Compensation Status Research Articles

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review.

This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = - 8.52), and body mass index (BMI; p < 0.014, β = -4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.

Dosage Compensation throughout the Schistosoma mansoni Lifecycle: Specific Chromatin Landscape of the Z Chromosome.

Differentiated sex chromosomes are accompanied by a difference in gene dose between X/Z-specific and autosomal genes. At the transcriptomic level, these sex-linked genes can lead to expression imbalance, or gene dosage can be compensated by epigenetic mechanisms and results into expression level equalization. Schistosoma mansoni has been previously described as a ZW species (i.e., female heterogamety, in opposition to XY male heterogametic species) with a partial dosage compensation, but underlying mechanisms are still unexplored. Here, we combine transcriptomic (RNA-Seq) and epigenetic data (ChIP-Seq against H3K4me3, H3K27me3, and H4K20me1 histone marks) in free larval cercariae and intravertebrate parasitic stages. For the first time, we describe differences in dosage compensation status in ZW females, depending on the parasitic status: free cercariae display global dosage compensation, whereas intravertebrate stages show a partial dosage compensation. We also highlight regional differences of gene expression along the Z chromosome in cercariae, but not in the intravertebrate stages. Finally, we feature a consistent permissive chromatin landscape of the Z chromosome in both sexes and stages. We argue that dosage compensation in schistosomes is characterized by chromatin remodeling mechanisms in the Z-specific region.

Clinical Outcomes and Complications of Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection.

The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers' compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief (P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. Level IV, case series.

Five-Year Outcomes and Return to Sport of Runners Undergoing Hip Arthroscopy for Labral Tears With or Without Femoroacetabular Impingement

Background: Recent evidence has demonstrated a high rate of return to running after hip arthroscopy for femoroacetabular impingement at short-term follow-up. The midterm outcomes and rates of continued running of these patients are unknown. Purpose: To evaluate midterm rates of return to running and outcomes after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip preservation surgery between July 2008 and November 2011. Patients were excluded for preoperative Tönnis osteoarthritis grade ≥2, previous ipsilateral hip conditions or hip surgery, or workers’ compensation status. All patients who participated in mid- to long-distance running before their surgery and intended on returning after their operation were considered for inclusion. Preoperative and minimum 5-year postoperative measures for the following patient-reported outcome scores (PROs) were necessary for inclusion in the final cohort: the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale (VAS) for pain. All patients were counseled about the risks of continued running after hip arthroscopy. Results: Sixty patients (62 hips) were eligible for inclusion, of which 50 (83.3%; 52 hips) had minimum 5-year follow-up. There were 10 male hips and 42 female hips. Mean ± SD age at surgery was 32.4 ± 12.4 years (range, 14.9-62.4), and mean body mass index was 22.9 ± 3.2 (range, 17.7-30.1). Latest follow-up was recorded at a mean 69.3 ± 8.5 months (range, 60.0-92.1 months). Level of competition included 39 recreational, 7 high school, 4 collegiate, and 2 professional athletes. There were significant improvements in all PROs and VAS scores preoperatively to latest follow-up. Mean modified Harris Hip Score improved from 67.5 to 88.2; mean Non-arthritic Hip Score, from 65.9 to 88.3; mean Hip Outcome Score–Sports Specific Subscale, from 49.5 to 81.0; and mean VAS, from 5.2 to 1.5. At latest follow-up, patient satisfaction was 8.4. Thirty-nine patients (78.0%, 41 hips) had returned to running postoperatively. When stratified by level of competition, 79% (31 of 39) of recreational, 100% (7 of 7) of high school, 50% (2 of 4) of collegiate, and 50% (1 of 2) of professional athletes returned to running. Conclusion: Hip arthroscopy for all levels of runners is associated with a significant increase in PROs and a low risk of complications. The rate of return to running is moderately high after hip arthroscopy at midterm follow-up. Hip arthroscopy may be considered for runners presenting with symptoms of femoroacetabular impingement that fail nonoperative treatments. Patients should be educated on the rate of return to running over time and the risks of continued running after hip arthroscopy.

Factors Associated With Clinically Significant Patient-Reported Outcomes After Primary Arthroscopic Partial Meniscectomy

The purpose of this study was to establish minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) after meniscectomy and factors associated with achieving these goals. A prospectively maintained institutional registry was retrospectively reviewed for all patients undergoing isolated arthroscopic partial meniscectomy from 2014 through 2017. MCID, SCB, and PASS were calculated for the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores by using the anchor-based methodology and nonparametric receiver operating characteristic curves. Subscores included joint replacement (JR), physical function (PF), symptoms (Sx), pain, activities of daily living (ADL), sport, and quality of life (QOL). A total of 269 patients were analyzed in the study, which reported outcomes between 6 and 7months after surgery. The average age of our population was 48.9 ± 12.4years. Twenty patients reported no change, 53 reported minimal improvement, and 137 reported substantial change after surgery; whereas 59 patients reported worse outcomes. One hundred seventy-seven patients were satisfied and 92 were not satisfied with the outcome of surgery. Established MCID/SCB/PASS for the IKDC, KOOS JR, KOOS PF, KOOS Sx, KOOS Pain, KOOS ADL, and KOOS QOL were 10.6/25.3/57.9, 10.7/13.2/68.3, -8.2/-11.3/26.2, 8.9/7.1/71.4, 9.7/22.2/76.4, 11.0/16.9/89.0, 12.5/27.5/55.6, and 15.6/34.4/46.9, respectively. Higher preoperative scores were associated with reduced odds of achieving MCID and SCB but greater odds of achieving PASS for nearly all scores (P < .05). Workers' compensation status, degenerative tears, medial-sided tears, and root tears were associated with reduced odds of achieving 2 or more clinically meaningful outcomes in 2 or more scores (P < .05). Clinically meaningful outcomes were established by patient self-assessment. Variables associated with achieving these outcomes include preoperative score (positively correlated with MCID/SCB, negatively correlated with PASS); workers' compensation; degenerative, medial-sided tears; and root tears(remaining negatively correlated with MCID/SCB/PASS). These variables should be accordingly measured for confounding in future outcome reporting.

The Effect of Workers' Compensation Status on the Patient Experience.

Background:Rating the patient experience is an increasingly important component of value-based health care. Generation of lower ratings on validated functional assessments by patients with Workers’ Compensation is well known; however, the relationship between Workers’ Compensation status and patient satisfaction is poorly described in orthopaedic patient populations.Methods:All orthopaedic outpatient patient satisfaction surveys (Press Ganey) generated over an 18-month period at a U.S. academic tertiary care center were included in this study. Data with regard to the primary payer, demographic characteristics, orthopaedic subspecialty, and planned surgical interventions with the provider for whom the survey was completed were analyzed in conjunction with patient satisfaction data.Results:During the study period, 3,720 consecutive patient satisfaction surveys were generated, and 244 surveys were generated by 215 patients with Workers’ Compensation. Satisfied patients with Workers’ Compensation were more likely to be male (p = 0.0007), to have higher mental health self-assessments (p = 0.004), and to be scheduled for surgical intervention (p = 0.03). Scheduling a surgical procedure was independently associated with improved patient satisfaction, whereas Workers’ Compensation status was independently associated with dissatisfaction when adjusting for sex, language, race, and marital status. Across all patient satisfaction domains, patients with Workers’ Compensation gave significantly lower scores (p < 0.05) compared with all other patients. Patients with Workers’ Compensation were more likely to rate their overall health as lower compared with other patients (p < 0.0001). Patients with Workers’ Compensation were more likely to give lower ratings to providers on a 1-to-10 scale (p < 0.0001) and were less likely to recommend the practice to others (p < 0.0001).Conclusions:Workers’ Compensation status is a non-modifiable independent predictor of dissatisfaction with health care compared with other primary payer groups. Further research is warranted to understand the factors influencing patient satisfaction ratings.

Worker compensation status increases the risk for presence of pain in the contralateral knee at final follow-up after arthroscopic knee surgery

ObjectivesIn patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.MethodsAll patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.ResultsA total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (<1%) reported pain in the contralateral knee, which increased to 113 patients (80%) at final follow-up surgery. Of the assessed risk factors, only worker compensation status was significant for the development of contralateral knee pain (OR 2.93 95% CI 1.08 to 7.95, p=0.040).ConclusionPain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related.Level of evidenceLevel IV case series.

Work-related burn injuries and claims for post-traumatic stress disorder in Korea

ObjectiveThe objective of this study is to broaden our understanding of psychiatric disorders due to work-related burn injury compensated by the Industrial Accident Compensation Insurance operated by the Korea Workers’ Compensation and Welfare Service (KCOMWEL). MethodsUsing the KCOMWEL electronic database, we collected data on psychiatric disorders due to work-related burn injury based on workers’ compensation records from 2005 to 2014 and analyzed the characteristics of the claims. ResultsThe average number of claims per year for post-traumatic stress disorder was 67 and the approval rate from 2005 to 2014 was 53.6%. Regarding occupation, 63 workers were elementary workers involved in the performance of simple and routine tasks which may require the use of hand-held tools and considerable physical effort and 59 were electrical and electronic equipment fitters and repairers. Acute stress disorder, nonorganic insomnia, and sexual dysfunction were the most commonly approved psychiatric disorders associated with work-related burn injury, followed by mixed anxiety-depressive disorder. ConclusionsWe analyzed the characteristics of the psychiatric disorders due to work-related burn injury for which compensation was received from 2005 to 2014 according to the approved results. To gain a long-term understanding of the management of workers’ compensation status for psychiatric disorders due to work-related burn injuries, we should gather accurate information on the risk factors involved in order to achieve the needed systematic improvements.

Establishing minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after biceps tenodesis

The purposes of this study were to establish thresholds for improvement in patient-reported outcome scores that signify the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) after biceps tenodesis (BT) and to assess patient variables that are associated with these clinically important outcomes. A prospectively maintained institutional shoulder registry was queried for patients undergoing isolated BT between 2014 and 2017. Anchor-based and distribution-based approaches were used to calculate the MCID whereas an anchor-based method was used to calculate the SCB and PASS for the Constant-Murley score, Single Assessment Numerical Evaluation (SANE) score, and American Shoulder and Elbow Surgeons score. A total of 123 patients who underwent isolated BT were included for analysis. The MCID, SCB, and PASS calculated for the American Shoulder and Elbow Surgeons score were 11.0, 16.8, and 59.6, respectively. For the Constant-Murley score, the calculated MCID and PASS were 3.8 and 19.5, respectively. The MCID, SCB, and PASS calculated for the SANE score were 3.5, 5.8, and 65.5, respectively. The following patient variables were significantly associated with decreased odds of achieving the MCID: workers' compensation status, male sex, and higher preoperative SANE score. Patients with a history of ipsilateral shoulder surgery had significantly reduced odds of achieving SCB. The only factor significantly associated with failing to reach the PASS was workers' compensation status. This study established values for the MCID, SCB, and PASS after BT without concomitant rotator cuff repair. Workers' compensation status, previous shoulder surgery, male sex, and higher preoperative patient-reported outcome measure scores are associated with lower odds of achieving clinically significant improvement after BT.

Establishing clinically significant outcome after arthroscopic rotator cuff repair

Outcomes reporting in rotator cuff repair (RCR) literature has been variable. The minimal clinical important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) bridge the gap between statistical significance and clinical relevance. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (Constant) scores were collected preoperatively and 1 year postoperatively for patients undergoing RCR between 2014 and 2017. An anchor-based approach was used to calculate the MCID, SCB change, and PASS for the ASES questionnaire. The study included 288 patients who underwent RCR. The MCID, SCB, and PASS were, respectively, 11.1, 17.5, and 86.7 for ASES, 4.6, 5.5, and 23.3 for the Constant score, and 16.9, 29.8, and 82.5 for the SANE score. Factors associated with reduced odds of achieving MCID were current smoking for ASES (odds ratio, 0.056) and single-row repair for the Constant score (odds ratio, 0.310). Workers' compensation patients had reduced odds of achieving ASES SCB (odds ratio, 0.267) and were associated with reduced odds of achieving PASS by ASES (odds ratio, 0.244), SANE (OR, 0.452), and Constant (odds ratio, 0.313). Lower preoperative scores were associated with achieving MCID and SCB and higher preoperative Constant scores associated with PASS (P < .001). This study establishes MCID, SCB, and PASS for ASES, Constant, and SANE scores in patients undergoing RCR. Factors associated with failing to achieve clinically significant values included current smoking, single-row repairs, high body mass index, and workers' compensation status.

Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting.

This study retrospectively analyzes prospectively collected data. Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. 3.

Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up.

Background:The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers.Purpose/Hypothesis:The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients.Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05.Results:A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group (P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups.Conclusion:Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.

Peculiarities of strategic management implementation of human resources at the enterprise

The paper argues that reward systems provide incentives and reinforce workforce behaviors and facilitate the implementation of strategies, while development systems provide the workforce skills required to implement them. Emphasis is placed on the need to consider the performance measurement systems they use to gather the information needed to share rewards and identify development needs. The purpose of the work is to investigate the peculiarities of implementing a strategic human resource management based on the organization of an effective remuneration system. The object of the study is the strategic management of human resources. There are different approaches to measuring performance that help assess the extent to which employee behavior at all organizational levels contributes to the implementation of strategies. Measures for the effectiveness of such work are implemented by remuneration systems. All methods of measuring and evaluating performance are potentially useful tools for providing feedback on the extent to which behavior is consistent with organizational strategies. In addition, they are all potentially useful tools for informing the remuneration system about how much employees deserve higher compensation, recognition, and more. It should be emphasized that they are all potentially significant sources of guidance for future development efforts. The study uses system-structural analysis; systematic approach, systematization, abstract-logical approach – at generalization of results of research and formulation of conclusions. The role of reward and development systems in strategy implementation is substantiated. The article points out that a number of assessment approaches have traditionally been used to measure performance. One of the most common is goal management, graphical rating scales, and stories. The most up-to-date performance appraisal systems are those that use the behavioral rating scale. The article discusses the goal-management approach that is widely applied to performance appraisal. In the case of goal management, it is easy to set strategy implementation, as goals can be defined as outcomes or milestones in the strategy implementation process. It is emphasized that goal management usually begins with the initial phase, in which the subordinate forms the goals or objectives to be achieved within the next period of time. As part of this process, the subordinate identifies the measures that will determine the achievement of such goals and outlines the plans of action he or she will use to achieve them. It is emphasized that, as with all approaches to performance evaluation, goal management has drawbacks. Goals for some jobs are harder to write, such as for staffing, and problems arise when goals are not well thought out. In addition, this process may be perceived with cynicism if senior executives are not evaluated by goal management. The article describes the reward systems that are used by leading businesses: goal management, graphical rating scales, performance descriptions, behavioral ratings, behavioral observation scales, and 360-degree feedback systems. The lack of performance evaluation at the executive level is emphasized. Suggestions are made for the wider application of management evaluation. After discussing measuring the effectiveness of the system, rewards were considered in terms of compensation. Traditional work-based pay systems are described and their inability to provide the flexibility needed in today’s competitive environment is discussed. The importance of an appropriate system of rewards in the implementation of the human resources management strategy has been proved. Because of the critical role of compensation in several work systems, organizational processes, and organizational structures, several innovative approaches to compensation have been discussed. Because highly competitive human resources will be required to gain future competitive advantage, reconciling rewards with skills can be critical to successful strategy implementation. A new broadband compensation approach was also explored. They also discussed team remuneration, which rewards joint efforts, and discussed variable compensation. Variable compensation is becoming more widespread as it helps to create a sense of common purpose among all employees. Variable compensation can also help to secure employment. The role and current status of compensation to performers were also examined.

Comparison of Surgeon Performance of Rotator Cuff Repair: Risk Adjustment Toward a More Accurate Performance Measure.

Movement toward a value-based health-care system necessitates the development of performance measures to compare physicians, hospitals, and health-care systems. Patient-reported outcomes (PROs) are a potential metric. However, valid use of PROs hinges on the ability to risk-adjust for baseline patient differences across a surgeon's panel of patients. The purpose of this study was to propose an approach for baseline risk adjustment and evaluate the importance of risk adjustment when comparing surgeons' performance of rotator cuff repair. Patients (n = 995) treated with arthroscopic rotator cuff repair by 34 surgeons from 2010 to 2017 were identified from a large sports medicine clinical data registry. A linear regression model was used to adjust for baseline PROs, patient demographics, and clinical characteristics to predict American Shoulder and Elbow Surgeons (ASES) change scores for each surgeon. A risk-adjusted performance measure was calculated as the difference between the average unadjusted ASES change scores and the risk-adjusted predicted ASES change scores across all patients treated by a surgeon. The differences between unadjusted and risk-adjusted performance scores varied widely across surgeons (range, -13.8 to 10.3 ASES points). Use of the risk-adjusted performance scores resulted in a dramatic change in the relative ranking of surgeons, compared with the ranking based on the observed ASES change scores, with 31 of the 34 surgeons' rank changing following risk adjustment. On average, the observed ASES scores improved from 49.5 ± 17.5 at baseline to 78.0 ± 22.5 at 6 months across all surgeons. In the risk-adjustment model (R = 0.44), male sex, Workers' Compensation status, higher scores on the Veterans RAND 12-item Health Survey (VR-12), lower baseline ASES scores, fair and poor tendon quality, and night pain all had a significant effect on the predicted ASES change scores (p < 0.05). Our results show wide variation of nearly 25 points in the risk-adjusted 6-month ASES performance difference from the highest to the lowest-performing surgeons. Additionally, 91% of surgeons' rank changed following risk adjustment. This suggests that performance measurement that does not account for baseline patient characteristics would likely result in incorrect conclusions about a surgeon's relative performance based on PROs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

2017 Infectious Diseases Society of America Physician Compensation Survey: Results and Analysis.

Analyzing health care reimbursement is a dynamic process. Infectious Diseases (ID) physicians have careers in diverse practice models. With current compensation models focusing on value and quality metrics, ID physicians are poised to be at the forefront of these delivery models. Monitoring and disseminating the current status of ID physician compensation are priorities of the Infectious Diseases Society (IDSA). In 2015, the IDSA conducted the largest ID physician compensation survey to date. The data were analyzed and disseminated, and the society subsequently responded with a plan to continue to develop and collect the most comprehensive and accurate data on ID physician compensation. Therefore, from May to June 2017, the IDSA conducted a follow-up compensation survey of its members. This survey resulted in the largest number of respondents of any ID compensation survey. It revealed that compensation across the different practice demographics had increased since the 2015 survey and is generally higher than salaries published in other comparable surveys. These data and the subsequent analyses focus on physicians who report patient care as their primary responsibility; they are presented by members of the IDSA’s Clinical Affairs Committee.

Real-World Effectiveness of Physical Therapy for Common Neck Pain Diagnoses: A Multivariate Analysis of 1554 Patients.

Retrospective cohort study (Level of evidence-3). The objective of this study was to investigate the real-life effectiveness of physical therapy (PT) for patients initially presenting with common neck pain diagnoses. Neck pain is a common cause of morbidity and a leading cause of disability in the United States. PT is prescribed as a first-line treatment for the vast majority of patients with neck pain; however, there is limited literature supporting the effectiveness of these treatments. A total of 1554 patients enrolled in PT for the nonoperative treatment of neck pain were included in the study. Three primary patient-reported outcome (PRO) measures [neck disability index (NDI), resting numeric pain rating scale (NPRS), and activity NPRS] were recorded before and at conclusion of therapy. Improvement was noted if patients met a threshold value for a minimal clinically important difference (MCID). Bivariate analysis using a χ test and multiple logistic regression analysis were performed to determine risk factors predictive of treatment failure. About 40.5% of patients achieved MCID for NDI with an average change of -6.31 points. For resting NPRS and activity NPRS scores, 50.6% and 52.1% of patients achieved MCID with an average change of -1.93 and -2.36, respectively. After multiple logistic regression analysis, worker's compensation status was found to be an independent predictor for treatment failure in all groups; whereas, Medicare status was found predictive of achieving MCID in the activity NPRS group. We observed that up to half of the patients analyzed met the minimum criteria for improvement in neck pain with respect to the PRO measures, suggesting that real-life effectiveness of PT for common neck pain diagnoses may approach 50%.

Sub- and Super-Synchronous Interactions Between STATCOMs and Weak AC/DC Transmissions With Series Compensations

With the increasing integration of power electronic converters into the power system, the interactions between converters and their adjacent transmissions bring emerging oscillation issues. A new type of sub- and super-synchronous interactions (S $^2$ SI) between STATCOMs and the weak AC/DC grid were detected in China Southern Grid. As an oscillation incident never reported before, as far as the authors know, its characteristics were quite different from the previous ones. Field measurements as well as simulation studies have revealed that the various factors contributing to the S $^2$ SI include the number of online STATCOMs, the strength of the AC system (in terms of effective short-circuit ratio), the status of series compensation, and the loading level of the HVDC. The mechanism of such oscillation has been clarified and it is caused by the S $^2$ SI between STATCOMs and weak AC grids, where sub- and super-synchronous components are involved in a coupled way. To fully represent such a coupling effect, the concept of sub- and super-synchronous coupled impedance model (IM), or S $^2$ SC-IM, is proposed and developed in order to establish a stability criterion for the S $^2$ SI. Based on the IM-based method as well as the time-domain simulations, the impacts on S $^2$ SI from the various factors are quantitatively analyzed. The results show good consistence among theoretical analysis, electromagnetic simulations, and field measurements. Therefore, the effectiveness of the developed models and the stability criterion has been well verified.

Higher Total Insulin Dose Has Positive Effect on Corneal Nerve Fibers in DM1 Patients.

Neuropathies are among the most common long-term complications of diabetes mellitus (DM) and good glycemic control is essential in prevention of this complication. DM patients with similar mean glucose levels or HbA1c levels often exhibit differences in glucose variability. We tested for possible associations between parameters of glycemia compensation and corneal sub-basal nerve fiber status. The study included 20 patients with DM type 1 treated using an intensified insulin regimen. The corneas of both eyes were examined using in vivo corneal confocal microscopy. Corneal nerve fiber density (NFD), nerve fiber length (NFL), and nerve branch density (NBD) were evaluated. Possible associations between parameters of glycemia compensation (HbA1c, glycemia SD, and insulin dose), and other clinical factors were analyzed. NBD was the highest in those with higher glycemic variability (P = 0.023). HbA1c had a negligible effect on corneal nerve parameters. NFD, NFL, and NBD were statistically significantly higher in those with higher total insulin per kilogram (P = 0.02, P = 0.01, and P = 0.012, respectively). Among other factors, a positive correlation between free thyroxine (fT4) levels and NFD and NBD was also found (P = 0.041 and P = 0.015, respectively). Total insulin dose per kilogram may be an important factor influencing nerve fiber status and needs to be considered in future studies of diabetic neuropathy pathophysiology and its progression. Also, more attention must be paid to other possible factors when elucidating the development of diabetic complications.

Treatment of Type Two Slap Lesion With Anatomic Suture Anchor Repair Without Biceps Tenotomy Or Tenodesis.

Background:Poor results after repair of type 2 SLAP tears are relatively common and some have reported better results after biceps tenodesis or tenotomy than repair. In addition, some believe that the long head of the biceps is expendable. Therefore, many now favor biceps tenotomy or tenodesis over biceps anchor repair either in all patients or in older patients, reserving SLAP lesion repair only for young athletes.Hypothesis:We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out.Methods:All patients with type 2 SLAP lesion repair by the senior author since he began repairing them with suture anchors were prospectively evaluated. Patients with more than one other concomitant procedure, simultaneous rotator cuff repair or worker’s compensation status were excluded.Results:77% of patients were available for minimum two year followup. No patient had subsequent surgery or manipulation under anesthesis as a result of their SLAP repair. Standardized shoulder test score increased by 4 points. Mean SANE score decreased from 53 pre-op to 14 post-op. Results were the same in those over versus under 40 years of age.Conclusion:Anatomic repair of Type 2 SLAP lesions at the biceps anchor without biceps tenodesis or tenotomy can produce good results in patients of all ages.

Risk Factors for Biceps Related Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Objectives:Our objective was to evaluate complications after arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and identify patient-related factors associated with postoperative cosmetic (Popeye) deformity, subjective weakness, and residual anterior shoulder pain.Methods:After obtaining IRB approval, the records of patients who underwent an arthroscopic LHBT tenotomy, between 2008 and 2015, at an integrated multi-center (14) and multi-surgeon (55) were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Demographic data, concomitant procedures, the appearance of the biceps tendon (presence or absence of hypertrophy) at time of arthroscopy, and postoperative complications were recorded. The development of each postoperative complication was compared by age, gender, hand dominance, workers’ compensation status, and intra-operative LHBT morphology.Results:192 patients met our inclusion criteria. The average age was 60.6 ± 9.5 years and 55% were male. Average follow-up was 10.6 ± 13.6 months. The most common concomitant procedures were subacromial decompression (82%), rotator cuff repair (72%), distal clavicle resection (26%), and glenohumeral debridement (18%). LHBT morphology based on arthroscopic images was as follows: normal (56%), mildly hypertrophic (24%), severely hypertrophic (20%). Postoperative complications cosmetic deformity (14%), subjective weakness (10.4%), persistent (residual) anterior shoulder pain (7.8%), conversion to tenodesis (3.6%), venous thromboembolism (1%). Seven (3.6%) patients underwent a revision surgery to convert the LHBT tenotomy to a tenodesis, most commonly for postoperative cosmetic deformity (6 patients, 86%). Male gender was significantly associated with the development of postoperative cosmetic deformity (Odds Ratio of 3.21, P<0.05). Biceps tenotomy on the dominant shoulder was significantly associated with postoperative subjective weakness (Odds Ratio 3.17, P<0.05). Patients with workers’ compensation injuries were more likely to have continued postoperative anterior shoulder pain (6.57, P<0.05). A full list of individual patient-related factors association with postoperative complications is presented in Table 1.Conclusion:In our series, in patients undergoing LHBT tenotomy, 14% developed a cosmetic deformity, 10% subjective reported weakness and 8% had persistent (residual) anterior shoulder pain. Male gender was associated with developing a cosmetic deformity, the dominant shoulder was associated with postoperative subjective weakness, and workers’ compensation status was associated with residual anterior shoulder pain. Older age and a hypertrophic biceps tendon demonstrated decreased odds of developing a postoperative cosmetic deformity but did not reach statistical significance. Surgeons who perform LHBT tenotomy should take these risk factors under consideration to minimize complications.Table 1Association of Patient-Related Characteristics with Postoperative Complications.Postoperative ComplicationPatient-Related CharacteristicDevelopment of Cosmetic DeformityReported Subjective WeaknessResidual Anterior Shoulder PainAverage AgeYes= 58 years oldYes= 59.6 years oldYes= 56.64No= 61 years oldNo= 60.7 years oldNo= 60.99P= 0.120P= 0.316P= 0.100GenderMale= 19%Male= 11%Male= 6.7%Female= 6.9%Female= 9.2%Female= 9.2%P= 0.013*P= 0.614P= 0.528Dominant ArmYes= 16.9%Yes= 14.2%Yes= 7.2%No=10%No= 5.0%No= 8.6%P= 0.171P= 0.038*P= 0.696Workers' CompensationYes= 28%Yes= 0%Yes= 42.8%No=13%No= 10.8%No= 6.5%P= 0.261P= 0.358P= 0.001*Biceps Tendon HypertrophyYes= 0%Yes= 0%Yes= 0%No= 19.4%No= 11.1%No= 8.3%P= 0.150P= 0.294P= 0.370* Indicates statistical significance