Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population

Background

Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time.

Young-Onset Rectal Cancer: Presentation,Pattern of Care and Long-term Oncologic Outcomes Compared to a Matched Older-Onset Cohort

Background  

Recent population-based studies have highlighted a disproportionate increase in the incidence of rectal cancer among adults younger than aged 50 years. To determine whether different intervention and surveillance strategies might be needed for younger patients, the patterns of care and oncologic outcomes among adults younger than aged 50 years with rectal cancer were investigated.     

Editorial Commentary: Timely Surgery,Optimizing Perioperative Care,and Prospective Data Collection Are Next Steps to Improving Return to Sport and Work Outcomes After Knee Osteotomy

Knee osteotomy is a valuable treatment option for younger knee osteoarthritis patients. Improved surgical techniques, including double-level osteotomies to address femoral and tibial malalignment, have led to reappreciation of this joint-sparing alternative to knee arthroplasty. Yet, postoperative ability to resume sport and work at the desired level needs further improvement. We believe that timely surgery, optimized perioperative care, including evidence-based advice for resumption of activities, and prospective data collection are interesting next steps in this process.     

Development of the Facial Skin Care Index: A Health-Related Outcomes Index for Skin Cancer Patients

BACKGROUND: Existing health-related quality-of-life (HRQOL) tools do not appear to capture patients' specific skin cancer concerns. OBJECTIVE: To describe the conceptual foundation, item generation, reduction process, and reliability testing for the Facial Skin Cancer Index (FSCI), a HRQOL outcomes tool for skin cancer researchers and clinicians. METHODS: Participants in Phases I to III consisted of adult patients (N=134) diagnosed with biopsy-proven nonmelanoma cervicofacial skin cancer. Data were collected via self-report surveys and clinical records. RESULTS: Seventy-one distinct items were generated in Phase I and rated for their importance by an independent sample during Phase II; 36 items representing six theoretical HRQOL domains were retained. Test-retest I results indicated that four subscales showed adequate reliability coefficients (alpha=0.60 to 0.91). Twenty-six items remained for test-retest II. Results indicated excellent internal consistency for emotional, social, appearance, and modified financial/work subscales (range 0.79 to 0.95); test-retest correlation coefficients were consistent across time (range 0.81 to 0.97; lifestyle omitted). CONCLUSION: Pretesting afforded the opportunity to select items that optimally met our a priori conceptual and psychometric criteria for high data quality. Phase IV testing (validity and sensitivity before surgery and 4 months after Mohs micrographic surgery) for the 20-item FSCI is under way.     

Using Big Data to Study the Impact of Mass Violence: Opportunities for the Traumatic Stress Field

Studying the community impact of mass violence using a Big Data approach from social media data (e.g., Twitter) offers traumatic stress researchers an unprecedented opportunity to study and clarify theoretical assumptions using large‐scale, observational, ecologically valid data. We describe challenges and benefits of working with Twitter data and briefly review studies that used Twitter data to explore community responses to mass violence. We then demonstrate the use of Twitter data to examine community responses to a specific event: the 2015 San Bernardino terrorist attack, in which 14 people were killed and 22 were wounded. In a 6‐week time frame around this attack, we evaluated the time course of community‐level negative emotion. We downloaded 1.16 million tweets, representing 25,894 users from San Bernardino, CA, and a matched control community, Stockton, CA. All tweets were coded in R using the Linguistic Inquiry and Word Count (LIWC) negative emotion dictionary. A piecewise regression technique with a discontinuity analysis was used to evaluate pre‐ and postevent trajectories of negative emotion across the study window. Controlling for within‐user variability, negative emotion increased by 6.2%, β = .182, SE = .014, p < .001, in San Bernardino on the day of the attack and remained elevated for 5 days; no elevation was observed in Stockton. We discuss how data‐driven text analytic techniques are useful for exploring Twitter content generated after collective traumas and describe challenges and opportunities accompanying analyses of social media data to understand the impact of mass violence on affected populations.     

Evolution of Standardized Clinical Pathways: Refining Multidisciplinary Care and Process to Improve Outcomes of the Surgical Treatment of Esophageal Cancer

Background

The aim of this study is to determine the effect of the implementation and evolution of a multidisciplinary esophagectomy care pathway on postoperative outcomes over a 20-year experience.

Study Design

All patients undergoing esophagectomy for cancer between 1991 and 2012 were included. Patients were divided into four groups (Gp1 1991–1996, Gp2 1997–2002, Gp3 2003–2007, and Gp4 2008–2012).

Results

Five hundred and ninety-five patients were included (Gp1 92, Gp2 159, Gp3 161, and Gp4 183). Age remained consistent over time; however, a progressive significant increase was observed in BMI and Charlson comorbidity index. Increases were also noted in patients with clinical stage III cancers, in the use of neoadjuvant chemoradiotherapy, in salvage esophagectomy and in the utilization of pretreatment jejunostomy. We observed a significant reduction in estimated blood loss (EBL) and operative room IV fluid administration (ORFA) during the study period. Median ICU stay and length of hospital stay (LOS) (10 (5–50) to 8 (5–115) days) decreased over time. In-hospital mortality (0.3 %) and postoperative complications remained consistent over time. cumulative sum (CUSUM) analysis showed that EBL, ORFA, and LOS all declined during the study period, reaching mean values at case 120, 310, and 175, respectively.

Conclusions

The results of this study show that process improvement within the pathway is likely more significant than the level of comorbidities, application of neoadjuvant chemoradiation, or technical approach in patients undergoing esophagectomy.