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Risk of revision and other complications in total ankle arthroplasty do not differ by surgeon specialty: Analysis of the PearlDiver Healthcare claims database from 2010 to 2023
No full textBackground: Total ankle arthroplasty (TAA) utilization has significantly increased in the US in recent years, and current studies examining surgeon specialty and TAA outcomes are limited.
Purpose: To explore the effect of surgeon specialty on long-term TAA survivorship and short-term postoperative complications.
Study design: Retrospective cohort study and time-to-event analysis METHODS: Using a large, national claims database (PearlDiver, Inc.) with more than 170 million patient files we examined the association of surgeon specialty (podiatric surgeon vs. other) on adverse patient outcomes from January 2010 to April 2023. Relevant covariates were adjusted for using multivariable Cox and logistic regression models.
Results: There were 16,485 people who underwent TAA for a cumulative rate of 9.7 per 100,000. Surgeon specialty was known for 13,514 TAA surgeries. There were 714 revisions corresponding to a revision rate of 0.053 (714/13,514) over the 13-year study period. Patients who underwent TAA by podiatric surgeons were no more likely to experience revision surgery than those undergoing TAA by other surgeon specialties (adjusted hazards ratio [HR] 0.84, 95% CI 0.46 to 1.53, p = 0.57). Furthermore, the risk of readmission (adjusted odds ratio [OR] 1.0, 95% CI 0.77 to 1.30), infection (adjusted OR 0.91, 95% CI 0.77 to 1.07), and venous thromboembolism (adjusted OR 0.83, 95% CI 0.61 to 1.09) within the first 90 days postoperatively did not differ among surgeon specialty type.
Conclusion: This information may be of interest to third party payers, health administrators, and healthcare consumers.
Clinical level of evidence: 3
Inside Aurora Sinai Medical Center, 2004 May
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events. This issue has a feature on the NICU.https://institutionalrepository.aah.org/alldocuments/2261/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 January
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2257/thumbnail.jp
In reply to: Pretransplant conditioning for haematopoietic cell transplants: The past is prologue
No full textConnection, 1996 October 23
No full textSinai Samaritan Medical Center, Milwaukee, WI: Internal publication for staff and volunteers. This issue highlights the hospital\u27s inclusion on the U.S. News & World Report list of America\u27s Best Hospitals.https://institutionalrepository.aah.org/alldocuments/2236/thumbnail.jp
Kolb\u27s experiential learning in action: A curriculum for residents
No full textBACKGROUND: Although there is a growing number of children dependent on medical technology, graduating paediatric residents are underprepared to adequately care for these patients.
OBJECTIVE: We aimed to help fill this educational gap by piloting a novel hands-on medical device curriculum and assessing learner-driven outcomes.
METHODS: We used Kern\u27s six-step approach to develop, implement, and evaluate our curriculum. Five educational workshops (central lines, chest tubes, enteral feeds, tracheostomies, shunts) were designed using Kolb\u27s experiential learning theory. Workshops were led by multidisciplinary content experts and integrated into a noon conference series. We studied the curricular impact by measuring feasibility and learner relevance as well as competency-based outcomes via self-evaluations, board-style knowledge assessments and Accreditation Council for Graduate Medical Education (ACGME) Milestones.
RESULTS: Thirteen postgraduate year 1 (PGY1) paediatric residents participated in the curriculum. Thematic analysis highlighted the value of practical application of skills with improved comfort managing medical devices. Exposed residents demonstrated statistical improvement in self-assessed skills associated with 3/5 devices and in 9/10 Milestones. These residents also scored higher on the knowledge assessment compared to nonexposed peers, though this was not statistically significant.
DISCUSSION: Our study demonstrates the value of a hands-on medical device curriculum in formal paediatric resident education. While this curriculum was successfully integrated into a traditional didactic series, was universally enjoyed, and had a meaningful impact on acquired skills and knowledge, further research on patient-level outcomes may be valuable for programmes interested in adapting a similar learning experience into their current educational model
Performance of multiple multi-cancer detection tests using a large independent reference set (Alliance A212102)
No full textBackground: Reference sets are needed to evaluate performance of multi-cancer detection (MCD) assays. The National Cancer Institute (NCI) funded the Alliance reference set study to assess MCDs for use in future trials.
Methods: Individuals with cancer and controls were recruited; blood specimens were collected prior to cancer treatment. A performance evaluation study was designed utilizing reference set samples. Companies (n = 6) were selected to participate based on review of performance data and ability to utilize the blood collection tube. Companies received samples from cancer types their assay was designed to detect ( targeted ), plus additional non-targeted and control samples. Companies reported positive/negative calls, risk scores, and tissue-of-origin (TOO) predictions. Sensitivity was computed for early (I-II) and late (III-IV) stage cases, based on positive/negative calls (SEPN) and at fixed 98% specificity (SE98). Specificity and TOO accuracy were computed.
Results: 549 cases (encompassing 13 cancer types) and 413 controls from the reference set were included in the study. Companies assessed samples from median 6 (range 5-9) targeted cancer types and median 8 (range: 7-11) overall cancer types. Median (range) specificity was 92.3% (76.5%-98.5%). Median (range) SEPN was 32% (25%-42%) for early stage 73% (48%-89%) for late stage; while median (range) SE98 was 19% (8%-35%) for early stage and 66% (13%-79%) for late stage. Median sensitivity for non-targeted types was 40% (early stage) and 52% (late stage). Median (range) TOO accuracy (primary predicted site) was 75% (64%-78%).
Conclusions: Sensitivity and specificity varied widely across assays with early-stage sensitivity substantially lower than late-stage sensitivity
Iterative modification and finalization of a patient decision-aid for immunosuppressive medication treatment decision-making in systemic lupus erythematosus by a racially diverse patient group
No full textObjective: To describe the patient-feedback process for iterative modification and finalization of the systemic lupus erythematosus (SLE) decision-aid.
Methods: We invited SLE patients during their regular outpatient visits to review the English or Spanish version of the SLE decision-aid on a touchpad computer. They provided qualitative and quantitative feedback on style, content, and usefulness of SLE decision-aid.
Results: Twenty-two racially diverse SLE patients, from 2 academic medical centers, reviewed the SLE decision-aid. Most patients found SLE decision-aid easily understandable, clear, and concise. Patients found a variety of different content interesting, such as the sections on steroids, and premenopausal women, and how the graphs helped them understand the information. The content helped patient understanding and provided clarity about SLE management. All the people with SLE found the information in the lupus decision-aid important. Most respondents (\u3e75%) each agreed that the use of SLE decision-aid would have made a difference in their initial treatment or strongly agreed that it is important to start treatment to prevent kidney damage.
Conclusion: Patient feedback contributed significantly to iterative modification and finalization of the SLE decision-aid, which kept it relevant to all SLE patients