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Errisuriz VL, Zambrana RE, Parra-Medina D. Critical analyses of Latina mortality: disentangling the heterogeneity of ethnic origin, place, nativity, race, and socioeconomic status. BMC Public Health 2024; 24:190. [PMID: 38229037 PMCID: PMC10790397 DOI: 10.1186/s12889-024-17721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.
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Affiliation(s)
| | - Ruth Enid Zambrana
- Harriet Tubman Department of Women, Gender and Sexuality Studies, University of Maryland, Susquehanna Hall 4200 Lehigh Rd. Room 4117, College Park, MD, 20742, USA
| | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th Street, GWB 1.102, Austin, TX, 78712, USA
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Vaos G, Dimopoulou A, Zavras N. A Review of History and Challenges of Evidence-Based Pediatric Surgery. J INVEST SURG 2021; 35:821-832. [PMID: 34569397 DOI: 10.1080/08941939.2021.1950875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Evidence-based pediatric surgery (EBPS) refers to the use of the best available evidence in making personalized decisions concerning the management of each pediatric surgical patient. This study aims to provide a comprehensive review on past and present evidence-based clinical decision, and challenges in pediatric surgery. MATERIAL AND METHODS A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding EBPS. RESULTS One hundred forty-five full-text published articles focusing on EPBS findings over the past 25 years were included. The rarity of many congenital anomalies, the inability to establish multicenter collaborations, the failure to perform double-blinded studies in children, the pediatric surgeons' reluctance to perform ethically unacceptable sham operations and their skepticism shown in accepting and implementing the documented results instead of applying their personal clinical practice methods and surgical techniques are among problems that hamper the accomplishment of randomized controlled trials (RCTs). CONCLUSIONS RCTs remain limited in clinical pediatric surgery practice due to problems in the design and publication of these trials. Moreover, skepticism exists regarding acceptance and implementation of the documented results of RCTs. Notwithstanding, pediatric surgeons must establish evidence-based centers in order to increase the number of well-designed RCTs, properly evaluate clinical research, make effective evidence-based clinical decisions and develop high-quality of pediatric surgeries care in the future.
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Affiliation(s)
- George Vaos
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Haidari, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Haidari, Athens, Greece
| | - Nick Zavras
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Haidari, Athens, Greece
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van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:876-886. [PMID: 27106926 PMCID: PMC5332499 DOI: 10.1007/s00167-016-4131-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- J. A. D. van der Woude
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - K. Wiegant
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - R. J. van Heerwaarden
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - S. Spruijt
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - P. M. van Roermund
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - R. J. H. Custers
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - S. C. Mastbergen
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. J. G. Lafeber
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Han JH, Kim HJ, Song JG, Yang JH, Bhandare NN, Fernandez AR, Park HJ, Nha KW. Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes. Knee Surg Relat Res 2015; 27:207-20. [PMID: 26675553 PMCID: PMC4678241 DOI: 10.5792/ksrr.2015.27.4.207] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose Bone grafting in opening wedge high tibial osteotomy (OWHTO) is still controversial. The purpose of this study is to compare the radiological outcomes of OWHTO with bone graft (autogenous, allogenous, and synthetic bone graft) and those without bone graft. Materials and Methods PubMed, MEDLINE, EMBASE and Cochrane Register of Studies databases were searched using specific inclusion and exclusion criteria for radiological studies involving OWHTO with bone graft and without bone graft groups. All reported delayed union, nonunion and correction loss were analyzed. Data were searched from the time period of January 2000 through July 2014. In addition, a modified Coleman methodology score (CMS) system was used to assess the methodological quality of the included studies. Results Twenty-five studies with a mean CMS value of 77 (range, 61 to 85 score) were included. In total, 1,841 patients underwent OWHTO using 4 different procedures for bone graft: autobone graft (n=352), allobone graft (n=547), synthetic bone graft (n=541) and no bone graft (n=401). There was a similar tendency for delayed union, nonunion and correction loss rate among the osteotomy space filling methods. Conclusions The meta-analysis showed there was a similar tendency for radiological union and correction maintenance among patients undergoing OWHTO regardless of the type of bone in all of the studies. However, the currently available evidence is not sufficient to strongly support the superiority of OWHTO with bone graft to OWHTO without bone graft.
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Affiliation(s)
- Jae Hwi Han
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Institute for Evidence-based Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Gwang Song
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Nikhl N Bhandare
- Department of Orthopaedic Surgery, Bhandare Hospital, Panaji, India
| | | | - Hyung Jun Park
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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Basso L, Izzo L, Giuliani A. It's got four wheels but is it a 'Ferrari' or a 'Fiat Bambino'? A critical reappraisal of evidence-based medicine. Colorectal Dis 2015; 17:186-7. [PMID: 25678330 DOI: 10.1111/codi.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Anagnostakos K, Mosser P. Negative pressure wound therapy in the management of postoperative infections after musculoskeletal tumour surgery. J Wound Care 2014; 23:191-4, 196-7. [PMID: 24762382 DOI: 10.12968/jowc.2014.23.4.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present retrospective study was to report on the effectiveness of the negative pressure wound therapy (NPWT) in the treatment of infected wounds after musculoskeletal tumour surgery. METHOD A total of 12 patients (10 male, 2 female, mean age 44.9 years with 9 early and 3 late infections) were included in the study. Patient parameters measured include age, gender, tumour diagnosis and localisation, pathogen organism, foam used, pressure height and modus, number of NPWT dressings changes, total duration of NPWT, need for secondary wound closure, length of hospitalisation, complications, and follow-up. RESULTS The NPWT dressings were changed on average 6.7 (SD±6.9) times after a mean duration of 5.6 (SD±2.4) days. The total duration of NPWT was 37.7 (SD±32.9) days. The mean hospital stay was 77.5 (SD±58.8) days. In 7 out of 12 cases, a split-thickness skin graft transplantation was performed. In these cases, no seroma or hematoma formation beneath the skin graft could be observed. At a mean follow-up 39.2 (range: 9-73) months, no reinfection or infection persistence was apparent. CONCLUSION NPWT can be of valuable assistance in the treatment of infected wounds following musculoskeletal tumour surgery. The patients should be informed about the long treatment period.
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Affiliation(s)
- K Anagnostakos
- Department of Orthopaedic Surgery, University Hospital of Saarland, Homburg/Saarland, Germany
| | - P Mosser
- Medical Resident, Department of Orthopaedic Surgery, University Hospital of Saarland, Homburg/Saarland, Germany
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A population-based, shared decision-making approach to recruit for a randomized trial of bariatric surgery versus lifestyle for type 2 diabetes. Surg Obes Relat Dis 2013; 9:837-44. [PMID: 23911345 DOI: 10.1016/j.soard.2013.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Randomized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients, which may limit the interpretation and generalizability of study findings. The objective of this study was to assess the feasibility of a population-based shared decision-making (SDM) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes. METHODS Adult members with a body mass index (BMI) between 30 and 45 kg/m(2) taking diabetes medications were identified in electronic databases and underwent a multiphase screening process. Candidates were given a telephone survey, education about treatment options for obesity and diabetes using decision aids, and an SDM phone call with a nurse practitioner, in addition to standard office-based consent. RESULTS We identified 1808 members, and 828 (45.7%) had a BMI of 30-34.9 kg/m(2). Among these, 1063 (59%) agreed to the telephone survey, 416 (23%) expressed interest in education about treatment options, and 277 (15%) completed the SDM process. The preferred treatment options were surgery (21 [8%]), diet and exercise (149 [53.8%]), pharmacotherapy (5 [2%]), none of the above (8 [3%]), and unsure (94 [34%]). Ultimately, 43 participants were randomly assigned to the trial. Significant differences, mainly related to sex, disease severity, and hypoglycemic medication use, were observed among people who did and did not agree to participate in our trial. CONCLUSION This population-based, SDM-based recruitment strategy successfully identified, enrolled, and randomly assigned patients who had balanced views of surgery and lifestyle management. Even with this approach, selection biases may remain, highlighting the need for careful characterization of nonparticipants in all future studies.
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Anagnostakos K, Mosser P, Kohn D. Infections after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21:161-9. [PMID: 22729805 DOI: 10.1007/s00167-012-2084-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/29/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE High tibial osteotomy is an established method in the treatment for knee osteoarthritis. Infections are a rare but severe complication that might endanger the clinical, radiological and functional outcome and might require several surgical revisions. METHODS A systematic literature review was performed through PubMed until November 2011. Search terms were "HTO" or "(high) tibial osteotomy", alone or in combination with "infection(s)", "infected" or "septic". Only articles focussing on the infection treatment or analysis of risk factors for emergence of infection after high tibial osteotomy were included. RESULTS A total of 26 studies could be identified. Seven studies were published before and 19 in or after 2000. One study had a level of evidence II, five level of evidence III and 20 level of evidence IV. Superficial infections were found in 1-9% and deep infections in 0.5-4.7% of the cases. Pin tract infections occurred in 2-71% of the cases. One study reported on a secondary bacterial arthritis in 4.5% of the cases. An oblique skin incision, non-smokers and a one-day hospitalization were found to be risk factors for infection emergence. Depending on the type of infection, treatment consisted of oral or systemic antibiotic therapy, alone or in combination with surgical revision, debridement and hardware removal. In some cases, antibiotic-loaded cement beads were inserted for local antibiotic therapy. CONCLUSION Infections after high tibial osteotomy are rare. Current data about infection rates, infection localization, risk factors for emergence of infection and treatment options allow not for a generalization of conclusions. A large multi-centre study is required to develop a diagnostic and therapeutic algorithm. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Konstantinos Anagnostakos
- Klinik für Orthopädie Und Orthopädische Chirurgie, Universitätsklinikum Des Saarlandes, 66421, Homburg, Saar, Germany.
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Marceau P, Biron S. Comments regarding a recent article comparing gastric bypass and duodenal switch and its questionable method and results. Surg Obes Relat Dis 2012; 8:239-40. [PMID: 22222300 DOI: 10.1016/j.soard.2011.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 11/23/2011] [Accepted: 11/25/2011] [Indexed: 11/24/2022]
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Kral JG, Kava RA, Catalano PM, Moore BJ. Severe obesity: the neglected epidemic. Obes Facts 2012; 5:254-69. [PMID: 22647306 DOI: 10.1159/000338566] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/12/2012] [Indexed: 12/18/2022] Open
Abstract
Severe obesity (SO) is increasing faster than obesity in adults and in children. Because it is associated with numerous comorbidities, SO accounts for more health care expenditures than any other medical condition. Furthermore, it is associated with poor pregnancy outcomes for mother, fetus, and infant and a high risk of offspring obesity carried into adulthood. Bariatric surgery is the treatment of choice for SO because nonoperative methods fail to provide medically significant durable weight loss and because it is both preventive and therapeutic. The number of operations has sharply increased globally, yet only a small fraction of eligible patients are referred for surgical treatment demonstrating the need for improved access, especially for those disproportionately affected by SO. The risks of surgery mandate careful postoperative long-term multidisciplinary follow-up care. Education is critical for truly informed consent and must continue postoperatively, especially for women with reproductive potential. Even so, surgical treatment of SO remains cost-effective compared to conventional nonoperative treatment, which also requires long-term care. Just as obesity affects all medical disciplines (from allergology and immunology to oncology, urology and women's health), so does postoperative management of bariatric surgery patients. We offer wide-ranging recommendations for policymakers and others to consider in addressing SO.
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Affiliation(s)
- John G Kral
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Friedlander AH. Re: Evidence-based oral and maxillofacial surgery: some pitfalls and limitations. J Oral Maxillofac Surg 2011; 69:1852; author reply 1852-4. [PMID: 21684443 DOI: 10.1016/j.joms.2011.02.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/02/2011] [Indexed: 11/29/2022]
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Pitak-Arnnop P, Hemprich A, Pausch NC. Evidence-Based Oral and Maxillofacial Surgery: Some Pitfalls and Limitations. J Oral Maxillofac Surg 2011; 69:252-7. [DOI: 10.1016/j.joms.2010.07.082] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/24/2010] [Accepted: 07/30/2010] [Indexed: 11/17/2022]
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Adams TD, Pendleton RC, Strong MB, Kolotkin RL, Walker JM, Litwin SE, Berjaoui WK, LaMonte MJ, Cloward TV, Avelar E, Owan TE, Nuttall RT, Gress RE, Crosby RD, Hopkins PN, Brinton EA, Rosamond WD, Wiebke GA, Yanowitz FG, Farney RJ, Halverson RC, Simper SC, Smith SC, Hunt SC. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese. Obesity (Silver Spring) 2010; 18:121-30. [PMID: 19498344 PMCID: PMC2864142 DOI: 10.1038/oby.2009.178] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI >or= 35 kg/m(2)) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years.
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Affiliation(s)
- Ted D Adams
- Department of Internal Medicine, Cardiovascular Genetics Division, University of Utah, Salt Lake City, Utah, USA.
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van Raaij TM, Reijman M, Furlan AD, Verhaar JAN. Total knee arthroplasty after high tibial osteotomy. A systematic review. BMC Musculoskelet Disord 2009; 10:88. [PMID: 19619275 PMCID: PMC2720911 DOI: 10.1186/1471-2474-10-88] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 07/20/2009] [Indexed: 11/10/2022] Open
Abstract
Background Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion Our analysis suggests that osteotomy does not compromise subsequent knee replacement. However, the low quality of evidence precludes solid clinical conclusions.
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Affiliation(s)
- Tom M van Raaij
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Affiliation(s)
- John G. Kral
- *Prof. Dr. John G. Kral Department of Surgery SUNY Downstate Medical Center 450 Clarkson Avenue, Box 40 Brooklyn NY 11203-2098, USA
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Clinical research: protection of the "vulnerable"? J Allergy Clin Immunol 2008; 121:1103-7. [PMID: 18313131 DOI: 10.1016/j.jaci.2008.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 11/20/2022]
Abstract
In this age of evidence-based medicine, clinical research is critical for developing new therapeutics and determining the best way to use these therapies. To perform appropriate clinical research, researchers must adhere to ethical standards. These standards have developed in large part as a response to egregious violations of ethically appropriate behavior. In this respect certain populations have been identified as at risk of being treated inappropriately in medical research. Current ethical guidelines prohibit or severely limit what types of research can be performed involving these "vulnerable" populations. Although this might protect these populations, the lack of research on them might actually do harm in limiting their access to life-saving therapies. We explore the historical underpinnings of protecting the vulnerable populations and whether a newer ethical paradigm that would allow for protected research on these populations should be adopted by society.
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Kitto SC, Borradale D, Jeffrey CA, Smith JA, Villanueva EV. Bariatric surgery in Australia: who, why and how? ANZ J Surg 2007; 77:727-32. [PMID: 17685946 DOI: 10.1111/j.1445-2197.2007.04211.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A review of published reports was conducted to identify gaps in the research regarding bariatric surgery. Much of the research that has been conducted is clinical outcome based; however, little research has been conducted in many key areas. Data on the demographics of the bariatric surgery group are patchy at best. The role of best practice and evidence-based medicine in bariatric surgery seems to be poorly understood, and equity issues and the role of clinical pathways in bariatric surgery need to be clarified. Significant gaps were identified in the published reports regarding pathways to bariatric surgery and multidisciplinary team use. Additionally, much of the published report and research data were from US studies, as few Australian studies have been conducted. Further research and policy and practice developments in bariatric surgery are needed, especially with regard to the Australian context.
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Affiliation(s)
- Simon C Kitto
- Department of Rural and Indigenous Health, School of Rural Health, Monash Univrsity, Melbourne, Victoria, Australia.
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van Raaij TM, Bakker W, Reijman M, Verhaar JAN. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 2007; 8:74. [PMID: 17683549 PMCID: PMC1955448 DOI: 10.1186/1471-2474-8-74] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Accepted: 08/03/2007] [Indexed: 11/16/2022] Open
Abstract
Background We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA). Methods From 1996 until 2003 356 patients underwent all cemented primary total knee replacement in our institution. Twelve patients with a history of 14 HTO were identified and matched to a control group of 12 patients with 14 primary TKA without previous HTO. The match was made for gender, age, date of surgery, body mass index, aetiology and type of prosthesis. Clinical and radiographic outcome were evaluated after a median duration of follow-up of 3.7 years (minimum, 2.3 years). The SPSS program was used for statistical analyses. Results The index group had more perioperative blood loss and exposure difficulties with one tibial tuberosity osteotomy and three patients with lateral retinacular releases. No such procedures were needed in the control group. Mid-term HSS, KSS and WOMAC scores were less favourable for the index group, but these differences were not significant. The tibial slope of patients with prior HTO was significantly decreased after this procedure. The tibial posterior inclination angle was corrected during knee replacement but posterior inclination was significantly less compared to the control group. No deep infection or knee component loosening were seen in the group with prior HTO. Conclusion We conclude that TKA after HTO seems to be technically more demanding than a primary knee arthroplasty, but clinical outcome was almost identical to a matched group that had no HTO previously.
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Affiliation(s)
- Tom M van Raaij
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Wouter Bakker
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan AN Verhaar
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Orsolini-Hain L, Malone RE. Examining the impending gap in clinical nursing expertise. Policy Polit Nurs Pract 2007; 8:158-169. [PMID: 18178922 DOI: 10.1177/1527154407309050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Much has been written about current and future nursing shortages and the numerical gap between nurses available and projected nursing needs. Very little analysis has focused on the implications of the pending expertise gap within the nursing workforce. A graying and retiring registered nurse workforce will greatly increase the proportion of novice nurses with minimal experience in bedside practice. The expertise gap will also affect nursing education. This article explores the implications of these phenomena. Without careful planning, efforts to address the numerical shortage may inadvertently worsen the expertise gap, contributing to unsafe care and affecting nursing retention.
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Affiliation(s)
- Liana Orsolini-Hain
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA
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Abstract
Cochrane systematic reviews are conducted to identify level 1a evidence. So far the ENT group have published 24 reviews, while around 70 titles are in various stages of the review process. Only one review has been able to produce Ia evidence and the rest recommended further trials. The majority of otorhinolaryngology reviews are unable to identify level 1a evidence due to the paucity of high quality randomised control trials. This presents a challenge, therefore - to identify and discuss alternate methods of evidence gathering for future research?
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21
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Kral JG. Patient selection for treatment of obesity. Surg Obes Relat Dis 2006; 1:126-32. [PMID: 16925228 DOI: 10.1016/j.soard.2005.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 02/09/2005] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Affiliation(s)
- John G Kral
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
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22
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Ternovits CA, Tichansky DS, Madan AK. Band versus bypass: randomization and patients' choices and perceptions. Surg Obes Relat Dis 2006; 2:6-10. [PMID: 16925305 DOI: 10.1016/j.soard.2005.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2005] [Revised: 09/21/2005] [Accepted: 10/04/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are becoming increasingly popular; however, little is understood about patients' motivational factors and reasons for choosing a particular procedure. This investigation explored patient choices and perceptions concerning LRYGB and LAGB. METHODS A survey was given to 120 consecutive patients who had undergone LRYGB or LAGB 3-24 months earlier. The survey was designed to ascertain why patients chose banding or bypass, and how they rated their surgical outcome. RESULTS A total of 101 patients responded (84%): 22 had undergone LAGB, 79 LRYGB. The top reason for choosing LRYGB was greater expectation of weight loss, whereas LAGB was chosen for its lower risk. Overall, 21% (18/84) of the patients were willing to be involved in a prospective randomized study of bariatric procedure choice. Six of 19 (32%) patients who underwent LAGB, but only 12 of the 65 (18%) who underwent LRYGB stated that they would be willing to accept randomization between the operations. CONCLUSIONS Patients expressed varied reasons for choosing their procedure, most related to weight loss or safety profiles. Patients undergoing LAGB would have predicted similar results with either procedure, whereas those undergoing LRYGB showed a trend toward greater overall satisfaction with their operations (p = 0.06) and would have predicted an inferior outcome with the other procedure. Although the overall percentage of patients willing to be randomized is not high, a busy bariatric practice could recruit sufficient numbers of willing patients to undergo a prospective randomized trial of LRYGB and LAGB.
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Affiliation(s)
- Craig A Ternovits
- Department of Surgery, University of Tennessee Health Science Center, Memphis, 38163, USA
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23
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Kral JG. “Tastes worse”—“More filling”: Surgical controversy, but who decides? Surg Obes Relat Dis 2006; 2:4-5. [PMID: 16925304 DOI: 10.1016/j.soard.2005.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 10/14/2005] [Indexed: 10/25/2022]
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Sauerland S, Neugebauer E. Re: flaws in methods of evidence-based medicine may adversely affect public health directives. Surgery 2005; 138:406-7; discussion 409-11. [PMID: 16213888 DOI: 10.1016/j.surg.2005.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 03/12/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Stefan Sauerland
- University of Cologne, Biochemical & Experimental Divsion, Medical Faculty, Ostmerheimer Str 200, Cologne D 51109, Germany.
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25
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Harken AH. Hyperbolic hypotheses. Surgery 2005; 138:404. [PMID: 16213886 DOI: 10.1016/j.surg.2005.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Accepted: 05/16/2005] [Indexed: 11/25/2022]
Affiliation(s)
- Alden H Harken
- University of California San Francisco, East Bay, Department of Surgery, 1411 East 31st St, Oakland, CA 94602, USA.
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26
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Twomey P. Re: flaws in methods of evidence-based medicine may adversely affect public health directives. Surgery 2005; 138:407. [PMID: 16213889 DOI: 10.1016/j.surg.2005.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Patrick Twomey
- Department of Surgery, University of California San Francisco, East Bay, USA.
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27
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Moss RL. The surgeon's use of evidence to care for our patients. Surgery 2005; 138:405-6; discussion 407-14. [PMID: 16213887 DOI: 10.1016/j.surg.2005.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 03/26/2005] [Indexed: 11/22/2022]
Affiliation(s)
- R Lawrence Moss
- Section of Pediatric Surgery, Yale University School of Medicine, 333 Cedar St, FMB 132, PO Box 208062, New Haven, CT 06520-8062, USA.
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28
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Moss RL. Of dodos and Goliath and alternative approaches to a common goal. Surgery 2005. [DOI: 10.1016/j.surg.2005.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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29
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Warshaw AL, Sarr MG. Hypothesis—Fact or Fiction? Surgery 2005. [DOI: 10.1016/j.surg.2005.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Henke PK. Improving quality of care in vascular surgery: the tools are available now. Am J Surg 2005; 190:333-7. [PMID: 16023455 DOI: 10.1016/j.amjsurg.2005.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 11/26/2022]
Abstract
This overview delineates the current evidence and suggested practice protocols for three areas of vascular disease evaluation and treatment that have shown particular patient benefit. Presented as brief topical reviews are (1) preoperative cardiac evaluation and risk factor modification, (2) use of autologous tissue and graft surveillance for infrainguinal bypass, and (3) deep vein thrombosis risk stratification and prophylaxis. It is this author's hope is that this overview will emphasize currently effective and underused therapies and stimulate further research into best practices for improving the quality of care for vascular surgery patients.
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Affiliation(s)
- Peter K Henke
- University of Michigan Health System, 1500 E. Medical Center Dr., 2210 Taubman Health Care Center, Ann Arbor, MI 48109-0329, USA.
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Abstract
Bariatric surgery is currently considered the best treatment option for morbid obesity. With the rapid development of laparoscopic techniques, a significant increase in the number bariatric procedures in recent years can be observed. Various surgical techniques to treat morbid obesity have been described, but only few prospective studies compare the different procedures, leading to a lack of evidence for their use. However, from the available literature some general recommendations can be given: (a) preoperative workup in an interdisciplinary team is mandatory, (b) primary bariatric procedures should be performed laparoscopically, and (c) the combination of restrictive and malabsorptive techniques is more efficient than a purely restrictive method, which is also true for the treatment of comorbid diabetes and arterial hypertension. In this paper, we present recent developments in bariatric surgery, with special emphasis on the available evidence for the best treatment of morbidly obese patients.
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Affiliation(s)
- M K Müller
- Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Schweiz
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