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32. Patient definitions of transplant success in upper extremity vascularized composite allotransplantation: A mixed-methods study

Author

Downey, Max C, primary, Gacki-Smith, Jessica, additional, Kuramitsu, Brianna, additional, Vanterpool, Karen B, additional, Nordstrom, Michelle, additional, Luken, Michelle, additional, Langlee, Whitney, additional, Riggleman, Tiffany, additional, Fichter, Shannon, additional, Altema, Withney, additional, Jensen, Sally E, additional, Dumanian, Gregory A, additional, Cooney, Carisa M, additional, Levan, Macey L, additional, Tintle, Scott, additional, Brandacher, Gerald, additional, and Gordon, Elisa J, additional

Published
2023
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35. Within Reach -- A Patient-Centered Website to Foster Informed Decision Making about Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Testing (Preprint)

Author

Vanterpool, Karen B., primary, Gacki-Smith, Jessica, additional, Kuramitsu, Brianna, additional, Downey, Max, additional, Nordstrom, MS, OTR/L, Michelle J,, additional, Luken, Michelle, additional, Riggleman, Tiffany, additional, Fichter, Shannon, additional, Altema, Withney, additional, Brucker, James B., additional, Cooney, Carisa M., additional, Dumanian, Gregory, additional, Jensen, Sally, additional, Levan, Macey, additional, Tintle, Scott M., additional, Brandacher, Gerald, additional, and Gordon, Elisa, additional

Published
2022
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38. Patient-Reported Outcomes in Orthopaedics

Author

Christensen, Daniel L., Dickens, Jonathan F., Freedman, Brett, Mauntel, Timothy, Owens, Brett D., Potter, Benjamin K., Provencher, Matthew, Tokish, John M., Waterman, Brian R., Antosh, Ivan, Bellamy, Jaime, Cameron, Kenneth L., Cook, Karon F., Eckel, Tobin T., Eichinger, Josef K., Garcia, EStephan J., Helgeson, Melvin D., Joyner, Patrick W., Kang, Daniel G., Kilcoyne, Kelly G., Krueger, Chad A., LeClere, Lance E., Li, Xinning, Martin, Kevin D., McCallum, Jeremy R., McDonald, Lucas S., Ortiz, Dionisio, III, Pallis, Mark P., Parada, Stephen A., Patzkowski, Jeanne C., Posner, Matthew A., Rivera, Jessica C., Robins, R. Judd, Rothrock, Nan, Schmitz, Matthew R., Slabaugh, Mark, Song, Daniel J., Stinner, Daniel J., Tintle, Scott M., Tucker, Christopher J., Waltz, Robert A., and Wilson, Kevin

Published
2018
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39. Information needs and development of a question prompt sheet for upper extremity vascularized composite allotransplantation: A mixed methods study

Author

Gacki-Smith, Jessica, primary, Kuramitsu, Brianna R., additional, Downey, Max, additional, Vanterpool, Karen B., additional, Nordstrom, Michelle J., additional, Luken, Michelle, additional, Riggleman, Tiffany, additional, Altema, Withney, additional, Fichter, Shannon, additional, Cooney, Carisa M., additional, Dumanian, Greg A., additional, Jensen, Sally E., additional, Brandacher, Gerald, additional, Tintle, Scott, additional, Levan, Macey, additional, and Gordon, Elisa J., additional

Published
2022
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43. Is the Lifetime Malignancy Risk in United States Military Personnel Sustaining Combat-related Trauma Increased Because of Radiation Exposure From Diagnostic Imaging?

Author

Anderson, Ashley B., Rivera, Julio A., Mullin, Edmund P., Harrington, Collin J., Potter, Benjamin K., Forsberg, Jonathan A., and Tintle, Scott M.

Subjects
RADIATION exposure, UNITED States armed forces, BLAST injuries, MILITARY personnel, DIAGNOSTIC imaging, ELECTRONIC health records, MILITARY hospitals, RADIOLOGIC technologists
Abstract

Background: Patients with complex polytrauma in the military and civilian settings are often exposed to substantial diagnostic medical radiation because of serial imaging studies for injury diagnosis and subsequent management. This cumulative radiation exposure may increase the risk of subsequent malignancy. This is particularly true for combat-injured servicemembers who receive care at a variety of facilities worldwide. Currently, there is no coordinated effort to track the amount of radiation exposure each servicemember receives, nor a surveillance program to follow such patients in the long term. It is important to assess whether military servicemembers are exposed to excessive diagnostic radiation to mitigate or prevent such occurrences and monitor for carcinogenesis, when necessary. The cumulative amount of radiation exposure for combat-wounded and noncombat-wounded servicemembers has not been described, and it remains unknown whether diagnostic radiation exposure meets thresholds for an increased risk of carcinogenesis. Questions/purposes: We performed this study to (1) quantify the amount of exposure for combat-wounded servicemembers based on medical imaging in the first year after injury and compare those exposures with noncombat-related trauma, and (2) determine whether the cumulative dose of radiation correlates to the Injury Severity Score (ISS) across the combat-wounded and noncombat-wounded population combined. Methods: We performed a retrospective study of servicemembers who sustained combat or noncombat trauma and were treated at Walter Reed National Military Medical Center from 2005 to 2018. We evaluated patients using the Department of Defense Trauma Registry. After consolidating redundant records, the dataset included 3812 unique servicemember encounters. Three percent (104 of 3812) were excluded because of missing radiation exposure data in the electronic medical record. The final cohort included 3708 servicemembers who had combat or noncombat injury trauma, with a mean age at the time of injury of 26 ± 6 years and a mean ISS of 18 ± 12. The most common combat trauma mechanisms of injury were blast (in 65% [2415 of 3708 patients]), followed by high-velocity gunshot wounds (in 22% [815 of 3708 patients]). We calculated the cumulative diagnostic radiation dose exposure at 1 year post-traumatic injury in patients with combat-related trauma and those with noncombat trauma. We did this by multiplying the number of imaging studies by the standardized effective radiation dose for each imaging study type. We then performed analysis of variance for four data subsets (battle combat trauma, nonbattle civilian trauma, high ISS, and high radiation exposure [> 50 mSv]) independently. To evaluate whether the total number of imaging studies, radiation exposure, and ISS values differed between battle-wounded and nonbattle-wounded patients, we performed a pairwise t-test. Results: The mean radiation exposure for combat-related injuries was 35 ± 26 mSv while the mean radiation exposure for noncombat-related injuries was 22 ± 33 mSv in the first year after injury. In the first year after trauma, 44% of patients (1626 of 3708) were exposed to high levels of radiation that were greater than 20 mSv, and 23% (840 of 3708) were exposed to very high levels of radiation that were greater than 50 mSv. Servicemembers with combat trauma-related injuries had eight more imaging studies than those who sustained noncombat injuries. Servicemembers with combat trauma injuries (35 ± 26 mSv) were exposed to more radiation (approximately 4 mSv) than patients treated for noncombat injuries (22 ± 33 mSv) (p = 0.01). We found that servicemembers with combat injuries had a higher ISS than servicemembers with noncombat trauma (p < 0.001). We found a positive correlation between radiation exposure and ISS for servicemembers. The positive relationship between radiation exposure and ISS held for combat trauma (r2 = 0.24; p < 0.001), noncombat trauma (r2 = 0.20; p < 0.001), servicemembers with a high ISS (r2 = 0.10; p < 0.001), and servicemembers exposed to high doses of radiation (r2 = 0.09; p < 0.001). Conclusion: These data should be used during clinical decision-making and patient counseling at military treatment facilities and might provide guidance to the Defense Health Agency. These recommendations will help determine whether the benefits of further imaging outweigh the risk of carcinogenesis. If not, we need to develop interdisciplinary clinical practice guidelines to reduce or minimize radiation exposure. It is important for treating physicians to seriously weigh the risk and benefits of every imaging study ordered because each test does not come without a cumulative risk. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Contributors

Author

Abbed, Khalid M., primary, Abdullah, Kalil G., additional, Ackerman, Paul D., additional, Alapan, Yunus, additional, Alentado, Vincent J., additional, Alvin, Matthew D., additional, Ames, Christopher P., additional, Anand, Neel, additional, Anderson, Paul A., additional, Angelov, Lilyana, additional, Anissipour, Alireza K., additional, Anson, John A., additional, Apfelbaum, Ronald I., additional, Archdeacon, Michael, additional, Arnold, Paul M., additional, Arun, Mike W.J., additional, Arzi, Harel, additional, Awad, Ahmed J., additional, Awad, Basem I., additional, Bahuleyan, Biji, additional, Bain, Mark D., additional, Baird, Lissa C., additional, Baisden, Jamie, additional, Baldwin, Nevan G., additional, Ball, Perry A., additional, Balsara, Karl E., additional, Baron, Eli M., additional, Batjer, H. Hunt, additional, Bauer, Andrew M., additional, Bauer, Thomas W., additional, Beckman, Joshua M., additional, Bell, Gordon R., additional, Bellabarba, Carlo, additional, Bennett, E. Emily, additional, Benzel, Edward C., additional, Bergey, Darren L., additional, Bhalla, Tarun, additional, Bierbrauer, Karin S., additional, Bilsky, Mark, additional, Birk, Harjus, additional, Bisson, Erica F., additional, Bono, Christopher, additional, Bransford, Richard J., additional, Brodke, Darrel S., additional, Brooks, Nathaniel, additional, Brotea, Cristian, additional, Brougham, Jared R., additional, Browd, Samuel R., additional, Buckley, Robert T., additional, Burch, Shane, additional, Butler, John, additional, Bydon, Mohamad, additional, Casha, Steven, additional, Ceuppens, Jeroen, additional, Chan, Andrew K., additional, Chen, Thomas C., additional, Cheng, Joseph, additional, Chou, Dean, additional, Choudhri, Tanvir, additional, Clark, Aaron J., additional, Conley, Adam M., additional, Cooper, Paul R., additional, Coric, Domagoj, additional, Corriveau, Mark, additional, Côté, Ian P., additional, Coumans, Jean-Valery C.E., additional, Crawford, Charles H., additional, Curry, William T., additional, Daffner, Scott D., additional, Dalbayrak, Sedat, additional, DeMicco, Russell C., additional, Deutsch, Harel, additional, Dhall, Sanjay S., additional, DiAngelo, Denis J., additional, Dickman, Curtis A., additional, Dodwad, Shah-Nawaz M., additional, Duarte, Siena M., additional, Ebrahim, Zeyd, additional, Eckardt, Gerald W., additional, Ehni, Bruce L., additional, Eichholz, Kurt M., additional, Eichler, Marc, additional, Elbabaa, Samer K., additional, Elder, Benjamin D., additional, Elder, James B., additional, Ellenbogen, Richard G., additional, Epstein, Nancy, additional, Errico, Thomas J., additional, Esquenazi, Yoshua, additional, Fahim, Daniel K., additional, Farag, Ehab, additional, Farley, Chad W., additional, Fehlings, Michael G., additional, Feigenbaum, Frank, additional, Fenton, Eoin, additional, Ferrara, Lisa A., additional, Fessler, R. David, additional, Fessler, Richard G., additional, Finn, Michael A., additional, Finnan, Ryan, additional, Fischgrund, Jeffrey S., additional, Foley, Kevin T., additional, Fontes, Ricardo B.V., additional, Francis, Todd B., additional, Freedman, Brett A., additional, Frost, Frederick, additional, George, John, additional, German, John W., additional, Gerszten, Peter C., additional, Ghobrial, George M., additional, Ghogawala, Zoher, additional, Gibson, Justin L., additional, Gillis, Christopher C., additional, Goel, Vijay K., additional, Goffin, Jan, additional, Gokaslan, Ziya L., additional, Gollogly, Sohrab, additional, Goodwin, C. Rory, additional, Goulart, Carlos R., additional, Goz, Vadim, additional, Gozal, Yair M., additional, Graham, Randall B., additional, Grant, Gerald A., additional, Guan, Jian, additional, Gulec, Ilker, additional, Gussous, Yazeed M., additional, Guyer, Richard D., additional, Gwinn, David, additional, Ha, Sung, additional, Hadar, Eldad, additional, Haldeman, Clayton L., additional, Halim, Alexander Y., additional, Hamilton, Kimberly M., additional, Hammer, Christine L., additional, Hanbali, Fadi, additional, Hann, Shannon W., additional, Harms, Jurgen, additional, Harrop, James S., additional, Hart, Blaine L., additional, Hart, David J., additional, Harwell, Daniel, additional, Hayek, Reyaad A., additional, Heary, Robert F., additional, Henderson, Fraser C., additional, Hitchon, Patrick W., additional, Hoh, Daniel J., additional, Holman, Paul J., additional, Hosono, Noboru, additional, Houseman, Clifford, additional, Houten, John K., additional, Hsieh, Joseph C., additional, Hsu, Wellington K., additional, Huang, Meng, additional, Hurlbert, R. John, additional, Hwang, Lee, additional, Hwang, Steven, additional, İnceoğlu, Serkan, additional, Infinger, Libby Kosnik, additional, de Oliveira, Tatiana von Hertwig Fernandes, additional, Jalan, Devesh, additional, Jha, Neilank, additional, Johnson, J. Patrick, additional, Jones, Charles I., additional, Jones, G. Alexander, additional, Jones, Michael, additional, Juthani, Rupa G., additional, Kager, Christopher D., additional, Kalani, Maziyar A., additional, Kalani, M. Yashar S., additional, Kalfas, Iain H., additional, Kalra, Ricky R., additional, Karimi, Reza J., additional, Kashlan, Osama, additional, Kasliwal, Manish K., additional, Kaul, Vikas, additional, Kaushal, Mayank, additional, Kenning, Tyler J., additional, Khairi, Saad, additional, Khalaf, Tagreed, additional, Khalil, Jad G., additional, Khoo, Larry T., additional, Kiapour, Ali, additional, Kim, Daniel H., additional, Kim, David H., additional, Kimmell, Kristopher T., additional, Kirshblum, Steven, additional, Kitab, Sameer A., additional, Klimo, Paul, additional, Klineberg, Eric O., additional, Koski, Tyler R., additional, Kosztowski, Thomas A., additional, Kowalski, Robert J., additional, Krishnaney, Ajit A., additional, Krupa, Kelly, additional, Krupa, Kristin, additional, Kshettry, Varun R., additional, Kukreja, Sunil, additional, Kuntz, Charles, additional, Kurpad, Shekar N., additional, Kusuma, Srinivasu, additional, LaBagnara, Michael, additional, La Marca, Frank, additional, Laufer, Ilya, additional, Lavelle, Elizabeth Demers, additional, Lavelle, William F., additional, Lawrence, W. Thomas, additional, Lebl, Darren R., additional, Lee, Bryan S., additional, Lee, Sun-Ho, additional, Lenke, Lawrence G., additional, Leon, Steven P., additional, Li, Amy, additional, Li, Yiping, additional, Lieberman, Isador H., additional, Liu, James K.C., additional, Lo, Victor P., additional, Lollis, S. Scott, additional, Lopez-Gonzalez, Miguel, additional, Lubelski, Daniel, additional, Luciano, Mark G., additional, Machado, Andre G., additional, Maddela, Raghu, additional, Madineni, Ravichandra A., additional, Madura, Casey, additional, Maiman, Dennis J., additional, Malone, David G., additional, Mammis, Antonios, additional, Marawar, Satyajit, additional, Marcotte, Nicolas, additional, Maroon, Joseph C., additional, Martin, Michael D., additional, Martinez-del-Campo, Eduardo, additional, Massicotte, Eric M., additional, Mattei, Tobias A., additional, Maurer, Paul K., additional, Mayer, Eric A.K., additional, del Valle, Miguel Mayol, additional, Mazanec, Daniel J., additional, McCormick, Paul C., additional, McCormick, William, additional, Medress, Zachary A., additional, Mendel, Ehud, additional, Metkar, Umesh S., additional, Miele, Vincent J., additional, Mohyeldin, Ahmed, additional, Monsef, Jad Bou, additional, Moore, Timothy A., additional, Morisue, Hikaru, additional, Morone, Peter, additional, Mroz, Thomas E., additional, Mullin, Jeffrey P., additional, Murtagh, F. Reed, additional, Murtagh, Ryan D., additional, Naderi, Sait, additional, Nagaraj, Usha D., additional, Nalley, Charles C., additional, Nanda, Anil, additional, Nasca, Richard J., additional, Nater, Anick, additional, Neal, Matthew T., additional, Nockels, Russ P., additional, Norwig, John A., additional, Ondoma, Solomon M., additional, Oni-Orisan, Akinwunmi, additional, Oren, Jonathan H., additional, Orning, Jennifer, additional, Orr, R. Douglas, additional, Orrico, Katie, additional, Osorio, Joseph A., additional, Otero-Lopez, Ernesto, additional, O'Toole, John, additional, Park, Paul, additional, Parmar, Vikas, additional, Pashman, Robert S., additional, Patel, Rakesh D., additional, Patel, Smruti K., additional, Perez-Cruet, Mick J., additional, Perin, Noel I., additional, Pettigrew, David B., additional, Phillips, H. Westley, additional, Placide, Rick, additional, Porensky, Paul, additional, Prager, Joshua P., additional, Prasad, Srinivas, additional, Prasarn, Mark L., additional, Ramakrishnan, Rakesh, additional, Ramayya, Ashwin G., additional, Rampersaud, Y. Raja, additional, Rasmussen, Peter A., additional, Ratliff, John K., additional, Rauschning, Wolfgang, additional, Rechtine, Glenn R., additional, Recinos, Pablo F., additional, Resnick, Daniel K., additional, Rhee, Jay, additional, Rhines, Laurence D., additional, Riccio, Alexander R., additional, Richardson, Marlin Dustin, additional, Richter, Bertram, additional, Riesenburger, Ron, additional, Riew, K. Daniel, additional, Rogers, Matthew, additional, Saavedra, Fanor M., additional, Safain, Mina G., additional, Saigal, Rajiv, additional, Sawin, Paul D., additional, Scheer, Justin K., additional, Scheidler, Joshua, additional, Schippert, David W., additional, Schlenk, Richard, additional, Schmidt, Bradley, additional, Schmidt, Meic H., additional, Sciubba, Daniel M., additional, Shaffrey, Christopher I., additional, Shaffrey, Mark E., additional, Shah, Anoli, additional, Sharan, Alok, additional, Sharan, Ashwini D., additional, Shedid, Daniel, additional, Shook, Steven, additional, Silverstein, Michael P., additional, Simpson, Venita M., additional, Sin, Anthony, additional, Singh, Harminder, additional, Smith, Donald A., additional, Smith, Gabriel A., additional, Smith, Justin S., additional, Smith, Kyle A., additional, Sonntag, Volker K.H., additional, Soriano-Baron, Hector, additional, Spetzler, Robert F., additional, Spiker, W. Ryan, additional, Staub, Blake, additional, Steinmetz, Michael P., additional, Stillerman, Charles B., additional, Strayer, Andrea, additional, Subramaniam, Gandhivarma, additional, Sukkarieh, Hamdi G., additional, Sumich, Andrew, additional, Sun, Derrick Y., additional, Sunna, Tarek P., additional, Sure, Durga R., additional, Tallarico, Richard A., additional, Tan, Lee A., additional, Tatsui, Claudio E., additional, Techy, Fernando, additional, Theodore, Nicholas, additional, Theologis, Alexander A., additional, Thomas, Nicholas W.M., additional, Thorp, Brian D., additional, Tintle, Scott, additional, Tjoumakaris, Stavropoula, additional, Tobler, William D., additional, Togawa, Daisuke, additional, Traul, David, additional, Traynelis, Vincent C., additional, Tritle, A. Sophia, additional, Trost, Gregory R., additional, Tsai, Eve C., additional, Ugokwe, Kene, additional, Uluc, Kutlauy, additional, Uribe, Juan S., additional, Vaccaro, Alexander R., additional, Valadka, Alex, additional, Vedantam, Aditya, additional, Veeravagu, Anand, additional, Verma, Kushagra, additional, Vitaz, Todd, additional, Voyadzis, Jean-Marc, additional, Wagner, Scott, additional, Wahlquist, Trevor C., additional, Waldrop, Robert, additional, Walsh, Kevin M., additional, Wang, Jeffrey C., additional, Wang, Michael Y., additional, Wang, Patrick T., additional, Ward, John D., additional, Wardak, Zabi, additional, Wathen, Connor, additional, Weinstein, Philip R., additional, Weisman, Michael, additional, Welch, William C., additional, Weller, Simcha J., additional, Westerlund, L. Erik, additional, White, Jonathan A., additional, Whitmore, Robert G., additional, Wilberger, Jack E., additional, Williams, Kim A., additional, Winkler, Ethan A., additional, Witiw, Christopher D., additional, Wolfla, Christopher E., additional, Wolinsky, Jean-Paul, additional, Wong, Cyrus, additional, Woodard, Eric J., additional, Yanamadala, Vijay, additional, Yanni, Daniel S., additional, Yazbak, Philip A., additional, Yen, Chun-Po, additional, Yilmaz, Mesut, additional, Yoganandan, Narayan, additional, Yonemura, Kenneth S., additional, Yonenobu, Kazuo, additional, Yuan, Hansen A., additional, Yue, John K., additional, Zanation, Adam M., additional, Zavarella, Salvatore M., additional, Zeidman, Seth M., additional, Zileli, Mehmet, additional, Zuckerman, Scott, additional, and Zywicke, Holly, additional

Published
2017
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50. Utilization of a Clinic-Based Hand Surgery Procedure Room in the US Military Health System: A Performance Improvement Analysis of Resource Savings and Patient Satisfaction.

Author

Clark, DesRaj M., Dingle, Marvin E., Wade, Sean M., Mescher, Patrick K., Nanos III, George P., and Tintle, Scott M.

Abstract

Recent studies examining the implementation of clinic-based procedure rooms (PRs) for wide-awake hand surgery have reported cost reduction, decreased burden on hospital systems, and improved patient satisfaction. This study evaluates other resource savings, primarily time spent by patients in the hospital. Thirty-two patients were enrolled in a PR or the operating room group for prospective evaluation. Time spent in the hospital on the day of surgery, several preprocedure appointments, complications, and cost comparisons were evaluated between the two groups. Patient-reported outcomes were also evaluated with postoperative surveys assessing anxiety, pain, and satisfaction. Significant time savings were noted between the groups. The median time spent in the hospital on the day of surgery for the patients in the operating room group was 256 minutes versus 90 minutes for the PR group, a time savings of approximately 3 hours. Eight additional preoperative clinic visits for operating room patients were generated compared with no additional preoperative visits for PR patients. Cost savings for surgeries performed in the clinic-based procedure amounted to $232,411. No postoperative complications were observed in the clinic setting. Continued utilization of the clinical PR for select hand surgery procedures will reduce the cost and time burdens for procedures while maintaining satisfaction and safety. A clinic-based PR for performing minor hand surgeries saves the patient time and ostensibly allows the operating room to be used for more complex surgeries that are not easily amenable to a wide-awake in-clinic procedure. [ABSTRACT FROM AUTHOR]

Published
2024
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