American Association Research Articles

Social Media Use by American Association of Hip and Knee Surgeons Members.

Social media offers physicians marketing opportunities previously unavailable. We sought to evaluate social media use and its correlation with public rankings among Association of Hip and Knee Surgeons members. A list of members and demographics was collected. Social media sites were reviewed for each surgeon, and a score was calculated based on active use. The US News and World Report (NWR) was used to determine rating and number of reviews. The Spearman correlation coefficient and independent samples t-test were used to measure correlation and compare means between the groups, respectively. A total of 2436 members were analyzed. The average social media score was 4.14. The average US NWR score was 4.25. A strong correlation was observed between social media and US NWR scores (r = 0.74, P < 0.01) but not with the number of reviews (r = 0.40, P = 0.17). A strong association with US NWR rating (r = 0.74, P = 0.04) and a weak correlation with the total number of reviews (r = 0.61, P = 0.06) were found. Social media use is correlated with US NWR scores. Association of Hip and Knee Surgeons members may be underutilizing social media for the promotion of their practices. Future studies are needed to evaluate whether it affects patient volume and outcomes.

Evaluating the Quality of Endometriosis Operative Reports Among High-Volume Endometriosis Surgeons

ObjectivesTo evaluate the quality of operative reports for endometriosis surgeries performed by fellowship-trained, high-volume endometriosis surgeons. MethodsIn this retrospective review, 5 consecutive deidentified surgical reports per surgeon were evaluated by 2 reviewers. Each dictation was assigned a quality score (between 0 and 28), based on the number of components from the American Association of Gynecologic Laparoscopists (AAGL) classification system that were documented. The primary outcome was the proportion of reports for which the endometriosis AAGL 2021 stage could be assigned. Secondary outcomes included median dictation quality scores, proportion of dictations for fertility-preserving cases where the Endometriosis Fertility Index score could be assigned, individual quality score components, and quality score variation between surgeons, institutions, and reporting methods. ResultsOverall, 82 operative reports were reviewed from 16 surgeons across 7 sites in Ontario. The AAGL stage could be assigned in 48/82 (59%) of cases, and the Endometriosis Fertility Index score could be assigned in 31/45 of fertility-preserving cases (69%). The median quality score was 57% (range 18%–86%). Only 13% of operative reports included comments on residual disease. Quality score consistency between reports was poor for a given surgeon (intraclass correlation coefficient 0.22; 95% CI 0.03–0.49). Quality scores differed significantly between surgeons (χ2 = 30.6, df = 16, P = 0.015) and institutions (χ2 = 19.59, df = 7, P = 0.007). Operative report quality score did not differ based on completion by trainee or staff, template use, or whether the report was completed by telephone or typed. ConclusionsThere is significant variability and inconsistency in endometriosis surgery documentation. There is a need to standardize surgical documentation for endometriosis surgeries, enhancing communication and ultimately patient care.

The year long journey: Transforming the BSN-DNP curriculum

BackgroundRevising a doctor of nursing practice (DNP) curriculum for family nurse practitioner and psychiatric mental health nurse practitioner education with an eye on future changes in competencies required planning and consensus among taskforce members. Major priorities included: the need to embed competency- based education (CBE), the National Taskforce Criteria for Nurse Practitioner (6th ed.) education, and the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN) Essentials, 2021). FindingsChallenges began with faculty knowledge of CBE, NP faculty skills in curriculum building, buying in to the revised degree, and reviewing all current literature on the DNP NP knowledge, skills and attitudes needed for current practice. The year long journey yielded a comprehensive curriculum model to share as well as several lessons learned and recommendations for this journey. ConclusionThe process resulted in a curriculum revision that thus far, is better suited to development of the “work-ready” graduate while still supporting individualized student needs in attending a doctoral-level program. Ongoing work is focused on specific “pillars” of program support including clinical preceptor placement and partnerships, preceptor resources, student retention resources, and exploration of competency-based tracking data management.Considering the impact on faculty workload, program leadership should actively assess levels of curricular expertise of faculty involved to determine additional development or training needs for individual professional growth.

Benchmarking a Foundation Large Language Model on its Ability to Relabel Structure Names in Accordance With the American Association of Physicists in Medicine Task Group-263 Report

To introduce the concept of using large language models (LLMs) to relabel structure names in accordance with the American Association of Physicists in Medicine Task Group-263 standard and to establish a benchmark for future studies to reference. Generative Pretrained Transformer (GPT)-4 was implemented within a Digital Imaging and Communications in Medicine server. Upon receiving a structure-set Digital Imaging and Communications in Medicine file, the server prompts GPT-4 to relabel the structure names according to the American Association of Physicists in Medicine Task Group-263 report. The results were evaluated for 3 disease sites: prostate, head and neck, and thorax. For each disease site, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50), and 50 patients were randomly selected for evaluation. Structure names considered were those that were most likely to be relevant for studies using structure contours for many patients. The per-patient accuracy was 97.2%, 98.3%, and 97.1% for prostate, head and neck, and thorax disease sites, respectively. On a per-structure basis, the clinical target volume was relabeled correctly in 100%, 95.3%, and 92.9% of cases, respectively. Given the accuracy of GPT-4 in relabeling structure names as presented in this work, LLMs are poised to become an important method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.

Advocacy: a reflection on my 30 years of orthopedic practice

As orthopedic surgeons, we have the responsibility for advocating for our patients and our profession, on the local, state, and federal levels. The American Academy of Orthopaedic Surgeons (AAOS) created the American Association of Orthopaedic Surgeons to allow for political advocacy. The Association Political Action Committee, OrthoPAC, was created in 1999 and has become an effective tool in our advocacy committee. The American Shoulder and Elbow Surgeons (ASES), along with many orthopedic subspecialty societies, has established an advocacy effort and works with the AAOS through the OrthoPAC as a member of the Advisor’s Circle, which is designed to provide AAOS Members’ group practices and specialty societies with a leadership role within the Political Action Committee of the American Association of Orthopaedic Surgeons (Orthopaedic PAC). If we are to preserve individual patient access to specialized musculoskeletal care, we must support state and federal advocacy efforts. This can be in the form of financial support or personal involvement in relationship building. I encourage all members of ASES, especially the younger ones, to support your state orthopedic societies, the ASES, and the AAOS in their advocacy efforts. The well-being of our patients and the future of our profession depend on you.

Standards of Care for Peripheral Intravenous Catheters: Evidence-Based Expert Consensus

Highlights Abstract Background: The insertion of a peripheral intravenous catheter (PIVC) is the most commonly performed invasive procedure in healthcare. Despite its frequency in placement in hospitalized patients, PIVCs are generally perceived as being safe; however, the prevalence of failure ranges from 35%-50%. Additionally, complications are common and often deemed “acceptable” by clinicians. Healthcare provider and clinician foundational knowledge and competency is lacking nationally. Considering the mere volume of PIVCs placed, the failure and complication rates, the human impact is significant. Methods: The Association for Vascular Access (AVA) has led a collaborative effort with representatives from the Infusion Nurses Society (INS), the American Association of Critical Care Nurses (AACN), ECRI, and content experts representing nursing vascular access, infusion therapy, infection prevention, critical care, pediatrics, healthcare leadership, a physician, and a patient representative. Our aim is to provide concise guidance that will enhance and standardize practices related to peripheral intravenous catheters (PIVC). By consolidating current standards of practice into a comprehensive document, our framework seeks to advance the quality of care and improve patient safety. Results: This document has undergone meticulous scrutiny to ensure its quality; including incorporation of current standards, methodology for consensus from the expert panel, and input received from public comments. Conclusions: We anticipate that this work will have a significant impact on healthcare professionals, policymakers, and, most importantly, patients’ experiences by the promotion of consistent, high-quality treatment, safety, and comfort for patients receiving a PIVC.

Enhancing competency-based assessment: Implementing oral boards in nursing education.

Competency-based education, pivotal in nursing programs, emphasizes learning methods over knowledge accumulation, integrating ongoing assessments for performance and outcomes. The American Association College of Nursing introduced competency-based education, urging educators to explore diverse assessment methods. This article explores the implementation of mock oral boards as an assessment method to synchronize performance standards with competencies in nursing education, specifically in preparing nurse practitioner students for clinical rotations.

Contemporary management and outcomes of blunt traumatic American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries in children: A Trauma Quality Improvement Program analysis.

The Trauma Quality Improvement Program (TQIP) database has delineated management strategies and outcomes for adults with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries and suggests that nonoperative management (NOM) is a viable option for these injuries. However, management strategies vary for children following significant pancreatic injuries and outcomes for these intermediate/high-grade injuries have not been sufficiently studied. Our aim was to describe the management and outcomes for grades III and IV pancreatic injuries using TQIP. We hypothesize that pediatric patients with intermediate/high-grade injuries can be safely managed with NOM. All pediatric patients (younger than 18 years) registered in TQIP between 2013 and 2021 who suffered a grade III or IV pancreatic injury due to blunt trauma were included in the current study. Patient demographics, clinical characteristics, complications, and in-hospital mortality were compared between the different treatment strategies for pancreatic injury: NOM versus drainage and/or pancreatic resection. A total of 580 patients meeting the inclusion criteria were identified. A total of 416 pediatric patients suffered a grade III pancreatic injury; 79% (n = 332) were NOM, 7% (n = 27) received a drain, and 14% (n = 57) underwent a pancreatic resection. A further 164 patients suffered a grade IV pancreatic injury; 77% (n = 126) were NOM, 11% (n = 18) received a drain, and 12% (n = 20) underwent a pancreatic resection. No differences in overall injury severity or demographical data were observed between the treatment groups. No difference in in-hospital mortality was detected between the different management strategies. Patients who received a drain had a longer hospital length of stay. The majority of children with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries are managed nonoperatively. Nonoperative management is a reasonable strategy for these injuries and results in equivalent in-hospital adverse outcome profiles as pancreatic drainage or resection with a shorter hospital length of stay. Therapeutic/Care Management; Level IV.

Imaging Findings Associated With Failure of Conservative Management After Blunt Extraperitoneal Bladder Injury

ObjectivesTo identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI). MethodsThe trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least one postoperative cystogram or catheter removal were included. A univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was completed. ResultsEighty-four patients with an EBI underwent CM. Seventy-eight (93%) patients had an associated pelvic fracture and 17 of 84 (20%) underwent embolization for pelvic hemorrhage. Thirty-four (41%) patients also had delayed phase imaging, 17 (20%) of whom had extravasation from their bladder on delays. Six (7%) patients failed initial CM. There was no association between the composite outcome and pelvic fracture (p=0.35) or embolization (p=0.41). American Association for the Surgery of Trauma (AAST) grade 5 injuries (p=0.01) and the presence of extravasation on delayed-phase Computed Tomography (p=0.03) were associated with the composite outcome. ConclusionsContrast extravasation on initial delayed-phase imaging despite urethral catheter drainage and AAST injury grade were associated with failed CM after EBI. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM.

Management of spinal trauma in pregnant patients: A systematic review of the literature.

Despite the high incidence of spine trauma globally, traumatic spinal cord injury (tSCI) during pregnancy is considered a rare medical emergency. The literature on acute management of these patients is sparse compared with that of mothers with preexisting tSCI. This systematic review aims to evaluate management strategies for tSCI during pregnancy in improving neurologic, obstetric, and neonatal outcomes. A systematic review of PubMed/MEDLINE was performed without language restriction from inception until November 2, 2023 for patients who acquired tSCI during pregnancy. Excluded articles described postpartum trauma, trauma before pregnancy, or SCI of nontraumatic etiology such as neoplastic, vascular, hemorrhagic, or ischemic origin. Primary outcomes investigated were maternal American Spinal Injury Association (ASIA) grade, pregnancy termination, cesarean delivery, prematurity, and neonatal adverse events. Data from 73 patients were extracted from 43 articles from 1955 to 2023. The mothers' median age was 24 years (interquartile range, 23-30 years), and the average gestational age at the time of injury was 21.1 ± 7.7 weeks. The thoracic spine was the most common segment affected (41.1%) and had the greatest proportion of complete tSCI (46.6%). Furthermore, ASIA score improvement was observed in 17 patients with 3 patients experiencing a 2-score improvement and 1 patient experiencing a 3-score improvement. Among these patients, 86% of ASIA B and 100% of ASIA C patients showed neurologic improvement, compared to only 17% of ASIA A patients. Surgically managed patients had a lower rate of neonatal adverse events than conservatively managed patients (11% vs. 34%). Acute tSCI requires a coordinated effort between a multidisciplinary team with careful consideration. While maternal neurologic improvement was observed more often following a better ASIA grade on presentation, the presence of neonatal adverse events was less common in patients treated with surgery than in patients who were managed conservatively. Systematic Review; Level IV.

An Investigation of Veterinary College Websites in the US and Canada: Representations and Content of Equity, Diversity, and Inclusion.

University websites are often a first point of contact for prospective students. Portrayals of diversity on the website can influence current and future students' perceptions. Using content and statistical analysis, all 38 veterinary college websites in Canada and the US were systematically coded for representations of people in photos and content related to equity, diversity, and inclusion (EDI). In both Canada and the United States, people perceived as male or Black, Indigenous, and/or People of Color (BIPOC) were more likely to be portrayed without animals, and fewer photos with males depicted engagement in an activity compared with those depicting females. Compared with the self-identified data reported by US colleges to the American Association of Veterinary Medical Colleges, BIPOC students were under-depicted by approximately 16.3% (95% confidence interval [CI] = 11.1%-21.7%) on some college websites and over-depicted on others by approximately 23.4% (95% CI = 15.4%-31.2%). A land acknowledgment or a link for a land acknowledgment was found on only six websites (16%). These results provide evidence and support that veterinary colleges should monitor their websites for depictions of people and content related to EDI, providing the opportunity to attract a diverse student audience.

Moisture Sensitivity Performance of Hot Mix Asphalt Mixture Incorporating Fly Ash Geopolymer (FAG) Asphalt Binder

In Malaysia, Hot Mix Asphalt (HMA) is widely used in asphalt production. HMA is a mixture of asphalt and aggregates that give durability to the road surface for pavement. Due to vehicles excessive traffic loadings that cause road surface damage, this pavement technology frequently undergoes maintenance and rehabilitation work. This study used recycled material as a modified binder and showned the best result in increasing stiffness and better rutting performance with high percentages of additives. This research focuses on the effect of FAG additive on asphalt mixture performance evaluation according to SuperpaveTM mixes design method. The procedures were specified according to the American Association of State Highway and Transportation Officials (AASHTO), American Society for Testing and Materials (ASTM), British Standard (BS) and Malaysian Standard (MS). The granite aggregate type was produced by a local quarry with conventional asphalt binder grade 80/100 and 60/70. Incorporation FAG in modified asphalt binder as levels of 0, 3, 5, 7, 9, and 11% by mass of asphalt binder. The performance of moisture sensitivity showed low moisture damage susceptibility for the mixture based on consistent values of TSR, in which all the specimens met the minimum TSR threshold of 80%. The optimization findings indicated that 9% of fly ash geopolymer might be the ideal content for modifying the asphalt binder. Overall, research findings suggest that using geopolymers may have improved some of the characteristics of asphalt binder and the performance of asphalt binders in pavement applications. Thus, the outcomes of this research were significantly used for further performance test and analysis on the asphalt mixture.

Assessing Radiology and Radiation Therapy Needs for Cancer Care in Low-and-Middle-Income Countries: Insight From a Global Survey of Departmental and Institutional Leaders

BackgroundThe global cancer burden and mortality rates are increasing, with significant disparities in access to care in low-and-middle-income countries (LMICs). This study aims to identify radiology and radiotherapy needs in LMICs from the perspective of departmental and institutional leaders. MethodsA survey was developed and conducted by the American Association of Physicists in Medicine (AAPM) Global Needs Assessment Committee (GNAC) and the AAPM International Council. The survey, organized into five sections (Introduction, Infrastructure Needs, Education Needs, Research Needs, and General Information), was open to respondents from March 1 to August 16, 2022. FindingsA total of 175 responses were received from six global regions: Africa (31.4%), Americas (17.7%), Eastern Mediterranean (14.3%), Europe (9.1%), South-East Asia (23.4%) and Western Pacific (4.0%). The greatest reported need was for new or updated equipment, particularly PET/CT imaging technology. There was also a high demand for clinical and equipment training. Approximately 25% of institutions reported a lack of radiology-based cancer screening programs due to high healthcare costs and a shortage of specialized equipment. Many institutions that expressed interest in research face funding and grant challenges. InterpretationThe findings highlight critical areas where organizations can support LMICs in enhancing radiology and radiotherapy services to mitigate the growing cancer burden.

Mildred Codding (1902–1991): Neurosurgery Medical Illustrator at Harvard Medical School, Peter Bent Brigham Hospital, and Boston's Children Hospital

This historical account reviews the life and times of Mildred Codding (1902-1991) in neurosurgery and medical illustration. The writing of this project was sparked by the discovery of original scientific and bibliographical information about Codding, testimony on personal relationships, and viewpoints after comprehensive compilation of information. Mildred Codding learned the carbon dust technique from Max Brödel at the Johns Hopkins Hospital (JHH) (Baltimore, Maryland USA), and worked at Peter Bent Brigham Hospital, now Brigham and Women's Hospital (Boston, Massachusetts, USA). Codding was Dr. Cushing's medical illustrator, colleague, and friend. She provided photographs, diagrams, and sketches for the majority of Cushing's collection of intracranial tumors from 1929 to 1932. A 1991 interview of Codding was hosted by Brigham and Women's Hospital and Boston Children's Hospital for the permanent collection of the Archives of the American Association of Neurological Surgeons and provides additional photographs and insignia, drawings with pen and ink method, multi-stepped layering, and illustration implements. Importantly, the Brigham Surgical Alumni insignia showing a surgeon's hand with scalpel was modeled after Codding's left hand. Outside of the operating room, Codding's interests included Pediatrics, Zoology and Genetics, atlantes of surgical operations, teatime, and paint with watercolor, particularly seascapes, lighthouses and dunes. This article provides glimpses into the personality and marked influence of Mildred Codding on neurosurgery and medical education and adds to the growing literature on her person.

Pediatric Cancer Screening in Hereditary Gastrointestinal Cancer Risk Syndromes: An Update from the AACR Childhood Cancer Predisposition Working Group.

Gastrointestinal (GI) polyposis and cancer in pediatric patients is frequently due to an underlying hereditary cancer risk syndrome requiring ongoing cancer screening. Identification of at-risk patients through family history, clinical features of a syndrome, or symptom onset ensures appropriate cancer risk assessment and management in childhood and beyond. In this 2024 perspective, we outline updates to the hereditary GI cancer screening guidelines first published by the American Association of Cancer Research Pediatric Cancer Predisposition Workshop in 2017. These guidelines consider existing recommendations by pediatric and adult gastroenterology consortia to ensure alignment with gastroenterology practices in managing polyposis conditions. We specifically address the recommendations for pediatric screening in familial adenomatous polyposis, Peutz-Jeghers syndrome, and juvenile polyposis syndrome. Further, we emphasize the importance of multidisciplinary care and partnership with gastroenterology, as it is crucial in management of children and families with these conditions.

Monitoring Overall Survival in Pivotal Trials in Indolent Cancers

Indolent cancers are characterized by lengthy overall survival (OS) times. Therefore, powering a clinical trial to provide definitive assessment of the effects of an experimental intervention on OS in a reasonable timeframe is generally infeasible. Instead, the primary outcome in many pivotal trials is an intermediate clinical response such as progression-free survival. In several recently reported pivotal trials of interventions for indolent cancers that yielded promising results on an intermediate outcome, however, more mature data or post-approval trials showed concerning OS trends. These problematic results have prompted a keen interest in quantitative approaches for monitoring OS that can support regulatory decision-making related to the risk of an unacceptably large detrimental effect on OS. The US Food and Drug Administration, the American Association for Cancer Research, and the American Statistical Association recently organized a one-day multi-stakeholder workshop entitled “Overall Survival in Oncology Clinical Trials.” In this article, we propose OS monitoring guidelines tailored for the setting of indolent cancers. Our pragmatic approach is modeled, in part, on the monitoring guidelines the FDA has used in cardiovascular safety trials conducted in Type 2 Diabetes Mellitus. We illustrate proposals through application to several examples informed by actual case studies.

Discussion: American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Discussion: American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Discussion: American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Discussion: American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Barriers to Early Mobilization after Spine Surgery

Introduction There has been increased interest in reducing a patient’s length of stay in the hospital. One of the critical factors towards a patient’s prolonged stay is delayed ambulation, which in turn leads to a higher risk of complications such as ileus, atelectasis, and urinary retention. The purpose of this pilot study is to identify barriers to in-hospital mobilization Methods Thirty patients undergoing 1-2 level lumbar fusion were identified and data on demographics, medical history and surgery were collected. The Mini-Mental Status Examination (MMSE) was administered while they were awaiting surgery, in the recovery room and during post-operative day one (POD-1). Whether they were mobilized on the first day after surgery or not and the reasons why there was a delay in ambulation were also collected. Results Of the 30 patients in this pilot study, only 9 ambulated on POD-1. There were no differences in age, sex, American Association of Anesthesiologists grade, body mass index, smoking status, operative time, estimated blood loss, recovery room stay or MMSE at any time point between patients who were mobilized and those who were not. The most common reason for not mobilizing was the lack of a floor bed (11), followed by a late surgery start (4) and being on complete bed rest (3). Other reasons included incomplete orders (1), no therapist available (1) and presence of neurologic deficit pre-op (1). Discussion Early patient mobilization is largely dependent on hospital administrative factors rather than patient characteristics or surgical parameters.

Perceptions of Diversity, Equity, Inclusion, and Anti-Racism Among Pharmacy Faculty by Racial and Ethnic Identity

ObjectiveTo compare perceptions of underrepresented minorities (URM), non-URM people of color (POC), and nonminoritized pharmacy faculty in academia in relation to workplace diversity, equity, inclusion, and anti-racism (DEIA) landscape in the United States. MethodsThis study utilized the DEIA Faculty Perceptions of College Climate (FPCC) scale, which was developed and validated by the authors. The FPCC scale was used to investigate perceptions of pharmacy faculty from the American Association of Colleges of Pharmacy membership directory regarding DEIA within their respective academic pharmacy institutions. Demographic differences were examined using a Pearson chi-square test, while response disparities in FPCC questions were analyzed with a one-way ANOVA. ResultsA total of 846 respondents met the inclusion criteria for the study and were included in the analysis. Results indicate disparities in perceptions within all 4 DEIA domains of the FPCC survey among the 3 demographic groups. ConclusionThis study uncovers significant differences in how pharmacy faculty perceive DEIA within pharmacy education, with nonminoritized faculty expressing more positive views compared to their URM and non-URM counterparts. These results emphasize the need for focused interventions and institutional support to bridge DEIA disparities, emphasizing the importance of fostering an inclusive academic environment to enhance faculty well-being and empower the pharmacy profession to meet diverse needs more effectively.