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2. Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials.

Author

Pechero, Guillermo, Pfaff, Branden, Rao, Mayank, Pogorzelski, David, McKay, Paula, Spicer, Ella, Howe, Andrea, Demyanovich, Haley K, Sietsema, Debra L, McTague, Michael F, Ramsey, Lolita, Holden, Martha, Rudnicki, Joshua, Wells, Jeff, Medeiros, Michelle, Slobogean, Gerard P, Sprague, Sheila, PREP-IT Investigators, Wells, Jeffrey, Bhandari, Mohit, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core, Patient Centred Outcomes Core, Orthopaedic Surgery Core, Operating Room Core, Infectious Disease Core, Military Core, PREP-IT Clinical Sites, O'Toole, Robert V, D'Alleyrand, Jean-Claude, Eglseder, Andrew, Johnson, Aaron, Langhammer, Christopher, Lebrun, Christopher, Manson, Theodore, Nascone, Jason, Paryavi, Ebrahim, Pensy, Raymond, Pollak, Andrew, Sciadini, Marcus, Degani, Yasmin, O'Hara, Nathan N, Joseph, Katherine, Camara, Megan, Aqueous-PREP and PREPARE, Aqueous-PREP, and PREPARE

Subjects
PREP-IT Investigators, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core, Patient Centred Outcomes Core, Orthopaedic Surgery Core, Operating Room Core, Infectious Disease Core, Military Core, PREP-IT Clinical Sites, Aqueous-PREP and PREPARE, Aqueous-PREP, PREPARE, Cluster randomized crossover, Consent, Deferred consent, Patient advisors, Stakeholder engagement, Trial design
Abstract

IntroductionCluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent.MethodsThe PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have.ResultsPatient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation.DiscussionInvolvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal.

Published
2021

4. Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Author

Slobogean, Gerard P., Bhandari, Mohit, Sprague, Sheila, D'Alleyrand, Jean-Claude, Harris, Anthony D., Mullins, Daniel C., Thabane, Lehana, Wells, Jeffrey, Wood, Amber, Della Rocca, Gregory J., Hebden, Joan, Jeray, Kyle J., Marchand, Lucas, O'Hara, Lyndsay M., Zura, Robert, Gardner, Michael J., Blasman, Jenna, Davies, Jonah, Liang, Stephen, Taljaard, Monica, Devereaux, P.J., Guyatt, Gordon H., Heels-Ansdell, Diane, Marvel, Debra, Palmer, Jana, Friedrich, Jeff, O'Hara, Nathan N., Grissom, Ms Frances, Gitajn, I. Leah, Morshed, Saam, O'Toole, Robert V., Petrisor, Bradley A., Camara, Megan, Mossuto, Franca, Joshi, Manjari G., Fowler, Justin, Rivera, Jessica, Talbot, Max, Dodds, Shannon, Garibaldi, Alisha, Li, Silvia, Nguyen, Uyen, Pogorzelski, David, Rojas, Alejandra, Scott, Taryn, Del Fabbro, Gina, Szasz, Olivia Paige, McKay, Paula, Howe, Andrea, Rudnicki, Joshua, Demyanovich, Haley, Little, Kelly, Mullins, C. Daniel, Medeiros, Michelle, Kettering, Eric, Hale, Diamond, Petrisor, Brad A., Johal, Herman, Ristevski, Bill, Williams, Dale, Denkers, Matthew, Rajaratnam, Krishan, Al-Asiri, Jamal, Leonard, Jordan, Marcano-Fernández, Francesc A., Gallant, Jodi, Persico, Federico, Gjorgjievski, Marko, George, Annie, Natoli, Roman M., Gaski, Greg E., McKinley, Todd O., Virkus, Walter W., Sorkin, Anthony T., Szatkowski, Jan P., Baele, Joseph R., Mullis, Brian H., Hill, Lauren C., Hudgins, Andrea, Osborn, Patrick, Pierrie, Sarah, Martinez, Eric, Kimmel, Joseph, Adams, John D., Beckish, Michael L., Bray, Christopher C., Brown, Timothy R., Cross, Andrew W., Dew, Timothy, Faucher, Gregory K., Gurich, Richard W., Jr., Lazarus, David E., Millon, S. John, Palmer, M. Jason, Porter, Scott E., Schaller, Thomas M., Sridhar, Michael S., Sanders, John L., Rudisill, L. Edwin, Jr., Garitty, Michael J., Poole, Andrew S., Sims, Michael L., Walker, Clark M., Carlisle, Robert M., II, Hofer, Erin Adams, Huggins, Brandon S., Hunter, Michael D., Marshall, William A., Ray, Shea Bielby, Smith, Cory D., Altman, Kyle M., Bedard, Julia C., Loeffler, Markus F., Pichiotino, Erin R., Cole, Austin A., Maltz, Ethan J., Parker, Wesley, Ramsey, T. Bennett, Burnikel, Alex, Colello, Michael, Stewart, Russell, Wise, Jeremy, Moody, M. Christian, Tanner, Stephanie L., Snider, Rebecca G., Townsend, Christine E., Pham, Kayla H., Martin, Abigail, Robertson, Emily, Miclau, Theodore, Kandemir, Utku, Marmor, Meir, Matityahu, Amir, McClellan, R. Trigg, Meinberg, Eric, Shearer, David, Toogood, Paul, Ding, Anthony, Donohoe, Erin, Murali, Jothi, Belaye, Tigist, Berhaneselase, Eleni, Paul, Alexandra, Garg, Kartik, Gary, Joshua L., Warner, Stephen J., Munz, John W., Choo, Andrew M., Achor, Timothy S., “Chip” Routt, Milton L., Rao, Mayank, Pechero, Guillermo, Miller, Adam, Hagen, Jennifer E., Patrick, Matthew, Vlasak, Richard, Krupko, Thomas, Sadasivan, Kalia, Koenig, Chris, Bailey, Daniel, Wentworth, Daniel, Van, Chi, Schwartz, Justin, Dehghan, Niloofar, Jones, Clifford B., Tracy Watson, J., McKee, Michael, Karim, Ammar, Talerico, Michael, Sietsema, Debra L., Williams, Alyse, Dykes, Tayler, Obremskey, William T., Jahangir, Amir Alex, Sethi, Manish, Boyce, Robert, Stinner, Daniel J., Mitchell, Phillip, Trochez, Karen, Rodriguez, Andres, Gajari, Vamshi, Rodriguez, Elsa, Pritchett, Charles, Boulton, Christina, Lowe, Jason, Wild, Jason, Ruth, John T., Taylor, Michel, Seach, Andrea, Saeed, Sabina, Culbert, Hunter, Cruz, Alejandro, Knapp, Thomas, Hurkett, Colin, Lowney, Maya, Prayson, Michael, Venkatarayappa, Indresh, Horne, Brandon, Jerele, Jennifer, Clark, Linda, Marcano-Fernández, Francesc, Jornet-Gibert, Montsant, Martínez-Carreres, Laia, Martí-Garín, David, Serrano-Sanz, Jorge, Sánchez-Fernández, Joel, Sanz-Molero, Matsuyama, Carballo, Alejandro, Pelfort, Xavier, Acerboni-Flores, Francesc, Alavedra-Massana, Anna, Anglada-Torres, Neus, Berenguer, Alexandre, Cámara-Cabrera, Jaume, Caparros-García, Ariadna, Fillat-Gomà, Ferran, Fuentes-López, Ruben, Garcia-Rodriguez, Ramona, Gimeno-Calavia, Nuria, Graells-Alonso, Guillem, Martínez-Álvarez, Marta, Martínez-Grau, Patricia, Pellejero-García, Raúl, Ràfols-Perramon, Ona, Peñalver, Juan Manuel, Domènech, Mònica Salomó, Soler-Cano, Albert, Velasco-Barrera, Aldo, Yela-Verdú, Christian, Bueno-Ruiz, Mercedes, Sánchez-Palomino, Estrella, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Teixidor-Serra, Jordi, Molero-Garcia, Vicente, Selga-Marsa, Jordi, Porcel-Vasquez, Juan Antonio, Andres-Peiro, Jose Vicente, Minguell-Monyart, Joan, Garcia-Sanchez, Yaiza, Nuñez-Camarena, Jorge, Tauste-Rubio, Eladia, Gonzalez-Amigo, Marta, Romeo, Nicholas M., Vallier, Heather A., Breslin, Mary A., Fraifogl, Joanne, Wilson, Eleanor S., Wadenpfuhl, Leanne K., Halliday, Paul G., Viskontas, Darius G., Apostle, Kelly L., Boyer, Dory S., Moola, Farhad O., Perey, Bertrand H., Stone, Trevor B., Lemke, H. Michael, Zomar, Mauri, Spicer, Ella, Fan, Chen “Brenda”, Payne, Kyrsten, Phelps, Kevin, Bosse, Michael, Karunakar, Madhav, Kempton, Laurence, Sims, Stephen, Hsu, Joseph, Seymour, Rachel, Churchill, Christine, Bartel, Claire, Mayberry, Robert Miles, Brownrigg, Maggie, Girardi, Cara, Mayfield, Ada, Hymes, Robert A., Schwartzbach, Cary C., Schulman, Jeff E., Malekzadeh, A. Stephen, Holzman, Michael A., Ramsey, Lolita, Ahn, James S., Panjshiri, Farhanaz, Das, Sharmistha, English, Antoinisha D., Haaser, Sharon M., Cuff, Jaslynn A.N., Pilson, Holly, Carroll, Eben A., Halvorson, Jason J., Babcock, Sharon, Goodman, J. Brett, Holden, Martha B., Bullard, Debra, Williams, Wendy, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Marchand, Lucas S., Neese, Ashley, Russell, Mark, Olsen, Zachary M., Coe, Marcus, Dwyer, Kevin, Mullin, Devin S., Reilly, Clifford A., DePalo, Peter, Hall, Amy E., Heng, Marilyn, Harris, Mitchel B., Smith, R. Malcolm, Lhowe, David W., Esposito, John G., Bansal, Mira, Bergin, Patrick F., Russell, George V., Graves, Matthew L., Morellato, John, Champion, Heather K., Johnson, Leslie N., McGee, Sheketha L., Bhanat, Eldrin L., Mehta, Samir, Donegan, Derek, Ahn, Jaimo, Horan, Annamarie, Dooley, Mary, Kuczinski, Ashley, Iwu, Ashley, Potter, David, VanDemark, Robert, III, Pfaff, Branden, Hollinsworth, Troy, Weaver, Michael J., von Keudell, Arvind G., McTague, Michael F., Allen, Elizabeth M., Jaeblon, Todd, Beer, Robert, Demyanovich, Haley K., Gage, Mark J., Reilly, Rachel M., Sparrow, Cindy, Pechero, Guillermo, Jr., Holden, Martha, Wells, Jeff, Eglseder, Andrew, Johnson, Aaron, Langhammer, Christopher, Lebrun, Christopher, Manson, Theodore, Nascone, Jason, Paryavi, Ebrahim, Pensy, Raymond, Pollak, Andrew, Sciadini, Marcus, Degani, Yasmin, and Joseph, Katherine

Published
2021
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5. Managing work flow in high enrolling trials: The development and implementation of a sampling strategy in the PREPARE trial

Author

Slobogean, Gerard P., Sprague, Sheila, Wells, Jeffrey, Bhandari, Mohit, D'Alleyrand, Jean-Claude, Harris, Anthony D., Mullins, Daniel C., Thabane, Lehana, Wood, Amber, Della Rocca, Gregory J., Hebden, Joan, Jeray, Kyle J., Marchand, Lucas, O'Hara, Lyndsay M., Zura, Robert, Gardner, Michael J., Blasman, Jenna, Davies, Jonah, Liang, Stephen, Taljaard, Monica, Devereaux, P.J., Guyatt, Gordon H., Heels-Ansdell, Diane, Marvel, Debra, Palmer, Jana, Friedrich, Jeff, O'Hara, Nathan N., Grissom, Ms. Frances, Gitajn, I. Leah, Morshed, Saam, O'Toole, Robert V., Petrisor, Bradley A., Camara, Megan, Mossuto, Franca, Joshi, Manjari G., Fowler, Justin, Rivera, Jessica, Talbot, Max, Dodds, Shannon, Garibaldi, Alisha, Li, Silvia, Nguyen, Uyen, Pogorzelski, David, Rojas, Alejandra, Scott, Taryn, Del Fabbro, Gina, Szasz, Olivia Paige, McKay, Paula, Howe, Andrea, Rudnicki, Joshua, Demyanovich, Haley, Little, Kelly, Mullins, C. Daniel, Medeiros, Michelle, Kettering, Eric, Hale, Diamond, Eglseder, Andrew, Johnson, Aaron, Langhammer, Christopher, Lebrun, Christopher, Manson, Theodore, Nascone, Jason, Paryavi, Ebrahim, Pensy, Raymond, Pollak, Andrew, Sciadini, Marcus, Degani, Yasmin, Demyanovich, Haley K., Joseph, Katherine, Petrisor, Brad A., Johal, Herman, Ristevski, Bill, Williams, Dale, Denkers, Matthew, Rajaratnam, Krishan, Al-Asiri, Jamal, Leonard, Jordan, Marcano-Fernández, Francesc A., Gallant, Jodi, Persico, Federico, Gjorgjievski, Marko, George, Annie, Natoli, Roman M., Gaski, Greg E., McKinley, Todd O., Virkus, Walter W., Sorkin, Anthony T., Szatkowski, Jan P., Baele, Joseph R., Mullis, Brian H., Hill, Lauren C., Hudgins, Andrea, Osborn, Patrick, Pierrie, Sarah, Martinez, Eric, Kimmel, Joseph, Adams, John D., Beckish, Michael L., Bray, Christopher C., Brown, Timothy R., Cross, Andrew W., Dew, Timothy, Faucher, Gregory K., Gurich, Richard W., Jr., Lazarus, David E., Millon, S. John, Palmer, M. Jason, Porter, Scott E., Schaller, Thomas M., Sridhar, Michael S., Sanders, John L., Rudisill, L. Edwin, Jr., Garitty, Michael J., Poole, Andrew S., Sims, Michael L., Walker, Clark M., Carlisle, Robert M., II, Hofer, Erin Adams, Huggins, Brandon S., Hunter, Michael D., Marshall, William A., Ray, Shea Bielby, Smith, Cory D., Altman, Kyle M., Bedard, Julia C., Loeffler, Markus F., Pichiotino, Erin R., Cole, Austin A., Maltz, Ethan J., Parker, Wesley, Ramsey, T. Bennett, Burnikel, Alex, Colello, Michael, Stewart, Russell, Wise, Jeremy, Moody, M. Christian, Tanner, Stephanie L., Snider, Rebecca G., Townsend, Christine E., Pham, Kayla H., Martin, Abigail, Robertson, Emily, Miclau, Theodore, Kandemir, Utku, Marmor, Meir, Matityahu, Amir, McClellan, R. Trigg, Meinberg, Eric, Shearer, David, Toogood, Paul, Ding, Anthony, Donohue, Erin, Belaye, Tigist, Berhaneselase, Eleni, Paul, Alexandra, Garg, Kartik, Gary, Joshua L., Warner, Stephen J., Munz, John W., Choo, Andrew M., Achor, Timothy S., “Chip” Routt, Milton L., Rao, Mayank, Pechero, Guillermo, Miller, Adam, Hagen, Jennifer E., Patrick, Matthew, Vlasak, Richard, Krupko, Thomas, Sadasivan, Kalia, Koenig, Chris, Bailey, Daniel, Wentworth, Daniel, Van, Chi, Schwartz, Justin, Dehghan, Niloofar, Jones, Clifford B., Watson, J Tracy, McKee, Michael, Karim, Ammar, Talerico, Michael, Sietsema, Debra L., Williams, Alyse, Dykes, Tayler, Obremskey, William T., Jahangir, Amir Alex, Sethi, Manish, Boyce, Robert, Stinner, Daniel J., Mitchell, Phillip, Trochez, Karen, Rodriguez, Andres, Gajari, Vamshi, Rodriguez, Elsa, Pritchett, Charles, Boulton, Christina, Lowe, Jason, Wild, Jason, Ruth, John T., Taylor, Michel, Seach, Andrea, Saeed, Sabina, Culbert, Hunter, Cruz, Alejandro, Knapp, Thomas, Hurkett, Colin, Lowney, Maya, Prayson, Michael, Venkatarayappa, Indresh, Horne, Brandon, Jerele, Jennifer, Clark, Linda, Marcano-Fernández, Francesc, Jornet-Gibert, Montsant, Martínez-Carreres, Laia, Martí-Garín, David, Serrano-Sanz, Jorge, Sánchez-Fernández, Joel, Sanz-Molero, Matsuyama, Carballo, Alejandro, Pelfort, Xavier, Acerboni-Flores, Francesc, Alavedra-Massana, Anna, Anglada-Torres, Neus, Berenguer, Alexandre, Cámara-Cabrera, Jaume, Caparros-García, Ariadna, Fillat-Gomà, Ferran, Fuentes-López, Ruben, Garcia-Rodriguez, Ramona, Gimeno-Calavia, Nuria, Graells-Alonso, Guillem, Martínez-Álvarez, Marta, Martínez-Grau, Patricia, Pellejero-García, Raúl, Ràfols-Perramon, Ona, Peñalver, Juan Manuel, Domènech, Mònica Salomó, Soler-Cano, Albert, Velasco-Barrera, Aldo, Yela-Verdú, Christian, Bueno-Ruiz, Mercedes, Sánchez-Palomino, Estrella, Guerra, Ernesto, García, Yaiza, Romeo, Nicholas M., Vallier, Heather A., Breslin, Mary A., Fraifogl, Joanne, Wilson, Eleanor S., Wadenpfuhl, Leanne K., Halliday, Paul G., Viskontas, Darius G., Apostle, Kelly L., Boyer, Dory S., Moola, Farhad O., Perey, Bertrand H., Stone, Trevor B., Lemke, H. Michael, Zomar, Mauri, Spicer, Ella, Fan, Chen “Brenda”, Payne, Kyrsten, Phelps, Kevin, Bosse, Michael, Karunakar, Madhav, Kempton, Laurence, Sims, Stephen, Hsu, Joseph, Seymour, Rachel, Churchill, Christine, Bartel, Claire, Mayberry, Robert Miles, Brownrigg, Maggie, Girardi, Cara, Mayfield, Ada, Hymes, Robert A., Schwartzbach, Cary C., Schulman, Jeff E., Malekzadeh, A. Stephen, Holzman, Michael A., Ramsey, Lolita, Ahn, James S., Panjshiri, Farhanaz, Das, Sharmistha, English, Antoinisha D., Haaser, Sharon M., Cuff, Jaslynn A.N., Pilson, Holly, Carroll, Eben A., Halvorson, Jason J., Babcock, Sharon, Goodman, J. Brett, Holden, Martha B., Bullard, Debra, Williams, Wendy, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Neese, Ashley, Russell, Mark, Coe, Marcus, Dwyer, Kevin, Mullin, Devin S., Reilly, Clifford A., DePalo, Peter, Hall, Amy E., Heng, Marilyn, Harris, Mitchel B., Smith, R. Malcolm, Lhowe, David W., Esposito, John G., Bansal, Mira, Bergin, Patrick F., Russell, George V., Graves, Matthew L., Morellato, John, Champion, Heather K., Johnson, Leslie N., McGee, Sheketha L., Bhanat, Eldrin L., Mehta, Samir, Donegan, Derek, Ahn, Jaimo, Horan, Annamarie, Dooley, Mary, Kuczinski, Ashley, Iwu, Ashley, Potter, David, VanDemark, Robert, III, Pfaff, Branden, Hollinsworth, Troy, Weaver, Michael J., von Keudell, Arvind G., McTague, Michael F., Allen, Elizabeth M., Jaeblon, Todd, Beer, Robert, Gage, Mark J., Reilly, Rachel M., Sparrow, Cindy, and McGee, Sheketha

Published
2021
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14. Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Author

Pechero, Guillermo, primary, Pfaff, Branden, additional, Rao, Mayank, additional, Pogorzelski, David, additional, McKay, Paula, additional, Spicer, Ella, additional, Howe, Andrea, additional, Demyanovich, Haley K., additional, Sietsema, Debra L., additional, McTague, Michael F., additional, Ramsey, Lolita, additional, Holden, Martha, additional, Rudnicki, Joshua, additional, Wells, Jeff, additional, Medeiros, Michelle, additional, Slobogean, Gerard P., additional, Sprague, Sheila, additional, Wells, Jeffrey, additional, Bhandari, Mohit, additional, O'Toole, Robert V., additional, D'Alleyrand, Jean-Claude, additional, Eglseder, Andrew, additional, Johnson, Aaron, additional, Langhammer, Christopher, additional, Lebrun, Christopher, additional, Manson, Theodore, additional, Nascone, Jason, additional, Paryavi, Ebrahim, additional, Pensy, Raymond, additional, Pollak, Andrew, additional, Sciadini, Marcus, additional, Degani, Yasmin, additional, O'Hara, Nathan N., additional, Joseph, Katherine, additional, Camara, Megan, additional, Harris, Anthony D., additional, Mullins, Daniel C., additional, Thabane, Lehana, additional, Wood, Amber, additional, Della Rocca, Gregory J., additional, Hebden, Joan, additional, Jeray, Kyle J., additional, Marchand, Lucas, additional, O'Hara, Lyndsay M., additional, Zura, Robert, additional, Gardner, Michael J., additional, Blasman, Jenna, additional, Davies, Jonah, additional, Liang, Stephen, additional, Taljaard, Monica, additional, Devereaux, P.J., additional, Guyatt, Gordon H., additional, Heels-Ansdell, Diane, additional, Marvel, Debra, additional, Palmer, Jana, additional, Friedrich, Jeff, additional, Grissom, Ms Frances, additional, Gitajn, I. Leah, additional, Morshed, Saam, additional, Petrisor, Bradley A., additional, Mossuto, Franca, additional, Joshi, Manjari G., additional, Fowler, Justin, additional, Rivera, Jessica, additional, Talbot, Max, additional, Dodds, Shannon, additional, Garibaldi, Alisha, additional, Li, Silvia, additional, Nguyen, Uyen, additional, Rojas, Alejandra, additional, Scott, Taryn, additional, Del Fabbro, Gina, additional, Szasz, Olivia Paige, additional, Demyanovich, Haley, additional, Little, Kelly, additional, Mullins, C. Daniel, additional, Kettering, Eric, additional, Hale, Diamond, additional, Petrisor, Brad A., additional, Johal, Herman, additional, Ristevski, Bill, additional, Williams, Dale, additional, Denkers, Matthew, additional, Rajaratnam, Krishan, additional, Al-Asiri, Jamal, additional, Leonard, Jordan, additional, Marcano-Fernández, Francesc A., additional, Gallant, Jodi, additional, Persico, Federico, additional, Gjorgjievski, Marko, additional, George, Annie, additional, Natoli, Roman M., additional, Gaski, Greg E., additional, McKinley, Todd O., additional, Virkus, Walter W., additional, Sorkin, Anthony T., additional, Szatkowski, Jan P., additional, Baele, Joseph R., additional, Mullis, Brian H., additional, Hill, Lauren C., additional, Hudgins, Andrea, additional, Osborn, Patrick, additional, Pierrie, Sarah, additional, Martinez, Eric, additional, Kimmel, Joseph, additional, Adams, John D., additional, Beckish, Michael L., additional, Bray, Christopher C., additional, Brown, Timothy R., additional, Cross, Andrew W., additional, Dew, Timothy, additional, Faucher, Gregory K., additional, Gurich, Richard W., additional, Lazarus, David E., additional, Millon, S. John, additional, Palmer, M. Jason, additional, Porter, Scott E., additional, Schaller, Thomas M., additional, Sridhar, Michael S., additional, Sanders, John L., additional, Rudisill, L. Edwin, additional, Garitty, Michael J., additional, Poole, Andrew S., additional, Sims, Michael L., additional, Walker, Clark M., additional, Carlisle, Robert M., additional, Hofer, Erin Adams, additional, Huggins, Brandon S., additional, Hunter, Michael D., additional, Marshall, William A., additional, Ray, Shea Bielby, additional, Smith, Cory D., additional, Altman, Kyle M., additional, Bedard, Julia C., additional, Loeffler, Markus F., additional, Pichiotino, Erin R., additional, Cole, Austin A., additional, Maltz, Ethan J., additional, Parker, Wesley, additional, Ramsey, T. Bennett, additional, Burnikel, Alex, additional, Colello, Michael, additional, Stewart, Russell, additional, Wise, Jeremy, additional, Moody, M. Christian, additional, Tanner, Stephanie L., additional, Snider, Rebecca G., additional, Townsend, Christine E., additional, Pham, Kayla H., additional, Martin, Abigail, additional, Robertson, Emily, additional, Miclau, Theodore, additional, Kandemir, Utku, additional, Marmor, Meir, additional, Matityahu, Amir, additional, McClellan, R. Trigg, additional, Meinberg, Eric, additional, Shearer, David, additional, Toogood, Paul, additional, Ding, Anthony, additional, Donohoe, Erin, additional, Murali, Jothi, additional, Belaye, Tigist, additional, Berhaneselase, Eleni, additional, Paul, Alexandra, additional, Garg, Kartik, additional, Gary, Joshua L., additional, Warner, Stephen J., additional, Munz, John W., additional, Choo, Andrew M., additional, Achor, Timothy S., additional, “Chip” Routt, Milton L., additional, Pechero, Guillermo, additional, Miller, Adam, additional, Hagen, Jennifer E., additional, Patrick, Matthew, additional, Vlasak, Richard, additional, Krupko, Thomas, additional, Sadasivan, Kalia, additional, Koenig, Chris, additional, Bailey, Daniel, additional, Wentworth, Daniel, additional, Van, Chi, additional, Schwartz, Justin, additional, Dehghan, Niloofar, additional, Jones, Clifford B., additional, Tracy Watson, J., additional, McKee, Michael, additional, Karim, Ammar, additional, Talerico, Michael, additional, Williams, Alyse, additional, Dykes, Tayler, additional, Obremskey, William T., additional, Jahangir, Amir Alex, additional, Sethi, Manish, additional, Boyce, Robert, additional, Stinner, Daniel J., additional, Mitchell, Phillip, additional, Trochez, Karen, additional, Rodriguez, Andres, additional, Gajari, Vamshi, additional, Rodriguez, Elsa, additional, Pritchett, Charles, additional, Boulton, Christina, additional, Lowe, Jason, additional, Wild, Jason, additional, Ruth, John T., additional, Taylor, Michel, additional, Seach, Andrea, additional, Saeed, Sabina, additional, Culbert, Hunter, additional, Cruz, Alejandro, additional, Knapp, Thomas, additional, Hurkett, Colin, additional, Lowney, Maya, additional, Prayson, Michael, additional, Venkatarayappa, Indresh, additional, Horne, Brandon, additional, Jerele, Jennifer, additional, Clark, Linda, additional, Marcano-Fernández, Francesc, additional, Jornet-Gibert, Montsant, additional, Martínez-Carreres, Laia, additional, Martí-Garín, David, additional, Serrano-Sanz, Jorge, additional, Sánchez-Fernández, Joel, additional, Sanz-Molero, Matsuyama, additional, Carballo, Alejandro, additional, Pelfort, Xavier, additional, Acerboni-Flores, Francesc, additional, Alavedra-Massana, Anna, additional, Anglada-Torres, Neus, additional, Berenguer, Alexandre, additional, Cámara-Cabrera, Jaume, additional, Caparros-García, Ariadna, additional, Fillat-Gomà, Ferran, additional, Fuentes-López, Ruben, additional, Garcia-Rodriguez, Ramona, additional, Gimeno-Calavia, Nuria, additional, Graells-Alonso, Guillem, additional, Martínez-Álvarez, Marta, additional, Martínez-Grau, Patricia, additional, Pellejero-García, Raúl, additional, Ràfols-Perramon, Ona, additional, Peñalver, Juan Manuel, additional, Domènech, Mònica Salomó, additional, Soler-Cano, Albert, additional, Velasco-Barrera, Aldo, additional, Yela-Verdú, Christian, additional, Bueno-Ruiz, Mercedes, additional, Sánchez-Palomino, Estrella, additional, Guerra-Farfan, Ernesto, additional, Tomas-Hernandez, Jordi, additional, Teixidor-Serra, Jordi, additional, Molero-Garcia, Vicente, additional, Selga-Marsa, Jordi, additional, Porcel-Vasquez, Juan Antonio, additional, Andres-Peiro, Jose Vicente, additional, Minguell-Monyart, Joan, additional, Garcia-Sanchez, Yaiza, additional, Nuñez-Camarena, Jorge, additional, Tauste-Rubio, Eladia, additional, Gonzalez-Amigo, Marta, additional, Romeo, Nicholas M., additional, Vallier, Heather A., additional, Breslin, Mary A., additional, Fraifogl, Joanne, additional, Wilson, Eleanor S., additional, Wadenpfuhl, Leanne K., additional, Halliday, Paul G., additional, Viskontas, Darius G., additional, Apostle, Kelly L., additional, Boyer, Dory S., additional, Moola, Farhad O., additional, Perey, Bertrand H., additional, Stone, Trevor B., additional, Lemke, H. Michael, additional, Zomar, Mauri, additional, Fan, Chen “Brenda”, additional, Payne, Kyrsten, additional, Phelps, Kevin, additional, Bosse, Michael, additional, Karunakar, Madhav, additional, Kempton, Laurence, additional, Sims, Stephen, additional, Hsu, Joseph, additional, Seymour, Rachel, additional, Churchill, Christine, additional, Bartel, Claire, additional, Mayberry, Robert Miles, additional, Brownrigg, Maggie, additional, Girardi, Cara, additional, Mayfield, Ada, additional, Hymes, Robert A., additional, Schwartzbach, Cary C., additional, Schulman, Jeff E., additional, Malekzadeh, A. Stephen, additional, Holzman, Michael A., additional, Ahn, James S., additional, Panjshiri, Farhanaz, additional, Das, Sharmistha, additional, English, Antoinisha D., additional, Haaser, Sharon M., additional, Cuff, Jaslynn A.N., additional, Pilson, Holly, additional, Carroll, Eben A., additional, Halvorson, Jason J., additional, Babcock, Sharon, additional, Goodman, J. Brett, additional, Holden, Martha B., additional, Bullard, Debra, additional, Williams, Wendy, additional, Higgins, Thomas F., additional, Haller, Justin M., additional, Rothberg, David L., additional, Marchand, Lucas S., additional, Neese, Ashley, additional, Russell, Mark, additional, Olsen, Zachary M., additional, Coe, Marcus, additional, Dwyer, Kevin, additional, Mullin, Devin S., additional, Reilly, Clifford A., additional, DePalo, Peter, additional, Hall, Amy E., additional, Heng, Marilyn, additional, Harris, Mitchel B., additional, Smith, R. Malcolm, additional, Lhowe, David W., additional, Esposito, John G., additional, Bansal, Mira, additional, Bergin, Patrick F., additional, Russell, George V., additional, Graves, Matthew L., additional, Morellato, John, additional, Champion, Heather K., additional, Johnson, Leslie N., additional, McGee, Sheketha L., additional, Bhanat, Eldrin L., additional, Mehta, Samir, additional, Donegan, Derek, additional, Ahn, Jaimo, additional, Horan, Annamarie, additional, Dooley, Mary, additional, Kuczinski, Ashley, additional, Iwu, Ashley, additional, Potter, David, additional, VanDemark, Robert, additional, Hollinsworth, Troy, additional, Weaver, Michael J., additional, von Keudell, Arvind G., additional, Allen, Elizabeth M., additional, Jaeblon, Todd, additional, Beer, Robert, additional, Gage, Mark J., additional, Reilly, Rachel M., additional, and Sparrow, Cindy, additional

Published
2021
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15. Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population.

Author

McGovern, Madeline M., McTague, Michael F, Stevens, Erin, Medina, Juan Carlos Nunez, Franco-Garcia, Esteban, Heng, Marilyn, McGovern, Madeline M., McTague, Michael F, Stevens, Erin, Medina, Juan Carlos Nunez, Franco-Garcia, Esteban, and Heng, Marilyn

Abstract

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy. Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form. Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent. Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the co

Published
2021

16. Patient and stakeholder engagement learnings: PREP-IT as a case study

Author

Medeiros, Michelle, primary, Love, T Rosie, additional, Slobogean, Gerard P., additional, Sprague, Sheila, additional, Perfetto, Eleanor M., additional, O'Hara, Nathan N., additional, Mullins, C. Daniel, additional, Wells, Jeffrey, additional, Bhandari, Mohit, additional, D'alleyrand, Jean-Claude, additional, Harris, Anthony, additional, Mullins, Daniel C., additional, Thabane, Lehana, additional, Wood, Amber, additional, Della Rocca, Gregory J., additional, Hebden, Joan, additional, Jeray, Kyle J., additional, Marchand, Lucas, additional, O'Hara, Lyndsay M., additional, Zura, Robert, additional, Gardner, Michael J., additional, Blasman, Jenna, additional, Davies, Jonah, additional, Liang, Stephen, additional, Taljaard, Monica, additional, Devereaux, PJ, additional, Guyatt, Gordon H., additional, Heels-Ansdell, Dianne, additional, Marvel, Debra, additional, Palmer, Jana, additional, Friedrich, Jeff, additional, O'Hara, Nathan, additional, Grissom, Frances, additional, Gitajn, Leah, additional, Morshed, Saam, additional, O'Toole, Robert, additional, Petrisor, Bradley A., additional, Camara, Megan, additional, Mossuto, Franca, additional, Joshi, Manjari G., additional, Fowler, Justin, additional, Rivera, Jessica, additional, Talbot, Max, additional, Dodds, Shannon, additional, Garibaldi, Alisha, additional, Li, Silvia, additional, Nguyen, Uyen, additional, Pogorzelski, David, additional, Rojas, Alejandra, additional, Scott, Taryn, additional, Del Fabbro, Gina, additional, Szasz, Olivia Page, additional, McKay, Paula, additional, Howe, Andrea, additional, Rudnicki, Joshua, additional, Demyanovich, Haley, additional, Little, Kelly, additional, Boissonneault, Adam, additional, Medeiros, Michellic, additional, Kettering, Eric, additional, Hale, Diamond, additional, Mahal, Nirmen, additional, Eglseder, Andrew, additional, Johnson, Aaron, additional, Langhammer, Christopher, additional, Lebrun, Christopher, additional, Manson, Theodore, additional, Nascone, Jason, additional, Paryavi, Ebrahim, additional, Pensy, Raymond, additional, Pollack, Andrew, additional, Sciadini, Marcus, additional, Degani, Yasmin, additional, Joseph, Katherine, additional, S. Marchand, Lucas, additional, Phipps, Heather, additional, Hempen, Eric, additional, Johal, Herman, additional, Risteyski, Bill, additional, Williams, Dale, additional, Denkers, Matthew, additional, Rajaratnam, Krishan, additional, Al-Asiri, Jamal, additional, Leonard, Jordan, additional, Marcano-Fernández, Francesc A., additional, Gallant, Jodi, additional, Persico, Federico, additional, Gjorgjievski, Marko, additional, George, Annie, additional, McGaugh, Sarah M., additional, Pusztai, Kaitlyn, additional, Piekarski, Sarah, additional, Lyons, Mavis, additional, Gennaccaro, Julia, additional, Natoli, Roman M., additional, Gaski, Greg E., additional, McKinley, Todd O., additional, Virkus, Walter W., additional, Sorkin, Anthony T., additional, Szatkowski, Jan P., additional, Baele, Joseph R., additional, Mullis, Brian H., additional, Jang, Yohan, additional, Lopas, Luke A., additional, Hill, Lauren C., additional, Hudgins, Andrea, additional, Fentz, Courteney L., additional, Diaz, Maricela M., additional, Garst, Katelyn M., additional, Denari, Emma W., additional, Osborn, Patrick, additional, Pierrie, Sarah, additional, Martinez, Eric, additional, Kimmel, Joseph, additional, Herrera, Maria, additional, Adams, John D., additional, Beckish, Michael, additional, Bray, Christopher, additional, Brown, Timothy R., additional, Cross, Andrew W., additional, Dew, Timothy, additional, Faucher, Gregory, additional, Gurich Jr, Richard W., additional, Lazarus, David E., additional, Millon, S. John, additional, Palmer, M. Jason, additional, Porter, Scott E., additional, Schaller, Thomas M., additional, Sridhar, Michael S., additional, Sanders, John L., additional, Rudisill Jr, Edwin L., additional, Garitty, Michael J., additional, Poole, Andrew S., additional, Sims, Michael L., additional, Walker, Clark M., additional, Carlisle II, Robert M., additional, Hofer, Erin Adams, additional, Huggins, Brandon S., additional, Hunter, Michael D., additional, Marshall, William A., additional, Ray, Shea Bielby, additional, Smith, Cory D., additional, Altman, Kyle M., additional, Bedard, Julia C., additional, Loeffler, Markus F., additional, Pichiotino, Erin R., additional, Cole, Austin A., additional, Maltz, Ethan J., additional, Parker, Wesley, additional, Ramsey, T. Bennett, additional, Burnikel, Alex, additional, Colello, Michael, additional, Stewart, Russell, additional, Wise, Jeremy, additional, Moody, M. Christian, additional, Anderson, Matthew, additional, Eskew, Joshua, additional, Judkins, Benjamin, additional, Miller, James M., additional, Tanner, Stephanie L., additional, Snider, Rebecca G., additional, Townsend, Christine E., additional, Pham, Kayla H., additional, Martin, Abigail, additional, Robertson, Emily, additional, Wilson Sykes, John, additional, Miclau, Theodore, additional, Kandemir, Utku, additional, Marmor, Meir, additional, Matityahu, Amir, additional, McClellan, R. Trigg, additional, Meinberg, Eric, additional, Shearer, David, additional, Toogood, Paul, additional, Ding, Anthony, additional, Donohue, Erin, additional, Murali, Jothi, additional, El Naga, Ashraf, additional, Tangtiphaiboontana, Jennifer, additional, Belaye, Tigist, additional, Berhaneselase, Eleni, additional, Paul, Alexandra, additional, Garg, Kartik, additional, Pokhvashchev, Dmitry, additional, Gary, Joshua L., additional, Warner, Stephen J., additional, Munz, John W., additional, Choo, Andrew M., additional, Achor, Timothy, additional, Routt, Milton L. "Chip", additional, Rao, Mayank, additional, Pechero, Guillermo, additional, Miller, Adam, additional, Kutzler, Michael, additional, Boutte, Sterling, additional, Warth, Ryan J., additional, Hagen, Jennifer E., additional, Patrick, Matthew, additional, Vlasak, Richard, additional, Krupko, Thomas, additional, Sadasivan, Kalia, additional, Talerico, Michael, additional, Horodyski, Marybeth, additional, Koenig, Chris, additional, Bailey, Daniel, additional, Wentworth, Daniel, additional, Van, Chi, additional, Schwartz, Justin, additional, Pazik, Marissa, additional, Lossada-Soto, Elizabeth, additional, Dehghan, Niloofar, additional, Jones, Clifford B., additional, Watson, J. Tracy, additional, McKee, Michael, additional, Karim, Ammar, additional, Sietsema, Debra L., additional, William, Alyse, additional, Dykes, Tayler, additional, Obremskey, William T., additional, Jahangir, Amir Alex, additional, Sethi, Manish, additional, Boyce, Robert, additional, Stinner, Daniel J., additional, Mitchell, Phillip, additional, Trochez, Karen, additional, Rodriguez, Andres, additional, Gajari, Vamshi, additional, Rodriguez, Elsa, additional, Pritchett, Chris, additional, Hogan, Natalie, additional, Moreno, Fidel A., additional, Boulton, Christina, additional, Lowe, Jason, additional, Wild, Jason, additional, Ruth, John T., additional, Taylor, Michel, additional, Askam, Brad, additional, Seach, Andrea, additional, Saeed, Sabina, additional, Culbert, Hunter, additional, Crus, Alejandro, additional, Knapp, Thomas, additional, Hurkett, Colin, additional, Lowney, Maya, additional, Featherston, Breanna, additional, Carlson, Robin, additional, Romero, Iliana, additional, Zarif, Isaac, additional, Prayson, Michael, additional, Venkatarayappa, Indresh, additional, Horne, Brandon, additional, Jerele, Jennifer, additional, Clark, Linda, additional, Marcano-Fernández, Francesc, additional, Jornet-Gibert, Montsant, additional, Martínez-Carreres, Laia, additional, Martí-Garín, David, additional, Serrano-Sanz, Jorge, additional, Sánchez-Fernández, Joel, additional, Sanz-Molero, Matsuyama, additional, Carballo, Alejandro, additional, Pelfort, Xavier, additional, Acerboni-Flores, Francesc, additional, Alavedra-Massana, Anna, additional, Anglada-Torres, Neus, additional, Berenguer, Alexandre, additional, Cámara-Cabrera, Jaume, additional, Caparros-García, Ariadna, additional, Fillat-Gomà, Ferran, additional, Fuentes-López, Ruben, additional, Garcia-Rodriguez, Ramona, additional, Gimeno-Clavia, Nuria, additional, Graells-Alonso, Guillem, additional, Martínez-álvarez, Marta, additional, Martínez-Grau, Patricia, additional, Pellejero-García, Raúl, additional, Ràfols-Perramon, Ona, additional, Peñalver, Juan Manuel, additional, Salomò Domènech, Mònica, additional, Soler-Cano, Albert, additional, Velasco-Barrera, Aldo, additional, Yela-Verdú, Christian, additional, Bueno-Ruiz, Mercedes, additional, Sánchez-Palomino, Estrella, additional, Andriola, Vito, additional, Molina-Corbacho, Matilde, additional, Maldonado-Sotoca, Yeray, additional, Gasset-Teixidor, Alfons, additional, Blasco-Moreu, Jorge, additional, Fernández-Poch, Núria, additional, Rodoreda-Puigdemasa, Josep, additional, Verdaguer-Figuerola, Arnau, additional, Enrique Cueva-Sevieri, Heber, additional, Garcia-Gimenez, Santiago, additional, Guerra-Farfán, Ernesto, additional, Tomas-Hernandez, Jordi, additional, Teixidor-Serra, Jordi, additional, Molero-Garcia, Vicente, additional, Selga-Marsa, Jordi, additional, Porcel-Vazquez, Juan Antonio, additional, Andres-Peiro, Jose Vicente, additional, Minguell-Monyart, Joan, additional, Nuñez-Camarena, Jorge, additional, del Mar Villar-Casares, Maria, additional, Mestre-Torres, Jaume, additional, Lalueza-Broto, Pilar, additional, Moreira-Borim, Felipe, additional, García, Yaiza, additional, Romeo, Nicholas M., additional, Vallier, Heather A., additional, Breslin, Mary A., additional, Fraifogl, Joanne, additional, Wilson, Eleanor S., additional, Wadenpfuhl, Leanne K, additional, Halliday, Paul G., additional, Heimke, Isabella, additional, Viskontas, Darius G., additional, Apostle, Kelly L., additional, Boyer, Dory S., additional, Moola, Farhad O., additional, Perey, Bertrand H., additional, Stone, Trevor B., additional, Lemke, H. Michael, additional, Zomar, Mauri, additional, Spicer, Ella, additional, Fan, Chen "Brenda", additional, Payne, Kyrsten, additional, Phelps, Kevin, additional, Bosse, Michael, additional, Karunakar, Madhav, additional, Kempton, Laurence, additional, Sims, Stephen, additional, Hsu, Joseph, additional, Seymour, Rachel, additional, Churchill, Christine, additional, Bartel, Claire, additional, Mayberry, Robert Miles, additional, Brownrigg, Maggie, additional, Girardi, Cara, additional, Mayfield, Ada, additional, Sweeney, Juliette, additional, Pollock, Hannah, additional, Hymes, Robert A., additional, Schwartzbach, Cary C., additional, Schulman, Jeff E., additional, Malekzadeh, A. Stephen, additional, Holzman, Michael A., additional, Wills, Jonathan, additional, Ramsey, Lolita, additional, Ahn, James S., additional, Panjshiri, Farhanaz, additional, Das, Sharmistha, additional, English, Antoinisha D., additional, Haaser, Sharon M., additional, Cuff, Jaslynn A.N., additional, Pilson, Holly, additional, Carroll, Eben A., additional, Halvorson, Jason J., additional, Babcock, Sharon, additional, Goodman, J. Brett, additional, Holden, Martha B., additional, Bullard, Debra, additional, Williams, Wendy, additional, Hill, Taylor, additional, Brotherton, Ariel, additional, Higgins, Thomas F., additional, Haller, Justin M., additional, Rothberg, David L., additional, Neese, Ashley, additional, Russell, Mark, additional, Olsen, Zachary M., additional, McGowan, Abby V., additional, Hill, Sophia, additional, Coe, Marcus, additional, Dwyer, Kevin, additional, Mullin, Devin S., additional, Reily, Clifford A, additional, DePalo, Peter, additional, Hall, Amy E., additional, Dabrowski, Rebecca E., additional, Chockbengboun, Theresa A., additional, Heng, Marilyn, additional, Harris, Mitchel B., additional, Smith, R. Malcolm, additional, Lhowe, David W., additional, Esposito, John, additional, Bansal, Mira, additional, McTague, Michael, additional, Alnasser, Ahmad, additional, Bergin, Patrick F., additional, Russell, George V., additional, Graves, Matthew L., additional, Morellato, John, additional, Champion, Heather K., additional, Johnson, Leslie N., additional, McGee, Skeketha L., additional, Bhanat, Eldrin L., additional, Thimothee, Josny, additional, Serrano, Jackie, additional, Mehta, Samir, additional, Donegan, Derek, additional, Ahn, Jaimo, additional, Horan, Annamarie, additional, Dooley, Mary, additional, Kuczinski, Ashley, additional, Iwu, Ashley, additional, Potter, David, additional, VanDemark II, Robert, additional, Pfaff, Branden, additional, Hollinsworth, Troy, additional, Atkins, Kristi, additional, Weaver, Michael J., additional, von Keudel, Arvind G., additional, McTague, Michael F., additional, Allen, Elizabeth M., additional, Sagona, Abigail E., additional, Jaeblon, Todd, additional, Beer, Robert, additional, Bauer, Brent, additional, Meredith, Sean, additional, Stone, Autumn, additional, Gage, Mark J., additional, Reilly, Rachel M., additional, Sparrow, Cindy, additional, Paniagua, Ariana, additional, Domes, Christopher M., additional, Johnson, Kristina P., additional, Shannon, Steven F., additional, Scott, Alesha N., additional, Clinch, Bobbi, additional, Lin, Carol A., additional, Vrahas, Mark S., additional, Moon, Charles N., additional, Marecek, Geoffrey S., additional, Dubuclet, Denice, additional, Scolaro, John A., additional, Learned, James R., additional, Lim, Philip K., additional, Demas, Susan, additional, Beltran, Michael J., additional, Archdeacon, Michael T., additional, Claude Sagi, Henry, additional, Wyrick, John D., additional, Toan Le, Theodore, additional, Laughlin, Richard T., additional, and Thomson, Cameron G., additional

Published
2021
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17. Managing work flow in high enrolling trials: The development and implementation of a sampling strategy in the PREPARE trial

Author

Pogorzelski, David, primary, Nguyen, Uyen, additional, McKay, Paula, additional, Thabane, Lehana, additional, Camara, Megan, additional, Ramsey, Lolita, additional, Seymour, Rachel, additional, Goodman, J. Brett, additional, McGee, Sheketha, additional, Fraifogl, Joanne, additional, Hudgins, Andrea, additional, Tanner, Stephanie L., additional, Bhandari, Mohit, additional, Slobogean, Gerard P., additional, Sprague, Sheila, additional, Wells, Jeffrey, additional, D'Alleyrand, Jean-Claude, additional, Harris, Anthony D., additional, Mullins, Daniel C., additional, Wood, Amber, additional, Della Rocca, Gregory J., additional, Hebden, Joan, additional, Jeray, Kyle J., additional, Marchand, Lucas, additional, O'Hara, Lyndsay M., additional, Zura, Robert, additional, Gardner, Michael J., additional, Blasman, Jenna, additional, Davies, Jonah, additional, Liang, Stephen, additional, Taljaard, Monica, additional, Devereaux, P.J., additional, Guyatt, Gordon H., additional, Heels-Ansdell, Diane, additional, Marvel, Debra, additional, Palmer, Jana, additional, Friedrich, Jeff, additional, O'Hara, Nathan N., additional, Grissom, Ms. Frances, additional, Gitajn, I. Leah, additional, Morshed, Saam, additional, O'Toole, Robert V., additional, Petrisor, Bradley A., additional, Mossuto, Franca, additional, Joshi, Manjari G., additional, Fowler, Justin, additional, Rivera, Jessica, additional, Talbot, Max, additional, Dodds, Shannon, additional, Garibaldi, Alisha, additional, Li, Silvia, additional, Pogorzelski, David, additional, Rojas, Alejandra, additional, Scott, Taryn, additional, Del Fabbro, Gina, additional, Szasz, Olivia Paige, additional, Howe, Andrea, additional, Rudnicki, Joshua, additional, Demyanovich, Haley, additional, Little, Kelly, additional, Mullins, C. Daniel, additional, Medeiros, Michelle, additional, Kettering, Eric, additional, Hale, Diamond, additional, Eglseder, Andrew, additional, Johnson, Aaron, additional, Langhammer, Christopher, additional, Lebrun, Christopher, additional, Manson, Theodore, additional, Nascone, Jason, additional, Paryavi, Ebrahim, additional, Pensy, Raymond, additional, Pollak, Andrew, additional, Sciadini, Marcus, additional, Degani, Yasmin, additional, Demyanovich, Haley K., additional, Joseph, Katherine, additional, Petrisor, Brad A., additional, Johal, Herman, additional, Ristevski, Bill, additional, Williams, Dale, additional, Denkers, Matthew, additional, Rajaratnam, Krishan, additional, Al-Asiri, Jamal, additional, Leonard, Jordan, additional, Marcano-Fernández, Francesc A., additional, Gallant, Jodi, additional, Persico, Federico, additional, Gjorgjievski, Marko, additional, George, Annie, additional, Natoli, Roman M., additional, Gaski, Greg E., additional, McKinley, Todd O., additional, Virkus, Walter W., additional, Sorkin, Anthony T., additional, Szatkowski, Jan P., additional, Baele, Joseph R., additional, Mullis, Brian H., additional, Hill, Lauren C., additional, Osborn, Patrick, additional, Pierrie, Sarah, additional, Martinez, Eric, additional, Kimmel, Joseph, additional, Adams, John D., additional, Beckish, Michael L., additional, Bray, Christopher C., additional, Brown, Timothy R., additional, Cross, Andrew W., additional, Dew, Timothy, additional, Faucher, Gregory K., additional, Gurich, Richard W., additional, Lazarus, David E., additional, Millon, S. John, additional, Palmer, M. Jason, additional, Porter, Scott E., additional, Schaller, Thomas M., additional, Sridhar, Michael S., additional, Sanders, John L., additional, Rudisill, L. Edwin, additional, Garitty, Michael J., additional, Poole, Andrew S., additional, Sims, Michael L., additional, Walker, Clark M., additional, Carlisle, Robert M., additional, Hofer, Erin Adams, additional, Huggins, Brandon S., additional, Hunter, Michael D., additional, Marshall, William A., additional, Ray, Shea Bielby, additional, Smith, Cory D., additional, Altman, Kyle M., additional, Bedard, Julia C., additional, Loeffler, Markus F., additional, Pichiotino, Erin R., additional, Cole, Austin A., additional, Maltz, Ethan J., additional, Parker, Wesley, additional, Ramsey, T. Bennett, additional, Burnikel, Alex, additional, Colello, Michael, additional, Stewart, Russell, additional, Wise, Jeremy, additional, Moody, M. Christian, additional, Snider, Rebecca G., additional, Townsend, Christine E., additional, Pham, Kayla H., additional, Martin, Abigail, additional, Robertson, Emily, additional, Miclau, Theodore, additional, Kandemir, Utku, additional, Marmor, Meir, additional, Matityahu, Amir, additional, McClellan, R. Trigg, additional, Meinberg, Eric, additional, Shearer, David, additional, Toogood, Paul, additional, Ding, Anthony, additional, Donohue, Erin, additional, Belaye, Tigist, additional, Berhaneselase, Eleni, additional, Paul, Alexandra, additional, Garg, Kartik, additional, Gary, Joshua L., additional, Warner, Stephen J., additional, Munz, John W., additional, Choo, Andrew M., additional, Achor, Timothy S., additional, “Chip” Routt, Milton L., additional, Rao, Mayank, additional, Pechero, Guillermo, additional, Miller, Adam, additional, Hagen, Jennifer E., additional, Patrick, Matthew, additional, Vlasak, Richard, additional, Krupko, Thomas, additional, Sadasivan, Kalia, additional, Koenig, Chris, additional, Bailey, Daniel, additional, Wentworth, Daniel, additional, Van, Chi, additional, Schwartz, Justin, additional, Dehghan, Niloofar, additional, Jones, Clifford B., additional, Watson, J Tracy, additional, McKee, Michael, additional, Karim, Ammar, additional, Talerico, Michael, additional, Sietsema, Debra L., additional, Williams, Alyse, additional, Dykes, Tayler, additional, Obremskey, William T., additional, Jahangir, Amir Alex, additional, Sethi, Manish, additional, Boyce, Robert, additional, Stinner, Daniel J., additional, Mitchell, Phillip, additional, Trochez, Karen, additional, Rodriguez, Andres, additional, Gajari, Vamshi, additional, Rodriguez, Elsa, additional, Pritchett, Charles, additional, Boulton, Christina, additional, Lowe, Jason, additional, Wild, Jason, additional, Ruth, John T., additional, Taylor, Michel, additional, Seach, Andrea, additional, Saeed, Sabina, additional, Culbert, Hunter, additional, Cruz, Alejandro, additional, Knapp, Thomas, additional, Hurkett, Colin, additional, Lowney, Maya, additional, Prayson, Michael, additional, Venkatarayappa, Indresh, additional, Horne, Brandon, additional, Jerele, Jennifer, additional, Clark, Linda, additional, Marcano-Fernández, Francesc, additional, Jornet-Gibert, Montsant, additional, Martínez-Carreres, Laia, additional, Martí-Garín, David, additional, Serrano-Sanz, Jorge, additional, Sánchez-Fernández, Joel, additional, Sanz-Molero, Matsuyama, additional, Carballo, Alejandro, additional, Pelfort, Xavier, additional, Acerboni-Flores, Francesc, additional, Alavedra-Massana, Anna, additional, Anglada-Torres, Neus, additional, Berenguer, Alexandre, additional, Cámara-Cabrera, Jaume, additional, Caparros-García, Ariadna, additional, Fillat-Gomà, Ferran, additional, Fuentes-López, Ruben, additional, Garcia-Rodriguez, Ramona, additional, Gimeno-Calavia, Nuria, additional, Graells-Alonso, Guillem, additional, Martínez-Álvarez, Marta, additional, Martínez-Grau, Patricia, additional, Pellejero-García, Raúl, additional, Ràfols-Perramon, Ona, additional, Peñalver, Juan Manuel, additional, Domènech, Mònica Salomó, additional, Soler-Cano, Albert, additional, Velasco-Barrera, Aldo, additional, Yela-Verdú, Christian, additional, Bueno-Ruiz, Mercedes, additional, Sánchez-Palomino, Estrella, additional, Guerra, Ernesto, additional, García, Yaiza, additional, Romeo, Nicholas M., additional, Vallier, Heather A., additional, Breslin, Mary A., additional, Wilson, Eleanor S., additional, Wadenpfuhl, Leanne K., additional, Halliday, Paul G., additional, Viskontas, Darius G., additional, Apostle, Kelly L., additional, Boyer, Dory S., additional, Moola, Farhad O., additional, Perey, Bertrand H., additional, Stone, Trevor B., additional, Lemke, H. Michael, additional, Zomar, Mauri, additional, Spicer, Ella, additional, Fan, Chen “Brenda”, additional, Payne, Kyrsten, additional, Phelps, Kevin, additional, Bosse, Michael, additional, Karunakar, Madhav, additional, Kempton, Laurence, additional, Sims, Stephen, additional, Hsu, Joseph, additional, Churchill, Christine, additional, Bartel, Claire, additional, Mayberry, Robert Miles, additional, Brownrigg, Maggie, additional, Girardi, Cara, additional, Mayfield, Ada, additional, Hymes, Robert A., additional, Schwartzbach, Cary C., additional, Schulman, Jeff E., additional, Malekzadeh, A. Stephen, additional, Holzman, Michael A., additional, Ahn, James S., additional, Panjshiri, Farhanaz, additional, Das, Sharmistha, additional, English, Antoinisha D., additional, Haaser, Sharon M., additional, Cuff, Jaslynn A.N., additional, Pilson, Holly, additional, Carroll, Eben A., additional, Halvorson, Jason J., additional, Babcock, Sharon, additional, Holden, Martha B., additional, Bullard, Debra, additional, Williams, Wendy, additional, Higgins, Thomas F., additional, Haller, Justin M., additional, Rothberg, David L., additional, Neese, Ashley, additional, Russell, Mark, additional, Coe, Marcus, additional, Dwyer, Kevin, additional, Mullin, Devin S., additional, Reilly, Clifford A., additional, DePalo, Peter, additional, Hall, Amy E., additional, Heng, Marilyn, additional, Harris, Mitchel B., additional, Smith, R. Malcolm, additional, Lhowe, David W., additional, Esposito, John G., additional, Bansal, Mira, additional, Bergin, Patrick F., additional, Russell, George V., additional, Graves, Matthew L., additional, Morellato, John, additional, Champion, Heather K., additional, Johnson, Leslie N., additional, McGee, Sheketha L., additional, Bhanat, Eldrin L., additional, Mehta, Samir, additional, Donegan, Derek, additional, Ahn, Jaimo, additional, Horan, Annamarie, additional, Dooley, Mary, additional, Kuczinski, Ashley, additional, Iwu, Ashley, additional, Potter, David, additional, VanDemark, Robert, additional, Pfaff, Branden, additional, Hollinsworth, Troy, additional, Weaver, Michael J., additional, von Keudell, Arvind G., additional, McTague, Michael F., additional, Allen, Elizabeth M., additional, Jaeblon, Todd, additional, Beer, Robert, additional, Gage, Mark J., additional, Reilly, Rachel M., additional, and Sparrow, Cindy, additional

Published
2021
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19. Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures.

Author

Stupay, Kristen L., Miller, Christopher P., Staffa, Steven, McTague, Michael F., Weaver, Michael J., and Kwon, John Y.

Abstract

Background: Early revision rates within 12 months after ankle fracture open reduction internal fixation (AF-ORIF) are fairly low; however, they remain relevant given the volume of ankle fractures occurring annually. Understanding these rates is complex because reoperation due to technical or mechanical complications is typically reported alongside soft tissue–related problems such as symptomatic hardware, wound dehiscence, or infection. There are limited data identifying risk factors specifically for revision of ankle fracture fixation in the absence of soft tissue complications. Understanding variables that predispose to aseptic technical and mechanical failure without this confounder may provide insight and improve patient care. Methods: A retrospective cohort study was performed at 2 large academic medical centers. Research Patient Data Registry (RPDR) data available from 2002 to 2019 were used to identify patients who underwent aseptic revision of AF-ORIF within 12 months (n = 33). A control group (n = 100) was selected by identifying sequential patients who underwent AF-ORIF not requiring revision within 12 months. Multiple factors were recorded for all patients in both cohorts. Each fracture was also evaluated according to the Ankle Reduction Classification System (ARCS) of Chien et al,8 which categorizes biplanar talar displacement in relation to a central tibial plumb line into 1 of 3 grades: A (0-2 mm), B (3-10 mm), and C (>10 mm). Adapted from its original purpose of grading reduction quality, we applied ARCS to pre-reduction radiographs to assess initial fracture displacement. All variables collected were compared in univariate analysis. Variables that achieved significance in univariate comparisons were included as candidates for multivariable analysis. Results: Final multivariable logistic regression modeling demonstrated the following factors to independently predict the need for aseptic revision surgery: documented falls in the early postoperative period (aOR, 298; 95% CI, 15.4, 5759; P <.001), movement-altering disorders (aOR, 81.7; 95% CI, 4.12, 1620; P =.004), a nonanatomic mortise (medial clear space [MCS] > superior clear space [SCS]) on immediate postoperative imaging (aOR, 38.4; 95% CI, 5.53, 267; P <.001), initial coronal plane tibiotalar displacement >10 mm and sagittal plane tibiotalar dislocation (ARCS-C) (aOR vs ARCS-A, 25.8; 95% CI, 2.81, 237; P =.004), substance abuse (aOR, 15.7; 95% CI, 2.66, 92.8; P =.002), and polytrauma (aOR, 12.3; 95% CI, 2.02, 74.8; P =.006). Conclusion: In this investigation we found a notable increase in risk for revision surgery after AF-ORIF for patients who had one of the following: (1) falls in the early postoperative period, (2) movement-altering disorders, (3) a nonanatomic mortise (MCS > SCS) on immediate postoperative imaging, (4) more severe initial fracture displacement, (5) substance abuse, or (6) polytrauma. Identifying these factors may allow surgeons to better understand risk and counsel patients, and may serve as future targets for intervention aimed at improving patient safety and outcomes after ankle fracture ORIF. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Published
2022
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26. The effectiveness of germicidal wipes and ultraviolet irradiation in reducing bacterial loads on electronic tablet devices used to obtain patient information in orthopaedic clinics: evaluation of tablet cleaning methods.

Author

Allen, E.M., McTague, M.F., Bay, C.P., Esposito, J.G., von Keudell, A., Weaver, M.J., Allen, Elizabeth M, and McTague, Michael F

Abstract

Background: Electronic tablet devices are commonly used in outpatient clinics to obtain patient information for both clinical and research purposes. These devices are often colonized with bacteria; there are many cleaning methods to reduce this bacterial load.Aim: The primary purpose of this study was to evaluate whether regular cleaning with either germicidal wipes or ultraviolet (UV) irradiation leads to lower bacterial levels compared with irregular cleaning.Methods: A randomized blinded trial was conducted of tablet cleaning strategies between each patient encounter in orthopaedic clinics. The cleaning method was randomized to either germicidal wipes, UV irradiation, or cleaning only when the tablet was visibly soiled. Research assistants (blinded to the treatment) obtained bacterial cultures from the tablets at the beginning and end of each clinic day.Findings: Using germicidal wipes between each patient encounter vs no routine cleaning resulted in a marked decrease in the amount of bacterial contamination (risk ratio (RR) = 0.17 (0.04-0.67)). Similarly, using UV irradiation between each patient encounter led to significantly lower bacterial contamination rates (RR = 0.29 (95% confidence interval (CI) = 0.09-0.95)) compared with no routine cleaning. The majority of bacteria identified were normal skin flora. No meticillin-resistant Staphylococcus aureus was identified and only sparse colonies of meticillin-sensitive S. aureus.Conclusion: Electronic tablets used in orthopaedic trauma clinics are colonized with bacteria if no routine cleaning is performed. Routine use of either UV irradiation or germicidal wipes significantly decreases this bacterial burden. Providers should implement routine cleaning of tablets between each patient encounter to minimize exposure to potential pathogens. [ABSTRACT FROM AUTHOR]

Published
2020
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28. Tracking occupational hearing loss across global industries: a comparative analysis of metrics.

Author

Rabinowitz PM, Galusha D, McTague MF, Slade MD, Wesdock JC, Dixon-Ernst C, Rabinowitz, Peter M, Galusha, Deron, McTague, Michael F, Slade, Martin D, Wesdock, James C, and Dixon-Ernst, Christine

Abstract

Occupational hearing loss is one of the most prevalent occupational conditions; yet, there is no acknowledged international metric to allow comparisons of risk between different industries and regions. In order to make recommendations for an international standard of occupational hearing loss, members of an international industry group (the International Aluminium Association) submitted details of different hearing loss metrics currently in use by members. We compared the performance of these metrics using an audiometric data set for over 6000 individuals working in 10 locations of one member company. We calculated rates for each metric at each location from 2002 to 2006. For comparison, we calculated the difference of observed-expected (for age) binaural high-frequency hearing loss (in dB/year) for each location over the same time period. We performed linear regression to determine the correlation between each metric and the observed-expected rate of hearing loss. The different metrics produced discrepant results, with annual rates ranging from 0.0% for a less-sensitive metric to more than 10% for a highly sensitive metric. At least two metrics, a 10dB age-corrected threshold shift from baseline and a 15dB nonage-corrected shift metric, correlated well with the difference of observed-expected high-frequency hearing loss. This study suggests that it is feasible to develop an international standard for tracking occupational hearing loss in industrial working populations. [ABSTRACT FROM AUTHOR]

Published
2012
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29. Skin Antisepsis before Surgical Fixation of Extremity Fractures.

Author

Sprague S, Slobogean G, Wells JL, O'Hara NN, Thabane L, Mullins CD, Harris AD, Wood A, Viskontas D, Apostle KL, O'Toole RV, Joshi M, Johal H, Al-Asiri J, Hymes RA, Gaski GE, Pilson HT, Carroll EA, Babcock S, Halvorson JJ, Romeo NM, Matson CA, Higgins TF, Marchand LS, Bergin PF, Morellato J, Van Demark RE 3rd, Potter GD, Gitajn IL, Chang G, Phelps KD, Kempton LB, Karunakar M, Jaeblon T, Demyanovich HK, Domes CM, Kuhn GR, Reilly RM, Gage MJ, Weaver MJ, von Keudell AG, Heng M, McTague MF, Alnasser A, Mehta S, Donegan DJ, Natoli RM, Szatkowski J, Scott AN, Shannon SF, Jeray KJ, Tanner SL, Marmor MT, Matityahu A, Fowler JT, Pierrie SN, Beltran MJ, Thomson CG, Lin CA, Moon CN, Scolaro JA, Amirhekmat A, Leonard J, Pogorzelski D, Bzovsky S, Heels-Ansdell D, Szasz OP, Gallant JL, Della Rocca GJ, Zura RD, Hebden JN, Patterson JT, Lee C, O'Hara LM, Marvel D, Palmer JE, Friedrich J, D'Alleyrand JG, Rivera JC, Mossuto F, Schrank GM, Guyatt G, Devereaux PJ, and Bhandari M

Subjects
Humans, 2-Propanol administration & dosage, 2-Propanol adverse effects, 2-Propanol therapeutic use, Antisepsis methods, Canada, Ethanol, Extremities injuries, Extremities microbiology, Extremities surgery, Preoperative Care adverse effects, Preoperative Care methods, Skin microbiology, Cross-Over Studies, United States, Anti-Infective Agents, Local administration & dosage, Anti-Infective Agents, Local adverse effects, Anti-Infective Agents, Local therapeutic use, Chlorhexidine administration & dosage, Chlorhexidine adverse effects, Chlorhexidine therapeutic use, Iodine administration & dosage, Iodine adverse effects, Iodine therapeutic use, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, Fractures, Bone surgery, Fracture Fixation
Abstract

Background: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture)., Methods: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications., Results: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups., Conclusions: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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30. Factors for Increased Hospital Stay and Utilization of Post -Acute Care Facilities in Geriatric Orthopaedic Fracture Patients.

Author

Van Der Vliet QMJ, Weaver MJ, Heil K, McTague MF, and Heng M

Abstract

Background: This study aims to determine the extent of utilization of health care resources in the geriatric fracture population and to identify factors associated with burden on resources., Methods: This is a retrospective study of 1074 patients ≥65 years admitted to an orthopaedic service for a long bone fracture between July 2014 - June 2015. Outcomes were hospital length of stay (LOS), discharge disposition, and post-acute care facility LOS. Secondarily, readmission rates and mortality were assessed. Multivariable regression was performed to identify factors associated with utilization., Results: Prior to injury, 96% of patients lived at home and 50% ambulated independently. Median hospital LOS was 5 days (IQR 3 - 7). 878 patients were discharged to a rehabilitation facility, with 45% being discharged <20 days. Ten percent of patients (n = 108) were re-admitted <90 days of their discharge. 924 patients were still alive one year after the injury. Higher Charlson Comorbidity Index (CCI) ( P=0.048 ), male sex ( P<0.001 ), pre-injury use of an ambulatory device ( P = 0.006 ), and undergoing surgical treatment ( P<0.001 ) were associated with longer hospital LOS. Older age ( P<0.001 ), pre-injury ambulatory device ( P=0.001 ), and surgery ( P=0.012 ) were risk factors for requiring discharge to another inpatient facility. Older age ( P<0.001 ), pre-injury ambulatory aid ( P<0.001 ), and pre-existing immobility ( P<0.001 ) were independent risk factors for LOS >20 days in a rehabilitation facility. Discharge home was not found to be associated with an increase in 1-year mortality after adjusting for age, CCI, sex, fracture location, and surgery ( P=0.727 ). Shorter LOS in rehabilitation facilities (<20 days) was also not associated with an increase in 1-year mortality ( P=0.520 )., Conclusion: Elderly fracture patients utilize a significant amount of post-acute care resources and age, CCI, surgery, fracture location, pre-injury ambulatory status, and pre-injury living status were found to be associated with the use of these resources.

Published
2021
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31. Long-term outcomes after operative treatment for tibial pilon fractures.

Author

van der Vliet QMJ, Ochen Y, McTague MF, Weaver MJ, Hietbrink F, Houwert RM, Leenen LPH, and Heng M

Abstract

Objectives: Aims of the present study were to establish generalizable outcome data on long-term functional outcomes and health-related quality of life (HRQoL) after operative treatment of pilon fractures on a large scale. Second, it was aimed to examine factors associated with these outcomes., Design: Retrospective cohort study with follow-up by questionnaire., Setting: Two level 1 trauma centers., Patients: Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%)., Intervention: Open reduction internal fixation for tibial pilon fracture., Main Outcome Measurements: Ankle function measured using the Foot and Ankle Ability Measure, physical function using the Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire and HRQoL using the EuroQol 5-Dimensions 3-Level (EQ-5D-3L) questionnaire., Results: At a medium follow-up of 82 months (82 (interquartile range (IQR), 45-120), median Foot and Ankle Ability Measure was 74 (IQR, 57-82), median PROMIS PF 49 (IQR, 44-57), median EQ-5D-3L 0.81 (IQR, 0.71-0.84). HRQoL was significantly lower compared to a reference population ( P  < .001). In multivariable regression analyses, smoking was associated with poorer HRQoL. Higher body mass index, deep infection, and lower HRQoL were associated with worse ankle function., Conclusions: Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context., Level of Evidence: Prognostic level III., Competing Interests: The authors have no conflicts of interest to disclose, (Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Published
2019
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