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Background: Digit amputations affect 45,000 Americans each year and are associated with substantial healthcare expenditures and loss of wages. Few patient-reported outcome measures (PROMs) are validated in patients with digit amputations. The brief Michigan Hand Outcomes Questionnaire (bMHQ) is a 12-item PROM used in several hand conditions. However, its psychometric properties have not been investigated in patients with digit amputations. Methods: The reliability and validity of the bMHQ was investigated using Rasch analysis. Data were collected from the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE) study. Participants were divided into replantation and revision amputation cohorts and then further separated into single-digit amputation (excluding thumb), thumb-only amputation and multiple-digit amputation (excluding thumb) subgroups. Each of the six subgroups were analysed for item fit, threshold ordering, targeting, differential item functioning (DIF), unidimensionality and internal consistency. Results: All treatment groups demonstrated high unidimensionality (Martin-Löf test = 1) and internal consistency (Cronbach's α > 0.85). The bMHQ is not a reliable PROM in individuals with single-digit or multiple-digit amputations. The aesthetics, satisfaction and two-handed activities of daily living (ADLs) items had the poorest fit to the Rasch model across all categories. Conclusions: The bMHQ is not well-suited for measuring outcomes in patients with digit amputations. We recommend clinicians use more comprehensive assessment tools, such as the complete MHQ, to measure outcomes in these complex patient populations. Level of Evidence: Level III (Diagnostic)

BACKGROUND The Michigan Hand Outcomes Questionnaire is a patient-reported outcome measure that has been validated in many upper extremity disorders using classic test theory. Rasch measurement analysis is a rigorous method of questionnaire validation that offers several advantages over classic test theory and was used to assess the psychometric properties of the Michigan Hand Outcomes Questionnaire. This study used Rasch analysis to evaluate the questionnaire for distal radius fractures in older adults. The incidence and costs of distal radius fractures are rising, and reliable assessment tools are needed to measure outcomes in this growing concern. METHODS Rasch analysis was performed using 6-month assessment data from the Wrist and Radius Injury Surgical Trial. Each domain in the Michigan Hand Outcomes Questionnaire was independently analyzed for threshold ordering, person-item targeting, item fit, differential-item functioning, response dependency, unidimensionality, and internal consistency. RESULTS After collapsing disordered thresholds and removing any misfitting items from the model, five domains (Function, Activities of Daily Living, Work, Pain, and Satisfaction) demonstrated excellent fit to the Rasch model. The Aesthetics domain demonstrated high reliability and internal consistency but had poor fit to the Rasch model. CONCLUSIONS Rasch analysis further supports the reliability and validity of using the Michigan Hand Outcomes Questionnaire to assess hand outcomes in older adults following treatment for distal radius fractures. Results from this study suggest that questionnaire scores should be interpreted in a condition-specific manner, with more emphasis placed on interpreting individual domain scores, rather than the summary Michigan Hand Outcomes Questionnaire score.

ImportanceCasting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age.ObjectiveTo examine how chronologic age compares with measures of physiologic age in DRF treatment recovery.Design, Setting, and ParticipantsThis retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016.InterventionsParticipants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Participants were stratified by chronologic age, number of comorbidities, and activity status.Main Outcomes and MeasuresThe primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. Partial correlation (PC) analysis adjusted for confounding.ResultsThe final cohort consisted of 293 participants (mean [SD] age, 71.1 [8.89] years; 255 [87%] female; 247 [85%] White), with 109 receiving casting and 184 receiving surgery. Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean [SD] score, −0.46 [0.21]; P = .03). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean [SD] score, 12.21 [5.18]; PC = 0.27; P = .02) and 12 months (mean [SD] score, 13.25 [5.77]; PC = 0.17; P = .02). Comorbidities were associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years.Conclusions and RelevanceIn this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting.Trial RegistrationClinicalTrials.gov Identifier: NCT01589692

Key Points Question What is the association between the Patient Protection and Affordable Care Act’s state-specific Medicaid expansion and the use of autologous breast reconstruction? Findings In this national cross-sectional study of 45 850 patients who underwent mastectomy and 9215 patients who received autologous breast reconstruction, although the proportion of patients undergoing autologous breast reconstruction increased from 18.1% to 23.0% over the study period, Medicaid expansion was associated with significantly decreased odds of undergoing reconstruction for African American, Hispanic, Asian, and Native American patients. Meaning Medicaid expansion was associated with decreased odds of autologous reconstruction for African American, Hispanic, and other patients with minority race/ethnicity., This cross-sectional study investigates the association between Medicaid expansion and autologous breast reconstruction rates among women who underwent mastectomy., Importance Despite demonstrated psychosocial benefits, autologous breast reconstruction remains underutilized. An analysis of the association between Medicaid expansion and autologous breast reconstruction has yet to be performed. Objective To compare autologous breast reconstruction rates and determine the association between Medicaid expansion and breast reconstruction. Design, Setting, and Participants A retrospective cross-sectional study was performed using the State Inpatient Database from January 1, 2012, through September 30, 2015, and included 51 340 patients. Patients were identified using the International Classification of Diseases, Ninth Revision, codes for breast cancer, mastectomy, and autologous breast reconstruction. Data from states that expanded Medicaid (New Jersey, New York, and Washington) were compared with states that did not expand Medicaid (Florida, North Carolina, and Wisconsin). Data were analyzed from June 1, 2020, through February 28, 2021. Exposures The Patient Protection and Affordable Care Act’s Medicaid expansion was implemented in 2014; the preexpansion period ranged from 2012 to 2013 (2 years), whereas the postexpansion period ranged from 2014 to 2015 quarter 3 (1.75 years). Main Outcomes and Measures Primary outcomes included use of autologous breast reconstruction before and after expansion. Independent covariates included patient demographics, comorbidities, and state of residence. Results Among 45 850 patients who underwent mastectomy and 9215 patients who received autologous breast reconstruction, 36 777 (67%) were White and 32 205 (59%) had private insurance. The use of immediate or delayed autologous reconstruction increased from 18.1% (4951 of 27 290) to 23.0% (4264 of 18 560) throughout the study period. Compared with 2012, the odds of reconstruction were 64% higher in 2015 (odds ratio [OR], 1.64; 95% CI, 1.48-1.80; P

Light-activated theranostics offer promising opportunities for disease diagnosis, image-guided surgery, and site-specific personalized therapy. However, current fluorescent dyes are limited by low brightness, high cytotoxicity, poor tissue penetration, and unwanted side effects. To overcome these limitations, we demonstrate a platform for optoelectronic tuning, which allows independent control of the optical properties from the electronic properties of fluorescent organic salts. This is achieved through cation-anion pairing of organic salts that can modulate the frontier molecular orbital without impacting the bandgap. Optoelectronic tuning enables decoupled control over the cytotoxicity and phototoxicity of fluorescent organic salts by selective generation of mitochondrial reactive oxygen species that control cell viability. We show that through counterion pairing, organic salt nanoparticles can be tuned to be either nontoxic for enhanced imaging, or phototoxic for improved photodynamic therapy.