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Sansosti LE, Joseph R, Grambart S. Teaching Science to the Next Generation. Clin Podiatr Med Surg 2024; 41:367-377. [PMID: 38388133 DOI: 10.1016/j.cpm.2023.06.014] [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: 02/24/2024]
Abstract
Teaching science to the next generation begins with foundations laid in podiatric medical school. Interest and immersion in research continues to develop through residency as trainees prepare for cases, participate in journal clubs, present posters and articles, and attend conferences. Having adequate training is essential to production of quality research. Although challenges and barriers exist, numerous resources are available at all levels of practice to guide those who are interested in contributing to the body of literature that supports the profession. Ensuring a robust pipeline of future clinician scientists is critical to the future of the profession.
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Affiliation(s)
- Laura E Sansosti
- Department of Surgery, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA; Department of Biomechanics, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
| | - Robert Joseph
- Robert Joseph DPM, PHD, FACFAS,D.ABFAS, Gainesville, FL, USA
| | - Sean Grambart
- Des Moines University College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
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Tator CH, Guest JD, Neal CJ, Howley SP, Toups EG, Harrop JS, Aarabi B, Shaffrey CI, Fehlings MG. History and Accomplishments of the North American Clinical Trials Network for Spinal Cord Injury, 2004-2022. J Neurotrauma 2023; 40:1823-1833. [PMID: 36515162 DOI: 10.1089/neu.2022.0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This is a historical account of the origin and accomplishments of the North American Clinical Trials Network (NACTN) for traumatic spinal cord injury (SCI), which was established in 2004 by Christopher Reeve and Robert Grossman. Christopher Reeve was an actor who became quadriplegic and started the Christopher & Dana Reeve Foundation (CDRF), and Robert Grossman was a neurosurgeon experienced in neurotrauma and a university professor in Houston. NACTN has member investigators at university and military centers in North America and has contributed greatly to the improvement of care, primarily acute care, of patients sustaining traumatic SCI. Its accomplishments are a clinical registry database of >1000 acute SCI patients documenting the care pathways, including complications. NACTN has assessed the effectiveness of treatment, including pharmacotherapy and the role and timing of surgery, and has also identified barriers to early surgery. The principal focus has been on improving neurological recovery. NACTN has trained many SCI practitioners and has collaborated with other SCI networks and organizations internationally to promote the care of SCI patients.
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Affiliation(s)
- Charles H Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James D Guest
- Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda Maryland, USA
| | - Susan P Howley
- Christopher & Dana Reeve Foundation, Short Hills, New Jersey, USA
| | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston Texas, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Weight-bearing in ankle fractures: An audit of UK practice. Foot (Edinb) 2019; 39:28-36. [PMID: 30933870 DOI: 10.1016/j.foot.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. METHODS A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. RESULTS 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. DISCUSSION The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. CONCLUSION This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.
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Hollis AC, Davis ET. Understanding the factors that influence patient participation in Orthopaedic Clinical Trials. INTERNATIONAL ORTHOPAEDICS 2018; 42:1769-1774. [PMID: 29560527 DOI: 10.1007/s00264-018-3890-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
AIM To assess the knowledge, attitudes and perceptions of orthopaedic patients towards participating in clinical trials (CTs). METHODS A cross-sectional study was conducted on 200 adult orthopaedic patients at a Tertiary Orthopaedic Centre. Data was collected using a self-completed questionnaire. Statistical analysis was used to compare responses between those that would and would not participate using the chi-squared and the Mann-Whitney U testing. RESULTS Eighty-four percent of the patients (n = 168) stated that they would be happy to participate in clinical trials research. However, 94% (n = 188) had never had a clinical trial discussed with them previously while only 4.5% (n = 9) had participated in a clinical trial to their knowledge. The main reason for participating in clinical trials was 'I believe results could help other patients in the future' with 58% selecting this option (n = 116). Travel distance was cited as the most important barrier to taking part (n = 83, 55%). Travel distance was also seen as significantly more important in patients who were willing to participate than patient who were not (n = 10, 33%) p = 0.04. There was no significant difference between groups in responses to the statement 'I have concerns over the use and storage of blood and tissue', (Mean score = 3.46, Mean score = 3.13, p = 0.89). CONCLUSION The prevailing sentiment is that patients are overwhelmingly positive towards participation in clinical trials. This study highlights that there appears to be an opportunity to improve the recruitment of clinical trial in orthopaedics thus improving evidence-based practice.
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Affiliation(s)
- Alexander C Hollis
- Sandwell and West Birmingham NHS Foundation Trust. City Hospital, Dudley Rd, Birmingham, B18 7QH, UK.
| | - Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Undergraduate Academy and The University of Birmingham, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, UK
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Nagra NS, Hamilton TW, Strickland L, Murray DW, Pandit H. Enhanced recovery programmes for lower limb arthroplasty in the UK. Ann R Coll Surg Engl 2017; 99:631-636. [PMID: 28768427 PMCID: PMC5696927 DOI: 10.1308/rcsann.2017.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Enhanced recovery programmes (ERPs) reduce patient morbidity and mortality, and provide significant cost savings by reducing length of stay. Currently, no uniform ERP guidelines exist for lower limb arthroplasty in the UK. The aim of this study was to identify variations in ERPs and determine adherence to local policy. METHODS Hospitals offering elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) (23 and 22 centres respectively) contributed details of their ERPs, and performed an audit (15 patients per centre) to assess compliance. RESULTS Contrasting content and detail of ERPs was noted across centres. Adherence to ERPs varied significantly (40-100% for TKA, 17-94% for THA). Analysis identified perioperative use of dexamethasone, tranexamic acid and early mobilisation for TKA, and procedures performed in teaching hospitals for THA as being associated with a reduced length of stay. CONCLUSIONS This study highlights variation in practice and poor compliance with local ERPs. Given the proven benefits of ERPs, evidence-based guidelines in the context of local skillsets should be established to optimise the patient care pathway.
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Affiliation(s)
- N S Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - T W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - L Strickland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Croker N, Lobo A, Croker A, Balogh ZJ, Dewar D. Who, where, what and where to now? A snapshot of publishing patterns in Australian orthopaedic surgery. ANZ J Surg 2017; 87:1044-1047. [PMID: 28809086 PMCID: PMC5724501 DOI: 10.1111/ans.14177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Development of core research competency is a principle of orthopaedic surgical training in Australia. This paper aims to provide an objective snapshot of publications by Australian orthopaedic trainees and surgeons, to contribute to the discussion on how to identify and build on research capability in the Australian Orthopaedic Association (AOA). METHODS By analysing journals with a journal impact factor >1 from 2009 to 2015, data were gathered to explore scientific journal publications by Australian orthopaedic surgeons and trainees in relation to who are the authors, what they are reporting and where they are publishing. RESULTS One thousand five hundred and thirty-nine articles were identified with 134 orthopaedic trainees and 519 surgeons as authors. The publication rate for both trainees and surgeons was just over two in five. The majority of studies were of level three or four evidence (Oxford's Centre for Evidence-Based Medicine guidelines). Only 5% of trainee papers were published without surgeons' co-authorship. Eighty-six percent of papers published by surgeons did not involve a trainee. The rates of trainees publishing with other trainees were low. CONCLUSION Only 5% of trainee papers were published without surgeons' co-authorship, highlighting the importance of surgeon mentorship in developing trainee research capability. The 86% of papers published by surgeons without trainee co-authorship raises the question of missed mentoring opportunities. Low rates of trainee co-authorship highlight potential for trainees to work together to support each other's research efforts. There is scope for more studies involving higher levels of evidence. This paper raises discussion points and areas for further exploration in relation to AOA trainee research capability.
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Affiliation(s)
- Nicholas Croker
- Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Abhirup Lobo
- Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Anne Croker
- Department of Rural Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - David Dewar
- Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Abstract
Hip fracture is a common injury associated with high mortality, long-term disability and huge socio-economic burden. Yet there has been relatively little research into best treatment, and evidence that has been generated has often been criticised for its poor quality. Here, we discuss the advances made towards overcoming these criticisms and the future directions for hip fracture research: how co-ordinating existing national infrastructures and use of now established clinical research networks will likely go some way towards overcoming the practical and financial challenges of conducting large trials. We highlight the importance of large collaborative pragmatic trials to inform decision/policy makers and the progress made towards reaching a consensus on a core outcome set to facilitate data pooling for evidence synthesis and meta-analysis. These advances and future directions are a priority in order to establish the high-quality evidence base required for this important group of patients.
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Affiliation(s)
- M A Fernandez
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | - X L Griffin
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - M L Costa
- University of Oxford, Headley Way, Oxford, OX3 9DU, UK
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Ghert M. The truths we seek and the randomised trial in orthopaedic surgery. Bone Joint Res 2015; 4:134-6. [PMID: 26271491 PMCID: PMC4566910 DOI: 10.1302/2046-3758.48.2000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- M. Ghert
- The Bone and Joint Journal, 22 Buckingham
Street, London, WC2N 6ET, UK
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