1
|
Giannopoulos S, AbuHasan Q, Connors JDN, Athanasiadis DI, Hilgendorf W, Gardiner R, Martine V, Baumgartner TC, Stefanidis D. Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey. Surg Endosc 2024; 38:2252-2259. [PMID: 38409612 DOI: 10.1007/s00464-023-10664-z] [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] [Received: 07/30/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known. OBJECTIVES Assess patient needs, goals, and preferences regarding WR treatment. SETTING Single MBSAQIP-accredited academic center, and online recruitment. METHODS An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations. RESULTS Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively. CONCLUSIONS Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.
Collapse
Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Qais AbuHasan
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - William Hilgendorf
- General Surgery, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Robin Gardiner
- Indiana University Health North Hospital, Carmel, IN, USA
| | - Victoria Martine
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
| |
Collapse
|
2
|
Giannopoulos S, Kapsampelis P, Pokala B, Nault Connors JD, Hilgendorf W, Timsina L, Clapp B, Ghanem O, Kindel TL, Stefanidis D. Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence. Surg Obes Relat Dis 2023; 19:972-979. [PMID: 37061437 DOI: 10.1016/j.soard.2023.02.027] [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] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons. OBJECTIVES Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS). SETTING Web-based survey of bariatric surgeons. METHODS A 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options. RESULTS One hundred ten surgeons from 19 countries responded to the survey. Ninety-eight percent responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss < 50% by 31.4%, as excess weight loss <25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (P = .036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% versus 18.2% versus 15.3%, respectively). CONCLUSIONS This survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a nonsatisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed.
Collapse
Affiliation(s)
| | | | - Bhavani Pokala
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Lava Timsina
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|
3
|
Giannopoulos S, Kalantar Motamedi SM, Athanasiadis DI, Clapp B, Lyo V, Ghanem O, Edwards M, Puzziferri N, Stefanidis D. Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices. Surg Obes Relat Dis 2023; 19:799-807. [PMID: 36717309 DOI: 10.1016/j.soard.2022.12.038] [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] [Received: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. OBJECTIVES Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers. METHODS The members of the ASMBS Research Committee developed and administered a web-based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS. RESULTS Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS members) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass index) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%. CONCLUSIONS VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.
Collapse
Affiliation(s)
| | | | | | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Victoria Lyo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Nancy Puzziferri
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|
4
|
Calek AK, Schöfl T, Zdravkovic V, Zurmühle P, Ladurner A. Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy-Treatment Assessment With the Forgotten Joint Score-12. Arthroplast Today 2022; 15:159-166. [PMID: 35601994 PMCID: PMC9121271 DOI: 10.1016/j.artd.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Aseptic loosening is among the most common reasons for revision total hip arthroplasty (RTHA). Modular revision stems implanted through an extended trochanteric osteotomy (ETO) promise good results, but patient-reported outcome measures (PROMs) are rarely conveyed. This study used the Forgotten Joint Score-12 (FJS-12) to assess patient-reported outcome in patients who had undergone RTHA for aseptic stem loosening using a modified ETO approach with a tapered, fluted modular stem. Material and methods A single-center analysis of aseptic RTHA was performed (2007–2019). Clinical results (range of motion, walking ability, function), radiographic results (ETO healing, stem subsidence), and PROMs (FJS-12, Harris Hip Score, European Quality of Life 5D Score) were assessed. Minimum follow-up duration was 1 year. Complications including revisions were recorded. Results Primary outcome parameters were assessed on 72 patients (mean age 73.3 years, mean body mass index 27.6kg/m2). Additional PROMs were collected by phone interviews from 41 patients (mean follow-up 5.7 years). In 76%, leg length was restored, and a normal gait was achieved. After 1 year, the ETO was healed in 93%; subsidence occurred in 8.3% of cases. The mean FJS-12 at the final follow-up was 85.6 ± 23.6, and the respective Harris Hip Score and European Quality of Life 5D Score averaged 87 ± 17.8 and 72.9 ± 15.9. Complication and revision rates were 33.3% and 13.9%, respectively. Conclusion Aseptic RTHA as presented here resulted in excellent PROMs in the medium term. FJS-12 score averaged 85.6 with a mean follow-up of 5.7 years. Treatment using a modular implant and a modified ETO was associated with good clinical and radiographic outcomes. Complication and revision rates were 33.3% and 13.9%, respectively.
Collapse
Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Thomas Schöfl
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Pia Zurmühle
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| |
Collapse
|
5
|
Schöfl T, Calek AK, Zdravkovic V, Zurmühle P, Ladurner A. Mid-term outcomes following transfemoral revision of total hip arthroplasty for Vancouver B2/B3 periprosthetic fractures. Injury 2022; 53:653-660. [PMID: 34862036 DOI: 10.1016/j.injury.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFF) are often the reason for revising total hip arthroplasty (RTHA). Converting these fractures into modified extended trochanteric osteotomy (mETO) facilitates stem revision. Modular revision stems are a common choice with good results. We present mid-term outcomes in patients undergoing RTHA for Vancouver B2/B3 PFF using a tapered, fluted modular stem with an mETO approach. MATERIALS AND METHODS A single-center analysis of patients with RTHA for Vancouver B2/B3 PFF using a single modular implant with mETO was performed (2007 - 2019). Clinical outcome (mobility, range of motion, function), radiological outcome (fracture healing, stem subsidence) and patient reported outcome measures (FJS-12, HHS, EQ-5D) were assessed. RESULTS Ninety-seven patients (mean age 78.1 years, BMI 25.8 kg/m2, 85.6% B2-fractures) were included; 80 patients had complete clinical and radiological follow-ups. Normal unaided gait without limping was achieved in 38/80 patients. After one year fracture / mETO healing occurred in 74/80 patients; 5.3 years after surgery, the respective FJS-12, HHS and EQ-5D (available in 34 patients) averaged 81.3 ± 30.2, 71.4 ± 18.7 and 0.8 ± 0.2. We documented 7 in-hospital deaths, 18.8% postoperative complications and 13.8% revisions with stem revisions being most commonly for subsequent PFF or subsidence. CONCLUSION Good clinical and radiological outcomes and rather low complication and revision rates (18.8% and 13.8%) were achieved. FJS-12 showed excellent results in patients undergoing RTHA for Vancouver B2/B3 PFF using a cementless, dual modular titanium revision stem and an mETO approach. Joint awareness was thereby similar to previously reported primary THA results at 5.3 years follow-up.
Collapse
Affiliation(s)
- Thomas Schöfl
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Pia Zurmühle
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland.
| |
Collapse
|
6
|
Meyer VM, Benjamens S, Moumni ME, Lange JFM, Pol RA. Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery. Ann Surg 2022; 275:e75-e81. [DOI: https:/doi.org/10.1097/sla.0000000000004078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
7
|
Meyer VM, Benjamens S, Moumni ME, Lange JFM, Pol RA. Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery: A Systematic Review. Ann Surg 2022; 275:e75-e81. [PMID: 32649458 PMCID: PMC8683255 DOI: 10.1097/sla.0000000000004078] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Identify key demographic factors and modes of follow-up in surgical survey response. SUMMARY BACKGROUND DATA Surveys are widely used in surgery to assess patient and procedural outcomes, but response rates vary widely which compromises study quality. Currently there is no consensus as to what the average response rate is and which factors are associated with higher response rates. METHODS The National Library of Medicine (MEDLINE/PubMed) was systematically searched from Januray 1, 2007 until February 1, 2020 using the following strategy: (((questionnaire) OR survey) AND "response rate") AND (surgery OR surgical). Original survey studies from surgical(-related) fields reporting on response rate were included. Through one-way analysis of variance we present mean response rate per survey mode over time, number of additional contacts, country of origin, and type of interviewee. RESULTS The average response is 70% over 811 studies in patients and 53% over 1746 doctor surveys. In-person surveys yield an average 76% response rate, followed by postal (65%) and online (46% web-based vs 51% email) surveys. Patients respond significantly more often than doctors to surveys by mail (P < 0.001), email (P = 0.003), web-based surveys (P < 0.001) and mixed mode surveys (P = 0.006). Additional contacts significantly improve response rate in email (P = 0.26) and web-based (P = 0.041) surveys in doctors. A wide variation in response rates was identified between countries. CONCLUSIONS Every survey is unique, but the main commonality between studies is response rate. Response rates appear to be highly dependent on type of survey, follow-up, geography, and interviewee type.
Collapse
Affiliation(s)
| | - Stan Benjamens
- Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Johan F M Lange
- Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| |
Collapse
|
8
|
Effect of black pepper, turmeric and ajwa date on the endocrine pancreas of the experimentally induced diabetes in wister albino rats: A histological and immunohistochemical study. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Ricardo Hamilton AE, Lin AA, Young CJ. The Benefits of Colorectal Surgery Surveys in Australia and New Zealand. Ann Coloproctol 2020; 36:102-111. [PMID: 32429010 PMCID: PMC7299568 DOI: 10.3393/ac.2019.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Pertaining to the Colorectal Surgery Society of Australia and New Zealand (CSSANZ) Executive and Research Support Committee, this study aimed to assess the usefulness and outcomes of surveys sent out by the society to its members. METHODS From 2009 to 2017, CSSANZ members received 38 surveys, most of which were distributed from within the society, and a few of which originated from other affiliated groups. Surveys were categorised by type, topics, times required for completion, delivery method, response rates, and advancement to publication. RESULTS Of 38 surveys, 20 (53%) were published and 18 remain unpublished. Four surveys were distributed annually on average, with 2.2 published annually on average, with a mean impact factor of 2.41 ± 1.55. Mean time to publication was 31 ± 17 months. Surveys contributed to 13 publications (34%). The most common survey topics were rectal cancer decisionmaking, in 6 publications (16%), preoperative assessment of colorectal patients, in 5 publications (13%), and anal physiology: continence and defaecation, in 4 publications (11%). Publication of surveys was not related to the number of surveys distributed per year, the number of questions per survey, or the time required by respondents to complete the surveys. CONCLUSION Most of the CSSANZ-distributed surveys resulted in publications, and one third of the surveys contributed to higher degrees obtained by investigators. These surveys aid research into areas that are otherwise difficult to assess, often indicating areas for future research.
Collapse
Affiliation(s)
- Auerilius Erastus Ricardo Hamilton
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
| | - Amelia Alice Lin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
| | - Christopher John Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Assessment of non-response in quality control of nasal septal surgery. The Journal of Laryngology & Otology 2019; 133:208-212. [PMID: 30813978 DOI: 10.1017/s002221511900032x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study evaluated the effect of mail non-response on the validity of the results of nasal septal surgery. METHOD Six months post-operatively, questionnaires with both prospective and retrospective ratings were mailed to patients. Patients who did not respond (non-responders) were contacted by telephone. This study compared two cohorts of patients using different interviewers (a nurse and a surgeon). Cohort one consisted of 182 patients (with 67 per cent mail response), and cohort two consisted of 454 patients (with 64.8 per cent mail response). RESULTS In both cohorts, the improvement in obstruction scores was significantly better among mail responders than among non-responders (telephone interviewees) using prospective ratings, but worse using retrospective ratings. CONCLUSION Mail responders had better improvement in nasal obstruction after septoplasty than non-responders. Therefore, low response rates may cause an overestimation of the results. The retrospective ratings obtained through telephone interviews are less reliable because they are influenced by memory and the patients' tendency to give socially acceptable answers.
Collapse
|
11
|
Nazari T, Vlieger EJ, Dankbaar MEW, van Merriënboer JJG, Lange JF, Wiggers T. Creation of a universal language for surgical procedures using the step-by-step framework. BJS Open 2018; 2:151-157. [PMID: 29951639 PMCID: PMC5989977 DOI: 10.1002/bjs5.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background Learning of surgical procedures is traditionally based on a master–apprentice model. Segmenting procedures into steps is commonly used to achieve an efficient manner of learning. Existing methods of segmenting procedures into steps, however, are procedure‐specific and not standardized, hampering their application across different specialties and thus worldwide uptake. The aim of this study was to establish consensus on the step‐by‐step framework for standardizing the segmentation of surgical procedures into steps. Methods An international expert panel consisting of general, gastrointestinal and oncological surgeons was approached to establish consensus on the preciseness, novelty, usefulness and applicability of the proposed step‐by‐step framework through a Delphi technique. All statements were rated on a five‐point Likert scale. A statement was accepted when the lower confidence limit was 3·00 or more. Qualitative comments were requested when a score of 3 or less was given. Results In round one, 20 of 49 experts participated. Eighteen of 19 statements were accepted; the ‘novelty’ statement needed further exploration (mean 3·05, 95 per cent c.i. 2·45 to 3·65). Based on the qualitative comments of round one, five clarifying statements were formulated for more specific statements in round two. Twenty‐two experts participated and accepted all statements. Conclusion The international expert panel consisting of general, gastrointestinal and oncological surgeons supported the preciseness, usefulness and applicability of the step‐by‐step framework. This framework creates a universal language by standardizing the segmentation of surgical procedures into step‐by‐step descriptions based on anatomical structures, and may facilitate education, communication and assessment.
Collapse
Affiliation(s)
- T Nazari
- Incision Academy Amsterdam The Netherlands.,Department of Surgery Erasmus University Medical Centre Rotterdam The Netherlands
| | | | - M E W Dankbaar
- Institute of Medical Education Research Rotterdam and Department of Education Erasmus University Medical Centre Rotterdam The Netherlands
| | - J J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
| | - J F Lange
- Department of Surgery Erasmus University Medical Centre Rotterdam The Netherlands
| | - T Wiggers
- Incision Academy Amsterdam The Netherlands
| |
Collapse
|
12
|
Management of symptomatic knee osteoarthritis in obesity: a survey of general practitioners' opinions and practice. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1183-1189. [PMID: 29696414 DOI: 10.1007/s00590-018-2184-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this survey was to explore general practitioners' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. METHODS Questionnaires were sent electronically to members of the Royal College of General Practitioners specialty interest groups: GPs with an Interest in Nutrition Group and the Physical Activity and Life Style group. RESULTS The response rate was 75% (142/190). The majority stated weight loss should be the first-line treatment. Half stated that community interventions were effective, and three quarters stated that bariatric surgery should be available to these patients. Two-thirds reported that their knowledge and training around obesity management was insufficient. CONCLUSION Our survey has shown a variation in the opinions and practices amongst respondents on the management of symptomatic knee osteoarthritis in obesity. Given the projected obesity epidemic, greater training and resources are required in the community setting to enable effective management. There is support for the creation of combined ortho-bariatric services.
Collapse
|
13
|
Li D, Li X, Zhao L, Zhou Y, Sun W, Wang Y. Linking multiple risk exposure profiles with adolescent Internet addiction: Insights from the person-centered approach. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.04.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Papathanasiou E, Finkelman M, Parashis AO. Letter to the Editor: Authors’ Response. J Periodontol 2017; 88:239-240. [DOI: 10.1902/jop.2017.160685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Evangelos Papathanasiou
- Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Massachusetts
| | - Matthew Finkelman
- Division of Biostatistics and Experimental Design, School of Dental Medicine, Tufts University
| | - Andreas O. Parashis
- Department of Periodontology, School of Dental Medicine, Tufts University, and private practice in periodontics, Athens, Greece
| |
Collapse
|
15
|
Papathanasiou E, Finkelman M, Hanley J, Parashis AO. Prevalence, Etiology and Treatment of Peri-Implant Mucositis and Peri-Implantitis: A Survey of Periodontists in the United States. J Periodontol 2016; 87:493-501. [DOI: 10.1902/jop.2015.150476] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Aframian A, Johnson DS, Hing CB. BASK survey of The Knee readership 2015. Knee 2015; 22:443-5. [PMID: 26254273 DOI: 10.1016/j.knee.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A convenience sample of the attendees of the 2015 annual meeting of the British Association of Knee showed that the majority of the attendees who responded read The Knee, would like a section on surgical tips, more themed supplements and guest editorials. There is still not enough support for purely electronic publication. For those that have submitted papers, the experience with the publication process was positive.
Collapse
Affiliation(s)
- Arash Aframian
- Trauma & Orthopaedics, St George's Hospital, London SW17 0QT, United Kingdom.
| | - David Sands Johnson
- Trauma & Orthopaedics, Stockport NHS Foundation Trust, Stepping Hill Hospital, Cheshire SK2 7JE, United Kingdom
| | | |
Collapse
|
17
|
Ruhee D, Mahomoodally F. Relationship between family meal frequency and individual dietary intake among diabetic patients. J Diabetes Metab Disord 2015; 14:66. [PMID: 26258111 PMCID: PMC4529702 DOI: 10.1186/s40200-015-0187-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/24/2015] [Indexed: 12/04/2022]
Abstract
Background Notoriously, the island of Mauritius has one of the highest prevalence of diabetes in the world. Management of the disease is very important and family meals are undoubtedly beneficial to patients as they promote the development of healthy eating behaviours and food choices. This study has aimed to probe into potential relationship(s) between family meal frequency and individual dietary intake among diabetic patients and to establish whether family cohesion may be a plausible mediator of this relationship. Methods A cross-sectional survey was carried out with a random sample of 384 diabetic patients. The Family Adaptability and Cohesion Evaluation Scale III was used to obtain information on two general aspects of family functioning, that is, cohesiveness and adaptability. Chi-squared (χ2) tests, independent sample t-tests and one-way ANOVA were used to determine statistical significance. Pearson correlation was used to examine associations between family meal frequency, individual dietary intake and family cohesion. Hierarchical linear regression models were performed for the mediation analysis. Results Family meal frequency (breakfast, lunch and dinner) was observed to be positively associated with intake of fish, raw vegetables, dried and fresh fruits, low-fat milk, cheese, yogurt, nuts and light butter and negatively associated with intake of red meat, white rice, white bread, whole egg fried, chocolates, fried cakes, burgers, chips, and fried noodles/rice. Average mediation (52.6 %) was indicated by family cohesion for the association between family meal frequency and individual dietary intake among diabetic patients. Sobel’s test further confirmed the trend towards complete mediation (z = 15.4; P < 0.05). Conclusions A strong relationship between family meal frequency and individual dietary intake among diabetic patients was recorded. The present study is one of the few studies that have examined family cohesion as a mediator of the relationship and to our best knowledge is the first work to demonstrate a trend towards complete mediation. Results obtained can be used by health professionals to devise strategies for increasing knowledge and awareness of both diabetic patients and their respective families to curd down this public health burden.
Collapse
Affiliation(s)
- Divya Ruhee
- Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius
| | - Fawzi Mahomoodally
- Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius
| |
Collapse
|
18
|
Yutkin V, Ahmed HU, Donaldson I, McCartan N, Siddiqui K, Emberton M, Chin JL. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Urology 2014; 84:1157-62. [PMID: 25443920 DOI: 10.1016/j.urology.2014.06.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our experience with salvage high-intensity focused ultrasound (HIFU) in patients with local failure after brachytherapy for prostate cancer. PATIENTS AND METHODS Whole-gland HIFU was administered to prospectively recruited patients with local histologic failure after brachytherapy at 2 institutions in the United Kingdom and Canada. Functional and oncologic outcomes of the procedure were analyzed. RESULTS Nineteen patients underwent the treatment, 12 with Gleason sum 7 and 5 with Gleason sum 8 at recurrence. Thirteen men had grade-3a or -3b complications by the Clavien system; there were no grade-4 or -5 complications. The most common postoperative complication was dysuria, which was self-limited. Three men developed rectourethral fistulae. The overall continence rate was 68.4%. At a mean follow-up of 51.6 months, all men were alive. The overall biochemical recurrence-free survival rate was 66.7% and 73.3% using the "nadir prostate-specific antigen level" +1.3 ng/mL and +2 mg/ml criteria, respectively. This study is limited by the small cohort size, relatively short follow-up period, and heterogeneity of the patient population. CONCLUSION In this, the largest prospective series to date, we demonstrate that salvage HIFU for locally recurrent prostate cancer after failed primary brachytherapy has encouraging disease control results, albeit with a relatively high complication rate.
Collapse
Affiliation(s)
- Vladimir Yutkin
- Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Hashim U Ahmed
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Ian Donaldson
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Neil McCartan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Khurram Siddiqui
- Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Joseph L Chin
- Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
19
|
Anens E, Emtner M, Zetterberg L, Hellström K. Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey. BMC Neurol 2014; 14:47. [PMID: 24612446 PMCID: PMC3975577 DOI: 10.1186/1471-2377-14-47] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey – Revised, Exercise Self-Efficacy Scale, Falls- Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active.
Collapse
Affiliation(s)
| | | | | | - Karin Hellström
- Department of Neuroscience, Section for Physiotherapy, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
20
|
Schulz AP, Jönsson A, Kasch R, Jettoo P, Bhandari M. Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons. BMC Musculoskelet Disord 2013; 14:96. [PMID: 23496954 PMCID: PMC3600018 DOI: 10.1186/1471-2474-14-96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 02/28/2013] [Indexed: 11/16/2022] Open
Abstract
Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. Methods We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. Results Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. Conclusions Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and implants. Manufacturers of medical devices in orthopaedics employ a considerable workforce to inform or influence hospital managers and leading doctors with marketing activities. Our results indicate that it might be far more effective to channel at least some of these funds into peer-reviewed research projects, thereby assuring significantly higher acceptance of the related products.
Collapse
|
21
|
Alazzawi S, Bardakos NV, Hadfield SG, Butt U, Beer ZH, Field RE. Patient-reported complications after elective joint replacement surgery: are they correct? ACTA ACUST UNITED AC 2012; 94:1120-5. [PMID: 22844056 DOI: 10.1302/0301-620x.94b8.29040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.
Collapse
Affiliation(s)
- S Alazzawi
- University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | | | | | | | | | | |
Collapse
|
22
|
A collaborative research system for functional outcomes following wartime extremity vascular injury. J Trauma Acute Care Surg 2012; 73:S7-12. [PMID: 22847098 DOI: 10.1097/ta.0b013e318260aa54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
23
|
Questionnaire Versus Telephone Follow-up to Detect Postdischarge Complications in Surgical Patients: Randomized Clinical Trial. World J Surg 2012; 36:2576-83. [DOI: 10.1007/s00268-012-1740-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
24
|
Cunningham ET. Surveying uveitis specialists-a call for consensus. J Ophthalmic Inflamm Infect 2012; 2:61-3. [PMID: 22454249 PMCID: PMC3345051 DOI: 10.1007/s12348-012-0061-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 12/14/2022] Open
|