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Song W, La Fontaine J, Shibuya N, Prochaska J, Jupiter DC. The Effect of Limb Salvage Efforts in Different Age Groups: Relationships Between Major and Minor Amputations. J Foot Ankle Surg 2024; 63:380-385. [PMID: 38266807 DOI: 10.1053/j.jfas.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
"Limb salvage" efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients' quality of life and the cost-effectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas Hospital Discharge Data Public Use Data File. Population estimates were obtained from the Texas Population Estimates Program from 2011 to 2015 and from intercensal estimates provided by the U.S. Census Bureau from 2006 to 2010. Raw numbers of minor, major, and all NLEA surgeries and the ratio of major amputations to total amputations per year were reported for each age group. Poisson regression and Joinpoint analyses were performed to capture these changes in trends. Rates of amputations increased, with significant decreasing relative prevalence of major amputations. Patients aged 45 to 64 with diabetes are likely driving these increases. Rates of lower extremity amputation in patients with diabetes increased from 2009 to 2015. This holds for all and minor amputations. In contrast, the ratio of major to all amputations decreased from 2010. Utilization of major and minor amputation differs between age groups, remaining stable in the youngest subjects, with minor amputation rates increasing in those aged 45 to 64.
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Affiliation(s)
- Wenye Song
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Javier La Fontaine
- University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Naohiro Shibuya
- Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Surgical Services, Central Texas Veterans Affairs Health Care System, Temple, TX.
| | - John Prochaska
- Department of Population Health and Health Disparities, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Shibuya N, Agarwal MR, Jupiter DC. A New Paradigm in Foot and Ankle Outcomes?: Away From Radiographs and Toward Patient-Centered Outcomes. Clin Podiatr Med Surg 2024; 41:259-268. [PMID: 38388122 DOI: 10.1016/j.cpm.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Having reasonable outcome measures is essential to unbiased research. For years, provider-measured outcomes have been valued as they are more objective and convenient for investigators. However, with the popularity of patient-centered medical care delivery, patient-reported outcome measures are appropriately becoming more popular in foot and ankle research.
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Affiliation(s)
- Naohiro Shibuya
- University of Texas Rio Grande Valley, School of Podiatric Medicine.
| | - Monica R Agarwal
- University of Texas Rio Grande Valley, School of Podiatric Medicine
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2101 Treasure Hills Boulevard, Harlingen, TX 78550, USA
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Shibuya N, Jupiter DC. Effectiveness of Concurrent Ankle Arthroscopy During Open Reduction and Internal Fixation of Malleolar Fractures in Prevention of Common Short-Term Complications. J Foot Ankle Surg 2024:S1067-2516(24)00053-X. [PMID: 38438101 DOI: 10.1053/j.jfas.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024]
Abstract
Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.
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Affiliation(s)
- Naohiro Shibuya
- Clinical Professor, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX.
| | - Daniel C Jupiter
- Associate Professor, Department of Biostatistics and Data Science, Department of Orthopaedic Surgery and Rehabilitaion, The University of Texas Medical Branch, Galveston, TX
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Tansey PJ, Janney CF, Jupiter DC, Henriques M, Alijanipour P, Morrissey PB. Cervical Disc Displacement in Military Pilots. Mil Med 2024:usae021. [PMID: 38334294 DOI: 10.1093/milmed/usae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/08/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Cervical disc displacement (CDD) may disqualify pilots from flying and have a profound impact on military unit capability. The objective of this retrospective database review is to characterize the incidence and demographic predictors of symptomatic cervical spine disc displacement in pilots of fixed- and rotary-wing aircraft and ground-based controls. MATERIALS AND METHODS The Defense Military Epidemiology Database was queried for first-occurrence ICD-9 code 722.0: CDD cases from 2007 to 2015. Injury count rates among aircraft groups and overall incidence per 1,000 person-years were calculated and standardized for age, gender, and military rank, and 95% confidence intervals (CIs) were compared to determine significance. RESULTS There were 934 new cases of CDD among active duty U.S. Military pilots during the study period. The overall incidence of CDD in all pilots during this time frame was 2.715 per 1,000 person-years (95% CI, 2.603-2.830). Helicopter pilots had a significantly higher incidence compared to all other aircraft pilots and crew at 3.79 per 1,000 person-years (95% CI, 3.48-4.13). This finding remained statistically significant after standardizing for age, gender, and rank. Among all military officers, increasing age was a risk factor for CDD. CONCLUSIONS The U.S. Military helicopter pilots have an increased risk compared to fixed-wing pilots and non-pilot controls. CDD remains a rare, though career-threatening, condition. Increased education and awareness training are warranted for both helicopter pilots and flight physicians to recognize signs and symptoms of cervical pathology. Continued investigations into preventive measures to minimize injury and time unfit for flight are warranted.
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Affiliation(s)
- Patrick J Tansey
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
| | - Cory F Janney
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
- Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX 77555-1150, USA
| | | | - Pouya Alijanipour
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
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Robbins JB, Stahel SA, Morris RP, Jupiter DC, Chen J, Panchbhavi VK. Radiographic Anatomy of the Lateral Ankle Ligament Complex: A Cadaveric Study. Foot Ankle Int 2024; 45:179-187. [PMID: 37994643 PMCID: PMC10860354 DOI: 10.1177/10711007231213355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI. METHODS Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated. RESULTS Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior. CONCLUSION The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this. CLINICAL RELEVANCE Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
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Affiliation(s)
- Jordan B. Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Shepheard A. Stahel
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randal P. Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Villarreal JV, Hussien DG, Panchbhavi VK, Jupiter DC. Predisposing Factors for 30-Day Complications Following Leg Amputation. Foot Ankle Spec 2024; 17:49-57. [PMID: 33771044 DOI: 10.1177/19386400211001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although amputation rates, morbidity, and mortality have been established for select populations, the impact of general demographic factors on postoperative surgical complications remains little studied. METHODS The American College of Surgeons' National Surgical Quality Improvement Program database was searched for leg amputations from 2012 to 2017 using CPT codes 27881, 27882, 27884, and 27886, identifying 4162 patients. A total of 29 demographic variables with 4 complications (surgical infection, additional service, and deep-vein thrombosis [DVT], and sepsis) were analyzed. RESULTS Preoperative open, contaminated, or dirty/infected wounds; longer intraoperative times; development of sepsis prior to surgery; and admission of patients from home or another hospital influenced postoperative infection rates. Preoperative open, infected, or dirty/infected wounds; height; weight; total length of hospital stay; and ethnicity affected postoperative additional service incidence. Preoperative congestive heart failure, large decreases in body weight, and total length of hospital stay influenced postoperative DVT rates. Preoperative functional heath status, total length of hospital stay, amputations conducted as emergency cases, preoperative acute renal failure, open or infected wounds, sepsis, and contaminated or dirty/infected wounds affected postoperative sepsis rates. BACKGROUND Conclusion. Understanding these risk factors may allow providers to anticipate and address higher rates of complications in certain patient populations. LEVEL OF EVIDENCE Level III: Prognostic.
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Affiliation(s)
- Joseph V Villarreal
- the School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Doha G Hussien
- the School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- the Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- the Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
- the Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas
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Robbins JB, Jupiter DC, Panchbhavi VK, Weiss WM, Hagedorn JC, Chen J. Return to Play Rates Following Operative Ankle Fractures Differ Between High- and Low-Performing National Football League Athletes. Orthopedics 2024; 47:22-27. [PMID: 37216567 DOI: 10.3928/01477447-20230517-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study investigated predictive factors for return to play among National Football League athletes after operative treatment of ankle fractures and the impacts of these injuries on career longevity and player performance. Athletes who underwent surgery to repair ankle fractures from the 2013 to 2017 seasons were identified from injury reserve lists and press releases. Demographics and season metrics were collected before and after the injury. Statistical analysis assessed for differences in recorded variables between injured and uninjured players. Thirty-one players met study inclusion criteria. Twenty-two (71%) athletes successfully returned to play. Players who did not return showed no significant differences (P>.05) in position, age, body mass index, number of games or seasons played preinjury, or snaps per game the season prior to injury and had a significantly lower (42.6%, P=.013) preinjury season approximate value (SAV) compared with returning players. Returning athletes showed no significant differences (P>.05) in SAV or snaps per game compared with their preinjury season or with uninjured controls. A high preinjury SAV is associated with successful return to play. No difference in game time or performance metrics was detectable between returning players and uninjured controls, or between preinjury and postinjury seasons. [Orthopedics. 2024;47(1):22-27.].
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Silva JD, Jupiter DC, Taglialatela G. Reduced Prevalence of Parkinson's Disease in Patients Prescribed Calcineurin Inhibitors. J Parkinsons Dis 2024; 14:533-543. [PMID: 38427501 DOI: 10.3233/jpd-230313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Preclinical evidence suggests calcineurin inhibitors (CNIs) combat α-synuclein-induced neuronal dysfunction and motor impairments. However, whether CNIs prevent or treat Parkinson's disease (PD) in humans has never been investigated. Objective We seek to ascertain if prescription of CNIs is linked to a decreased prevalence of PD in a varied patient population and to glimpse into the mechanism(s) and target site through which CNIs might decrease PD prevalence. Methods We analyzed electronic health records (EHRs) from patients prescribed the brain penetrant CNI tacrolimus (TAC), the peripherally restricted CNI cyclosporine (CySp), or the non-CNI sirolimus (SIR). For comparison, EHRs from a diverse population from the same network served as a general population-like control. After propensity-score matching, prevalence, odds, and hazards of PD diagnoses among these cohorts were compared. Results Patients prescribed CNIs have decreased odds of PD diagnosis compared to the general population-like control, while patients prescribed SIR do not. Notably, patients prescribed TAC have a decreased prevalence of PD compared to patients prescribed SIR or CySp. Conclusions Our results suggest CNIs, especially those acting within the brain, may prevent PD. The reduced prevalence of PD in patients prescribed TAC, compared to patients prescribed SIR, suggests that mechanisms of calcineurin inhibition- other than immunosuppression, which is common to both drugs- are driving the reduction. Therefore, CNIs may provide a promising therapeutic approach for PD.
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Affiliation(s)
- Jacqueline D Silva
- Department of Neurology, Mitchell Center for Neurodegenerative Disorders, University of Texas Medical Branch, Galveston, TX, USA
- Pharmacology and Toxicology Graduate Program, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Giulio Taglialatela
- Department of Neurology, Mitchell Center for Neurodegenerative Disorders, University of Texas Medical Branch, Galveston, TX, USA
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Venugopal NK, O'Leary S, Robledo A, Husain A, Tom RB, Nuti SA, Jupiter DC, Panchbhavi VK. Safe driving recommendations following lower extremity orthopedic surgery: a systematic review. Eur J Orthop Surg Traumatol 2024; 34:59-66. [PMID: 37639004 DOI: 10.1007/s00590-023-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE We analyzed the published literature on return-to-driving (RTD) recommendations following lower extremity orthopedic surgery, including knee and hip arthroplasty and ankle and foot surgery. METHODS We conducted a PubMed MEDLINE database search for the relevant literature spanning from 1988 to 2022. Data were extracted from the selected articles independently by six investigators, and the mean, standard deviation, and range of RTD recommendations for each surgical region and procedure were calculated. RESULTS The 34 studies included in our review evaluated brake response time, reaction time, movement time, braking force, and other parameters. Average RTD recommendations in weeks were: hip surgeries, 4.1 (± 2.7); foot surgeries, 6.67 (± 0.94); Achilles surgeries, 6.67 (± 0.25); ankle surgeries, 4 (± 2); knee surgeries, 5.42 (± 0.77); and multiple lower extremity surgeries, 3.85 (± 0.15). CONCLUSION Our findings can assist physicians in providing informed recommendations to patients, promoting safe driving practices, and optimizing postoperative recovery. LEVEL OF EVIDENCE Therapeutic, Level III: Retrospective comparative study.
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Affiliation(s)
- Navneet K Venugopal
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Sean O'Leary
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Ariadna Robledo
- Department of Neurosurgery, The University of Texas Medical Branch, 1005 Harborside Dr, Fifth Floor, Galveston, TX, 77555, USA
| | - Adam Husain
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Roshan B Tom
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Shiva A Nuti
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, 700 Harborside Drive, Ewing Hall 1.134, Galveston, TX, 77555-1148, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
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Bowcutt JT, Shibuya N, Jupiter DC. Preoperative Serum Albumin and Other Risk Factors Related to 30-Day Postoperative Complications in Total Ankle Arthroplasty. J Foot Ankle Surg 2023:S1067-2516(23)00175-8. [PMID: 37549784 DOI: 10.1053/j.jfas.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
This study investigates effects of preoperative albumin on 30-day total ankle arthroplasty (TAA) outcomes. Additionally, other preoperative risk factors are addressed, including American Anesthesia Society (ASA) class, functional status, chronic obstructive pulmonary disease (COPD), diabetes, smoking status, time of operation, and age. Outcomes assessed were readmission, return to operating room, surgical site infection, wound dehiscence, and total length of stay (TLOS). Data were extracted from the National Surgical Quality Improvement Program database. Bivariate comparisons were analyzed using correlation coefficients, t tests, or chi-squared tests; multivariate comparisons used linear or logistic regression. Our data showed no significant correlation between serum albumin and patients with readmission (odds ratio -0.14, P = 0.06), return to operating room (-0.07, P = 0.61), or surgical site infection (-0.08, P = 0.56). With bivariate analysis, functional status and COPD were significant for readmission (12.67, P < 0.001 and 7.83, P < 0.001, respectively) and dehiscence (30.52, P < 0.001 and 6.74, P = 0.05, respectively), while high ASA class (0.4, P = 0.01), increased age (0.1, P < 0.001), and longer time of operation (0.19, P < 0.001) were associated with longer TLOS. With multivariate analysis, functional status showed higher odds of readmission (7.42, P = 0.02) and dehiscence (20.47, P = 0.01), while COPD showed higher odds for readmission (6.65, P < 0.001) and longer TLOS (0.31, P = 0.05). High ASA class (0.42, P < 0.001) and female sex (0.32, P < 0.001) also had higher odds for longer TLOS. In summary, low albumin was not significant for readmission, return to operating room, or surgical site infection in TAA. COPD, functional status, high ASA class, longer time of operation, increased age, and female sex were all correlated with adverse outcomes in TAA.
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Affiliation(s)
- Jeffrey T Bowcutt
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- The University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Lewis LK, Jupiter DC, Panchbhavi VK, Chen J. Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty. Foot Ankle Spec 2023:19386400231169368. [PMID: 37148165 DOI: 10.1177/19386400231169368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Ankle arthritis adversely affects patients' function and quality of life. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). A 5-item modified frailty index (mFI-5) has predicted adverse outcomes following multiple orthopaedic procedures; this study evaluated its suitability as a risk-stratification tool in patients undergoing TAA. METHODS The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed for patients undergoing TAA between 2011 and 2017. Bivariate and multivariate statistical analyses were performed to investigate frailty as a possible predictor of postoperative complications. RESULTS In total, 1035 patients were identified. When comparing patients with an mFI-5 score of 0 versus ≥2, overall complication rates significantly increased from 5.24% to 19.38%, 30-day readmission rate increased from 0.24% to 3.1%, adverse discharge rate increased from 3.81% to 15.5%, and wound complications increased from 0.24% to 1.55%. After multivariate analysis, mFI-5 score remained significantly associated with patients' risk of developing any complication (P = .03) and 30-day readmission rate (P = .005). CONCLUSIONS Frailty is associated with adverse outcomes following TAA. The mFI-5 can help identify patients who are at an elevated risk of sustaining a complication, allowing for improved decision-making and perioperative care when considering TAA. LEVELS OF EVIDENCE III, Prognostic.
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Affiliation(s)
- Lauren K Lewis
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
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Chokshi SN, Efejuku TA, Chen J, Jupiter DC, Somerson JS, Panchbhavi VK. The Effects of COVID-19 on Orthopaedic Surgery Training Programs in the United States. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00007. [PMID: 37141516 PMCID: PMC10155886 DOI: 10.5435/jaaosglobal-d-22-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/12/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION This study investigates the effects of the COVID-19 pandemic on medical education, research opportunities, and mental health in orthopaedic surgical training programs. METHODS A survey was sent to the 177 Electronic Residency Application Service-participating orthopaedic surgery training programs. The survey contained 26 questions covering demographics, examinations, research, academic activities, work settings, mental health, and educational communication. Participants were asked to assess their difficulty in performing activities relative to COVID-19. RESULTS One hundred twenty-two responses were used for data analysis. Difficulties were experienced in collaborating with others (49%), learning through online web platforms (49%), maintaining the attention span of others through online web platforms (75%), and in gaining knowledge as a presenter or participating through online web platforms (56%). Eighty percent reported that managing time to study was the same or easier. There was no reported change in difficulty for performing activities in the clinic, emergency department, or operating room. Most respondents reported greater difficulty in socializing with others (74%), participating in social activities with coresidents (82%), and seeing their family (66%). Coronavirus disease 2019 has had a significant effect on the socialization of orthopaedic surgery trainees. DISCUSSION Clinical exposure and engagement were marginally affected for most respondents, whereas academic and research activities were more greatly affected by the transition from in-person to online web platforms. These conclusions merit investigation of support systems for trainees and evaluating best practices moving forward.
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Affiliation(s)
- Shivan N Chokshi
- From the John Sealy School of Medicine (Mr. Chokshi and Mr. Efejuku), Department of Orthopaedic Surgery and Rehabilitation (Dr. Chen, Dr. Jupiter, Dr. Somerson, and Dr. Panchbhavi), Department of Preventive Medicine and Population Health (Dr. Jupiter), The University of Texas Medical Branch, Galveston, TX
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Reistetter TA, Dean JM, Haas AM, Prochaska JD, Jupiter DC, Eschbach K, Kuo YF. Development and Evaluation of Rehabilitation Service Areas for the United States. BMC Health Serv Res 2023; 23:204. [PMID: 36859285 PMCID: PMC9976368 DOI: 10.1186/s12913-023-09184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Geographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries. METHODS A patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward's clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data (n = 2,730,366) to develop the RSAs and 2015 data (n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries. RESULTS The method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care. CONCLUSIONS Rehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.
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Affiliation(s)
- Timothy A Reistetter
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Julianna M Dean
- University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX, 77058, USA
| | - Allen M Haas
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - John D Prochaska
- The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Daniel C Jupiter
- The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Karl Eschbach
- The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Yong-Fang Kuo
- The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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14
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Silva JD, Taglialatela G, Jupiter DC. Reduced Prevalence of Dementia in Patients Prescribed Tacrolimus, Sirolimus, or Cyclosporine. J Alzheimers Dis 2023; 95:585-597. [PMID: 37574739 PMCID: PMC10578212 DOI: 10.3233/jad-230526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Evidence suggests patients prescribed calcineurin inhibitors (CNIs) have a reduced prevalence of dementia, including Alzheimer's disease (AD); however, this result has never been replicated in a large cohort and the involved mechanism(s) and site of action (central versus periphery) remain unclear. OBJECTIVE We aim to determine if prescription of CNIs is associated with reduced prevalence of dementia, including AD, in a large, diverse patient population. Furthermore, we aim to gain insight into the mechanism(s) and site of action for CNIs to reduce dementia prevalence. METHODS Electronic health records (EHRs) from patients prescribed tacrolimus, cyclosporine, or sirolimus were analyzed to compare prevalence, odds, and hazard ratios related to dementia diagnoses among cohorts. EHRs from a random, heterogeneous population from the same network were obtained to generate a general population-like control. RESULTS All drugs examined reduced dementia prevalence compared to the general population-like control. There were no differences in dementia diagnoses upon comparing tacrolimus and sirolimus; however, patients prescribed tacrolimus had a reduced dementia prevalence relative to cyclosporine. CONCLUSION Converging mechanisms of action between tacrolimus and sirolimus likely explain the similar dementia prevalence between the cohorts. Calcineurin inhibition within the brain has a greater probability of reducing dementia relative to peripherally-restricted calcineurin inhibition. Overall, immunosuppressants provide a promising therapeutic avenue for dementia, with emphasis on the brain-penetrant CNI tacrolimus.
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Affiliation(s)
- Jacqueline D. Silva
- Mitchell Center for Neurodegenerative Disorders, Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA
- Pharmacology and Toxicology Graduate Program, University of Texas Medical Branch, Galveston, TX, USA
| | - Giulio Taglialatela
- Mitchell Center for Neurodegenerative Disorders, Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopedics and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
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15
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Kocjan K, Safavi KS, Flaherty B, Rezvani A, Jupiter DC, Janney CF, Smith JL. Current Gender Diversity and Geographic Trends Among Orthopaedic Sports Medicine Surgeons in the United States. Orthop J Sports Med 2022; 10:23259671221134091. [PMID: 36466594 PMCID: PMC9709180 DOI: 10.1177/23259671221134091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Female representation varies geographically among orthopaedic residency programs, with the southern region of the United States reported as having relatively lower rates of female orthopaedic surgeons. PURPOSE To determine the gender and geographic distributions of US-based orthopaedic sports medicine surgeons and analyze geographic patterns between their training locations and present-day practices. STUDY DESIGN Cross-sectional study. METHODS American Orthopedic Society of Sports Medicine (AOSSM) fellowship completion data from the 2016-2021 academic years were analyzed with regard to gender and fellowship location. Medical school, residency, and current practice locations were obtained via internet searches for all individuals identified within the databases. Locations were categorized into regions based on the US Census Bureau definitions. Descriptive statistical analysis was performed on the data. RESULTS A total of 1268 sports orthopaedic surgeons who graduated fellowship from 2016 to 2021 were analyzed: 141 (11%) were female and 1127 (89%) were male. The percentage of female sports medicine surgeons in fellowship remained constant (11%-12%) from 2016 to 2021. On average, the annual percentage of female orthopaedic sports medicine fellows was 7.2% in the South, 10.4% in the West, 14.2% in the Midwest, and 14.7% in the Northeast. Based on the orthopaedic sports medicine fellowship graduates from 2016 to 2021, the mean percentage of current female orthopaedic sports medicine surgeons in practice was 7.4% in the South, 11.7% in the Northeast, 12.8% in the Midwest, and 14.4% in the West. CONCLUSION Approximately 11% of our sample was female; however, this percentage varied heavily by region, with the southern region having significantly lower rates of gender diversity.
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Affiliation(s)
| | - Kiya Shazadeh Safavi
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Brett Flaherty
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Aryan Rezvani
- Texas A&M College of Medicine, College Station, Texas, USA
| | - Daniel C. Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Cory F. Janney
- Naval Medical Center San Diego, San Diego, California, USA
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Shazadeh Safavi K, Okereke R, Rezvani A, Kocjan K, Jupiter DC, Janney CF. Gender and Geographic Trends Among Foot and Ankle Surgeons: Where Are We and Where Do We Need to Improve? Foot Ankle Spec 2022:19386400221123619. [PMID: 36168716 DOI: 10.1177/19386400221123619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women have historically been underrepresented in orthopaedics. This study analyzes the geographic distribution of female orthopaedic foot and ankle (OFA) surgeons, as well as geographic patterns between their training locations and current practices. METHODS American Orthopaedic Foot and Ankle Society (AOFAS) data regarding fellowship completion from 1988 to 2021 were analyzed. Internet searches were then performed to identify medical school, residency, and current practice locations of individual surgeons. States were categorized into regions and divisions based on US Census Bureau guidelines. RESULTS Of the 1088 OFA surgeons analyzed, 166 (15.26%) were women and 922 (84.74%) were men. The South has a higher number of female OFA surgeons; however, this region and the Midwest have the lowest percentages of female representation. The West and Northeast had significantly higher percentages of female representation and higher retention rates for women. There was high variability in the number and percentage of female OFA surgeons in divisions both within and between regions. CONCLUSION Although the number of female OFA surgeons has increased, their representation remains low. Geographically, the East South Central division of the United States consistently had the least number of OFA surgeons, whereas the South Atlantic division had the highest.Level of Evidence: Not applicable.
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Affiliation(s)
| | - Robyn Okereke
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Aryan Rezvani
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas
| | | | - Daniel C Jupiter
- The University of Texas Medical Branch, Department of Preventive Medicine and Population Health, Galveston, Texas
| | - Cory F Janney
- Naval Medical Center San Diego, San Diego, California
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Korst GS, Ratliff HT, Torian J, Jimoh RO, Jupiter DC. Delayed Diagnosis of Charcot Foot: A Systematic Review. J Foot Ankle Surg 2022; 61:1109-1113. [PMID: 35236617 DOI: 10.1053/j.jfas.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
This study aims to examine the duration and rate of delayed diagnosis in Charcot foot. We systematically reviewed articles published in Medline, SCOPUS, and Cumulative Index of Nursing and Allied Health Literature to identify articles discussing delayed or misdiagnosis of Charcot foot. Random-effects models were generated to determine the average time from symptom onset to correct diagnosis (diagnostic delay duration) and proportion of patients misdiagnosed prior to being correctly diagnosed (delayed diagnosis rate). Our search identified 142 articles, 7 of which are included in this review. The review found that 53.2% of cases of Charcot osteoarthropathy experienced a delay in diagnosis (95% CI: 28.9%-77.4%). Overall, the duration of diagnostic delay was determined to be 86.9 days (95% CI: 10.5-162.1). We found that patients with Charcot foot experienced prolonged delays from symptom onset to correct diagnosis, and a majority of patients are misdiagnosed. These delays in diagnosis contribute to worse patient outcomes.
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Affiliation(s)
- Genevieve S Korst
- School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Hunter T Ratliff
- School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Joseph Torian
- School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Raliat O Jimoh
- School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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18
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Hansen R, Shibuya N, Jupiter DC. An Updated Epidemiology of Foot and Ankle Fractures in the United States: Complications, Mechanisms, and Risk Factors. J Foot Ankle Surg 2022; 61:1034-1038. [PMID: 35181206 DOI: 10.1053/j.jfas.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Foot and ankle fractures are prevalent emergent injuries, about which there remains a lack of in-depth epidemiological information. This analysis of the epidemiology of foot and ankle injuries in the United States updates a previously conducted study. Data from the National Trauma Data Bank (2012-2017) were used for analysis. Demographic variables, mechanism of injuries, and comorbidities were analyzed to determine risk factors for complications after foot and ankle injuries. Young adults aged 21 to 30 years had the highest injury rates; however, in general, older individuals were more at risk for complications. Black individuals were more at risk for certain complications, while Asians were at lower risk, when compared to White individuals. The comorbidities of bleeding disorders, diabetes, smoking, hypertension, and chronic obstructive pulmonary disease all increased risk of at least 1 complication. In terms of mechanism, traffic incidents were found to be the most strongly associated with complications.
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Affiliation(s)
- Regina Hansen
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Shazadeh Safavi K, Rezvani A, Janney CF, Chen J, Cassis W, Darayan N, Panchbhavi VK, Jupiter DC. Assessing the Utility of Deltoid Ligament Repair in Ankle Fracture: A Systematic Review. Cureus 2022; 14:e27040. [PMID: 35989770 PMCID: PMC9388398 DOI: 10.7759/cureus.27040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
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20
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Smith S, Jupiter DC, Panchbhavi VK, Chen J. Quality and Readability of Information Regarding Total Ankle Arthroplasty Available to Patients on the Internet. Foot Ankle Spec 2022:19386400221109423. [PMID: 35848229 DOI: 10.1177/19386400221109423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to evaluate the reliability, comprehensiveness, and readability of ankle arthroplasty information available on the Internet. We evaluated websites based on category, Journal of the American Medical Association (JAMA) criteria, Health on the Net (HON) code, DISCERN score, an author-created Ankle Replacement Index (ARI), and readability metrics. Based on the ARI, 80 (62.5%) websites provided poor information. The mean reading level was 8.96 ± 2.66, which is above the recommended sixth-grade reading level for patient information. Academic websites had the highest mean DISCERN, ARI, and JAMA scores, and a midrange reading level. The government category had high DISCERN and JAMA scores, a fair ARI score, and the lowest reading level. We found significant correlation between website class and DISCERN score, as well as HON code and DISCERN score. Our results suggest that academic and government websites provide more reliable, complete information than other categories and that websites with an HON code contain more reliable information than those without. We recommend that physicians create handouts to point patients to reliable resources and encourage them to critically evaluate information they read online. We also encourage physicians to take part in evaluating and updating information on their practice websites.Level of Clinical Evidence: N/A.
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Affiliation(s)
- Sydney Smith
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Jie Chen
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
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21
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Wukich DK, Raspovic KM, Jupiter DC, Heineman N, Ahn J, Johnson MJ, Liu GT, VanPelt MD, Lafontaine J, Lavery L, Kim P, Nakonezny PA. Amputation and infection are the greatest fears in patients with diabetes foot complications. J Diabetes Complications 2022; 36:108222. [PMID: 35717355 DOI: 10.1016/j.jdiacomp.2022.108222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/30/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
Abstract
AIMS To determine the degree patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations fear complications (death, dialysis, heart attack, stroke, blindness, diabetic foot infection, minor and major lower extremity amputation [LEA]) that can occur and to assess if there is a difference between fears of patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations and diabetic patients without these complications. METHODS 478 patients completed an eight question Likert scale survey. The study group was defined as non-infected foot ulcers, neuropathic fractures and Charcot neuroarthropathy. RESULTS Of the 478 patients, 121 (25.3 %) had diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations and 357 (74.7 %) did not. The study group had significantly higher odds of reporting extreme fear of foot infection (OR 2.8, 95 % CI 1.8-4.5), major LEA (OR 2.8, 95 % CI 1.8-4.4), minor LEA (OR 2.3, 95 % CI 1.5-3.5), blindness (OR 2.0, 95 % CI 1.3-3.2), dialysis (OR 2.0, 95 % CI 1.1-3.3), and death (OR 2.4, 95 % CI 1.4-4.2). In the study group highest rated fear measures were foot infection (3.71, SD 1.23), minor amputation (3.67, SD 1.45) and major amputation (3.63, SD 1.52). There were no significant differences in the mean fear of infection, minor amputation or major amputation. CONCLUSION Patients with diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations reported higher fear ratings of diabetes-related complications compared to those without these complications.
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Affiliation(s)
- Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America.
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health Office of Biostatistics, University of Texas Medical Branch Galveston, TX 77550, United States of America
| | - Nathan Heineman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - George T Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Michael D VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Javier Lafontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Larry Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Paul Kim
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Paul A Nakonezny
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, United States of America
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22
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Nsekpong TB, Amin AS, Ali SR, Beasley BJ, Panchbhavi V, Jupiter DC. Comparative Analysis of Secondary Outcomes in Treatment of Charcot Neuropathy: A Systematic Review. Foot Ankle Spec 2022:19386400221106635. [PMID: 35778875 DOI: 10.1177/19386400221106635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Charcot neuroarthropathy (CN) is commonly associated with diabetic neuropathy and can predispose patients to amputations. Management remains a challenge, with no definitive treatment. This study examines major postoperative complications associated with open reduction with internal (intramedullary) nails, fixation, external fixation, or combined internal and external fixation for correction of the deformity. METHODS We reviewed available literature using PubMed, OvidSP, Scopus, and Cochrane and searched bibliographies of the included studies to identify additional pertinent references. After review and agreement among 4 raters, a total of 15 studies were included in this analysis. RESULTS Hardware removal rates were 0.133 for intramedullary nails, 0.007 for external fixators, and 0.050 for combined fixation. Rates of hardware complication were 0.182 for intramedullary nails and 0.007 for external fixators. Wound dehiscence occurred at rates of 0.059 for intramedullary nails and 0.216 for combined fixation. The rate of deep infections was 0.031 for intramedullary nails, 0.032 for external fixators, and 0.113 for combined fixation. The rate of irrigation and debridement was 0.007 for external fixators. CONCLUSION Rates of hardware removal (13.3%) and complications (18.2%) were high with intramedullary nails. Dehiscence (21.6%) and deep infection (11.3%) were high in combined fixation. Other complications occurred relatively rarely. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Atish S Amin
- The University of Texas Medical Branch, Galveston, Texas
| | - Shahrukh R Ali
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas
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Abstract
BACKGROUND Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Ankle fracture patients with diabetes may experience prolonged healing, higher risk of hardware failure, an increased risk of wound dehiscence and infection, and higher pain scores pre- and postoperatively, compared to patients without diabetes. However, the duration of opioid use among this patient cohort has not been previously evaluated. The purpose of this study is to retrospectively compare the time span of opioid utilization between ankle fracture patients with and without diabetes mellitus. METHODS We conducted a retrospective cohort study using our institution's TriNetX database. A total of 640 ankle fracture patients were included in the analysis, of whom 73 had diabetes. All dates of opioid use for each patient were extracted from the data set, including the first and last date of opioid prescription. Descriptive analysis and logistic regression models were employed to explore the differences in opioid use between patients with and without diabetes after ankle fracture repair. A 2-tailed P value of .05 was set as the threshold for statistical significance. RESULTS Logistic regression models revealed that patients with diabetes are less likely to stop using opioids within 90 days, or within 180 days, after repair compared to patients without diabetes. Female sex, neuropathy, and prefracture opioid use are also associated with prolonged opioid use after ankle fracture repair. CONCLUSION In our study cohort, ankle fracture patients with diabetes were more likely to require prolonged opioid use after fracture repair. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Wenye Song
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX, USA
| | - Naohiro Shibuya
- College of Medicine, Texas A&M University, Temple, TX, USA.,Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX, USA.,Department of Surgery, Baylor Scott & White Health, Temple, TX, USA
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA.,Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Faaitiiti KL, Jupiter DC. Diabetes-Specific Dementia: A Structured Literature Review of Cognitive Assessment Methods. J Foot Ankle Surg 2022; 61:401-409. [PMID: 34893425 PMCID: PMC8936078 DOI: 10.1053/j.jfas.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
Diabetes mellitus is a known risk factor for the development of multiple subtypes of dementia and mild cognitive impairment. Recent research identifies a cause-specific diabetes-related dementia with a unique set of characteristics. Currently, there is no standard cognitive assessment battery recommended to specifically assess dementia that is a direct consequence of chronic diabetes, and some evaluations have been used for decades with minimal revisions, regardless of appropriateness. We performed a systematic review of the dementia/cognition evaluation methods most commonly used in the literature for assessing diabetic patients and identified which cognitive domains are typically assessed in this setting, and whether cognitive changes were more reflective of a vascular pathology, Alzheimer's pathology, or something else entirely. Search results yielded 1089 articles. After screening for appropriateness, a total of 11 full-text articles were assessed. In general, subjects in the reviewed studies were assessed using a variety of testing methods, examining different combinations of cognitive domains. A standard, clear definition of which cognitive domains are the most important to assess in diabetic patients is needed in order to determine what combination of assessment tools are most pertinent. Given the growing subset of the US population, careful reconsideration of cognitive assessment methods is needed to create self-care plans that take into account a specific collection of cognitive challenges for those with diabetes.
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Affiliation(s)
- Kelli L. Faaitiiti
- Medical Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C. Jupiter
- Associate Professor, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX,Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
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Bilello J, Jupiter DC. A Pilot Survey: Knowledge of Charcot Neuroarthropathy Among Family and Internal Medicine Practitioners. J Foot Ankle Surg 2021; 60:1204-1206. [PMID: 34148799 DOI: 10.1053/j.jfas.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Abstract
Charcot neuroarthropathy secondary to diabetes mellitus is a serious complication, requiring specialist management. As a relatively rare pathology bearing similarity to other, more common diseases, it may be misdiagnosed at initial presentation, potentially leading to delays in appropriate management. We conducted a 2-part online survey of primary care physicians within an academic medical institution to assess knowledge of presentation, complications, diagnosis, and treatment of Charcot neuropathy. The first section was designed to assess physician knowledge of Charcot foot, while the second section was completed only by physicians who were familiar with the condition and was designed to gauge their level of knowledge. Most clinicians were familiar with Charcot, encountering it at least annually. They identified common signs of Charcot (eg, swelling, pain) and complications due to its mismanagement (eg, ulcer, amputation). However, there was some disagreement on how to diagnose the pathology, with some relying on film, others referring to specialists, and some saying they were unsure. There was uncertainty on when to choose surgical options; fewer than half referred to specialists for help with this decision, and a quarter were unsure how to make the decision. While, in general, clinicians were aware of Charcot and its characteristics, there was confusion regarding how to diagnose or appropriate nonsurgical treatment.
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Affiliation(s)
- Joshua Bilello
- Medical Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
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Song W, Mobli K, Jupiter DC, Radhakrishnan RS. CVP and echo Measurements are Associated with Improved Outcomes in Patients with Gastrointestinal (GI) Hemorrhage: A Retrospective Analysis of the MIMIC- IV Database. J Intensive Care Med 2021; 37:925-935. [PMID: 34636687 DOI: 10.1177/08850666211046175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Mortality associated with acute Gastrointestinal (GI) hemorrhage in intensive care units (ICU) has remained high in patients suffering from hemodynamic instability. Prompt recognition and rapid assessment of bleeding severity are crucial to improve survival. Central venous pressure (CVP) monitoring is commonly used for early recognition of intravascular imbalances, but its effectiveness in predicting fluid responsiveness is often questioned. Echocardiography (echo) is a rapid, noninvasive method to repeatedly assess cardiac function and fluid responsiveness. This study investigated the impact of CVP and echo measurements on the outcomes of critically ill patients with GI hemorrhage. Methods: The study was based on the Medical Information Mart for Intensive Care IV (MIMIC- IV) database. Patients were divided into four groups according to the usage of CVP and/or echo. The primary outcomes were 7-day, 14-day, 28-day, and overall mortalities after ICU admission. Cox Proportional-Hazards Models were used to elucidate the relationship between CVP/ Echo monitoring and mortality. The severity of illness of patients were adjusted by qSOFA score, SOFA score and base deficit level at admission. Results: Among 1705 eligible patients, 82 patients had both CVP and echo, 85 had CVP only, and 116 had Echo only. The results of survival analysis indicated that, comparing with those without either CVP or echo, the echo utilization was associated with improved mortalities at all time points during ICU stay for patients with moderate GI hemorrhage, and the combined use of CVP and echo was associated with lower 7-day,14-day and overall mortalities for patients with severe GI hemorrhage. Conclusion: Early usage of CVP and echo monitoring or echo alone are associated with lower mortality in the short and long-term when compared to patients without either measurement. Clinicians should consider goal-directed resuscitation guided by echo with/without CVP in patients with GI hemorrhage early after admission to ICU.
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Affiliation(s)
- Wenye Song
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA.,12338 Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Texas, USA
| | - Keyan Mobli
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA
| | - Daniel C Jupiter
- 12338 Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Texas, USA
| | - Ravi S Radhakrishnan
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA
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Villarreal JV, Shibuya N, Jupiter DC. Thromboprophylaxis and Bleeding Complications in Orthopedic and Trauma Patients: A Systematic Review. J Foot Ankle Surg 2021; 60:1014-1022. [PMID: 33896723 DOI: 10.1053/j.jfas.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
This systematic review was conducted to investigate the effects of currently used chemoprophylactic modalities to assess concerns regarding their usage. Preventive benefits of thromboprophylaxis were weighed against potential complications in orthopedic and trauma patients. The Ovid MEDLINE® database was used to identify relevant studies. The authors independently screened the initial study articles by title and abstract, eliminating articles not dealing with venous thromboembolism (VTE) chemoprophylaxis in orthopedic or trauma populations. The remaining articles were assessed for eligibility through full-text analysis. The analyzed studies within this review suggested that Factor Xa inhibitors and direct oral anticoagulants hold promise as safe and potentially more effective thromboprophylactic entities when compared to low molecular weight heparin in trauma and orthopedic patients. Thromboprophylaxis had little to no effect on major bleeding incidence, although we could not definitively conclude there was no effect on overall bleeding. Early thromboprophylaxis, especially when identifiable risk factors are present, can improve VTE prevention without changing major bleeding rates. Additionally, we could not conclude whether extended prophylaxis affects VTE incidence, although it seemed to have no effect on major bleeding. Finally, we determined that thromboprophylaxis in the lower extremity trauma population is questionable without the presence of underlying risk factors.
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Affiliation(s)
- Joseph V Villarreal
- Medical Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX.
| | - Naohiro Shibuya
- Professor, College of Medicine, Department of Surgery, Texas A&M University Health Science Center, Round Rock, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Podiatry Specialist, Department of Surgery, Baylor Scott & White Health, Temple, TX
| | - Daniel C Jupiter
- Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Associate Professor, Department of Preventive Medicine and Population Health, Division of Biostatistics, The University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
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Donoughe JS, Safavi KS, Rezvani A, Healy N, Jupiter DC, Panchbhavi VK, Janney CC. Industry Payments to Foot and Ankle Surgeons and Their Effect on Total Ankle Arthroplasty Outcomes. Foot & Ankle Orthopaedics 2021; 6:24730114211034519. [PMID: 35097468 PMCID: PMC8702911 DOI: 10.1177/24730114211034519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The Centers for Medicare & Medicaid Services (CMS) Open Payments public database provides a means for increased transparency of physicians’ financial relationships with industry. Total ankle arthroplasty is a procedure with long-term clinical implications and variable outcomes. We compared physician-reported conflict-of-interest (COI) disclosures in the journal Foot & Ankle International (FAI) to CMS database information to evaluate for discrepancies. Methods: Articles published in FAI reporting clinical outcomes of total ankle arthroplasty from 2015 and 2019 were reviewed. Payment information in the CMS database was cross-referenced with disclosure statements and International Committee of Medical Journal Editors (ICMJE) forms associated with the manuscript. Statistical analysis was performed to determine if industry payments were appropriately disclosed or influenced outcomes. Results: We reviewed 173 articles pertaining to ankle arthroplasty, with 27 meeting inclusion criteria. Of 120 total authors with 98 unique authors, 114 (95%) disclosed appropriately in disclosure statements. Twenty-two studies (82%) had appropriate declarations for the entire manuscript. For the 27 senior authors, only 2 discrepancies between manuscript disclosure and the Open Payments public database were noted, showing 13 total disclosures in the Open Payments public database vs 11 disclosed in the manuscript. There was no relationship between industry payments and the outcome of the manuscript (P = .725). Conclusion: The majority of author disclosure statements accurately reflected the Open Payments public data. Additionally, payments were not significantly associated with positive outcomes reported for the specific implant. Overall, authors publishing on ankle arthroplasty in FAI are disclosing appropriately. Level of Evidence: Level IV, systematic review; survey study; literature review.
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Affiliation(s)
- J. Scott Donoughe
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Aryan Rezvani
- Texas A&M College of Medicine, College Station, TX, USA
| | - Nicholas Healy
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Daniel C. Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Cory C. Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
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Killeen AL, Malone M, Jupiter DC, Lavery L. A Critical Look at a Diabetic Foot Randomized Controlled Trial: Can You Ever Have Too Many Patients? J Foot Ankle Surg 2021; 60:592-594. [PMID: 33509720 DOI: 10.1053/j.jfas.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 02/03/2023]
Abstract
The objective of this article series is to teach approaches for critical appraisal to consumers of medical literature. The aim is to build a deeper understanding of standard procedure in clinical research so clinicians can determine whether medical evidence can be applied to their practices. We will choose published articles with methodological flaws to serve as discussion points. In the first article of this series, we will proceed section by section through an article to teach readers what is usually reported, and illustrate what was done correctly and what was not. Subsequently, later articles in this series of critical appraisals will discuss more focused topics. There were several interesting flaws in our first examined paper. This study provides the unusual flaw of reporting a sample size justification and then exceeding enrollment. In addition, the authors enrolled a relatively large number of subjects (n = 16) that evidently completed the study but were subsequently excluded from analysis because they did not fit the inclusion and exclusion criteria.
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Affiliation(s)
- Amanda L Killeen
- Assistant Instructor, Fellow, Diabetic Limb Salvage and Research, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Matthew Malone
- Director of Research, South West Sydney Limb Preservation and Wound Research Academic Unit, South Western Sydney LHD, Sydney, AUS
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Lawrence Lavery
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Hussien DG, Villarreal JV, Panchbhavi V, Jupiter DC. Predisposing Factors for 30-Day Complications Following Achilles Tendon Repair. J Foot Ankle Surg 2021; 60:288-291. [PMID: 33461920 DOI: 10.1053/j.jfas.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 02/03/2023]
Abstract
Certain risk factors for Achilles tendon repair complications, including tobacco use, diabetes mellitus, steroid use, and obesity, have been well-reviewed. This study analyzes the impact of a range of demographic factors on unique surgical complications within the 30-day postoperative period. We extracted data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2017 and searched for Achilles tendon repairs using CPT codes 27650, 27652, and 27654, identifying 4,040 patients. Twenty-two demographic variables and their association with each of 4 complications were analyzed using t tests or chi-squared tests. A logistic regression was conducted to determine independent risk factors for each outcome, based on results from the bivariate analyses. Variables having p <.2 on bivariate analysis were included in the multivariate analysis of the corresponding surgical complication. Patients with open or infected wounds preoperatively were more likely to return with a postoperative surgical infection (p< .001). Likewise, each additional year of the patient's age increased their likelihood of developing a surgical infection (p= .03). Patients with "clean/contaminated" wound sites prior to repair were more likely to return for an additional service (p= .02). Furthermore, each additional inch of the patient's height (p= .03) and every additional minute of operative time increased a patient's risk of developing a new-onset deep vein thrombosis (p= .01). This study offers providers a more complete picture of which preoperative characteristics affect Achilles tendon repair patients, directing management to reduce postoperative complication rates.
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Affiliation(s)
- Doha G Hussien
- Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX.
| | - Joseph V Villarreal
- Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Vinod Panchbhavi
- Professor, Department of Orthopedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Professor, Department of Orthopedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX
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Aya K, Johnson CS, Emili U, Jupiter DC, Lindsey RW. Identifying risk factors for missed compartment syndrome in patients with tibia shaft fractures: An analysis of the national trauma data bank. Injury 2021; 52:1621-1624. [PMID: 33487405 DOI: 10.1016/j.injury.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB). METHODS NTDB data files from 2007 to 2016 were accessed to collect information on patients undergoing surgical fixation of TSFs. Patients with an Injury Severity Score (ISS) > 15 or inferred Gustilo-Anderson IIIB/IIIC fractures were excluded to create a more homogenous sample of lower-grade TSFs. Compartment syndrome that was originally missed leading to late intervention was the main outcome under investigation. Bivariate tests were used to assess the relationships between missed CS and the preoperative variables. If a variable and a complication had an association with a P ≤ 0.2, it was included in a multivariate logistic regression model. RESULTS A total of 184,612 patients met our inclusion criteria, and 1,269 patients (0.76%) had a missed CS diagnosis. Bivariate analysis demonstrated that male gender had a significant positive association with a missed CS diagnosis, while older age had a significant negative association (odds ratio [OR] = 2.17, 0.99; P < 0.001). Multivariate analysis revealed that male gender was the most significant independent risk factor for a missed diagnosis of compartment syndrome (OR = 1.84, P < 0.00001), followed by alcoholism, penetrating trauma, and smoking (OR = 1.51, 1.46, 1.43; P < 0.02). The only significant protective factor was open fracture (OR = 0.70, P < 0.0001). CONCLUSIONS Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.
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Affiliation(s)
- Kessiena Aya
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States.
| | - Connor S Johnson
- School of Medicine, The University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555, United States
| | - Uchechukwu Emili
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, United States
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Ewing Hall, Suite 1.134 G, 700 Harborside Dr, Galveston, TX 77555, United States
| | - Ronald W Lindsey
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States
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Ratliff HT, Shibuya N, Jupiter DC. Minor vs. major leg amputation in adults with diabetes: Six-month readmissions, reamputations, and complications. J Diabetes Complications 2021; 35:107886. [PMID: 33653663 DOI: 10.1016/j.jdiacomp.2021.107886] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
AIMS The objective of this study was comparing medium-term outcomes between comparable minor and major amputations in adults with diabetes. METHODS We used data from the 2016-2017 National Readmissions Database to construct a representative cohort of 15,581 adults with diabetes with lower extremity amputations. Patients were categorized by level of index amputation (major/minor), and propensity score matched to compare outcomes in candidates for either level of amputation. Readmission and reamputations were assessed at 1, 3, and 6 months following index amputation. RESULTS In the 6 months following index amputation, large proportions of patients were readmitted (n = 7597, 48.8%) or had reamputations (n = 1990, 12.8%). Patients with minor amputations had greater odds of readmission (OR = 1.25; 95% CI 1.18-1.31), reamputation (OR = 3.71; 95% CI 3.34-4.12), and more proximal reamputation (OR = 2.61; 95% 2.33-2.93) (all P < 0.001). Further, minor amputation patients had higher and lower odds of readmission for postoperative infection (OR = 4.45; 95% CI 3.27-6.05), or sepsis (OR = 0.79; 95% CI 0.68-0.93), respectively. CONCLUSION Patients desire to save as much limb as possible and should be counseled on higher risk for reamputation, readmission, and infection with minor amputations.
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Affiliation(s)
- Hunter T Ratliff
- School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States
| | - Naohiro Shibuya
- Texas A&M University, College of Medicine, Temple, TX, United States; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX, United States.
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1148, United States; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0165, United States.
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Reistetter TA, Eschbach K, Prochaska J, Jupiter DC, Hong I, Haas AM, Ottenbacher KJ. Understanding Variation in Postacute Care: Developing Rehabilitation Service Areas Through Geographic Mapping. Am J Phys Med Rehabil 2021; 100:465-472. [PMID: 32858537 PMCID: PMC8262929 DOI: 10.1097/phm.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to demonstrate a method for developing rehabilitation service areas and to compare service areas based on postacute care rehabilitation admissions to service areas based on acute care hospital admissions. DESIGN We conducted a secondary analysis of 2013-2014 Medicare records for older patients in Texas (N = 469,172). Our analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, long-term care hospitals, and home health agencies. We used Ward's algorithm to cluster patient ZIP Code Tabulation Areas based on which facilities patients were admitted to for rehabilitation. For comparison, we set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions in Texas. Two methods were used to evaluate rehabilitation service areas: intraclass correlation coefficient and variance in the number of rehabilitation beds across areas. RESULTS Rehabilitation service areas had a higher intraclass correlation coefficient (0.081 vs. 0.076) and variance in beds (27.8 vs. 21.4). Our findings suggest that service areas based on rehabilitation admissions capture has more variation than those based on acute hospital admissions. CONCLUSIONS This study suggests that the use of rehabilitation service areas would lead to more accurate assessments of rehabilitation geographic variations and their use in understanding rehabilitation outcomes.
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Affiliation(s)
- Timothy A Reistetter
- From the Department of Occupational Therapy, University of Texas Health Science Center at San Antonio, School of Health Professions, San Antonio, Texas (TAR); Department of Preventive Medicine and Population Health, University of Texas Medical Branch, School of Medicine, Galveston, Texas (KE, JP, DCJ, AMH); Department of Occupational Therapy, Yonsei University, College of Health Sciences, Gangwon-do, Republic of Korea (IH); and Division of Rehabilitation Sciences, University of Texas Medical Branch, School of Health Professions, Galveston, Texas (KJO)
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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Jupiter DC, LaFontaine J, Barshes N, Wukich DK, Shibuya N. Transmetatarsal and Minor Amputation Versus Major Leg Amputation: 30-Day Readmissions, Reamputations, and Complications. J Foot Ankle Surg 2021; 59:484-490. [PMID: 32354505 DOI: 10.1053/j.jfas.2019.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 02/03/2023]
Abstract
AIMS The optimal level of lower-extremity amputation, particularly in diabetic patients with ulceration, is debated. Proximal amputations more greatly decrease function versus distal amputations, but healing and complication rates may differ between the 2 types. This study compares early postoperative outcomes after transmetatarsal and other partial foot amputations and major leg amputations. METHODS Data were derived from National Surgical Quality Improvement Program datasets covering 2012 to 2014. Outcomes studied include 30-day rates of readmission to hospital for wound complications. We matched the 2 types of amputation patients by propensity score to fairly compare between levels of amputation when either type of amputation might be indicated. The same analysis was then performed with emphasis on diabetic patients. RESULTS Major amputation patients were more likely to have dependent functional status, although their surgeries tended to be more complicated. Minor amputation patients had 2.5 times the odds of irrigation and debridement compared with major amputation patients, but only 0.49 and 0.47 times the odds of urinary tract infection or transfusion, respectively. CONCLUSIONS Although short-term complications, readmissions, and reoperations were more common in distal amputation, UTI and the need for transfusion were higher in major amputation.
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Affiliation(s)
- Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX; Research Associate, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
| | - Javier LaFontaine
- Professor, Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Neal Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Dane K Wukich
- Professor and Chairman, Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Naohiro Shibuya
- Professor, Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Department of Surgery, Baylor Scott & White Health, Temple, TX
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Okereke IC, Miller AL, Jupiter DC, Hamilton CF, Reep GL, Krill T, Andersen CR, Pyles RB. Microbiota Detection Patterns Correlate With Presence and Severity of Barrett's Esophagus. Front Cell Infect Microbiol 2021; 11:555072. [PMID: 33708643 PMCID: PMC7942024 DOI: 10.3389/fcimb.2021.555072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background The microbiome has been increasingly associated with different disease processes, but its role in esophagus is largely unknown. Our goal was to determine the associations of the esophageal microbiota with Barrett’s esophagus. Methods A total of 74 patients were included in this prospective study, including 34 patients with Barrett’s esophagus and 40 patients without Barrett’s esophagus. Esophageal swabs were obtained from the uvula, and mucosal biopsies were obtained from the proximal esophagus and distal esophagus in each patient. The microbiome of each sample was assessed using a customized Esophageal Microbiome qPCR array (EMB). For each clinical sample, we completed a detection/non-detection analysis for each organism in the EMB. The limit of detection (LOD) for each target was established by analysis of plasmid dilutions. Results Average age was 60.2 years. There were significantly different microbial detection patterns in patients with Barrett’s esophagus compared to the control population. There were a greater number of organisms which had different likelihoods of detection in the distal esophagus, compared to the proximal esophagus or uvula. In addition, as the length of the Barrett’s column increased, multiple organisms were less likely to be detected. This decreased likelihood occurred only in the distal esophagus. Beside Barrett’s esophagus, no other demographic factors were associated with differences in detection patterns. Conclusions Microbial community structures differ between patients with and without Barrett’s esophagus. Certain organisms are less likely to be detected as the severity of Barrett’s esophagus worsens. These results suggest that particular organisms may have a protective effect against the development of Barrett’s esophagus.
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Affiliation(s)
- Ikenna C Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Aaron L Miller
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, TX , United States
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Catherine F Hamilton
- Division of Cardiothoracic Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Gabriel L Reep
- Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Timothy Krill
- Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Clark R Andersen
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Richard B Pyles
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, TX , United States
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Yu A, Janney CF, Panchbhavi VK, Jupiter DC. National electronic injury surveillance system sports-related arm fractures in the United States: thrower's fractures. J Sports Med Phys Fitness 2021; 61:1235-1241. [PMID: 33555665 DOI: 10.23736/s0022-4707.21.11675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Humerus fractures are common in the United States. The purpose of this study was to utilize the National Electronic Injury Surveillance System (1) to compare overall and age stratified incidence rates of proximal and distal arm fractures presenting to United States emergency departments, (2) to compare relative humerus fracture locations by age, and (3) to compare anatomical humerus fracture locations stratified by sports between 2005-2009 and 2015-2019. METHODS The National Electronic Injury Surveillance System was used to obtain estimated proximal and distal arm fractures between 2005-2009 and 2015-2019. Fracture rates were normalized using United States census estimates and stratified by age. Case summaries were filtered for anatomical and non-specific (proximal, middle, distal third) humerus fractures. Relative humerus fractures, inclusive of anatomical and non-specific fractures, were stratified by age and compared between 2005-2009 and 2015-2019. Anatomical fractures were stratified by sports. Chi-squared tests was used to compare fracture rates between time periods. RESULTS There was a decrease (p<.0001) in proximal and distal arm fracture rates and a difference (p<.0001) in fracture rates with respect to age between 2005-2009 and 2015-2019. There was a significant difference in reported relative humeral fractures (p<.0001) between the two periods. Impact related sports trauma accounted for most fracture cases for both periods. Non-impact related sports trauma consisted entirely of thrower's fractures. CONCLUSIONS United States proximal and distal arm fracture rates decreased, and distributions differed by age between 2005-2009 and 2015-2019. Relative humerus fractures differed by time periods. One major non-impact sports related humerus fracture was extreme external rotational torque from throwing.
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Affiliation(s)
- Alexander Yu
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA -
| | - Cory F Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA.,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Camarano JG, Ratliff HT, Korst GS, Hrushka JM, Jupiter DC. Predicting in-hospital mortality after traumatic brain injury: External validation of CRASH-basic and IMPACT-core in the national trauma data bank. Injury 2021; 52:147-153. [PMID: 33070947 DOI: 10.1016/j.injury.2020.10.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) prognostic prediction models offer value to individualized treatment planning, systematic outcome assessments and clinical research design but require continuous external validation to ensure generalizability to different settings. The Corticosteroid Randomization After Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis on Clinical Trials in TBI (IMPACT) models are widely available but lack robust assessments of performance in a current national sample of patients. The purpose of this study is to assess the performance of the CRASH-Basic and IMPACT-Core models in predicting in-hospital mortality using a nationwide retrospective cohort from the National Trauma Data Bank (NTDB). METHODS The 2016 NTDB was used to analyze an adult cohort with moderate-severe TBI (Glasgow Coma Scale [GCS] ≤ 12, head Abbreviated Injury Scale of 2-6). Observed in-hospital mortality or discharge to hospice was compared to the CRASH-Basic and IMPACT-Core models' predicted probability of 14-day or 6-month mortality, respectively. Performance measures included discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plots and Brier scores). Further sensitivity analysis included patients with GCS ≤ 14 and considered patients discharged to hospice to be alive at 14-days. RESULTS A total of 26,228 patients were included in this study. Both models demonstrated good ability in differentiating between patients who died and those who survived, with IMPACT demonstrating a marginally greater AUC (0.863; 95% CI: 0.858 - 0.867) than CRASH (0.858; 0.854 - 0.863); p < 0.001. On calibration, IMPACT overpredicted at lower scores and underpredicted at higher scores but had good calibration-in-the-large (indicating no systemic over/underprediction), while CRASH consistently underpredicted mortality. Brier scores were similar (0.152 for IMPACT, 0.162 for CRASH; p < 0.001). Both models showed slight improvement in performance when including patients with GCS ≤ 14. CONCLUSION Both CRASH-Basic and IMPACT-Core accurately predict in-hospital mortality following moderate-severe TBI, and IMPACT-Core performs well beyond its original GCS cut-off of 12, indicating potential utility for mild TBI (GCS 13-15). By demonstrating validity in the NTDB, these models appear generalizable to new data and offer value to current practice in diverse settings as well as to large-scale research design.
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Affiliation(s)
- Joseph G Camarano
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Hunter T Ratliff
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Genevieve S Korst
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Jaron M Hrushka
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas 77555, USA; Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas, 77555 USA.
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Jupiter DC, Hsu ES, Liu GT, Reilly JG, Shibuya N. Risk Factors for Short-Term Complication After Open Reduction and Internal Fixation of Ankle Fractures: Analysis of a Large Insurance Claims Database. J Foot Ankle Surg 2021; 59:239-245. [PMID: 32130984 DOI: 10.1053/j.jfas.2019.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 02/03/2023]
Abstract
Although fractures of the ankle are common injuries treated by surgical podiatrists and orthopaedic surgeons specializing in foot and ankle surgery, postoperative complications can occur, often imposing an economic burden on the patient. As health care in the United States moves toward value-based care, cost reduction has primarily focused on reducing complications and unplanned episodes of care. We used a large modern database of insurance claims to examine patterns of complications after open reduction internal fixation of ankle fractures, identifying diabetes mellitus and history of myocardial infarction as risk factors for postoperative infection within 30 days of surgery. Lateral malleolar repair was less likely to lead to infection, or need for repeated surgery, than was medial malleolar fracture repair. Diabetes mellitus, neuropathy, and chronic obstructive pulmonary disease were associated with development of postoperative cellulitis. Patients with a history of cerebrovascular accident were more likely to return to the emergency department or to have a pulmonary embolism. Male sex, presence of lupus, and increased age were associated with repeat surgery.
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Affiliation(s)
- Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; Assistant Professor, Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
| | - En Shuo Hsu
- Associate Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - George Tye Liu
- Associate Professor, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - John G Reilly
- Medical Student, Texas A&M, College of Medicine, Bryan, TX
| | - Naohiro Shibuya
- Professor, Texas A&M University, College of Medicine, Temple, TX; Chief, Section of Podiatry, Surgical Services, Central Texas Veterans Affairs Health Care System, Temple, TX; Staff, Department of Surgery, Baylor Scott & White Health, Temple, TX
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Prochaska JD, Jupiter DC, Horel S, Vardeman J, Burdine JN. Rural-urban differences in estimated life expectancy associated with neighborhood-level cumulative social and environmental determinants. Prev Med 2020; 139:106214. [PMID: 32693175 PMCID: PMC10797641 DOI: 10.1016/j.ypmed.2020.106214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
Diverse neighborhood-level environmental and social impacts on health are well documented. While studies typically examine these impacts individually, examining potential health impacts from multiple sources as a whole can provide a broader context of overall neighborhood-level health impacts compared to examining each component independently. This study examined the association between cumulative neighborhood-level potential health impacts on health and expected life expectancy within neighborhoods (census tracts) across Texas using the Neighborhood Potential Health Impact Score tool. Among urban census tract neighborhoods, a difference of nearly 5 years was estimated between neighborhoods with the least health promoting cumulative health impacts compared to neighborhoods with the most health promoting cumulative health impacts. Differences were observed between rural and urban census tract neighborhoods, with rural areas having less variability in expected life expectancy associated with neighborhood-level cumulative potential health impacts compared to urban areas.
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Affiliation(s)
- John D Prochaska
- Department of Preventive Medicine & Population Health, School of Medicine, University of Texas Medical Branch, 301 University Blvd, Route 1153, Galveston, TX 77555, United States of America.
| | - Daniel C Jupiter
- Department of Preventive Medicine & Population Health, School of Medicine, University of Texas Medical Branch, 301 University Blvd, Route 1153, Galveston, TX 77555, United States of America
| | - Scott Horel
- School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, United States of America
| | - Jennifer Vardeman
- Jack J. Valenti School of Communication, University of Houston, 3347 Cullen Blvd., Houston, TX 77204, United States of America
| | - James N Burdine
- School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, United States of America
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Brennan K, Elifritz KM, Comire MM, Jupiter DC. Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial. J Man Manip Ther 2020; 29:216-226. [PMID: 32990529 DOI: 10.1080/10669817.2020.1824469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
STUDY DESIGN Prospective, randomized. OBJECTIVES To determine the difference in rate and maintenance of improvement of pain and disability for Dry Needling (DN) compared to Dry Needling with Intramuscular Electrical Stimulation (DN/IMES), in Myofascial Pain Syndrome (MPS). BACKGROUND DN and neuromuscular electrical stimulation (NMES) have been shown to be efficacious in treating MPS. DN/IMES for MPS treatment has not been studied extensively, but initial results are promising. METHODS Forty-five subjects were randomly assigned to the DN (n = 25) or DN/IMES (n = 20) group. Both groups received six consecutive weekly treatments and completed NDI and NPRS questionnaires (week 0, 3, 6, and 12). RESULTS Both DN and DN/IMES groups showed significant improvement between weeks 0-6 on NDI (p = 0.008 and 0.00002, respectively) and NPRS scores (0 = 0.017 and p = 0.018, respectively). DN/IMES group showed significant within group changes on the NPRS between weeks 0-3 (p = 0.029). No changes were noted in the DN or DN/IMES groups between week 6-12 on NDI (p = 0.497 and p = 0.714, respectively) or NPRS (p = 0.801 and p = 0.164, respectively). CONCLUSION DN and DN/IMES demonstrated improvement and maintenance in disability and pain for 6 weeks. No differences in improvement of disability or pain existed between the groups at week 6 or 12.
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Affiliation(s)
- Kindyle Brennan
- Doctor of Physical Therapy Program, University of Mary Hardin-Baylor, Belton, TX, USA
| | - Katherine M Elifritz
- Department of Physical Therapy, Virginia Sportsmedicine Institute, Arlington, VA, USA
| | - Megan M Comire
- Department of Physical Therapy, Inspire Physical Therapy, College Station, TX, USA
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.,Graduate School of Biomedical Sciences, University of Texas Medical Branch, Galveston, TX, USA
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Tasnim S, Miller AL, Jupiter DC, Hamilton CF, Reep GL, Krill TS, Pyles RB, Okereke IC. Effects of proton pump inhibitor use on the esophageal microbial community. BMC Gastroenterol 2020; 20:312. [PMID: 32967615 PMCID: PMC7513526 DOI: 10.1186/s12876-020-01460-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background Changes in the esophageal microbiome correlate with esophageal disease, but the effects of proton pump inhibitor (PPI) drugs are incompletely characterized. Our objective was to identify the effects of PPI use on the microbial community of the esophagus. Methods Mucosal biopsies of the distal esophagus were analyzed using a customized esophageal microbiome qPCR panel array (EMB). Patient demographics, use of PPIs, duration of use and dose were recorded. Results Fifty-eight patients were included. Mean age was 60.5 years. Ninety percent (52/58) of patients were on PPIs. Mean dose was 42.7 mg. Mean duration of use was 2.5 years. The use of PPIs led to a significant difference in absolute levels of only one organism, Actinomyces, in the entire array (p < 0.01). Among patients who used proton pump inhibitors, there was no significant association between dose and absolute levels of any organism. Similarly, there was no association between duration of use and absolute levels of any organism. Conclusions PPI use does not seem to cause significant changes in the distal esophageal microbial community. Future studies with larger sample sizes and esophageal pH testing should be performed to determine the level of acidity and its relationship to the microbial community.
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Affiliation(s)
- Sadia Tasnim
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Aaron L Miller
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine F Hamilton
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Gabriel L Reep
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Timothy S Krill
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard B Pyles
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna C Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
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Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing Osteomyelitis: A Histology Guide for Pathologists. J Foot Ankle Surg 2020; 59:75-85. [PMID: 31753572 DOI: 10.1053/j.jfas.2019.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 06/22/2019] [Indexed: 02/03/2023]
Abstract
Histopathologic examination of bone specimens coupled with bone culture is considered the gold standard for the diagnosis of osteomyelitis (OM). Despite this, studies have demonstrated interpathologist agreement in the diagnosis of OM as low as 30%, largely stemming from a lack of specific definitions and diagnostic criteria. Review of the literature has provided insight into the lifecycle of OM, illustrating the histologic progression of OM phases from acute to chronic, and provides support for defining subcategories of OM. Using an algorithmic histopathologic tool consisting of 15 criteria, each with an associated score, we defined 5 categories of OM: (1) acute OM, (2) acute and chronic OM, (3) chronic OM, (4) chronic active OM, and (5) chronic inactive OM. We reviewed 462 microscopic slides from 263 patients with suspected OM, and for each slide, we determined an algorithm-derived diagnosis, which was then used to calculate a total histopathologic load score (Jupiter score). Algorithm-derived diagnoses recapitulated original clinical diagnoses and diagnosed cases as OM that had not been originally diagnoses. These novel cases were more likely to have subsequent clinical complications. Finally, pathologic load scores were assessed for association with the category of OM.
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Affiliation(s)
- Amelia B Sybenga
- Clinical Fellow, Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
| | - V O Speights
- Professor, Department of Pathology and Laboratory Medicine, Scott & White Medical Center, Baylor Scott and White Health, Texas A&M Health Science Center, Temple, TX
| | - Arundhati Rao
- Professor, Department of Pathology and Laboratory Medicine, Scott & White Medical Center, Baylor Scott and White Health, Texas A&M Health Science Center, Temple, TX
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Graney C, Shibuya N, Patel H, Jupiter DC. Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery. Foot Ankle Spec 2019; 12:530-534. [PMID: 30628467 DOI: 10.1177/1938640018823061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ultrasound-guided popliteal blocks for postoperative pain management have grown in popularity within foot and ankle surgery. The purpose of this study was to evaluate the efficacy of popliteal block in preventing postoperative emergency department visits after foot and ankle surgery. We compared rates of presentation to the emergency department for pain following foot and ankle surgery between surgeries with a popliteal block and those with local field block alone. We identified 101 charts, of which 26 presented to the emergency department for postoperative pain following popliteal block. Our results demonstrated that popliteal blocks did not perform better than local blocks, and that there is no statistically significant difference between the 2 methods of postoperative pain control in terms of rates of presentation to the emergency department for pain. Levels of Evidence: Level III, All statistical analyses were carried out using the R statistical package by the primary author (NS) (R Developmental, Core Team. R: A Language and Environment for Statistical Computing, 2012. http://www.R-project.org ).
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Affiliation(s)
- Colin Graney
- Scott and White Health Care System, Texas A&M Health Science Center, Temple, Texas
| | - Naohiro Shibuya
- Department of Surgery, Texas A&M University, College of Medicine, Central Texas Veterans Health Care System, Staff, Baylor Scott and White Health Care System, Temple, Texas
| | - Himani Patel
- Scott and White Health Care System, Texas A&M Health Science Center, Temple, Texas
| | - Daniel C Jupiter
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas
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Affiliation(s)
- Lawrence A Lavery
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, Assistant Dean for Recruitment, Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX
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Shibuya N, Jasper J, Peterson B, Sessions J, Jupiter DC. Relationships Between First Metatarsal and Sesamoid Positions and Other Clinically Relevant Parameters for Hallux Valgus Surgery. J Foot Ankle Surg 2019; 58:1095-1099. [PMID: 31562061 DOI: 10.1053/j.jfas.2019.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 02/03/2023]
Abstract
Relationships between hallux valgus (HV) and other measurements within the first ray have been extensively studied. It is becoming more popular to correct HV deformity with tarsometatarsal joint arthrodesis while internally (varus) rotating the first metatarsal. This, in turn, reduces the sesamoid position when viewed in the dorsoplantar projection on radiographs. However, it has been shown that not all HV deformities have pathological external (valgus) rotation of the first metatarsal. In this study, we explored the relationships between frontal-plane rotations of the first metatarsal as well as the sesamoids, and other factors not limited to the first ray, to better understand the pathological process of HV deformity and to assist in surgical planning. We found that when adjusting for these covariates, the only factor associated with first metatarsal external rotation was having less metatarsus adductus. Sesamoid rotation, on the other hand, was independently associated with the HV angle, tibial sesamoid position, and medial column collapse. When surgically treating HV, correction of sesamoid rotation may need to be prioritized.
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Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX; Chief, Section of Podiatry, Central Texas Veterans Health Care System, Temple, TX; Staff, Baylor Scott and White Health Care System, Temple, TX.
| | - Jacob Jasper
- Podiatric Medicine and Surgery Resident, Texas A&M Health Science Center, Scott and White Health Care System, Temple, TX
| | - Blake Peterson
- Podiatric Medicine and Surgery Resident, Texas A&M Health Science Center, Scott and White Health Care System, Temple, TX
| | - John Sessions
- Podiatric Medicine and Surgery Resident, Texas A&M Health Science Center, Scott and White Health Care System, Temple, TX
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
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Jupiter DC, Saenz F, Mileski W, Shibuya N. Acute Deep Venous Thrombosis and Pulmonary Embolism in Foot and Ankle Trauma in the National Trauma Data Bank: An Update and Reanalysis. J Foot Ankle Surg 2019; 58:1152-1162. [PMID: 31543380 DOI: 10.1053/j.jfas.2019.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 02/03/2023]
Abstract
The data regarding rates of deep venous thrombosis and pulmonary embolism after foot and ankle trauma remain sparse. In this study of the National Trauma Data Bank Data set (2007-2009 and 2010-2016), these rates were reexamined and risk factors associated with these complications were assessed. Data quality is improved in the later data set; the incidence of deep venous thrombosis and pulmonary embolism was 0.28% and 0.21%, respectively, in the 2010-2016 data. Prophylaxis, male gender, treatment in a university hospital, open reduction, chronic obstructive pulmonary disease, and hypertension were notable significant risk factors for pulmonary embolism. For deep venous thrombosis, male gender, bleeding disorder, angina, and prophylaxis were risk factors. Careful, individualized assessment of the risk factors associated with deep venous thrombosis and pulmonary embolism is important, and the merits of routine prophylaxis remain in question.
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Affiliation(s)
- Daniel C Jupiter
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX.
| | - Florentino Saenz
- Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - William Mileski
- Chief, Trauma Services and Co-Director, Division of Emergency Medicine, Department of Surgery, Trauma Division, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Round Rock, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Professor, Department of Surgery, Baylor Scott & White Health, Temple, TX
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Still GP, Pfau ZJ, Cordoba A, Jupiter DC. Intraoperative Nerve Monitoring for Tarsal Tunnel Decompression: A Surgical Technique to Improve Outcomes. J Foot Ankle Surg 2019; 58:1203-1209. [PMID: 31679673 DOI: 10.1053/j.jfas.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 02/03/2023]
Abstract
The aim of the current study was to evaluate the effectiveness of intraoperative neuromonitoring (INM) as an adjunct in performing tarsal tunnel decompression surgery. We reviewed 38 patients who met inclusion criteria. INM was used to measure the voltage of the abductor hallucis and digiti quinti muscles both before and after decompression. Observed changes intraoperatively were acute and within minutes of the decompression performed by the surgeon. Patient outcomes were ascertained from clinical findings and classified as excellent, fair, or poor. Patient outcomes and the voltage change were measured and assessed for association, and statistically significant differences were found between outcome groups. Of the 38 patients, 29 (76%) had excellent outcomes, with a mean change in microvolts of 2088.28 ± 1172.44 (684%) (p = .0004) and 2173.24 ± 1228.39 (742%) (p = .0014) for abductor hallucis and abductor digiti quinti, respectively. The study supports INM as a useful adjunct in performing tarsal tunnel decompression.
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Affiliation(s)
| | - Zeno J Pfau
- Surgeon, Pueblo Ankle and Foot Care, Pueblo, CO
| | - Aniela Cordoba
- Chief Resident, North Colorado Medical Center, Greeley, CO
| | - Daniel C Jupiter
- Associate Professor, University of Texas Medical Branch, Galveston, TX
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Prochaska JD, Buschmann RN, Jupiter DC. A NEIGHBORHOOD-LEVEL POTENTIAL HEALTH IMPACT SCORING TOOL TO SUPPORT LOCAL-LEVEL HEALTH IMPACT ASSESSMENTS. ACTA ACUST UNITED AC 2019; 4:345-352. [PMID: 33718601 DOI: 10.1080/23748834.2019.1654280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health Impact Assessments (HIAs) have quickly become a widely utilized tool for integrating health and health-related evidence and data into decision making processes across a range of projects and polices. Integrating and utilizing the wide range of available data can be daunting. To support communities seeking to engage in health impact assessments, we developed the Neighborhood Potential Health Impact Score (NPHIS) methodology. We present the NPHIS method's four step process, and how this process was applied to an HIA focusing on the rebuilding of public housing following a natural disaster. We discuss developing the boundary definition, selection and definition of indicators, calculation of the NPHIS, and interpretation and utilization of the scores. Findings were validated using feedback from a community stakeholder advisory board as well as through feedback collected from focus groups of community residents. NPHIS methodology has proven to be a useful resource in better understanding the complex sources of potential health impacts facing communities, and in being an evidence-based, data-driven resource for HIA decision-makers and their stakeholders in our specific application. Other groups seeking to integrate similar data into their decision-making processes could benefit from replicating the NPHIS in their efforts.
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Affiliation(s)
- John D Prochaska
- Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Robert N Buschmann
- Community-University Partnership for the Study of Children, Youth and Families, Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Jupiter
- Department of Preventive Medicine & Community Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA
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Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) Open Payments public database, resulting from the Physician Payments Sunshine Act of 2010, was designed to increase transparency of physicians' financial relationships with pharmaceutical manufacturers. We compared physician-reported conflict-of-interest (COI) disclosures in journal articles with this database to determine any discrepancies in physician-reported disclosures. METHODS COIs reported by authors from 2014 through 2016 were analyzed in 3 journals: Foot & Ankle International (FAI), The Journal of Bone & Joint Surgery (JBJS), and The Journal of Arthroplasty (JOA). Payment information in the CMS Open Payments database was cross-referenced with each author's disclosure statement to determine if a disclosure discrepancy was present. RESULTS We reviewed 3,465 authorship positions (1,932 unique authors) in 1,770 articles. Within this sample, 7.1% of authorships had a recorded undisclosed COI (disclosure discrepancy), and 13.2% of articles had first and/or last authors with a disclosure discrepancy. Additionally, we saw a great variation in the percentage of authorships with disclosure discrepancies among the journals (JBJS, 2.3%; JOA, 3.6%; and FAI, 23.7%). CONCLUSIONS Discrepancies exist between payment disclosures made by authors and those published in the CMS Open Payments database. Although the percentage of articles with these discrepancies varies widely among the journals that were analyzed in this study, no trend was found when analyzing the number of discrepancies over the 3-year period. CLINICAL RELEVANCE COI disclosures are important for the interpretation of study results and need to be accurately reported. However, COI disclosure criteria vary among orthopaedic journals, causing uncertainty regarding which conflicts should be disclosed.
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Affiliation(s)
- Cory F Janney
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas.,United States Navy, Navy Medical Center San Diego, San Diego, California
| | - Kiya Shazadeh Safavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Gregory J Schneider
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
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