Alyssa A. Federico

Background/Objectives: Metastatic bone disease (MBD) of the pelvis is commonly managed with open reconstruction despite substantial morbidity and high complication rates ranging from 16–32%. Percutaneous fixation techniques have emerged as a lower morbidity alternative; however, robust evaluations of outcomes remain limited. Therefore, the primary aim of this systematic review was to evaluate changes in pain and function following percutaneous fixation for pelvic MBD, and to determine the complication and reoperation rates of these procedures. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Scopus, and Cochrane Library databases were searched from inception through 15 May 2025. Studies evaluating percutaneous fixation for pelvic MBD in adults were included. Pooled estimates of visual analog scale (VAS) pain scores, Eastern Cooperative Oncology Group (ECOG) performance status scores, complication rates, and reoperation rates were generated using meta-analysis techniques. Results: Twenty-five studies were included in the final analysis. VAS pain scores were reported in 15 studies, with an average decrease of 5.0 points (95% CI: 3.9–6.1) from pre- to postoperative. ECOG performance status scores were reported in 8 studies, with an average improvement of 1.1 points (95% CI: 0.7–1.5) from pre- to postoperative. Complications were reported in 24 studies, with a pooled complication rate of 8% (95% CI: 6–12%) and reoperation rate of 4% (95% CI: 2–7%). Conclusions: Percutaneous fixation for pelvic MBD provides meaningful improvements in pain and function with relatively low complication rates. However, substantial study heterogeneity exists in the patient population, surgical techniques, and implant selection, reflecting the novelty of this treatment strategy and the absence of standardized guidelines.

Objective: Prediction models are increasingly being sought in epilepsy surgery to predict postoperative outcomes and support clinical decision‐making. Studies summarizing the evidence in this area can provide insight into the type of surgical prediction models, their methodology, and their performance and inform areas for future research. Our aim was to address these knowledge gaps through a comprehensive systematic review of prediction models in epilepsy surgery. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines using four databases. Papers were included if they were primary research studies, human‐based, studied adult or pediatric populations, studied people with epilepsy undergoing surgical management, and developed or validated a multivariable tool to predict epilepsy surgery outcomes. Data extraction was reviewed in triplicate, and the quality of evidence in each paper was assessed using the Prediction Model Risk of Bias Assessment Tool. Results: The literature search yielded a total of 11 614 papers, with 42 papers and 113 prediction models included in the final analysis. The median area under the curve and accuracy for all models were .75 (interquartile range = .68–.83) and .76 (interquartile range = .69–.83), respectively. Overall, 54.0% of models underwent internal validation, and 20.4% underwent external validation. Models of cognitive–language outcomes seemed to perform better than those for other outcomes. Overall risk of bias was high in 81% of models, with weakest performance in outcomes and analyses, but trended toward improvement over time. Concerns for applicability were low in 89% of the models. Significance: Prediction models in epilepsy surgery are rapidly proliferating, but most lack external validation, and many still exhibit a high risk of bias. Therefore, caution is needed when interpreting and applying these predictive tools. Evidence of improvement in methodological quality holds promise for enhancing patient care, if coupled with improved model performance.

» Wearable technologies (wearables), including smartphones, smartwatches, and sensors, such as accelerometers and inertial measurement units, enable continuous, real-time, and objective data collection on physical function, health behaviors, and patient perceptions. » Wearables can track mobility metrics such as step count, activity duration, and joint range of motion, providing valuable longitudinal insights into recovery trajectories. » In orthopaedic surgery, wearables support timely, personalized patient education and improve communication between patients and surgical teams, contributing to better functional outcomes and patient satisfaction. » Smart implants and virtual/augmented reality systems are emerging as innovative approaches to enhancing engagement and adherence during postoperative rehabilitation. » Key challenges to implementation include concerns about data privacy, accessibility, and integration into clinical workflows.

Introduction: Diagnosis and treatment of acute stroke depends upon imaging, namely non-contrast CT (NCCT), CT angiography (CTA), CT perfusion (CTP), and MRI. We sought to i) examine available data from around the world on six categories related to acute stroke imaging: utilization, time to imaging, radiation exposure, contrast dose, availability, and cost, and ii) compare that information with similar data from our province (Alberta). Methods: Using a scoping review methodology, six categories related to acute stroke diagnostic imaging were examined: utilization, time to imaging, radiation exposure, contrast dose, availability, and cost. Metadata for these categories in Alberta were collected from Alberta Health Services administrative records for comparison. Results: A total of 6693 articles/documents were initially identified through database searches, of which 83 were included for analysis. CT (range = 55-100%) was used more frequently than MRI (range = 23.6-94.0%) in acute stroke, with high CTA use in Alberta (55.7%) compared to other centres (range = 8.6-36.0%; Table 1). CT time to imaging was < 25 min (target time) in most centres, but not in Alberta (mean = 3.2 hr, median = 2.0 hr). MRI was not used urgently in most centres (mean = 0.4-21.0 hr), including Alberta (mean = 15.4 hr, median = 13.0 hr). CTA radiation exposure was greater in Alberta compared to other centres (5.7 mSv vs 2.8-5.4 mSv) whereas it was similar for NCCT and CTP. Contrast doses for CTA and CTP were similar between Alberta (CTA = 50-70 mL, CTP = 45 mL) and other centres (CTA = 40-150 mL, CTP = 30-60 mL). Lastly, the number of CT and MRI scanners per million population and cost of operating them was similar worldwide. Conclusions: In conclusion, no studies were identified that provide a comprehensive overview of all six factors relevant to diagnostic imaging in acute stroke. The Alberta metadata fills in this literature gap, specifically in the context of Canadian stroke care. Download figure