Technology-assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta-analysis.

PURPOSE: To investigate the effect of technology-assisted Anterior Cruciate Ligament Reconstruction (ACLR) on post-operative clinical outcomes and tunnel placement compared to conventional arthroscopic ACLR. METHODS: CENTRAL, MEDLINE, and Embase were searched from January 2000 to November 17, 2022. Articles were included if there was intraoperative use of computer-assisted navigation, robotics, diagnostic imaging, computer simulations, or 3D printing (3DP). Two reviewers searched, screened, and evaluated the included studies for data quality. Data were abstracted using descriptive statistics and pooled using relative risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI), where appropriate. RESULTS: Eleven studies were included with total 775 patients and majority male participants (70.7%). Ages ranged from 14 to 54 years (391 patients) and follow-up ranged from 12 to 60 months (775 patients). Subjective International Knee Documentation Committee (IKDC) scores increased in the technology-assisted surgery group (473 patients; P = 0.02; MD 1.97, 95% CI 0.27 to 3.66). There was no difference in objective IKDC scores (447 patients; RR 1.02, 95% CI 0.98 to 1.06), Lysholm scores (199 patients; MD 1.14, 95% CI - 1.03 to 3.30) or negative pivot-shift tests (278 patients; RR 1.07, 95% CI 0.97 to 1.18) between the two groups. When using technology-assisted surgery, 6 (351 patients) of 8 (451 patients) studies reported more accurate femoral tunnel placement and 6 (321 patients) of 10 (561 patients) studies reported more accurate tibial tunnel placement in at least one measure. One study (209 patients) demonstrated a significant increase in cost associated with use of computer-assisted navigation (mean 1158€) versus conventional surgery (mean 704€). Of the two studies using 3DP templates, production costs ranging from $10 to $42 USD were cited. There was no difference in adverse events between the two groups. CONCLUSION: Clinical outcomes do not differ between technology-assisted surgery and conventional surgery. Computer-assisted navigation is more expensive and time consuming while 3DP is inexpensive and does not lead to greater operating times. ACLR tunnels can be more accurately located in radiologically ideal places by using technology, but anatomic placement is still undetermined because of variability and inaccuracy of the evaluation systems utilized. LEVEL OF EVIDENCE: Level III.

Optimizing early education provided at the Hull-Ellis Concussion and Research Clinic: A multiple methods evaluation from the Toronto Concussion Study.

OBJECTIVES: The purpose of this study was to determine factors and characteristics associated with changes in knowledge among adults receiving education within the first 8 weeks post-concussion. The study also aimed to understand desired preferences (i.e. content, format) for education post-concussion from the perspective of patients and physicians. METHODS: Patient-participants (17-85 years) were prospectively recruited within one week of a concussion. Participants received education over visits from Weeks 1 to 8 post-injury. Primary outcome measures were participant responses on a concussion knowledge questionnaire at Weeks 1 (n = 334) and 8 (n = 195), and feedback regarding education through interviews. Other variables collected included preexisting medical history, physician assessed recovery and symptoms. RESULTS: There was a significant increase in average knowledge on the concussion knowledge questionnaire across time (71% vs 75% correct; p = 0.004). Participants with higher levels of education, female sex and preexisting diagnoses of depression or anxiety had more correct responses at Week 1. Healthcare providers had varying comfort levels addressing mood-related symptoms. CONCLUSIONS: There is a need to tailor education provided to concussion patients based on preinjury characteristics, i.e., mood disorders and demographic factors. Healthcare providers may need additional training in addressing mood symptoms and should modify the approach to fit patients' unique needs.

How Are Patient Order and Shift Timing Associated with Imaging Choices in the Emergency Department? Evidence From Niagara Health Administrative Data.

STUDY OBJECTIVE: We assessed whether the timing and order of patients over emergency shifts are associated with receiving diagnostic imaging in the emergency department and characterized whether changes in imaging are associated with changes in patients returning to the ED. METHODS: In this retrospective study, we used multivariate and instrumental variable regressions to examine how the timing and order of patients are associated with the use of diagnostic imaging. Outcomes include whether a patient receives a radiograph, a computed tomography (CT) scan, an ultrasound, and 7-day bouncebacks to the ED. The variables of interest are time and order during a physician's shift in which a patient is seen. RESULTS: A total of 841,683 ED visits were examined from an administrative database of all ED visits to Niagara Health. Relative to the first patient, the probability of receiving a radiograph, CT, and ultrasound decreases by 6.4%, 9.1%, and 3.8% if a patient is the 15th patient seen during a shift. Relative to the first minute, the probability of receiving a radiograph, CT, or ultrasound increases by 1.9%, 2.7%, and 1.1% if a patient is seen in the 180th minute. Seven-day bounceback rates are not consistently associated with patient order or timing in a shift and imaging orders. CONCLUSION: Imaging in the ED is associated with shift length and especially patient order, suggesting that physicians make different imaging decisions over the course of their shifts. Additional imaging does not translate into reductions in subsequent bouncebacks to the hospital.

Perceptions of patients and nurses regarding the use of wearables in inpatient settings: a mixed methods study.

Wearable devices for hospitalized patients could help improve care. The purpose of this study was to highlight key barriers and facilitators involved in adopting wearable technology in acute care settings using patient and clinician feedback. Hospitalized patients, 18 years or older, were recruited at the General Medicine inpatient units in Toronto, Ontario to wear the Fitbit® Charge 2 or Charge 3. Fifty General Medicine adult inpatients were recruited. Patients and nurses provided feedback on structured questionnaires. Key themes from open-ended questions were analyzed. Primary outcomes of interest included the exploring patient and nurse perceptions of their experiences with wearable devices as well as their feasibility in clinical settings. Overall, both patients (n = 39) and nurses (n = 28) valued the information provided by Fitbits and shared concerns about device functionality and wearable design. Specifically, patients were interested in using wearables to enhance their self-monitoring, while nurses questioned data validity, as well as ease of incorporating wearables into their workflow. We found that patients wanted improved device design and functionality and valued the opportunity to improve their self-efficacy and to work in partnership with the medical team using wearable technology. Nurses wanted more device functionality and validation and easier ways to incorporate them into their workflow. To achieve the potential benefits of using wearable devices for enhanced monitoring, this study identifies challenges that must first be addressed in order for this technology to be widely adopted in clinical settings.