Randomized control trial of unconditional versus conditional incentives to increase study enrollment rates in participants at increased risk of lung cancer.

INTRODUCTION: Understanding how incentives and their timing influence study enrollment rates is important to efficient study design and increasing the generalizability of findings. This 2-arm, parallel randomized trial evaluated how conditional vs. unconditional mailed incentives of a $20 gift card affected study enrollment in a sample of participants screened for lung cancer screening. METHODS: Eligible participants included Black and White adults who underwent lung cancer screening with low-dose CT and had negative screening results at two North Carolina imaging facilities in 2018. We used a stratified randomization scheme, by sex and race, to assign incentive type (conditional vs. unconditional). We used the Tailored Design Method with six points of mailed contact to engage participants. We compared study enrollment rates using chi-square tests and logistic regression analyses. RESULTS: After adjusting for sex, race, age, smoking status, participant residence, and screening site, participants who received unconditional incentives were 74% more likely to enroll than those who received conditional incentives (adjusted OR = 1.74 (95% CI: 1.01, 3.00). CONCLUSIONS: Type of incentive can play a role in increasing study enrollment, especially mailed surveys that target individuals who currently or previously smoked. Unconditional incentives may be worth the initial cost to engage study participants.

Glenohumeral osteoarthritis with intact rotator cuff treated with reverse shoulder arthroplasty: a systematic review.

BACKGROUND: Although reverse shoulder arthroplasty (RSA) has shown satisfactory outcomes in rotator cuff-deficient shoulders, its performance in shoulders with an intact rotator cuff has not been fully elucidated. Shoulder osteoarthritis can present with alterations in glenoid morphology, which have contributed to inconsistent outcomes in anatomic shoulder replacement. The glenoid component is responsible for a predominance of these arthroplasty complications. Given these glenoid-related difficulties, RSA may provide a more favorable option. We aimed to summarize the current literature on rotator cuff intact osteoarthritis treated with primary RSA and to determine whether morphologic changes in the glenoid led to inferior outcomes. METHODS: A literature search was performed using an inclusion criterion of primary RSA for osteoarthritis with an intact rotator cuff. The Modified Coleman Methodology Score was calculated to analyze reporting quality. Following appropriate exclusions, of the 1002 studies identified by the databases, 13 were selected. RESULTS: Postoperative improvement in weighted means for Constant scores reached statistical significance (P = .02). The mean rate of major complications was 3.8%. A subset of 8 studies was created that detailed the following descriptions of altered glenoid morphology: "static posterior instability," "severe posterior subluxation," "posterior glenoid wear >20°," "significant posterior glenoid bone loss," "biconcave glenoid," "B2 glenoid," and "B/C glenoid." Within this subset, the mean complication rate was 4.7%, with 4 of the 7 studies having a rate ≤ 3%, and improvements in the Constant score (P = .002) and external rotation (P = .02) reached statistical significance. DISCUSSION: RSA as treatment for osteoarthritis with an intact rotator cuff provides optimal outcomes with low complication rates across a short term of follow up. Preoperative considerations for using reverse arthroplasty in the treatment of osteoarthritis with an intact rotator cuff include glenoid retroversion, posterior humeral subluxation, and glenoid bone loss. The attributes of reverse arthroplasty that contribute to favorable outcomes in arthritic shoulders include its semiconstrained design and robust glenoid fixation. Soft-tissue imbalances as a consequence of pathologic glenoid morphology and chronic humeral subluxation can be mitigated with the RSA semiconstrained design. Glenoid bone loss can be effectively managed with RSA's robust glenoid fixation, with and without the use of bone graft. The capability to lateralize the joint center of rotation may be valuable when faced with a medialized glenoid wear pattern. The current findings suggest that reverse arthroplasty can achieve highly favorable outcomes for glenohumeral osteoarthritis with an intact rotator cuff.

Reverse shoulder arthroplasty used for revision of reverse shoulder arthroplasty: a systematic review.

Background: As reverse shoulder arthroplasty (RSA) cases increase, so too will the need to revise subsequent failures. Many of the complications associated with revising anatomic total shoulder and hemiarthroplasty have been adequately addressed by RSA including glenoid bone deficiency, instability, and functional outcomes. However, the risk for complication when revising a failed reverse prosthesis may be more pronounced with increased bone and soft tissue deficiency. The ability for the reversed prosthesis to accommodate these insufficiencies following a prior reversed prosthesis is unclear. Methods: PubMed, Embase, and Google Scholar were queried for articles which fit the inclusion criteria of a reversed prosthesis used to revise a failed primary reverse prosthesis with a minimum follow-up of 12 months and clinical outcome reporting. Results: After exclusions, 9 studies reporting on 242 reverse shoulders with a mean follow-up of 40.29 months were analyzed. The differences between preoperative and postoperative weighted means were not significant for Constant (P = .26), American Shoulder and Elbow Surgeons Shoulder score (P = .61), SSV (P = .57), and visual analog scale for pain (P = .48). Functional improvements in elevation (74°-102°) and external rotation (18°-21°) were consistent with those reported for primary reverse procedures, although differences in preoperative and postoperative measures were not statistically significant. Patient satisfaction was 89% with a major complication rate of 25%. Discussion: The reverse shoulder prosthesis has proven satisfactory in revising hemiarthroplasty and anatomic total shoulder arthroplasty. The current results indicate RSA is also a satisfactory treatment option when revising a prior reverse prosthesis. Inherent to revision shoulder surgery is the obstacle of humeral and glenoid bone loss, an attenuated soft-tissue envelope, and instability. The reverse prosthesis may adequately address these commonly confronted difficulties with its inherent design characteristics. RSA provides a secure glenoid fixation for bone grafting, the ability to increase construct stability with component sizing, and a reliance on the deltoid for function. As our learning about revision of RSA improves, so will our ability to preemptively address potential issues which may lead to decreased complications in these cases. Despite the 25% rate of major complication, patients reported satisfaction of 89% which demonstrates the improvements in function and pain relief that are provided by the reverse prosthesis.

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis.

Purpose: The aims of this systematic review were to examine the use of radiolunate (RL) or radioscapholunate (RSL) arthrodesis as surgical management for patients with advanced radiocarpal arthritis that failed conservative management and to assess postoperative outcomes. Methods: We reviewed articles from PubMed, EMBASE, and Web of Science from inception through December 2019. We identified complete manuscripts written in English reporting on RL or RSL arthrodesis for treatment of wrist pathology that included the primary outcomes (pain or grip strength) and at least 2 secondary outcomes (range of motion, patient-reported outcomes, or nonunion). Data pooling was used to calculate weighted averages. Results: We identified 2,252 articles and selected 13 for inclusion. Across all studies, RSL arthrodesis was performed for 180 patients (49% female; 45 years old) and RL for 94 (87% female; 50 years old). Both procedures exhibited improvements in pain score and grip strength. Both cohorts demonstrated postoperative changes in flexion-extension arc, flexion, extension, ulnar deviation, supination, and pronation after data pooling. The nonunion rate for RSL was 15% versus 2% for RL, whereas the rate of progression to total wrist arthrodesis for RSL and RL was 4% and 0%, respectively. Conclusions: Both RL and RSL arthrodesis can be successfully used to manage debilitating radiocarpal arthritis by affording patients with pain reduction. Each has its own benefits, in which RSL arthrodesis provides a total arc of motion within the functional demands of most activities of daily living, and RL arthrodesis has low rates of nonunion and progression to total wrist arthrodesis. Further research is needed to compare the 2 surgeries directly and prospectively in comparable patient groups. Type of study/level of evidence: Therapeutic III.