Development of hip displacement in cerebral palsy: a longitudinal register study of 1,045 children

Background and purpose — Hip surveillance in children with cerebral palsy (CP) includes repeated radiographic hip examinations and measurements of the hip migration percentage (MP) to identify hips in need of surgery early, to prevent dislocation with the fewest number of radiographic examinations possible. We analyzed the early development of the MP in hips operated on to prevent hip dislocation and hips stabilized without surgery Patients and methods — From the Swedish Surveillance Programme for CP, 5,899 radiographic measurements from 1,045 children with a Gross Motor Function Classification System level III–V born in 1996–2011 were analyzed. For children operated on to prevent hip dislocation, measurements up to the most recent preoperative radiograph were included. The hip with highest MP was analyzed for each child. A mixed-effects model was used to estimate the development of the MP at each age for each child and the population mean. Results — In the 702 children who did not undergo preventive surgery, the mean MP increased with decreasing velocity up to age 6 years. Here it reached 24% (95% confidence interval [CI] 24–25), with a velocity of 0.3%/year (CI 0.0–0.5), remaining approximately stable up to age 12 years. In the 343 children who underwent preventive surgery (219 adductor–psoas lengthening, 124 varus derotation osteotomy of proximal femur), the mean MP increased with an increasing velocity from a mean of 30% (CI 27–32) 3 years before the operation. Interpretation — An increasing rate of hip displacement in hips with an MP > 24% indicates the need for preventive surgery. Hips stabilized without preventive surgery had a decreasing displacement rate and were usually stabilized with an MP < 30% at age 6 years.

The impact of novel COVID-19 initial pandemic on orthopedic healthcare: an experience from a single institution of South Korea

Background: This study was to investigate the cancellation rate and trend of orthopedic surgeries during the novel coronavirus disease 2019 (COVID-19) pandemic. Moreover, we assessed the psychologic status of orthopedic healthcare workers, and investigated the details of the preventive surgeries underwent in COVID-19-positive patients.Methods: For 3 months after January 20, 2020, cancellation rates of elective surgeries were investigated, and the number of elective surgeries conducted in the same period over the last two years was compared. Four different questionnaires were used to investigate psychologic status among the orthopedic health care workers. We compared the outcomes according to occupation (physician or nurse), and type of work (faculty staff or resident physician). Outcomes according to occupation and type of work were compared. Preventive surgeries underwent in patients who could not wait for the results of the COVID-19 diagnosis were investigated.Results: Spine and hip surgery had relatively lower cancellation rates, and elective surgeries were significantly reduced. During the initial pandemic, the cancellation rate of orthopedic elective surgeries was significantly higher than in the same period of the previous year and was different for each subdivision depending on the degree of pain or disability. The psychological outcomes were within the normal range and there were no significant differences between groups. After preventive surgery, all medical staff involved in the operation tested negative.Conclusion: During the COVID-19 pandemic, the cancellation rate of orthopedic elective surgeries was significantly higher than in the same period of the previous year. Orthopedic health care workers did not seem to have significant psychological distress. As a result of the preventive surgery in specialized facilities, all the medical staff who participated in the operation tested negative.

Preventive surgery after multiplex genetic panel testing (MGPT).

1525 Background: Guidelines recommend consideration of prophylactic surgery for patients with a germline pathogenic variant in some cancer predisposition genes. We assessed surgery utilization in a prospective, multi-institutional cohort study of MGPT. Methods: 2000 patients had MGPT and completed questionnaires at 3, 6, and 12 months. Patients reported surgical utilization and indication (treatment or prevention). Surgery utilization was assessed according to cancer history and MGPT test results: Positive, pathogenic variant; VUS, variant of uncertain significance; Negative, benign variants. Results: Overall, 12.9% (198/1537) of patients reported surgery after MGPT (median follow-up 13 months). Only 31.3% (62/198) of patients specified that their surgery was preventive. Preventive surgery utilization was significantly higher among patients who tested positive (n=30, 14.9%) compared to those testing negative (n=20, 2.3%, p<0.001) or VUS (n=12, 2.2%, p<0.001). Preventive surgery was very low among patients testing negative or VUS who had no personal history of cancer in the relevant organ (Table). For example, mastectomy was not reported among any patients testing negative or VUS who had no personal history of breast cancer (Table). Conclusions: More than one year after MGPT, prophylactic surgery use was low among patients with VUS or negative results, especially among those with no personal history of cancer at the relevant site. Surgery utilization. [Table: see text]

Twitter and Non-Elites: Interpreting Power Dynamics in the Life Story of the (#)BRCA Twitter Stream

In May 2013 and March 2015, actress Angelina Jolie wrote in the New York Times about her choice to undergo preventive surgery. In her two op-eds, she explained that − as a carrier of the BRCA1 gene mutation − preventive surgery was the best way to lower her heightened risk of developing breast and ovarian cancer. By applying a digital methods approach to BRCA-related tweets from 2013 and 2015, before, during, and after the exposure of Jolie’s story, this study maps and interprets Twitter discursive dynamics at two time points of the BRCA Twitter stream. Findings show an evolution in curation and framing dynamics occurring between 2013 and 2015, with individual patient advocates replacing advocacy organizations as top curators of BRCA content and coming to prominence as providers of specialist illness narratives. These results suggest that between 2013 and 2015, Twitter went from functioning primarily as an organization-centered news reporting mechanism, to working as a crowdsourced specialist awareness system. This article advances a twofold contribution. First, it points at Twitter’s fluid functionality for an issue public and suggests that by looking at the life story—rather than at a single time point—of an issue-based Twitter stream, we can track the evolution of power roles underlying discursive practices and better interpret the emergence of non-elite actors in the public arena. Second, the study provides evidence of the rise of activist cultures that rely on fluid, non-elite, collective, and individual social media engagement.