Loyola University Medical Center

The purpose of this study was to investigate the impact of demographic, psychological, and social factors on self-reported recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). Psychological and social factors would be associated with lower patient-reported outcome scores (PROMS) after ACLR. Case series. Level 4. Retrospective review was conducted of patients who underwent ACLR at a single institution. Recovery was measured by using the PROMIS 10 SF Global Health Physical score, Lysholm Knee score, International Knee Documentation Committee (IKDC) score, and Knee Outcome Survey (KOS) scores. Multivariable linear regression models were developed to predict 6-month PROMIS 10 SF Global Health Physical, Lysholm Knee, IKDC, and KOS scores. Sociodemographic, surgical, and preoperative PROMS with variance inflation factors >5 were removed to minimize collinearity. A total of 67 patients who underwent ACLR between December 2013 to August 2023 were included in this study, with a mean age of 31.1 ± 10.3 years. Smoking history was consistently associated with lower 6-month IKDC (β = -33.5 [-54.0, -13.0], P = 0.002), KOS (β = -35.6 [-42.3, -18.4], P < 0.001), and Lysholm (β = -27.6 [-45.1, -10.0], P = 0.004) scores. White race was associated with lower Lysholm scores (β = -8.0 [-13.1, -3.0], P = 0.003). Higher preoperative PROMIS mental health scores were associated with higher KOS (β = 0.4 [0.1, 0.6], P = 0.01). Patients with Medicaid reported higher KOS scores (β = 7.2 [2.4, 12.0], P = 0.004). Several psychosocial and demographic factors may influence recovery after ACL reconstruction. In our study, smoking predicted worse outcomes, while having Medicaid insurance was unexpectedly linked to better self-reported recovery. White race predicted worse outcomes. Mental health findings were contradictory, with high preoperative PROMIS mental health scores, representing current mental health, and a history of depression potentially associated with improved outcomes. Identifying psychological and social factors preoperatively can help clinicians better understand which patients may be at risk for lower self-reported outcomes.

INTRODUCTION: Climate change poses a major threat to global health, with healthcare itself contributing an estimated 5% of worldwide greenhouse gas emissions. Operating rooms are particularly resource-intensive, producing disproportionate emissions and hospital waste. Some studies estimate up to 50–70% of all hospital waste is from the operating room. Efforts to mitigate this impact have emphasized sustainable surgical practices, including optimization of pre-packaged surgical trays. Frequently unused and overpacked surgical trays result in unnecessary sterilization, processing, and resource consumption. Streamlining surgical trays reduces waste, greenhouse gases, and costs without requiring additional investments. As such, tray optimization offers a high-yield, practical intervention to advance environmental stewardship while maintaining surgical quality and safety. OBJECTIVE: Evaluate the frequency of use of reusable instruments in universal hysteroscopy and laparoscopy surgical trays at our institution, to determine if modifications can be made to decrease waste. METHODS: Prospective observational study, at a single-site tertiary academic center. All scheduled benign gynecologic laparoscopic and hysteroscopic cases from July 2024 to January 2025 were eligible. This included diagnostic and operative hysteroscopies, diagnostic laparoscopies, ovarian cystectomy, salpingo-oophorectomies, and laparoscopic hysterectomies. Cases were excluded if they were converted to an open approach or were completed in combination with oncology or urogynecology procedures. An inventory was created for the surgical trays opened for both laparoscopic and hysteroscopic cases. The resident on the surgical team documented which instruments were used via an inventory survey. Residents were provided with a picture atlas of the surgical instruments to ensure the use of instruments was properly documented. RESULTS: 27 laparoscopic cases were included in our study, including 16 laparoscopic hysterectomies, and 11 other laparoscopic procedures. 24 hysteroscopic cases were included. For hysteroscopic cases, 1 tray containing 58 reusable instruments is opened for each case. The average number of instruments used was 8.5/58, or 15% of the tray. The maximum number of instruments used in any of the recorded cases was 13/58 instruments. For laparoscopic cases, 3 trays containing 72 reusable instruments are opened for each case. The average number of instruments used was 20/72, or 27% of all opened instruments. The maximum number of instruments used in any of the recorded cases was 31/72 instruments. CONCLUSIONS: Our study demonstrates that over two-thirds of reusable surgical instruments for both hysteroscopy and gynecologic laparoscopy go unused at our institution, which contributes to waste within the operating room and during sterilization procedures. Our findings highlight a substantial opportunity to reformat gynecologic surgical trays. Streamlining trays could decrease waste, reduce costs, and improve environmental sustainability in the operating room.

Introduction Lower extremity injuries are common in male professional soccer players, yet no known studies examine how these injuries impact return to play in these athletes. Objective To analyze whether lower extremity injuries affected the rate of return to play and performance in male Major League Soccer players. Materials/Methods Injury data from the 2018-2023 men’s professional soccer seasons for both Major League Soccer and International Leagues were collected from FBref, Transfermrkt, and the MLS Player Availability Report. Players were included if they experienced a lower extremity injury during the 2018-2023 soccer seasons. Injuries were included if they resulted in absence from a minimum of 14 days, including games or practices. Performance metrics were analyzed across three periods: short-term, defined as within the same year of injury; medium-term, up to one-year post-injury; and long-term, up to two years post-injury. Statistical analysis comparing performance metrics before and after the injury were conducted using Microsoft excel and Julius. Paired t-tests were used to asses statistical significance. Results Of the 1,522 total injuries from 2018-2023, 838 (55.1%) were considered lower extremity injuries. Among all positions, the knee was the most commonly injured structure (151.18%). The Center Back was the most commonly injured position (166 injuries, 19.8%). Conclusions Through the data, it was found that the knee was the most injured body part. Center Backs experienced both declines and improvements in performance metrics. Forwards demonstrated a decrease in goals per game and other offensive metrics following injury. These findings can help sports medicine professionals enhance patient recovery, prolong players’ career, and develop targeted injury prevention strategies by understanding the position specific impacts of lower extremity injuries on soccer performance.

Background: Enhancing stroke care outcomes necessitates strict adherence to evidence-based protocols, robust interdisciplinary collaboration, and ongoing quality surveillance. Performance data from an academic medical center identified areas for improvement in emergency department (ED) neurological assessments and post-procedural monitoring. To address these gaps, a Stroke Champions Committee (SCC) was formed using a shared governance framework, empowering frontline staff and fostering sustainable quality improvement. Purpose: The SCC aimed to elevate stroke care quality by empowering nursing staff to engage in decision-making, apply evidence-based practices, and track outcomes through data analysis and feedback. Methods: The SCC comprises nurses from the ED, neuroscience intensive care unit, cath lab, and neuroscience stepdown unit. The SCC committee meets monthly to review performance data, identify care gaps, and implement targeted interventions. Progress and outcomes are reported quarterly to the Stroke Quality Improvement Committee. Interventions have included staff education, the use of standardized tools, and accountability measures such as timer-based documentation for groin and pulse checks post-procedure. Results: A targeted initiative focused on improving ED neurological assessment documentation, which had a baseline compliance rate of 70–73% in April–May 2024. Following SCC-led interventions, compliance improved to 92.5% by June 2024, peaked at 100% in October 2024, and remained consistently above the 80% target through March 2025 (ranging from 86–94%). Similarly, compliance with post-procedural groin and pulse checks improved from 50% in Q4 2023 to 93% by Q1 2025. These outcomes underscore the effectiveness of structured interventions, nurse-driven collaboration, and shared accountability in driving sustained quality improvement. Conclusions: A shared governance model can effectively translate nurse engagement across diverse stroke care units into measurable improvements in care quality. The SCC serves as a replicable framework for institutions aiming to strengthen stroke systems, maintain protocol adherence, and empower nursing staff through collaborative leadership.