Faculty Bibliography

Introduction The COVID-19 pandemic has exacerbated known risk factors for mental health deterioration, including economic instability, social isolation, and uncertainty, while also disrupting access to mental healthcare. Suicide remains a major public health concern in the United States, and self-inflicted injuries, although a minority of emergency department presentations, are associated with high morbidity and mortality. Objective This study examines whether the number of trauma evaluations related to violent suicide attempts or self-harm increased during the pandemic compared to pre-pandemic levels. Materials and methods We conducted a retrospective review of trauma registry data from one Level 1 and one Level 2 trauma center within Bon Secours Mercy Health, a regional hospital system. The pre-pandemic period extended from September 1, 2018, through February 29, 2020, and the pandemic period extended from March 1, 2020, through August 31, 2021. Adults aged 18 years or older who underwent trauma evaluation for a suicide attempt or self-harm were included. Patients younger than 18 years and those pronounced dead on arrival were excluded. The primary outcome was the number of trauma evaluations resulting from suicide attempts or self-harm. The secondary outcome was in-hospital mortality among patients who arrived alive and underwent trauma evaluation. Data were analyzed using two-tailed Wilcoxon two-sample tests, chi-square tests, and Fisher's exact tests, as appropriate. Crude risk ratios with 95% confidence intervals were calculated for in-hospital mortality and ICU admission. Results A total of 147 trauma evaluations occurred among 129 unique patients during the study period. The pre-pandemic period included 76 evaluations among 61 unique patients, whereas the pandemic period included 71 evaluations among 68 unique patients, representing five fewer evaluations during the pandemic period. No patient underwent a qualifying trauma evaluation during both study periods. In-hospital mortality was 18.0% before the pandemic and 22.1% during the pandemic, corresponding to a crude risk ratio of 1.22 (95% CI, 0.61-2.46). ICU admission occurred in 42.6% of pre-pandemic patients and 50.0% of pandemic patients, corresponding to a crude risk ratio of 1.17 (95% CI, 0.81-1.71). Conclusion The pandemic period included slightly fewer trauma evaluations than the pre-pandemic period. No statistically significant differences were observed in the measured patient-level characteristics or in-hospital mortality between the study periods. Although the point estimates for in-hospital mortality and ICU admission rose slightly during the pandemic, the large confidence intervals reflected considerable uncertainty and prevented any conclusion that the periods were comparable. Repeat evaluations demonstrated continued utilization of trauma-system resources by a subset of patients. Larger multicenter studies are warranted to further evaluate temporal patterns in suicide-related trauma presentations.

BACKGROUND/UNASSIGNED:Non-tobacco nicotine dependence (NTND) from products like electronic cigarettes and pouches is rapidly rising. Smoking can negatively impact outcomes following arthroscopic partial meniscectomy (APM), but literature on NTND is sparse. The purpose of this study was to compare outcomes following APM in patients with and without NTND. MATERIALS AND METHODS/UNASSIGNED:The TriNetX database was queried to identify patients older than 18 years who underwent isolated primary APM. Patients were stratified into 2 cohorts based on NTND history and underwent 1:1 propensity score matching on demographics, substance use, and comorbidities. Outcomes included (1) postoperative complications and health care use within 90 days, (2) opioid prescriptions within 1 year, and (3) subsequent knee surgery within 2 years. Subgroup analyses compared ipsilateral revision meniscus surgery rates and opioid prescriptions in opioid-naive patients. RESULTS/UNASSIGNED:< .001) but no differences in revision rates. CONCLUSION/UNASSIGNED:NTND is associated with higher rates of health care use, complications, subsequent meniscus surgery, and opioid prescriptions, including among opioid-naive patients, following APM. Preoperative nicotine screening and patient education are warranted.

BACKGROUND/UNASSIGNED:High rates of osteoarthritis have been reported after partial and total meniscectomy, attributed to increased joint contact stresses in meniscus-deficient knees. Meniscal allograft transplantation (MAT) with hybrid root fixation has emerged as a treatment for meniscal deficiency, combining the advantages of bony and all-soft-tissue techniques. INDICATIONS/UNASSIGNED:MAT is best suited for patients <55 years with symptomatic meniscal deficiency and may require correction of modifiable factors, such as obesity, malalignment, instability, or cartilage loss, before the procedure. TECHNIQUE DESCRIPTION/UNASSIGNED:A size-matched fresh-frozen meniscal allograft is prepared with meticulous preservation of 1 to 2 mm bony wafers at the anterior and posterior roots to maintain meniscal length and enhance fixation. Diagnostic arthroscopy was performed to debride residual tissue and prepare a bleeding cancellous bed for graft integration. Posterior and anterior root tunnels were created using an anterior cruciate ligament tibial guide, enabling precise shuttle and anatomic graft positioning. All inside sutures are used to fixate the meniscus. Final fixation was achieved by tensioning the wafer-root sutures through transtibial tunnels and securing them over cortical buttons at 60° of knee flexion to optimize graft stability. RESULTS/UNASSIGNED:Long-term outcomes of MAT are favorable, with a systematic review of 688 cases (mean age, 33 years) reporting 74% survivorship at 10 years and 60% at 15 years, improved postoperative International Knee Documentation Committee (IKDC) scores, and similar results between bony (53.8%) and suture-only (46.2%) fixation techniques. A recent meta-analysis of 25 studies found graft extrusion to be common but generally comparable between fixation methods, with some evidence suggesting slightly less extrusion with bony fixation. DISCUSSION/CONCLUSION/UNASSIGNED:Hybrid root fixation for medial meniscal allograft transplantation provides increased fixation flexibility with the advantages of bone-to-bone healing. PATIENT CONSENT DISCLOSURE STATEMENT/UNASSIGNED:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

BACKGROUND:Anterior cruciate ligament (ACL) ruptures are among the most common knee injuries and impose a substantial health burden. ACL injuries are common, and meniscal tears frequently co-occur with acute ACL ruptures, most often involving the medial meniscus. Proper management of combined ACL and meniscus injuries is critical to restore knee function and prevent long-term degeneration. Although concurrent meniscal repair with ACL reconstruction (ACLR) is increasingly favoured over meniscectomy, reported patient-reported outcomes remain inconsistent across registries and are drawn largely from retrospective, Western cohorts, leaving uncertainty about short-term recovery in prospectively followed South Asian populations. METHODS:We conducted a single-centre prospective observational study of 115 consecutive patients (mean age = 31.3 ± 10.5 years; range = 17-58) undergoing arthroscopic ACLR with concurrent meniscal repair. All patients were assessed preoperatively and postoperatively at six weeks, three months, and six months using the visual analogue scale (VAS) for pain, the Lysholm Knee Score, and the International Knee Documentation Committee (IKDC) subjective score. Because the Shapiro-Wilk test showed all outcome variables were non-normally distributed at every time point (p < 0.05), non-parametric methods were used: the Friedman test assessed overall change across the four time points, and Wilcoxon signed-rank tests (Bonferroni-corrected) compared each postoperative time point with baseline. Data are summarised as median (interquartile range, IQR); effect sizes are Kendall's W (Friedman) and r (Wilcoxon). A two-tailed p < 0.05 was considered significant. RESULTS:Of 115 patients, 92 (80.0%) were male, and 23 (20.0%) were female; medial meniscus tears were present in 61 (53.0%), lateral in 39 (33.9%), and combined medial-lateral in 15 (13.0%). All 115 patients completed six-month follow-up with no losses to follow-up, and no intraoperative or postoperative complications (infection, graft failure, or re-tear) were observed. VAS pain improved from a median of 4.0 (IQR = 3.0-5.0) preoperatively to 0.0 (0.0-0.0) at six months (Friedman χ²(3) = 298.7, p < 0.001; Wilcoxon vs. preoperatively p < 0.001, r = 0.87). The Lysholm score improved from 66.0 (60.0-73.0) to 94.0 (94.0-94.0) (Friedman χ²(3) = 292.3, p < 0.001; r = 0.86 at six months). The IKDC subjective score transiently declined at six weeks (median = 42.5 vs. 44.8 preoperatively, p < 0.001) before improving to 77.0 (72.4-81.6) at six months (Friedman χ²(3) = 278.1, p < 0.001; r = 0.87). All pairwise comparisons against baseline were significant except the Lysholm score at six weeks (p ≈ 0.05). CONCLUSION/CONCLUSIONS:In this single-arm prospective cohort, arthroscopic ACLR with concurrent meniscal repair was associated with significant improvements in pain and patient-reported knee function over six months, with no observed complications. Because the study lacked a comparison group, these findings demonstrate favourable within-cohort outcomes and suggest that incorporating meniscal repair into ACLR does not appear to compromise short-term recovery; they cannot establish the efficacy or comparative effectiveness of the intervention. Further comparative and longitudinal studies are warranted.

PURPOSE/UNASSIGNED:To evaluate the effects of medial open-wedge high tibial osteotomy (MOWHTO) combined with arthroscopic partial meniscectomy (APM) on spatiotemporal gait parameters and plantar pressure distribution in patients with varus knee osteoarthritis (KOA). METHODS/UNASSIGNED:A prospective study was conducted including 25 patients with medial compartment KOA who underwent MOWHTO combined with APM and 25 healthy controls. Gait parameters and plantar pressure were recorded preoperatively and 4 months postoperatively using the Zebris FDM pressure platform. Radiographic parameters-including the femorotibial angle (FTA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBLR), and tibial plafond inclination (TPI)-as well as clinical scores (VAS, HSS, WOMAC, and Lysholm) were assessed. RESULTS/UNASSIGNED:Postoperative radiographic parameters and clinical scores significantly improved (P < 0.001). Stride length (P < 0.05), gait velocity, and affected-limb stance duration (P < 0.01) increased. COP path length (P < 0.001) and gait temporal symmetry indices (P < 0.01) decreased. Radiographic correction correlated with plantar-pressure variables (P < 0.05). Medial forefoot (M1) and medial heel (HM) contact time and peak pressure also increased (P < 0.05). CONCLUSION/UNASSIGNED:MOWHTO combined with APM was associated with improvements in lower-limb alignment, gait performance, plantar-pressure distribution, and gait symmetry during the short-term postoperative period.

Randomized controlled trials (RCTs) often include subgroup analyses to assess whether treatment effects vary across prespecified patient populations. However, these analyses frequently suffer from small sample sizes, which limit the power to detect heterogeneous effects. Power can be improved by leveraging predictors of the outcome-that is, through covariate adjustment-as well as by borrowing external data from similar RCTs or observational studies. The benefits of covariate adjustment may be limited when the trial sample is small. Borrowing external data can increase the effective sample size and improve power, but it introduces two key challenges: (i) integrating data across sources can lead to model misspecification, and (ii) practical violations of the positivity assumption-where the probability of receiving the target treatment is near zero for some covariate profiles in the external data-can lead to extreme inverse-probability weights and unstable inferences, ultimately negating potential power gains. To account for these shortcomings, we present an approach to improving power in preplanned subgroup analyses of small RCTs that leverages both baseline predictors and external data. We propose de-biased estimators that accommodate parametric, machine learning (ML), and nonparametric Bayesian methods. To address practical positivity violations (PPVs), we introduce three estimators: A covariate-balancing approach, an automated de-biased machine learning (DML) estimator, and a calibrated-DML estimator. We show improved power in various simulations and offer practical recommendations for the application of the proposed methods. Finally, we apply them to evaluate the effectiveness of citalopram for negative symptoms in first-episode schizophrenia (FES) patients across subgroups defined by duration of untreated psychosis (DUP), using data from two small RCTs.

OBJECTIVE/UNASSIGNED:To test whether AI-generated, clinician-edited after-visit summaries (AVS) are more patient-friendly than clinician-generated AVS, without compromising safety, when implemented in a live inpatient setting. PATIENTS AND METHODS/UNASSIGNED:grade reading levels, and presence of a "simplified" description of both the diagnosis and treatment/interventions. Our composite outcome was positive if all 3 of these outcomes were positive. We also surveyed patients, nurses, and clinicians on perceptions of safety, empathy, and understandability. RESULTS/UNASSIGNED:grade than the control group (8.5 vs 10.6, P <.001). The AI-generated, clinician-edited AVS were also more likely to contain simplified explanations of diagnoses (96.7% vs 12.9%, P <.001) and hospital interventions (86.7% vs 12.9%, P <.001). Our composite outcome favored AI-generated, clinician-edited summaries (13.3% vs 6.5%, p = 0.637). CONCLUSION/UNASSIGNED:In this small, randomized trial, exploratory and component measures suggest improved patient-friendliness in AI-generated, clinician-edited AVS, although no significant difference was observed in the primary outcome. CLINICALTRIALSGOV NUMBER/UNASSIGNED:NCT06711458.

Patients with chronic or end stage kidney disease often require multiple medications as part of their treatment regimen. The role of nephrology nurses in medication administration is to follow the five rights of medication administration, ensure all medication-related education is completed, and provide patient safety that enhances the delivery of quality care. By adding a medication and barcode scanning process in our outpatient dialysis units, we are demonstrating a solid commitment to accuracy and engagement in patient safety processes. Just as there is a need in the hospital for safety parameters for medication administration, medication safety strategies need to be implemented in outpatient settings. This approach helps minimize the risk of medication errors and adverse medication errors caused by polypharmacy and drug interactions.