JPS Health Network

Human papillomavirus (HPV) vaccine rates are low in the USA, with additional disparities noted in and within states such as Texas. To increase HPV vaccine uptake, healthcare providers and clinical team members are essential agents in promoting HPV vaccination to their patients. The purpose of this study was to examine the knowledge, attitudes, and behaviors of clinic team members, stratified by clinicians (i.e., physicians, nurse practitioners, and physician assistants) and non-clinician staff (i.e., nurses and medical assistants) in North Texas. Survey data were collected as part of a quality improvement project to improve HPV vaccination in a safety-net health system and federally qualified health center. Knowledge items were related to guidelines for HPV vaccination by patient age and the types of cancer the HPV vaccine can prevent. Attitudes were related to the importance of recommending the HPV vaccine and self-efficacy in making vaccine recommendations, and behavioral items included current recommendation behaviors and barriers to recommendations. Data were stratified by role, clinicians and non-clinicians, and were analyzed in SAS. Participants (n = 125) were knowledgeable, but significant differences were noted by the individual's role (p < 0.05). Participants differed in their knowledge of the cancers the HPV vaccine can prevent. Common barriers reported were parental vaccine hesitancy (70% clinicians, 45% non-clinicians) and parents lacking information (49% clinicians, 58% non-clinicians). Given that HPV vaccination requires a clinic team approach to promote uptake, identification of the knowledge, attitudes, and barriers among these clinical team members can guide the development of tailored education strategies to improve vaccine uptake.

Primary care researchers and clinicians are facing an ever-growing evidence base, more options to access research evidence, and increasingly limited time. Incorporating search filters into primary care systematic reviews can significantly improve the efficiency and confidence of the search process. Search filters, or hedges, are predeveloped search strategies that combine controlled vocabulary and free text terms using Boolean operators (words like "AND," "OR"). Search filters help to manage the diverse terminology in the literature, such as the various synonyms for primary care, and can be tailored to the specific needs of the review, whether it aims to be exhaustive or more focussed. Resources such as specialized librarians, databases such as PubMed, and repositories such as the InterTASC Information Specialists Sub-Group provide access to these valuable tools. However, as primary care terminology continues to evolve, regular updates to these filters are necessary to maintain their relevance and effectiveness. This method brief presents search filters and highlights their value for finding research literature in primary care.

Metacarpal fractures are common injuries that can lead to debilitating outcomes if not treated appropriately. Intramedullary fixation has gained popularity as a treatment option, allowing for earlier mobilization with few reported complications. A retrospective chart review of all patients treated with intramedullary implants for a metacarpal fracture between August 2018 and February 2024 at a single center was performed. Medical records and radiographs were reviewed to identify instances of hardware failure/bent implant. In patients with bent implants, the mechanism of re-injury was recorded. 648 total metacarpal fractures were surgically treated during the study period, with 90 patients receiving intramedullary fixation (56 ExsoMed INnate, 31 Acumed acutrak, 3 Arthrex headless compression screw). Five patients (7 screws) experienced postoperative hardware failure/bending of the implant, all resulting from a punching mechanism. Furthermore, all patients with postoperative hardware failure sustained their initial metacarpal fracture as a result of a punching mechanism. Additionally, 1 patient initially treated at an outside hospital presented with a bent implant following a punching-related reinjury. All affected patients were male, and the time from initial surgery to implant failure ranged from 4 weeks to 7 months. This series highlights a notable complication (bent implant) associated with intramedullary fixation of metacarpal fractures and includes our strategy for implant removal. Furthermore, we now consider patients with a history of closed-fist striking as a mechanism of injury as a contraindication to intramedullary metacarpal fixation due to this complication.

Cement-augmented pedicle screw instrumentation procedures are performed for stabilization in patients with surgical spinal conditions with poor bone quality at the target levels. Although this is done to combat the risk of failure due to loosening, cutting out or pulling out of the screws, failure may still occur. The purpose of this study was to identify the modalities and rates of failure of CAPSI constructs to better predict occurrence of failure. We retrospectively reviewed clinical data of patients who underwent CAPSI fusion procedures between 2010 and 2022. We collected pre, intra and post-operative clinical and radiographic data. 621 pedicle screws in 319 levels were augmented out of 1333 screws in 809 instrumented levels in 120 patients. F:M = 3:1; mean age 68.6years and mean BMI 27.10. The mean length of follow up overall was 2.2years (Range 7days-11years). The most common surgical indications were degenerative scoliosis and osteoporotic fractures. Construct failure occurred in 32 cases; seven cases were associated with trauma and 11 cases presented with a neurologic deficit. The most common modality of failure was osteonecrotic collapse (20 cases); proximal construct failure occurred in 22 cases; there was evidence of haloing at the screw-bone-cement interfaces in 23 out 32 cases. 21 out of 32 cases required revision surgical procedures within an average of 453days. Failure of CAPSI constructs occurred in 26.7% of patients. High occurrence of osteonecrotic collapse and haloing at the screw-cement-bone interfaces likely represents a relationship with construct failure.

Background: Cubital tunnel syndrome is a common condition caused by compression of the ulnar nerve around the medial elbow. Surgical treatment usually involves open in situ ulnar nerve decompression unless ulnar nerve instability is noted. Endoscopic techniques for cubital tunnel release have been developed and implemented with excellent patient and surgeon satisfaction. Endoscopic cubital tunnel release can be performed in an office based procedure room under wide awake local anesthesia no tourniquet principles. We present our setup and technique for performing an endoscopic cubital tunnel release procedure in an office based setting under local anesthesia. Methods: Local anesthesia is injected along the course of the ulnar nerve on the medial arm and forearm extending 10 cm proximal and distal to the medial epicondyle. After allowing approximately 30 min for appropriate vasoconstriction, the patient is placed in a supine position with the arm abducted and externally rotated position. The endoscopic cubital tunnel release is then performed. Discussion: Our described technique eliminates the need for placement of a prophylactic tourniquet and thereby the need for the procedure to be performed within an OR setting. It also utilizes a single-stage anesthetic administration, which facilitates ease of completion and performance in an office based setting. There is a significant cost savings when endoscopic cubital tunnel release is performed in an office-based procedure room compared to in the operating room. Conclusions: Office-based endoscopic cubital tunnel release can be safely performed utilizing WALANT techniques, leading to high patient satisfaction and decreased overall cost of care. Level of Evidence: Therapeutic IV