Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2020
Delayed Diagnosis Is the Primary Cause of Sarcoma Litigation: Analysis of Malpractice Claims in the United States.
Sarcoma care is highly litigated in medical malpractice claims. Understanding the reasons for litigation and legal outcomes in sarcoma care may help physicians deliver more effective and satisfying care to patients while limiting their legal exposure. However, few studies have described malpractice litigation in sarcoma care. ⋯ Physicians can mitigate their malpractice risk while reducing delays in diagnosis of sarcomas by carefully reviewing all existing diagnostic studies, establishing closed-loop communication protocols to communicate critical findings from diagnostic studies, and developing policies to facilitate second-opinion consultation, particularly for imaging studies, with an experienced sarcoma specialist. Musculoskeletal oncologists may be able to help further reduce the rates of malpractice litigation in sarcoma care by helping patients understand that delays in diagnosis do not necessarily constitute medical malpractice.
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Clin. Orthop. Relat. Res. · Oct 2020
Multicenter StudyWhat Is the Accuracy of Three Different Machine Learning Techniques to Predict Clinical Outcomes After Shoulder Arthroplasty?
Machine learning techniques can identify complex relationships in large healthcare datasets and build prediction models that better inform physicians in ways that can assist in patient treatment decision-making. In the domain of shoulder arthroplasty, machine learning appears to have the potential to anticipate patients' results after surgery, but this has not been well explored. ⋯ Three different commercially available machine learning techniques were used to train and test models that predicted clinical outcomes after aTSA and rTSA; this device-type comparison was performed to demonstrate how predictive modeling techniques can be used in the near future to help answer unsolved clinical questions and augment decision-making to improve outcomes after shoulder arthroplasty.
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Clin. Orthop. Relat. Res. · Oct 2020
Minimum Clinically Important Differences of the Hospital for Special Surgery Dysphagia and Dysphonia Inventory and Other Dysphagia Measurements in Patients Undergoing ACDF.
Postoperative dysphagia is a common complication after anterior cervical surgery, and it can be measured using patient-reported outcome measures (PROMs). The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a condition-specific PROM to evaluate dysphagia and dysphonia after anterior cervical discectomy and fusion (ACDF). The minimum clinically important difference (MCID) of the HSS-DDI has not, to our knowledge, been established. Other PROMs have been used to assess dysphagia (SWAL-QOL and MD Anderson Dysphagia Inventory [MDADI]) in ACDF. Currently, few studies have addressed the MCIDs of these PROMs. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Oct 2020
How Does the Skeletal Oncology Research Group Algorithm's Prediction of 5-year Survival in Patients with Chondrosarcoma Perform on International Validation?
The Skeletal Oncology Research Group (SORG) machine learning algorithm for predicting survival in patients with chondrosarcoma was developed using data from the Surveillance, Epidemiology, and End Results (SEER) registry. This algorithm was externally validated on a dataset of patients from the United States in an earlier study, where it demonstrated generally good performance but overestimated 5-year survival. In addition, this algorithm has not yet been validated in patients outside the United States; doing so would be important because external validation is necessary as algorithm performance may be misleading when applied in different populations. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Oct 2020
What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?
In response to the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare and Medicaid Services pledged payment for telehealth visits for the duration of this public health emergency in an effort to decrease COVID-19 transmission and allow for deployment of residents and attending physicians to support critical-care services. Although the COVID-19 pandemic has vastly expanded telehealth use, no studies to our knowledge have analyzed the implementation and success of telehealth for orthopaedic trauma. This population is unique in that patients who have experienced orthopaedic trauma range in age from early childhood to late adulthood, they vary across the socioeconomic spectrum, may need to undergo emergent or urgent surgery, often have impaired mobility, and, historically, do not always follow-up consistently with healthcare providers. ⋯ Level III, therapeutic study.