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Ayoola M, Abelleyra Lastoria DA, Casey L, Dardak S, Rupra R, Hing CB, Radcliffe S, Kellett C. Noise in operating theatres, is it safe? Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05489-x. [PMID: 39105841 DOI: 10.1007/s00402-024-05489-x] [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: 06/17/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Noise-Induced Hearing Loss (NIHL) is a condition caused by repeated exposure to loud noise, with operating theatre personnel potentially at risk. The aims of this study were to establish the typical noise levels in orthopaedic theatres and to compare these to The Control of Noise at Work Regulations 2005. MATERIALS AND METHODS We measured the average noise levels in 40 trauma and orthopaedic surgeries in a single centre. We used the Decibel X app to take measurements, then performed corrections to ascertain noise levels at the surgeon's ear (Leq). The daily noise exposure level for theatre staff for each procedure (LEP, d) and the LEP, d over an average 8-hour working day when performing different groups of procedures were calculated. Data were analysed using descriptive statistics, ANOVA, t-test and the Pearson coefficient of correlation. RESULTS The LEP, d lower action value (80 dBA) as set by the Health and Safety Executive (HSE) was met by performing a single revision total knee replacement or a right open ankle debridement. Assuming three procedures are conducted per list, lists consisting of joint replacements (82 dBA) or medium elective procedures (81 dBA) exceed this lower limit. Additionally, lists comprising large and medium bone fractures would be within 1 dB of the limit (79 dBA and 79 dBA, respectively). Soft tissue (74 dBA), arthroscopic (73 dBA), and small bone fracture (71 dBA) procedures had the lowest LEP, d. The greatest contributors to noise levels were surgical instruments. The number of people in the room made a significant difference to noise levels (p = 0.032). CONCLUSIONS We have established the baseline noise levels in various orthopaedic procedures. Measures should be taken to meet UK regulations. Further research should determine suitable measures for protection from hearing damage for theatre staff and evaluate the risks high noise levels pose to patients.
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Affiliation(s)
- Maliha Ayoola
- St George's University of London, London, SW17 0RE, UK
| | | | - Laura Casey
- St George's Hospital NHS Foundation Trust, London, UK
| | - Sara Dardak
- St George's Hospital NHS Foundation Trust, London, UK
| | - Roshan Rupra
- St George's Hospital NHS Foundation Trust, London, UK
| | | | - Sarah Radcliffe
- Curload Consultants Limited, Consultants in Acoustics, Somerset, UK
| | - Catherine Kellett
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Raftery D, Emmanuel S, Ramsay G. A Quantitative Analysis of Intraoperative Distractions and When They Occur During General Surgical Operations. Cureus 2024; 16:e60700. [PMID: 38899270 PMCID: PMC11186621 DOI: 10.7759/cureus.60700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Distractions in operating theatres prevent team members from concentrating on the complex tasks required for a successful operation. This can be a potential hazard to care for, and previously, correlations have been made between increased theatre distractions and adverse events. However, it remains unclear how frequently such events occur during routine care in theatres. The present study aims to quantify distractions and analyse any differences between staff groups, operative stages, and modes of operation. Methods A single-centre prospective study was conducted to assess disruptions in general surgical theatres. Events were recorded using a previously described categorization system on a proforma by a single researcher. The source and severity of distraction were recorded, as well as the mode of operation (elective/emergency), stage of operation, and staff team (scrubbed/floor). Results A total of 4,219 minutes of surgery were observed over four weeks, and 1,095 distraction events were recorded. Of the 14 elective and nine emergency procedures recorded, there was a mean of 54.8 distractions per procedure and a frequency of one distraction every three minutes and 51 seconds (15.6 hr-1). Irrelevant communication relating to the patient's case was the most common source, accounting for 24.7% of all distractions. The most frequently disrupted stage of the procedure for scrubbed staff was during anastomosis/resection for both elective and emergency procedures, with 16.9 and 32.6 distractions occurring per hour, respectively. Scrubbed staff were significantly more susceptible to distraction in emergency procedures than the floor staff. Discussion Our study reflects previous assessments with irrelevant communications and emergency procedures yielding the highest prevalence of distraction. This investigation provides novel information about the different stages of general surgery and the frequency of distractions that occur.
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Affiliation(s)
- David Raftery
- General Surgery, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, GBR
| | - Shanen Emmanuel
- General Surgery, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, GBR
| | - George Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, GBR
- Colorectal Surgery, National Health Service (NHS) Grampian, Aberdeen, GBR
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Alkahtany SM, Alabdulkareem SE, Alharbi WH, Alrebdi NF, Askar TS, Bukhary SM, Almohaimede AA, Al-Manei KK. Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study. BMC MEDICAL EDUCATION 2024; 24:371. [PMID: 38575914 PMCID: PMC10996191 DOI: 10.1186/s12909-024-05347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University. METHODS Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa. RESULTS SURVEY All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001). OBSERVATION The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors. CONCLUSIONS Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.
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Affiliation(s)
- Sarah M Alkahtany
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia.
| | - Shaima E Alabdulkareem
- General Dentist, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Wajd H Alharbi
- General Dentist, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Norah F Alrebdi
- General Dentist, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Tomather Sultan Askar
- General Dentist, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Sundus M Bukhary
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Amal A Almohaimede
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
| | - Kholod Khalil Al-Manei
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, 11527, Riyadh, PO Box 68004, Saudi Arabia
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De Meurechy NKG, Decoste C, Mommaerts MY. On the use of intraoperative 3D-RX C-arm imaging in orthognathic surgery: a prospective non-consecutive case series study. Oral Maxillofac Surg 2024; 28:101-109. [PMID: 36279049 DOI: 10.1007/s10006-022-01119-1] [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: 06/09/2021] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Segment and osteosynthesis malposition resulting in patients' complaints (mainly about asymmetries) are encountered in orthofacial/orthognathic surgery. OBJECTIVE, DESIGN, AND SETTING We planned to investigate the usefulness of intraoperative three-dimensional (3D) imaging concerning positioning and fixation of bone segments and osteosynthesis in orthognathic/orthofacial surgery. We performed a prospective study of non-consecutive cases. All patients receiving a bimaxillary osteotomy, genioplasty, and their combinations were included in the study from May 2016 to May 2020. Unilateral and bilateral sagittal split osteotomies were excluded. There were no gender and age limitations. All were intraoperatively examined using the BV Pulsera 3D-RX System (Philips Medical, Eindhoven, The Netherlands). The outcome variables were the percentage of revisions of segment positioning and osteosynthesis. Predictor variables were age, gender, type of surgery, timing (pre- and post-imaging), and surgeon experience (senior vs assistant). RESULTS Forty female and twenty-two male patients were included (mean age 25.25 years ± 7.52 and 29.1 years ± 12.6 respectively). We evaluated 27 genioplasties and 34 Le Fort "type-I" osteotomies. Indications for segment repositioning and redo-osteosynthesis increased after intraoperative imaging as compared to operator's clinical judgment before intraoperative imaging (95% confidence interval; p < .001 and p = .002 respectively). CONCLUSION Suboptimal positioning and fixation of bone segments or osteosynthesis were more apparent with 3D imaging. In addition, some satisfactory cases were also revised for an optimal outcome. As a result, surgeons were prompted to more revisions than judged necessary without intraoperative imaging.
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Affiliation(s)
- Nikolas K G De Meurechy
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Christopher Decoste
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Maurice Y Mommaerts
- European Face Centre, University Hospital Brussels, Laarbeeklaan 101, B-1090, Brussels, Belgium.
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Posthuma LM, Breteler MJM, Lirk PB, Nieveen van Dijkum EJ, Visscher MJ, Breel JS, Wensing CAGL, Schenk J, Vlaskamp LB, van Rossum MC, Ruurda JP, Dijkgraaf MGW, Hollmann MW, Kalkman CJ, Preckel B. Surveillance of high-risk early postsurgical patients for real-time detection of complications using wireless monitoring (SHEPHERD study): results of a randomized multicenter stepped wedge cluster trial. Front Med (Lausanne) 2024; 10:1295499. [PMID: 38249988 PMCID: PMC10796990 DOI: 10.3389/fmed.2023.1295499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome. Methods In this prospective, multicenter, stepped-wedge cluster randomized study, patients in the control group received standard monitoring. The intervention group received continuous wireless monitoring of heart rate, respiratory rate and temperature on top of standard care. Automated alerts indicating vital signs deviation from baseline were sent to ward nurses, triggering the calculation of a full early warning score followed. The primary outcome was the occurrence of new disability three months after surgery. Results The study was terminated early (at 57% inclusion) due to COVID-19 restrictions. Therefore, only descriptive statistics are presented. A total of 747 patients were enrolled in this study and eligible for statistical analyses, 517 patients in the control group and 230 patients in the intervention group, the latter only from one hospital. New disability at three months after surgery occurred in 43.7% in the control group and in 39.1% in the intervention group (absolute difference 4.6%). Conclusion This is the largest randomized controlled trial investigating continuous wireless monitoring in postoperative patients. While patients in the intervention group seemed to experience less (new) disability than patients in the control group, results remain inconclusive with regard to postoperative patient outcome due to premature study termination. Clinical trial registration ClinicalTrials.gov, ID: NCT02957825.
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Affiliation(s)
- Linda M. Posthuma
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | | | - Philipp B. Lirk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiologie, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Els J. Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Center, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Maarten J. Visscher
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jennifer S. Breel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Carin A. G. L. Wensing
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jimmy Schenk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Lyan B. Vlaskamp
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | | | - Jelle P. Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G. W. Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Cor J. Kalkman
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | - Benedikt Preckel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Amsterdam Cardiovascular Science, Diabetes and Metabolism, Amsterdam, Netherlands
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6
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Levesque MJ, Etherington C, Lalonde M, Moradi N, Sikora L, Stacey D. Interventions to facilitate interprofessional collaboration in the operating theatre: A scoping review. J Perioper Pract 2024; 34:6-19. [PMID: 36468241 PMCID: PMC10771025 DOI: 10.1177/17504589221137978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ineffective collaboration can increase adverse events in the operating theatre. When professionals work collaboratively, they are more likely to improve patient safety and outcomes. AIM To identify interprofessional collaboration interventions involving operating theatre teams and describe their effect on facilitating communication, teamwork, and safety. METHODS A scoping review of four databases. Results were analysed by identifying interventions and mapping their related outcomes. RESULTS Twenty studies evaluated single or multi-faceted interventions. Despite low-quality study designs (no randomised controlled trials), four interventions (eg: briefings, checklists, team training, debriefing) improved communication and teamwork, and enhanced safety outcomes. Only one study, using team training, reported that organisational level interventions (eg: Standard Operating Procedures, Lean quality improvement management system) improved teamwork and safety outcomes. CONCLUSION Several studies reported interventions enhanced interprofessional collaboration within operating theatre teams. Although findings were in favour of improved communication and teamwork, more rigorous research is required.
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Affiliation(s)
| | | | - Michelle Lalonde
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Narges Moradi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Hansen D, Itotoh F, Helena K, Aitken RJ. Observations from Australia's National Surgical Mortality Audit. World J Surg 2023; 47:3140-3148. [PMID: 37882828 DOI: 10.1007/s00268-023-07205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Australia is the only country with a national surgical mortality audit. Every Australian surgical mortality is independently and externally reviewed by another surgeon. Extensive educational feedback to surgeons and hospitals is provided through individual patient reviews, state and national symposia and reports, and the distribution of deidentified informative cases. This study reports a longitudinal analysis of the Australian surgical morality audit. METHODS The standardised mortality ratio (SMR) was calculated for each state and territory, nine surgical specialties and nationally. The index year used was 2016, or every 5 years for those states with earlier data. Overall data were analysed in three groups-all deaths, postoperative deaths and non-operative deaths. Overall specialty data were analysed nationally. RESULTS There was a consistent progressive fall, usually in excess of 20%, in the SMR in each state and territory and by specialty when compared to the index year. This was statistically significant nationally (p = 0.044). The same change was observed in earlier years in states with longer-term data. CONCLUSION The period of this observational study has been associated with a nationwide fall in surgical mortality. As other improvements in care will have occurred during this period, the contribution that Australia's national mortality audit made towards the lower surgical mortality cannot be stated with certainty.
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Affiliation(s)
- Dylan Hansen
- Royal Australasian College of Surgeons (RACS), Melbourne, Australia
| | - Franca Itotoh
- Royal Australasian College of Surgeons (RACS), Melbourne, Australia
| | - Kopunic Helena
- Royal Australasian College of Surgeons (RACS), Melbourne, Australia
| | - R James Aitken
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
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Barksdale S, Stark Taylor S, Criss S, Kemper K, Friedman DB, Thompson W, Donelle L, MacGilvray P, Natafgi N. Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial. JMIR Form Res 2023; 7:e51541. [PMID: 37971799 PMCID: PMC10690523 DOI: 10.2196/51541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/29/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. OBJECTIVE We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. METHODS We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. RESULTS Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. CONCLUSIONS This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
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Affiliation(s)
- Shanikque Barksdale
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shannon Stark Taylor
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine Residency Greenville, Prisma Health, Greenville, SC, United States
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Karen Kemper
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Wanda Thompson
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| | - Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Phyllis MacGilvray
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine, Prisma Health, Greenville, SC, United States
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
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Delma S, Ozdag Y, Manzar S, El Koussaify J, Foster BK, Akoon A, Dwyer CL, Klena JC, Grandizio LC. The Effect of an Intraoperative Real-Time Counter on Radiation Exposure Events During Operative Treatment of Distal Radius Fractures. J Hand Surg Am 2023; 48:1105-1113. [PMID: 37676191 DOI: 10.1016/j.jhsa.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs). METHODS We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023. All cases performed on or after January 1, 2022 used an intraoperative radiograph counter, referred to as a "shot-clock" (SC) group. Cases prior to this date were performed without a SC and served as a control group (NoSC group). Baseline demographics, fracture, and surgical characteristics were recorded. Final intraoperative radiographs were reviewed to record reduction parameters (radial inclination, volar tilt, and ulnar variance). REEs, fluoroscopy exposure times, and total radiation doses milligray (mGy) were compared between groups. RESULTS A total of 160 ORIF DRF cases were included in the NoSC group, and 135 were included in the SC group. The NoSC group had significantly more extra-articular fractures compared with the SC group. Reduction parameters after ORIF were similar between groups. The mean number of REEs decreased by 48% in the SC group. Cases performed with the SC group had significantly lower total radiation doses (0.8 vs 0.5 mGy) and radiation exposure times (41.9 vs 24.2 seconds). Mean operative times also decreased for the SC group (70 minutes) compared with that for the NoSC group (81 minutes). CONCLUSIONS A real-time intraoperative radiograph counter was associated with decreased REEs, exposure times, and total radiation doses during ORIF DRFs. Cases performed with a SC had significantly shorter operative times without compromising reduction quality. Using an intraoperative SC counter during cases requiring fluoroscopy may aid in decreasing radiation exposure, which serves as an occupational hazard for hand and upper-extremity surgeons. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Stephanie Delma
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Yagiz Ozdag
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Shahid Manzar
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Jad El Koussaify
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Brian K Foster
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Anil Akoon
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - C Liam Dwyer
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
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Alstrup L, Stryhn K, Riber C, Hadad R, Hvistendahl J, Tollund C, Haugaard SB, Funch-Jensen P. Perioperative optimization and profitability (POP) in a high-volume bariatric surgery center. Surg Endosc 2023; 37:7634-7641. [PMID: 37488441 DOI: 10.1007/s00464-023-10292-7] [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: 05/05/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Currently, bariatric surgery is the most effective long-term treatment of obesity. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the primary types of bariatric surgery performed worldwide. To minimize the risks of surgical complications and optimize cost-effectiveness, it is essential to develop fast-track protocols and patient logistics. At Aleris Hospitals in Denmark, a fast-track methodology in bariatric surgery has been implemented and continuously optimized over the last 15 years. The main objective was to demonstrate timelines recorded during one consecutive year in a fast-track, high-volume bariatric surgery setting after logistic optimization. METHODS This study included 949 consecutive patients who had undergone primary bariatric surgery in 2021. The primary outcomes were length of hospital stay and perioperative timeline recordings that were prospectively collected. The secondary outcomes were mortality, complication rates, and weight loss data. RESULTS The vast majority of our patients (99.1%) were discharged from the hospital within the day after surgery. The median total surgery time was 30 min, after 12 min of patient preparation and with a turnover time between patients of seven min. The median knife-to-knife time in one operating room was 56 min. Mortality was zero, 30-day reoperation rate was 1.2%, and 30-day readmission rate was 0.8%. SG and RYGB patients had an excess weight loss after four months of 45.6% and 57.9%, respectively. CONCLUSION Implementation of fast-track principles in the clinical practice of bariatric surgery allows for an optimized, cost-effective surgical organization supporting the quality of procedures and patient safety.
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Affiliation(s)
- Lærke Alstrup
- Department of Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Søborg, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Stryhn
- Department of Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Søborg, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Riber
- Department of Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Søborg, Denmark
| | - Rakin Hadad
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Hvistendahl
- Department of Anesthesiology, Aleris Hospitals, Søborg, Denmark
| | - Carsten Tollund
- Department of Anesthesiology, Aleris Hospitals, Søborg, Denmark
| | - Steen B Haugaard
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Aleris Hospitals, Søborg, Denmark
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Funch-Jensen
- Department of Surgery, Aleris Hospitals, Gyngemose Parkvej 66, 2860, Søborg, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aquilo Consulting, Copenhagen, Denmark.
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Seo CH, Howe KL, McAllister KB, McDaniel BL, Sharp HD, Lucktong TA, Bower KL, Collier BR, Gillen JR. Standardizing Opioids Prescribed at Discharge in Trauma Surgery. J Surg Res 2023; 290:52-60. [PMID: 37196608 DOI: 10.1016/j.jss.2023.03.049] [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: 10/24/2022] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Excessive opioid use after sustaining trauma has contributed to the opioid epidemic. Standardizing the quantity of opioids prescribed at discharge can improve prescribing behavior. We hypothesized that adopting new electronic medical record order sets would be associated with decreased morphine milligram equivalents (MME) prescribed at discharge for trauma patients. METHODS This was a quasi-experimental study examining opioid prescribing practices at a Level 1 Trauma Center. All patients ages 18-89 admitted to the Trauma Service from January 2017 through March 2021 and hospitalized for at least 2 d were included. In November 2020, new trauma admission and discharge order sets were implemented with recommended discharge opioid quantity based on inpatient opioid usage the day prior to discharge multiplied by five. Postintervention prescribing practices were compared to historical controls. The primary outcome was MME at discharge. RESULTS Baseline characteristics between preintervention and postintervention cohorts were comparable. There was a significant reduction in median MME prescribed at discharge postintervention (112.5 versus 75.0, P < 0.0001). Median inpatient MME usage also significantly reduced postintervention (184.1 versus 160.5; P < 0.0001). There were trends toward increased ideal prescribing per order set recommendation and a reduction in overprescribing. Patients receiving the recommended opioid quantity at discharge had the lowest opioid refill prescription rate (under: 29.6%, ideal: 7.3%, over: 19.7%, P < 0.0001). CONCLUSIONS For trauma patients requiring inpatient opioid therapy, a pragmatic and individualized intervention was associated with a reduced quantity of discharge opioids without negative outcomes. Reduction in inpatient opioid use was also associated with standardizing prescribing practices of surgeons with electronic medical record order sets.
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Affiliation(s)
- Claire H Seo
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
| | - Katherine L Howe
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Kelly B McAllister
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Bradford L McDaniel
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hunter D Sharp
- Carilion Clinic Health Analytics Research, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Tananchai A Lucktong
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Katie L Bower
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Brian R Collier
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Jacob R Gillen
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
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Maillard M, Bandiaky ON, Maunoury S, Alliot C, Alliot-Licht B, Serisier S, Renard E. The Effectiveness of Calcium Phosphates in the Treatment of Dentinal Hypersensitivity: A Systematic Review. Bioengineering (Basel) 2023; 10:bioengineering10040447. [PMID: 37106634 PMCID: PMC10135917 DOI: 10.3390/bioengineering10040447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Dentin hypersensitivity (DH) pain is a persistent clinical problem, which is a common condition known to affect patients' quality of life (QoL), but no treatment has ever been agreed upon. Calcium phosphates, available in different forms, have properties that allow sealing the dentinal tubules, which may relieve dentin hypersensitivity. The aim of this systematic review is to evaluate the ability of different formulations of calcium phosphate to reduce dentin hypersensitivity pain level in clinical studies. The inclusion criterion was as follows: clinical randomized controlled studies using calcium phosphates in treating dentin hypersensitivity. In December 2022, three electronic databases (Pubmed, Cochrane and Embase) were searched. The search strategy was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bias assessment risks results were carried out using the Cochrane Collaboration tool. A total of 20 articles were included and analyzed in this systematic review. The results show that calcium phosphates have properties that reduce DH-associated pain. Data compilation showed a statistically significant difference in DH pain level between T0 and 4 weeks. This VAS level reduction is estimated at about -2.5 compared to the initial level. The biomimetic and non-toxic characteristics of these materials make them a major asset in treating dentin hypersensitivity.
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Affiliation(s)
- Mélanie Maillard
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Conser-Vatrice et Pediatrique, Nantes Université, F-44000 Nantes, France
| | - Octave Nadile Bandiaky
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, F-44000 Nantes, France
| | - Suzanne Maunoury
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Conser-Vatrice et Pediatrique, Nantes Université, F-44000 Nantes, France
| | - Charles Alliot
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Restauratrice et Chirurgicale, Nantes Université, F-44000 Nantes, France
| | - Brigitte Alliot-Licht
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Conser-Vatrice et Pediatrique, Nantes Université, F-44000 Nantes, France
| | - Samuel Serisier
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, F-44000 Nantes, France
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Restauratrice et Chirurgicale, Nantes Université, F-44000 Nantes, France
| | - Emmanuelle Renard
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, F-44000 Nantes, France
- Faculté de Chirurgie Dentaire, CHU Nantes, Service Odontologie Restauratrice et Chirurgicale, Nantes Université, F-44000 Nantes, France
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Soumpasis I, Nashef S, Dunning J, Moran P, Slack M. Safe implementation of surgical innovation: a prospective registry of the Versius Robotic Surgical System. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000144. [PMID: 36865989 PMCID: PMC9972451 DOI: 10.1136/bmjsit-2022-000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
Objectives To describe a new, international, prospective surgical registry developed to accompany the clinical implementation of the Versius Robotic Surgical System by accumulating real-world evidence of its safety and effectiveness. Interventions This robotic surgical system was introduced in 2019 for its first live-human case. With its introduction, cumulative database enrollment was initiated across several surgical specialties, with systematic data collection via a secure online platform. Main outcome measures Pre-operative data include diagnosis, planned procedure(s), characteristics (age, sex, body mass index and disease status) and surgical history. Peri-operative data include operative time, intra-operative blood loss and use of blood transfusion products, intra-operative complications, conversion to an alternative technique, return to the operating room prior to discharge and length of hospital stay. Complications and mortality within 90 days of surgery are also recorded. Results The data collected in the registry are analyzed as comparative performance metrics, by meta-analyses or by individual surgeon performance using control method analysis. Continual monitoring of key performance indicators, using various types of analyses and outputs within the registry, have provided meaningful insights that help institutions, teams and individual surgeons to perform most effectively and ensure optimal patient safety. Conclusions Harnessing the power of large-scale, real-world registry data for routine surveillance of device performance in live-human surgery from first use will enhance the safety and efficacy outcomes of innovative surgical techniques. Data are crucial to driving the evolution of robot-assisted minimal access surgery while minimizing risk to patients. Trial registration number CTRI/2019/02/017872.
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Affiliation(s)
| | | | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Paul Moran
- Department of Obstetrics and Gynaecology, Worcestershire Royal Hospital, Worcester, UK
| | - Mark Slack
- Cambridge Medical Robotics Surgical Ltd, Cambridge, UK
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Moore GC, Smith KT, Christiansen MM, Anderson L, Moravec LJ, Okano DK, Samson KK, Ramer-Tait A, Beede K, Reinhardt RA, Killeen AC. Effect of interproximal home oral hygiene on clinical parameters and inflammatory biomarkers in patients receiving periodontal maintenance. J Periodontol 2023. [PMID: 36799307 DOI: 10.1002/jper.22-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The purpose of this 6-week, single-blinded, randomized clinical trial was to determine if the use of an interproximal brush, with or without a tracking device, is more effective than an oral irrigator in improving interproximal probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and inflammatory markers. METHODS Seventy-six patients with Stages III-IV, Grade B periodontitis and a 5-7 mm posterior interproximal PD with BOP were randomized: (1) interproximal brush alone (IB; n = 26), (2) interproximal brush with tracking device (TD; n = 23), (3) oral irrigator (OI; n = 27). Participants used devices once daily for 6 weeks. Clinical measurements (PD, CAL, PI, BOP, GI) and gingival crevicular fluid (GCF) samples were collected at baseline and 6 weeks. RESULTS All groups showed a significant reduction in PD and CAL (≥1.1 mm, p < 0.0001) and improvement in BOP (≥56%, p < 0.0001) and GI (≥82%, p < 0.001) at the experimental site with no differences among groups. The IB and IB+TD groups showed a significant reduction in PI (≥0.9, p ≤ 0.01). Interleukin (IL)-1β was reduced in all groups (p = 0.006), but IB+TB more than OI (p ≤ 0.05). IL-10 was reduced among all groups (p = 0.01), while interferon-gamma significantly increased (p = 0.01) in all groups. CONCLUSIONS IB and OI improved clinical parameters of PD and CAL and reduced inflammatory markers (BOP, GI, GCF IL-1β). IB had better interproximal plaque reduction. Tracking did not significantly improve clinical parameters compared with the IB and OI groups, suggesting future modifications are needed.
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Affiliation(s)
- Grace C Moore
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Kevin T Smith
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Laura Anderson
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Lisa J Moravec
- Department of Dental Hygiene, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - David K Okano
- Department of Periodontics, University of Utah School of Dentistry, Salt Lake City, Utah, USA
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Amanda Ramer-Tait
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Kristin Beede
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
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15
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CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL): A multicentre prospective observational study. Front Oncol 2023; 12:1049627. [PMID: 36688936 PMCID: PMC9846732 DOI: 10.3389/fonc.2022.1049627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Despite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors. Methods A prospective observational cohort study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis. Results A total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p<0.01), but no other technique reached significance. There was evidence that certain characteristics make CSF rhinorrhoea more likely - such as previous endonasal surgery and the presence of intraoperative CSF leak. Conclusions There is a wide range of skull base repair techniques used across centres. Overall, CSF rhinorrhoea rates across the UK and Ireland are lower than generally reported in the literature. A large proportion of postoperative leaks occurred in the context of occult intraoperative CSF leaks, and decisions for universal sellar repairs should consider the risks and cost-effectiveness of repair strategies. Future work could include longer-term, higher-volume studies, such as a registry; and high-quality interventional studies.
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Hatipoglu Majernik G, Wolff Fernandes F, Al-Afif S, Heissler HE, Palmaers T, Atallah O, Scheinichen D, Krauss JK. Routine postoperative admission to the neurocritical intensive care unit after microvascular decompression: necessary or can it be abandoned? Neurosurg Rev 2022; 46:12. [PMID: 36482263 PMCID: PMC9732061 DOI: 10.1007/s10143-022-01910-4] [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] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Postoperative neurocritical intensive care unit (NICU) admission of patients who underwent craniotomy for close observation is common practice. In this study, we performed a comparative analysis to determine if there is a real need for NICU admission after microvascular decompression (MVD) for cranial nerve disorders or whether it may be abandoned. The present study evaluates a consecutive series of 236 MVD surgeries performed for treatment of trigeminal neuralgia (213), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2). All patients were operated by the senior surgeon according to a standard protocol over a period of 12 years. Patients were admitted routinely to NICU during the first phase of the study (phase I), while in the second phase (phase II), only patients with specific indications would go to NICU. While 105 patients (44%) were admitted to NICU postoperatively (phase I), 131 patients (56%) returned to the ward after a short stay in a postanaesthesia care unit (PACU) (phase II). Specific indications for NICU admission in phase I were pneumothorax secondary to central venous catheter insertion (4 patients), AV block during surgery, low blood oxygen levels after extubation, and postoperative dysphagia and dysphonia (1 patient, respectively). There were no significant differences in the distribution of ASA scores or the presence of cardiac and pulmonary comorbidities like congestive heart failure, arterial hypertension, or chronic obstructive pulmonary disease between groups. There were no secondary referrals from PACU to NICU. Our study shows that routine admission of patients after eventless MVD to NICU does not provide additional value. NICU admission can be restricted to patients with specific indications. When MVD surgery is performed in experienced hands according to a standard anaesthesia protocol, clinical observation on a neurosurgical ward is sufficient to monitor the postoperative course. Such a policy results in substantial savings of costs and human resources.
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Affiliation(s)
- Gökce Hatipoglu Majernik
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Malathi A, Jasim K. Validating the relationship between service quality, patient sensitivity and experience towards medical applications using SERVQUAL. Int J Med Inform 2022; 168:104883. [DOI: 10.1016/j.ijmedinf.2022.104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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Ow TW, Sukocheva OA, Tran V, Lin R, Lee SZ, Chu M, Angelica B, Rayner CK, Tse E, Iyngkaran G, Bampton PA. Quality of colonoscopy performed by medical or surgical specialists and trainees in five Australian hospitals. World J Gastrointest Endosc 2022; 14:672-683. [PMID: 36438878 PMCID: PMC9693691 DOI: 10.4253/wjge.v14.i11.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ensuring colonoscopy procedure quality is vital to the success of screening and surveillance programmes for bowel cancer in Australia. However, the data on the performance of quality metrics, through adequate adenoma detection, bowel preparation, and procedure completion rates, in the Australian public sector is limited. Understanding these can inform quality improvement to further strengthen our capacity for prevention and early detection of colorectal cancer.
AIM To determine the quality of colonoscopy in Australian teaching hospitals and their association with proceduralist specialty, trainee involvement, and location.
METHODS We retrospectively evaluated 2443 consecutive colonoscopy procedure reports from 1 January to 1 April, 2018 from five public teaching tertiary hospitals in Australia (median 60 years old, 49% male). Data for bowel preparation quality, procedure completion rates, and detection rates of clinically significant adenomas, conventional adenomas, and serrated lesions was collected and compared to national criteria for quality in colonoscopy. Participating hospital, proceduralist specialty, and trainee involvement indicators were used for stratification. Data was analysed using Chi-squared tests of independence, Mann-Whitney U, One-way ANOVA, and multivariate binary logistic regression.
RESULTS Fifty-two point two percent (n = 1276) and 43.3% (n = 1057) were performed by medical and surgical proceduralists respectively, whilst 29.8% (n = 728) involved a trainee. Inadequate bowel preparation affected 7.3% of all procedures. The procedure completion rate was 95.1%, which increased to 97.5% after adjustment for bowel preparation quality. The pooled cancer, adenoma, and serrated lesion detection rates for all five hospitals were 3.5%, 40%, and 5.9% respectively. Assessed hospitals varied significantly by patient age (P < 0.001), work-force composition (P < 0.001), adequacy of bowel preparation (P < 0.001), and adenoma detection rate (P < 0.001). Two hospitals (40%) did not meet all national criteria for quality, due to a procedure completion rate of 94.5% or serrated lesion detection rate of 2.6%. Although lower than the other hospitals, the difference was not significant. Compared with surgical specialists, procedures performed by medical specialists involved older patients [65 years (inter-quartile range, IQR 58-73) vs 64 years (IQR 56-71); P = 0.04] and were associated with a higher adenoma detection rate [odds ratio (OR) 1.53; confidence interval: 1.21-1.94; P < 0.001]. Procedures involving trainee proceduralists were not associated with differences in the detection of cancer, adenoma, or serrated lesions, compared with specialists, or according to their medical or surgical background. On multivariate analysis, cancer detection was positively associated with patient age (OR 1.04; P < 0.001) and negatively associated with medical compared to surgical proceduralists (OR 0.54; P = 0.04). Conventional adenoma detection rates were independently associated with increasing patient age (OR 1.04; P < 0.001), positively associated with medical compared to surgical proceduralists (OR 1.41; P = 0.002) and negatively associated with male gender (OR 0.53; P < 0.001).
CONCLUSION Significant differences in the quality of colonoscopy in Australia exist, even when national benchmarks are achieved. The role of possible contributing factors, like procedural specialty and patient gender need further evaluation.
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Affiliation(s)
- Tsai-Wing Ow
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park 5042, SA, Australia
| | - Olga A Sukocheva
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Vy Tran
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Richard Lin
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Shawn Zhenhui Lee
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South 5011, SA, Australia
| | - Matthew Chu
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South 5011, SA, Australia
| | - Bianca Angelica
- Department of Gastroenterology, Royal Darwin Hospital, Darwin 0810, NT, Australia
| | - Christopher K Rayner
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Edmund Tse
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Guru Iyngkaran
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - Peter A Bampton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
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Radhakrishnan U, Chinello F, Koumaditis K. Investigating the effectiveness of immersive VR skill training and its link to physiological arousal. VIRTUAL REALITY 2022; 27:1091-1115. [PMID: 36405878 PMCID: PMC9663202 DOI: 10.1007/s10055-022-00699-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/13/2022] [Indexed: 06/05/2023]
Abstract
This paper details the motivations, design, and analysis of a study using a fine motor skill training task in both VR and physical conditions. The objective of this between-subjects study was to (a) investigate the effectiveness of immersive virtual reality for training participants in the 'buzz-wire' fine motor skill task compared to physical training and (b) investigate the link between participants' arousal with their improvements in task performance. Physiological arousal levels in the form of electro-dermal activity (EDA) and ECG (Electrocardiogram) data were collected from 87 participants, randomly distributed across the two conditions. Results indicated that VR training is as good as, or even slightly better than, training in physical training in improving task performance. Moreover, the participants in the VR condition reported an increase in self-efficacy and immersion, while marginally significant differences were observed in the presence and the temporal demand (retrieved from NASA-TLX measurements). Participants in the VR condition showed on average less arousal than those in the physical condition. Though correlation analyses between performance metrics and arousal levels did not depict any statistically significant results, a closer examination of EDA values revealed that participants with lower arousal levels during training, across conditions, demonstrated better improvements in performance than those with higher arousal. These findings demonstrate the effectiveness of VR in training and the potential of using arousal and training performance data for designing adaptive VR training systems. This paper also discusses implications for researchers who consider using biosensors and VR for motor skill experiments. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00699-3.
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Affiliation(s)
- Unnikrishnan Radhakrishnan
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
| | - Francesco Chinello
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
| | - Konstantinos Koumaditis
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
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The Effect of a Patient Education Multimodal Digital Platform on Knowledge Acquisition, Self-efficacy, and Patient Satisfaction. Comput Inform Nurs 2022; 41:356-364. [PMID: 36071664 DOI: 10.1097/cin.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the impact of digital training instrument based on multimodal learning approach on surgical ward hospitalized patient education-related variables. The study was conducted as a multisite study in a large medical center as a two-arm, controlled trial with randomized cluster sampling. All patients meeting the inclusion criteria were offered the opportunity to participate. The control group (n = 40) received nurse explanation on home self-injection of enoxaparin sodium, whereas the intervention group (n = 40) received a tablet for multimodal learning specifically developed for this study. All participants completed before-and-after questionnaires evaluating knowledge acquisition, change in self-efficacy, and patient satisfaction. Results showed that the intervention group gained significantly more knowledge than the control group (P < .01). There was no significant difference in the level of self-efficacy change between the groups, and it was found that the control group patients were more satisfied with the training process (P = .01). This study shows that the use of a digital application for the benefit of patients' self-injection learning is effective in achieving educational goals such as knowledge acquisition and therefore can be a helpful resource for caregivers. Yet, these applications are not a substitute for attention provided by professionals, which is highly valued by patients.
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21
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Pandit JJ, Ramachandran SK, Pandit M. The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review. Anaesthesia 2022; 77:1030-1038. [PMID: 35863080 PMCID: PMC9543504 DOI: 10.1111/anae.15797] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 01/11/2023]
Abstract
This article reviews the background to overlapping surgery, in which a single senior surgeon operates across two parallel operating theatres; anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. We assess whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short (<2 h) and where 'critical portions' of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.
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Affiliation(s)
- J. J. Pandit
- University of OxfordUK,Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - S. K. Ramachandran
- Department of AnesthesiaBeth Israel Deaconess Medical CenterBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - M. Pandit
- Oxford University Hospitals NHS Foundation TrustOxfordUK
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22
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Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion? Otol Neurotol 2022; 43:789-796. [PMID: 35861647 DOI: 10.1097/mao.0000000000003588] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. STUDY DESIGN Prospective, randomized clinical trial. SETTING Ten high-volume, tertiary care CI centers. PATIENTS Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. METHODS Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. RESULTS Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. CONCLUSIONS Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."
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Kuhlenschmidt KM, Choi E, Moonmoon K, Blackwell J, Comish PB, Balentine C, Grant J, Park C, Dultz LA, Shoultz T, Cripps MW, Dumas RP. Provider Perception of Time During Trauma Resuscitation: A Prospective Quantitative Trauma Video Review Analysis. J Surg Res 2022; 274:207-212. [DOI: 10.1016/j.jss.2021.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/20/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
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24
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Kim GW, Moon HJ, Lim H, Kim YJ, Lee CA, Park YJ, Lee KM, Woo JH, Cho JS, Jeong WJ, Choi HJ, Kim CS, Choi HJ, Choi IK, Heo NH, Park JS, Lee YH, Park SM, Jeong DK. Effects of Smart Advanced Life Support protocol implementation including CPR coaching during out-of-hospital cardiac arrest. Am J Emerg Med 2022; 56:211-217. [DOI: 10.1016/j.ajem.2022.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 01/23/2023] Open
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Grundmann CD, Wischermann JM, Fassbender P, Bischoff P, Frey UH. Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension. Acta Anaesthesiol Scand 2021; 65:1404-1412. [PMID: 34322869 DOI: 10.1111/aas.13964] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone. METHODS We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n = 50; HPI, n = 50). A personalized treatment protocol was applied in both groups. The primary endpoint was the incidence and duration of hypotensive events defined as MAP <65 mmHg evaluated by time-weighted average of hypotension. RESULTS In the FloTrac group, 42 patients (84%) experienced a hypotension while in the HPI group 26 patients (52%) were hypotensive (p = 0.001). The median (IQR) time-weighted average of hypotension in the FloTrac group was 0.27 (0.42) mmHg versus 0.10 (0.19) mmHg in the HPI group (p = 0.001). Finally, the median duration of each hypotensive event (IQR) was 2.75 (2.40) min in the FloTrac group compared to 1.00 (2.06) min in the HPI group (p = 0.002). CONCLUSIONS The application of the HPI combined with a personalized treatment protocol can reduce incidence and duration of hypotension when compared to arterial waveform analysis alone. This study therefore provides further evidence of the transition from prediction to actual prevention of hypotension using HPI.
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Affiliation(s)
- Carla D. Grundmann
- Klinik für Anästhesiologie Operative Intensivmedizin Schmerz‐ und Palliativmedizin, Marien Hospital Herne – Universitätsklinikum der Ruhr‐Universität Bochum Herne Germany
| | - Jan M. Wischermann
- Klinik für Anästhesiologie Operative Intensivmedizin Schmerz‐ und Palliativmedizin, Marien Hospital Herne – Universitätsklinikum der Ruhr‐Universität Bochum Herne Germany
| | - Philipp Fassbender
- Klinik für Anästhesiologie Operative Intensivmedizin Schmerz‐ und Palliativmedizin, Marien Hospital Herne – Universitätsklinikum der Ruhr‐Universität Bochum Herne Germany
| | - Petra Bischoff
- Klinik für Anästhesiologie Operative Intensivmedizin Schmerz‐ und Palliativmedizin, Marien Hospital Herne – Universitätsklinikum der Ruhr‐Universität Bochum Herne Germany
| | - Ulrich H. Frey
- Klinik für Anästhesiologie Operative Intensivmedizin Schmerz‐ und Palliativmedizin, Marien Hospital Herne – Universitätsklinikum der Ruhr‐Universität Bochum Herne Germany
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Herndon CL, Levitsky MM, Ezuma C, Sarpong NO, Shah RP, Cooper HJ. Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty. Arthroplast Today 2021; 11:6-9. [PMID: 34401423 PMCID: PMC8358092 DOI: 10.1016/j.artd.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023] Open
Abstract
Background The choice of anesthesia plays a significant role in the success of total joint arthroplasty (TJA). Isobaric bupivacaine spinal anesthesia is often used. However, dosing of bupivacaine has not been extensively studied and is usually at the discretion of the treating anesthesiologist and surgeon. The goal of this study was to determine what, if any, effect the dose of bupivacaine spinal anesthesia had on perioperative outcomes in TJA. Methods A total of 761 TJAs performed with bupivacaine spinal anesthesia by arthroplasty surgeons were retrospectively reviewed. Perioperative outcomes evaluated were operation duration, estimated blood loss, length of stay (LOS) in the postanesthesia care unit, hospital LOS, discharge disposition, episodes of intraoperative hypotension, postoperative nausea and vomiting, and missed physical therapy sessions because of postoperative symptoms of hypotension. A Student’s t-test was used for continuous variables, and a chi-squared test was used for categorical variables. Results Of the 761 patients, 499 (65.6%) received 15 mg isobaric bupivacaine while 262 (34.4%) received <15 mg (range = 7.5-14.5 mg, median = 12.5 mg). With the numbers available in this cohort, lower doses of bupivacaine were not associated with any significant differences between groups for any of the studied perioperative outcomes, including proportion of patients discharged home or LOS. Conclusion Dosage of bupivacaine spinal anesthetic did not affect perioperative outcomes. Bupivacaine may not have a dose-related response curve in this regard, and if seeking to perform same-day or outpatient TJA, other agents may need to be considered, rather than smaller doses of bupivacaine.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew M Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Chimere Ezuma
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Matuszewski PE, Joseph K, O'Hara NN, DiClemente C, O'Toole RV. Prospective Randomized Trial on Smoking Cessation in Orthopaedic Trauma Patients: Results From the Let's STOP (Smoking in Trauma Orthopaedic Patients) Now Trial. J Orthop Trauma 2021; 35:345-351. [PMID: 33252440 DOI: 10.1097/bot.0000000000002028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Determine if extended inpatient counseling increases smoking cessation. DESIGN Prospective randomized trial. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Current smokers with an operative fracture. INTERVENTION Randomly assigned to control (no counseling), brief counseling (inpatient counseling), or extended counseling (brief counseling plus follow-up counseling) groups in a 1:3:3 ratio. MAIN OUTCOME MEASUREMENTS Smoking cessation confirmed by exhaled carbon monoxide at 3 and 6 months. Secondary outcomes are proportion accepting services from a nationally based quitline. RESULTS Overall, 266 patients participated, with 40, 111, and 115 patients in the control and 2 treatment groups, respectively. At 3 months, 17% of control patients versus 11% in the brief counseling and 10% in the extended counseling groups quit smoking, respectively (P = 0.45, 0.37). At 6 months, 15% of control, and 10% and 5% of the respective counseling groups quit (P = 0.45, 0.10). Extended counseling patients were 3 times more likely to accept referral to a quitline [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.4-6.9], and brief counseling patients were more than 2 times as likely to accept referral (OR, 2.3; 95% CI, 1.0-5.1) than the control group. Extended counseling (OR, 8.2; 95% CI, 1.0-68.5) and brief counseling (OR, 5.3; 95% CI, 0.6-44.9) patients were more likely to use quitline services than the control group. CONCLUSION Increasing levels of inpatient counseling can improve successful referral to a smoking quitline, but it does not seem to influence quit rates among orthopaedic trauma patients. Extended counseling does not appear to provide substantial benefit over brief counseling. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky School of Medicine, Lexington, KY
| | | | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and
| | | | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and
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Cragg J, Mushtaq F, Lal N, Garnham A, Hallissey M, Graham T, Shiralkar U. Surgical cognitive simulation improves real-world surgical performance: randomized study. BJS Open 2021; 5:6280341. [PMID: 34021326 PMCID: PMC8140200 DOI: 10.1093/bjsopen/zrab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the acknowledgement of human factors, application of psychological methods by surgeons to improve surgical performance is sparse. This may reflect the paucity of evidence that would help surgeons to use psychological techniques effectively. There is a need for novel approaches to see how cognitive training might be used to address these challenges. METHODS Surgical trainees were divided into intervention and control groups. The intervention group received training in surgical cognitive simulation (SCS) and was asked to apply the techniques while working in operating theatres. Both groups underwent procedure-based assessment based on the UK and Ireland Intercollegiate Surgical Curriculum Programme (ISCP) before the training and 4 months afterwards. Subjective evaluations of SCS application were obtained from the intervention group participants. RESULTS Among 21 participants in the study, there was a statistically significant improvement in 11 of 16 procedure-based assessment domains (P < 0.050) as well as a statistically significant mean reduction in time to complete the procedure in the intervention group (-15.98 versus -1.14 min; P = 0.024). Subjectively, the intervention group experienced various benefits with SCS, especially in preoperative preparedness, intraoperative focus, and overall performance. CONCLUSION SCS training has a statistically significant impact in improving surgical performance. Subjective feedback suggests that surgeons are able to apply it in practice. SCS may prove a vital adjunct for skill acquisition in surgical training.
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Affiliation(s)
- J Cragg
- Correspondence to: Department of Vascular Surgery, Russells Hall Hospital, Pensett Road, Dudley DY1 2HQ, UK (e-mail: )
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - N Lal
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - A Garnham
- Department of Vascular Surgery, New Cross Hospital, Wolverhampton, UK
| | - M Hallissey
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - T Graham
- Postgraduate School of Surgery, West Midlands Deanery, UK
| | - U Shiralkar
- Worcestershire Health and Care NHS trust, Worcestershire, UK
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SELF-DESIGNATION OF THE TREATED EYE BEFORE INTRAVITREAL INJECTIONS: Prevalence and Predictors of Incorrect Calling. Retina 2021; 41:1005-1009. [PMID: 32826789 DOI: 10.1097/iae.0000000000002956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify risk factors for incorrect self-identification of the treatment eye before intravitreal injections. METHODS This prospective study included consecutive patients who were asked to designate the eye for which the intravitreal injection was intended and were subsequently divided into two groups according to whether or not they identified the correct eye. RESULTS Overall, 349 eyes (n = 349) were included, and 8.6% (n = 30) designated the incorrect eye or did not know which eye was intended for treatment. Incorrect designation was associated with diabetic macular edema (odds ratio [OR] = 0.33 [0.15-0.75]), first injection in the intended eye or ≥1 year since previous injection (OR = 0.34 [0.14-0.87]), Arabic native tongue (OR = 0.48 [0.22-1.01]), previous injection to the fellow eye (OR = 0.26 [0.10-0.64]), and concurrent treatment of both eyes (OR = 0.35 [0.16-0.74]). Multivariate analysis showed the first injection or ≥1 year since last injection in the treatment eye (R2 = 2.24%, P = 0.004, OR = 0.20 [0.07-0.57]) and previous injection in the fellow eye (R2 = 6.55%, P < 0.001, OR = 0.20 [0.07-0.52]) as significant independent predictors of incorrect identification. CONCLUSION Several factors are associated with a greater probability for incorrect patient's self-identification of the eye laterality intended for intravitreal injections. These findings may help identify patients with a higher risk of such potential errors.
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Zheng DJ, Sur PJ, Ariokot MG, Juillard C, Ajiko MM, Dicker RA. Epidemiology of injured patients in rural Uganda: A prospective trauma registry's first 1000 days. PLoS One 2021; 16:e0245779. [PMID: 33481891 PMCID: PMC7822551 DOI: 10.1371/journal.pone.0245779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of injury in rural Uganda is limited. Hospital-based trauma registries are a critical tool in illustrating injury patterns and clinical outcomes. This study aims to characterize the traumatic injuries presenting to Soroti Regional Referral Hospital (SRRH) in order to identify opportunities for quality improvement and policy development. From October 2016 to July 2019, we prospectively captured data on injured patients using a locally designed, context-relevant trauma registry instrument. Information regarding patient demographics, injury characteristics, clinical information, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. A total of 4109 injured patients were treated during the study period. Median age was 26 years and 63% were male. Students (33%) and peasant farmers (31%) were the most affected occupations. Falls (36%) and road traffic injuries (RTIs, 35%) were the leading causes of injury. Nearly two-thirds of RTIs were motorcycle-related and only 16% involved a pedestrian. Over half (53%) of all patients had a fracture or a sprain. Suffering a burn or a head injury were significant predictors of mortality. The number of trauma patients enrolled in the study declined by five-fold when comparing the final six months and initial six months of the study. Implementation of a context-appropriate trauma registry in a resource-constrained setting is feasible. In rural Uganda, there is a significant need for injury prevention efforts to protect vulnerable populations such as children and women from trauma on roads and in the home. Orthopedic and neurosurgical care are important targets for the strengthening of health systems. The comprehensive data provided by a trauma registry will continue to inform such efforts and provide a way to monitor their progress moving forward.
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Affiliation(s)
- Dennis J. Zheng
- Department of Surgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Patrick J. Sur
- UC Riverside School of Medicine, University of California, Riverside, California, United States of America
| | | | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California, Los Angeles, California, United States of America
| | | | - Rochelle A. Dicker
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California, Los Angeles, California, United States of America
- * E-mail:
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Setti P, Pesce P, Dellepiane E, Bagnasco F, Zunino P, Menini M. Angled implant brush for hygienic maintenance of full-arch fixed-implant rehabilitations: a pilot study. J Periodontal Implant Sci 2020; 50:340-354. [PMID: 33124211 PMCID: PMC7606898 DOI: 10.5051/jpis.1905320266] [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] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/18/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses. METHODS Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance. RESULTS A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene. CONCLUSIONS Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.
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Affiliation(s)
- Paolo Setti
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy.
| | - Paolo Pesce
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Elena Dellepiane
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Francesco Bagnasco
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Paola Zunino
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Maria Menini
- Division of Implant Prosthodontics, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
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Athanasiadis DI, Monfared S, Whiteside J, Engle T, Timsina L, Banerjee A, Butler A, Stefanidis D. Comparison of operating room inefficiencies and time variability in laparoscopic gastric bypass. Surg Obes Relat Dis 2020; 16:1226-1235. [DOI: 10.1016/j.soard.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
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Matthes N, Diers J, Schlegel N, Hankir M, Haubitz I, Germer CT, Wiegering A. Validation of MTL30 as a quality indicator for colorectal surgery. PLoS One 2020; 15:e0238473. [PMID: 32857807 PMCID: PMC7454590 DOI: 10.1371/journal.pone.0238473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/16/2020] [Indexed: 01/01/2023] Open
Abstract
Background Valid indicators are required to measure surgical quality. These ideally should be sensitive and selective while being easy to understand and adjust. We propose here the MTL30 quality indicator which takes into account 30-day mortality, transfer within 30 days, and a length of stay of 30 days as composite markers of an uneventful operative/postoperative course. Methods Patients documented in the StuDoQ|Colon and StuDoQ|Rectal carcinoma register of the German Society for General and Visceral Surgery (DGAV) were analyzed with regard to the effects of patient and tumor-related risk factors as well as postoperative complications on the MTL30. Results In univariate analysis, the MTL30 correlated significantly with patient and tumor-related risk factors such as ASA score (p<0.001), age (p<0.001), or UICC stage (p<0.001). There was a high sensitivity for the postoperative occurrence of complications such as re-operations (p<0.001) or subsequent bleeding (p<0.001), as well as a significant correlation with the CDC classification (p<0.001). In multivariate analysis, patient-related risk factors and postoperative complications significantly increased the odds ratio for a positive MTL30. A negative MTL30 showed a high specify for an uneventful operative and postoperative course. Conclusion The MTL30 is a valid indicator of colorectal surgical quality.
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Affiliation(s)
- Niels Matthes
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Johannes Diers
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nicolas Schlegel
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mohammed Hankir
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Imme Haubitz
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, Theodor Boveri Institute, University of Wuerzburg, Wuerzburg, Germany
- * E-mail:
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Estrada S, Arancibia M, Stojanova J, Papuzinski C. General concepts in biostatistics and clinical epidemiology: Experimental studies with randomized clinical trial design. Medwave 2020; 20:e7869. [PMID: 32469850 DOI: 10.5867/medwave.2020.02.7869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
In experimental studies, researchers apply an intervention to a group of study participants and analyze the effects over a future or prospective timeline. The prospective nature of these types of studies allows for the determination of causal relationships, but the interventions they are based on require rigorous bioethical evaluation, approval from an ethics committee, and registration of the study protocol prior to implementation. Experimental research includes clinical and preclinical testing of a novel intervention or therapy at different phases of development. The main objective of clinical trials is to evaluate an interventions efficacy and safety. Conventional clinical trials are blinded, randomized, and controlled, meaning that participants are randomly assigned to either the study intervention group or a comparator (a control group exposed to a placebo intervention or another non-placebo or active interventionor not exposed to any intervention) to reduce selection and confounding biases, and researchers are also unaware of the type of intervention being applied. Intention-to-treat analysis (inclusion of all originally randomized subjects) should be done to avoid the effects of attrition (dropout) and crossover (variance in the exposure or treatment over time). A quasi-experimental design and external controls may also be used. Metrics used to measure the magnitude of effects include relative risk, absolute and relative risk reductions, and numbers needed to treat and harm. Confounding factors are controlled by randomization. Other types of bias to consider are selection, performance, detection, and reporting. This review is the fifth of a methodological series on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile. It describes general theoretical concepts related to randomized clinical trials and other experimental studies in humans, including fundamental elements, historical development, bioethical issues, structure, design, association measures, biases, and reporting guidelines. Factors that should be considered in the execution and evaluation of a clinical trial are also covered.
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Affiliation(s)
- Sebastián Estrada
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
| | - Marcelo Arancibia
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
| | - Jana Stojanova
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
| | - Cristian Papuzinski
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
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