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Meyr AJ. Durability of Retrospective Foot and Ankle Case Series'. J Foot Ankle Surg 2024; 63:503. [PMID: 38729292 DOI: 10.1053/j.jfas.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Andrew J Meyr
- Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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Adalbert JR, Constantinescu DS, Orton KS, D'Apuzzo MR. Miscoding in the Nationwide Inpatient Sample Database Raises Questions About Validity for Arthroplasty Research. J Arthroplasty 2024; 39:S104-S109. [PMID: 38237876 DOI: 10.1016/j.arth.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The use of administrative databases in arthroplasty research has increased over the past decade. The Nationwide Inpatient Sample (NIS) is one of the first and most frequently used. Despite many published articles using this dataset, there exists no standardization resource accounting for the potential of biased results. The purpose of our study was to assess the amount of discordant data between clinically relevant variables and propose a standard for using this database in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS An initial set of patients undergoing total joint arthroplasty were identified from the NIS between 2016 and 2019 using the International Classification of Diseases, 10th Revision, Procedure Coding System. All records with THA and TKA in any of the procedure variables (PR1-PR20) were included. A total of 63 relevant and consistent variables were selected for individual comparison including diagnosis-related group (1), elective (1), procedure codes (20), day of main procedure (1), and diagnosis codes (40). Descriptive statistics were used. A total of 3,562,819 patients were included in the initial set. RESULTS Using diagnosis-related groups, 5.3% were revision surgeries, 4.7% were not elective, 2.3% did not have THA or TKA as their primary procedure for hospitalization, and 2.9% of THA and 9.7% of TKA were bilateral. A total of 6.2% of the surgeries were done day(s) before or after admission, and 10.8% of THA and 6.3% of TKA were missing an orthopedic diagnosis for admission. Many had multiple orthopedic diagnoses for admission, 3.2% of THA and 0.7% of TKA. Overall miscoding was 23.3%. CONCLUSIONS Using the NIS without standardized data processing to study elective, unilateral, primary THA and TKA introduces major bias. A logical and stepwise approach to curate the data before analysis is proposed to improve research quality when using this database in hip and knee arthroplasty studies.
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Affiliation(s)
- Jenna R Adalbert
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - David S Constantinescu
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kevin S Orton
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michele R D'Apuzzo
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
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3
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Edmonds SW, Cullen L, DeBerg J. The Problem with the Pyramid for Grading Evidence: The Evidence Funnel Solution. J Perianesth Nurs 2024; 39:484-488. [PMID: 38823963 DOI: 10.1016/j.jopan.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 06/03/2024]
Affiliation(s)
- Stephanie W Edmonds
- Nurse Scientist, Nursing Administration, Abbott Northwestern Hospital, part of Allina Health, Minneapolis, MN
| | - Laura Cullen
- Evidence-Based Practice Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics.
| | - Jennifer DeBerg
- User Services Librarian, Hardin Library for Health Sciences, University of Iowa, Iowa City, IA
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Wang Y, Shen C, Zhang J, Yang Q, Li J, Tan J, Yu H, Mei Z. A protocol for a pooled analysis of cohort studies: The association between depression and anxiety in epileptic disorders. PLoS One 2023; 18:e0295328. [PMID: 38060471 PMCID: PMC10703227 DOI: 10.1371/journal.pone.0295328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND/INTRODUCTION Depressive and anxiety disorders constitute major mental health challenges affecting adults of all ages globally. It has been reported that individuals with depressive or anxiety disorders face an elevated risk of developing neurological conditions, including seizures and epilepsy. Additionally, people with these disorders tend to exhibit distinct clinical outcomes compared to the general population. However, the associations between depressive or anxiety disorders and epilepsy remain contentious. Thus, this study aims to elucidate the associations between these neuropsychiatric disorders, including depressive and anxiety disorders, and epilepsy or seizures. METHODS We will systematically search three electronic databases-PubMed, EMBASE, and the Cochrane Library-from inception through March 2023 to identify relevant cohort studies investigating the associations between depressive or anxiety disorders and epilepsy or seizures. Two independent reviewers will extract data from eligible studies using pre-designed standardized data extraction forms, and cross-check results. A third author will resolve any discrepancies. Quality assessment will be performed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Pooled risk estimates (Relative risks or hazard ratios with their 95% CI) will be calculated using the DerSimonian-Laird random-effects model. If between-study heterogeneity is identified, we will conduct subgroup analyses or meta-regressions to explore the possible sources of heterogeneity (participants, exposure, outcome, and study design) stratified by various study characteristics. Potential publication bias will be detected through the inspection of funnel plot asymmetry, complemented by the Egger linear regression approach (Egger's test) and the Begg rank correlation test (Begg's test). DISCUSSION This pooled analysis will evaluate the association between depressive or anxiety disorders and epilepsy or seizures, providing high-level evidence to inform early identification and prevention strategies for epilepsy or seizures. ETHICS AND DISSEMINATION Given that the data utilized for analysis in this pooled analysis does not involve human subjects or medical records, no ethical approval is required for this study. We intend to present the results of this study at national or international conferences or submit the findings to a peer-reviewed journal. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/WM2X8.
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Affiliation(s)
- Yan Wang
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Changbo Shen
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Junyan Zhang
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Qingcheng Yang
- Department of Neurology, The People’s Hospital of Anyang City, Anyang, China
| | - Jianshe Li
- Department of Neurology, Xinxiang Central Hospital, Henan Province, China
| | - Jun Tan
- Department of Neurology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hang Yu
- Emergency Department, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
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Dvorak MF, Evaniew N, Chen M, Waheed Z, Rotem-Kohavi N, Fallah N, Noonan VK, Fisher C, Charest-Morin R, Dea N, Ailon T, Street J, Kwon BK. Impact of Specialized Versus Non-Specialized Acute Hospital Care on Survival Among Patients With Acute Incomplete Traumatic Spinal Cord Injuries: A Population-Based Observational Study from British Columbia, Canada. J Neurotrauma 2023; 40:2638-2647. [PMID: 37294210 PMCID: PMC10698776 DOI: 10.1089/neu.2022.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Given the complexity of care necessitated after an acute traumatic spinal cord injury (SCI), it seems intuitively beneficial for such care to be delivered at hospitals with specialized SCI expertise. Demonstrating these benefits is not straightforward, however. We sought to determine whether specialized acute hospital care influenced the most fundamental outcomes after SCI: mortality within the first year of injury. We compared survival among patients with incomplete tSCI admitted to a single quaternary-level trauma hospital with a specialized acute SCI program versus those admitted to trauma hospitals without specialized acute SCI care. We performed a population-based retrospective observational cohort study using administrative and clinical data linked from multiple sources in British Columbia (BC) from 2001 to 2017. Among a cohort of 1920 patients, there were 193 deaths within one year. We failed to identify a significant overall benefit for survival after adjusting for potential confounders, and the confidence intervals (CIs) were compatible with both benefit and harm (odds ratio [OR] 1.01, 95% CI 0.17 to 6.11, p = 0.99). Significant associations were observed with age greater than 65 (OR 4.92, 95% CI 1.66 to 14.57, p < 0.01), Charlson Comorbidity Index (OR 1.61, 95% CI 1.42 to 1.83, p < 0.01), Injury Severity Score (OR 1.08, 95% CI 1.06 to 1.11, p < 0.01), and traumatic brain injury (OR 2.12, 95% CI 1.32 to 3.41, p < 0.01). Among patients with acute tSCI, admission to a hospital with specialized acute SCI care was not associated with improved overall one-year survival. Subgroup analyses, however, suggested heterogeneity of effects, with little benefit for older patients with less polytrauma and substantial benefit for younger patients with greater polytrauma.
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Affiliation(s)
- Marcel F. Dvorak
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Nathan Evaniew
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Melody Chen
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K. Kwon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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Boretto JG, Holc F, Gallucci GL, Donndorff A, Rellán I, De Carli P. Fibula flap in upper extremity segmental/critical size bone defects fixed with locking plates. Single-institution observational cohort. Injury 2023; 54 Suppl 6:110737. [PMID: 37072279 DOI: 10.1016/j.injury.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Management of bone defects in the upper extremity can vary depending on the size and location of the defect. Large defects may require complex reconstruction techniques. Vascularized bone grafts, mainly free vascularized fibula flap (FVFF), have many advantages in the treatment of bone or osteocutaneous defects. However, complications such as graft fracture are the most common, with a free fibula flap for bone defects in the upper extremity. This study aimed to describe the results and complications associated with the treatment of posttraumatic bone defects in the upper extremity using FVFF. We hypothesized that performing osteosynthesis using locking plates would prevent or reduce the fracture of the fibula flap MATERIALS AND METHODS: This was a retrospective single-centre cohort study. Patients with segmental bone defects caused by trauma who underwent reconstructive surgery with FVFF fixed with locking compression plates (LCP) between January 2014 and 2022 were included. Demographic variables and preoperative data, such as bone defect, location, and time until reconstruction, were collected. Bone defects were classified according to the Testworth classification. Intraoperative variables included the length of the FVFF, type of graft (osteocutaneous or not), type and technique of arterial and venous sutures, number of veins used as output flow, and the osteosynthesis technique used. RESULTS Ten patients were included (six humerus, three ulna, and one radius). All patients had critical-size bone defects, and nine patients had a history of infection. In 9 of 10 patients, bone fixation was performed with a bridge LCP and in one patient with two LCP plates. In eight cases, the FVFF was osteocutaneous. All the patients showed bone healing at the end of the follow-up period. There was one early complication, donor site wound dehiscence, and two long-term complications (proximal radioulnar synostosis and soft-tissue defect). CONCLUSION A high rate of bone union with a low rate of complications can be obtained with an FVFF in upper extremity segmental/critical-size bone defects. Rigid fixation with locking plates avoids stress fractures of the grafts, mainly in humeral reconstruction. However, in these cases, a bridge plate should be used.
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Affiliation(s)
- Jorge G Boretto
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
| | - Fernando Holc
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
| | - Gerardo L Gallucci
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
| | - Agustín Donndorff
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
| | - Ignacio Rellán
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
| | - Pablo De Carli
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi". Hospital Italiano de Buenos Aires, Argentina.
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Chung WT, Chung KC. The use of the E-value for sensitivity analysis. J Clin Epidemiol 2023; 163:92-94. [PMID: 37783401 DOI: 10.1016/j.jclinepi.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Observational research designs enable clinicians to investigate topics for which randomized-controlled trials may be difficult to conduct. However, the lack of randomization in observational studies increases the likelihood of confounders introducing bias to study results. Analytical methods such as propensity score matching and regression analysis are employed to reduce the effects of such confounding, mainly by determining characteristics of patient groups and adjusting for measured confounders. Sensitivity analyses are subsequently applied to elucidate the extent to which study results could still be affected by unmeasured confounding. The E-value is one such approach. By presenting a value that quantifies the strength of unmeasured confounding necessary to negate the observed results, the E-value is a useful heuristic concept for assessing the robustness of observational studies. This article provides an introductory overview of how the E-value can be evaluated and presented in clinical research studies.
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Affiliation(s)
- William T Chung
- Clinical Research Assistant, Section of Plastic Surgery, Department of Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Evaniew N, Bogle A, Soroceanu A, Jacobs WB, Cho R, Fisher CG, Rampersaud YR, Weber MH, Finkelstein JA, Attabib N, Kelly A, Stratton A, Bailey CS, Paquet J, Johnson M, Manson NA, Hall H, McIntosh G, Thomas KC. Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network. Global Spine J 2023; 13:1293-1303. [PMID: 34238046 PMCID: PMC10416588 DOI: 10.1177/21925682211029863] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN). METHODS We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol. RESULTS Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation. CONCLUSIONS Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.
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Affiliation(s)
- Nathan Evaniew
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Bogle
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Alex Soroceanu
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - W. Bradley Jacobs
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Roger Cho
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Charles G. Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael H. Weber
- Division of Orthopaedics, McGill University, Montreal, Quebec, Canada
| | | | | | - Adrienne Kelly
- Northern Ontario School of Medicine, Sault Ste. Marie, Ontario, Canada
| | - Alexandra Stratton
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jerome Paquet
- Department of Orthopaedics, Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - Michael Johnson
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Neil A. Manson
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada
| | - Kenneth C. Thomas
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
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Wang CW, Chung WT, Baxter NB, Chung KC. Are Observational Studies on Distal Radius Fracture Treatment Robust? An E-value Approach to Analysis. Clin Orthop Relat Res 2023; 481:1174-1192. [PMID: 36728049 PMCID: PMC10194513 DOI: 10.1097/corr.0000000000002528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reported complication frequencies after distal radius fracture (DRF) treatment vary widely in the literature and are based mostly on observational evidence. Whether that evidence is sufficiently robust to use in practice is controversial. The E-value is an innovative sensitivity analysis that quantitates the robustness of observational evidence against unmeasured confounders, whereby a greater E-value usually implies more robust evidence and vice versa; with DRF complications, this approach can help guide readers to a more confident interpretation of the available evidence. QUESTIONS/PURPOSES In this study, we sought (1) to compare the complication frequencies among different DRF treatment modalities, and (2) to evaluate the robustness of these observational studies using the E-value as an index for unmeasured confounding. METHODS We searched PubMed, Embase, and SCOPUS for observational studies on the management of DRFs that were published from January 2001 to July 2021 with the last database search performed on July 31, 2021. All articles that compared different DRF treatment modalities with reported complication frequencies were included to accurately capture the quality of the observational studies in research about DRF. Risk ratios (RRs) of the overall complication and major complication risks were calculated for each subgroup comparison: volar plating versus dorsal plating, casting, external fixation, and percutaneous K-wire fixation. The RRs and their corresponding lower limits of the 95% confidence intervals (CIs) were used to derive the E-values. E-values can have a minimum possible value of 1, which signifies that the treatment-outcome association is not strong and can readily be overturned by unmeasured confounders. By contrast, a large E-value means that the observed treatment-outcome association is robust against unmeasured confounders. We averaged RRs and E-values for the effect estimates and lower limits of CIs across studies in each treatment comparison group. We identified 36 comparative observational studies that met the inclusion criteria. Seven studies compared volar with dorsal plating techniques. Volar plating was also compared with casting (eight studies), external fixation (15 studies), and percutaneous K-wire fixation (six studies). RESULTS Total and major complication risks did not differ among different DRF treatments. The mean RRs for total and major complications were 1.2 (95% CI 0.4 to 3.9; p = 0.74) and 1.8 (95% CI 0.4 to 11.4; p = 0.52) for the volar versus dorsal plating group; 1.2 (95% CI 0.3 to 11.2; p = 0.87) and 1.5 (95% CI 0.3 to 14.9; p = 0.74) for the volar plating versus casting group; 0.6 (95% CI 0.2 to 2.2; p = 0.33) and 0.8 (95% CI 0.2 to 6.7; p = 0.86) for the volar plating versus external fixation group; and 0.6 (95% CI 0.2 to 2.6; p = 0.47) and 0.7 (95% CI 0.2 to 4.0; p = 0.67) for the volar plating versus K-wire fixation group. The mean E-values for total and major complication frequencies for the between-group comparison ranged from 3.1 to 5.8; these were relatively large in the context of a known complication risk factor, such as high-energy impact (RR 3.2), suggesting a reasonable level of robustness against unmeasured confounding. However, the E-values for lower limits of CIs remained close to 1, which indicates the observed complication frequencies in these studies were likely to have been influenced by unmeasured confounders. CONCLUSION Complication frequencies did not differ among different DRF treatment modalities, but the observed complication frequencies from most comparative observational studies were less robust against potential unmeasured confounders. The E-value method, or another type of sensitivity analysis, should be implemented in observational hand surgery research at the individual-study level to facilitate assessment of robustness against potential unmeasured confounders. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Chien-Wei Wang
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - William T. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Natalie B. Baxter
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Marmor M, Guenthner G, Getman T, Ghert M. The Importance of Pragmatic Study Design to the Scholarly Influence of Surgical Hip Fracture Randomized Controlled Trials. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00004. [PMID: 36881775 PMCID: PMC9995088 DOI: 10.5435/jaaosglobal-d-21-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Surgical randomized controlled trials (RCTs) have potential drawbacks, leading some to question their role in filling the information gap in orthopaedic surgery. Pragmatism in study design was introduced to increase the clinical applicability of study results. The purpose of this study was to examine how pragmatism affects the scholarly influence of surgical RCTs. METHODS A search for surgical hip fracture-related RCTs published between 1995 and 2015 was done. Journal impact factor, citation number, research question, significance and type of outcome, number of centers involved, and the Pragmatic-Explanatory Continuum Indicator Summary-2 level of pragmatism score were recorded for each study. Scholarly influence was estimated by a study's inclusion into orthopaedic literature or guidelines or through the study's average yearly citation rate. RESULTS One hundred sixty RCTs were included in the final analysis. A multivariate logistic regression identified large study sample size as the only predictor of an RCT being used in clinical guidance texts. Large sample size and multicenter RCTs were predictors of high yearly citation rates. The level of pragmatism in study design did not predict scholarly influence. CONCLUSIONS Pragmatic design is not independently associated with increased scholarly influence; however, large study sample size was the most important study characteristic affecting scholarly influence.
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How to Create an Orthopaedic Arthroplasty Database Project: A Step-by-Step Guide Part II: Study Execution. J Arthroplasty 2023; 38:414-418. [PMID: 36243277 DOI: 10.1016/j.arth.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years, the use of national databases in orthopaedic surgery research has grown substantially with database studies comprising an estimated ∼10% of all published lower extremity arthroplasty research. The aim of this review is to serve as a guide on how to: (1) design; (2) execute; and (3) publish an orthopaedic database arthroplasty project. In part II, we discuss how to collect data, propose a novel checklist/standards for presenting orthopaedic database information (SOPOD), discuss methods for appropriate data interpretation/analysis, and summarize how to convert findings to a manuscript (providing a previously published example study). Data collection can be divided into two stages: baseline patient demographics and primary/secondary outcomes of interest. Our proposed SOPOD is more orthopaedic-centered and builds upon previous standards for observational studies from the EQUATOR network. There are a host of statistical methods available to analyze data to compare baseline demographics, primary/secondary outcomes, and reduce type 1 errors seen in large datasets. When drafting a manuscript, it is important to consider and discuss the limitations of database studies, including their retrospective nature, issues with coding/billing, differences in statistical versus clinical significance (or relevance), lack of surgery details (approach, laterality, and implants), and limited sampling or follow-up. We hope this paper will serve as a starting point for those interested in conducting lower extremity arthroplasty database studies.
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How to Create an Orthopaedic Arthroplasty Administrative Database Project: A Step-by-Step Guide Part I: Study Design. J Arthroplasty 2023; 38:407-413. [PMID: 36241012 DOI: 10.1016/j.arth.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of clinical and administrative databases in orthopaedic surgery research has grown substantially in recent years. It is estimated that approximately 10% of all published lower extremity arthroplasty research have been database studies. The aim of this review is to serve as a guide on how to (1) design, (2) execute, and (3) publish an orthopaedic administrative database arthroplasty project. METHODS In part I, we discuss how to develop a research question and choose a database (when databases should/should not be used), detailing advantages/disadvantages of those most commonly used. To date, the most commonly published databases in orthopaedic research have been the National Inpatient Sample, Medicare, National Surgical Quality Improvement Program, and those provided by PearlDiver. General advantages of most database studies include accessibility, affordability compared to prospective research studies, ease of use, large sample sizes, and the ability to identify trends and aggregate outcomes of multiple health care systems/providers. RESULTS Disadvantages of most databases include their retrospective observational nature, limitations of procedural/billing coding, relatively short follow-up, limited ability to control for confounding variables, and lack of functional/patient-reported outcomes. CONCLUSION Although this study is not all-encompassing, we hope it will serve as a starting point for those interested in conducting and critically reviewing lower extremity arthroplasty database studies.
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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Evaniew N, Swamy G, Jacobs WB, Bouchard J, Cho R, Manson NA, Rampersaud YR, Paquet J, Bailey CS, Johnson M, Attabib N, Fisher CG, McIntosh G, Thomas KC. Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network. Global Spine J 2022; 12:1676-1686. [PMID: 33406897 PMCID: PMC9609527 DOI: 10.1177/2192568220985470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Uncontrolled retrospective observational study. OBJECTIVES Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). METHODS We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. RESULTS Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being "somewhat" or "extremely" satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. CONCLUSIONS Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.
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Affiliation(s)
- Nathan Evaniew
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada,Nathan Evaniew, University of Calgary Spine
Program, Foothills Medical Centre, 12th Floor, 1403 29 Street NW, Calgary,
Alberta, Canada.
| | - Ganesh Swamy
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada
| | - W. Bradley Jacobs
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada
| | - Jacques Bouchard
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada
| | - Roger Cho
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada
| | - Neil A. Manson
- Canada East Spine Centre, Saint John,
New Brunswick, Canada
| | | | - Jerome Paquet
- Département de Chirurgie, Université
Laval, Quebec City, Quebec, Canada
| | | | - Michael Johnson
- Department of Surgery, University of
Manitoba, Winnipeg, Manitoba, Canada
| | | | - Charles G. Fisher
- Department of Orthopaedics, University
of British Columbia, Vancouver, British Columbia, Canada
| | - Greg McIntosh
- Canadian Spine Outcomes and Research
Network, Markdale, Ontario, Canada
| | - Kenneth C. Thomas
- University of Calgary Spine Program,
University of Calgary, Alberta, Canada
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Krivicich LM, Kunze KN, Parvaresh KC, Jan K, DeVinney A, Vadhera A, LaPrade RF, Chahla J. Comparison of Long-term Radiographic Outcomes and Rate and Time for Conversion to Total Knee Arthroplasty Between Repair and Meniscectomy for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2023-2031. [PMID: 34251898 DOI: 10.1177/03635465211017514] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous meta-analyses have demonstrated superior outcomes in patients undergoing arthroscopic repair of medial meniscus posterior root tears (MMPRTs) compared with meniscectomy. However, these analyses have considered only short- or midterm outcomes and low-quality evidence. PURPOSE To compare the mid- to long-term rates of radiographic osteoarthritis (OA) between repair and meniscectomy for MMPRT. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, EMBASE, Ovid/MEDLINE, and Cochrane Central Register of Controlled Trials databases were queried for articles evaluating repair and meniscectomy for MMPRT. Articles were eligible if they had a minimum mean 4-year follow-up for radiographic OA or conversion to total knee arthroplasty (TKA) and were at least level 3 evidence. Radiographic OA was assessed using Kellgren-Lawrence (KL) progression. Rates of conversion to TKA and International Knee Documentation Committee (IKDC) scores were also extracted. DerSimonian-Laird binary random-effects models were created to evaluate differences in radiographic OA and TKA conversion rates, with odds ratios (ORs) representing pooled estimates. Continuous random-effects models with standardized mean differences (SMDs) were used to compare postoperative IKDC scores. RESULTS Repair and meniscectomy cohorts were followed for a mean of 64.8 months and 62.5 months, respectively, for KL progression; and 82.8 months and 73.8 months, respectively, for TKA rates and IKDC scores. Overall, 59 of 144 (41%) patients undergoing surgical intervention for MMPRT demonstrated OA progression; 18 of 82 (22%) who underwent repair for MMPRT exhibited OA progression compared with 41 of 62 (66%) who underwent meniscectomy (OR, 0.17; 95% CI, 0.03-0.83; P = .029). Overall, 30 of 143 (21%) patients converted to TKA; 9.8% (8/82) of patients who underwent repair converted to TKA (range, 47-131 months), while 36% (22/61) who underwent meniscectomy converted to TKA (range, 17.8-101 months) (OR, 0.15; 95% CI, 0.05-0.44; P < .001). No significant differences between postoperative IKDC scores were observed (SMD, 0.51; 95% CI, -0.02 to 1.05; P = .06). CONCLUSION Medial meniscus posterior root repair results in significantly lower rates of radiographic OA progression and conversion to TKA at >60-month follow-up. On the basis of these findings, we recommend consideration of repair of MMPRTs when degenerative changes are not severe, as it can yield improved outcomes.
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Affiliation(s)
| | - Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | | | - Kyleen Jan
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - Annie DeVinney
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - Amar Vadhera
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
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Jacobs J, Olivier B, Dawood M, Panagodage Perera NK. Prevalence and incidence of injuries among female cricket players: a systematic review and meta-analyses. JBI Evid Synth 2021; 20:1741-1790. [PMID: 34954723 DOI: 10.11124/jbies-21-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to describe the incidence and prevalence of injuries among female cricket players of all ages, participating in all levels of play. INTRODUCTION Cricket, a bat-and-ball sport, is becoming popular among women of all ages and abilities worldwide. However, cricket participation carries a risk of injury. Injuries negatively affect sport participation, performance, and short- and long-term health and well-being. Injury prevention, therefore, is the key to safe, long-term cricket participation as a physical activity goal. Epidemiological data are needed to underpin evidence-based injury-prevention strategies. INCLUSION CRITERIA Studies reporting incidence and prevalence of injuries in female cricket players of all ages, participating in all levels of play, were included in this review, including studies that report data by sex or by sport. Studies without enough data to calculate prevalence or incidence, that do not distinguish female injury data from males', that focus on athletes participating in other sports, or that focus on case studies were excluded. METHODS A systematic review and meta-analyses were conducted according to the JBI and PRISMA 2020 guidelines. MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro), EBSCO MasterFILE Premier, EBSCO CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and Science Direct were systematically searched from inception to August 2021. Additionally, Cochrane Controlled Trials Register and ClincalTrail.gov were searched. EBSCO MegaFile Premier (EBSCO), OpenGrey (SIGLE), WorldCat, Grey Matters, Grey Literature, and Google Scholar databases were searched for gray literature. Full-text articles that met the inclusion criteria were critically appraised using JBI-tools, and were extracted and synthesized in narrative summary and tabular forms. Three meta-analyses were conducted: injury incidence rate, injury prevalence proportions, and injury incidence proportions. Heterogeneity was assessed using the I2 statistic and the random-effects model. RESULTS Of the 7057 studies were identified and only 4256 screened after duplicates removed, 23 studies met the inclusion criteria. Risk of bias was low for 21 studies. The injury incidence rate for elite cricket was 71.9 (SE 21.3, 95% CI 30.2-113.6) injuries per 1000 player hours, time-loss injury incidence rate was 13.3 (SE 4.4, 95% CI 4.6-22.0) injuries per 1000 player hours, and non-time-loss injury incidence rate was 58.5 (SE 16.9, 95% CI 25.6-91.7) injuries per 1000 player hours. The injury prevalence proportions for community to elite cricket was 65.2% (SE 9.3, 95% CI 45.7-82.3) and injury prevalence proportions for community cricket was 60% (SE 4.5, 95% CI 51.1-68.6). The injury incidence proportions for community cricket was 5.6 (SE 4.4, 95% CI 0.1-18.3) injuries per 10,000 participants. Elite cricket players were more frequently injured than community cricket players. The most prevalent body regions injured were the shoulder and knee, and most were sustained by fast bowlers. Injuries to the hand, wrist, and fingers had the highest incidence and were most sustained by fielders. CONCLUSIONS The study's findings can help stakeholders (including players, coaches, clinicians, and policymakers) make informed decisions about cricket participation by informing and implementing strategies to promote cricket as a vehicle for positive public health outcomes. This review also identified gaps in the available evidence base and addressing these through future research would enhance women's cricket as a professional sport. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020166052.
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Affiliation(s)
- Jolandi Jacobs
- The Wits-JBI Centre for Evidenced-Based Practice: A JBI Affiliated Group, Johannesburg, South Africa Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Physiotherapy Department, Faculty of Health Sciences, Sefakho Makgatho Health Sciences University, Ga-Rankuwa, South Africa Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, VIC, Australia University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce ACT, Australia
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McKnight RR, Ruffolo M, Wally MK, Seymour RB, Jeray K, E Matuszewski P, Weinlein J, Hsu JR. Traumatic Arthrotomies: Do They All Need the Operating Room? J Orthop Trauma 2021; 35:612-618. [PMID: 34387570 DOI: 10.1097/bot.0000000000002093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare complications and cost of care in patients with traumatic arthrotomies (TAs) treated with surgical debridement, irrigation, and closure to those treated with nonoperative treatment and local wound care. DESIGN This is a prospective observational multicenter study. SETTING This study was conducted at multiple Level I trauma centers. PATIENTS Patients with TAs. INTERVENTION Patients were treated with operative versus nonoperative management decided by the attending surgeon. Nonoperative treatment of TAs included bedside irrigation, primary closure, antibiotics, and discharge from the emergency department with close follow-up unless admission was otherwise indicated. MAIN OUTCOME MEASUREMENTS Primary outcomes included adverse outcomes and cost. VR-12 was captured at the time of injury and 3 months postinjury. RESULTS Of 189 major joint TAs, 64 arthrotomies were treated nonoperatively and 125 operatively. Seventy percent of the arthrotomies in the nonoperative group were small (less than 50 mm in size) and 95% had minimal/no gross contamination, whereas the operative group (OG) had significantly more arthrotomies greater than 50 mm in size and with moderate/severe gross contamination. There was one septic joint in the nonoperative group (1.5%) and 7 in the OG (5.6%). Nonoperative treatment was associated with significantly lower total charges when compared with the OG. CONCLUSIONS Although further study may still be needed, this study suggests that small, minimally contaminated TAs with no associated fracture have a low risk of adverse complications, can safely be treated nonoperatively, and are associated with a significantly decreased cost of care. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Michael Ruffolo
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Kyle Jeray
- Department of Orthopaedic Surgery, Prisma Health-Upstate, Greenville, SC
| | - Paul E Matuszewski
- Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - John Weinlein
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Regional One Health, Memphis, TN
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
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Gazendam AM, Nucci NW, Ekhtiari S, Lanting BA, MacDonald SJ, Wood TJ. Quantifying the Level of Evidence of Podium Presentations at the American Association of Hip and Knee Surgeons From 2015 to 2019. J Arthroplasty 2021; 36:2219-2222. [PMID: 33648843 DOI: 10.1016/j.arth.2021.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The American Association of Hip and Knee Surgeons (AAHKS) Annual Scientific Meeting is a leading forum for the presentation and dissemination of research regarding the management of hip and knee pathology making research presented at these meetings a representation of the current literature in the field. The purpose of this study was to quantify the level of evidence of podium presentations presented at the AAHKS annual meeting from 2015 to 2019. METHODS Two reviewers evaluated the abstracts for the available presentations. Basic science and biomechanical studies were excluded from the review. Economic studies that were not able to be evaluated based on the American Academy of Orthopedic Surgeon guidelines were also excluded. The two reviewers then independently evaluated each abstract and assigned a level of evidence (level I-V) based on the American Academy of Orthopedic Surgeon classification scheme. RESULTS A total of 258 podium presentations were included. In total, 17 (7%) abstracts were graded level I evidence, 57 (22%) were graded level II, 85 (33%) were graded level III, and 98 (38%) were graded level IV (Table 1). There was a significant change in the distribution of the level of evidence of podium presentations over time (χ2 = 24.6, P = .02). The proportion of level I studies has increased between 2015 and 2019 (from 3.9% to 11.8%) with a concomitant decrease in level IV studies (from 42.3% to 21.6%) over that time period. CONCLUSIONS There has been a significant improvement in the levels of evidence of podium presentations at the AAHKS Annual Meeting from 2015 to 2019.
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Affiliation(s)
- Aaron M Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas W Nucci
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Rahmani N, Salehi A, Molavi Vardanjani H, Marzban M, Behbood A. Using STROBE checklist to assess the reporting quality of observational studies affiliated with Shiraz University of Medical Sciences, and its correlates: a scientometric study from Iran. Scientometrics 2019. [DOI: 10.1007/s11192-019-03317-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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20
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Gomes DF, Gallo LG, Leite BF, Silva RB, da Silva EN. Clinical effectiveness of enzyme replacement therapy with galsulfase in mucopolysaccharidosis type VI treatment: Systematic review. J Inherit Metab Dis 2019; 42:66-76. [PMID: 30740728 DOI: 10.1002/jimd.12028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Mucopolysaccharidosis VI is a rare disease characterized by the arylsulfatase B enzyme deficiency, which is responsible for different clinical manifestations. The treatment consists of enzyme replacement therapy with intravenous administration of galsulfase. OBJECTIVE Evaluate the effectiveness of the enzyme replacement therapy with galsulfase for the mucopolysaccharidosis VI treatment. METHOD Systematic review of observational studies. The databases of PubMed, Cochrane Library, Lilacs, and Journal of Inherited Metabolic Disease were reviewed. The selection of studies, data mining, and methodological quality assessment were independently conducted by two authors. RESULTS Eighteen studies fulfilled the inclusion criteria. Two studies were cohorts, one was longitudinal study, one was cross-sectional, one was a case-control, eight were case series, and five were case reports. A total of 362 participants with mucopolysaccharidosis type VI were evaluated, and 14 different outcomes related to the treatment effect were identified. Seven outcomes showed positive results, characterized by the patient survival, quality of life, respiratory function, joint mobility, physical resistance, reduction of urinary glycosaminoglycans, and growth. The hearing function and the cognitive development were stable after the treatment. Other outcomes related to the cardiac function, visual acuity, sleep apnea, and the size of the liver and spleen presented inconclusive outcomes. Concerning safety, light adverse reactions of hypersensitivity were reported. CONCLUSION This review provided a broader panoramic view of the outcomes related to mucopolysaccharidosis type VI. Regardless of the inherent limitations of observational studies, the outcomes indicate that the enzyme replacement therapy has a positive effect on most of the outcomes associated to the disease.
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Affiliation(s)
- Dalila Fernandes Gomes
- Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Post-Graduation Program in Collective Health, Health Sciences School, Darcy Ribeiro University Campus, University of Brasilia, Asa Norte, Brasília 70910-900, Brazil
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Malchau H, Garellick G, Berry D, Harris WH, Robertson O, Kärrlholm J, Lewallen D, Bragdon CR, Lidgren L, Herberts P. Arthroplasty implant registries over the past five decades: Development, current, and future impact. J Orthop Res 2018; 36:2319-2330. [PMID: 29663575 DOI: 10.1002/jor.24014] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
Local, regional, and national registries have played an important role in the development of hip and knee arthroplasty and the treatment of patients with various maladies of these joints. Four arthroplasty registries stand out as leading forces behind the drive to popularize the use of registries and pursue the concept of evidence based medicine. The Mayo registry, started by Mark Coventry, is recognized as the oldest continuing registry for arthroplasty. The Harris Registry at Massachusetts General Hospital, along with the Mayo Registry, has greatly contributed to the advancement of arthroplasty surgery and have served an important role of identifying poorly performing implants and techniques in the United States. The Swedish Knee Arthroplasty Registry is the oldest national registry dedicated to joint arthroplasty and along with the Swedish Hip Arthroplasty Registry have established the infrastructure, analysis and reporting mechanisms, and leadership that has enabled other countries to subsequently develop national registries around the world. As more countries have adopted the concept of national registries, a new area of research is possible by pooling the resources of large registries as is now occurring with the Nordic countries. Several international organizations have been formed to promote future collaboration and develop international standards. The process of globalization of registries is a result of continued efforts over the past 50 years in improving and disseminating the knowledge gained from the early registries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2319-2330, 2018.
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Affiliation(s)
- Henrik Malchau
- Sahlgrenska University Hospital, Molndal, Sweden.,Swedish Hip Arthroplasty Register Goteborg, Sweden.,Massachusetts General Hospital, Boston, Massachusetts
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Randomized clinical trials and observational studies in the assessment of drug safety. Rev Epidemiol Sante Publique 2018; 66:217-225. [PMID: 29685700 DOI: 10.1016/j.respe.2018.03.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/15/2017] [Accepted: 03/13/2018] [Indexed: 01/17/2023] Open
Abstract
Randomized clinical trials are considered as the preferred design to assess the potential causal relationships between drugs or other medical interventions and intended effects. For this reason, randomized clinical trials are generally the basis of development programs in the life cycle of drugs and the cornerstone of evidence-based medicine. Instead, randomized clinical trials are not the design of choice for the detection and assessment of rare, delayed and/or unexpected effects related to drug safety. Moreover, the highly homogeneous populations resulting from restrictive eligibility criteria make randomized clinical trials inappropriate to describe comprehensively the safety profile of drugs. In that context, observational studies have a key added value when evaluating the benefit-risk balance of the drugs. However, observational studies are more prone to bias than randomized clinical trials and they have to be designed, conducted and reported judiciously. In this article, we discuss the strengths and limitations of randomized clinical trials and of observational studies, more particularly regarding their contribution to the knowledge of medicines' safety profile. In addition, we present general recommendations for the sensible use of observational data.
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Prolo LM, Oklund SA, Zawadzki N, Desai M, Prolo DJ. Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes? World Neurosurg 2018; 115:490-502. [PMID: 29631080 DOI: 10.1016/j.wneu.2018.03.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the 1980s, numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These operations often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of PLIF with allogeneic bone (allo-PLIF). METHODS Between 1981 and 2006, 321 patients aged 12-80 years underwent 339 1-level or 2-level allo-PLIFs for degenerative instability and were followed for 1-28 years. Fusion status was determined by radiographs and as available, by computed tomography scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. RESULTS Of the 321 patients, 308 were followed postoperatively (average 6.7 years) and 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, P = 0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores after initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (P = 0.001). A positive association between a patient characteristic and outcome was observed only with age 65 years and greater, whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to the low back, or industrial injuries. The total complication rate was 7%. CONCLUSIONS With 3 decades of follow-up, we found that successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone.
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Affiliation(s)
- Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sally A Oklund
- Western Transplantation Services, San Jose, California, USA
| | - Nadine Zawadzki
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donald J Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Western Transplantation Services, San Jose, California, USA.
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Rouleau DM. Designing clinical studies in orthopedic traumatology. Orthop Traumatol Surg Res 2018; 104:S1-S7. [PMID: 29155312 DOI: 10.1016/j.otsr.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 02/02/2023]
Abstract
The design of clinical studies in orthopedic traumatology is challenging in several respects. In this era of evidence-based medicine, the pressure is high to choose our treatments solely based on randomized controlled studies. This type of study, when well-constructed, makes it possible to discern the best treatment for a specific fracture in a given group of patients and in connection with a specific outcome. Randomized controlled trials require a lot of resources and are not designed to answer all research questions. Observational studies, such as case-control studies, prospective cohort studies, and cross-sectional studies, also have a role to play in improving scientific knowledge in orthopedic trauma. Regardless of the type of study chosen, the researcher must follow a strict methodology that conforms to practice guidelines in order to ensure the study's conclusions are valid. The guidelines for randomized studies can be found at http://www.consort-statement.org and at http://www.strobe-statement.org for cohort studies. It is also very important to register randomized studies before they begin on a website such as http://www.clinicaltrials.gov, since registration is an increasingly common requirement when submitting an article for publication. Although this preparation is relatively cumbersome, it is essential for producing articles that meet modern scientific criteria.
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Affiliation(s)
- D M Rouleau
- Department of Surgery, université de Montréal, hôpital du Sacré-Cœur-de-Montréal, CIUSSS NIM, 5400, boulevard Gouin-O, Montréal, QC, Canada.
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Thompson BJ, Stock MS, Mota JA, Drusch AS, DeFranco RN, Cook TR, Hamm MA. Adaptations Associated With an After-School Strength and Conditioning Program in Middle-School-Aged Boys: A Quasi-Experimental Design. J Strength Cond Res 2017; 31:2840-2851. [PMID: 28933713 DOI: 10.1519/jsc.0000000000001712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-intensity strength and conditioning programs aimed at improving youth performance are becoming increasingly prevalent. The purpose of this study was to investigate the effects of a 16-week after-school strength and conditioning program on performance and body composition in middle-school-aged boys. Subjects in the training group (n = 16, mean age = 11.8 years) performed 90 minutes of supervised plyometric and resistance training twice weekly for 16 weeks. A group of control subjects (n = 9, age = 12.1 years) maintained their current activity levels. Sprint speed, 5-10-5 proagility, jump height, isometric peak torque of the leg extensors and flexors, and dual energy x-ray absorptiometry-derived body composition were examined during pretesting and posttesting. Data were analyzed by performing independent samples t-tests on the absolute change scores between groups. The primary findings were that the training intervention elicited significant improvements in 20-m sprint times (p = 0.03; mean change for training group = -0.17 seconds) and body-fat percentage (p = 0.03; 2.5% absolute improvement), the latter of which was a function of reduced fat mass (p = 0.06; -0.84 kg). Between-group differences were not noted for agility, jump height, lean mass, or strength measures; however, effect sizes generally showed greater improvements for the training group. In contrast to findings in longitudinal studies performed in collegiate athletes, sprint speed may be particularly adaptable during adolescence. In addition to potentially improving sport performance, high-intensity plyometric and resistance training programs offer the added benefit of improved body composition. These programs appear less effective for agility and jump performance and do not elicit substantial improvements in muscle mass above maturation.
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Affiliation(s)
- Brennan J Thompson
- 1Department of Kinesiology and Health Science, Utah State University, Logan, Utah;2Department of Health Professions, University of Central Florida, Orlando, Florida;3Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina;4Center for Rehabilitation Research, Texas Tech University Health Science Center, Lubbock, Texas; and5Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
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Bennett V, Gourkow N, Mills DS. Facial correlates of emotional behaviour in the domestic cat (Felis catus). Behav Processes 2017; 141:342-350. [PMID: 28341145 DOI: 10.1016/j.beproc.2017.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/03/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
Leyhausen's (1979) work on cat behaviour and facial expressions associated with offensive and defensive behaviour is widely embraced as the standard for interpretation of agonistic behaviour in this species. However, it is a largely anecdotal description that can be easily misunderstood. Recently a facial action coding system has been developed for cats (CatFACS), similar to that used for objectively coding human facial expressions. This study reports on the use of this system to describe the relationship between behaviour and facial expressions of cats in confinement contexts without and with human interaction, in order to generate hypotheses about the relationship between these expressions and underlying emotional state. Video recordings taken of 29 cats resident in a Canadian animal shelter were analysed using 1-0 sampling of 275 4-s video clips. Observations under the two conditions were analysed descriptively using hierarchical cluster analysis for binomial data and indicated that in both situations, about half of the data clustered into three groups. An argument is presented that these largely reflect states based on varying degrees of relaxed engagement, fear and frustration. Facial actions associated with fear included blinking and half-blinking and a left head and gaze bias at lower intensities. Facial actions consistently associated with frustration included hissing, nose-licking, dropping of the jaw, the raising of the upper lip, nose wrinkling, lower lip depression, parting of the lips, mouth stretching, vocalisation and showing of the tongue. Relaxed engagement appeared to be associated with a right gaze and head turn bias. The results also indicate potential qualitative changes associated with differences in intensity in emotional expression following human intervention. The results were also compared to the classic description of "offensive and defensive moods" in cats (Leyhausen, 1979) and previous work by Gourkow et al. (2014a) on behavioural styles in cats in order to assess if these observations had replicable features noted by others. This revealed evidence of convergent validity between the methods However, the use of CatFACS revealed elements relating to vocalisation and response lateralisation, not previously reported in this literature.
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Affiliation(s)
- Valerie Bennett
- Joseph Banks Laboratories, School of Life Sciences, University of Lincoln, Lincoln, Lincs LN6 7DL UK
| | - Nadine Gourkow
- University of Queensland, Gatton Qld 4343, Centre for Animal Welfare and Ethics, The Whitehouse Building 8143, Australia
| | - Daniel S Mills
- Joseph Banks Laboratories, School of Life Sciences, University of Lincoln, Lincoln, Lincs LN6 7DL UK.
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Boretto JG, Zaidenberg E, Gallucci GL, Alfie V, De Carli P. Delayed Repair of Ulnar Artery at the Distal Forearm. Hand (N Y) 2017; 12:150-153. [PMID: 28344526 PMCID: PMC5349407 DOI: 10.1177/1558944716643275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:The purpose of this study was to evaluate the rate of patency after delayed repair of the ulnar artery following primary ligation. Methods: Adult patients with primary ligation of the injured ulnar artery at the forearm who had a delayed repair of the artery were included. Postoperative arterial patency was determined by either physical examination or color Doppler ultrasonographic imaging. Postoperative complications and Disabilities of the Arm, Shoulder and Hand score were recorded. Results: Eight consecutive patients during a 3-year period were included. The mean age was 35 years. Four cases were women. The surgery was performed at a mean of 5 days after the injury and ligation. At a mean follow-up of 22 months, 7 patients had a patent artery. One patient suffered a hematoma. Conclusions: A high rate of patency can be obtained after delayed repair of the ulnar artery at the forearm.
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Affiliation(s)
- Jorge G. Boretto
- Hospital Italiano de Buenos Aires, Argentina,Jorge G. Boretto, Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Potosí 4247, Ciudad Autónoma de Buenos Aires C1199ACK, Argentina.
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Lerman DM, Cable MG, Thornley P, Evaniew N, Slobogean GP, Bhandari M, Healey JH, Randall RL, Ghert M. Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time? Clin Orthop Relat Res 2017; 475:853-860. [PMID: 26920571 PMCID: PMC5289162 DOI: 10.1007/s11999-016-4763-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind. QUESTIONS/PURPOSES (1) Has the LOE presented at the Musculoskeletal Tumor Society (MSTS) annual meeting improved over time? (2) Over the past decade, how do the MSTS and Orthopaedic Trauma Association (OTA) annual meetings compare regarding LOE overall and for the subset of therapeutic studies? METHODS We reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014. Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE; there were 577 abstracts from MSTS and 645 from OTA. Changes in the distributions of study type and LOE over time were evaluated by Pearson chi-square test. RESULTS There was no change over time in MSTS LOE for all study types (p = 0.13) and therapeutic (p = 0.36) study types during the reviewed decade. In contrast, OTA LOE increased over this time for all study types (p < 0.01). The proportion of Level I therapeutic studies was higher at the OTA than the MSTS (3% [14 of 413] versus 0.5% [two of 387], respectively), whereas the proportion of Level IV studies was lower at the OTA than the MSTS (32% [134 of 413] versus 75% [292 of 387], respectively) during the reviewed decade. The proportion of controlled therapeutic studies (LOE I through III) versus uncontrolled studies (LOE IV) increased over time at OTA (p < 0.021), but not at MSTS (p = 0.10). CONCLUSIONS Uncontrolled case series continue to dominate the MSTS scientific program, limiting progress in evidence-based clinical care. Techniques used by the OTA to improve LOE may be emulated by the MSTS. These techniques focus on broad participation in multicenter collaborations that are designed in a comprehensive manner and answer a pragmatic clinical question.
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Affiliation(s)
- Daniel M Lerman
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew G Cable
- Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Thornley
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada
| | - John H Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Lor Randall
- Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada.
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Shaha SH, Sayeed Z, Anoushiravani AA, El-Othmani MM, Saleh KJ. Big Data, Big Problems: Incorporating Mission, Values, and Culture in Provider Affiliations. Orthop Clin North Am 2016; 47:725-32. [PMID: 27637659 DOI: 10.1016/j.ocl.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article explores how integration of data from clinical registries and electronic health records produces a quality impact within orthopedic practices. Data are differentiated from information, and several types of data that are collected and used in orthopedic outcome measurement are defined. Furthermore, the concept of comparative effectiveness and its impact on orthopedic clinical research are assessed. This article places emphasis on how the concept of big data produces health care challenges balanced with benefits that may be faced by patients and orthopedic surgeons. Finally, essential characteristics of an electronic health record that interlinks musculoskeletal care and big data initiatives are reviewed.
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Affiliation(s)
- Steven H Shaha
- Center for Public Policy and Administration, 260 South Central Campus Drive, Room 214, University of Utah, Salt Lake City, UT 84112, USA
| | - Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Honeybul S, Ho KM. Predicting long-term neurological outcomes after severe traumatic brain injury requiring decompressive craniectomy: A comparison of the CRASH and IMPACT prognostic models. Injury 2016; 47:1886-92. [PMID: 27157985 DOI: 10.1016/j.injury.2016.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/26/2016] [Accepted: 04/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Predicting long-term neurological outcomes after severe traumatic brain (TBI) is important, but which prognostic model in the context of decompressive craniectomy has the best performance remains uncertain. METHODS This prospective observational cohort study included all patients who had severe TBI requiring decompressive craniectomy between 2004 and 2014, in the two neurosurgical centres in Perth, Western Australia. Severe disability, vegetative state, or death were defined as unfavourable neurological outcomes. Area under the receiver-operating-characteristic curve (AUROC) and slope and intercept of the calibration curve were used to assess discrimination and calibration of the CRASH (Corticosteroid-Randomisation-After-Significant-Head injury) and IMPACT (International-Mission-For-Prognosis-And-Clinical-Trial) models, respectively. RESULTS Of the 319 patients included in the study, 119 (37%) had unfavourable neurological outcomes at 18-month after decompressive craniectomy for severe TBI. Both CRASH (AUROC 0.86, 95% confidence interval 0.81-0.90) and IMPACT full-model (AUROC 0.85, 95% CI 0.80-0.89) were similar in discriminating between favourable and unfavourable neurological outcome at 18-month after surgery (p=0.690 for the difference in AUROC derived from the two models). Although both models tended to over-predict the risks of long-term unfavourable outcome, the IMPACT model had a slightly better calibration than the CRASH model (intercept of the calibration curve=-4.1 vs. -5.7, and log likelihoods -159 vs. -360, respectively), especially when the predicted risks of unfavourable outcome were <80%. CONCLUSIONS Both CRASH and IMPACT prognostic models were good in discriminating between favourable and unfavourable long-term neurological outcome for patients with severe TBI requiring decompressive craniectomy, but the calibration of the IMPACT full-model was better than the CRASH model.
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Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Western Australia, Australia; Department of Neurosurgery, Royal Perth Hospital, Western Australia, Australia.
| | - Kwok M Ho
- Department of Intensive Care Medicine and School of Population Health, University of Western Australia, Australia
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Thornley P, de Sa D, Evaniew N, Farrokhyar F, Bhandari M, Ghert M. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016; 5:130-6. [PMID: 27105650 PMCID: PMC4921052 DOI: 10.1302/2046-3758.54.2000578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
Objectives Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. Materials and Methods A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. Results A total of 353 surgeons completed the survey. Surgeons achieved consensus on the ‘importance’ of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Conclusion Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality. Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578.
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Affiliation(s)
- P Thornley
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - D de Sa
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - N Evaniew
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - F Farrokhyar
- McMaster University, 39 Charlton Avenue East Hamilton, Ontario, L8N 1Y3, Canada
| | - M Bhandari
- McMaster University, 293 Wellington Street North Hamilton, Ontario, L8L 8E7, Canada
| | - M Ghert
- McMaster University, 711 Concession Street Level B3 Surgical Offices Hamilton, Ontario, L6J 4J9, Canada
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Johal H, Devji T, Schemitsch EH, Bhandari M. Viscosupplementation in Knee Osteoarthritis: Evidence Revisited. JBJS Rev 2016; 4:e11-e111. [DOI: 10.2106/jbjs.rvw.15.00098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Evidence-based indications for hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1386-95. [PMID: 26744282 DOI: 10.1007/s00167-015-3965-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/23/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The 2-portal hindfoot endoscopic technique with the patient in prone position, first introduced by van Dijk et al. (Arthroscopy 16:871-876, 2000), is currently the most used by foot and ankle surgeons to address endoscopically pathologies located in the hindfoot. This article aims to review the literature to provide a comprehensive description of the level of evidence available to support the use of the 2-portal hindfoot endoscopy technique for the current generally accepted indications. METHODS A comprehensive review was performed by use of the PubMed database to isolate literature that described therapeutic studies investigating the results of different hindfoot endoscopy treatment techniques. All articles were reviewed and assigned a classification (I-V) of level of evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for hindfoot endoscopy. A subscale was used to further describe the evidence base for indications receiving a grade of recommendation indicating poor-quality evidence. RESULTS On the basis on the available evidence, posterior ankle impingement syndrome, subtalar arthritis and retrocalcaneal bursitis have the strongest recommendation in favour of treatment (grade Cf). CONCLUSION Although a low level of evidence of the included studies, the review showed that adequate literature to support the use of the 2-portal endoscopic techniques for most currently accepted indications exists. Future "higher quality" evidence could strengthen current recommendations and further help surgeons in evidence-based practice. LEVEL OF EVIDENCE Level V, Review of Level III, IV and V studies.
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Krueger CA, Hsu JR, Belmont PJ. What to Read and How to Read It: A Guide for Orthopaedic Surgeons. J Bone Joint Surg Am 2016; 98:243-9. [PMID: 26842415 DOI: 10.2106/jbjs.o.00307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chad A Krueger
- Orthopaedic Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234. E-mail address:
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204
| | - Philip J Belmont
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920
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Staub LP, Ryser C, Röder C, Mannion AF, Jarvik JG, Aebi M, Aghayev E. Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials. Spine J 2016; 16:136-45. [PMID: 26674445 DOI: 10.1016/j.spinee.2015.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Several randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PURPOSE This study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. STUDY DESIGN AND SETTING A retrospective analysis of registry data was carried out. PATIENT SAMPLE Inclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. OUTCOME MEASURES Neck and arm pain relief and COMI score improvement were the outcome measures. METHODS Three separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). RESULTS Matching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. CONCLUSIONS The results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.
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Affiliation(s)
- Lukas P Staub
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Christoph Ryser
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Christoph Röder
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Anne F Mannion
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, CH-8008 Zurich, Switzerland
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcome Research Centre, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98104, USA
| | - Max Aebi
- Department of Orthopaedic Surgery, Salem Spital, Schänzlistrasse 39, Bern 3025, Switzerland
| | - Emin Aghayev
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland.
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Caram-Deelder C, Kreuger AL, Rosendaal FR, van der Bom JG, Middelburg RA. Continuing use of the terms prospective and retrospective and quality of reporting of observational studies: time to update the STROBE guideline? Int J Epidemiol 2016; 45:587-9. [PMID: 26721602 DOI: 10.1093/ije/dyv335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma 2015; 33:468-81. [PMID: 26529320 PMCID: PMC4779323 DOI: 10.1089/neu.2015.4192] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. We included four RCTs and 17 observational studies. MPS was not associated with an increase in long-term motor score recovery (two RCTs: 335 participants; mean difference [MD], −1.11; 95% confidence interval [CI], −4.75 to 2.53; p = 0.55, low confidence; two observational studies: 528 participants; MD, 1.37; 95% CI, −3.08 to 5.83; p = 0.55, very low confidence) or improvement by at least one motor grade (three observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI, 0.53–1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated superior short-term motor score improvement if MPS was administered within 8 h of injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97–7.94; p = 0.01, low confidence), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI, 1.13–4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited.
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Affiliation(s)
- Nathan Evaniew
- 1 Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Emilie P Belley-Côté
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Nader Fallah
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopedics, Blusson Spinal Cord Center, University of British Columbia , Vancouver, British Columbia, Canada
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Devji T, Kleinlugtenbelt Y, Evaniew N, Ristevski B, Khoudigian S, Bhandari M. Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials. CMAJ Open 2015; 3:E396-405. [PMID: 26770963 PMCID: PMC4701658 DOI: 10.9778/cmajo.20140130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The popularity of surgery for acute displaced midshaft clavicle fractures has been fuelled by early randomized controlled trials (RCTs) showing improved rates of radiographic union and perceived functional benefits compared with nonoperative approaches. We performed a meta-analysis to determine the effect of operative and nonoperative interventions on the risk of secondary operation and complications and on long-term function. METHODS We search MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for reports of relevant RCTs published to Mar. 7, 2014. Two reviewers assessed eligibility of potential reports and the risk of bias of included trials. The Grading of Recommendations Assessment, Development and Evaluation approach was used to summarize the quality of evidence for all outcomes. RESULTS We included 15 RCTs (9 trials comparing operative and nonoperative interventions, 5 comparing implants for operative treatment, and 1 comparing nonoperative treatments). Nonoperative treatments did not differ from operative treatments in the risk of secondary operation (risk ratio [RR] 1.16, 95% confidence interval [CI] 0.58 to 2.35) or all complications (RR 0.90, 95% CI 0.55 to 1.50). One in 4 patients had a complication regardless of the treatment approach. Differences in functional outcomes, although smaller than the threshold for minimal important differences at 1 year, favoured operative interventions (standardized mean difference 0.38, 95% CI 0 to 0.75). Evidence for the type of implant or approach to nonoperative treatment remained inconclusive. INTERPRETATION Current evidence does not support the routine use of internal fixation for the treatment of displaced midshaft clavicle fractures. Complication rates were high regardless of the treatment approach.
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Affiliation(s)
- Tahira Devji
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
| | - Ydo Kleinlugtenbelt
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
| | - Nathan Evaniew
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
| | - Bill Ristevski
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
| | - Shoghag Khoudigian
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
| | - Mohit Bhandari
- Department of Clinical Epidemiology and Biostatistics (Devji, Evaniew, Khoudigian, Bhandari) and Division of Orthopaedic Surgery (Kleinlugtenbelt, Evaniew, Riskevski, Bhandari), McMaster University, Hamilton, Ont
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Pugely AJ, Martin CT, Harwood J, Ong KL, Bozic KJ, Callaghan JJ. Database and Registry Research in Orthopaedic Surgery: Part I: Claims-Based Data. J Bone Joint Surg Am 2015; 97:1278-87. [PMID: 26246263 DOI: 10.2106/jbjs.n.01260] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be grossly categorized as either administrative claims or clinical registries. Administrative claims data comprise the billing records associated with the delivery of health-care services. Orthopaedic researchers have used both government and private claims to describe temporal trends, geographic variation, disparities, complications, outcomes, and resource utilization associated with both musculoskeletal disease and treatment. Medicare claims comprise one of the most robust data sets used to perform orthopaedic research, with >45 million beneficiaries. The U.S. government, through the Centers for Medicare & Medicaid Services, often uses these data to drive changes in health policy. Private claims data used in orthopaedic research often comprise more heterogeneous patient demographic samples, but allow longitudinal analysis similar to that offered by Medicare claims. Discharge databases, such as the U.S. National Inpatient Sample, provide a wide national sampling of inpatient hospital stays from all payers and allow analysis of associated adverse events and resource utilization. Administrative claims data benefit from the high patient numbers obtained through a majority of hospitals. Using claims, it is possible to follow patients longitudinally throughout encounters irrespective of the location of the institution delivering health care. Some disadvantages include lack of precision of ICD-9 (International Classification of Diseases, Ninth Revision) coding schemes. Much of these data are expensive to purchase, complicated to organize, and labor-intensive to manipulate--often requiring trained specialists for analysis. Given the changing health-care environment, it is likely that databases will provide valuable information that has the potential to influence clinical practice improvement and health policy for years to come.
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Affiliation(s)
- Andrew J Pugely
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely:
| | - Christopher T Martin
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely:
| | - Jared Harwood
- Department of Orthopaedics, The Ohio State University Hospital, 376 West 10th Avenue, Suite 725, Columbus, OH 43210
| | - Kevin L Ong
- Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104
| | - Kevin J Bozic
- Department of Orthopaedic Surgery, University of California San Francisco, 3333 California Street, Suite 265, Box 0936, San Francisco, CA 94118
| | - John J Callaghan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely:
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Vitamin C to Prevent Complex Regional Pain Syndrome in Patients With Distal Radius Fractures: A Meta-Analysis of Randomized Controlled Trials. J Orthop Trauma 2015. [PMID: 26197022 DOI: 10.1097/bot.0000000000000305] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether vitamin C is effective in preventing complex regional pain syndrome (CRPS) in patients with distal radius fractures. DATA SOURCES MEDLINE (1946 to present), EMBASE (1974 to present), and The Cochrane Library (no date limit) were systematically searched up to September 6, 2014, using MeSH and EMTREE headings with free text combinations. STUDY SELECTION Randomized trials comparing vitamin C against placebo were included. No exclusions were made during the selection of eligible trials on the basis of patient age, sex, fracture severity, or fracture treatment. DATA EXTRACTION Two reviewers independently screened articles, extracted data, and applied the Cochrane Risk of Bias tool. Evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS Heterogeneity was quantified using the χ test and the I statistic. Outcome data were combined with a random effects model. RESULTS Across 3 trials (n = 890) of patients with distal radius fractures, vitamin C did not reduce the risk for CRPS (risk ratio = 0.45; 95% confidence interval, 0.18-1.13; I = 70%). This result was confirmed in sensitivity analyses to test the importance of missing data because of losses to follow-up under varying assumptions. Heterogeneity was explained by diagnostic criteria, but not regimen of vitamin C or fracture treatment. CONCLUSIONS The evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences.
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da Assunção RE, Pollard TCB, Hrycaiczuk A, Curry J, Glyn-Jones S, Taylor A. Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem. Bone Joint J 2015. [DOI: 10.1302/0301-620x.97b8.34431] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Periprosthetic femoral fracture (PFF) is a potentially devastating complication after total hip arthroplasty, with historically high rates of complication and failure because of the technical challenges of surgery, as well as the prevalence of advanced age and comorbidity in the patients at risk. This study describes the short-term outcome after revision arthroplasty using a modular, titanium, tapered, conical stem for PFF in a series of 38 fractures in 37 patients. The mean age of the cohort was 77 years (47 to 96). A total of 27 patients had an American Society of Anesthesiologists grade of at least 3. At a mean follow-up of 35 months (4 to 66) the mean Oxford Hip Score (OHS) was 35 (15 to 48) and comorbidity was significantly associated with a poorer OHS. All fractures united and no stem needed to be revised. Three hips in three patients required further surgery for infection, recurrent PFF and recurrent dislocation and three other patients required closed manipulation for a single dislocation. One stem subsided more than 5 mm but then stabilised and required no further intervention. In this series, a modular, tapered, conical stem provided a versatile reconstruction solution with a low rate of complications. Cite this article: Bone Joint J 2015;97-B:1031–7.
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Affiliation(s)
- R. E. da Assunção
- Western Sussex Hospitals NHS Foundation
Trust, Lyndhurst Road, Worthing, BN11
2DH, UK
| | | | - A. Hrycaiczuk
- University Hospitals Bristol NHS Trust
Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2
8HW, UK
| | - J. Curry
- Sir Charles Gairdner Hospital, Hospital
Avenue, Nedlands, WA, 6009, Australia
| | - S. Glyn-Jones
- University of Oxford, Windmill
Road, Oxford, OX3 7LD, UK
| | - A. Taylor
- Oxford University Hospitals NHS Trust, Windmill
Road, Headington, Oxford, OX3
7HE, UK
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Evaniew N, Noonan VK, Fallah N, Kwon BK, Rivers CS, Ahn H, Bailey CS, Christie SD, Fourney DR, Hurlbert RJ, Linassi AG, Fehlings MG, Dvorak MF. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry. J Neurotrauma 2015; 32:1674-83. [PMID: 26065706 PMCID: PMC4638202 DOI: 10.1089/neu.2015.3963] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR). We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression. Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1-T1) rather than thoracolumbar (T2-L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02) NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.
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Affiliation(s)
- Nathan Evaniew
- 1 Division of Orthopaedics, McMaster University , Hamilton, Ontario, Canada
| | - Vanessa K Noonan
- 2 Rick Hansen Institute, Vancouver, Canada .,3 University of British Columbia , Vancouver, Canada
| | - Nader Fallah
- 2 Rick Hansen Institute, Vancouver, Canada .,3 University of British Columbia , Vancouver, Canada
| | - Brian K Kwon
- 3 University of British Columbia , Vancouver, Canada
| | | | - Henry Ahn
- 4 St. Michael's Hospital , Toronto, Ontario, Canada .,5 University of Toronto Spine Program, University of Toronto , Ontario, Canada
| | - Christopher S Bailey
- 6 Division of Orthopaedic Surgery, Western University ; London Health Services Centre, London, Ontario, Canada
| | - Sean D Christie
- 7 Division of Neurosurgery-Halifax Infirmary, Dalhousie University , Halifax, Nova Scotia, Canada
| | - Daryl R Fourney
- 8 Department of Surgery, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - R John Hurlbert
- 9 University of Calgary Spine Program , Calgary, Alberta, Canada
| | - A G Linassi
- 10 Department of Physical Medicine and Rehabilitation, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - Michael G Fehlings
- 5 University of Toronto Spine Program, University of Toronto , Ontario, Canada .,11 Division of Neurosurgery, University of Toronto , Ontario, Canada
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Boye GN, Murray K, Clohisy JC, Kim YJ. Feasibility of a Randomized Clinical Trial for Treatment of Femoroacetabular Impingement of the Hip. Orthop J Sports Med 2015; 3:2325967115592844. [PMID: 26673688 PMCID: PMC4622329 DOI: 10.1177/2325967115592844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Symptomatic femoroacetabular impingement (FAI) is currently corrected by surgery. However, it is possible that nonsurgical treatment could resolve symptomatic FAI in some patients; thus, uncertainty about the necessity of surgical treatment exists. The current equipoise concerning FAI treatment presents an opportunity to conduct a randomized controlled trial (RCT) of surgical and nonsurgical treatment options. Given the unique challenge of adequate patient enrollment in RCTs, it is important that a preliminary study is done to appraise the feasibility of conducting an RCT. PURPOSE To estimate enrollment rates of a planned future RCT to compare surgical and nonsurgical treatments for symptomatic FAI and to identify factors associated with patients' willingness to participate in the randomized trial. STUDY DESIGN Cross-sectional study; Level of evidence, 4. METHODS Patients diagnosed with FAI at 2 orthopaedic centers were presented with a hypothetical randomized trial comparing 2 treatment options for FAI. All patients completed forms providing information regarding their willingness to participate and treatment preferences. RESULTS A total of 75 patients participated in the study: 53 and 22 from 2 centers, respectively. Twenty-eight percent indicated absolute willingness to participate in the trial, 40% were probably willing or unsure, and 32% were definitely not willing; 18.7% had a strong preference for surgery while 2.7% strongly preferred nonsurgical treatment. The majority (78.6%) had no strong preference for either treatment arm. There were correlations between treatment preferences and willingness to participate. Patients with a strong treatment preference and/or a preference for surgery were less likely to be willing to participate. CONCLUSION The study findings suggest that sufficient patient accrual for a randomized trial of FAI treatment is currently feasible while equipoise still exists among patients and surgeons.
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Affiliation(s)
- Gloria N Boye
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerri Murray
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John C Clohisy
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Young-Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Thornley P, Evaniew N, Riediger M, Winemaker M, Bhandari M, Ghert M. Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. CMAJ Open 2015; 3:E338-43. [PMID: 26457293 PMCID: PMC4596117 DOI: 10.9778/cmajo.20150012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections. METHODS We systematically searched MEDLINE, Embase and the Cochrane Library for randomized controlled trials (RCTs) published up to Aug. 15, 2014. We included all RCTs that compared postoperative antibiotic prophylaxis with postoperative placebo or no treatment in patients undergoing primary total hip or knee arthroplasty for osteoarthritis. We combined outcomes for surgical-site infection using a random-effects model and quantified heterogeneity using the χ2 test and the I2 statistic. We assessed the overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We identified 4 RCTs (n = 4036) that met the inclusion criteria. Surgical-site infections occurred in 3.1% (63/2055) of patients in the prophylaxis group and 2.3% (45/1981) in the control group. Postoperative prophylaxis did not reduce the rate of surgical-site infections compared with placebo (risk difference 0.01, 95% confidence interval 0.00 to 0.02; I2 = 26%). This result was robust to sensitivity testing for losses to follow-up. According to the GRADE approach, the overall quality of evidence was very low. INTERPRETATION The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself.
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Affiliation(s)
- Patrick Thornley
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
| | - Nathan Evaniew
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
| | - Michael Riediger
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
| | - Mitchell Winemaker
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
| | - Mohit Bhandari
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
| | - Michelle Ghert
- Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
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Liu CH, Wu SQ, Ke XB, Wang HL, Chen CX, Lai ZL, Zhuang ZY, Wu ZQ, Lin Q. Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore) 2015. [PMID: 26200640 PMCID: PMC4602994 DOI: 10.1097/md.0000000000001207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Subcutaneous and submuscular anterior ulnar nerve transposition have been widely used in patients with cubital tunnel syndrome. However, the reliable evidence in favor of 1 of 2 surgical options on clinical improvement remains controversial. To maximize the value of the available literature, we performed a systematic review and meta-analysis to compare subcutaneous versus submuscular anterior ulnar nerve transposition in patients with ulnar neuropathy at the elbow. PubMed, Cochrane Library, and EMBASE databases were searched for randomized and observational studies that compared subcutaneous transposition with submuscular transposition of ulnar nerve for cubital tunnel syndrome. The primary outcome was clinically relevant improvement in function compared to the baseline. Randomized and observational studies were separately analyzed with relative risks (RRs) and 95% confidence intervals (CIs). Two randomized controlled trials (RCTs) and 7 observational studies, involving 605 patients, were included. Our meta-analysis suggested that no significant differences in the primary outcomes were observed between comparison groups, both in RCT (RR, 1.16; 95% CI 0.68-1.98; P = 0.60; I2= 81%) and observational studies (RR, 1.01; 95% CI 0.95-1.08; P = 0.69; I2 = 0%). These findings were also consistent with all subgroup analyses for observational studies. In the secondary outcomes, the incidence of adverse events was significantly lower in subcutaneous group than in submuscular group (RR, 0.54; 95% CI 0.33-0.87; P = 0.01; I2 = 0%), whereas subcutaneous transposition failed to reveal more superiority than submuscular transposition in static two-point discrimination (MD, 0.04; 95% CI -0.18-0.25; P = 0.74; I = 0%). The available evidence is not adequately powered to identify the best anterior ulnar nerve transposition technique for cubital tunnel syndrome on the basis of clinical outcomes, that is, suggests that subcutaneous and submuscular anterior transposition might be equally effective in terms of postoperative clinical improvement. However, differences in clinical outcomes metrics should be noted, and these findings largely rely on the outcomes data from observational studies that are potentially subject to a high risk of selection bias. Therefore, more high-quality and adequately powered RCTs with standardized clinical outcomes metrics are necessary for proper comparison of these techniques.
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Affiliation(s)
- Chun-Hua Liu
- From the Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian university of Traditional Chinese Medicine (C-HL, X-BK, H-LW, C-XC, Z-LL, Z-YZ, Z-QW); Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou (S-QW); and Department of Orthopaedic Surgery, Fuzhou Second Hospital of Xiamen University, Xiamen, Fujian province, China (QL)
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Flageole H, Kanters DM, Tan CN, Pemberton J. The level of evidence keeps improving: An updated analysis of the scientific program at the Canadian Association of Paediatric Surgeons Annual Meeting. J Pediatr Surg 2015; 50:815-8. [PMID: 25783360 DOI: 10.1016/j.jpedsurg.2015.02.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/13/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The purpose of this study is to examine the scientific program of the Canadian Association of Pediatric Surgeons (CAPS) to determine if the quality of research has improved. METHODS CAPS abstracts from 2010 to 2013 were reviewed by two independent researchers. Presentation type, study design, and level of evidence (LOE) were recorded. All differences were adjudicated by an epidemiologist. Fisher's exact test compared results to a previous study that assessed LOE in CAPS abstracts from 2005 to 2009. RESULTS 291 abstracts were reviewed with 53 excluded and 238 included in final analysis. Reviewers demonstrated high agreement for study design (ICC=0.767 95%CI 0.715-0.810) and LOE (ICC=0.914 95%CI 0.892-0.931). Out of 238 studies, 117 (49%) were podium and 122 (51%) posters. Number of high-quality studies increased in 2010-2013 versus 2005-2009 (n=253), specifically systematic reviews (n=15 (6%) vs. n=3 (1%) p<0.01), randomized controlled trials (n=4 (2%) vs. n=0 (0%), p=0.05), and prospective cohort studies (n=41 (17%) vs. n=26 (10%), p<0.001). Retrospective cohort is still the most common. However, the number of studies has significantly decreased (n=121 (51%) vs. n=171 (68%), p<0.001). The proportion of high-level studies (LOE 2 or better) also improved (48 (20%) vs. 24 (10%) p<0.001). CONCLUSION The quality of research presented at CAPS has greatly improved, especially in the past five years.
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Affiliation(s)
- Helene Flageole
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5.
| | - David M Kanters
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada L8S 4L8
| | - Collin N Tan
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada L8S 4L8
| | - Julia Pemberton
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada L8S 4L8
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Evaniew N, Khan M, Drew B, Kwok D, Bhandari M, Ghert M. Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis. CMAJ Open 2014; 2:E295-305. [PMID: 25485257 PMCID: PMC4251505 DOI: 10.9778/cmajo.20140048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery for discectomy may accelerate recovery and reduce pain, but it also requires technical expertise and is associated with increased risks. We performed a meta-analysis to determine the effects of minimally invasive versus open surgery on functional outcomes, pain, complications and reoperations among patients undergoing cervical or lumbar discectomy. METHODS We searched MEDLINE, Embase and the Cochrane Library for reports of relevant randomized controlled trials published to Jan. 12, 2014. Two reviewers assessed the eligibility of potential reports and the risk of bias of included trials. We analyzed functional outcomes and pain using standardized mean differences (SMDs) that were weighted and pooled using a random-effects model. RESULTS We included 4 trials in the cervical discectomy group (n = 431) and 10 in the lumbar discectomy group (n = 1159). Evidence overall was of low to moderate quality. We found that minimally invasive surgery did not improve long-term function (cervical: SMD 0.11, 95% confidence interval [CI] -0.09 to 0.31; lumbar: SMD 0.04, 95% CI -0.11 to 0.20) or reduce long-term extremity pain (cervical: SMD -0.21, 95% CI -0.52 to 0.10; lumbar: SMD 0.08, 95% CI -0.16 to 0.32) compared with open surgery. The evidence suggested overall higher rates of nerve-root injury (risk ratio [RR] 1.62, 95% CI 0.45 to 5.84), incidental durotomy (RR 1.56, 95% CI 0.80 to 3.05) and reoperation (RR 1.48, 95% CI 0.97 to 2.26) with minimally invasive surgery than with open surgery. Infections were more common with open surgery than with minimally invasive surgery (RR 0.24, 95% CI 0.04 to 1.38), although the difference was not statistically significant. INTERPRETATION Current evidence does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy. Well-designed trials are needed given the lack of high-quality evidence.
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Affiliation(s)
- Nathan Evaniew
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Brian Drew
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Desmond Kwok
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - Michelle Ghert
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
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Saulino M, Guillemette S, Leier J, Hinnenthal J. Medical cost impact of intrathecal baclofen therapy for severe spasticity. Neuromodulation 2014; 18:141-9; discussion 149. [PMID: 25145312 DOI: 10.1111/ner.12220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the economic effects of intrathecal baclofen (ITB) for patients with severe spasticity based on costs of care before and after implantation of an intrathecal drug delivery system. MATERIALS AND METHODS An actuarial projection of post-implant experience in the absence of ITB intervention was used to simulate a continued conventional medical management protocol (ITB-free) by assuming a reasonable trend rate based on health-care industry standards. Cost projections were developed over a 30-year time horizon at various reimplantation rates. The model was informed by retrospective analysis of commercial administrative claims data from 409 pediatric and adult spasticity patients who received a pump implant (ITB-experienced) within a 3-year service period (January 2006 to January 2009). Common indications associated with pump implant included multiple sclerosis (N = 124), cerebral palsy (N = 131), and spinal cord injury (N = 40). RESULTS ITB was less costly than the conventional protocol over our baseline implantation cycle. Costs in the month of implant and in the year following were cumulatively $26,375 more than with the conventional protocol. However, ITB financial break-even occurs between the second and third years post-implant. The lifetime analysis indicates that savings for ITB are $8009 per patient per year compared with conventional therapy. Most of the savings are derived from reductions in inpatient admissions, physician office visits, and outpatient physiotherapy. CONCLUSIONS The results suggest that spasticity patients receiving ITB would expect to experience a reduction in cumulative future medical costs relative to anticipated costs in the absence of a pump implant. This finding complements the existing literature on the cost-effectiveness of ITB.
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Daffada PJ, Walsh N, McCabe CS, Palmer S. The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review. Physiotherapy 2014; 101:25-33. [PMID: 25442672 DOI: 10.1016/j.physio.2014.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/25/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cortical change, in the manner of cortical remapping is a common feature of and potential driver for chronic low back pain (CLBP). Novel interventions such as graded motor imagery (GMI) and mirror visual feedback (MVF) have been shown to facilitate correction of cortical changes and improve symptoms in other chronic pain states. However, little is known regarding the effectiveness of these treatment approaches in CLBP. OBJECTIVE To identify and assess the current evidence regarding the effectiveness of interventions which target cortical remapping in the management of CLBP. DATA SOURCES The electronic databases Medline, Embase, CINAHL, AMED, OVID, PEDro, BNI, PsycINFO, HMIC, and Cochrane library were systematically searched. STUDY SELECTION Of 11 potential citations identified, 5 articles were identified for inclusion and critiqued. These comprised 3 randomised controlled trials (RCTs), 1 randomised cross-over study, and 1 multiple case study design. RESULTS Visualisation of lumbar movement may significantly improve movement-related pain severity and duration. A combined sensorimotor retraining approach has been shown to produce short-term improvements in both pain and disability outcomes in CLBP. The relative effectiveness of individual interventions and their long-term efficacy have yet to be established. CONCLUSIONS There is a paucity of robust literature which has examined the application and efficacy of these novel treatments in the management of CLBP. Results from the few CLBP studies which are available are encouraging. Further, robust research is needed to optimise treatment protocols and establish their long-term effectiveness in CLBP.
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Affiliation(s)
- P J Daffada
- Department of Physiotherapy, St. David's Hospital, Cardiff and Vale University Health Board (UHB), United Kingdom; North Somerset Community Partnership (NSCP), United Kingdom.
| | - N Walsh
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of West of England (UWE), United Kingdom
| | - C S McCabe
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of West of England (UWE), United Kingdom
| | - S Palmer
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of West of England (UWE), United Kingdom
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Cochrane in CORR®: Viscosupplementation for the treatment of osteoarthritis of the knee. Clin Orthop Relat Res 2014; 472:2028-34. [PMID: 24218162 PMCID: PMC4048421 DOI: 10.1007/s11999-013-3378-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 01/31/2023]
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