Assessment and Management of the High-Risk Dental Patient with Active Substance Use Disorder.

Every dentist cares for patients with a history of substance use disorder (SUD), regardless of a patient's socioeconomic status, education, or ethnicity. SUD is a global epidemic, with approximately 8% of the general US population meeting diagnostic criteria for a SUD and more than 20% of the global population experiencing a SUD. The importance of understanding how to identify substance use, manage patients with a SUD, and offer appropriate referral is essential for all dental professionals.

A decision analysis of treatment strategies for acute periprosthetic joint infection: Early irrigation and debridement versus delayed treatment based on organism.

Objective: The purpose of this study was to investigate whether immediate or delayed tailored DAIR treatment based on microbial species is the optimal treatment for acute post-operative periprosthetic joint infection (PJI).

Methods: A multicenter retrospective study was conducted to identify patients who underwent debridement, antibiotics, and implant retention (DAIR) for PJI. Decision analysis modeling was employed to determine the treatment strategy that yielded the greatest patient outcome.

necrotizing fasciitis following elective surgery.

Necrotizing fasciitis is a potentially fatal soft tissue infection that requires prompt clinical suspicion, pharmacological and surgical interventions. Bacterial pathogens, such as beta-hemolytic streptococcus and , are the main etiology of necrotizing fasciitis, however, rare cases caused by fungal pathogens, such as , have been reported following trauma. Here, we present the first case of necrotizing fasciitis following an elective surgical procedure in an immunocompetent adult.

Utility of Volumetric Measurement via Weight-Bearing Computed Tomography Scan to Diagnose Syndesmotic Instability.

Background: Weight-bearing computed tomography (WBCT) allows evaluation of the distal syndesmosis under physiologic load. We hypothesized that WBCT volumetric measurement of the distal syndesmosis would be increased on the injured as compared to the contralateral uninjured side and that these 3-dimensional (3D) calculations would be a more sensitive determinant than 2-dimensional (2D) methodology among patients with syndesmotic instability.

Methods: Twelve patients with unilateral syndesmotic instability requiring operative fixation who underwent preoperative bilateral foot and ankle WBCT were included in the study group.

Three-Year Efficacy and Safety of the Misago Peripheral Stent for Superficial Femoral Artery Disease: Final Results from the OSPREY Trial.

Purpose: This study evaluated the long-term outcomes of the Misago peripheral stent trial (Terumo) for atherosclerotic lesions in the superficial femoral artery (SFA) in patients with claudication.

Materials And Methods: This was a prospective multicenter, single-arm, clinical trial of primary stent placement for de novo cases of SFA disease conducted in the United States and Asia. The primary endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) at 36 months.

Diagnosing endometriosis before laparoscopy: radiologic tools to evaluate the disease.

Purpose Of Review: The current gold standard for diagnosing endometriosis is laparoscopy with tissue biopsy. This review presents new evidence regarding advanced imaging for more optimal clinical assessment and preoperative evaluation for endometriosis.

Recent Findings: A systematic approach to the imaging evaluation of endometriosis using transvaginal ultrasound and magnetic resonance imaging has been proposed by expert groups and societies.

ACR Appropriateness Criteria® Crohn Disease.

Three common clinical scenarios involving use of imaging in Crohn disease are covered. These include the initial evaluation of Crohn disease when the diagnosis has not been previously established, the evaluation for anticipated exacerbation of known disease, and the evaluation of disease activity during therapy monitoring. The appropriateness of a given imaging modality for each scenario is rated as one of three categories (usually appropriate, may be appropriate, usually not appropriate) to help guide evaluation.

Legacy Genetic Testing Results for Cancer Susceptibility: How Common are Conflicting Classifications in a Large Variant Dataset from Multiple Practices?

Purpose: The classification of germline variants may differ between labs and change over time. We apply a variant harmonization tool, Ask2Me VarHarmonizer, to map variants to ClinVar and identify discordant variant classifications in a large multipractice variant dataset.

Methods: A total of 7496 variants sequenced between 1996 and 2019 were collected from 11 clinical practices.

Development of machine learning and natural language processing algorithms for preoperative prediction and automated identification of intraoperative vascular injury in anterior lumbar spine surgery.

Background: Intraoperative vascular injury (VI) may be an unavoidable complication of anterior lumbar spine surgery; however, vascular injury has implications for quality and safety reporting as this intraoperative complication may result in serious bleeding, thrombosis, and postoperative stricture.

Purpose: The purpose of this study was to (1) develop machine learning algorithms for preoperative prediction of VI and (2) develop natural language processing (NLP) algorithms for automated surveillance of intraoperative VI from free-text operative notes.

Patient Sample: Adult patients, 18 years or age or older, undergoing anterior lumbar spine surgery at two academic and three community medical centers were included in this analysis.

Short-Term Clinical Outcomes of a Conical Prosthesis Used in Revision Total Hip Arthroplasty.

Introduction: Although primary total hip arthroplasty (THA) stem designs have evolved from conventional lengths to shorter lengths, revision stems have not undergone a similar change. Tapered, conical prostheses have performed well in primary THA, however their use in revision THA has not been thoroughly investigated. Our purpose was to report the short-term radiographic and clinical outcomes of the Wagner Cone Prosthesis® (Zimmer Biomet, Warsaw, Indiana) in revision THA.

There are isoheight points that measure constant femoral condyle heights along the knee flexion path.

Purpose: It is a challenge to evaluate the maintenance of medial and lateral soft tissue balance in total knee arthroplasty (TKA). This study aimed to determine the "isoheight" points and the "isoheight" axis (IHA) that can measure constant medial/lateral condyle heights during flexion of the knee, and compare the IHA with two major anatomical axes, the transepicondylar axis (TEA) and the geometric center axis (GCA).

Methods: Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging system while performing a single-legged lunge (0°-120°).

Clinical staging in pancreatic adenocarcinoma underestimates extent of disease.

Background/objectives: We sought to identify the reliability of AJCC clinical staging was in comparison to pathologic staging in surgically resected patients with pancreatic cancer.

Methods: We used the National Cancer Database Pancreas from 2004 to 2016 and evaluated patients who underwent resection for PDAC with all documented components of clinical and pathologic stage. We first evaluated the distribution of overall clinical stage and pathologic stage and then evaluated for stage migration by assessing the number of patients who shifted from a clinical stage group to a respective pathologic stage group.

Opioid Stewardship Program and Postoperative Adverse Events: A Difference-in-differences Cohort Study.

Background: A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals.

Methods: Outcomes were extracted from medical records for 12 months before and after the intervention start date.

Use of immunotherapy and surgery for stage IV melanoma.

Background: Immunotherapy for stage IV melanoma has dramatically changed the overall prognosis and treatment strategies. The aim of this study was to evaluate whether changes in systemic immunotherapy options have significantly altered surgical resection rates for patients with stage IV melanoma.

Methods: The National Cancer Database (2004-2015) was used to perform a difference-in-difference analysis to evaluate whether the rate of surgical resection of metastatic disease for stage IV melanoma differed with the use of immunotherapy in the checkpoint inhibitor era in comparison with the use of immunotherapy in the pre-checkpoint inhibitor era.

Can natural language processing provide accurate, automated reporting of wound infection requiring reoperation after lumbar discectomy?

Background: Surgical site infections are a major driver of morbidity and increased costs in the postoperative period after spine surgery. Current tools for surveillance of these adverse events rely on prospective clinical tracking, manual retrospective chart review, or administrative procedural and diagnosis codes.

Purpose: The purpose of this study was to develop natural language processing (NLP) algorithms for automated reporting of postoperative wound infection requiring reoperation after lumbar discectomy.

Socioeconomic determinants of the surgical treatment of colorectal liver metastases.

Objective: We hypothesized that differences in resection rates of colorectal liver metastases exist based on socioeconomic status (SES) inequalities.

Methods: The NCDB was utilized to study patients of different median household income diagnosed with colon adenocarcinoma from 2010 to 2015.

Results: A total of 21,258 patients met inclusion criteria, of whom 3,587 (16.

Tibial Stress Fracture Following Ankle Arthrodesis.

Background: End-stage ankle arthritis is frequently treated with either tibiotalar or tibiotalocalcaneal (TTC) arthrodesis, but the inherent loss of accommodative motion increases mechanical load across the distal tibia. Rarely, patients can go on to develop a stress fracture of the distal tibia without any antecedent traumatic event. The purpose of this study was to determine the incidence of tibial stress fracture after ankle arthrodesis, highlight any related risk factors, and identify the effectiveness of treatment strategies and their healing potential.

SCAI publications committee manual of standard operating procedures.

Evidence-based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society's education, advocacy, and quality improvement initiatives.

Catastrophic Failure of a MiniHip Femoral Stem: A Case Report.

Case: The patient is a 63-year-old man who previously underwent a right total hip arthroplasty with the Corin MiniHip femoral stem. Within the first few months postoperatively, he had a fall that resulted in subsidence of his femoral prosthesis and subsequent revision shortly thereafter with a 10-mm skirted cobalt chrome femoral head. Eight years after the index procedure, the patient heard a crack and then collapsed while putting on bicycle shorts.