Faculty Bibliography

PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and patient-reported outcomes, achievement of clinically significant thresholds, and reoperation rates in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at minimum 10-year follow-up. METHODS:A retrospective review of a prospectively gathered database of hip arthroscopy patients from August 2012 to June 2014 was conducted. Inclusion criteria were patients ≥18 years with clinically and radiographically confirmed FAIS and labral tearing who underwent primary hip arthroscopy with labral repair or debridement and had ≥10 years of follow-up. MRI labral width measurements were performed by 2 blinded musculoskeletal radiologists at standardized clockface locations using a validated technique. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were classified as hypoplastic if they had a labral width below the mean on 2 or more views. Outcomes and reoperation rates were compared between groups using independent samples t-tests for continuous variables and chi-square tests for categorical variables. RESULTS:were included, with a mean follow-up of 11.30 ± 0.47 years. Patients were categorized into hypoplastic (n = 42) and nonhypoplastic (n = 41) groups. There was no significant difference between hypoplastic and nonhypoplastic groups with respect to age, sex, smoking status, or intraoperative procedures. Additionally, there were no significant intergroup differences in mHHS or NAHS improvement at 5 or 10 years postoperatively. Both groups showed high achievement of the mHHS minimal clinically important difference threshold at 10-year follow-up with no significant difference (nonhypoplastic: 90.3% vs hypoplastic: 85.2%, P = .549). There was also no difference achievement of the patient acceptable symptom state (nonhypoplastic: 64.5% vs. hypoplastic: 70.4%, P = .636). However, the hypoplastic group had a significantly higher rate of revision arthroscopy (28.6% vs 9.8%, P = .030) and conversion to total hip arthroplasty (21.4% vs 4.9%, P = .026) when compared with the nonhypoplastic group. CONCLUSIONS:Hypoplastic labral width on preoperative MRI was associated with an increased risk of revision hip arthroscopy and conversion to total hip arthroplasty at 10 year follow-up in patients with FAIS. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative case series.

BACKGROUND/UNASSIGNED:Racial and ethnic disparities are a concern in lung cancer screening. OBJECTIVE/UNASSIGNED:To investigate the performance of risk prediction models to define screening eligibility across 4 U.S. racial and ethnic groups. DESIGN/UNASSIGNED:Cohort study. SETTING/UNASSIGNED:United States, Lung Cancer Cohort Consortium. PARTICIPANTS/UNASSIGNED:641 830 participants aged 50 to 80 years with a smoking history from 12 U.S. cohorts, including 6390 Asian, 9781 Hispanic, 39 872 non-Hispanic Black, and 585 787 non-Hispanic White participants. MEASUREMENTS/UNASSIGNED:Calibration and discrimination were quantified for 16 lung cancer prediction models. Then, screening-related metrics were calculated after applying model thresholds to select the same number of eligible participants as the 2021 criteria from the U.S. Preventive Services Task Force (USPSTF-2021). These included eligibility, sensitivity, and efficiency measured as estimated number needed to screen (NNS; the ratio between participants and lung cancer cases) for each strategy or prediction model in each racial and ethnic group. RESULTS/UNASSIGNED:General patterns across the 16 models included substantial underestimation of lung cancer risk in non-Hispanic Black participants (expected-observed ratio < 0.75 for 11 of 16 models), lower discrimination in Asian participants than all other groups (13 of 16 models), and lower discrimination in non-Hispanic Black than non-Hispanic White participants (15 of 16 models). When a same-sized screening-eligible population as USPSTF-2021 (38.0%) was enforced, all risk-based strategies achieved better average estimated screening efficiency and reduced racial and ethnic differences in efficiency compared with USPSTF-2021. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 (PLCOm2012) and Life Years gained From Screening-Computed Tomography model (LYFS-CT) performed best (mean estimated NNS, 36.5 [SD, 8.8] and 40.1 [SD, 8.2], respectively). However, no strategy could simultaneously optimize eligibility, sensitivity, and efficiency while also reducing racial and ethnic differences. LIMITATION/UNASSIGNED:Smaller sample for Asian and Hispanic participants. CONCLUSION/UNASSIGNED:To optimize efficiency and minimize its variation across racial and ethnic groups, risk-based strategies were superior to USPSTF criteria. Further optimization of prediction models for the diverse U.S. population is needed. PRIMARY FUNDING SOURCE/UNASSIGNED:U.S. National Cancer Institute, Lung Cancer Research Foundation, and Cancer Research UK.

IMPORTANCE/UNASSIGNED:Patient portal messaging volume has increased substantially and is linked to clinician burnout. In response, health systems are increasingly adopting large language models (LLMs) to generate draft replies to patient messages, yet little is known about how patients interpret and evaluate artificial intelligence (AI) involvement in this communication channel. OBJECTIVE/UNASSIGNED:To understand how patients perceive AI-drafted responses to electronic patient portal messages and to identify implications for patient-centered implementation. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This qualitative study used vignette-based prompts mirroring scenarios from a prior survey on patient preferences regarding AI-drafted online messaging. Participants included a sample of 40 adult patients from a large academic health system who had previously been surveyed about AI-drafted portal messaging. Recruitment sought increased representation of individuals from minoritized racial and ethnic groups, older patients, and participants with lower satisfaction with AI-drafted messaging in prior survey responses. Data were collected between April and August 2025. EXPOSURE/UNASSIGNED:One-time interviews conducted via videoconference. Interviews included vignettes and draft messages varying in tone, length, and implied authorship, alongside questions about messaging preferences, AI, and health care. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Patient perspectives regarding (1) portal messaging preferences, (2) comfort with AI-drafted replies, (3) preferred message tone and content, and (4) AI disclosure expectations. RESULTS/UNASSIGNED:This study of 40 patients included 30 women (75.0%), 9 men (22.5%), 14 Black or African American participants (35.0%), 13 White participants (32.5%), and 13 patients aged 65 years or older (32.5%). Patients described portal messaging as transactional, prioritizing timely problem resolution over relational depth. Patients expressed high comfort with AI-drafted messages, conditional on clinician oversight. Patient preferences for tone and expressions of empathy varied across individuals and contexts and were driven less by whether messages appeared AI-like or human-like than by whether tone, length, and detail fit the purpose and stakes of the communication. Participants broadly endorsed AI disclosure, describing transparency as important for trust, but differed in preferred disclosure timing and format. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this qualitative study of patient perspectives on AI-drafted portal messaging, patients supported AI use when it improved communication efficiency, so long as clinicians reviewed and remained accountable for messages. Implementation should prioritize clinician oversight, context-sensitive communication standards, standardized disclosure practices, and monitoring for downstream effects on quality, equity, and patient trust and safety.

Concentrated bone marrow aspirate (cBMA) is an autologous biologic increasingly used in orthopaedic surgery for its regenerative potential. It contains mesenchymal stem cells (MSCs), growth factors, and cytokines that contribute to tissue repair and immunomodulation. Mesenchymal stem cells primarily exert their effects through paracrine signaling and macrophage reprogramming, promoting a shift from a pro-inflammatory (M1) to a reparative (M2) phenotype. Emerging evidence also suggests a role for mitochondrial transfer in this process. In foot and ankle surgery, cBMA has been investigated in the management of osteochondral lesions of the talus, fracture healing, and tendon disorders. Early clinical studies suggest potential improvements in functional outcomes, healing rates, and revision rates; however, the available evidence remains heterogeneous and is largely limited to small, non-randomized studies. Variability in cBMA preparation and reporting further limits comparability across studies. As such, while cBMA represents a promising adjunct in foot and ankle surgery, its clinical role is not yet fully defined. Future research should focus on prospective, controlled studies with standardized methodologies and explore emerging cell-free approaches, including MSC-derived extracellular vesicles, to optimize regenerative strategies.

INTRODUCTION/BACKGROUND:State regulations governing opioid treatment programs (OTPs) vary widely in their restrictiveness, yet how state policies relate to the availability of services offered within OTPs remains understudied. In this study, we compare the availability of medication for opioid use disorder (MOUD) options, psychosocial services, and housing supports across OTPs operating in states with different levels of OTP policy restrictions. METHODS:We conducted a cross-sectional study of 1501 opioid treatment programs (OTPs) in the United States. Exposures included 11 state-level OTP policies that impose legal or administrative barriers to opening or operating OTPs or to patients' receipt of care (e.g., pharmacy licensure requirements, zoning restrictions, government identification requirements, and administrative discharge for positive drug screenings). Data on OTP service offerings-including buprenorphine, naltrexone, all three medications for opioid use disorder, mental health services, contingency management, trauma-informed counseling, and housing services-and organizational characteristics were obtained from the 2023 Mental Health and Addiction Treatment Tracking Repository, a national longitudinal database of licensed substance use disorder treatment facilities. These data were linked to a previously developed state policy typology using latent class analysis, which categorized states as having low or high OTP restrictiveness. Regression models adjusted for state- and organizational-level characteristics and accounted for clustering within states. RESULTS:In descriptive analyses, OTPs in highly restrictive states were significantly less likely (p < 0.05) to offer all three MOUDs and behavioral health services, including mental health services, trauma-informed counseling, and contingency management, compared with OTPs in low-restrictiveness states. In adjusted Poisson regression models, facilities in highly restrictive states were significantly less likely to offer naltrexone (ARR: 0.73; 95% CI: 0.54-0.97) and all three MOUDs (ARR: 0.70; 95% CI: 0.53-0.92). CONCLUSIONS:Given that OTPs are the only facilities in which methadone can be legally dispensed, these facilities are a critical point of access for individuals in need of evidence-based OUD treatment. However, our findings suggest that states that place additional restrictions on OTPs also offer less services within their OTPs.

BACKGROUND/UNASSIGNED:Craniopharyngiomas are rare parasellar tumors, and papillary craniopharyngiomas (PCPs) represent 8 to 20% of cases. DESIGN/UNASSIGNED:Interim analysis of retrospective data collected from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). SETTING/UNASSIGNED:Fourteen U.S.-based academic skull base centers between 2011 and 2023. PARTICIPANTS/UNASSIGNED:Patients with PCPs. MAIN OUTCOME MEASURES/UNASSIGNED:Demographic, imaging, surgical, and outcome variables. RESULTS/UNASSIGNED: CONCLUSIONS/UNASSIGNED:RAPID consortium enabled the largest real-world clinical information dataset for PCPs. Early findings support that GTR and stalk preservation are important to outcomes. Iterative analysis and discussion of data led to the generation of a framework for future studies to fully leverage the capabilities of multicenter registries.

INTRODUCTION/UNASSIGNED:Excess cumulative fluid balance is a common complication impacting critically ill pediatric patients that is associated with worse clinical outcomes. Nevertheless, there are inconsistent practices in recognizing and reducing excess fluid balance. PURPOSE/UNASSIGNED:Assess contextual factors that inform fluid-based practices across four pediatric intensive care units. METHODS/UNASSIGNED:We conducted semi-structured interviews across 4 PICUs from August to October 2025. Through an iterative process informed by prior survey data, we followed the established implementation science Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation and Sustainability Model framework to develop an interview guide. Questions explored fluid balance recognition and reduction. Participants were recruited using purposive sampling via email recruitment. We used Rapid Assessment Procedures with two independent coders. Thematic saturation was reached within the first round of interviews. RESULTS/UNASSIGNED: = 3). Institutions had balanced numbers of interviews. Theme 1 centered on the limitations of data used for fluid balance recognition, namely that these data are affected by patient variability, rely on subjective exam findings, and depend on inaccurate tools. Theme 2 highlighted insufficient emphasis on limiting unnecessary fluid administration. Theme 3 addressed cultural barriers including educational gaps, lack of standardization, entrenched unit practices, and insufficient communication. DISCUSSION/UNASSIGNED:These themes highlight the need for accurate data reporting, shifts in emphasis of fluid management, and cultural/systemic changes. We theorize that these suboptimal approaches to fluid balance management could inform clinical decision support tools, research priorities, and quality improvement initiatives.

Vision-language models (VLMs) have demonstrated remarkable performance across a wide range of computer-vision tasks, sparking interest in their potential for digital health applications. Here, we apply VLMs to two fundamental challenges in data-driven stroke rehabilitation: automatic quantification of rehabilitation dose and impairment from videos. We formulate these problems as motion-identification tasks, which can be addressed using VLMs. We evaluate our proposed framework on 20 healthy controls and 51 stroke survivors. Our results show that current VLMs lack the fine-grained motion understanding required for precise quantification: dose estimates are comparable to a baseline that excludes visual information, and impairment scores cannot be reliably predicted. Nevertheless, several findings suggest future promise. With optimized prompting and post-processing, VLMs can classify high-level activities from a few frames, detect motion and grasp with moderate accuracy, and approximate dose counts within 30% of ground truth for mildly impaired and healthy participants, all without task-specific training or finetuning. These results highlight both the current limitations and emerging opportunities of VLMs for data-driven stroke rehabilitation and broader clinical video analysis.

PURPOSE/OBJECTIVE:To evaluate the effect of baseline dementia on postoperative outcomes in hip fracture patients undergoing hemiarthroplasty. METHODS:A retrospective review was conducted of patients aged 55 years or older who underwent hemiarthroplasty for displaced femoral neck fracture (AO/OTA 31B) between 2012 and 2024 at a large urban academic institution. Dementia was identified by ICD-10 codes and confirmed by chart review. A 3:1 propensity score matched cohort was created using the Score for Trauma Triage in Geriatric and Middle-aged (STTGMA). Demographics and baseline characteristics were compared to ensure similarity. Outcomes included total complications, major and minor complications, periprosthetic dislocation, length of stay, ICU admission, discharge location, 30- and 90-day readmission, revision surgery, inpatient, and 30-day and 1-year mortality. RESULTS:A total of 1,030 patients were included, with 241 patients with dementia and 839 controls. After 3:1 STTGMA propensity matching, baseline characteristics were comparable (mean age 82.75 vs. 83.0 years, P = 0.065; Charlson Comorbidity Index 1.96 vs. 1.92, P = 0.42; STTGMA 0.022 vs. 0.020, P = 0.50). Patients with dementia had increased major complications (17.92% vs. 10.93%, P = 0.013), including sepsis (5.00% vs. 2.21%, P = 0.027), urinary tract infections (13.33% vs. 6.78%, P = 0.002), and hip hemiarthroplasty dislocations (6.25% vs. 2.21%, P = 0.002). Patients with dementia also had longer length of stay (7.84 ± 5.83 vs. 6.80 ± 2.24 days, P = 0.030), increased 30-day readmissions (15.83% vs. 8.85%, P < 0.001), increased 90-day readmission (20.00% vs. 11.76%, P < 0.001), and higher 1-year mortality (16.25% vs. 8.02%, P < 0.001). No differences were observed in pneumonia, stroke, myocardial infarction, cardiac arrest, venothromboembolism, acute kidney injury, anemia, and revision surgery. CONCLUSION/CONCLUSIONS:Dementia was associated with increased major complications, hip hemiarthroplasty dislocations, higher readmission, and mortality after hemiarthroplasty. These findings highlight the need for targeted perioperative planning and multidisciplinary care pathways in cognitively impaired patients.