Artificial Intelligence in Predicting Microsatellite Instability and KRAS, BRAF Mutations from Whole-Slide Images in Colorectal Cancer: A Systematic Review.

Mismatch repair deficiency (d-MMR)/microsatellite instability (MSI), , and mutational status are crucial for treating advanced colorectal cancer patients. Traditional methods like immunohistochemistry or polymerase chain reaction (PCR) can be challenged by artificial intelligence (AI) based on whole slide images (WSI) to predict tumor status. In this systematic review, we evaluated the role of AI in predicting MSI status, , and mutations in colorectal cancer.

Methodology for Online Reliability Studies: A Primer for Orthopedic Surgeons.

In orthopedic surgery, there is an increasing number of papers about online studies on the reliability of classification systems. Useful classification systems need to be reliable and valid. Measurement of validity can be variable and is prone to observer bias.

Towards evidence based plastic surgery; how a national research agenda can unite research.

We describe the development of the Research Agenda of the Dutch Society for Plastic Surgery, supported and democratically created by plastic surgeons, patients, and other stakeholders. The agenda contains the 10 most relevant knowledge gaps encountered in clinical practice, as prioritized by the abovementioned groups. The aim is to stimulate national collaborations and research networks to initiate trials to answer these knowledge gaps.

Variation in Treatment for Trapeziometacarpal Arthrosis.

Background: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis.

Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis.

Symptoms of Burnout Among Surgeons Are Correlated with a Higher Incidence of Perceived Medical Errors.

Background: Nearly 44% of practicing physicians in the USA report symptoms of burnout. Psychological distress and loss of joy in medicine are associated with malpractice lawsuits and attrition from medical practice and may correlate with the rate of perceived medical errors.

Questions/purposes: We sought to answer two questions: (1) What physician factors are associated with the number of perceived medical errors among practicing surgeons in the prior 3 months? (2) What characteristics are associated with symptoms of burnout among practicing surgeons?

Methods: We created a cross-sectional survey and invited members of the Science of Variation Group to respond between December 2018 and January 2019.

Interdisciplinary consensus of virtual monochromatic dual-energy CT images: is there discrepancy in preferred photon energy between surgeons and radiologists for the assessment of non-unions?

Aim: To investigate possible differences between surgeons and radiologists in selecting optimal photon energy settings from a set of virtual monochromatic dual-energy computed tomography (CT) images for the assessment of bone union in patients with a suspected non-union of the appendicular skeleton.

Materials And Methods: Fifty patients suspected of having bone non-union after operative fracture treatment with a variety of fixation implants were included. Patients were scanned on a dual-source CT machine using 150/100-kVp.

Dorsal Subluxation of the Proximal Interphalangeal Joint After Volar Base Fracture of the Middle Phalanx.

Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with subluxation of these fractures. In this retrospective chart review, 413 volar base fractures of the middle phalanx were included.

Do Patient Preferences Influence Surgeon Recommendations for Treatment?

Background: When the best treatment option is uncertain, a patient's preference based on personal values should be the source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation in treatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patient preferences.

Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operative treatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.

Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions.

Background: In orthopaedic surgery, there is known surgeon-to-surgeon variation in recommendations for surgery. Variation in recommendations for nonsurgical treatment of common upper extremity conditions for which surgery is discretionary remains unclear.

Methods: One hundred eighty-three surgeons were included after completing six questions on six scenarios of upper extremity conditions regarding nonsurgical treatment recommendations.

Reliability of Diagnosis of Partial Union of Scaphoid Waist Fractures on Computed Tomography.

Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers.

Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures.

 Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable.  A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures.

How Reliable is the Radiographic Diagnosis of Mild Madelung Deformity?

 Patients with Madelung deformity exhibit a spectrum of mild to severe deformity and distortion of wrist geometry. It may be difficult to reliably distinguish mild Madelung deformity from normal.  This study thus tested the reliability of the diagnosis of mild Madelung deformity on a single posteroanterior (PA) radiograph.

Management of metastatic humeral fractures: Variations according to orthopedic subspecialty, tumor characteristics.

Hypothesis: This study assessed, if there was a difference in surgical decision making for metastatic humeral lesions based on; orthopaedic subspecialty, tumor characteristics.

Study Type: Cross sectional survey study.

Materials And Methods: Twenty-four case scenarios were created by combining: tumor type, life expectancy, fracture type, and anatomical location.

Interobserver Agreement in Diagnosing Early-Stage Kienböck Disease on Radiographs and Magnetic Resonance Imaging.

Background: The appearance of early Kienböck disease on radiographs and magnetic resonance imaging (MRI) may be difficult to distinguish from other conditions that affect the lunate. We aimed to assess the interobserver agreement in the diagnosis of early Kienböck disease when evaluated on different imaging modalities.

Methods: Forty-three hand surgeon members of the Science of Variation Group were randomized to evaluate radiographs and 35 hand surgeons to evaluate radiographs and MRI scans of 26 patients for the presence of Kienböck disease, the lunate type, and the ulnar variance.

Does a Comparison View Improve the Reliability of Staging Wrist Osteoarthritis?

Background: Radiological grading of wrist osteoarthritis associated with scaphoid nonunion advanced collapse (SNAC) can be difficult. A comparison radiograph of the contralateral healthy wrist and an educational training in the various SNAC stages may improve reliability. Our purposes were to evaluate the difference in the reliability: (1) between observers who rate SNAC wrists with and without a comparison radiograph; and (2) between observers who receive training prior to ratings and those who do not.

How do Orthopaedic Surgeons Address Psychological Aspects of Illness?

Background: Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons' attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment.

Online Studies on Variation in Orthopedic Surgery: Computed Tomography in MPEG4 Versus DICOM Format.

The purpose of this study was to compare the observer participation and satisfaction as well as interobserver reliability between two online platforms, Science of Variation Group (SOVG) and Traumaplatform Study Collaborative, for the evaluation of complex tibial plateau fractures using computed tomography in MPEG4 and DICOM format. A total of 143 observers started with the online evaluation of 15 complex tibial plateau fractures via either the SOVG or Traumaplatform Study Collaborative websites using MPEG4 videos or a DICOM viewer, respectively. Observers were asked to indicate the absence or presence of four tibial plateau fracture characteristics and to rate their satisfaction with the evaluation as provided by the respective online platforms.

The Effect of Two Factors on Interobserver Reliability for Proximal Humeral Fractures.

Introduction: The purpose of this study was to assess whether training observers and simplifying proximal humeral fracture classifications improve interobserver reliability among a large number of orthopaedic surgeons.

Methods: One hundred eighty-five observers were randomized to receive training or no training in a simple classification for proximal humeral fractures before evaluating preoperative radiographs of a consecutive series of 30 patients who were treated with open reduction and internal fixation.

Results: The overall interobserver reliability of the simple proximal humeral fracture classification system was low and not significantly different between the training and the no training group (κ = 0.

Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians.

Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict.

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation.

Purpose: Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

Coaching of patients with an isolated minimally displaced fracture of the radial head immediately increases range of motion.

Study Design: Prospective cohort.

Introduction: Elbow stiffness is the most common adverse event after isolated radial head fractures.

Purpose Of The Study: To assess the effect of coaching on elbow motion during the same office visit in patients with such fractures.

Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout.

Background: Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions.

6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures.

Introduction: Six week follow-up radiographs are a common reference standard for the diagnosis of suspected scaphoid fractures. The main purpose of this study was to evaluate the interobserver reliability and diagnostic performance characteristics of 6-weeks radiographs for the detection of scaphoid fractures. In addition, two online techniques for evaluating radiographs were compared.