Performance and jump-to-jump development in the first female ski flying competition in history.

In 2023, for the first time in history, the international ski and snowboard federation (FIS) arranged an official ski flying competition where the 15 highest ranked women were allowed to participate. This study investigated jump-to-jump performance development in female ski flying, with men's results used as reference data. Official FIS data from all six jumps of women were evaluated together with the eight jumps by men. Performance was evaluated by a score, where the distance points compensated by wind were divided by take-off speed, enabling performance to be evaluated across jumps and sexes. Women improved performance by 96% from the first to the sixth jump, with two major leaps; from the first to the second jump and from the first to the second day. In contrast, men mainly improved from training to competition. The best women had performance scores equivalent to the 10-20 best ranked men and the sex-difference between the top 3 athletes was 26.2%. This difference was thereafter compared to similar results in the normal and large hill World championship in Planica 2023, in which sex-differences between the top 3 were 8.6% and 14.6% in normal and large hill. This historical competition showed the importance of gaining practical experience with ski flying on performance, exemplified by the large improvement of female athletes. This, together with the enlarge sex-differences in large compared to normal hills, indicates that female ski jumpers have a particularly large improvement-potential in ski flying and must gain specific experience on this through traning and competitions.

A systematic approach to adaptive sequential design for clinical trials: using simulations to select a design with desired operating characteristics.

The failure rates of phase 3 trials are high. Incorrect sample size due to uncertainty of effect size could be a critical contributing factor. Adaptive sequential design (ASD), which may include one or more sample size re-estimations (SSR), has been a popular approach for dealing with such uncertainties. The operating characteristics (OCs) of ASD, including the unconditional power and mean sample size, can be substantially affected by many factors, including the planned sample size, the interim analysis schedule and choice of critical boundaries and rules for interim analysis. We propose a systematic, comprehensive strategy which uses iterative simulations to investigate the operating characteristics of adaptive designs and help achieve adequate unconditional power and cost-effective mean sample size if the effect size is in a pre-identified range.

Technical performance scores associate with early prognosis of tetralogy of Fallot repair.

Objective: This study aimed to investigate the relationship between technical performance scores (TPS) and the early prognosis of tetralogy of Fallot repair (TOF). Methods: A retrospective study was conducted on TOF repair patients at our center from Oct 2017 to Oct 2022. Patients were classified into Class 1 (no residua), Class 2 (minor residua), or Class 3 (major residua) based on TPS derived from predischarge echocardiograms and need for reintervention. Statistical methods were used to assess the association between TPS and early prognosis. Results: A total of 75 TOF repair patients (40% female, 60% male) were analyzed and categorized into TPS1 (24%), TPS2 (53.3%), and TPS3 (22.6%) based on pre-discharge echocardiographic findings. The median follow-up time was 7.0 months. The multivariable Cox regression analysis indicated that TPS3 scores are associated with a 12.68-fold increase in risk compared to TPS1 and TPS2 scores [95% CI = 12.68 (0.9∼179.28), P = 0.06]. The Spearman rank correlation analysis revealed a weak positive correlation between TPS classification and low cardiac output syndrome (r = 0.26, P = 0.03). However, there were no significant differences in ICU stay or duration of mechanical ventilation among the groups. Conclusion: TPS3 after intracardiac TOF repair is associated with higher risk of early re-intervention, highlighting the importance of close follow-up and monitoring in this patient population. Patients who develop low cardiac output syndrome in the early postoperative period may have residual defects that require prompt identification.

Extension of a conditional performance score for sample size recalculation rules to the setting of binary endpoints.

BACKGROUND: Sample size calculation is a central aspect in planning of clinical trials. The sample size is calculated based on parameter assumptions, like the treatment effect and the endpoint's variance. A fundamental problem of this approach is that the true distribution parameters are not known before the trial. Hence, sample size calculation always contains a certain degree of uncertainty, leading to the risk of underpowering or oversizing a trial. One way to cope with this uncertainty are adaptive designs. Adaptive designs allow to adjust the sample size during an interim analysis. There is a large number of such recalculation rules to choose from. To guide the choice of a suitable adaptive design with sample size recalculation, previous literature suggests a conditional performance score for studies with a normally distributed endpoint. However, binary endpoints are also frequently applied in clinical trials and the application of the conditional performance score to binary endpoints is not yet investigated. METHODS: We extend the theory of the conditional performance score to binary endpoints by suggesting a related one-dimensional score parametrization. We moreover perform a simulation study to evaluate the operational characteristics and to illustrate application. RESULTS: We find that the score definition can be extended without modification to the case of binary endpoints. We represent the score results by a single distribution parameter, and therefore derive a single effect measure, which contains the difference in proportions [Formula: see text] between the intervention and the control group, as well as the endpoint proportion [Formula: see text] in the control group. CONCLUSIONS: This research extends the theory of the conditional performance score to binary endpoints and demonstrates its application in practice.

High correlation of the subjective elbow value with Mayo Elbow Performance Score and Oxford Elbow Score in patients with elbow dislocation.

Background: The purpose of this study was to analyze the correlation of the Subjective Elbow Value (SEV) with 2 widely used elbow scoring systems: Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES) in patients following elbow dislocation. Methods: In this retrospective single-center study, patients who sustained an elbow dislocation between January 2008 and December 2019 and were at least 2 years out from injury were included. SEV, OES and MEPS were assessed and statistical correlation was calculated using Pearson's correlation coefficient. Results: A total of 114 patients (61 male, 53 female) with a mean age of 47.1 years (range, 16-70) were analyzed following elbow dislocation. The mean SEV was 87.4% (95% confidence interval (CI) 84.2-90.7), mean MEPS was 88.1 (95% CI 85.1-91.0) points and mean OES was 40.0 (95% CI 38.4-41.7) points. Both MEPS (r = 0.710, P < .001), and OES (r = 0.764, P < .001) demonstrated high correlation with the SEV. Conclusion: This study demonstrates that the SEV is a valid tool to assess overall status of the elbow in patients following elbow dislocations and presents an expressive but easy to perform addition to more complex scoring systems.

Health Outcomes with Curative and Palliative Therapies in Real World: Role of the Quality of Life Summary Score in Thoracic Oncology Patients.

BACKGROUND: For patients receiving therapy with curative or palliative intent for a thoracic malignancy, prediction of quality of life (QOL), once therapy starts, remains challenging. The role of health assessments by the patient instead of the doctor herein remains ill-defined. AIMS: To assess the evolution of QOL in patients with thoracic malignancies treated with curative and palliative intent, respectively. To identify factors that determine QOL one year after the start of cancer therapy. To identify factors that affect survival. METHODS: We prospectively included consecutive patients with a thoracic malignancy who were starting anti-cancer therapy and measured QOL with QLQ-C30 before the start of therapy, and thereafter at regular intervals for up to 12 months. A multivariate regression analysis of the global health score (GHS) and QOL summary scores (QSS) one year after the start of therapy was conducted. A proportional hazards Cox regression was conducted to investigate the effects of case-mix variables on survival. RESULTS: Of 587 new patients, 375 started different forms of therapy. Most had non-small cell lung cancer (n = 298), 35 had small cell lung cancer, and 42 had other thoracic malignancies or were diagnosed on imaging alone. There were 203 who went for a curative intent and 172 for a palliative intent strategy. The WHO score of 0-1 was more prevalent in the former group (p = 0.02), and comorbidities were equally distributed. At baseline, all QOL indices were better in the curative group (p < 0.05). The curative group was characterized by a significant worsening of GHS and QSS (p < 0.05). The palliative group was characterized by an improvement in GHS and emotional health (p < 0.05), while other dimensions of functioning remained stable. GHS at 12 months was estimated in a multivariate linear regression model (R2 = 0.23-p < 0.001) based on baseline GHS, QSS, and comorbidity burden. QSS at 12 months was estimated (R2 = 0.31-p < 0.001) by baseline QSS and therapeutic intent strategy (curative vs. palliative). The prognostic factors for overall survival were the type of therapy (curative vs. palliative intent, p < 0.001) and occurrence of early toxicity-related hospitalization (grade ≥ 3, p = 0.001). CONCLUSION: Patients with thoracic malignancies treated with curative intent experience a worsening of their QOL in the first year, whereas those receiving palliative anti-cancer therapy do not. QOL one year after the start of therapy depends on the baseline health scores as determined by the patient, comorbidity burden, and therapeutic strategy. Survival depends on therapeutic strategy and early hospitalization due to toxicity.

Management of metastatic colorectal cancer in patients ≥70 years - a single center experience.

Background: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. Patients and methods: In this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. Results: We included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. Conclusions: Our findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.

Efficacy of a training programme for the management of diabetes mellitus in the hospital: A randomized study (stage 2 of GOVEPAZ healthcare).

AIMS: To assess the efficacy of a structured educational intervention for health professionals on the appropriateness of inpatient diabetes care and on some clinical outcomes in hospitalised subjects. METHODS: A multicentre (6 regional hospitals) cluster-randomized (2:1) two parallel-group pragmatic intervention trials, as a part of the GOVEPAZ study, was conducted in three clinical settings, that is, Internal Medicine, Surgery and Intensive Care. Intervention consisted of a 2-month structured education of clinical staff to inpatient diabetes care. Twelve wards - 2 for each hospital - and 6 wards - 1 for each hospital - were randomized to usual care and to the intervention arm, respectively. Consecutively hospitalised diabetic subjects (n = 524, age 74 ± 14 years, 57% males, median HbA1C 57 mmol/mol) were included. The clinical appropriateness of inpatient diabetes management was assessed by a previously validated multi-domain performance score (PS). Clinical outcomes included hypoglycemia, glucose control biomarkers, clinical conditions at discharge and inpatient mortality rate. RESULTS: A numerically, but not statistically significant, higher PS (+0.94; 95% C.I.: -0.53 - +2.4) was achieved in the intervention than in the usual care wards. Hypoglycemias (p = 0.32), glucose control (p = 0.89) and survival rates (p = 0.71) were similar in the two experimental arms. Plasma glucose on admission (OR = 1.52 per 1 SD; C.I. 1.07-2.17; p = 0.021) and the number of hypoglycemic events per patient (OR = 1.55 per 1 SD; C.I.:1.11-2.16; p = 0.011) were independently associated with the inpatient mortality rate. CONCLUSIONS: Structured education of the clinical staff failed to improve the inpatient appropriateness of diabetes care or clinical outcomes. In-hospital hypoglycemia was confirmed to be an independent indicator of death risk.

Convergent dislocation of the elbow in adults: A retrospective study.

BACKGROUNDS: This study aims to evaluate the surgical treatment and clinical outcomes of convergent dislocation of the elbow (CDE) in adults. METHODS: Between January 2017 and September 2022, we performed a retrospective study of patients with CDE presenting in XXX and XXX Hospital and receiving operative treatments after failed closed reductions. The elbow and the forearm's range of motion (ROM) were measured and compared using a paired t-test between pre- and post-operation. Furthermore, the Mayo Elbow Performance Score (MEPS) assessed objective elbow evaluation and functional outcomes. RESULTS: Eleven patients were followed up for an average period of 9.8 months. Four males and seven females were enrolled, aged 31.5 ± 9.0 years. The average ROM of flexion-extension at the elbow was significantly improved after surgery (27.3 ± 12.3° vs. 116.8 ± 23.7°, p < 0.001). The average pronation-supination also showed a similar increase (21.8 ± 9.3° vs. 106.4 ± 23.4°, p < 0.001). The MEPS of the final follow-up was 95.9 ± 7.0 points. However, seven cases were found to have varying degrees of elbow stiffness. Furthermore, secondary procedures were performed in three cases, including the elbow arthrolysis and the anterior transposition of the ulnar nerve. CONCLUSIONS: Our study showed several operative methods following failed closed reduction attempts where anatomical reduction of humeroulnar and proximal radioulnar joints and instant rehabilitation obtained relatively satisfactory clinical outcomes.

Application of TOPSIS method for flood susceptibility mapping using Excel and GIS.

This study elaborately manifests a simplified Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) multicriteria decision-making (MCDM) approach that goals to determine the disparity among the distances between the positive and negative ideal solutions. MCDM methods evaluate options based on a variety of criteria by using mathematical and analytical methodologies. This promotes a more transparent and objective decision-making process by removing human biases and subjective judgements. By considering the comparative proximity to the optimal situation, TOPSIS considers the distances between the ideal and the negative-ideal alternatives. This study has concentrated on the normalization process, the appropriate determination of the ideal and the anti-ideal solution, and the metric utilized to compute the euclidean distances from the ideal best and the ideal worst.•This study expresses the simplified TOPSIS methodology as stated by Hwang and Yoon (1981). The categorization and weight assignments of the criteria have been executed from the expert's opinion and based on existing literatures.•Integration of the TOPSIS technique with GIS has been properly performed for the production of a flood susceptibility map of a highly vulnerable region and visual interpretation of the TOPSIS algorithm.•This kind of investigation saved time by sufficiently skilled specialized personnel in this field.

Early versus Delayed Tumor-Specific Therapy and Survival in Patients with Lung Cancer: A Retrospective Study.

INTRODUCTION: The timing of tumor-specific palliative therapy and its influence on the survival of patients with stage IV lung cancer remain unclear. METHODS: 375 patients with stage IV lung cancer who experienced an early or delayed therapy (early or delayed therapy group [TG]) were investigated using histology and ECOG performance score (ECOG-PS)-related subgroups. Kaplan-Meier and Cox regression analyses were used for survival analyses. RESULTS: Patients in the early TG had a significantly shorter median overall survival (OS) than those in the delayed TG (6 vs. 11 months). Patients with an ECOG-PS of ≥1 were significantly more present in the early TG than in the delayed TG (66.8 vs. 51.9%). But an early therapy was also significantly associated to a shorter median OS in ECOG-matched subgroups (ECOG-PS of 0, 7 vs. 23 months; ECOG ≥1, 6 vs. 8 months). An early therapy was associated to a significantly worse median OS in histological subgroups (NSCLC, 5 vs. 11 months; SCLC, 7 vs. 11 months) and was an independent risk factor in uni- and multivariate analyses. CONCLUSIONS: An early initiation of cancer-specific therapy was associated with a shorter survival time in palliative lung cancer patients, independent of the ECOG-PS and histological subtype.

Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults.

Background Overall, 2% of all adult fractures are attributed to fractures of the distal humerus, including both supracondylar and intercondylar fractures. According to recent studies, stable fixation with anatomical reduction of intra-articular fragments and early mobilization is required for best outcomes. This study included patients with distal end humerus fractures treated by open reduction and internal fixation (ORIF) with anatomical locking plates and evaluated their clinical outcomes. Methodology This prospective study was conducted at a medical college teaching hospital in southern Rajasthan, India. In total, 20 adult patients with distal end humerus fractures who presented to the orthopedic outpatient department or casualty were admitted. Patients were treated by ORIF with anatomical locking plates, followed up, and evaluated for clinical and functional outcomes. Results Using the Mayo Elbow Performance Score, out of 20 cases, excellent results were noted in five patients, good results in seven patients, fair results in six patients, and poor results in two patients. Conclusions Locking plates are reliable and effective management options for distal humerus fractures. As locking plates are strong and rigid, the period of immobilization can be decreased. Early mobilization helps in preventing joint stiffness and fixed deformity of the joint.

Controversial Outcomes in Neck Rehabilitation between Surgically and Conservatively Treated Patients-Results of an Observational Study.

The present study aimed to compare changes during inpatient rehabilitation between conservatively and surgically treated patients. A total of n = 162 patients with cervical spine complaints were included in the study (n = 107 conservatively treated, n = 55 after surgery). Patients completed disease-specific (NDI) and generic (NPRS, EQ-5D-5L, HAQ) patient reported outcome measures (PROMs) before and after rehabilitation. In addition, the range of motion (ROM) in the transversal plane of the cervical spine was measured. Changes and correlations between PROMs and ROM values during rehabilitation were assessed. The influence of moderating factors on NDI outcomes was examined. Significant improvements with large effect sizes were found in PROMs and ROM (all p < 0.001). The conservatively treated patients showed significantly greater NDI improvements than operated patients (p = 0.050), but a greater proportion of poor performance in ROM (p = 0.035). Baseline NDI (ß = 0.66), HAQ (ß = 0.14), and ROM scores (ß = -0.17) explained 63.7% of the variance in NDI after rehabilitation. Both patient groups showed different outcomes. The findings of this study indicate that the unique needs of patients may require different therapeutic interventions and highlight the importance of using multidimensional outcome measures when implementing a multimodal rehabilitation approach.

Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old.

AIMS: There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). METHODS: We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal. RESULTS: The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis. CONCLUSION: The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy.Level of Evidence: Therapeutic Level IVCite this article: Bone Jt Open 2023;4(1):19-26.

Revision surgery for periprosthetic elbow infection: eradication rate, complications, and functional outcomes-a systematic review.

INTRODUCTION: The aim of this systematic review was to investigate the outcomes of revision surgery after periprosthetic elbow infection (PEI). MATERIAL AND METHODS: Eighteen studies with 332 PEI that underwent revision surgery were included. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported. RESULTS: Staphylococcus aureus was the most common microorganism (40%). Pre-operatively, the mean white blood cell count was 8400 ± 4000 per microliter; the mean C-reactive protein level was 41.6 ± 66.9 mg/dl, and the mean erythrocyte sedimentation rate was 45 ± 66.9 mm/h. The Coonrad-Morrey total elbow prosthesis represented 41.2% of the infected implant, and it also represented the most common system used for the PEI revision surgery. Two-stage revision and debridement and implant retention (DAIR) were the most common procedures performed for PEI, and, on the whole, they represented 35.7 and 32.7%, respectively. The eradication rate was 76% with 2-stage, 71% with resection arthroplasty (RA), 66.7% with 1-stage, 57.7% with DAIR, and 40% with arthrodesis (EA). DAIR showed a significantly lower eradication rate than 2-stage (P = 0.003). The mean postoperative Mayo Elbow Performance Score was significantly higher in patients who underwent DAIR, and 2-stage compared with RA (P < 0.001 for all). Postoperative flexion-extension ROM was significantly higher in patients who underwent DAIR compared with 1-stage, 2-stage, and RA (P < 0.001 for all). Moreover, 1-stage and 2-stage showed a significantly greater postoperative flexion-extension ROM compared with RA (P < 0.001 for all). Reoperations occurred in 40% of patients after EA, 33.3% after 1-stage, 26.9% after DAIR and RA, and 24.1% after 2-stage. Conversion to amputation occurred in 2.2% of patients after RA and 1% after DAIR. CONCLUSIONS: Two-stage revision and DAIR are the most common procedures used to manage PEI; however, the former procedure showed a significantly higher eradication rate. Resection arthroplasty showed a high eradication rate, but postoperative lower clinical and functional outcomes limit the indications for this technique. One-stage procedure showed a limited role in the current practice of PEI treatment. LEVEL OF EVIDENCE: Level IV.

Does environmental, social, and governance performance mitigate earnings management practices? Evidence from US commercial banks.

Environmental, social, and governance (ESG) performance has attracted debates of regulatory bodies and the academic community. Previous studies highlighted the relationship between corporate social responsibility (CSR) disclosure index and earnings management (EM) for non-financial firms. In this paper, we examine the relationship between the ESG performance and EM practices for a sample of US commercial banks over the period 2010-2019. We use two proxies for earnings management: abnormal loan loss provisions (ALLP) and EM to meet the threshold of reporting small positive profit or avoiding losses (SPOS). Consistent with the transparent financial reporting hypothesis, we find that banks reporting higher ESG performance are less likely engaged in income-increasing practice through ALLP. However, no evidence supports that ESG score mitigates EM through loss avoidance. Furthermore, we disaggregate the ESG score into its main three components: environmental, social, and governance. Our findings show that the governance pillar effectively mitigates EM practice under its two proxies. Specifically, the social pillar also seems to be an efficient constraint of banks' EM through income-increasing abnormal loan loss provisions and loss avoidance activity. However, no supporting evidence of a mitigating role for the environmental pillar is provided. Taken together, our results show that, except the environmental pillar, ESG performance score acts as an efficient mitigating tool for EM practices for US banks. Our findings provide a better understanding of banks' earnings management practices. Our findings are helpful for managers when undertaking long-term investment strategies in ESG reporting practices, regulators when issuing new standards, and banks' stakeholders when assessing both the financial and non-financial performance of such entities.

Total Elbow Arthroplasty in Young Patients - An 8-Year Follow-up Case Series.

Introduction: Certain elbow pathologies can give rise to considerable loss of joint function, which would severely affect the daily living activities of the patients. Total elbow arthroplasty (TEA) can be a safe and reasonable motion-preserving and pain-relieving option in such debilitating elbow conditions. The aim of this case series is to evaluate the functional outcome of TEA in young patients with four different indications after an 8-year follow-up. Case Report: We report a case series of four TEA cases done for different indications, namely rheumatoid arthritis, chronic elbow dislocation, post-traumatic elbow ankylosis, and failed primary total elbow replacement, all in relatively young patients. All patients were given a semi-constrained Coonrad-Morrey prosthesis using a posterior Bryan-Morrey approach. The cases were done during the years 2013-2014. Eight-year follow-up of each case showed excellent functional outcome and persistent pain relief with a high Mayo Elbow Performance Score. All the patients have given written consent for publishing this article. Conclusion: Despite being uncommon, total elbow replacement can be the choice of surgery for certain elbow affections, giving satisfactory functional recovery and good pain relief, even in a younger population.

Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors.

Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5−21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09−0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children's PROs and parents' proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents' assessment of changes during rehab was low to moderate (r = 0.19−0.59), the use of the performance score led to substantially increased scores (r = 0.29−0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

Elbow hemiarthroplasty vs. open reduction internal fixation for acute Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures-A systematic review.

Background: Open reduction and internal fixation (ORIF) is the standard treatment for multifragmentary intra-articular distal humeral fractures. Fractures not amenable by ORIF are treated with total elbow arthroplasty (TEA). In recent years, elbow hemiarthroplasty (EHA) has been used as an alternative to TEA, as weight bearing restrictions and risk of component loosening are lower. We systematically reviewed the literature reporting functional outcomes and complication rates after either EHA or ORIF for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures. Methods: We searched PubMed, Embase, The Cochrane Library, and Scopus. The inclusion criteria were at least 5 patients, aged ≥50 years, AO/OTA type 13C fracture treated with ORIF or EHA, and evaluation with the Mayo Elbow Performance Score. Literature screening and data extraction were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The results were synthesized qualitatively using weighted means. No comparative statistical analyses were done. Results: We included 27 articles, which included 96 patients treated with EHA and 535 patients treated with ORIF. We identified 1 randomized controlled trial and 26 case series. The weighted mean Mayo Elbow Performance Score was 86.9 (n = 89) in the EHA group and 84.7 (n = 535) in the ORIF group. There were 26 (33%) complications (n = 78) in the EHA group and 103 (38%) complications (n = 270) in the ORIF group. Complication rates were generally high in both groups. Conclusion: We found comparable results of EHA and ORIF, which indicate that EHA is a viable treatment option for AO/OTA type 13C fractures not amenable by ORIF. Because of high risk of bias, interpretation of the results should be done with caution.

Cardiac rehabilitation performance predicts 1-year major adverse cardiovascular events.

BACKGROUND: Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes. HYPOTHESIS: Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events. METHODS: We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group"). RESULTS: Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03). CONCLUSION: Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.