potential to improve the care of individuals with SCD. OBJECTIVE The aim of this study was to assess the value of an electronic teaching module (ETM) provided by Emmi Solutions for educating adult SCD patients on VOC self-management and treatment options for SCD. METHODS A pretest assessed adults with SCD for baseline knowledge with regard to self-management of VOCs. Participants then watched the 35-min ETM and completed a posttest and survey on the ETM. RESULTS A total of 20 adults enrolled. Their knowledge scores improved (pretest median 66.5% and posttest median 85%; P<.001). In total, 18 participants (18/20, 90%) agreed that they “learned a lot” or “learned something” from the ETM. The most common topic about which they reported learning was hydroxyurea. A total of 12 participants (12/20, 60%) agreed with the statement that they “would recommend the module to a friend or family member with sickle cell disease.” CONCLUSIONS The ETM is associated with an increase in knowledge in patients with SCD. Limitations of the study include small sample size, no assessment of knowledge before premodule questionnaire completion, and no longitudinal follow-up. Identifying patients with SCD who demonstrate affinity for self-education via an ETM may further enhance utility of this tool to educate and empower patients.

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Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

Endocrine ◽

10.1007/s12020-020-02432-z ◽

2020 ◽

Vol 70 (2) ◽

pp. 218-231

Author(s):

Leah T. Braun ◽

German Rubinstein ◽

Stephanie Zopp ◽

Frederick Vogel ◽

Christine Schmid-Tannwald ◽

...

Keyword(s):

Medical Therapy ◽

Cushing’S Disease ◽

Small Sample Size ◽

Case Reports ◽

Treatment Options ◽

Pituitary Surgery ◽

Small Sample ◽

Bilateral Adrenalectomy ◽

Cushing's Disease ◽

Success Rates

Abstract Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer.

Cancers ◽

10.3390/cancers11091355 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1355 ◽

Cited By ~ 14

Author(s):

Cattrini ◽

Castro ◽

Lozano ◽

Zanardi ◽

Rubagotti ◽

...

Keyword(s):

Prostate Cancer ◽

Small Sample Size ◽

Treatment Options ◽

Current Treatment ◽

Abiraterone Acetate ◽

Small Sample ◽

Phase 3 ◽

Tumor Patient ◽

Randomized Controlled ◽

Hormone Sensitive

The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-naïve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient’s risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers.

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Surgical management of 2- or 3-part proximal humeral fractures: comparison of plate, nail and K-wires

MUSCULOSKELETAL SURGERY ◽

10.1007/s12306-020-00686-4 ◽

2020 ◽

Author(s):

N. Setaro ◽

M. Rotini ◽

P. Luciani ◽

G. Facco ◽

A. Gigante

Keyword(s):

Intramedullary Nailing ◽

Revision Surgery ◽

Short Form ◽

Functional Results ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Group Iii ◽

Group I ◽

Group Ii

Abstract Background Proximal humeral fractures (PHFs) are fairly common injuries, and their treatment is a challenge. The aim of this study is to compare clinical and functional outcomes of different osteosynthesis techniques. Materials and methods We retrospectively reviewed patients’ files and the hospital’s digital database between March 2002 and April 2018. We treated surgically 148 patients with 2- and 3-part PHFs: 64 with plate and screws, 53 with intramedullary nailing and 31 with retrograde K-wires. We constituted three groups according to the type of treatment and two subgroups for each according to the number of fragments (Neer II or Neer III). Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-12 (SF-12) scores were recorded. Results Mean DASH and SF-12 scores both from the group treated with plate (Group I) and the one subjected to intramedullary nailing (Group II) were statistically superior to results from the patients treated by retrograde K-wires (Group III), while nails showed better functional results than the locking plates. In the first two groups, no difference was found between Neer II and III subgroups, while in Group III the DASH scores were significantly better in Neer II subgroup than those in Neer III subgroup. Avascular necrosis was the most frequent cause of revision surgery in Group I (4 cases) where we had 8 cases of reintervention (12.5%). In Group II, the subacromial impingement was the only cause for revision surgery with 3 cases (5.6%). Conclusions Intramedullary nails showed better functional results and a lower complication rate than the locking plates. Both techniques showed superior results compared to those available with retrograde K-wires. So the nail seems to be a more reliable and adequate method for treating 2- and 3-part proximal humeral fractures.

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The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01800-z ◽

2019 ◽

Vol 55 (7) ◽

pp. 839-876 ◽

Cited By ~ 5

Author(s):

Ruimin Ma ◽

Farhana Mann ◽

Jingyi Wang ◽

Brynmor Lloyd-Evans ◽

James Terhune ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Social Isolation ◽

Mental Health Problems ◽

Small Sample Size ◽

Intervention Development ◽

Health Problems ◽

Small Sample ◽

Current Evidence ◽

Physical And Mental Health

Abstract Purpose Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation. Methods Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary. Results In total, 30 RCTs met the review’s inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants’ characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies. Conclusion The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

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Step Test Scores Are Related to Measures of Activity and Participation in the First 6 Months After Stroke

Physical Therapy ◽

10.2522/ptj.20080368 ◽

2009 ◽

Vol 89 (10) ◽

pp. 1061-1071 ◽

Cited By ~ 19

Author(s):

Vicki Stemmons Mercer ◽

Janet Kues Freburger ◽

Shuo-Hsiu Chang ◽

Jama L. Purser

Keyword(s):

Motor Control ◽

Lower Extremity ◽

Physical Function ◽

Gait Speed ◽

Short Form ◽

Small Sample Size ◽

Small Sample ◽

Stroke Recovery ◽

Step Test ◽

Additional Step

Background: The Step Test (ST) is a measure of dynamic standing balance and paretic–lower-extremity motor control in patients with stroke. Little is known about the extent to which impairments assessed by the ST relate to activity and participation during stroke recovery.Objective: The purpose of this study was to determine relationships between ST scores and measures of activity and participation during the first 6 months after stroke.Design: This was a prospective cohort study.Methods: Thirty-three individuals (18 men, 15 women) with a diagnosis of a single, unilateral stroke participated in the study. Participants were tested one time per month from 1 to 6 months poststroke. The ST was considered an impairment-level measure. Self-selected gait speed and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Function Index (PFI) were used to assess physical function. Three domains (mobility, basic and instrumental activities of daily living, participation) of the Stroke Impact Scale were used to assess self-reported disability. Regression analyses were conducted to examine the bivariate associations between ST scores and each physical function and disability measure at each time point (1–6 months).Results: The ST scores were positively associated with both physical function measures. The associations were stronger for self-selected gait speeds (R2=.60–.79) than for the PFI scores (R2=.32–.60). During the first 6 months after stroke, each additional step with the paretic lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed, and each additional step with the nonparetic lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase. The impairment-disability associations were weaker than the impairment-physical function associations.Limitations: Limitations of the study include a relatively small sample size and lack of examiner blinding with regard to participant characteristics.Conclusions: Impairments in balance and paretic–lower-extremity motor control, as measured by the ST, relate to physical function and disability during the first 6 months following stroke.

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Relationship of Personality to Dissociation and Childhood Trauma in Borderline Personality Disorder

CNS Spectrums ◽

10.1017/s109285290001912x ◽

2003 ◽

Vol 8 (10) ◽

pp. 755-762 ◽

Cited By ~ 29

Author(s):

Daphne Simeon ◽

Dorothy Nelson ◽

Rachela Elias ◽

Jennifer Greenberg ◽

Eric Hollander

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Childhood Trauma ◽

Short Form ◽

Small Sample Size ◽

Borderline Personality ◽

Small Sample ◽

Emotional Neglect ◽

Childhood Trauma Questionnaire ◽

The Relationship

ABSTRACTBackground:Dissociation is a prominent feature in some individuals with borderline personality disorder (BPD), yet our understanding of the meanings and implications of prominent dissociation in BPD remains limited. The purpose of this study was to investigate the relationship between dissociation and childhood trauma in BPD and to explore the relationships of dissociation and trauma to various personality features of BPD.Methods:Twenty BPD subjects and 24 healthy comparison subjects of similar age and gender were administered the Dissociative Experiences Scale, the Childhood Trauma Questionnaire—short form, the Tridimensional Personality Questionnaire, the Defense Style Questionnaire, the Relationship Style Questionnaire, and the Schema Questionnaire.Results:The BPD group exhibited greater dissociation and childhood trauma, as well as greater pathology in most personality variables, compared with the healthy group. Dissociation in BPD was not significantly related to total childhood trauma, but only to emotional neglect, which accounted for 23% of the variance in dissociation scores.Conclusion:Within the BPD group, dissociation was associated with fearful attachment and immature defenses, while total childhood trauma and emotional neglect were associated with overconnection and disconnection schemata. This is a preliminary study with a small sample size, yet the correlates of dissociation in BPD merit further investigation.

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